Asian Journal of Research and Reports in Gastroenterology

Uncommon Presentation of Intestinal Lithobezoar in an Elderly Female: A Case Report

Thu, 04 Jan 2024 00:00:00 +0000

Intestinal litho-bezoars, comprising accumulations of ingested foreign bodies, are rare clinical entities often associated with unusual dietary habits. We present a case of a 73-year-old female who presented with abdominal distension and pain. Clinical examination revealed tachycardia, hypertension, low oxygen saturation, and tachypnea. An abdominal X-ray and non-contrast computed tomography revealed gaseous distension with a radio-opaque mass in the right iliac fossa. The patient underwent an emergency exploratory laparotomy, which revealed a hard, immovable mass located 40 cm proximal to the ileocecal junction. Enterotomy was performed, and a 5x4 cm single, ovoid, brown-colored, hard lithobezoar weighing 47 grams was extracted. The proximal bowel loop exhibited dilation and ischemic changes, necessitating a 15 cm ileal resection with a two-layer ileal anastomosis. Stone analysis confirmed the composition as calcium oxalate, with histologically identifiable vegetative material on the outer surface. Detailed dietary history revealed a lifelong habit of consuming mud. This case highlights the importance of considering rare etiologies in patients presenting with acute abdominal symptoms, especially in elderly individuals. Intestinal lithobezoars, though uncommon, should be considered in the differential diagnosis, particularly when associated with distinctive dietary habits. Timely recognition and intervention are crucial to prevent life-threatening complications and ensure optimal patient outcomes.

Pantoprazole-Induced Thrombocytopenia in a Patient with Upper Gastrointestinal Bleeding: A Case Report

Maryam, Treesa P. Varghese, Syeda Neha Fatima, Iqra Jahan — Thu, 15 Feb 2024 00:00:00 +0000

Although it seems relatively rare, pantoprazole-induced thrombocytopenia is a potentially serious side effect^[6]. Proton pump inhibitors (PPIs), which have the potential to stabilize blood clot formation, are frequently used in the treatment of upper gastrointestinal bleeding (UGIBs)^[7]. Helicobacter pylori infection, stomach ulcers, erosive esophagitis, and stress ulcer prophylaxis in high-risk critically ill individuals are the indications for PPI therapy. In intensive care units (ICUs), stress ulcer prophylaxis with acid-suppressing therapy is frequently prescribed. PPIs are a class of medications that are routinely used in intensive care units (ICU) to treat and prevent stress ulcers (stress-related mucosal disease). The mainstay of treatment for peptic ulcer bleeding includes PPIs, with consensus recommendations currently prescribing high-dose intravenous (IV) PPI therapy (IV bolus followed by continuous therapy).2 PPIs have been demonstrated to lessen symptoms of bleeding at index endoscopy and to lessen rebleeding following endoscopic hemostasis. Although PPIs are well-tolerated and frequently given to patients with acute UGIBs, serious side effects could happen. Patients who used PPIs for a brief period of time experienced a variety of moderate systemic symptoms. When taking PPIs for less than two weeks, serious adverse effects typically start off moderate. However, as treatment time goes on, side effects have been found to become more frequent and severe. Patients with UGIBs may experience significant hemodynamic instability and rebleeding risks due to thrombocytopenia. Here, we present a case of thrombocytopenia that developed after pantoprazole was introduced. After the drug was discontinued, the thrombocytopenia was recovered. According to the Naranjo probability scale causality assessment, the relationship between thrombocytopenia and pantoprazole is found to be probable. We emphasize this case to raise awareness about drug-induced thrombocytopenia.

Esophageal Cytomegalovirus and Herpes Simplex Virus Co-infection in an Immunocompetent Patient: A Case Report

Wed, 28 Feb 2024 00:00:00 +0000

Infectious esophagitis is a rare disease that usually affects immunocompromised patients. Diagnosis is made by upper endoscopy showing esophagitis and confirmed by histological examination and sometimes PCR on biopsies. We present a case of esophageal cytomegalovirus (CMV) and herpes simplex virus (HSV) co-infection in an immunocompetent patient. The patient is a 50-year-old male with no past history of medical importance. He presented to our department with a recent onset of dysphagia, a fever of 40°C, and chills. Upper endoscopy revealed an erythematous esophageal mucosa and circumferential and confluent superficial ulcers bleeding spontaneously, located mostly in the lower 1/3 of the esophageous. PCR for CMV and HSV on esophageal biopsies was positive, confirming the diagnosis. Primary immune deficiency was excluded. The Human Immunodeficiency Virus (HIV) test was negative. He was treated with ganciclovir and showed clinical improvement. Repeat upper endoscopy after hospital discharge showed complete healing of the esophageal mucosa.

A Case of Severe CMV Colitis Complicated with Megacolon and Perforation in an Immunocompetent Prisoner

Yeo Tian Ming, Zalwani Zainuddin, Kiew Kuang Kiat — Fri, 08 Mar 2024 00:00:00 +0000

Aims and Introduction: Cytomegalovirus (CMV) colitis often occurs in immunocompromised patients and those with inflammatory bowel disease, but only occurs occasionally in those without previous medical illness. Here we report on a patient without previous medical illness who presented acutely and was eventually diagnosed as CMV colitis.

Case Presentation: A 44 year old prisoner had a one week history of diarrhea and abdominal pain, and presented in septic shock. Abdominal X-rays and CT scan showed marked colon dilatation. Although he had transient clinical improvement with intravenous Meropenem, he experienced clinical deterioration after 2 weeks, including episodes of acute lower gastrointestinal bleeding. Limited sigmoidoscopy revealed friable mucosa with diffuse ulceration. He then developed colon perforation and required partial colectomy, but died of septic shock shortly after. Histopathological examination of the biopsy and colectomy specimens revealed the diagnosis of CMV colitis.

Discussion: CMV colitis most often presents with diarrhea which can be acute or chronic, and may lead to lower gastrointestinal bleeding. Severe CMV colitis may result in toxic megacolon or perforation. Tissue biopsy for histopathological examination and immunostaining is the gold standard for diagnosis of CMV colitis. Once diagnosed, timely treatment with IV Ganciclovir is recommended.

Conclusion: This case highlights that CMV colitis should be considered in the differential diagnosis of severe colitis with colon dilatation, including in immunocompetent patients. Sigmoidoscopy should be considered in such cases to obtain tissue biopsies to confirm the diagnosis.

Exceptional Association of Pneumatosis Cystoides Intestinalis with Ascites Secondary to Gastric Ulcer

Mon, 18 Mar 2024 00:00:00 +0000

Pneumatosis cystoides Intestinalis (PCI) is a rare disease characterized by the presence of gas-filled cysts in the intestinal wall, which can affect the entire digestive tract, with a predilection for the small intestine and colon. It can be primary or secondary, associated with multiple gastrointestinal or other pathologies. Diagnosis can be challenging to establish, and only a combined radiological and endoscopic evaluation ensures proper therapeutic management, often preventing unnecessary emergency surgical interventions. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications We report an unusual case of pneumatosis cystoides intestinalis associated with ascites, in a 65 year-old patient who presented with chronic abdominal pain and vomiting. The abdomen CT showed multiple small air cysts in the intestinal wall, ascites, and free abdominal air. Upper gastrointestinal endoscopy showed a gastric ulcer without no evidence of malignancy on histopathological examination, but with the presence of Helicobacter pylori. Ascitic fluid analysis revealed an exudative pattern. The patient was treated with Helicobacter pylori eradication therapy along with proton pump inhibitors. The outcome was favorable with the disappearance of abdominal pain and ascites. An abdominopelvic CT scan performed after 4 months showed complete regression of cystic images and ascites. To date, very few cases of intestinal pneumatosis associated with ascites have been reported.

Insights into Gastric Tuberculosis: A Case Study of Immunocompetent Patients

Mon, 08 Apr 2024 00:00:00 +0000

Gastric tuberculosis is a rare manifestation of Mycobacterium tuberculosis infection outside the lungs. Its clinical presentation is nonspecific and can be misleading, often resembling peptic ulcer disease or malignancy. The primary source of information pertaining to this rare medical condition predominantly originates from case reports, with scarce publication of comprehensive case series addressing the disease. Diagnosis is most commonly established through histopathological examination of a surgical specimen subsequent to the onset of disease-related complications. However, upper gastrointestinal endoscopy with biopsy represents the technique of choice for diagnosis in the absence of complications. We report two cases of gastric tuberculosis in immunocompetent patients, presenting with chronic abdominal pain, vomiting, and progressive weight loss over several months. The diagnosis was established through endoscopy coupled with biopsy findings Both patients underwent antibacterial treatment with favorable clinical outcomes.

Comparative Analysis of Outcomes of Patients with Hepatitis C Virus-Related Cirrhosis and Those with Hepatitis C Virus-Related Hepatocellular Carcinoma

Mehriban Huseynova Rafael , Nuru Bayramov Yusif , Brian I. Carr — Wed, 17 Jan 2024 00:00:00 +0000

Objective: We attempted to identify risk factors for the development of HCC by comparing the parameters of patients with HCV related liver cirrhosis without HCC (HCV-LC-without HCC) and those with HCV related liver cirrhosis plus HCC (HCV-LC-HCC).

Materials and Methods: We retrospectively analysed our database of 40 patients with HCV-LC without HCC and 42 patients with HCV-LC-HCC. A diagnosis of cirrhosis was based on the results of histological examination and/or elastography. HCC was diagnosed histologically or by the detection of consistent ﬁndings using at least two imaging techniques from among US, CT, or MRI. Hepatitis C virus infection was detected by enzyme linked immunosorbent assay (ELISA). Other baseline laboratory investigations such as CBC, liver function tests, including serum total bilirubin, ALT, AST, GGT, ALKP, AFP and serum albumin levels, and serum creatinine levels were also measured.

Results: HCC patients had significantly higher serum levels of NLR, PLR, GLR, ALKP and AFP and lower albumin levels, than the non-HCC patients. For the HCC patients, 33.3% had low AFP levels, 35.7% had macroscopic PVT and only 48.1% had a tumor diameter <5cm. Patients with high AFP, PVT and large tumor size had characteristic differences from those with low AFP, absent PVT and smaller tumor size.

Conclusions: Older age, male gender, increased levels of NLR, PLR, GLR, ALKP, AFP and decreased levels of albumin in HCV-related cirrhosis are associated with an increased risk of HCC. In addition, high levels of ALKP, very high levels of AFP (>1000 IU/ml), and presence of large (≥5 cm) tumors increase suspicion of presence of portal vein thrombosis. Consideration of these indicators in routine monitoring may be useful in early diagnosis and treatment of HCC in HCV-related cirrhosis.

Dietary Pattern, and Helicobacter Pylori Infection among Gastric Cancer Patients attending Benghazi Medical Center

Fri, 19 Jan 2024 00:00:00 +0000

Stomach cancer is one of the most prevalent cancers worldwide. Stomach cancer is the most common leading cause of death in many countries. H. Pylori and many dietary factors are associated with development of stomach cancers. The current study aims to assess the association between dietary pattern, helicobacter pylori infection among gastric cancer patients in Benghazi Medical Center. It is a retrospective cohort study. The inclusion criterion was all adult with stomach cancer, a body weight records, and twenty four dietary recall. Description and analysis of data was done by SPSS version 22. The prevalence of H. Pylori history among 219 subjects of the current study is (57%). Male gender, frequent intake of fried foods were the variables associated with gastric cancer in this study.

Place of Echo Endoscopy in Unexplained Acute Pancreatitis: A Retrospective Study

Mon, 12 Feb 2024 00:00:00 +0000

Introduction: Acute pancreatitis may escape etiological diagnosis after clinical, biological and morphological investigation in 10-30% of patients. Echo-endoscopy is promising and particularly effective in exploring the bilio-pancreatic region.

The aim of our study is to evaluate the contribution of echo-endoscopy in unexplained acute pancreatitis.

Materials and Methods: This is a retrospective descriptive study, including 89 patients who underwent echoendoscopy for unexplained acute pancreatitis between January 2008 and December 2022.

Results: The mean age of our patients was 55 ± 16.3 years, with extremes ranging from 17 to 89 years. The sex ratio (M/F) was 0.81, with a slight female predominance of 55.1%.

A history of previous acute pancreatitis was found in 31.9% of cases, and 16.3% of patients had undergone cholecystectomy.

The diagnostic yield in our study was 68% of patients. Biliary origin was retained in 40.4% (n=36) of patients; 19 of whom benefited́ from complementary ERCP at the same anesthetic time. A tumor pathology was found in 32.5% of cases (n=30) and chronic pancreatitis in 22.4% of patients (n=20). We also found two cases of pancreas divisum, one case of sphincter of Oddi dysfunction and one case of choledochocele.

Echo-endoscopy was normal in the remaining 32% of cases, with no cause found.

Conclusion: Echo-endoscopy is currently an indispensable tool in the etiological investigation of unexplained acute pancreatitis. In our study, the diagnostic yield was 68%.

Expert Opinion on the Effectiveness of Proton Pump Inhibitors Therapy in Gastroesophageal Reflux Disease in Indian Settings

Manjula S, Krishna Kumar M — Fri, 16 Feb 2024 00:00:00 +0000

Objective: To gather expert opinion regarding the commonly prescribed proton pump inhibitors (PPIs) in clinical practice, with a specific focus on the use of pantoprazole as a treatment for gastroesophageal reflux disease (GERD) in Indian settings.

Methodology: The questionnaire-based survey, comprised of 19 questions, collected perspectives of experts across various regions of India regarding the usage of PPI therapy for the management of GERD in their clinical practice.

Results: The present survey included 238 participants. The majority (84%) of the clinicians recommended PPIs as the first-line therapy for gastritis. According to 85% of clinicians, there were no significant side effects associated with PPI use in GERD treatment. Most of the experts (92%) recommended pantoprazole as the most frequently prescribed PPI. Approximately 46% of experts preferred pantoprazole 20 mg for pediatric use, while 41% preferred prescribing pantoprazole 80 mg for adults. A significant portion (63%) of clinicians suggested pantoprazole as an adjuvant therapy alongside other medications. The benefits of using pantoprazole include a quicker onset of action, safety, good tolerance, and extended acid suppression, as reported by 71%, 14%, and 13% of experts, respectively.

Conclusion: As per the expert consensus, PPI was the preferred first-line therapy for gastritis and GERD with negligible side effects. Pantoprazole emerged as the most favorable PPI for GERD treatment and was also regarded as a valuable adjuvant therapy when combined with other medications. Experts have shown a preference for prescribing 20 mg and 80 mg doses of pantoprazole for children and adults, respectively. With its rapid onset of action, safety profile, excellent tolerability, and sustained acid suppression, pantoprazole presented significant advantages, making it a valuable therapeutic option for GERD treatment.