Gastroenterol. Insights, Volume 7, Issue 1 (August 2016) – 12 articles

A 76-year-old gentleman presented with anemia. He had a history of perforated duodenal ulcer six years ago, with Billroth II repair performed. A large gastric bezoar (8×6 cm²) with a clean base ulcer at the anastomotic junction was found during the initial oesophago- gastro-duodenoscopy (OGDS). Rapid urease test was negative. He presented with melena during the subsequent follow up (OGDS showed a Forrest Ib prepylori ulcer). We have successfully removed the gastric bezoar with dissolution therapy initially (injection of cokecola into the bezoar, followed by drinking 325 mL Coca-ColaTM twice daily), followed by four attempts of OGDS with endoscopic fragmentation. Histopathology reported as degenerated vegetable matter, acellular debris mixed with scattered fungal and bacterial colonies, which was compatible with bezoar. Follow-up OGDS showed complete clearance of the bezoar. Coca-ColaTM ingestion should be considered as initial treatment as it is non-invasive, and it enables further successful endoscopic fragmentation. Full article

Symptomatic gastrointestinal (GI) amyloidosis is a rare manifestation of systemic amyloid light chain amyloidosis. Further, the presentation of primary GI amyloidosis without previously diagnosed systemic amyloidosis is exceptionally rare. We describe a case of a patient presenting with abdominal pain, nausea, vomiting, and weight loss later to be diagnosed with localized GI amyloidosis from underlying multiple myeloma. Unfortunately, the GI disease was insurmountable leading to her death. Amyloidosis exerts its pathology at the level of the mucosa, soft tissue, nerves, and vascular supply of the GI tract. No specific treatments for the GI complications of amyloidosis are available and supportive measures are universally employed. GI amyloidosis is not only infrequently amenable to systemic and symptomatic treatment, but has a negative impact on both quality of life and survival. Full article

MicroRNAs (miRNAs) are impressive regulators of gene expression that have a critical role in the pathogenesis of colorectal cancer (CRC). With respect to the aberrant expression of miRNA-383 (miR-383) in some types of human malignancy, this prospective study characterized its contribution to CRC tumorigenesis. The real-time reverse transcriptionpolymerase chain reaction was used to examine miR-383 expression levels prospectively in 40 sample pairs of CRC tissues and adjacent noncancerous tissues (>2 cm from cancer tissue). No significant relationship was found between miR-383 expression levels and clinicopathological features. The ability of miR-383 to function as a tumor marker was also examined. Showing significant changes overall, miR-383 expression levels were significantly down regulated in the group of CRC samples compared with matched noncancerous tissue samples. A receiver-operating characteristic (ROC) curve also showed ROC area of 70% for miR-383 with 68 and 75% sensitivity and specificity, respectively. Therefore, miR-383 can be considered as a tumor marker in CRC and help as a potential predictive biomarker in the diagnosis of colorectal cancer. Full article

Gallbladder cancer prevalence is ever increasing with Salmonella typhi chronic infection being one of the predisposing factors. Altered ratios or expression of transforming growth factor-β (TGF-β) receptors and changes in its function are associated with loss in anti-proliferative effects of TGF-β and cancer progression. Using reverse transcriptase polymerase chain reaction we monitor any changes in TGF-β receptor gene expression. We simultaneously screen for S. typhi within the samples. From 73 patients undergoing cholecystectomy 39-50% had significant expression (P<0.05) of TGF-β receptor (TβR)- I and TβR-II during chronic cholelithiasis as compared to the remaining 19-23% with acute chronic cholelithiasis. There was no significant increase in TβR-III receptor expression. Patient’s positive for S. typhi (7/73) did not show any significant changes in expression of these receptors, thus indicating no direct relation in regulating the host TGFβ-signaling pathway. Further analysis on expression of downstream Smad components revealed that patients with up-regulated TGFβ receptor expression show >2-fold increase in the RSmads and Co-Smads with a >2-fold decrease in I-Smads. Thus gain of TβR-I and II expression in epithelial cells of the gallbladder was associated with chronic inflammatory stages of the gallbladder disease. Full article

Insulin is a debatable risk factor for colon adenoma (Ad) among type II diabetes mellitus (DM II) patients. Obesity is an important confounding variable. The study involved chart review of DM II patients undergoing screening colonoscopy. Study population was divided into obese [body mass index (BMI)≥30] and nonobese (BMI<30) groups which were further divided into insulin and non-insulin subgroup. Colonoscopy and pathology reports were used to calculate Ad detection rate (ADR) and AAd detection rate (AADR). A total of 538 subjects satisfied the inclusion and exclusion criteria. The study population composed of 52.8% obese and 47.2% non-obese subjects. Obese group had 28.9% insulin and 71.1% non-insulin subjects. Non-obese group composed of 29.9% insulin and 70.1% non-insulin subjects. ADR for non-obese insulin and non-insulin subgroup was 31.6% and 37.1% respectively. AADR for non-obese insulin and non-insulin subgroup was 13.2% and 11.2% respectively. ADR for obese insulin and non-insulin subgroup was 41.5% and 34.2% respectively. AADR for obese insulin and non-insulin subgroup was 15.9% and 16.3% respectively. Insulin exposure lacked statistically significant association with ADR or AADR among obese and non-obese DM II subjects. Full article

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction with rash, fever and multiorgan dysfunction potentially lethal in up to 10% of cases. It often affects liver function, but it can also affect kidney, lungs, and heart. Severe gastrointestinal involvement is rare. We present a case of a 31-year-old hispanic woman with pseudomembranous colitis associated with lamotrigine-induced DRESS syndrome. To the best of our knowledge, this is the fourth reported case of severe involvement of the gastrointestinal tract and the first to report pseudomembranous colitis in the setting of DRESS syndrome. Full article

Intestinal intussusception is an uncommon acute condition in adults and is most commonly caused by an intestinal tumor mass. Helminthic parasitosis is a widespread infection in Africa, and the load of worms is often high in individuals living in areas with inadequate sanitation. We report a case of intestinal obstruction caused by Ascaris lumbricoides infection, which was complicated by ileo-caecal intussusception and required surgical treatment in a 40-year-old Ugandan woman. This case reinforces the importance of anthelminthic prophylaxis in African rural areas. Full article

Alpha-fetoprotein (AFP) is a tumor marker routinely used for the diagnosis and follow-up of malignant neoplasms. We report a case of extremely high serum levels of AFP associated with benign lesions of the liver and of the lungs with a spontaneous and gradual drop to normal values in the 9-month follow-up without any form of treatment. As a result a high serum level of AFP does not necessarily indicate a malignant tumor and every patient presenting with such finding must be thoroughly examined before making a definitive diagnosis. Full article

Due to the lack of effective medical treatment for non-alcoholic steatohepatitis (NASH), we aimed to evaluate new treatment options. In particular, our goal was to investigate and compare the effects of N-acetylcysteine (NAC) and Adalimumab treatment on tumor necrosis factor alpha (TNF-α) and oxidative stress during the development of NASH in a rat model of the disease. Our study included a total of 35 female Wistar albino rats that were divided into 5 groups of 7 each, and evaluated over a 6 week period. One group received a normal diet, while the other four groups received a methionine and choline deficient (MCD) diet. One of the groups receiving the MCD diet did not take any medicine, while the other three were administered NAC, adalimumab, or a NAC/adalimumab combination therapy. NASH was successfully established in the MCD diet group. Levels of TNF-α were effectively suppressed in the three groups that received therapy. Even though adalimumab significantly enhanced suppression of TNF-α, the NASH score was suppressed to a more statistically significant extent in the groups receiving NAC. Our study showed that TNF-α and oxidative stress play an important role in NASH pathogenesis. The antioxidant agent, NAC, was found to be superior to the anti-TNF agent, Adalimumab, in the improvement of total NASH score. Although these drugs did not prevent the development of NASH, it was shown that they mildly reverse the NASH histopathology score, suggesting improvement of and overall liver function. Full article

Mucocele is an uncommon pathology of the vermiform appendix estimated to be seen in 0.2-0.3%. The term mucocele means dilation of the appendix due to mucus, caused either by a benign or a malignant process. Herein, we report the case of a 77-year-old man with Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly and Telangiectasias syndrome, a limited form of Scleroderma, who had presented an abdominal cyclical pain and in which abdominopelvic computed tomography scan concluded to the diagnosis of appendiceal mucocele. Surgery and histopathology confirmed the diagnosis of mucinous cystadenoma. This association appendiceal mucocele and scleoderma has not been previously reported. The clinical and radiological features of this unusual complication are reviewed. Full article

Infliximab drug level checking has started to revolutionize the treatment of inflammatory bowel disease, allowing for more accurate dosing. Recently, Brandse and colleagues and Gagniere and colleagues both noted the potential benefit of a re-introduction of infliximab after prior failure in patients with Crohn’s disease. Unfortunately though, approximately 1/3 of patients stopped the drug due to side effects of the attempted retreatment from infusion reactions. In their study, they also noted that concomitant usage of a thiopurine did not provide any additional benefit. Presumably, majority of these reactions are secondary to antibody formation to infliximab. In order to reduce the risk of infusion reactions, we present a case of a patient with Crohn’s disease who was retried on infliximab and had antibody testing after the first dose to assess if it would be safe to continue the drug, as most infusion reactions occur at the second dose. Full article

Gastroesophageal reflux disease (GERD) is common in the general population. Pregnancy is known to be associated with high incidence of GERD symptoms. Although, there are previously conducted studies involving both genders to determine the prevalence of GERD in different population groups in Nigeria, our preliminary literature search showed that there is a dearth of data on the prevalence of GERD among Nigerian pregnant women. The aim of this study is to determine the prevalence of GERD using the GerdQ questionnaire and to test the association between pregnancy and GERD among women of south-western Nigeria. The study was a descriptive hospital based cross-sectional survey involving three medical facilities in two states of south-western Nigeria. A total of 796 women consisting of 413 (51.9%) healthy pregnant women at various gestational ages and 383 (48.1%) nonpregnant women were interviewed. A predesigned questionnaire consisting of sociodemographic data, obstetrics information, the GerdQ questionnaire and previous history of GERD symptoms was administered to each of the participants. Of the 796 women interviewed, 413 (51.9%) were pregnant women with a mean of 27.42 (±5.00) years and 383 (48.1%) non-pregnant women of child bearing age with a mean of 26.72 (±6.46) years. The prevalence of GERD among the pregnant women was 14.5% while that among the nonpregnant group was 9.7%. This difference was statistically significant (P=0.036). Following adjustment for potential confounders, pregnancy maintained a positive statistically significant relationship with GERD [OR=1.67 (95% CI=1.07, -2.61), P=0.023]. GERD has a moderate prevalence in pregnancy in southwestern Nigeria. Pregnancy has a significant association with GERD, independent of the other risk factors. Full article