Repair of post polypectomy colonic perforation by Endoclip: a case report

A 73-year-old woman was admitted to evaluate for iron deficiency anemia, increased serum creatinine, and ascites. Her colonoscopy revealed a polyp at the junction of sigmoid and descending colon, and after polypectomy, a 6 mm colonic perforation was seen. The perforation was detected by radiography and CT scan; and beside conservative management and antibiotics, her perforation was closed by using Endoclip. The patient was observed and discharged from hospital without any surgery 5 days later, and in follow-up there was no problem regarding perforation. Resumo: Mulher, 73 anos, internada para avaliação para anemia ferropriva, com aumento da creatinina sérica e ascite. A colonoscopia revelou um pólipo na junção dos colos sigmoide e descendente e, em seguida à polipectomia, foi observada uma perfuração de 6 mm no cólon, comprovada por radiografias e tomografia computadorizada. Além do tratamento conservador e da antibioticoterapia, a perfuração foi ocluída com Endoclip. A paciente ficou sob observação e recebeu alta do hospital sem qualquer cirurgia 5 dias mais tarde. Durante o seguimento, não foram observados problemas com relação à perfuração. Keywords: Polypectomy, Colonic perforation, Endoclip, Palavras-chave: Polipectomia, Perfuração de cólon, Endocli

Stool Antigen Tests for the Detection of Helicobacter Pylori in Children

Objective: Reliable non-invasive methods for detection of Helicobacter Pylori (H. pylori) infection are required to investigate the incidence, transmission, and clearance of infection in childhood. Detecting bacterial antigens in stool offer an alternative noninvasive diagnostic test. However its accuracy in developing countries is not well established. The aim of this study was to evaluate the performance of stool antigen test for H pylori in Iranian children with recurrent abdominal pain necessitating endoscopy. Methods: One hundred three children enrolled in this study. Endoscopy and biopsy was done on all patients providing a criterion standard for validation of the H. pylori stool antigen (HpSA) tests. The presence of H. pylori organisms in stool was determined by an enzyme-linked immunosorbent assay using a commercially available polyclonal antibody. HpSA sensitivity, specificity, and positive and negative likelihood ratios were determined with reference to the results of cultures of gastric biopsy. Findings: Of the 103 children tested 41 (39.8%) and 39 (37.8%) were positive for H. pylori according to the results of cultures of gastric biopsy and HpSA, respectively. The sensitivity, specificity, and positive and negative likelihood ratios of HpSA were found to be 85%, 93%, 89.7%, and 90%, respectively. Conclusion: In this pilot study, a low-cost and rapid diagnostic technique, stool antigen test proved to be highly sensitive and specific for detecting H pylori infection in children with recurrent abdominal pain. Our results are comparable to those reported elsewhere in children and demonstrate that the HpSA test can replace endoscopy and biopsy for detecting H. pylori infection

Relationship of Demographic and Clinical Variables with the Severity of Disease in Patients with Ulcerative Colitis Relapse in Qom Shahid Beheshti Hospital During 2017, (Iran)

Background and Objectives: Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD), which is identified by inflammation and damage to colonic mucosal cells and leads to ulceration and bleeding. This study aims to investigate the relation of demographic and clinical variables with the severity of the disease in patients with UC relapse.   Methods: This cross sectional study was conducted on 65 patients with UC relapse referred to Shahid Beheshti hospital during 2017-2018. Demographic, clinical, and laboratory data were collected using a checklist. Data were analyzed by statistical tests of ANOVA and Chi-square.   Results: In this study, among 65 participants, 35 were male and 30 were female. The mean age of the patient was 36±14 years, of whom, 40% had mild and 60% moderate and severe relapse of the disease. From all studied variables, young age (p=0.050), higher body temperature (p=0.019), higher pulse rate, lower level of hemoglobin, and higher levels of ESR and WBC (all with p<0.001), had a direct relationship with the severity of the disease.   Conclusion: Patients with younger age and more severe inflammatory state experience a more severe relapse periods. Therefore, future studies can focus on reducing the severity and frequency of the relapse episodes

The Effect of Antiviral Therapy with Tenofovir on Liver Fibrosis and Liver Function in Patients with Chronic Hepatitis B

Background and Objectives: Chronic viral hepatitis B is a global health problem, which, if not treated, can lead to some serious complications, such as liver cirrhosis and hepatocellular carcinoma. In this study, the effect of antiviral therapy with tenofovir, was investigated on reduction of liver fibrosis and improvement of liver function in patients with chronic hepatitis C. &nbsp; Methods: In this clinical trial, 40 patients with chronic hepatitis B underwent antiviral therapy with tenofovir 300 mg daily. Demographic information and results of laboratory tests (before treatment and 6 months after the start of treatment), were collected using a checklist. Liver stiffness was measured and recorded using a fibroscan device (before and 6 months after the treatment). Data were analyzed using Wilcoxon and paired t- tests. The level of significance was considered to be p<0.05. &nbsp; Results: Among 40 patients, one person was excluded from the project due to lack of follow-up. Of remaining 39 patients, 27 subjects (69.2%) were male and 12 subjects (30.8%) were female. The mean age of the patients was 47.53&plusmn;13.68 years. The mean levels of AST, ALT, Child score, and liver stiffness did not show significant improvement during a 6-month follow-up according to Wilcoxon and paired t- tests. &nbsp; Conclusion: This study showed that although hepatic fibrosis and liver function in patients with chronic hepatitis B are reversible after treatment, changes require long-term treatment and follow-up. &nbsp

Outcomes and Complications of Percutaneous Endoscopic Gastrostomy in Qom Shahid Beheshti Hospital During 2014-2017

Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) is a common method for maintaining enteral nutrition in patients who, for any reason, have dysphagia for more than 30 days. With respect to widespread application of this method, the present study was carried out with the aim of determining its outcomes and complications. &nbsp; Methods: This cross-sectional study was conducted by Gastroenterology and Hepatology Diseases Research Center of Qom University of Medical Sciences using information of patients who underwent PEG tube placement in Qom Shahid Beheshti Hospital during 2014-2017. Data were analyzed by using Chi-square test. &nbsp; Results: Out of 717 patients, 402 (56.07%), were male with the mean age of 47&plusmn;8 years, and 315 subjects (43.93%), were female with the mean age of 53&plusmn;11 years. The most common indication of PEG placement was cerebrovascular accident. Seventy-nine (11.01%) patients had complications, and the most observed complication was reported to be leakage (21.52%), which in most cases was delayed (in 3 month follow-up). Displacement of the PEG tube, obstruction, and infection or bleeding of the site, were expressed as common complications. There was also no significant difference between the two genders in terms of the incidence of complications, and mortality rate was reported 0 in the 3 month follow-up. &nbsp; Conclusion: Based on the results of this study, PEG placement can be a safe method for maintaining enteral nutrition with low rate of complications and mortality. &nbsp