Study clinical signs, gastroscopic and oesophageal histopathologic features, pH monitoring 24h in the patients with gastroesophageal reflux disease

Background: pH monitoring 24h is used to diagnose atypical gastroesophageal reflux disease or can be applied to consider surgery for cases poorly respond with medical treatment. Objective: To study clinical signs, gastroscopic and oesophageal histopathologic features, pH monitoring 24h in the patients with gastroesophageal reflux disease (GERD). Subjects and method: The descriptive, cross-sectional study was conducted in patients with gastroesophageal reflux disease treated at Bach Mai Hospital from November 2005 to October 2006. 73 patients with GERD diagnosed according to Romell criteria were underwent gastroscopy and biopsy. 15 patients having extraesophageal manifestations of gastroesophageal reflux disease were underwent gastroesophageal reflux monitoring pH. Results: 31 (42.4%) patients had oesophagitis in which 67.7% grade A, 6.5% grade D and C, 2.7% Barret, and 53.4% having gastritis associated. 61 % oesophagitis and 13.9% Barret were seen on the biopsy. 40% (6/15) patients had abnormal pH monitoring but there was no statistically significant difference in pH monitoring between the group having oesophagitis from those without oesophagitis (p > 0.05). Conclusions: Among 15 patients underwent Ph monitoring, the rate of patients with abnormal pH monitoring was 40%. There was no statistically significant difference of pH monitoring result between patients with or without esophagus lesion.

Comment on the variation of plasma iron and ferritin levels in liver cirrhosis patients

Background: Anemia in patients with liver cirrhosis can be due to either iron deficiency as the result of gastroesophageal bleeding or vitamin B12 and folic acid deficiency in patients with alcohol - induced liver cirrhosis. Nevertheless excessive iron level in liver can induce damages to hepatic cells and further advance the cirrhosis process. Objective: To investigate the function of iron in the treatment of anemia in liver cirrhosis patients, collecting data on plasma iron and ferritin concentrations. Subjects and method: Research on 100 patients with liver cirrhosis has been conducted at Department of Gastroenterology, Bach Mai Hospital. Results: 59% patients had low plasma iron level and 9% had high level whereas 13% and 61 % patients had low and high plasma ferritin levels respectively. Plasma iron levels reduced significantly at patients with liver cirrhosis at advanced stage (p < 0.01) and at patients with gastroesophageal (GE) haemorrhage (p < 0.05). Plasma ferritin levels reduced in patients with gastroesophageal bleeding (p < 0.05) but increased in patients with liver cirrhosis at advanced stage (p <0.01) and at alcohol - induced liver cirrhosis patients (p < 0.05). Conclusions: For patients having chronic anemia, plasma levels of iron and ferritin should be determined before a decision of prescribing iron being made.

Spontaneous bacterial peritonitis in the patients with liver cirrhosis

Background: Spontaneous bacterial peritonitis (SBP) is severe complication of the patients with liver cirrhosis, can also develop renal hepatic syndrome or hepatic encephalopathy. Objective: To study clinical signs and the frequency of SBP according to the severity of liver disease and the change of biochemical parameters, characteristics of ascitic fluid. Subjects and method: 37 patients with liver cirrhosis having SBP diagnosed or by an ascitic fluid polymorphonuclear neutrophil (PMN) leukocyte count of > 250 cells per mm3 and/ or microbial positive culture ascites. The conventional method of culture ascites by plating out a loop of fluid on agar plates in the microbiology laboratory. All patients were treated at Bach Mai Hospital. Results:78.4% SBP in patients with Child - Pugh C 64.9% in patients having abundant ascites fluid, 72.9% having ascitic protein < 10g/l, the very low frequency of culture - positive ascitic fluid (5.4%). The frequency clinical signs were abdominal pain (67.6%) and diarrhea (73.0%). Conclusions: Considering the SBP preventive treatment for patients with liver cirrhosis having low - protein ascites < 10g/l) and setting up ascitic fluid culture with a larger volume of ascites into aerobic and anaerobic blood culture bottles at the beside improves the sensitivity of detection of an organism.

Study the difference of clinical and laparoscopic features between peritoneal tuberculosis and peritoneal malignancy

Background: Peritoneal tuberculosis (PT) and peritoneal malignancy (PM) are the most frequent causes of exsudate ascitic fluid but the different diagnosis between the former and the latter is also difficult and elusive. Objective: To study the difference of clinical and laparoscopic features between PT and PM. Subjects and method: 76 patients with PT and 50 with PM were diagnosed by laparoscopy and peritoneal biopsy. Ascitic mycobacterium tuberculosis was detected by PCR analysis. Exsudate ascites was confirmed according to criteria of Light. Results and Conclusions: Average age of PT was younger than of PM (p < 0.001). The frequency of fever, pleural effusion in the patients with PT was higher than those in PM (p < 0.001 and 0.05). The anemia and abdominal tumefaction in those of PM was more frequent than in those of PT (p < 0.05 and 0.001). High protein ascitic fluid and numerous lymphocytes in the patients with PT was frequent than in those with PM (p < 0.05). Laparoscopic features: In those patients with PT the white "miliary nodules" or adhesions between abdominal wall was more frequent than in those with PM (p < 0,05) and in patients with PM omental thickening, tumor formation was more than in those with PT.