Background: Bleeding esophageal varices (OVs) due to portal hypertension are one of the major complications with high mortality in liver cirrhosis. So, early detection and management are mandatory. Aim: To evaluate th...Background: Bleeding esophageal varices (OVs) due to portal hypertension are one of the major complications with high mortality in liver cirrhosis. So, early detection and management are mandatory. Aim: To evaluate the role of Von Willebrand factor (VWF) in predicting the presence of OVs. Patients and Methods: 62 patients with liver cirrhosis representing different Child-Pugh classes were included. The diagnosis of liver cirrhosis was based on the combination of clinical, laboratory and US examinations. All included patients underwent the following investigations: complete blood count, liver function tests (ALT, AST, serum bilirubin, albumin and total protein, prothrombin time (PT) and concentration (PC), INR and serum alkaline phosphatase), serum creatinine, Von Willebrand factor antigen (VWF-Ag) measurement and abdominal US. Upper endoscopic evaluation was done to detect presence or absence of varices (esophageal or gastric) and/or PHG. Results: 38 males and 24 females with their mean age (46 ± 12 years old) were included. Plasma Von Willebrand factor-Ag level was significantly higher in patients with OVs than those without varices (P value = 0.000). Also, its level was significantly higher in patients with higher grade of OVs, G3 than those with G1 or G2 (P value = 0.000). Patients with large OVs including those with G2 and G3 showed significantly higher values of VWF than those with small OVs (NO and G1) (P value = 0.000). VWF was independent predictor for detecting the presence of OVs with good sensitivity (90), specificity (77.3) and accuracy (85.5) at a cutoff value of 1.74 U/ml. Also it was an independent predictor for detecting the presence of large OVs with good sensitivity (91.2), specificity (85.7) and accuracy (88.7) at a cutoff value of 2.16 U/ml. Conclusion: VWF-Ag could be used as a non invasive laboratory independent predictor for the detection of OVs.展开更多
BACKGROUND Pancreatic cystic lesions(PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunit...BACKGROUND Pancreatic cystic lesions(PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions.AIM To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen(CA)19-9, CA72-4], carcinoembryonic antigen(CEA), serine protease inhibitor Kazal-type 1(SPINK1), interleukin 1 beta(IL1-β), vascular endothelial growth factor A(VEGF-A), and prostaglandin E2(PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound(EUS) and EUS-fine needle aspiration(EUS-FNA) for characterization and sampling of different PCLs.RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance(59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively(P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance(P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions.CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.展开更多
BACKGROUND The current coronavirus disease 2019(COVID-19)pandemic has affected routine endoscopy service across the gastroenterology community.This led to the suspension of service provision for elective cases.AIM To ...BACKGROUND The current coronavirus disease 2019(COVID-19)pandemic has affected routine endoscopy service across the gastroenterology community.This led to the suspension of service provision for elective cases.AIM To assess the potential barriers for resuming the endoscopy service in Egypt.METHODS A national online survey,four domains,was disseminated over a period of 4 wk in August 2020.The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the survey.The waiting list was increased by≥50% in 44.9% of areas with clusters of COVID-19 cases(n=49)and in 35.5% of areas with sporadic cases(n=62).Thirty nine(34.8%)centers suffered from staff shortage,which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis.In multivariate analysis,the burden of cases in the unit locality,staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice(P=0.029,<0.001 and 0.02,respectively)and Odd’s ratio(0.15,1.8 and 0.16,respectively).CONCLUSION The COVID-19 pandemic has led to restrictions in endoscopic volumes.The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery.Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.展开更多
<span style="font-family:Verdana;">Gender difference in chronic hepatitis C (CHC) infection is not previously well studied. We aimed to analyze the effect of gender difference on the risk factors of CH...<span style="font-family:Verdana;">Gender difference in chronic hepatitis C (CHC) infection is not previously well studied. We aimed to analyze the effect of gender difference on the risk factors of CHC, disease progression, and outcome after oral direct acting antiviral (DAA) therapy. The study</span><span style="font-family:Verdana;"> was</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> conducted at Tropical Medicine and Gastroenterology Department, Sohag University, Egypt, in the period between 2018 and 2020. 775 patients were evaluated for hepatitis C virus (HCV) risk factors. Laboratory investigations, abdominal ultrasound and liver Shear </span><span style="font-family:Verdana;">wave elastography (SWE) were done. The patients were given antiviral therap</span><span style="font-family:Verdana;">y and followed up to assess the response and side effects of DAA therapy. 434</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">(56%) of study patients were males and 341</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">(44%) were females. Catching infection from blood transfusion and intravenous (IV) injection of </span><span style="font-family:Verdana;">tarter emetic w</span></span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> significantly higher in males, while catching infection from surgical operation was significantly higher in females. Hepatic fibrosis was significantly more extensive in males. Side effects were reported more in females. Sustained virological response (SVR)</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">12 was reported in 98.6%. Females had a slightly better SVR12 than males (99.4% versus 97.9%). In conclusion males were different from females in exposure to HCV risk factors. After introduction of blood screening and stoppage of </span><span style="font-family:Verdana;">parenteral anti-bilharzial therapy the risk of HCV infection could be greatly prevented in males, while the exposure of females to obstetric procedure is increasing nowadays which hide</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> a risk of ongoing infection in females. So, HCV surveillance programs in females retain </span><span style="font-family:Verdana;">their </span><span style="font-family:Verdana;">importance in early detection and management of CHC. Although hepatic fibrosis</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">progression was more in males, females were more liable to adverse events of DAA therapy. So, researchers should consider the gender of their patients in drug design and administration.</span>展开更多
AIM:To determine the prevalence and possible risk factors of Barrett's esophagus(BE) in patients with chronic gastroesophageal reflux disease(GERD) in El Minya and Assuit, Upper Egypt.METHODS:One thousand consecut...AIM:To determine the prevalence and possible risk factors of Barrett's esophagus(BE) in patients with chronic gastroesophageal reflux disease(GERD) in El Minya and Assuit, Upper Egypt.METHODS:One thousand consecutive patients with chronic GERD symptoms were included in the study over 2 years.They were subjected to history taking including a questionnaire for GERD symptoms, clinical examination and upper digestive tract endoscopy.Endoscopic signs suggestive of columnar-lined esophagus(CLE) were defined as mucosal tongues or an upward shift of the squamocolumnar junction.BE was diagnosed by pathological examination when specialized intestinal metaplasia was detected histologically in suspected CLE.pH was monitored in 40 patients.RESULTS:BE was present in 7.3% of patients with chronic GERD symptoms, with a mean age of 48.3 ± 8.2 years, which was signif icantly higher than patients with GERD without BE(37.4 ± 13.6 years).Adenocarcinomawas detected in eight cases(0.8%), six of them in BE patients.There was no signiflcant difference between patients with BE and GERD regarding sex, smoking, alcohol consumption or symptoms of GERD.Patients with BE had significantly longer esophageal acid exposure time in the supine position, measured by pH monitoring.CONCLUSION:The prevalence of BE in patients with GERD who were referred for endoscopy was 7.3%.BE seems to be associated with older age and more in patients with nocturnal gastroesophageal reflux.展开更多
Since its advent in 1980,the scope of endoscopic ultrasound(EUS)has grown to include a wide range of indications,and it is now being incorporated as an integral part of everyday practice in the field of gastroenterolo...Since its advent in 1980,the scope of endoscopic ultrasound(EUS)has grown to include a wide range of indications,and it is now being incorporated as an integral part of everyday practice in the field of gastroenterology.Its use is extending from an adjuvant imaging aid to utilization as a therapeutic tool for various gastrointestinal disorders.EUS was first used to visualize remote organs,such as the pancreas and abdominal lymph nodes.When fine needle aspiration was introduced,the indications for EUS expanded to include tissue sampling for diagnostic purposes.At the same time,the needle can be used to convey a potential therapy to the internal organs,allowing access to remote sites.In this review,we aim to highlight the expanding spectrum of EUS indications and uses in the field of gastroenterology.展开更多
AIM: To investigate and clarify, for the first time, the role of inosine triphosphate pyrophosphatase (ITPA ) polymorphism in Egyptian chronic hepatitis C virus (HCV) patients.METHODS:The human genomic DNA of all pati...AIM: To investigate and clarify, for the first time, the role of inosine triphosphate pyrophosphatase (ITPA ) polymorphism in Egyptian chronic hepatitis C virus (HCV) patients.METHODS:The human genomic DNA of all patients was extracted from peripheral blood cells in order to determine the single nucleotide polymorphism (SNP) of ITPA (rs1127354). SNP genotyping was performed by real time polymerase chain reaction (PCR, ABI TaqMan allelic discrimination kit) for 102 treatment-naive Egyptian patients with chronic HCV. All patients had no evidence of cardiovascular or renal diseases. They received a combination treatment of pegylated interferon α (PEG-IFNα) as a weekly subcutaneous dose plus an oral weight-adjusted dose of ribavirin (RBV). The majority received PEG-IFNα2a (70.6%) while 29.4% received PEG-IFNα2b. The planned duration of treatment was 24-48 wk according to the viral kinetics throughout the course of treatment. Pre-treatment liver biopsy was done for each patient for evaluation of fibrosis stage and liver disease activity. The basal viral load level was detected quantitatively by real time PCR while viral load throughout the treatment course was performed qualitatively by COBAS TaqMan assay. RESULTS: Ninety-three patients (91.2%) had ITPA SNP CC genotype and 9 (8.8%) had non-CC genotype (CA and AA). The percentage of hemoglobin (Hb) decline was higher for CC patients than for non-CC patients, particularly at weeks 4 and 8 (P=0.047 and 0.034, respectively). During the first 12 wk of treatment, CC patients had significantly more Hb decline > 3 g/dL than non-CC patients: 64.5% vs 22.2% at weeks 8 and 12, respectively, (P=0.024 and 0.038). Reduction of the amount of the planned RBV dose was significantly higher for CC patients than non-CC patients during the first 12 wk (18% ± 12.1% vs 8.5% ± 10.2%, P=0.021). The percentage of CC patients with RBV dose reduction was significantly greater than that of non-CC patients (77.4% vs 44.4%, P=0.044). Multivariate analysis identified only the percentage of RBV dose as a predictor for Hb decline. Platelet decline was significantly higher in non-CC patients than CC patients at weeks 12, 24 and 48 (P=0.018, 0.009 and 0.026, respectively). CONCLUSION: Rs1127354 ITPA polymorphism plays a decisive role in protecting against treatment-induced anemia and the need for RBV dose reduction in Egyptian HCV patients.展开更多
AIM:To address the diagnostic value of the regular arrangement of collecting venules(RAC)among old age patients. METHODS:A total of 390 consecutive patients whose Helicobacter pylori(H.pylori)status was known and who ...AIM:To address the diagnostic value of the regular arrangement of collecting venules(RAC)among old age patients. METHODS:A total of 390 consecutive patients whose Helicobacter pylori(H.pylori)status was known and who received upper gastrointestinal endoscopy,were retrospectively studied for the presence or absence of RAC as well as gastric mucosal atrophy.The sensitivity, specificity,positive predictive value,negative predic-tive value and accuracy of RAC to detect normal gastric mucosa were assessed and were compared among two different age groups of patients. RESULTS:The mean age±standard deviation(SD)of included patients(n=390),was 62.9±13 years.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of RAC to detect normal gastric mucosa were 91.7%,66.1%,18.8%,99%and 68.1%respectively.Although the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of RAC among patients<60 years(n= 139)was 94.7%,71.2%,46.2%,98.1%and 76.1%,respectively,it was 80%,64.3%,5.1%,93%and 64.6%, respectively,among patients≥60 years(n=251). Younger Patients(<60 years),have highly significant rates of RAC sensitivity,positive predictive value,and accuracy(P≤0.001,≤0.001 and≤0.02,respectively).Older patients had highly significant rates of H. pylori infection and gastric mucosal atrophy(P≤0.01). CONCLUSION:Although RAC is a valuable sign for real-time identification of normal gastric mucosa,its accuracy seems to be affected by the patient's age.展开更多
Background: Bacterial infection in cirrhotic patients is a fatal complication. The high incidence of bacterial infections in those patients may be related to several alterations in the defensive mechanisms against inf...Background: Bacterial infection in cirrhotic patients is a fatal complication. The high incidence of bacterial infections in those patients may be related to several alterations in the defensive mechanisms against infections and increased intestinal permeability with bacterial translocation. Aim: To evaluate the role of portal hypertension (PH) in predicting the occurrence of bacterial infections in decompensated cirrhosis. Patients and Methods: In this retrospective cohort study, 99 patients—56 males and 43 females, with decompensated liver cirrhosis were included. Diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic examinations. Patients were classified according to the presence of bacterial infection into patients with infection—Group 1, and those without infection—Group 2. Laboratory, abdominal US and upper endoscopic data for all patients were collected. Logistic regression analysis was done to detect the independent factors for prediction of bacterial infection. Results: The mean age of patients was 50.5 ± 14.2 years. Bacterial infection was found in 41 patients (41.4%) and no infection in 58 patients (58.6%). Infected patients showed statistically significant higher values in the level of bilirubin, PT and Child-Pugh score (P value = 0.000) and lower values in the level of albumin, total serum protein and PC than those without infection (P value = 0.006, 0.000 and 0.000 respectively). Portal vein diameter (PVD) and splenic diameter (SD) showed statistically significant higher values in infected patients than in those without infection (P value = 0.028 and 0.000 respectively), also infection was more significantly prevalent in patients with varices than those without varices (P value = 0.000). The independent predictors for bacterial infection were: the age, total serum bilirubin, serum albumin, PT, PC, child score, PVD, SD and the presence of varices. Conclusion: Presence of varices (as a complication of PH) is an independent risk factor for the development of bacterial infection in decompensated cirrhotic patients and reduction of PH by any way could decrease this fatal complication.展开更多
BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 ...BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.展开更多
Background and Aim: Early diagnosis of hepatocellular carcinoma (HCC) is essential for achieving good prognosis. Glypican 3 (GPC3) has been reported to be raised in HCC in comparison with non-neoplastic lesions. This ...Background and Aim: Early diagnosis of hepatocellular carcinoma (HCC) is essential for achieving good prognosis. Glypican 3 (GPC3) has been reported to be raised in HCC in comparison with non-neoplastic lesions. This work aimed to study the role of GPC3 in the early diagnosis of HCC in post-chronic hepatitis C (CHC) cirrhotic patients. Patients and Methods: A comparative study included 60 patients, 40 patients with HCC (HCC group) and 20 patients of CHC without HCC (control group). Diagnosis of HCC was based on abdominal ultrasound and triphasic CT, while biopsy was performed in debating cases. Serum samples for measurement of GPC3 and AFP levels were obtained from all participants. Results: The median levels of both AFP and GPC3 were significantly higher among HCC cases compared to controls. Analysis of the ROC curve showed that both AFP and GPC3 could be used to differentiate HCC cases from controls. AUROCs of GPC3 and AFP were 0.928 and 0.727 respectively, and both were statistically significant with p-values Conclusion: Serum GLP-3 is highly sensitive and specific for detecting HCC, more than AFP for the early detection of HCC, and the combination of both yielded improved sensitivity.展开更多
BACKGROUND Insufficient and contradictory data are available about the relation between directacting antivirals(DAAs)and hepatocellular carcinoma(HCC)development in patients with hepatitis C virus(HCV).AIM To analyze ...BACKGROUND Insufficient and contradictory data are available about the relation between directacting antivirals(DAAs)and hepatocellular carcinoma(HCC)development in patients with hepatitis C virus(HCV).AIM To analyze differences in basic clinical,radiological,and laboratory characteristics in addition to tumor behavior upon HCC diagnosis between patients with and without a previous history of DAAs exposure.METHODS This multicenter case-control study included 497 patients with chronic HCVrelated HCC,allocated into one of two groups according to their history of antiviral treatment for their HCV.RESULTS Group I included 151 HCC patients with a history of DAAs,while 346 patients who had never been treated with DAAs were assigned to group II.A significant difference was observed between both groups regarding basic assessment scores(Child,MELD,and BCLC),which tended to have more advanced liver disease and HCC stage upon diagnosis in group I.However,serum albumin was significantly affected,and serumα-fetoprotein was significantly higher in group II(P<0.001).In addition,group I showed significant HCC multicentricity than group II,while the incidence of portal vein thrombosis was significantly higher in group I(P<0.001).CONCLUSION The basic clinical scores and laboratory characteristics of HCC patients are advanced in patients who are naïve to DAAs treatment;however,HCC behavior is more aggressive in DAA-treated patients.展开更多
Background/Purpose: Early assessment of the severity of acute pancreatitis (AP) is a highly challenge for a physicians’ practice to improve the management and decrease the mortality. We aimed to determine early progn...Background/Purpose: Early assessment of the severity of acute pancreatitis (AP) is a highly challenge for a physicians’ practice to improve the management and decrease the mortality. We aimed to determine early prognostic factors for AP related in-hospital mortality. Methods: Upon hospital admission, predictors of AP related in-hospital mortality were prospectively assessed using regression analysis over 129 consecutive AP patients. Predictive abilities of these prognostic factors were compared using the area under receiver operating characteristic curve (AUC). Results: AP related in-hospital mortality was 10.9%. Red cell distribution (RDW), serum creatinine, glucose and albumin were associated with AP mortality. RDW had the highest AUC followed by serum creatinine and albumin (AUC: 914, 95% CI: 0.797 - 0.975;0.797, 95% CI: 0.695 - 0.878;0.798, 95% CI: 0.677 - 0.865 respectively). The cut-off with the best ability to predict in-hospital mortality was 14.2 for RDW. By coupling RDW and serum creatinine, AUC was improved to 0.940, 95% CI: 0.839 - 0.986. Conclusion: RDW, serum creatinine, albumin, and glucose even with borderline level changes may predict AP related in-hospital mortality, where, RDW has the highest prognostic accuracy. Coupling RDW and serum creatinine model significantly improves their predictive accuracy that may aid in further improvement of the quality of care of AP patients.展开更多
BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced ...BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques(ERTs).However,there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.AIM To investigate the knowledge,attitude,and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’infrastructures toward these techniques.METHODS An online 2-pages questionnaire was used.The first page comprised demographic data,and questions for all physicians,about the knowledge(11 questions)of and attitude(5 questions)toward ERTs as a therapeutic option for SBN.The second page investigated the practice of ERTs by endoscopists(6 questions)and the infrastructures of their endoscopy units(14 questions).The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.RESULTS The complete responses were 833/2300(36.2%).The majority of the participants were males(n=560,67.2%),middle-aged(n=366,43.9%),consultants(n=464,55.7%),gastroenterologists(n=678,81.4%),spending≥15 years in practice(n=368,44.2%),and were working in university hospitals(n=569,68.3%).The majority correctly identified the definition of SBN(88.4%)and the terms polypectomy,endoscopic mucosal resection(EMR),and endoscopic submucosal dissection(ESD)(92.1%,90.2%,and 89.1%respectively).However,26.9%,43.2%and 49.5%did not recognize the clear indication of polypectomy,EMR,and ESD respectively.Although 68.1%of physicians are convinced about the ERTs for management of SBN;only 8.9%referred all candidate cases for ERTs.About 76.5%of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9%and 7.2%respectively.About 71.6%and 88.4%of endoscopists did not perform EMR or ESD in the last one year.Consequently,the complication rate reported by endoscopists was limited to 18.1%(n=103)of endoscopists.Only 25.8%of endoscopists feel confident in the management of ERTs-related complications and a half(49.9%)were not sure about their competency.Regarding the end-oscopy units’infrastructures,only 4.2%of the centers had their endoscopes 100%armed with optical enhancements and 54.4%considered their institutions ready for managing ERTs-related complications.Only 18.3%(n=104)of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding(26.7%),and perforations(17%).CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs.The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.展开更多
Introduction: Hepatitis C virus (HCV) genotype 4 is the most prevalent in Egypt. Vis-ceral adiposity index (VAI) and (TyG) index are newly developed indices for assess-ment of metabolic syndrome (MS) and insulin resis...Introduction: Hepatitis C virus (HCV) genotype 4 is the most prevalent in Egypt. Vis-ceral adiposity index (VAI) and (TyG) index are newly developed indices for assess-ment of metabolic syndrome (MS) and insulin resistance (IR). We aimed at comparing their levels in HCV-patients with healthy controls and validate their use for prediction of hepatic histopathological changes. Patient and Methods: 78 chronic HCV-infected patients proven by PCR, viral genotyping and hepatic histopathology, and 67 healthy controls were enrolled. Presence of MS, Homeostasis Model Assessment for IR esti-mation (HOMA-IR), TyG index, and VAI were assessed. Results: HOMA-IR, TyG and frequency of MS were significantly higher in patients’ group (p p p = 0.002). Conclusion: HCV genotype 4 is significantly associated with MS and increased values of HOMA IR and TyG index. TyG index and VAI are valuable simple indices that could predict the histopathological changes in Egyptian CHC pa-tients.展开更多
The emerging evidence of the potentially clinical importance of occult hepatitis B virus(HBV) infection(OBI) increases the interest in this topic. OBI may impact in several clinical contexts, which include the possibl...The emerging evidence of the potentially clinical importance of occult hepatitis B virus(HBV) infection(OBI) increases the interest in this topic. OBI may impact in several clinical contexts, which include the possible transmission of the infection, the contribution to liver disease progression, the development of hepatocellular carcinoma, and the risk of reactivation. There are several articles that have published on OBI in Egyptian populations. A review of MEDLINE database was undertaken for relevant articles to clarify the epidemiology of OBI in Egypt. HBV genotype D is the only detectable genotype among Egyptian OBI patients. Higher rates of OBI reported among Egyptian chronic HCV, hemodialysis, children with malignant disorders, and cryptogenic liver disease patients. There is an evidence of OBI reactivation after treatment with chemotherapy. The available data suggested that screening for OBI must be a routine practice in these groups of patients. Further studies needed for better understand of the epidemiology of OBI among Egyptian young generations after the era of hepatitis B vaccination.展开更多
AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study...AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts:(1) personal information regarding the physician(name, age, specialty and type of health care setting); and(2) professional experience in the care of patients at risk for HCC development(screening, knowledge about the cause and natural course of liver diseases and HCC risk). RESULTS: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus(HCV) genotype as risk factor for HCC development(P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis(P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health(MOH) doctors consider HCV infection as the leading cause of HCC in Egypt(P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening(P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo(P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.CONCLUSION: In Egypt, physicians specialized in tropical medicine, internal medicine or gastroenterology with an MD degree and working in a University Hospital are best informed about HCC.展开更多
BACKGROUND The incidence of colorectal cancer(CRC)is increasing among young individuals in the Arab world as well as in other regions of the world.AIM To explore the incidence and prevalence of CRC in the Arab world.M...BACKGROUND The incidence of colorectal cancer(CRC)is increasing among young individuals in the Arab world as well as in other regions of the world.AIM To explore the incidence and prevalence of CRC in the Arab world.METHODS The PubMed,Scopus,Web of Science,EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year.The search terms were("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal")AND("cancer OR malignancy OR malignant OR neoplasm")AND("Jordan"OR"United Arab Emirates"OR"Bahrain"OR"Tunisia"OR"Algeria"OR"Djibouti"OR"Saudi Arabia"OR"Sudan"OR"Syria"OR"Somalia"OR"Iraq"OR"Oman"OR"Palestine"OR"Qatar"OR"Comoros"OR"Kuwait"OR"Lebanon"OR"Libya"OR"Egypt"OR"Morocco"OR"Mauritania"OR"Yemen").Reviews,metaanalyses,and articles containing nonoriginal data were excluded.Retrieved articles were screened,and relevant data were extracted.Descriptive statistics were used for data analysis.RESULTS Nine studies were included.Five of the studies provided information regarding the prevalence of CRC.The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate,while in Egypt,it ranged from 0.4% to 14%.Four studies showed information regarding the incidence.The annual incidence rate of CRC in Qatar was 7.5/100000/year.In Egypt,the crude incidence rate(CIR)in males was 3.1 for colon cancer and 1 for rectal cancer,while in females,it was 2.3 for colon cancer and 0.8 for rectal cancer.The age-standardized rate for CRC incidence in 2003 was 36.90 for males,26.50 for females,and 30.49 for both sexes in Saudi Arabia.In 2016,the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer,respectively,while in males,it was 3.3 and 2.8 for colon cancer and rectal cancer,respectively.One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old.CONCLUSION There is a considerable prevalence of CRC in some Arab countries.More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.展开更多
Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, ste...Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, stent placement, and surgery. The aims of the study: This is a retrospective study to assess the success rate of different treatment modalities for post-corrosive esophageal stricture including: endoscopic dilatation, stenting or surgery and to define any complications. Methods: Clinical and endoscopic data for patients with post-corrosive esophageal stricture admitted to the endoscopy unit between September 2012 and September 2017 were collected. Retrospective analysis of data was done to detect the types of treatment, success rate and any detectable complications. Results: A total of 50 patients with their ages ranged between 3 and 20 years were included in this study. Male patients represented 54% (27 patients) and females were 23 (46%). The cause of caustic material ingestion was mainly accidental (47 patients, 94%) and only 3 patients were suicidal (6%). Dilatation was successful in most cases either with or without injection of corticosteroids (39 patients, 78%). Stenting was a good option in cases of refractory or recurrent dilatations (11 patients;22%) with excellent results. Surgery rarely needed (only in one patient) and only when dilatation and stenting failed. Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good result and low rate of complications. The covered self-expandable metal stent (SEMS) is a good option in cases of refractory strictures, surgery rarely needed and after failure of previous modalities.展开更多
Background/purpose: Noninvasive assessment of esophageal varices (EVs), their size and bleeding stigmata may reduce endoscopic burden, cost and drawbacks. We aimed to evaluate the diagnostic performance of noninvasive...Background/purpose: Noninvasive assessment of esophageal varices (EVs), their size and bleeding stigmata may reduce endoscopic burden, cost and drawbacks. We aimed to evaluate the diagnostic performance of noninvasive fibrosis scores (AAR, APRI, FIB-4, King and VITRO scores) in predicting the presence of EVs and high risk varices needing treatment (VNT) in HCV-related cirrhosis of Egyptian patients. Methods: This prospective study included 154 HCV-related advanced compensated cirrhotic patients with no history of bleeding who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and VITRO scores were assessed. Results: Esophageal varices were found in 120 patients (77.9%) and VNT in 92 patients (59.7%). Apart from AAR, all scores demonstrated statistically significant correlations with the presence and the size of EVs. Using area under receiver operating characteristic curve (AUC), these scores were good predictors for the presence of EVs and VNT, where VITRO score had the highest AUC (0.920 and 0.900) and accuracy (97.1% and 87%), sensitivity (75, 82.6%), specificity (100, 93.5%), PPV (100, 95%) and NPV (53.2, 78.4%) with cutoffs >1.3 and >1.8 respectively. Conclusion: Noninvasive fibrosis scores can predict the presence of EVs and VNT. VITRO score was the best predictor with higher accuracy for clinical applicability than studied scores.展开更多
文摘Background: Bleeding esophageal varices (OVs) due to portal hypertension are one of the major complications with high mortality in liver cirrhosis. So, early detection and management are mandatory. Aim: To evaluate the role of Von Willebrand factor (VWF) in predicting the presence of OVs. Patients and Methods: 62 patients with liver cirrhosis representing different Child-Pugh classes were included. The diagnosis of liver cirrhosis was based on the combination of clinical, laboratory and US examinations. All included patients underwent the following investigations: complete blood count, liver function tests (ALT, AST, serum bilirubin, albumin and total protein, prothrombin time (PT) and concentration (PC), INR and serum alkaline phosphatase), serum creatinine, Von Willebrand factor antigen (VWF-Ag) measurement and abdominal US. Upper endoscopic evaluation was done to detect presence or absence of varices (esophageal or gastric) and/or PHG. Results: 38 males and 24 females with their mean age (46 ± 12 years old) were included. Plasma Von Willebrand factor-Ag level was significantly higher in patients with OVs than those without varices (P value = 0.000). Also, its level was significantly higher in patients with higher grade of OVs, G3 than those with G1 or G2 (P value = 0.000). Patients with large OVs including those with G2 and G3 showed significantly higher values of VWF than those with small OVs (NO and G1) (P value = 0.000). VWF was independent predictor for detecting the presence of OVs with good sensitivity (90), specificity (77.3) and accuracy (85.5) at a cutoff value of 1.74 U/ml. Also it was an independent predictor for detecting the presence of large OVs with good sensitivity (91.2), specificity (85.7) and accuracy (88.7) at a cutoff value of 2.16 U/ml. Conclusion: VWF-Ag could be used as a non invasive laboratory independent predictor for the detection of OVs.
文摘BACKGROUND Pancreatic cystic lesions(PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions.AIM To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen(CA)19-9, CA72-4], carcinoembryonic antigen(CEA), serine protease inhibitor Kazal-type 1(SPINK1), interleukin 1 beta(IL1-β), vascular endothelial growth factor A(VEGF-A), and prostaglandin E2(PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound(EUS) and EUS-fine needle aspiration(EUS-FNA) for characterization and sampling of different PCLs.RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance(59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively(P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance(P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions.CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.
文摘BACKGROUND The current coronavirus disease 2019(COVID-19)pandemic has affected routine endoscopy service across the gastroenterology community.This led to the suspension of service provision for elective cases.AIM To assess the potential barriers for resuming the endoscopy service in Egypt.METHODS A national online survey,four domains,was disseminated over a period of 4 wk in August 2020.The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the survey.The waiting list was increased by≥50% in 44.9% of areas with clusters of COVID-19 cases(n=49)and in 35.5% of areas with sporadic cases(n=62).Thirty nine(34.8%)centers suffered from staff shortage,which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis.In multivariate analysis,the burden of cases in the unit locality,staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice(P=0.029,<0.001 and 0.02,respectively)and Odd’s ratio(0.15,1.8 and 0.16,respectively).CONCLUSION The COVID-19 pandemic has led to restrictions in endoscopic volumes.The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery.Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.
文摘<span style="font-family:Verdana;">Gender difference in chronic hepatitis C (CHC) infection is not previously well studied. We aimed to analyze the effect of gender difference on the risk factors of CHC, disease progression, and outcome after oral direct acting antiviral (DAA) therapy. The study</span><span style="font-family:Verdana;"> was</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> conducted at Tropical Medicine and Gastroenterology Department, Sohag University, Egypt, in the period between 2018 and 2020. 775 patients were evaluated for hepatitis C virus (HCV) risk factors. Laboratory investigations, abdominal ultrasound and liver Shear </span><span style="font-family:Verdana;">wave elastography (SWE) were done. The patients were given antiviral therap</span><span style="font-family:Verdana;">y and followed up to assess the response and side effects of DAA therapy. 434</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">(56%) of study patients were males and 341</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">(44%) were females. Catching infection from blood transfusion and intravenous (IV) injection of </span><span style="font-family:Verdana;">tarter emetic w</span></span><span style="font-family:Verdana;">as</span><span style="font-family:Verdana;"> significantly higher in males, while catching infection from surgical operation was significantly higher in females. Hepatic fibrosis was significantly more extensive in males. Side effects were reported more in females. Sustained virological response (SVR)</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">12 was reported in 98.6%. Females had a slightly better SVR12 than males (99.4% versus 97.9%). In conclusion males were different from females in exposure to HCV risk factors. After introduction of blood screening and stoppage of </span><span style="font-family:Verdana;">parenteral anti-bilharzial therapy the risk of HCV infection could be greatly prevented in males, while the exposure of females to obstetric procedure is increasing nowadays which hide</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> a risk of ongoing infection in females. So, HCV surveillance programs in females retain </span><span style="font-family:Verdana;">their </span><span style="font-family:Verdana;">importance in early detection and management of CHC. Although hepatic fibrosis</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">progression was more in males, females were more liable to adverse events of DAA therapy. So, researchers should consider the gender of their patients in drug design and administration.</span>
基金Supported by Fund from Minya University, Minya, Egypt
文摘AIM:To determine the prevalence and possible risk factors of Barrett's esophagus(BE) in patients with chronic gastroesophageal reflux disease(GERD) in El Minya and Assuit, Upper Egypt.METHODS:One thousand consecutive patients with chronic GERD symptoms were included in the study over 2 years.They were subjected to history taking including a questionnaire for GERD symptoms, clinical examination and upper digestive tract endoscopy.Endoscopic signs suggestive of columnar-lined esophagus(CLE) were defined as mucosal tongues or an upward shift of the squamocolumnar junction.BE was diagnosed by pathological examination when specialized intestinal metaplasia was detected histologically in suspected CLE.pH was monitored in 40 patients.RESULTS:BE was present in 7.3% of patients with chronic GERD symptoms, with a mean age of 48.3 ± 8.2 years, which was signif icantly higher than patients with GERD without BE(37.4 ± 13.6 years).Adenocarcinomawas detected in eight cases(0.8%), six of them in BE patients.There was no signiflcant difference between patients with BE and GERD regarding sex, smoking, alcohol consumption or symptoms of GERD.Patients with BE had significantly longer esophageal acid exposure time in the supine position, measured by pH monitoring.CONCLUSION:The prevalence of BE in patients with GERD who were referred for endoscopy was 7.3%.BE seems to be associated with older age and more in patients with nocturnal gastroesophageal reflux.
文摘Since its advent in 1980,the scope of endoscopic ultrasound(EUS)has grown to include a wide range of indications,and it is now being incorporated as an integral part of everyday practice in the field of gastroenterology.Its use is extending from an adjuvant imaging aid to utilization as a therapeutic tool for various gastrointestinal disorders.EUS was first used to visualize remote organs,such as the pancreas and abdominal lymph nodes.When fine needle aspiration was introduced,the indications for EUS expanded to include tissue sampling for diagnostic purposes.At the same time,the needle can be used to convey a potential therapy to the internal organs,allowing access to remote sites.In this review,we aim to highlight the expanding spectrum of EUS indications and uses in the field of gastroenterology.
基金Supported by A Grant–in-Aid for Comprehensive Research from the Ministry of Education, Culture, Sports Science and Technology of Japan
文摘AIM: To investigate and clarify, for the first time, the role of inosine triphosphate pyrophosphatase (ITPA ) polymorphism in Egyptian chronic hepatitis C virus (HCV) patients.METHODS:The human genomic DNA of all patients was extracted from peripheral blood cells in order to determine the single nucleotide polymorphism (SNP) of ITPA (rs1127354). SNP genotyping was performed by real time polymerase chain reaction (PCR, ABI TaqMan allelic discrimination kit) for 102 treatment-naive Egyptian patients with chronic HCV. All patients had no evidence of cardiovascular or renal diseases. They received a combination treatment of pegylated interferon α (PEG-IFNα) as a weekly subcutaneous dose plus an oral weight-adjusted dose of ribavirin (RBV). The majority received PEG-IFNα2a (70.6%) while 29.4% received PEG-IFNα2b. The planned duration of treatment was 24-48 wk according to the viral kinetics throughout the course of treatment. Pre-treatment liver biopsy was done for each patient for evaluation of fibrosis stage and liver disease activity. The basal viral load level was detected quantitatively by real time PCR while viral load throughout the treatment course was performed qualitatively by COBAS TaqMan assay. RESULTS: Ninety-three patients (91.2%) had ITPA SNP CC genotype and 9 (8.8%) had non-CC genotype (CA and AA). The percentage of hemoglobin (Hb) decline was higher for CC patients than for non-CC patients, particularly at weeks 4 and 8 (P=0.047 and 0.034, respectively). During the first 12 wk of treatment, CC patients had significantly more Hb decline > 3 g/dL than non-CC patients: 64.5% vs 22.2% at weeks 8 and 12, respectively, (P=0.024 and 0.038). Reduction of the amount of the planned RBV dose was significantly higher for CC patients than non-CC patients during the first 12 wk (18% ± 12.1% vs 8.5% ± 10.2%, P=0.021). The percentage of CC patients with RBV dose reduction was significantly greater than that of non-CC patients (77.4% vs 44.4%, P=0.044). Multivariate analysis identified only the percentage of RBV dose as a predictor for Hb decline. Platelet decline was significantly higher in non-CC patients than CC patients at weeks 12, 24 and 48 (P=0.018, 0.009 and 0.026, respectively). CONCLUSION: Rs1127354 ITPA polymorphism plays a decisive role in protecting against treatment-induced anemia and the need for RBV dose reduction in Egyptian HCV patients.
文摘AIM:To address the diagnostic value of the regular arrangement of collecting venules(RAC)among old age patients. METHODS:A total of 390 consecutive patients whose Helicobacter pylori(H.pylori)status was known and who received upper gastrointestinal endoscopy,were retrospectively studied for the presence or absence of RAC as well as gastric mucosal atrophy.The sensitivity, specificity,positive predictive value,negative predic-tive value and accuracy of RAC to detect normal gastric mucosa were assessed and were compared among two different age groups of patients. RESULTS:The mean age±standard deviation(SD)of included patients(n=390),was 62.9±13 years.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of RAC to detect normal gastric mucosa were 91.7%,66.1%,18.8%,99%and 68.1%respectively.Although the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of RAC among patients<60 years(n= 139)was 94.7%,71.2%,46.2%,98.1%and 76.1%,respectively,it was 80%,64.3%,5.1%,93%and 64.6%, respectively,among patients≥60 years(n=251). Younger Patients(<60 years),have highly significant rates of RAC sensitivity,positive predictive value,and accuracy(P≤0.001,≤0.001 and≤0.02,respectively).Older patients had highly significant rates of H. pylori infection and gastric mucosal atrophy(P≤0.01). CONCLUSION:Although RAC is a valuable sign for real-time identification of normal gastric mucosa,its accuracy seems to be affected by the patient's age.
文摘Background: Bacterial infection in cirrhotic patients is a fatal complication. The high incidence of bacterial infections in those patients may be related to several alterations in the defensive mechanisms against infections and increased intestinal permeability with bacterial translocation. Aim: To evaluate the role of portal hypertension (PH) in predicting the occurrence of bacterial infections in decompensated cirrhosis. Patients and Methods: In this retrospective cohort study, 99 patients—56 males and 43 females, with decompensated liver cirrhosis were included. Diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic examinations. Patients were classified according to the presence of bacterial infection into patients with infection—Group 1, and those without infection—Group 2. Laboratory, abdominal US and upper endoscopic data for all patients were collected. Logistic regression analysis was done to detect the independent factors for prediction of bacterial infection. Results: The mean age of patients was 50.5 ± 14.2 years. Bacterial infection was found in 41 patients (41.4%) and no infection in 58 patients (58.6%). Infected patients showed statistically significant higher values in the level of bilirubin, PT and Child-Pugh score (P value = 0.000) and lower values in the level of albumin, total serum protein and PC than those without infection (P value = 0.006, 0.000 and 0.000 respectively). Portal vein diameter (PVD) and splenic diameter (SD) showed statistically significant higher values in infected patients than in those without infection (P value = 0.028 and 0.000 respectively), also infection was more significantly prevalent in patients with varices than those without varices (P value = 0.000). The independent predictors for bacterial infection were: the age, total serum bilirubin, serum albumin, PT, PC, child score, PVD, SD and the presence of varices. Conclusion: Presence of varices (as a complication of PH) is an independent risk factor for the development of bacterial infection in decompensated cirrhotic patients and reduction of PH by any way could decrease this fatal complication.
文摘BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.
文摘Background and Aim: Early diagnosis of hepatocellular carcinoma (HCC) is essential for achieving good prognosis. Glypican 3 (GPC3) has been reported to be raised in HCC in comparison with non-neoplastic lesions. This work aimed to study the role of GPC3 in the early diagnosis of HCC in post-chronic hepatitis C (CHC) cirrhotic patients. Patients and Methods: A comparative study included 60 patients, 40 patients with HCC (HCC group) and 20 patients of CHC without HCC (control group). Diagnosis of HCC was based on abdominal ultrasound and triphasic CT, while biopsy was performed in debating cases. Serum samples for measurement of GPC3 and AFP levels were obtained from all participants. Results: The median levels of both AFP and GPC3 were significantly higher among HCC cases compared to controls. Analysis of the ROC curve showed that both AFP and GPC3 could be used to differentiate HCC cases from controls. AUROCs of GPC3 and AFP were 0.928 and 0.727 respectively, and both were statistically significant with p-values Conclusion: Serum GLP-3 is highly sensitive and specific for detecting HCC, more than AFP for the early detection of HCC, and the combination of both yielded improved sensitivity.
文摘BACKGROUND Insufficient and contradictory data are available about the relation between directacting antivirals(DAAs)and hepatocellular carcinoma(HCC)development in patients with hepatitis C virus(HCV).AIM To analyze differences in basic clinical,radiological,and laboratory characteristics in addition to tumor behavior upon HCC diagnosis between patients with and without a previous history of DAAs exposure.METHODS This multicenter case-control study included 497 patients with chronic HCVrelated HCC,allocated into one of two groups according to their history of antiviral treatment for their HCV.RESULTS Group I included 151 HCC patients with a history of DAAs,while 346 patients who had never been treated with DAAs were assigned to group II.A significant difference was observed between both groups regarding basic assessment scores(Child,MELD,and BCLC),which tended to have more advanced liver disease and HCC stage upon diagnosis in group I.However,serum albumin was significantly affected,and serumα-fetoprotein was significantly higher in group II(P<0.001).In addition,group I showed significant HCC multicentricity than group II,while the incidence of portal vein thrombosis was significantly higher in group I(P<0.001).CONCLUSION The basic clinical scores and laboratory characteristics of HCC patients are advanced in patients who are naïve to DAAs treatment;however,HCC behavior is more aggressive in DAA-treated patients.
文摘Background/Purpose: Early assessment of the severity of acute pancreatitis (AP) is a highly challenge for a physicians’ practice to improve the management and decrease the mortality. We aimed to determine early prognostic factors for AP related in-hospital mortality. Methods: Upon hospital admission, predictors of AP related in-hospital mortality were prospectively assessed using regression analysis over 129 consecutive AP patients. Predictive abilities of these prognostic factors were compared using the area under receiver operating characteristic curve (AUC). Results: AP related in-hospital mortality was 10.9%. Red cell distribution (RDW), serum creatinine, glucose and albumin were associated with AP mortality. RDW had the highest AUC followed by serum creatinine and albumin (AUC: 914, 95% CI: 0.797 - 0.975;0.797, 95% CI: 0.695 - 0.878;0.798, 95% CI: 0.677 - 0.865 respectively). The cut-off with the best ability to predict in-hospital mortality was 14.2 for RDW. By coupling RDW and serum creatinine, AUC was improved to 0.940, 95% CI: 0.839 - 0.986. Conclusion: RDW, serum creatinine, albumin, and glucose even with borderline level changes may predict AP related in-hospital mortality, where, RDW has the highest prognostic accuracy. Coupling RDW and serum creatinine model significantly improves their predictive accuracy that may aid in further improvement of the quality of care of AP patients.
文摘BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques(ERTs).However,there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.AIM To investigate the knowledge,attitude,and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’infrastructures toward these techniques.METHODS An online 2-pages questionnaire was used.The first page comprised demographic data,and questions for all physicians,about the knowledge(11 questions)of and attitude(5 questions)toward ERTs as a therapeutic option for SBN.The second page investigated the practice of ERTs by endoscopists(6 questions)and the infrastructures of their endoscopy units(14 questions).The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.RESULTS The complete responses were 833/2300(36.2%).The majority of the participants were males(n=560,67.2%),middle-aged(n=366,43.9%),consultants(n=464,55.7%),gastroenterologists(n=678,81.4%),spending≥15 years in practice(n=368,44.2%),and were working in university hospitals(n=569,68.3%).The majority correctly identified the definition of SBN(88.4%)and the terms polypectomy,endoscopic mucosal resection(EMR),and endoscopic submucosal dissection(ESD)(92.1%,90.2%,and 89.1%respectively).However,26.9%,43.2%and 49.5%did not recognize the clear indication of polypectomy,EMR,and ESD respectively.Although 68.1%of physicians are convinced about the ERTs for management of SBN;only 8.9%referred all candidate cases for ERTs.About 76.5%of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9%and 7.2%respectively.About 71.6%and 88.4%of endoscopists did not perform EMR or ESD in the last one year.Consequently,the complication rate reported by endoscopists was limited to 18.1%(n=103)of endoscopists.Only 25.8%of endoscopists feel confident in the management of ERTs-related complications and a half(49.9%)were not sure about their competency.Regarding the end-oscopy units’infrastructures,only 4.2%of the centers had their endoscopes 100%armed with optical enhancements and 54.4%considered their institutions ready for managing ERTs-related complications.Only 18.3%(n=104)of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding(26.7%),and perforations(17%).CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs.The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
文摘Introduction: Hepatitis C virus (HCV) genotype 4 is the most prevalent in Egypt. Vis-ceral adiposity index (VAI) and (TyG) index are newly developed indices for assess-ment of metabolic syndrome (MS) and insulin resistance (IR). We aimed at comparing their levels in HCV-patients with healthy controls and validate their use for prediction of hepatic histopathological changes. Patient and Methods: 78 chronic HCV-infected patients proven by PCR, viral genotyping and hepatic histopathology, and 67 healthy controls were enrolled. Presence of MS, Homeostasis Model Assessment for IR esti-mation (HOMA-IR), TyG index, and VAI were assessed. Results: HOMA-IR, TyG and frequency of MS were significantly higher in patients’ group (p p p = 0.002). Conclusion: HCV genotype 4 is significantly associated with MS and increased values of HOMA IR and TyG index. TyG index and VAI are valuable simple indices that could predict the histopathological changes in Egyptian CHC pa-tients.
文摘The emerging evidence of the potentially clinical importance of occult hepatitis B virus(HBV) infection(OBI) increases the interest in this topic. OBI may impact in several clinical contexts, which include the possible transmission of the infection, the contribution to liver disease progression, the development of hepatocellular carcinoma, and the risk of reactivation. There are several articles that have published on OBI in Egyptian populations. A review of MEDLINE database was undertaken for relevant articles to clarify the epidemiology of OBI in Egypt. HBV genotype D is the only detectable genotype among Egyptian OBI patients. Higher rates of OBI reported among Egyptian chronic HCV, hemodialysis, children with malignant disorders, and cryptogenic liver disease patients. There is an evidence of OBI reactivation after treatment with chemotherapy. The available data suggested that screening for OBI must be a routine practice in these groups of patients. Further studies needed for better understand of the epidemiology of OBI among Egyptian young generations after the era of hepatitis B vaccination.
文摘AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts:(1) personal information regarding the physician(name, age, specialty and type of health care setting); and(2) professional experience in the care of patients at risk for HCC development(screening, knowledge about the cause and natural course of liver diseases and HCC risk). RESULTS: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus(HCV) genotype as risk factor for HCC development(P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis(P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health(MOH) doctors consider HCV infection as the leading cause of HCC in Egypt(P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening(P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo(P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.CONCLUSION: In Egypt, physicians specialized in tropical medicine, internal medicine or gastroenterology with an MD degree and working in a University Hospital are best informed about HCC.
文摘BACKGROUND The incidence of colorectal cancer(CRC)is increasing among young individuals in the Arab world as well as in other regions of the world.AIM To explore the incidence and prevalence of CRC in the Arab world.METHODS The PubMed,Scopus,Web of Science,EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year.The search terms were("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal")AND("cancer OR malignancy OR malignant OR neoplasm")AND("Jordan"OR"United Arab Emirates"OR"Bahrain"OR"Tunisia"OR"Algeria"OR"Djibouti"OR"Saudi Arabia"OR"Sudan"OR"Syria"OR"Somalia"OR"Iraq"OR"Oman"OR"Palestine"OR"Qatar"OR"Comoros"OR"Kuwait"OR"Lebanon"OR"Libya"OR"Egypt"OR"Morocco"OR"Mauritania"OR"Yemen").Reviews,metaanalyses,and articles containing nonoriginal data were excluded.Retrieved articles were screened,and relevant data were extracted.Descriptive statistics were used for data analysis.RESULTS Nine studies were included.Five of the studies provided information regarding the prevalence of CRC.The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate,while in Egypt,it ranged from 0.4% to 14%.Four studies showed information regarding the incidence.The annual incidence rate of CRC in Qatar was 7.5/100000/year.In Egypt,the crude incidence rate(CIR)in males was 3.1 for colon cancer and 1 for rectal cancer,while in females,it was 2.3 for colon cancer and 0.8 for rectal cancer.The age-standardized rate for CRC incidence in 2003 was 36.90 for males,26.50 for females,and 30.49 for both sexes in Saudi Arabia.In 2016,the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer,respectively,while in males,it was 3.3 and 2.8 for colon cancer and rectal cancer,respectively.One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old.CONCLUSION There is a considerable prevalence of CRC in some Arab countries.More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.
文摘Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, stent placement, and surgery. The aims of the study: This is a retrospective study to assess the success rate of different treatment modalities for post-corrosive esophageal stricture including: endoscopic dilatation, stenting or surgery and to define any complications. Methods: Clinical and endoscopic data for patients with post-corrosive esophageal stricture admitted to the endoscopy unit between September 2012 and September 2017 were collected. Retrospective analysis of data was done to detect the types of treatment, success rate and any detectable complications. Results: A total of 50 patients with their ages ranged between 3 and 20 years were included in this study. Male patients represented 54% (27 patients) and females were 23 (46%). The cause of caustic material ingestion was mainly accidental (47 patients, 94%) and only 3 patients were suicidal (6%). Dilatation was successful in most cases either with or without injection of corticosteroids (39 patients, 78%). Stenting was a good option in cases of refractory or recurrent dilatations (11 patients;22%) with excellent results. Surgery rarely needed (only in one patient) and only when dilatation and stenting failed. Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good result and low rate of complications. The covered self-expandable metal stent (SEMS) is a good option in cases of refractory strictures, surgery rarely needed and after failure of previous modalities.
文摘Background/purpose: Noninvasive assessment of esophageal varices (EVs), their size and bleeding stigmata may reduce endoscopic burden, cost and drawbacks. We aimed to evaluate the diagnostic performance of noninvasive fibrosis scores (AAR, APRI, FIB-4, King and VITRO scores) in predicting the presence of EVs and high risk varices needing treatment (VNT) in HCV-related cirrhosis of Egyptian patients. Methods: This prospective study included 154 HCV-related advanced compensated cirrhotic patients with no history of bleeding who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and VITRO scores were assessed. Results: Esophageal varices were found in 120 patients (77.9%) and VNT in 92 patients (59.7%). Apart from AAR, all scores demonstrated statistically significant correlations with the presence and the size of EVs. Using area under receiver operating characteristic curve (AUC), these scores were good predictors for the presence of EVs and VNT, where VITRO score had the highest AUC (0.920 and 0.900) and accuracy (97.1% and 87%), sensitivity (75, 82.6%), specificity (100, 93.5%), PPV (100, 95%) and NPV (53.2, 78.4%) with cutoffs >1.3 and >1.8 respectively. Conclusion: Noninvasive fibrosis scores can predict the presence of EVs and VNT. VITRO score was the best predictor with higher accuracy for clinical applicability than studied scores.
