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The endoscopic pneumatic balloon dilation in treating achalasia in a Moroccan center

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Open Journal of Gastroenterology 2012年第4期2卷 172-176页

作者： mounia el yousfi Nada Lahmidani Adil Ibrahimi Dafr-Allah Benajah Department of Hépato-Gastroenterology University Sidi Mohammed Ben Abdillah Fez Morocco

Aim of the work: Achalasia is a rare pathology whose physiopathogenesis is mysterious. The treatment is based on endoscopic pneumatic dilation (PD) and surgery. The aim of our work is to show our experiment about endoscopic pneumatic dilation as the principal treatment suggested for patients presenting achalasia. Material and method: It is a retrospective study relating 21 cases of achalasia indexed between 2002 and 2007. The remission was judged on Eckardt’s clinical criteria. If the symptoms persist after three episodes of PD, there’s a therapy failure and the patients were then proposed to surgery or recurrent DP. The results: The Middle Age at the time of diagnosis was of 44 ± 10, 66 years (20 to 76). The sex ratio was 1, 3 (12M?9F) (p = 0.5). The diagnosis of achalasia is based on imaging, endoscopy and manometric arguments. The PD of the cardia was proposed in first intention, except two patients who were treated 6 and 15 years before by surgery. 38 dilations were performed for 21 patients with an average of 1.8 PD per patient [1-6]. The rate of good answers after the third episode of PD was about 90.47% (19 patients). There was no complication of the PD. In plain-varied analysis, no predictive factor of good answers to PD was retained. Conclusion: PD is an effective cure with a negligible morbidity and no mortality. The surgery is reserved for the failures of pneumatic dilation.

关键词： Achalasia Esophagus Treatment Pneumatic Dilation

Young patient with juvenile polyposis syndrome: A case report

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Open Journal of Gastroenterology 2012年第3期2卷 105-108页

作者： mounia el yousfi Bahija Benyachou Adil Ibrahimi Laila Chbani Afaf Amarti Gastroenterology Department Fez University Hospital Fez Morocco Pathology Department Fez University Hospital Fez Morocco

A case is reported here of juvenile polyposis in a 15- year-old girl. She was diagnosed upon the assessment of the dysenteric syndrome. Coloscopy and gastro- scopy had shown polyps of variable size whose histological study confirmed the hamartomatous character typical of the youthful non adenomatous polyps free of dysplasia. There was no localization in the small bowel. Coloprotectomy with ileoanal anastomosis was carried out in view of the importance of diarrhoea and the impacts on the general state of health.

关键词： Hamartomatous Polyp Polyposis Juvenile Polyp Juvenile Polyposis

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

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

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Open Journal of Gastroenterology 2014年第3期4卷 141-148页

作者： Iliass Charif Kaoutar Saada Ihssane Mellouki mounia el yousfi Dafrallah Benajah Mohamed el Abkari Adil Ibrahimi Nourdin Aqodad Department of Gastroenterology and Hepatology Hassan II University Hospital Fez Morocco

Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and sociodemographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p elena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001);low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four

关键词： Cirrhosis Portal Hypertension Intra-Hospital Mortality

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 num

关键词： Achalasia Pneumatic Dilatation Manometry Eckardt Score

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

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

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Open Journal of Gastroenterology 2018年第3期8卷 107-117页

作者： Hakima Abid Fatima Babakhouya Ihssane Mellouki mounia el yousfi Noureddine Aqodad Dafr Allah Benajah Adil Ibrahimi Mohamed el Abkari Hepatogastroenterology Department Hassan II University Hospital of Fez Univesity Sidi Mohamed Ben Abdellah Fez Morocco

Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency;its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005-2015). We included all patients admitted for severe acute colitis;all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 - 70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma;totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively;it is due to the delayed admission of pati

关键词： Acute Severe Ulcerative Colitis Infliximab Cyclosporine Colectomy

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 o

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