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Treatment Modalities for Post Corrosive Esophageal Strictures: 5 Years Experience

Open Journal of Gastroenterology 2018年第11期8卷 394-404页

作者： Mohamed Abdelshafy Mohamed hasan sedeek mahmoud Mohammed Tag-Adeen Department of General Surgery Faculty of Medicine South Valley University Qena Egypt Department of Tropical Medicine and Gastroenterology Faculty of Medicine South Valley University Qena Egypt Department of Internal Medicine Faculty of Medicine South Valley University Qena Egypt

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.

关键词： Post-Corrosive Esophageal Stricture Caustic Ingestion Endoscopic Treatment

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Role of Portal Hypertension in Prediction of Bacterial Infection in Decompensated Cirrhosis

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Open Journal of Gastroenterology 2014年第3期4卷 97-104页

作者： hasan sedeek mahmoud Shamardan Ezz El-Din S. Bazeed Department of Tropical Medicine and Gastroenterology Qena Faculty of Medicine South Valley University Qena Egypt

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 r

关键词： Portal Hypertension Bacterial Infection Liver Cirrhosis

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Rapid Urease Test and Faecal Antigen Detection for Rapid Diagnosis of Helicobacter pylori Infection in Dyspepsia

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Open Journal of Gastroenterology 2016年第1期6卷 5-10页

作者： hasan sedeek mahmoud Hanan M. Fayed Ghada S. Osman Tropical Medicine and Gastroenterology Department Qena Faculty of Medicine South Valley University Qena Egypt Department of Clinical Pathology Qena Faculty of Medicine South Valley University Qena Egypt Department of Pathology Qena Faculty of Medicine South Valley University Qena Egypt

Background: Helicobacter pylori (H. pylori) is considered as one of the most prevalent gastric infections which cause chronic gastritis and predispose to cancer stomach. So, diagnosis and eradication should be rapid to decrease the risk of gastric cancer. Aim of the study: To evaluate the role of rapid urease test (RUT) and faecal antigen test (FAT) added to serological test for rapid diagnosis of active H. pylori infection. Patients and methods: 270 patients with dyspepsia and positive serology for H. pylori infection were included. Two antral and two corporal gastric biopsies were taken for RUT and Histopathological examination. Fresh stool samples were obtained from all patients for FAT. Results: The mean age of the studied patients was 45 ± 25. H. pylori infection was found in 256 (94.8%) of the included patients: 236 (92.18%) with positive all tests, 5 (1.95%) with positive both RUT and FAT, 8 (3.12%) with positive both histology and RUT and 7 (2.73%) with positive histology and FAT. The sensitivity, specificity and positive predictive values for RUT were as follows: 97.27%, 85.71% and 99.20% respectively and 96.88%, 85.71% and 99.20% respectively for FAT. Conclusions: RUT or FAT in patients with positive serological test could be used for rapid diagnosis of active H. pylori infection with good sensitivity and specificity without waiting for the results of histology or culture.

关键词： Rapid Urease Test Faecal Antigen Test Helicobacter Pylori

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Evaluation of CD64 Index in HBV and in Chronic HCV Infections

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Open Journal of Gastroenterology 2017年第6期7卷 173-186页

作者： hasan sedeek mahmoud Sanaa Shaker Aly Heba Ahmed Osman Asmaa Mohamed Zahran Muhammad Abbas El Masry Tropical Medicine and Gastroenterology Department Qena Faculty of Medicine South Valley University Qena Egypt Clinical and Chemical Pathology Department Qena Faculty of Medicine South Valley University Qena Egypt Oncological Clinical Pathology Department South Egypt Cancer Institute Assiut University Assiut Egypt Internal Medicine Department Division of Gastroenterology Assiut Faculty of Medicine Assiut Egypt

Background and aims: CD64 [Fc gamma receptor 1 (FcγRI)] is a promising biomarker used in predicting severe bacterial infection. The study was designed to assess their level in all stages of HBV infection and in chronic HCV infection before and after treatment with direct acting antiviral therapy as a possible biomarker of inflammation. Patients and methods: A case-control study was conducted, 50 patients with different disease stages of HBV infection (10 acute, 15 chronic hepatitis, 15 liver cirrhosis (LC) and 10 with hepatocellular carcinoma (HCC)), twenty patients with chronic HCV and 15 as a control group. Laboratory and imaging studies were evaluated. The levels of CD64 expressions in peripheral blood and CD64 Index were measured for all patients by flowcytometry using fluorescein isothiocyanate (FITC)-conjugated anti-CD64 monoclonal antibody. Results: The levels of CD64 expressions in peripheral blood and CD64 index were significantly higher in patients with HBV and HCV than in control group (P value = 0.01, 0.01 and 0.000, 0.000 respectively). They were increased significantly with disease progression in patients with HBV infection, acute hepatitis B infection showed the highest values. Their levels were significantly decreased in patients with HCV infection post treatment than before treatment. Conclusions: The levels of CD64 expressions in peripheral blood and CD64 index are considered good biomarkers of inflammation in viral hepatitis both B and C and could detect disease progression and also suppression of inflammation after antiviral therapy.

关键词： CD64 HBV HCV

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Reliability of Plasma Von Willebrand Factor Antigen in Prediction of Esophageal Varices in Patients with Liver Cirrhosis

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Open Journal of Gastroenterology 2015年第6期5卷 49-57页

作者： hasan sedeek mahmoud Ali A. Ghweil Shamardan E. Bazeed Hanan M. Fayed Mona M. Abdel Meguid Department of Tropical Medicine and Gastroenterology Faculty of Medicine South Valley University Qena Egypt Department of Clinical Pathology Faculty of Medicine South Valley University Qena Egypt

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.

关键词： Von Willebrand Factor Antigen Esophageal Varices Prediction

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