Impact of juxta-ampullary duodenal diverticula on ERCP complications

Juxta-ampullary diverticulum is an acquisitive disorder generally observed in patients over the age of forty years. The purpose of this study is to evaluate the relationship between this abnormality and the incidence of post-ERCP complications. This was a case-control cross-sectional study that compared post- ERCP complications between patients with juxta-ampullary diverticula and those with no juxta-ampullary diverticula. We classified diverticula based on anatomic locations with respect to the ampulla. A total of 718 patients referred to our endoscopic ward during one year for ERCP. From these cases, 685 patients underwent ERCP. A total of 47 [6.9%] patients had juxta-ampullary diverticuli, which consisted of type A [25.5%], type B [46.8%], type C [12.8%] and type D [14.9%]. The frequency of CBD stones and cholangitis in the case group was significantly more than die control group [p<0.00l]. The mean age of patients in the case group was ten years older than patients in die control group [68.04dbl5.02 vs. 58.25 +/- 17.48], which was significant [p<0.00l]. There is an association between juxta-ampullary diverticula and the frequency of CBD stones and post-ERCP complications

Comparison of metronidazole and placebo in control of gaseous symptoms in patients with functional bowel disorders; a randomized double- blind controlled study

To compare the efficacy of metronidazoie versus placebo in the control of gaseous symptoms in patients with functional bowel disease. In the absence of organic or systemic diseases, all cases with chief complaints of bloating and normal laboratory tests were consecutively enrolled in this double-blind study. Lactase deficiency and bacterial overgrowth were ruled out by the lactose breath test. Patients were randomly assigned to receive either metronidazole or placebo. Demographic characteristics as well as frequency and severity of the patients' scores [mean total symptom score] before and after therapy, their compliance and drug adverse effects were evaluated. A 50% decrease in the total symptom scores was defined as effective treatment. During one year, 46 patients [17 males, 29 females, mean age: 38.9 +/- 9.9 years] were enrolled in the study. A total of 23 patients received metronidazole [cases] and 23 received placebo [controls]. Two patients in the metronidazole group did not tolerate the drug and one patient in the placebo group did not continue with follow-up. Patients responded similarly to both regimens: 59% of patients in the placebo group and 52.2% of patients in the metronidazole group had a 50% decrease in their total symptom score [p = 0.64]. Side effects of metronidazole were frequent, but tolerable. Bad taste in the mouth and anorexia were the most common complaints in the metronidazole group. This study showed no difference between placebo and metronidazole in relief of bloating and other related complaints in patients with functional bowel disease

Accuracy of endosonography in the diagnosis of obstructive jaundice

Endoscopic retrograde cholangiopancreatography [ERCP] has been used as the method of choice in assessment of obstructive jaundice for a long time. Recently, the development of endoscopic ultrasonography [EUS] has attracted the attention of clinicians as an alternative accurate, safe and cheap method to replace the ERCP procedures performed only for diagnostic purposes, the present study aims to examine the accuracy of endoscopic ultrasonography as an alternative diagnostic procedure to ERCP for detection of causes of cholestasis'. In this study, 100 patients underwent endoscopic ultrasonography in Digestive Disease Research Center, Shariati Hospital. The patients were divided into two groups: 1] those with operable periampullary tumors who were referred to the surgeons, 2] other patients. The final diagnosis made after ERCP and operative removal of the mass was considered as the gold standard and was compared with accuracy of endoscopic ultrasonography. The overall accuracy of endoscopic ultrasonography in the diagnosis of obstructive cholestasis was 92.0%. Sensitivity and specificity of this method in diagnosis of choledocholithiasis were 95.2% and 96.4% respectively. The corresponding values for diagnosis of periampullary tumors were 96.2% and 95.8%.In this study the accuracy of EUS in diagnosis of obstructive jaundice and its sensitivity and specificity for diagnosis of choledocholithiasis and periampullary tumors were high. Therefore, it could be concluded that endoscopic ultrasonography is a reliable diagnostic tool for extrahepatic cholestasis

[Review of articles clinical presentation, diagnostic methods and different treatment modalities of Achalasia]

Achalasia is the most recognized esophageal motor disorder with an unknown etiology. Symptoms rather than physical findings are hallmarks of the disease. Modalilies for treatment include pharmacologic, botulinum toxin injection, pneumatic dilation and surgery. To review the diagnostic and therapeutic options currently available for achalasia. A medline search identified the original articles and reviews published in the English language literature. We also reviewed our research center [Digestive Disease Research Center] articles. Pre and post treatment symptom score and timed esophagogram are important for assessment of treatment success rate. Pharmacotherapy, injection of botulinum toxin, pneumatic dilation and cardiomyotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strengths and weaknesses which make them each suitable in certain population, but pneumatic dilation and surgery are the most effective options. The optimal treatment for achalasia remains an area of controversy. In our opinion preumatic dilation is the best primary treatment in majority of Achalasia patients and Botulinum toxin injection and surgery should be reserved for patients that pneumatic dilation is high risk or ineffective in them

[Cavernous hemangioma of liver presenting with high fever and severe abdominal pain; a case report]

Intra-tumoral bleeding, rupture and thrombosis are common complications of hemangioma but spontaneous and self limited rupture and fever is a very rare presentation of hemangioma. This report is about a 38-year-old woman with sever abdominal pain and high fever came for evaluation. In US she had a liver mass of about 15 cm in left lobe with possibility of being hemangioma and, CT scan and MRI confirmed diagnosis of hemangioma. She had persistently abdominal discomfort and fullness in upper abdomen and referred for surgery. Left lobectomy and resection of hemangioma was done successfully