RESUMEN
Lack of precise diagnostic criteria and sufficient findings in support of biopsy sampling during upper gastrointestinal endoscopy is one of the special challenge in endoscopy assessment in Barrett's esophagus. The aim of this study was to evaluate the mucosa in the distal esophagus tissues through a biopsy during upper gastrointestinal endoscopy in gastroesophogeal reflux disease patients whose symptoms don't improve or only partially resolve with treatment. A cross-sectional study was done in patients with gastroesophogeal reflux disease medically resistant to treatment. The patients were assessed by gastroenterology department in Sina Hospital, Tehran, Iran, since September 2012 to September 2013. Patients with coagulopathy, esophageal varicose, esophageal cancer, earlier detection of developing Barrett's esophagus, history of irritable bowel syndrome, psychological disorders and using of nonsteroidal anti-inflammatory drugs [NSAIDs] such as aspirin, were excluded. Esophageal squamous epithelium and cylindrical tissue of stomach was carefully checked by endoscope. Then 2 to 4 biopsy of the Z-line above the gastroesophageal mucosa were obtained. One hundred and fifty three patients included 78 men [511/6] and 75 females [49%] with a mean age of 47.92 +/- 17.57 years participated in the study. The mean of body mass index of patients was 25.05 +/- 4.17 kg/m[2] and body mass index in 45.8% of the patients more than 230 kg/m[2]. Biopsy specimens were taken in 31 cases were not enough for histological examination. In other patients, 25 cases [20.5%] were normal and 97 cases [79.5%] had the following pathological diagnosis: mild esophagitis [49 cases; 40.2%], moderate esophagitis [24 cases; 19.7%], severe esophagitis [14 cases; 11.5%], Barrett's esophagus [8 cases, 6.5%], fungal esophagitis [1 cases, 0.8%], and eosinophilic esophagitis [1 cases; 0.8%]. 117 patients [76.5%] had H. pylori infection. Sensitivity and specifity of endoscopy for detection of Barrett's esophagus during upper gastrointestinal endoscopy were 100% and 84.13% [CI 95%:78.53-89.09%], respectively. Our data showed that doing of accurate and adequate biopsy samples from lesions in upper GI endoscopy can be helpful in the diagnosis of Barrett's esophagus
RESUMEN
Background: Percutaneous endoscopic gastrostomy [PEG] is one of the ways to non-oral feeding in patients with dysphagia caused by conditions such as stroke, oropharyngeal malignancy and motor neuron disease. The aim of study was assessment of early outcome of PEG in hospitalized patients according to clinical situation and underlying disease
Methods: This study was cross- sectional and prospective. Sixty five patients were included with PEG from April 2011 to July 2012, at Sina University Hospital, Tehran, Iran. Tube function, feeding, and patients' symptoms were assessed and patients were followed six month at least to one year after procedure .The follow up of patients were stopped if the patient died or removal of tube
Results: Sixty five patients [33 men, 32 women] enrolled in this study. The mean age of patients was 57.45+/-16.83 years [19-94 years]. Head trauma and postoperative thoracic surgery were in 15 [23.1%] and 4 [6.2%] cases. 36 of patients [55.39%] had no symptoms. The complications include lickage [11 cases], stenosis [9 cases], cellulitis [7 cases], and PEG separation [2 cases]. A total of 29 patients were complicated and 21 patients [72%] of them complicated 2 -5 months after PEG. No statistical significant differences between two sexes in PEG complication. 27 patients [41%] died that have no relation to complications of PEG
Conclusion: Finally, the study showed the PEG is a safe method to enteral nutrition. The advantages of this method include its simplicity, no need to general anesthesia and low rate of complications especially in inpatient under the supervision of medical staff. Therefore it can be used as a favorable method