[Galbladder contractility in children with functional dyspepsia]

Disturbances of the gallbladder and biliary tract in children, contrary to those in adults, were not included in Ill Rome Criteria of functional disorders of the alimentary tract. The aim of the work was sonographic assessment of gallbladder function in functional dyspepsia in children.

MATERIAL AND METHODS

The study included 45 children, aged 6 to 18 years (28 girls and 17 boys) with functional dyspepsia and 32 healthy children without symptoms form the alimentary tract of the same age, who were regarded as the control group. Diagnosis of functional dyspepsia was made based on Ill Rome Criteria. Anatomy and contractility of the gallbladder were assessed sonographically taking into consideration its volume in fasting state, than 30 and 60 minutes after the test meal. In anatomy assessment the presence of septum, thickness of the wall and the presence of thickened bile were taken into account.

RESULTS

Anatomical anomalies and wall thickness changes were observed statistically significantly more frequently in children with functional dyspepsia. There was no statistical difference in the volume of the gallbladder in fasting state and its contractility after test meal.

CONCLUSIONS

Anatomical anomalies of the gallbladder were more frequent in children with functional dyspepsia in comparison to healthy children, however, there were no statistical differences in its volume in fasting state and contractility after test meal.

Prevalence of Helicobacter pylori in a First Nations population in northwestern Ontario

OBJECTIVE

To assess prevalence of Helicobacter pylori infection, reasons for referral for gastroscopy, and clinical findings of gastroscopy in a symptomatic First Nations population in northwestern Ontario from 2009 to 2011.

DESIGN

Three hundred four hospital charts of symptomatic patients who underwent upper endoscopy between June 2009 and March 2011 were reviewed.

SETTING

Meno Ya Win Health Centre in Sioux Lookout, Ont.

PARTICIPANTS

First Nations patients with dyspepsia undergoing gastroscopy.

MAIN OUTCOME MEASURES

Reason for referral, and clinical and histologic findings on gastroscopy.

RESULTS

The most common reasons for referral for gastroscopy were dyspepsia (59.2%) and undiagnosed anemia (18.1%). Overall, 66.8% of patients underwent biopsies; 37.9% of these patients tested positive for H pylori. Gastritis was encountered the most often, in 46.1% of patients; gastric ulcers in 6.9% of patients; and normal gastric mucosa was seen 36.8% of the time. The rate of H pylori infection is higher than in urban Canadian populations, but lower than in previous aboriginal prevalence estimates, particularly those based on seroprevalence values.

CONCLUSION

This study raises the clinical question of how eradication testing and treatment protocols should be addressed in remote regions with high disease prevalence. As more is learned about the role H pylori infection plays in serious gastrointestinal diseases, rural and aboriginal populations might need a special focus on testing availability and treatment close to home.

Clinical outcome of pediatric collagenous gastritis: Case series and review of literature

Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endo-histopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mononuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term malignant transformation. In summary, CG in children is a chronic disease, typically with a variable clinical response and an indolent course that is distinct from the adult phenotype. Long term therapy usually inclused iron supplementation but cannot be standardized, given the chronicity of the disease, variability of response and potential for adverse events.

[Clinical characteristics of dyspepsia in patients with diabetes mellitus type 2]

AIM

To estimate the prevalence of dyspepsia and to study its clinical manifestations and risk factors in patients with type 2 diabetes mellitus.

SUBJECTS AND METHODS

One hundred and seven patients with type 2 DM and 33 with functional dyspepsia were examined. A clinical and laboratory study and testing were made to identify the symptoms of dyspepsia; dyspepsia-associated factors were studied.

RESULTS

Dyspepsia was observed in 71.0% of the examined patients with type 2 DM. It may be attributed to organic gastrointestinal tract (GIT) diseases only in 42.3% of cases. In the type 2 DM patients, dyspepsia that could not be explained by organic GIT diseases was mainly manifested by a dyskinetic type while an ulcer-like type was prevalent in those with organic GIT diseases. In the patients with type 2 DM, dyspepsia that could not be accounted for GIT diseases was associated with the duration of carbohydrate metabolism disturbance, the presence of diabetic complications, Helicobacter pylori infection, and patient age. Some symptoms of dyspepsia (repletion and epigastric discomfort), which could not be explained by organic GIT diseases in patients with type 2 DM were associated with diabetic complications and carbohydrate metabolic parameters.

CONCLUSION

Dyspepsia in type 2 DM was observed in 71% of cases; it can be due to organic GIT diseases in 42.3% and its association with digestive organ pathology was not revealed in 57.7%.

[Syndrome of functional dyspepsia and/or chronic gastritis?]

Definition and prevalence of syndrome of functional dyspepsia (SFD) are discussed along with the brief history of the problem, priority works of V.P. Obraztsov and other authors, current views of SFD etiology and pathogenesis with reference to the role of H. pylori infections. Clinical variants of SFD, their diagnostic criteria and principals of differential diagnostics are described. Special attention is given to the debatable relationship between CFD and chronic gastritis. Nosological and syndromal diagnostics, structure-function relationship, goals and methods of SFD treatment and other matters of dispute are considered.

[Dyspepsia and Helicobacter pylori: should it be treated?]

Epigastric pains are currently one of the most frequent reasons of clinic visits in ambulatory medicine, generating high direct and indirect costs each year. Corresponding to pains in the epigastric area, they result from different underlying diseases such as gastro-esophageal reflux, dyspepsia and peptic ulcers. If the role of Helicobacter pylori is well defined in the pathogenesis of gastro-duodenal ulcers, its implication in dyspepsia is less clear. The Maastricht IV Consensus recommends to test and treat Helicobacter pylori among patients with dyspepsia and no alarm symptoms.

Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip

BACKGROUND

Nonsteroid anti-inflammatory drugs represent an important osteoarthritis (OA) therapy component, but also a leading cause of gastropathy: one of the most frequent and serious OA therapy complications. The aim of the present study was to study the influence of GI health in an OA population receiving either ginger or diclofenac.

METHODS

Forty-three (43) patients with confirmed OA (knee and hip) were included in a randomized controlled study. A ginger group of 21 patients (17 women, 4 men) was given a specific ginger combination daily (340 mg EV.EXT 35 Zingiber officinalis extract) for 4 weeks. A diclofenac group (positive control) of 22 patients (18 women, 4 men) received 100 mg diclofenac daily for the same period. Both groups also received 1000 mg glucosamine daily. Gastrointestinal pain and dyspepsia were evaluated according to the severity of dyspepsia assessment (SODA) form. Patients also underwent esophagogastroduodenoscopy (EGDS) including biopsy before and after the treatment. Serum gastrin-17 levels, and stomach mucosa prostaglandins (PG) E1, E2, F2α, and 6-keto PGF1α (PGI2) levels were measured. Arthritic pain was evaluated using the visual analogue scale (VAS) on standing and moving.

RESULTS

The ginger group showed a slight but significantly lowered SODA pain and no change of SODA dyspepsia. EGDS showed significantly increased levels of PGE1, PGE2, and PGF2α in the stomach mucosa. This rise in gastric mucosa PG levels correlated with an increase in serum gastrin-17. On the other hand, the diclofenac group showed increased SODA pain and dyspepsia values with a corresponding significant decrease of stomach mucosa prostaglandins and general negative stomach mucosa degeneration. Both groups showed a relevant and significantly lowered VAS pain both on standing and moving.

CONCLUSIONS

The ginger combination is as effective as diclofenac but safer in treating OA, being without effect on the stomach mucosa. The increased mucosal PGs synthesis in the ginger group supports an increased mucosa-protective potential. VAS; visual analogue scale, 0-100 mm.

Russell body gastritis in an HIV positive patient: case report and review of literature

Russell body gastritis is characterized by accumulation of plasma cells, filled with Russell bodies, in the gastric mucosa. Twelve cases have been reported in the English language medical literature. Its association with Helicobacter pylori gastritis or immunosuppression is known. The present case is the third to be reported in association with HIV infection. An 82-year-old male presented with dyspepsia, loose stools, loss of appetite and weight. Computed tomography scan showed esophageal and gastric wall thickening. Gastrointestinal endoscopy revealed gastritis. Microscopic examination of the biopsy revealed gastric mucosa with diffuse plasma cell infiltration in the lamina propria, associated with large eosinophilic Russell bodies. Immunoperoxidase stains revealed positivity for CD 138 and lambda and kappa chains. Special stain for Helicobacter pylori and immunostain for CD68 were negative. The differential diagnoses include plasmacytoma and mucosa associated lymphoid tissue (MALT) lymphoma with plasmacytic differentiation, which are entities with different prognostic and therapeutic implications.

Epidemiology of functional dyspepsia

Functional dyspepsia (FD) is the most common cause of dyspeptic symptoms. It refers to a heterogeneous group of symptoms located in the upper abdomen. The prevalence of dyspepsia is variable in different populations and is related to the different definitions of dyspepsia as inclusion criterias, variation in survey population and environmental factors. Epidemiologically some risk factors have been identified and underlying psychological disturbances have been shown to be important factors in FD. Age and ethnicity do not appear to be predictive of dyspepsia. A majority of patients suffering from significant levels of abdominal pain that interrupt daily activities and treatment remains unsatisfactory in this chronic condition.

[Impairment of intestinal mucosa composition in mechanisms of intestinal dysfunction development in patients with hepatic cirrhosis]

AIM

To investigate the role of intestinal microflora impairment in development of clinical manifestations of intestinal dyspepsia in patients with hepatic cirrhosis (HC).

MATERIAL AND METHODS

Endoscopic and morphological examinations of duodenal and colon mucosa were performed in 160 patients with viral HC and portal hypertension (PH) taking consideration of the presence of portal chypertensive duodeno- and colonopathy. Intestinal microflora was studied with lactulose respiration hydrogen test, bacteriological examination of the feces was also made. Clinical manifestations of intestinal dyspepcia were analysed as in irritable colon syndrome (ICS). The following disturbances were recognized: diarrhea, constipation, mixed, syndrome of duodenal hypertension.

RESULTS

Most of HC patients suffered from disturbed intestinal microflora composition, 46,3 % had bacterial overgrowth in the small intestine. 38 (23,8 %)--isolated impairment of colon microflora. Structural changes of intestinal mucosa associated with HC were found in 80% patients. Abnormal intestinal biocenosis occurred more often in patients with portal hypertensive duodeno- and colonopathy. ICS-like disorders were detected in 80,4 % patients with abnormal intestinal biocenosis, 33,1 %--had symptoms characteristic of duodenal hypertension.

CONCLUSION

In HC patients intestinal dysbiosis is an essential pathogenetic factor of formation of intestinal dyspeptic syndrome. Detection of portal hypertensive dyodenopathy and/or colonopathy in HC patients is a definite risk factor of impairment of normal composition of intestinal microflora.

Spectrum of endoscopic findings in Nigerians with dyspepsia

BACKGROUND

Dyspepsia is a common gastrointestinal disorder originating from the gastroduodenal region, and is the most common indication for upper gastrointestinal tract endoscopy. There are differing information on the commonest endoscopic findings in patients with dyspepsia from Nigeria.

OBJECTIVE

The aim of this study was to determine the spectrum of endoscopic findings in patients with dyspepsia.

PATIENTS AND METHODS

This is a hospital-based prospective study carried out at the Endoscopy Unit of Federal Medical Centre, Yola from November, 2006 to May, 2010. Patients with clinical features of dyspepsia who underwent upper gastrointestinal tract endoscopy as part of their workup were recruited. Their biodata, history and duration of dyspepsia were noted on a proforma. The spectrum of endoscopic findings was also noted.

RESULTS

A total of 259 patients with dyspepsia had upper gastrointestinal tract endoscopy. Ninety-nine (38.2%) were males while 160 (61.8%) were females, giving a male to female ratio of 1:1.6. Clinically significant endoscopic findings were seen in 241 (93.1%) patients while gastroduodenitis was the commonest finding. One hundred and two (39.4%) patients had two endoscopic findings, and 7 (2.7%) had three findings.

CONCLUSION

Majority of patients with dyspepsia had clinically significant endoscopic findings. Gastroduodenitis was the commonest endoscopic finding.

[Clinic pathogenetic features of gastroduodenal erosions and ulcers in patients with unstable stenocardia]

OBJECTIVE

To reveal the clinical, morphological and pathogenic features of gastroduodenal erosions and ulcers in unstable angina.

METHODS

135 patients with unstable angina were examined and divided into 2 groups, depending on the presence of a pathological process in the gastroduodenal zone. The state of microcirculation in the tissues of the gastroduodenal zone, secretory and motor function of the stomach were estimated by complex of techniques, adapted to the severity of the patients.

RESULTS

It is found that the pathological process in the gastroduodenal zone in patients with unstable angina was presented primarily by acute erosions, less - acute ulcers or recurrent peptic ulcer disease. In this case, the leading symptom of acute erosions was dyspepsia, that as a rule prevailed over the indistinct abdominal pain, and often disappeared in the first few days of treatment. Clinical picture of acute ulcers was determined by gastric dyspepsia and was often combined with abdominal pain and symptoms of gastrointestinal bleeding. The recurrence of peptic ulcer disease was characterized by the combination of moderate abdominal pain, often with migration in retrosternal and cardiac area and loss of circadian rhythm inherent in anthro-duodenal ulcer localization, and dyspeptic disorders. The severity of symptoms of ulcerous process was gradually decreased with time, but in most patients, they had remained by the end of the 2nd week of treatment. The basis of development of erosions and ulcers in unstable angina were the focal mainly thrombohaemorrhagic disorders of the terminal blood flow in the gastroduodenal mucosa. Its were combined with changes in the functional state of the stomach, manifested with an increase activity of acid-peptic factor, reduced production of gastromucoproteins, hypomotor dyskinesia and discoordination of anthro-duodenal propulsion on the hypotonic type.

CONCLUSION

Erosive and ulcerative lesions of gastroduodenal zone in unstable angina have a number of clinical and pathogenetic features that should be considered in the process of diagnosis and treatment.

[Comparative analysis between breath test, serological immunoassay and rapid-urease test for detection of Helicobacter pylori infection in Mexican patients with non-investigated dyspepsia]

INTRODUCTION

There are multiple Helicobacter pylori (Hp) detection tests, some are invasive and other noninvasive. The diagnostic accuracy of these methods varies according to the prevalence of the disease.

OBJECTIVE

To determine the diagnostic accuracy of the breath test, serology and rapid urease test, considering gastric biopsy with Giemsa stain as the gold standard in Hp-infected subjects with uninvestigated dyspepsia.

METHODS

Eighty four subjects (64 women, mean age 45 years) who were referred for dyspeptic symptoms were evaluated. Also, 20 healthy volunteers (12 men, average age 38 years) were evaluated. All the subjects underwent hystological analysis with Giemsa stain, breath test (Heliprobe®), rapid urease test (CLOtest®) and serological immunoassay (Hexagon®).

RESULTS

Overall, Hp infection was diagnosed by histological analysis in 59 subjects (49 patients and 10 healthy subjects). Positivity to breath test, rapid urease test and serology were 56%, 46% and 44% respectively. Agreement with the histological analysis was 0.902 for the breath test, 0.620 for rapid urease test and 0.45 for serology. The area under the curve for the breath test was 0.95, for the rapid urease test was 0.82 and for serological test was 0.74.

CONCLUSIONS

In our population, the breath test shown to have a diagnostic accuracy equivalent to histological analysis by Giemsa in subjects with uninvestigated dyspepsia.

Appropriateness of referrals for upper gastrointestinal endoscopy

BACKGROUND

Uncomplicated dyspepsia has a low predictive value in diagnosing upper gastrointestinal organic disease making early endoscopy essential.

OBJECTIVE

To assess the reliability of clinical information in the diagnosis of organic disease in patients referred for upper gastrointestinal endoscopy.

METHODS

Patients who were referred for gastroscopy to the Korle Bu Teaching Hospital, in Accra between January and December, 2008 were interviewed and evaluated for this study. The patients' clinical data were correlated with the endoscopic findings to determine how appropriate the referrals were, based on the clinical information.

RESULTS

One thousand, six hundred and forty three patients were studies of whom 372 presented with alarm symptoms. Uncomplicated dyspepsia was the principal presenting symptom in 1271 patients. Overall, 522 (31.8%) patients had organic disease, 440 (26.8%) inflammatory conditions and 681 (41.4%) were negative endoscopies. Two hundred and nine (56.2%) patients with alarm symptoms and 313 (24.6%) without alarm symptoms (p value, OR, 95% CI; <0.001, 3.92, 3.083-5.00) had organic disease. Presentations with bleeding and suspicion of malignancy showed statistical significance with the finding of organic disease while anaemia did not. Dyspepsia was strongly associated with negative endoscopy, 84% vrs 60%, p value <0.001. Gastric malignancies were associated with age 50 years and above. The three common benign diseases of peptic ulcer, gastric ulcer and gastritis showed strong similarity in presentation and were unpredictable clinically.

CONCLUSION

Patients referred for endoscopy were young in whom there was a high prevalence of organic disease which were mostly benign.