prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

Background and study aims: the clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome [IBS]. The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS [according to Rome III criteria]

Patients and methods: this study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS [fulfilling Rome III criteria]. They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody [anti-tTG] test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy sample collected from the second part of the duodenum

Results: all of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients [8%] exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two group: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain [p>0.05]. The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients [p<0.01], as was the Na level in anti-tTG-negative patients [p<0.05]. A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protien and serum albumin

Conclusion: some symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients

Comparison between accuracy of different scoring systems in prediction of liver cirrhosis-related complications

Background: Many scoring systems have been widely applied in recent years for assessing and predicting the mortality across a broad spectrum of liver diseases. The two most commonly used prognostic models are the Child-Turcotte-Pugh score and the more recently described the model of end-stage liver disease [MELD] score and its derivatives

Aim of the work: The main objective of this work was to evaluate and compare the accuracy of the Child-Pugh score, the MELD score, and the new scores, MELD-Na, the integrated MELD [iMELD], and the MELD-to-sodium [MESO] index in the prediction of liver cirrhosis complications

Patients and methods: This study was conducted on 60 patients with chronic liver disease. They were divided into two groups: group I consisted of 17 [28.3%] patients with uncomplicated liver cirrhosis. They were 10 [58.8%] male and seven [41.1%] female patients. Their mean age was 58.7 +/- 10.7 years. Group II consisted of 43 [71.7%] patients with liver cirrhosis-related complications. They were 37 [86%] male and six [13.9%] female patients. Their mean age was 55.1 +/- 6.38 years. All were recruited from the Internal Medicine and Hepatology Department in Ain Shams University Hospitals. They were subjected to full medical history, clinical examination, lab investigations, upper gastrointestinal endoscopy, and imaging studies to assess the state of the liver disease and its complications. The MELD, its derivatives, and the Child-Turcotte-Pugh score were calculated for assessing their prognostic accuracy in relation to complications of chronic liver disease

Results: In this study, the most common complication was portal hypertension [70%], which is the leading cause for ascites and hematemesis due to esophageal varices. In this study, there was a highly significant statistical difference between group I and group II regarding albumin and International normalization ratio and a significant statistical difference between group I and group II regarding total bilirubin, platelets, and the sodium level [Na]. In this study, there was also a highly significant statistical difference between group I and group II regarding Child, MELD, MELD-Na, MESO index, and iMELD scores. Regarding the comparison between Child, MELD, MELD-Na, MESO index, and iMELD scores as predictors for liver cirrhosis complications, our study showed that the Child-Pugh score was the most sensitive score with the highest predictive accuracy. The Child score at a cutoff greater than 7.5 has a sensitivity of 97.7%, a specificity of 70.6%, and an accuracy of 0.95 in predicting the occurrence of complications. MELD at a cutoff greater than 12.5 has a sensitivity of 93%, a specificity of 70.6%, and an accuracy of 0.913 in predicting the occurrence of complications. MELD-Na at a cutoff greater than 16 has a sensitivity of 90.7%, a specificity of 70.6%, and an accuracy of 0.867 in predicting the occurrence of complications. The MESO index at a cutoff greater than 0.95 has a sensitivity of 90.7%, a specificity of 70.6%, and an accuracy of 0.919 in predicting the occurrence of complications. iMELD at a cutoff greater than 30.6 has a sensitivity of 95.3%, a specificity of 41.2%, and an accuracy of 0.841 in predicting the occurrence of complications. For the detection of the most common complication, that is, esophageal varices, the MELD score was found to be the most specific, with a specificity of 100% and a sensitivity of 43% and the cutoff point greater than 18. This was followed by the MESO index, with a specificity of 100% and a sensitivity of 39.2% and the cutoff point greater than 1.4, whereas other scores could not be significantly related to the prediction of such complications

Conclusion: This study concluded the superiority of the Child score over MELD, MELD-Na, MESO index, and iMELD scores in the prediction of liver cirrhosis-related complications, whereas the MELD score and the MESO index were the best for predicting the occurrence of esophageal varices

Clinical spectrum of fever of unknown origin among adult Egyptian patients admitted to Ain Shams university hospitals: a hospital based study

This prospective study was designed to analyze the clinical spectrum of fever of unknown origin [FUO] among adult Egyptian patients admitted to Ain Shams University Hospitals during the period from May 2009 till the end of December 2010. All Egyptian patients fulfilling the criteria of FUO admitted during this period were followed up till reaching the diagnosis. 93 patients were included in the study. They were 48 [51.6%] females and 45 [48.4%] males, their ages ranged from 15 to 65 years [34.39 +/- 13.6]. Infections were the commonest cause of FUO[41.94%] followed by malignancies[30.11%]. While autoimmune diseases represented 15.05% and in 12.9% of patients the diagnosis was not established. Brucellosis and infective endocarditis were the commonest infections, while hematological malignancies were the commonest oncological diseases. Systemic lupus erythematosus [SLE] was the commonest auto-immune disease. Brucellosis, infective endocarditis, hematological malignancies and SLE must be considered in the differential diagnosis of adult FUO in Egypt

Causes and outcome of upper gastrointestinal bleeding in emergency endoscopy unit of Ain Shams University Hospital

This prospective follow-up study was designed to analyze the causes and outcome of upper gastrointestinal bleeding among patients presenting by hematemesis and/or melena to Emergency Endoscopy Unit, Ain Shams University Hospitals. One thousand patients presented by upper GIT bleeding were subjected to complete clinical evaluation, emergency upper gastrointestinal endoscopy and therapeutic interventions as indicated. Follow up was done for occurrence of re-bleeding or mortality. Variceal causes of bleeding were the most common, representing 70.1% followed by non-variceal causes [26.1%] and obscure causes [3.8%]. Esophageal varices [EV] alone represented 17.8% of causes of variceal bleeding, while combined esophageal and gastric varices represented 39.5% and isolated gastric varices 12.8%. Gastric lesions were the most common causes of non variceal bleeding. Recurrence of bleeding occurred in 19.4% of variceal group in comparison to 6.1% of non variceal group, while mortality was found in 4.3% of variceal group in comparison to 1.5% of non variceal group with very highly significant difference [P <0.001]. Hypertension, ascites, EV columns, EV grade IV, presence of gastric varices and associated respiratory disorder were independent factors as-sociated with recurrence of bleeding in variceai group. In non variceal group, recurrence of bleeding was significantly related only to the presence of gastric ulcers [P=0.035]. Independent factors associated with mortality in studied patients were age, associated diabetes, presence of esophageal varices and associated duodenal ulcer