Role of Endoscopic Retrograde Cholangiopancreatography in Benign Biliary Diseases

Endoscopic retrograde cholangiopancreatography (ERCP) is a combination of endoscopy and X-ray technique, which was introduced as a diagnostic tool but with the advancement in the technology such as balloon dilatation or stent placement in combination with ERCP has transformed the latter into therapeutic accessory for multiple biliary diseases. It can also be used as an adjunct tool to increase the success rate of therapy. This diversified application of ERCP emphasizes the importance of this procedure for patients with biliary diseases despite the certain post-interventional complications. The scope of ERCP procedure is continuously increasing in the detection of anatomical or physiological abnormalities. ERCP plays an important role in conditions with biliary obstruction or biliary leaks, which may be due to primary or secondary causes. Biliary stents can be placed in combination with ERCP, which can assist in achieving therapeutic goals in patients with biliary strictures or clearance of biliary sludge

Rising trend of women in gastroenterology: A paradigm shift

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Hepatitis E: Genotypes, strategies to prevent and manage, and the existing knowledge gaps

Hepatitis E virus (HEV) is considered an emergent source of viral hepatitis worldwide, with an increasing burden of jaundice, liver failure, extrahepatic illnesses, and deaths in developed countries. With the scarcity of data from efficient animal models, there are still open-ended questions about designing new models to study pathogenesis, types, virology, and evolution of these viruses. With an emphasis on available data and updates, there is still enough information to understand the HEV life cycle, pathogen interaction with the host, and the valuation of the role of vaccine and new anti-HEV therapies. However, the World Health Organization (WHO) and the European Association for the Study of the Liver (EASL) preferred to stress prevention and control measures of HEV infections in animals, zoonotic transmission, and foodborne transmission. It is being reviewed that with current knowledge on HEV and existing prevention tools, there is an excellent room for in-depth information about the virus strains, their replication, pathogenicity, and virulence. The current knowledge set also has gaps regarding standardized and validated diagnostic tools, efficacy and safety of the vaccine, and extrahepatic manifestations specifically in pregnant females, immunocompromised patients, and others. This review highlights the areas for more research exploration, focusing on enlisted research questions based on HEV infection to endorse the need for significant improvement in the current set of knowledge for this public health problem

Redesigning the Landscape for Women and Leadership: Insights gained from the covid-19 pandemic. On behalf of women in gastroenterology network Asia pacific (WIGNAP) and women in endoscopy (WIE)

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Nutritional status in patients with Hepatitis C

OBJECTIVE: To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011. METHODOLOGY: Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) tool was used to assess nutritional status. RESULTS: A total of 400 patients were enrolled. Most of the patients in the HC group were class \u27A\u27 (best nutritional status). In contrast, the majority (64%) in the DC group were in the class \u27C\u27 (worst status). The compensated cirrhosis (CC) group showed that 90% of patients were malnourished, while 98% of all patients were malnourished in the DC group, predominantly class \u27C\u27. Most importantly, 14% of patients with chronic hepatitis C (CHC) also scored a \u27B\u27 on the SGA; which when compared to HC was statistically significant (p=0.005). As the groups progressed in their disease from CHC to DC, the transition in nutritional status from \u27A\u27 to \u27C\u27 between groups was statistically significant. CONCLUSION: Malnutrition occurs early in the course of HCV, and progresses relentlessly throughout the spectrum of HCVdisease

Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study

<p>Abstract</p> <p>Background</p> <p>Ascitic fluid infection (AFI) in cirrhotic patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). The aim of this study was to determine the outcome in cirrhotic patients with culture positive (SBP) and culture negative neutrocytic ascites.</p> <p>Methods</p> <p>We analyzed 675 consecutive hepatitis B and/or C related cirrhosis patients with ascites admitted in our hospital from November 2005 to December 2007. Of these, 187 patients had AFI; clinical and laboratory parameters of these patients including causes of cirrhosis, Child Turcotte Pugh (CTP) score were recorded.</p> <p>Results</p> <p>Out of 187 patients with AFI, 44 (23.5%) had SBP while 143 (76.4%) had CNNA. Hepatitis C virus (HCV) infection was the most common cause of cirrhosis in 139 (74.3%) patients. Patients with SBP had high CTP score as compared to CNNA (12.52 ± 1.45 vs. 11.44 ± 1.66); p < 0.001. Platelets count was low in patients with SBP (101 ± 53 × 10⁹/L) as compared to CNNA (132 ± 91 × 10⁹/L), p = 0.005. We found a high creatinine (mg/dl) (1.95 ± 1.0 vs. 1.44 ± 0.85), (p = 0.003) and high prothrombin time (PT) in seconds (24.8 ± 6.6 vs. 22.4 ± 7.2) (p = 0.04) in SBP as compared to CNNA. More patients with SBP (14/44; 31.8%) had blood culture positivity as compare to CNNA (14/143; 9.8%), p = 0.002. Escherichia. Coli was the commonest organism in blood culture in 15/28 (53.5%) patients. SBP group had a higher mortality (11/44; 25%) as compared to CNNA (12/143; 8.4%), p = 0.003. On multiple logistic regression analysis, creatinine >1.1 mg/dl and positive blood culture were the independent predictors of mortality in patients with SBP.</p> <p>Conclusion</p> <p>Patients with SBP have a higher mortality than CNNA. Independent predictors of mortality in SBP are raised serum creatinine and a positive blood culture.</p

Histopathological Changes in the Gall Bladder Mucosa Associated with Helicobacter Pylori Gastritis

Objective: To detect Helicobacter Pylori (HP) gastritis associated histopathological changes in Gall Bladder (GB) mucosa in patients undergoing cholecystectomy. Material and Methods: This prospective comparative cross-sectional study was conducted in Gastroenterology department of Liaquat National Hospital, Karachi, Pakistan, from December 2021 till December 2022.This study was conducted on all patients admitted with diagnosis of any Gall Bladder pathology and those who were electively planned for cholecystectomy. Patients were enrolled after informed consent. Participants were allotted into two groups on the basis of presence of HP (group A) and no HP (group B) in gastric mucosa prior to cholecystectomy. Detection of HP was done using different methods as HP stool antigen (HPSA), Urea breath test (UBT), HP antibodies and also by biopsy proven with gastroscopy. All post cholecystectomy specimens were sent to single histopathology laboratory and were reviewed by single histopathologist to avoid operator error. Results: Mean age of the patients of group A was 42.88+8.28 years and of group B was 43.35+8.74 years (p=0.458). In accordance to the GB histological findings Chronic cholecystitis + focal Cholesterolosis was significantly higher in group A 75.4%, while Chronic cholecystitis was significantly high in group B 66.2% (p=0.001). Although dysplasia was noted more in group B as compared to group A.Histopathologic finding of erosion was found to be more in group A patients than in group B (p=0.001).Patient with persistent symptoms in HP positive group although not significant but showed improvement in symptoms post eradication(p=0.527) Conclusion: The histological findings of chronic cholecystitis and focal Cholesterolosis were significantly higher in HP positive group compared to HP negative group, while chronic cholecystitis alone was significantly higher in HP gastritis negative group. Increased symptom improvement was also noted in few HP gastritis group patient post HP eradication

Hepatic cystic echinococcosis: clinical characteristics and outcomes in Pakistan

Hepatic cystic echinococcosis (HCE) is an emerging disease in central Asia, particularly in Pakistan, due to the migration of infected people. Medical records of Patients with HCE admitted between 1995 and 2006 to a tertiary care hospital were reviewed. A total of 106 Patients were admitted with a mean age of 34 +/- 17 years, 60 (56.6%) were men, 72 (67.9%) were residing in rural areas of Pakistan and 21 (19.8%) were Afghan refugees.Twenty-seven (25.4%) had extra hepatic cysts and liver cysts. All Patients received albendazole. Percutaneous aspiration, instillation and reaspirarion was done in 14 (13.2%) Patients and 71 (66.9%) underwent surgery. Three (2.8%) died and 14 (13.2%) had morbidity. This is one of the largest series of HCE reported from Pakistan. HCE is mostly prevalent in rural areas and among Afghan refugees with low mortality and recurrence, but with significant morbidity