Ball Valve Syndrome is caused by Colon Polyp

BACKGROUND: Intestinal obstruction caused by ball valve syndrome, is a potentially lethal pathology. This case report will show ball valve syndrome in the large intestine (mechanical obstruction) and endoscopic treatment. CASE PRESENTATION: Our patient presented with abdominal pain and with intestinal obstruction-ileus. After colonoscopic examination was noticed, a large precancerous pedunculated polyp obstructed of large intestine due to ball valve effect. Mechanical obstruction was removed with endoscopic polypectomy. CONCLUSION: Endoscopic polypectomy must first be performed and if does not succeed, then indicated surgical interventions.

Large Hiatal Hernia Associated with Cameron Ulcers and Consecutive Sideropenic Anemia: Case Presentation

BACKGROUND: Cameron lesions are seen in 5.2% of patients with hiatal hernia who undergo esophagogastroduodenoscopic examinations. The prevalence of Cameron lesions seems to be dependent on the size of the hernial sac, with an increased prevalence in the larger-sized sac. In about two-thirds of the cases, multiple Cameron lesions are noted rather than a solitary erosion or ulcer. AIM: The aim of this case report is to present the patient with Cameron ulcers associated with hiatal hernia. CASE PRESENTATION: Our patient presented with postprandial retrosternal pain, especially immediately after eating, vomiting, dyspnea, weight loss, fatigue, signs, and symptoms of severe hypochromic microcytic anemia without signs of acute gastrointestinal bleeding. No history of gastroesophageal disease. Colonoscopy was done and eliminate colic cause of anemia. The endoscopy showed a large hiatal hernia and linear erosions and ulcerations at the level of gastrodiaphragmatic contact (Cameron ulcers) and one non-sanguinant subcardial elipsoid ulceration. After conservative and operative treatment, there was significant clinically and laboratory improvement definitively, after 6 months. Cameron lesion is a rare cause of refractory sideropenic anemia. Diagnosis is very difficult in developing countries, where iron deficiency anemia is more common. A history of disease, clinical course, and laboratory findings are the important facts for diagnosis. CONCLUSION: Endoscopy is the gold standard for diagnosis, although it is not uncommon to overlook these lesions due to their unique location. There are two modalities for the treatment of Cameron lesions: Medical or surgical, which should be individualized for each patient. By severe refractory anemia and large hiatal hernia, associated with clinical signs, surgical approach is very important.

Anatomic Variations of Pancreaticobiliary Union

AIM:

This study was designated to evaluate the frequency of anatomic variations of the pancreaticobiliary union.

MATERIALS AND METHODS:

Our research was observational, comparative and analytical. The investigation was conducted from January 2016-May 2017. This study included 63 patients from Clinic of Gastroenterology and Hepatology – Prishtina, assessed pancreaticobiliary union with Magnetic Resonance cholangiopancreatography.

RESULTS:

Union of the common bile duct and the major pancreas was biliary-pancreatic type The angle between common bile duct and the major pancreas duct had different sizes average 35.6°. We did not distinguish significant statistical significance in the size of the pancreaticobiliary angle. In men, the union angle was from the average 36.9°, while in females was average 34.3°. No correlation between the age and size of the angle between common bile duct and the major pancreas duct.

CONCLUSIONS:

The union of the common bile duct and the major pancreas duct was in most cases B-P Type. The common channel and angle between common bile duct and the major pancreas duct were normal in most cases.

Proton Pump Inhibitors Diminish Barrett's Esophagus Length: Our Experience

AIM

Our main objectives were to evaluate the influence of two-year proton pump inhibitors (PPI) therapy in patients with Barrett's oesophagus on its length, in both types, short and long segment.

METHODS

In this single-centre, prospective interventional controlled study were analysed data collected prospectively over two years from patients with Barrett's oesophagus diagnosed by endoscopy. Patients who received continuous proton pump inhibitors (PPI) for 2 years were included. At each patient visit symptoms were recorded, and at each endoscopy, the length of Barrett's oesophagus (BE) was measured. Biopsies were taken along the length of the oesophagus at intervals of 1 cm. In total, 50 patients with Barrett's oesophagus were included in the study: 10 of whom had long-segment Barrett's oesophagus, and 40 patients had short-segment Barrett's oesophagus. The mean number of endoscopies performed was 3 per patient.

RESULTS

The length of Barrett's esophagus (BE) was influenced by PPI therapy: Circumferential extension in BE patients short-segment Barrett's esophagus (SSBE) (before treatment was 1.5 cm and after treatment was 0.8 cm Maximum proximal extension in SSBE group before treatment was 2.3 cm (SD ± 1.1 cm), and 1.1 cm (SD ± 0.9 cm), respectively. Squamous islands were detected in 25% of patients examined after 2 years on PPIs.

CONCLUSIONS

PPIs achieve a reduction to the length of Barrett's oesophagus, in both types, and the development of squamous islands is commonly associated with their use.

Endoscopic Removal of a Giant Complicated Hyperplastic Gastric Polyp

The patient, a 40-year-old male, was referred to our clinic with intermittent nausea, vomiting and symptomatic anemia for 4 months. Notable hematological indices were low hemoglobin levels of 9.6 g/dl and hematocrit levels of 35.8%, while after receiving two units of concentrated red blood cells, at discharge; they achieved levels of 15.2 g/dl and 42.3%, respectively. Esophagogastroduodenoscopy revealed a 3 cm antral pedunculated polyp, prolapsing into pylorus thus causing intermittent pyloric obstruction and anemia. Histological examination revealed a hyperplastic polyp without evidences of malignancy. No atrophy, metaplasia, dysplastic changes or Helicobacter pylori infection were detected in samples taken from the antrum and the corpus; however, the examination provided evidence for gastritis. Follow-up endoscopy was provided after 12 weeks to see polypectomy site after a course of Pantoprazole administration, and to define symptom-free time after polypectomy. Endoscopic removal of complicated gastric polyps should be considered at the time of initial diagnostic endoscopy. Endoscopic resection of polyps enables to determine the exact histopathologic type as well as to effectively treat symptomatic gastric outlet obstruction and anemia.

Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree

Objective:

According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation.

Aim:

Our aim was to compare the hemorrhoid laser procedure with open surgical procedure for outpatient treatment of symptomatic hemorrhoids.

Material and method:

A comparison trial between hemorrhoid laser procedure or open surgical hemorrhoidectomy was made. This study was conducted at Aloka hospital in Kosovo. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 20 patients treated with the laser hemorrhoidoplasty, and 20 patients–with open surgery hemorrhoidectomy. Operative time and postoperative pain with visual analog scale, were evaluated.

Results:

A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty and open surgical procedure were observed in operative time and early postoperative pain. There was a statistically significant difference between the two groups regarding the early postoperative period: 1 week, 2 weeks, 3 weeks and 1 month after respective procedure (p<0.01). The procedure time for LHP was 15.94 min vs. 26.76 min for open surgery (p<0.01).

Conclusion:

The laser hemorrhoidoplasty procedure was more effective than open surgical hemorrhoidectomy. Postoperative pain and duration time are only two indicators for this difference between there procedures.

The prevalence of helicobacter pylori infection in patients with reflux esophagitis - our experience

Introduction and aim:

The role of Helicobacter pylori in esophageal disease has not been clearly defined. To clarify this issue, we analyzed 120 patients with histologically confirmed esophageal disease.

Material and methods:

In this prospective study, 120 patients who underwent upper endoscopy examination were included; among them 70 patients with clinically, endoscopically and histologically confirmed GERD, and 50 patients with BE. This investigation was performed in the Clinic of Gastrohepatology in Prishtina, during the period: June 2009–December 2011. Each patient was investigated for H. pylori infection, by performing biopsy for HUT test.

Results:

In BE group, H. pylori infection was present in 16.0% of patients. In GERD group, H. pylori infection was present in 42.9%, and in patients of the control group, in 52.0% of cases. So, in BE group, the prevalence of H. pylori infection showed less significant difference, compared to the control group (P = 0.003) and in GERD group (P = 0.0035). Between GERD group and the control group there was no significant difference (GERD vs. G control. P = 0.421).

Conclusion:

The prevalence of H. pylori infection in patients with BE (16%) was lower in comparison with patients with GERD (42.9%) and with control group (p <0.01). The prevalence of H. pylori infection in patients with BE, especially those with LSBE (9.1%) was very low, which indicates a possible protective role of this microorganism.

Relationship of left ventricular size to left atrial and left atrial appendage size in sinus rhythm patients with dilated cardiomyopathy

Introduction:

Thromboembolic events are a frequent cause of mortality in patients with congestive heart failure. The aim of or study was to evaluate the relationship of left ventricular end diastolic diameter (LVEDD) to left atrial (LA) size and left atrial appendage (LAA) size in patients with dilated cardiomyopathy in sinus rhythm, as well as to determine the prevalence of thrombi in LV and LA /LAA.

Methods:

This was a prospective cross-sectional study, conducted from December 2009 until December 2011. The study included 95 patients with dilated cardiomyopathy in sinus rhythm. Patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flatter, severe systolic dysfunction, and/or patients who were taking oral anticoagulation therapy were excluded.

Results:

Mean patient age was 58.6 ± 12.2 years and 68.4% were men. Mean LVEDD of our population was 66.5 ± 6.5 mm, while mean LA atrium, LA volume and LAA maximal area were 46 ± 5.1 mm, 87.2 ± 38.7 cm³ and 4.7 ± 1.2 cm², respectively. LA diameter (p<0.001) and LAA maximal area (p=0.01) showed to be independent predictors of LV size. LV thrombus was detected in 13 (13.7%) patients, while LAA thrombus in 46 (48.4%) patients of our study population.

Conclusions:

In conclusion, dilated LV size is associated with enlarged LA and LAA size. On the other hand, dilation of LV, LA and LAA is related to high prevalence of left chamber cardiac thrombi.

What are Predictive Factors for Developing of Barrett's Esophagus in Patients with Gerd-our Experience

Introduction:

Barrett’s esophagus (BE) is a condition in which the normal squamous epithelium of the esophagus is replaced with metaplastic intestinal-type epithelium. This epithelium can progress sequentially from metaplasia to low-grade dysplasia, then to high-grade dysplasia and finally to invasive adenocarcinoma. Many factors that appear to be risk factors for the presence of BE include obesity, the presence of hiatal hernia, and interestingly, the absence of Helicobacter pylori infection.

The aim:

The aim of this study was to determine the predictive factors for progression of gastroesophageal reflux disease (GERD) to BE.

Methods:

42 patients with endoscopically diagnosed and histopathologically verified BE were included in this prospective study. We analysed predictive factors such as: age, sex, obesity, alcohol consumption and smoking, reflux symptom duration in this patients, prevalence of short and long segment of BE, and the presence of hiatal hernia. After endoscopic examination of these patients, the presence of BE was verified with histopathological examination and finally, infection with H. pylori was determined.

Results:

Among 42 subjects, 25 (59%) were males and 17 (41%) were females, with mean age of 52.8±3.28 years. Obesity was present in 24 of 42 patients (57%). 27 of 42 patients (64%) were smokers. Symptom duration in this patients was approximately 9.4 years. From total number of patients, 52% were with SSBE and 48% patients were with LSBE. Hiatal hernia was present in 64% of patients, of which 66% were with LSBE and 34% with SSBE. In these patients, prevalence of infection with H. pylori was present in 12% of cases, 9.5% in patients with SSBE and 2.5% in patients with LSBE.

Conclusions:

The important risk factors for appearance of BE in GERD patients were male sex, middle age, smooking and alcohol consumption. Obesity is an important factor for development of BE. Most of patients with BE also had hiatal hernia, in majority of cases these were patients with LSBE. The prevalence of infection with H. Pylori in patients with BE was lower and this may predict a protective role of this microorganism.

Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo

Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient’s clinical condition.

The influence of the type of ulcers in the degree of atrophic gastritis

PURPOSE

Chronic Gastritis is the most common manifestation of infection with Helicobacter pylori. Changes in the gastric mucosa have tendency to progress towards mucosal atrophy, most likely in patients with gastric ulcer. We have explored the frequency of the presence of atrophic gastritis in patients with gastric and duodenal ulcers.

MATERIAL AND METHOD

We included 175 patients in a prospective study, 119 of whom were patients with duodenal ulcer and 56 suffered from gastric ulcer. The mean age of the patients with duodenal ulcer was 42.27 years, while patients with gastric ulcer had a mean age of 51.87 years. Biopsy was done on all patients with gastric and duodenal ulcer for histopathological examination, in order to confirm the presence of atrophic gastritis. All examined patients were positive for H. Pylori status.

RESULTS

The presence of gastritis by type of ulcer, duodenal or gastric, was as follows: type without atrophy 20% and 0%, mild atrophy 61% and 14% and severe atrophy 22% and 86%, respectively.

CONCLUSIONS

In patients with duodenal ulcers more often occurs mild atrophic gastritis (p < 0001). In the patients with gastric ulcers most often occur alterations with more pronounced gastric atrophy (p < 0.01).

Helicobacter pylori infection and precancerous lesions of the stomach

INTRODUCTION

Chronic atrophic gastritis, intestinal metaplasia, hereditary non-polyposos colon cancer, gastric dysplasia, gastric adenoma, Barrett esophagitis and familiar adenomatous polyposis are confirmed precancerous lesions of the stomach. Most of these conditions are correlated with long-term infections with Helicobacter pylori.

MATERIAL AND METHOD

Patients which were included in our study underwent gastro endoscopy with multiple biopsies from antrum and corpus ventricle, also urease test and histopathological examination, using special coloring for Helicobacter pylori.

RESULTS

802 patients entered this study, of which 369 female and 483 male. Among female patients 56.4% resulted Helicobacter pylori positive, whereas among male patients this was at a rate of 62.6%. The most affected age was 40-49 years, in which group Helicobacter pylori infection was 64.2%. In each precancerous lesion positivity of Helicobacter pylori infection was very high.-in patients with intestinal metaplasia: 71.7%, with gastric dysplasia: 71.4%, with gastric ulcer: 68.4%, with atrophic gastritis: 66.0% and with Barrett esophagitis: 55.0%.

DISCUSSION

The main purpose of this study was to determine the percentage of Helicobacter pylori infection among patients with precancerous lesions, which resulted to be very high. The highest percentage of infection resulted in patients with intestinal metaplasia (71.7%).

CONCLUSIONS

Precancerous lesions of stomach are associated with high percentage of Helicobacter pylori infection. This confirms once more the importance of Helicobacter pylori eradication in early stages and patient's surveillance.

Effectiveness of proton pump inhibitors in the treatment of patients with endoscopic esophagitis

Gastroesophageal reflux disease (GERD) is a common disorder, typically diagnosed by a history of chronic heartburn. Proton pump inhibitors (PPIs) eliminate symptoms and heal esophagitis more frequently and more rapidly than other agents. The aims of this study were to evaluate the effectiveness of proton pump inhibitors (PPIs) in terms of symptom resolution and endoscopic healing in patients with erosive reflux disease. In this prospective study we included 380 patients with positive history for the main symptoms of erosive reflux disease. Symptoms were evaluated before and after treatment with PPI on the period of three months and were recorded with heartburn system score and regurgitation score. All patients were classified according to Los Angeles classification for erosive reflux disease, before and after the three months treatment with PPI and were conducted for their healing of erosive oesophagitis in the finish of the treatment. Before the treatment, 95% of patients were with heartburn, 90% with regurgitation and 70% with epigastric pain. Quantification for pyrosis and regurgitation were obtained in each patient. After treatment of these patients with PPIs, resolution for pyrosis was from 95% to 25%, for regurgitation from 90% to 20% and for epigastric pain from 70% to 10%. In 71.67% of patients was found complete healing of erosive oesophagitis and minimal progression in 1.05% of patients. Results of this study showed that PPI treatment of patients with erosive reflux disease can influence on very good symptomatic and mucosal resolution after three months. Epigastric pain was shown not to bee specific for erosive reflux disease.