Open Access Case Study

Caroli’s Disease Revealed by Acute Pancreatitis and Angiocholitis: Case Report

Abdelilah El Bakouri, Abderrahmane Lamnaouar, Othmane Elyamine, Mounir Bouali, Khalid Elhattabi, Fatimazahra Bensardi, Abdelaziz Fadil

Asian Journal of Research and Reports in Gastroenterology, Page 1-5

Background: Caroli's disease (CD) is a rare congenital disorder. The early diagnosis of the disease and differentiation of types I and II are of extreme importance to patient survival. This case report was designed to review, discuss to clarify the clinical characteristics of the disease.

Methods: The demographic and clinical feature, laboratory indicators, imaging findings and pathology results were reviewed.

Results: Caroli's disease can occur at any age specially young age. Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) examinations were most useful in diagnosing CD.

Conclusions: No typical symptoms, signs or laboratory indicators are able to distinguish CD from other conditions. Both MRI and CT were most valuable in diagnosis.

Open Access Case Study

The Elusive Colonic Ulcer in Mycophenolate Mofetil Colitis – Is It Inflammatory or Neoplastic?

Keng Hoong Chiam, Andrew Ruszkiewicz, Rajvinder Singh

Asian Journal of Research and Reports in Gastroenterology, Page 31-36

Introduction and Aims: Gastrointestinal toxicity resulting in diarrhea is a common side effect in patients taking Mycophenolate mofetil (MMF). The challenge is in making the decision to pursue further workup being mindful of malignancy and opportunistic infection in these group of immunosuppressed individuals, or to stop the offending agent and observe. Colonoscopy with biopsies remains the gold-standard diagnostic tool to establish the underlying etiology, but lesions found are often non-specific especially when there is ongoing active inflammation. We report a case of an inflammatory colonic ulcer that turned out to be neoplastic which healed with time making it difficult to locate on subsequent colonoscopies.

Case Presentation: A 77-year-old man with a background history of heart transplant was referred for endoscopic resection to a solitary high-grade dysplastic tubular adenomatous lesion in the hepatic flexure. This was detected incidentally while he was being investigated for persistent diarrhea. A solitary ulcer on a background of colitis was visualized on index colonoscopy. The colitis was attributed to MMF. The MMF was stopped and his symptoms improved. A repeated colonoscopy performed 6 weeks later revealed no obvious abnormalities. Upon discussion with the patient, he was referred on to an expert endoscopy center for reassessment. In this instance, a 9 mm subtle, flat and mildly erythematous lesion was detected. We were able to define and characterize the lesion better using Narrow Band Imaging. An Endoscopic Submucosal Dissection was then carried out and the lesion resected in an en-bloc fashion. Histopathological evaluation revealed this to be an intramucosal adenocarcinoma.

Conclusion: In immunosuppressed patients, given the atypical and often subtle presentation of colon cancers, it is important to be extra vigilant and biopsy all suspicious lesions, particularly solitary ulcers. It is worthwhile to tattoo an area distally to aid in identification if the area needs to be reevaluated or resected at a later date.

Open Access Original Research Article

Stapled Haemorrhoidopexy: Comorbidities and Outcome

Ashok Kumar, Somanath Malage, Murugappan Nachiappan

Asian Journal of Research and Reports in Gastroenterology, Page 6-13

Aim: Stapled haemorrhoidopexy (SH) is one of the commonly performed procedure for grade 3 haemorrhoids. High-risk surgical patients require additional care and are reported to have high morbidity. The present study is aimed to analyze the outcome of SH in high-risk patients.

Study Design: Retrospective analysis of prospectively maintained data.

Place and Duration of Study: Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India, between2005-2019.

Methodology: Data of all the patients who underwent SH between 2005-2019 were retrieved from the hospital database. The outcome of the surgery in high-risk patients was compared with patients without the risk factor.

Results: There were a total of 136 patients (101 males and 35 females) in the age range of 16- 87 years. 67 patients (49.3%) had high-risk factors in the form of single or multiple comorbidities and those more than 65 years of age. Three patients (2.2%) had bleeding in the postoperative period. One of them required reoperation. Two patients had a recurrence of the disease on the long term follow up. There was no mortality.

Conclusion: SH can be safely performed in elderly patients, patients at high risk for bleeding and also in patients with associated comorbidities.

Open Access Original Research Article

Prevalence and Socio-Demographic Determinants of Ascariasis among Primary School Pupils in Central Nigeria

Haruna Isa Mohammed, Salamatu Bashar Buhari, Idris Muhammad Mukhtar

Asian Journal of Research and Reports in Gastroenterology, Page 14-20

Aims: This study was conducted to evaluate the prevalence and socio-demographic determinants of Ascariasis among primary school pupils in Central Nigeria.

Study Design: The study was a cross sectional study.

Place and Duration of Study: Keffi, Nasarawa State, between March and June 2019.

Methodology: 300 stool samples (100 from each of the 3 selected primary schools) were collected from the pupils and information about them were obtained by structured questionnaires. The ova or cyst of Ascaris lumbricoides were microscopically detected from the samples using formal-ether concentration technique. Data collected were analysed using Smith’s Statistical Package (version 2.8, California, USA) and P value of ≤ 0.05 was considered statistically significant.

Results: Out of the 300 pupils screened, 49(16.3%) were positive for Ascariasis. Ahmadu Maikwato primary school had the highest prevalence (24.0%) of the infection followed by Nurudeen (19.0%) and Model Science (6.0%) primary schools.  Age, gender, location and occupation of parents were not significantly associated with the parasitic infection (P>0.05). However, the rate of the infection was higher among pupils aged ≥16 years (33.3%), males (19.4%), from rural areas (19.4%) and whose parents were farmers (21.9%).

Conclusion: This study confirms the presence of Ascariasis in the study population. Hence, improved personal and environmental hygiene together with health education and regular deworming of pupils are highly advocated as these will facilitate elimination of the infection in the year 2025 as advocated in the global strategic plan.

Open Access Original Research Article

Relationship of Serum Brain Natriuretic Peptide Levels with Severity of Chronic Liver Disease

Sana Mushtaq, Mehnaz Munir

Asian Journal of Research and Reports in Gastroenterology, Page 21-30

Aims: To determine mean serum B-type natriuretic peptide (BNP) levels and their relationship with the severity of disease in patients with chronic liver disease (CLD).

Study Design:  Descriptive cross-sectional study

Place and Duration of Study: Department of Medicine, Unit-2, Jinnah Hospital, Lahore, from 5th August 2015 to 4th February 2016.

Methodology: A study was done on 80 patients of Chronic liver disease. Under aseptic conditions, venous blood samples were obtained from cases at the time of presentation along with asking some questions related to disease and measure their weight and height. Serum albumin and BNP levels (outcome variable) were measured by using standard chemical analyzer in laboratory. Association between BNP levels with patients’ personal and disease factors of patients were analyzed by SPSS 21.

Results: Mean age of the patients was 55.4±10.43 years. Out of 80 patients, 48 (60%) were male. Mean BMI was 21.89±5.45 kg/m2, mean duration of CLD was 11.23±5.22 years and mean serum albumin and BNP was 3.18±1.05 g/dl and 393.13±289.36 pg/ml respectively. Upper gastro-intestinal bleeding observed in 22 (27.5%) patients, ascites was present in 60 (75%). Child Pugh class-A observed in 19 (23.8%) patients, class-B in 30 (37.5%) patients and class-C found in 31 (38.8%) patients. Serum BNP level was positively related with history of upper GI bleed (p=0.000), ascites (p=0.000) and Child Pugh classification (p=0.000) and negatively related with albumin level (p=0.000).

Conclusion: Elevated serum brain natriuretic peptide correlate with severity of chronic liver disease in cirrhotic patients. The use of this marker in cirrhotic patients should be cautiously interpreted for cardiomyopathy.