Upper gastrointestinal tract endoscopy

[Upper gastrointestinal (UGI) endoscopy in Louga (Senegal): patients' profile and difficulties encountered]

Introduction

Les objectifs de cette étude étaient de déterminer le profil épidémiologique, clinique et endoscopique des patients adressés pour endoscopie digestive haute à la clinique Magou de Louga et d'analyser les difficultés rencontrées.

Méthodes

il s'agit d'une étude rétrospective et descriptive qui analyse les comptes rendus de 248 gastroscopies réalisées entre le 1^er janvier et le 31 decembre 2014.

Résultats

L'âge moyen était de 39,9 ans, le sex ratio était de 2,3 en faveur des femmes. La majorité des patients (56,5%) provenait d'une zone rurale. Les patients étaient surtout des femmes au foyer (55,2%). Les principaux prescripteurs étaient les médecins (77,8%). L'épi gastralgie était la principale indication. La hernie hiatale domine avec 33,1% suivi d'examen normaux 22,5% et le reflux gastrooesophagien isolé 12,5% des cas. Seulement 2 résultats anatomopathologiques sur 13 ont été reçus. Aucun contrôle endoscopique demandé n'a été fait.

Conclusion

Peu d'endoscopie digestive haute sont réalisées à Louga. Le profil type du patient est une femme au foyer jeune vivant en zone rurale se plaignant d'épi gastralgies dont l'examen endoscopique à défaut d'être normal retrouve une hernie hiatale ou reflux gastrooesophagien. Les difficultés sont liées aux résultats d'analyses anatomopathologiques non reçus et à l'absence de contrôle endoscopique après traitement.

Bleeding in children caused by gastrointestinal vascular lesions

Intestinal vascular malformations in infants and children are rare but must be considered in the differential diagnosis of gastrointestinal bleeding. Many vascular malformation syndromes have associated intestinal lesions. Localization of vascular lesions is essential for successful management. A variety of treatment options including laser photoablation, surgical resection, and other nonoperative therapies have been utilized to treat these disorders.

Long-term follow-up of childhood duodenal ulcers

PURPOSE

This study reports the long-term results in children who have duodenal ulcers diagnosed by endoscopy who were treated with H2-receptor antagonist.

METHODS

The medical records of 32 children admitted into The Queen Mary Hospital with endoscopically proven duodenal ulcers between 1975 and 1988 were reviewed to evaluate the long-term outcome of childhood duodenal ulcers after initial treatment with H2-receptor antagonist (H2RA). Follow-up details were updated and patients who had been lost to follow-up were recalled. The age of the 22 boys and 10 girls at the time of diagnosis of the ulcers ranged from 3 to 16 years (mean, 11.8 yrs). The duration of follow-up ranged from 8.5 to 21 years (mean, 11.6 yrs).

RESULTS

Their primary presentations included epigastric pain (n = 9, 28.0%); nonsteroidal antiinflammatory drug (NSAID)-induced gastrointestinal bleeding (GIB, n = 6, 18.7%); unprovoked GIB (n = 12, 37.5%); perforation (n = 4, 12.5%); and pyloric obstruction (n = 1, 3.0%). All 13 patients who had NSAID-induced ulcers (pain and bleeding) responded to H2RA therapy and required no further treatment. All 14 patients who had unprovoked ulcers who presented with pain or bleeding did not respond to H2RA treatment. Ulcer healing was achieved only after eradication of Helicobacter pylori with antibiotics (n = 8) or definitive surgery involving either truncal vagotomy and pyloroplasty (VP, n = 4) or proximal gastric vagotomy (PGV, n = 2). The patient who had gastric outlet obstruction had vagotomy and antrectomy. All four patients who had perforation were initially treated with patch repair, but two had persistent ulceration despite H2RA treatment and required PGV. Complications developed in none of the four patients who had PGV, whereas two of the four patients with VP had problems (diarrhea, n = 1; bezoar obstruction, n = 1).

CONCLUSIONS

Unprovoked childhood duodenal ulcer is associated with significant long-term morbidity and requires continued follow-up. The majority of the ulcers are resistant to H2RA treatment alone and ultimately require either eradication of H. pylori or surgery. In the absence of obstruction, PGV may be enough to resolve the ulcer diathesis.

Peptic ulcer disease in children

Primary duodenal ulcer disease occurs in children of all ages, but is most often seen in those over 10 years. As in the adult, it often pursues a chronic course. Primary gastric ulcer is seen in children under 6 years, is more unusual, and does not tend to recur. Stress ulcers are seen most often in infants and in critically ill children and are asymptomatic until the complications of hemorrhage or perforation appear. Drug-related ulcers are being seen more frequently as the use of nonsteroidal anti-inflammatory agents increases. With the use of new therapeutic agents, management has been simplified and surgical intervention has become a rarity. Helicobacter pylori is now a recognized cause of antral gastritis and ulceration in the child.

Pediatric upper gastrointestinal endoscopy: a 13-year experience

This report describes a series of 553 flexible upper gastrointestinal (GI) endoscopies performed on 382 children in two surgical centers between 1975 and 1987. Indications included abdominal pain (180), reassessment of known disease (149), upper GI bleeding (99), foreign body ingestion (77), vomiting (14), dysphagia (10), and miscellaneous (24). Findings were chronic peptic ulcer (47), gastritis/duodenitis (63), healing disease (92), nonhealing disease (22), recurrent disease (32), foreign body impaction (22), stricture (9), esophagitis (7), varices (7), mass (6 [3 polyp, 1 lymphoma, 1 fungus ball, 1 inflammation]), normal (209), and miscellaneous (37). Endoscopic diagnosis was uniformly correct except on two occasions, when the presence of recurrent tracheoesophageal fistula in small infants was missed due to use of an inadequate instrument. A pathologic lesion is likely to be identifiable in GI bleeding (84.8%). Endoscopic surveillance for progress of known disease was found to be valuable, particularly in peptic ulcer management, as both incomplete healing after standard therapy as well as recurrence are frequent. The recent practice of routine antral biopsy in children with severe "nonspecific abdominable pain" enabled four cases of Campylobacter pylori colonization in the stomach to be diagnosed, thus allowing appropriate treatment. Endoscopy was therapeutic on 61 occasions: injection sclerotherapy (32), foreign body removal (20), polypectomy (3), and stricture dilatation (6). Endoscopy-guided bougienage, in particular, represents a recent major advance. There was no morbidity or mortality in the entire series. It is concluded that pediatric upper GI endoscopy performed by experienced surgeons is safe and effective. As a result of better understanding and technological advances, a changing trend of wider and more rational applications of the procedure is now evident.

Peptic ulcer disease in the pediatric population

Peptic ulcer disease occurs in infants, children, and adolescents. Primary and stress ulcers pose a challenge to the pediatrician, who needs to arrange for appropriate diagnostic and therapeutic services. Highlights of our understanding of the pathophysiology, genetics, natural history, diagnosis, and therapy of peptic ulcer disease are presented.

Duodenitis in children: clinical, endoscopic, and pathological aspects

In a retrospective study of 320 gastroduodenoscopies performed on children in the last 2 years, 32 cases of duodenal damage, either isolated or associated with esophagitis, gastritis, or both, were selected. Twenty matched children with dyspeptic symptoms but an endoscopically normal duodenum were chosen as controls. Histological sections of fiberoptic biopsy specimens were submitted to double-blind examination by two observers: only four fulfilled accepted criteria for histological duodenitis. The concordance between endoscopic and histological results in our patients was 13.8%. No changes of duodenal endoscopic appearance predictive of duodenitis were identified. In 8 more cases (6 patients and 2 controls) the histological examination showed an isolated lymphocyte and plasma cell infiltration of the lamina propria without any additional damage. We called this picture "minimal change duodenitis" and considered it as a variation of normal. In 17 patients and 11 controls, basal and maximal acid outputs were calculated and no significant differences were found. We concluded that duodenitis in children may be present, although rare, and its diagnosis requires histological examination of duodenal mucosa.

Duodenal ulceration: review of 110 cases

This paper describes 110 cases of childhood duodenal ulcer, which were diagnosed over 26 years: 63 were diagnosed by barium meal examination; 47 by upper gastrointestinal endoscopy. The mean age at diagnosis was 11.2 years, with symptoms reported in 46% before 10 years and in 15% before 6 years of age. There was often a considerable delay in diagnosis, particularly in the younger age group. Nocturnal pain (61%) and a close family history of duodenal ulcer disease (62%) were the most valuable pointers to the diagnosis. Fifteen children had required surgery for persistent symptoms. Thirty four had received treatment with an H2 receptor antagonist, and all but four had had a satisfactory initial response. Seventy per cent relapsed within six months of discontinuing treatment, and long term maintenance treatment may therefore be necessary.

Twenty year review of duodenal ulcer

Of 31 patients (18 male and 13 female) followed up 13-29 years after diagnosis, recurrent or persistent duodenal ulcer had occurred in four. In 22 (71%) gastrointestinal symptoms persisted into adult life, although only abdominal pain was significantly more frequent than in 126 controls.