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Unraveling the Impact of Direct-Acting Antivirals on Hepatitis-Linked Cirrhosis: A Comprehensive Analysis of Fibrosis, Child Score, and Disease Progression

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Open Journal of Gastroenterology 2024年第6期14卷 203-212页

作者： Hajar Cherkaoui Maryam elkhayari Maria Lahlali Asmae Lamine Nada Lahmidani Amine Mekkaoui Mounia elyousfi Dafr Allah Benajah mohammed el abkari Adil Ibrahimi Hakima Abid Department of Hepato-Gastroenterology Hassan II University Hospital Fez Morocco Faculty of Medicine and Pharmacy of Fez USMBA Fez Morocco

The treatment of hepatitis C has undergone a significant boom since the advent of direct acting antivirals (DAA). Indeed, the interferon-ribavirin combination that has been used to treat hepatitis C has a virological response in only 45% of cases with significant side effects. The advent of direct-acting antivirals has changed the prognosis of cirrhotic patients with hepatitis C. DAAs have ensured a sustained viral response in the majority of patients. Our work aims to see the evolution of hepatitis C patients at the cirrhosis stage under DAA. We conducted a retrospective study over 15 years (January 2009, January 2024) including all patients with post-viral cirrhosis C, whom we divided into two groups: group A, cirrhotic patients who received ribavirin and interferon, and group B, patients on DAA. From January 2009 to January 2024, we conducted a study of 182 patients with viral hepatitis C, including 102 cirrhotic patients. The mean age was 55 years. 66% of patients were initially treated with the ribavirin interferon combination, while 34% received direct-acting antivirals (DAAs). Since the introduction of DAAs, the most commonly used regimens have been sofosbuvir/daclatasvir with or without ribavirin and sofosbuvir/ledipasvir with or without ribavirin. Group A achieved sustained virological response (SVR) in 60% of cases, with notable side effects. In Group B, SVR was 98.18%, with improved tolerability and fewer side effects than previous treatments. Fifteen patients developed hepatocellular carcinoma (HCC), with a significantly lower mortality rate in those treated with DAAs compared with pegylated dual therapy (p: 0.001).

关键词： Post-Viral Cirrhosis C Pegylated Interferon Direct Acting Antivirals Sustained Viral Response Child Score Fibrosis

The Impact of Gastroesophageal Reflux on the Quality of Life: About a Series of 100 Patients at Fez University Hospital

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Open Journal of Gastroenterology 2019年第6期9卷 99-108页

作者： Houda Meyiz mohammed el Agheb Asmae Lamine Mounia el Yousfi Nordin Aqodad Dafr Benajeh mohammed el abkari Adil Ibrahimi Ihsane Mellouki Hepato-Gastroenterology Department Hassan II University Medical Center Fez Morocco Faculty of Medicine Sidi Mohammed Ben Abdellah University Fez Morocco

The gastroesophageal reflux disease (GERD) represents a major problem for public health because of its high prevalence. The chronic character of the symptoms can have a very important impact on the quality of life (QoL). The purpose of this study is to assess the impact of the GERD on the quality of life of our patients and to determine the main aggravating factors. Patients and Methods: This is a cross-sectional, observational study of 100 patients presenting signs of GERD in the gastroenterology department of the university medical center Hassan II-Fez, for a period of 3 months (October to December 2014). We used the Reflux-Qual short form (RQS®) to evaluate the QoL of our patients. Results: Over the study period, 100 patients were included. The average age of our patients was 47 years [20 - 75 years] with a sex-ratio F/M in 2.12. Among our patients, 20% (n = 20) were chronic cigarette smokers. The diagnosis of GERD was clinical in 75% of the cases (n = 75) and based on 24-hour pH monitoring in the remaining 25% (n = 25). Approximately 2/3 of the patients were receiving proton pump inhibitors (PPIs) treatment at the time of the questionnaire. The impairment of QoL was moderated to severe (RQS® p = 0.01), female sex (p = 0.03) and the frequency of symptoms (p = 0.001). Moreover, patients having a GERD that requiring a daily and continuous administration of PPIs had a lower index of RQS® (p = 0.001). The quality of life impairment was not associated with chronic cigarette smoking (p = 0.3). Conclusion: The impairment of the QoL was moderated to severe (RQS® elderly, female sex, frequency and in case of GERD requiring continuous administration of PPIs.

关键词： Gastroesophageal Reflux Reflux-Qual Short Form Quality of Life

What Impact Does COVID-19 Have in Cirrhotics?

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Open Journal of Gastroenterology 2021年第1期11卷 16-27页

作者： Hakima Abid Hajar Cherkaoui Maria Lahlali Nada Lahmidani mohammed el abkari Sidi Adil Ibrahimi Department of Hepato-gastroenterology Hassan II University Hospital Fez Morocco Faculty of Medicine and Pharmacy of Fez University of Sidi Mohammed Ben Abdellah Fez Morocco

SARS-Cov-2 is a novel coronavirus discovered in Wuhan, China in late 2019 and responsible for respiratory distress. Aim: study the impact of COVID-19 among patients with cirrhosis. Patients and methods: We conducted a prospective study for a period of 9 months (April 1st-December 1st) that included cirrhotic patients infected with SARS-Cov-2 followed in the gastroenterology department in the University Hospital Hassan II. Results: Among 1437 patients hospitalised for SARS-Cov-2, 8 cirrhotic patients were included in a period of 9 months (April 1st-December 1st). The mean age is 55 y/o and most are female (n = 6). The aetiology of cirrhosis is mostly HCV (n = 3), HBV (n = 2). Half of the infected patients had acute bleeding (one of them had hepatic encephalopathy) and one patient had respiratory distress. Most of the patients had a negative PCR at the end of the hospital stay (n = 5). The mortality rate was 25% and patients were followed up for a period of 4 months. Conclusion: In the studied population, clinical manifestations were essentially a decompensation of cirrhosis.

关键词： SARS-Cov-2 Cirrhosis Decompensation Severity

Aortodigestive Fistula: A Rare Cause of Digestive Bleeding

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Case Reports in Clinical Medicine 2021年第4期10卷 126-132页

作者： Nada Lahmidani Mouna Figuigui Hakima Abid Mounia el Yousfi mohammed el abkari Sidi Adil Ibrahimi Dafr Allah Benajah Department of Gastroenterology University Hospital Hassan II Sidi Mohammed Ben Abdallah University Fez Morocco

Backgound: Aorto-digestive fistulas remain a fatal disease entity often occurring after vascular surgeries. Eso-gastro-duodenal endoscopy is essential to explore the upper digestive bleeding. The negativity of morphological examinations should not exclude the diagnosis. Diagnosis has benefited in recent years from developments in cross-sectional imaging: computed tomography (CT) and magnetic resonance imaging (MRI). The severity of bleeding is linked to the vital consequences (mortality close to 50% up to 100% in the absence of treatment), functional (30% amputation), and to the underlying infection itself correlated with the attack of the stent and the anastomosis. Patients: We report three cases of aorto-digestive fistulas treated at The University Hospital Hassan II to show the challenging diagnosis and therapeutic of such rare causes of upper digestive bleeding. Results: three patients were admitted to the emergency endoscopy unit for upper digestive bleeding, 2 of them had a medical history of Behcet Disease and two had past aortic aneurism surgery. The couple’s upper endoscopy and CT scan angiography made the diagnosis. Unfortunately, 2 patients died from fatal bleeding. Conclusion: Aortodigestive fistula is an extremely serious complication of aortic aneurisms and a rare cause of gastrointestinal bleeding. This diagnosis should be considered in any patient presenting with digestive bleeding with vascular disease or previous history of vascular stent.

关键词： Aorto Digestive Fistula Bleeding Endoscopy Primary

What Is the Role of Endoscopic Retrograde Cholangio-Pancreato-Grahy in the Management of Hepatic Hydatid Disease Complications?

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Open Journal of Gastroenterology 2020年第5期10卷 107-117页

作者： Hakima Abid Ghita Ousseur Nada Lahmidani Mounia el Yousfi Noureddin Aqodad mohammed el abkari Adil Ibrahimi Dafr Allah Benajah Department of Hepato-Gastro-Enterology University Hospital Hassan II Fez Morocco Faculty of Medicine Sidi Mohamed Ben Abdellah University Fez Morocco

Liver hydatid cyst is a parasitic disease that is endemic in Morocco. Its gravity is essentially due to its complications, such as Intrabiliary rupture. The aim of our study was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the management of intrabiliary rupture of hydatid disease of the liver. Materials and Methods: This is a retrospective study in the department of Gastroenterology in the University Hospital Hassan II of Fez over a period of 12 years from March 2005 to October 2017. All patients admitted for hepatic hydatid disease and who received ERCP were included. We analyzed the success rate of catheterization of the common bile duct (CBD), the successful clearance of the bile duct and the complications. Results: 2860 patients had received therapeutic ERCP, 151 patients (5.3%) had hepatic hydatid disease, 112 of which had intrabiliary disruption of hepatic hydatid and 39 patients were admitted for sphincteromy for reversal of the flow after surgery of hydatid cyst. The average age of our patients was 41 years old [12 - 85]. The sex ratio F/H = was 1.12. 74% (N = 112) patients were admitted to a table cholangitis and 26% of cases were operated for KHF fistulized in the bile ducts with persistence of a large biliary flow in post-operative (39 cases). The success of initial catheterization of the commun bile duct was achieved for 138 patients (91%) or obtained secondarily after precut for 13 patients. The evacuation of hydatid membranes was carried out in 51% of them (N = 78);twenty two (14.5%) patients had one or more calculations with or without hydatid membranes. A case of gastrointestinal bleeding post ERCP was observed. All the patients followed evolved well in the long term except for two patients who presented in few months after the first ERCP severe cholangitis which required the use of a second ERCP with successful evacuation of membranes. Conclusion: In our study, endoscopic management of hydatid cyst remains a dominant position, with

关键词： Hydatid Cyst Intrabiliary Rupture Complications Endoscopic Retrograde Cholangiopancreatography Endoscopic Sphincterotomy

Peripheral Neuropathy under Infliximab Therapy: About One Case

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Open Journal of Gastroenterology 2020年第9期10卷 242-246页

作者： Fatima-Zahra Hamdoun Hakima Abid Nada Lahmidani Mounia el Yousfi Dafr-Allah Benajah mohammed el abkari Adil Ibrahimi Department of Hepato-Gastroenterology Hassan II University Hospital of Fez Faculty of Medicine University Sidi Mohammed Ben Abdelalh Fez Morocco

A-TNF inhibitors are increasingly used in various inflammatory disorders. Multiple side effects have been reported in recent years, particularly peripheral neuropathies. We report a case of axonal neuropathy occurring after the start of treatment with Infliximab. This is a 47 years old patient, followed for Crohn’s disease requiring treatment with Infliximab. Twenty-two weeks later, the patient presented a grade 4 of axonal neuropathy. We concluded to a medicinal sensitive neuropathy after elimination of other etiologies. Given the severity of the neurological symptoms, we decided to change the therapeutic class.

关键词： Crohn’s Disease Infliximab Peripheral Neuropathy

Endoscopic Treatment of Esophageal Achalasia: Experience of the Hepato-Gastroenterology Service of Fez

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Open Journal of Gastroenterology 2019年第8期9卷 164-173页

作者： Houda Meyiz Asmae Lamine Mounia el Yousfi Nourdin Aqodad mohammed el abkari Adil Ibrahimi Dafr Allah Benajeh Ihssane Mellouki Department of Hepato-Gastroenterology University Hospital Hassan II Fez Morocco Faculty of Medicine-Fez University Sidi Mohammed Ben Abdellah Fez Morocco

The achalasia is a rare primary esophageal motor disorder characterized by relaxation disorders of the lower esophageal sphincter and absence of the esophageal body peristalsis. Several studies suggest that the response to the endoscopic treatment depends on several predictors. The aim of our study was to evaluate the endoscopic treatment of esophageal achalasia and identify the predictive factors of endoscopic treatment response. Patients and Methods: This is a retrospective analytical study of 78 patients with achalasia, managed in the gastroenterology department of the university medical center Hassan II-Fez, during a period of 5 years (January 2009 to December 2014). The diagnosis of achalasia was retained on a set of clinical, endoscopic, manometric and radiological arguments. A graded dilation protocol starting with a 35 mm balloon three times for 30 seconds in progressive pressure between 5 and 8 psi was performed. We used the Eckardt score to evaluate the clinical remission. Results: During the study period, 78 patients were included. The average age of our patients was 47 years old [18 - 81] with a sex-ratio M/F of 1.05. The average of Eckardt score before dilation was 5.9 [3 - 9]. An average of 1.41 dilation sessions was performed per patient with 85.9% of the initial success rate (n = 67). Initial success without further dilation sessions was achieved in 55.1% of our patients (n = 43). A clinical recurrence requiring further dilation sessions was observed in 30.8% of the cases (n = 24). The average relapse time after first dilation success was 2.7 years, 75% occurs within the first year. Dilation failure was retained in 14 patients (17.9%) requiring surgery. Only one post-dilation perforation was noted. In multivariate analysis, only odynophagia and the number of dilatation sessions were factors of failure of the endoscopic dilation. Conclusion: Pneumatic dilation is a minimally morbid and effective procedure. Our work showed that odynophagia, and the number of dilation sessions, are two predictive fac

关键词： Achalasia Pneumatic Dilatation Manometry Eckardt Score

Portal Vein Thrombosis in Non Cirrhotic Patients: Experience of Gastroenterology and Hepatology Department University Hospital Hassan II

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Open Journal of Gastroenterology 2020年第12期10卷 349-356页

作者： Nada Lahmidani Mariam el Khayari Maria Lahlali Asmae Lamine Hakima Abid Mounia el Yousfi Dafr Allah Benajah Sidi Adil Ibrahimi mohammed el abkari Department of Gastroenterology and Hepatology School of Medicine and Pharmacy of Fez University Hospital Hassan II University Sidi Mohammed Ben Abdallah Fez Morocco

Portal thrombosis (PT) is a rare condition of heterogeneous etiologies. The aim of our work is to study the epidemiological and etiological profile of portal thrombosis in non cirrhotic patients through the experience of our department. Patients and Methods: This is a retrospective study over a 9-year period (January 2009-July 2018), 54 cases of PT in non cirrhotic patients were collected in the department of Hepato-Gastro-Enterology of the HASSAN II Fez Hospital, 73 cases of PT were excluded among cirrhotic patients. Results: We collected 54 cases of PT cases;the average age was 45 years, with an F/M ratio of 1.42. PT was revealed by abdominal pain in 20 cases, complications of portal hypertension in 24 cases, and ultrasound discovery in 10 asymptomatic cases. Main underlying causes of PT were: A proteine S deficiency in 7 cases, Acute pancreatitis in 5 cases, colonic cancer in 4 cases, pancreatic cancer in 4 cases, Hydatic liver Echinococcoses (3 cases), anti phospholipid syndrom (3 cases), myeloproliferative syndrom (2 cases) and jak mutation 2 in 1 case, non identified etiology was reported in 20 cases (37%). Treatment was based on anticoagulation, treatment of portal hypertension complications, and etiological treatment in cases where etiological diagnosis was certainly posed. Conclusion: PT is a rare but serious condition, according to our study neoplastic causes are predominant followed by protein S deficiency. Etiological investigations have to be wide and early treatment is the best option to avoid extension and complication.

关键词： Portal Thrombosis Etiology Anticoagulant Non Cirrhotic

Update on Gastric Cancer Epidemiology and Risk Factors

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Journal of Cancer Therapy 2018年第3期9卷 242-254页

作者： Nada Lahmidani Mounia el Yousf Nourdine Aqodad Dafr Allah Benajah mohammed el abkari Adil Ibrahimi Adil Najdi Zineb Benbrahim Naoufal Mellas Department of Gastroenterology University Hospital Hassan II School of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdallah University Fez Morocco Department of Epidemiology and Biostatistics School of Medicine and Pharmacy of Tangier Tangier Morocco Department of Medical Oncology University Hospital Hassan II School of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdallah University Fez Morocco

Gastric adenocarcinoma is the most common gastric tumor. It is the fifth most common cancer worldwide after lung cancer, breast, colo rectal and prostate cancer. Long considered enigmatic, its epidemiology has changed over time. In fact, the incidence of distal gastric cancer has declined while that of the cardia was stable or increased. This cancer is multifactorial but reducing the incidence of distal cancer is particularly attributed to advances in the treatment of H. pylori infection. In this review, we analyzed the available data concerning the changing epidemiology of gastric cancer and the main risk factors. The incidence of distal cancer is definitely declining due to the control of Helicobacter pylori infection. Proximal gastric cancer and cardia cancer is particularly due to smoking, overweight.

关键词： Adenocarcinoma Gastric Incidence Risk Factors Helicobacter pylori