Management of foreign bodies in the upper gastrointestinal tract with flexible endoscope

To evaluate the management of foreign bodies in the upper Gastrointestinal tract in a tertiary care hospital in Peshawar. In this descriptive study, conducted at Gastroenterology Department Hayatabad Medical Complex Peshawar from May 2002 to May 2009, a total of 40 consecutive patients presenting with history of foreign body ingestion were included. Radiological survey was made before endoscopy in all the patients. Flexible endoscope, esophageal over tube and other accessories were used for removal of the foreign bodies. Female to male ratio was 1.5:1. The mean age of the sample was 19.92 +/- 23.5. Dysphagia [n=18, 45%] was the most common symptom in the esophageal foreign bodies followed by retrosternal pain or discomfort [n=11, 27.5%]. The most common foreign body was coin ingestion [n=24, 60%]. Meat bolus and bone chip impaction was present in 9 [22.7%] patients. The success rate in case of esophageal foreign bodies was 93.75%. While in the case of gastric foreign bodies, it was 100%. There was a small perforation which occurred in only one patient with esophageal foreign body which was managed conservatively. In the case of gastric foreign bodies, no procedure related complications occurred. Flexible endoscopy was a safe and effective technique for the management of foreign bodies in the upper gastrointestinal tract in our study

Injection sclerotherapy of bleeding gastric varices using absolute alcohol

To evaluate the effectiveness of absolute alcohol injection in the management of bleeding gastric varices. This descriptive study was conducted in the department of Gastroenterology, Hayatabad Medical Complex Peshawar from September 2006 to September 2009. Twenty Seven patients with portal hypertension fulfilling the inclusion criteria and consenting were included in the study. Endoscopy was arranged within 12 hours of admission to the hospital. The gastric varices were injected with 5-10 ml of absolute alcohol depending upon the size of the varices. Both intravariceal and paravariceal techniques were used. Subsequent endoscopy sessions were arranged at 2 weeks intervals. The outcomes assessed were variceal eradication, rebleed and death. Findings were noted and entered into a structured proforma. Data was analyzed using SPSSv.10. Fifteen [55.56%] patients were male and 12 [44.44%] were female with a mean age of 47.52 +/- 15.09 years. Twenty one [77.78%] patients had cirrhosis due to chronic hepatitis C, 4 [14.81%] were HBV related while 2 [7.40%] had alcoholic liver disease. Majority [70.73%] had child's class C followed by B and A [18.51% and 11.11% respectively]. Variceal eradication was achieved in 19[70.37%] patients. Three were lost to follow up while 5 died due to uncontrolled bleeding. Post sclerotheraphy ulceration was the most common complication [64%] followed by pyrexia [28%], Retrosternal/epigastric pain [16%] and dysphagia [8%]. Sclerotherapy with absolute alcohol may be effective in achieving hemostasis in bleeding gastric varices but with exceptionally high rate of complications

Frequency of organic pathologies in patients with irritable bowel syndrome

To evaluate Irritable bowel syndrome [IBS] labeled patients, meeting symptom based criteria of IBS, for organic pathologies. This descriptive study was carried out in Gastroenterology Department, Hayat Abad Medial Complex, Peshawar, during the period from March 2003 to March 2005. A total of 85 consecutive patients were included in the study, who were labeled as IBS by the General Practioners. All of them were meeting symptom based criteria [ROME II] for IBS. Informed consent was taken. Patients with alarm signs including dysphagia, rectal bleeding, anemia, weight loss, family history of colon cancer, were excluded from the study. Detailed history and physical examination was done. Laboratory evaluation, which included complete blood count, erythrocyte sedimentation rate[ESR], blood urea, serum creatinine, serum electrolytes, liver function tests, thyroid function tests, and stool examination for ova, parasites and culture when indicated, was done. Patients underwent Upper G I Endoscopy, Ultrasound of the abdomen, Flexible sigmoidosopy and/or Full length colonoscopy as indicated. Other investigations like small gut biopsy, celiac serology and biopsy from the large gut were done as needed. Out of the 85 patients, 68 [80%] were males and 17 [20%] were females. Abdominal pain was the most common, present in 65 [76%] patients out of 85 patients. All these patients had mixed type of IBS symptoms, having both diarrhea and Constipation. Laboratory investigations were normal in almost all patients except in 5 [5.8%] patients, who were having evidence of hypochromic microcytic anemia. All these five patients were having mixed pattern IBS. Three [3.5%] were males and their celiac serology and small gut biopsy showed evidence of celiac sprue. Ten [12%] of patients were having cysts of Amoeba in their stools routine examination but there were no trophozytes found. Another 15 [17%] patients were having non significant hemorrhoids on lower GI endoscopy. 17 [20%] of patients were having antral gastritis on EGD, but the biopsy showed non specific gastritis. Irritable bowel syndrome can be diagnosed clinically, using ROME II criteria and a few inexpensive and non invasive tests. In patients with IBS-D and IBS-M routine serological screening for celiac sprue may be a cost effective strategy