17^th International Conference on Gastroenterology and Hepatology September 03-04, 2018 Dubai, UAE

Biography:

Dr Eyad Gadour is currently senior specialist registrar in training program in Manchester-UK.  He is about to become a Consultant Gastroenterologist with special interest in Hepatology and Hepatobiliary. His MBBS was obtained from The National Ribat University in Sudan. His General medicine training is conducted mainly in Manchester and done Fellowship in Inflammatory Bowel Disease IBD as well as Liver Transplantation at St James’s University Hospital in Leeds. Dr Gadour has publications in Gastroenterology, Hepatology as well as Upper GI Surgery with few international presentations.

Abstract:

Introduction:

Inflammatory bowel diseases (IBD) are a group of chronic diseases of the bowels which have unknown aetiology. Reports indicate that prolonged inflammation leads to the damage of the GI tract. There are two major types of IBD; namely, Crohn’s Disease abbreviated as CD and Ulcerative Colitis abbreviated as UC.              

Study Aim:

The main aim of this study is to monitor the glycaemic status of IBD patients during the remission and flare-up. The study will investigate if there is any relation between blood glucose level and remission in patient with IBD. 

The hypothesis is glucose status is abnormal in active inactive IBD.

Methodology:

A cross-sectional study determines exposure and outcome simultaneously for every subject.  The total numbers of sample employed in this study was 160. The study participants were classified into three groups. The first group included the patients with IBD in remission while the second group comprised of the patients who are experiencing flare up. The third group comprised of normal subjects who were equally described as the control group. The inclusion criteria for the participants in this study included age that encompassed 16-90 year-old, the medical condition of the patient where the ones included were known to have IBD, and the patients under gastroenterology team at University Hospital of South Manchester. . The exclusion criteria for a subject to be removed or not allowed to take part in this study were pregnancy.  In this research, the software SPSS version 20 was used to analyse the data. The relationship between study variables was equally examined using the Chi-Square test, and independent T test. Study hypothesis was examined using One Way Anova Test. Regression analysis was also used to identify predictors of IBD. Significance was considered at alpha level <0.05.

Results:

The total number of participants in this study were 160 whose medical records were analysed as well as tests conducted for various indicators of IBD disease on their blood samples. 57% of 91 participants were female (57%) while 69 participants were male (43%). Out of this population, 68% were aged 40years and above while 32% were below 40 years of age. This indicates that Inflammatory Bowel disease (IBD) affects mostly people above 40 years of age. The Montreal classification type A2L1B1 (8.1%) L1- location Ileocolonic and B1-inflammtory behaviour was lower compared to 16% of E1S0. This indicates that most IBD patients are in this category of Montreal classification. There are no significant statistical differences seen in the other disease types. The other Montreal classification category A2L2B2 [16%] equally had a high percentage in diabetes patient but found to have no statistical difference between other Montreal classifications. 

A1L1B1 Montreal classification category participants has the least relationship with diabetic patients (0.6%).

Conclusion:

In conclusion, the principal aim of this study is to monitor the glycaemic status of IBD patients during the remission and flare-up.  The chi-square of age and sex indicated a variance of 1.55. And (p<0.05). This shows that there is no significant difference between age and sex hence most people are affected by IBD. This thus rejects the null hypothesis and accepts alternative hypothesis that states that there is a relationship between glycaemic status of IBD patients during the remission and flare-up. The hypothesis also proves that there is a relation between blood glucose level and remission in patient with IBD.  

Biography:

Prof. Emad S. Aljahdli is currently serving as an Assistant professor of Internal Medicine at King Abdul Aziz University Hospital in Jeddah.  He is also the Gastroenterology Fellowship Program Director at King Abdul Aziz University Hospital. Prof. Emad S. Aljahdli is certified with CFMG certified American Board of Internal Medicine Certified and American Board of Gastroenterology Certified. He graduated from King Abdul Aziz University Medical school in 2015. 

Abstract:

Cystic pancreatic neoplasms are being found with increasing prevalence, especially in elderly asymptomatic individuals. The overall risk of malignancy is very low. Associated with a significant degree of anxiety and further medical investigation due to concerns about malignancy. The increasing numbers of cases we are seeing is in part related to the increased awareness of their existence. Increased use of cross-sectional imaging (CT and MRI), which had led to accidental discovery of many pancreatic cysts.  Nonetheless, because of the known malignant potential of this diagnosis, their identification generates anxiety, need for subsequent imaging, and sometimes invasive testing or surgery. In this presentation, I will discuss the different types of pancreatic cysts(benign and malignant) and the risk of developing pancreatic cancer in each of them. Also, I will discuss the current diagnostic modalities and management approach. The presentation will also shed light on ongoing research and clinical trials on erous cystadenoma, IPMN, mucinous, and pseudo cysts in improving the diagnostic yield that will help to treat patients better y avoiding unnecessary surgery.

Biography:

Prof. Emad S. Aljahdli is currently serving as an Assistant professor of Internal Medicine at King Abdul Aziz University Hospital in Jeddah.  He is also the Gastroenterology Fellowship Program Director at King Abdul Aziz University Hospital. Prof. Emad S. Aljahdli is certified with CFMG certified American Board of Internal Medicine Certified and American Board of Gastroenterology Certified. He graduated from King Abdul Aziz University Medical school in 2015. 

Abstract:

Cystic pancreatic neoplasms are being found with increasing prevalence, especially in elderly asymptomatic individuals. The overall risk of malignancy is very low. Associated with a significant degree of anxiety and further medical investigation due to concerns about malignancy. The increasing numbers of cases we are seeing is in part related to the increased awareness of their existence. Increased use of cross-sectional imaging (CT and MRI), which had led to accidental discovery of many pancreatic cysts.  Nonetheless, because of the known malignant potential of this diagnosis, their identification generates anxiety, need for subsequent imaging, and sometimes invasive testing or surgery. In this presentation, I will discuss the different types of pancreatic cysts(benign and malignant) and the risk of developing pancreatic cancer in each of them. Also, I will discuss the current diagnostic modalities and management approach. The presentation will also shed light on ongoing research and clinical trials on erous cystadenoma, IPMN, mucinous, and pseudo cysts in improving the diagnostic yield that will help to treat patients better y avoiding unnecessary surgery.

Biography:

Prof. Aamir Ghafoor Khan currently heads GI & Hepatology division at Lady Reading Hospital in Peshawar, Pakistan. Besides being the Focal Person for Hepatology in KPK Province of Pakistan, Prof. Aamir is actively involved in undergraduate and postgraduate teaching and is examiner for MRCP(UK) and FCPS exams. He is currently International Adviser(IA) to Royal College of Physician of London and also Royal College of Physician of Edinburgh. Prof. Aamir Ghafoor Khan is Past President of Pakistan Society of Gastroenterology & GI Endoscopy. He has a sound academic background with presence on editorial boards and as reviewer for various Journals like Arab Journal of Gastroenterology, Hepatitis Journal of Iran, and Pakistan Journal of Gastroenterology etc. He is a core committee member of World Gastroenterology Organisation (WGO) Guidelines Committee. Prof. Aamir is a frequent speaker at various International GI & Hepatology meetings and his unit is actively engaged in clinical research in field of Gastroenterology, with nearly 40 publications to his credit.

Abstract:

Esophageal varices are Porto-systemic collaterals, i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. Rupture and bleeding from esophageal varices are major complications of portal hypertension and are associated with a high mortality rate. Variceal bleeding accounts for 10–30% of all cases of upper gastrointestinal bleeding.

A gold standard approach is feasible for regions and countries where the full scale of diagnostic tests and medical treatment options are available for the management of esophageal varices. However, throughout much of the world, such resources are not available. With Diagnostic and Treatment Cascades the WGO Guidelines provide a resource sensitive approach.

Cascade: a hierarchical set of alternative diagnostic, therapeutic and management options to deal with risk and disease - ranked by resources available.

Biography:

Prof. Dr. Amin El-Gohary completed his MBBCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. He was appointed as Chief Disaster Officer during Gulf War. He also held post as the Clinical Dean of Gulf Medical College, Ajman for 3 years. Prof. Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He is the President of the Pediatric Surgical Association of UAE. He was awarded the Shield of the College of Pakistan and the Medal of International Recognition in pediatric urology from the Russian Association of Andrology. Prof. Dr. Amin is also the founder and member of the Arab Association of Pediatric Surgeons. Prof. Dr. Amin has an intensive academic and teaching experience, has written several publications in distinguished medical journals, and has made several poster and paper presentations in national and international conferences. Currently, he is an external examiner for the Royal College of Surgeons

Abstract:

Gohary’s  disease is a new phenomenon that has not been described before. It depicts a group of children who present to emergency department with severe agonizing abdominal pain. The pain tends to start and ends abruptly , no predisposing factor and recurs after minutes or hours. Ultrasonography revealed a mesas at right iliac fossa ,which is usually  diagnosed as intussusception.  The underlying cause of such phenomenon is the fecal impaction of stool at terminal ileum which act as intermittent intestinal obstruction. We have encountered 19 cases over the last 5 years, their age varied from 9 months to 8 years with the majority under the age of 2 years.  The cardinal symptoms and signs are

1: severe abdominal pain that warrants urgent attention

2: Empty rectum on examination

3: Ultrasound diagnosis of intussusception

All of these cases were managed by fleet enemas with immediate response.

Awareness of this condition will help to avoid unnecessary investigation and unjustified exploration.

Biography:

Abstract:

The transverse abdominis plane (TAP) block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall (T6 to L1). It was first described in 2001 by Rafi as a traditional blind landmark technique using the lumbar triangle of Petit1. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, Open transversus abdominis plane block and a subcostal access termed the 'oblique subcostal' access.

OBJECTIVES:

New technique review aiming to describe the technique of direct laparoscopic technique in transverse abdominal plan blockade for different surgical interventions

METHODS:

Detailed review of TAP blockad starting from relevant anatomy, brief description of old TAP blockade techniques. Details of Direct Laparoscopic TAP blockade, with description of complications, technical difficulties, results and expectations

CONCLUSIONS:

Direct laparoscopic transverse abdominal plan blockades is simple procedure, with high quality efficacy, can be used routinely in most of laparoscopic surgery procedures of the abdomen and pelvis

Biography:

Dr MATHEW VADUKOOT L completed MD Medicine from INDIA and did DM gastroenterology from AMRITA INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE ,KERALA,INDIA. He worked in Transplant Hepatology, pancreatology, Interventional and pediatric gastroenterology. He also presently working in Life care hospital Abu Dhabi as Specialist Gastroenterologist. 

Abstract:

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent form of chronic liver

disease in the world. NAFLD exhibits a histological spectrum, ranging from steatosis to the more aggressive necro-inflammatory form, non-alcoholic steatohepatitis to cirrhosis leading to Hepatocellular carcinoma. Ongoing clinical trials are focused on an array of disease mechanisms and reviewed here are how these treatments fit into the current paradigm of substrate overload lipotoxic liver injury. Emerging data suggests fibrosis, rather than NASH per se, to be the most important histological predictor of liver and non-liver related death. Nevertheless, only a small proportion of individuals develop cirrhosis, NAFLD has led to predictions that it will become a leading cause of end stage liver disease, Hepatocellular carcinoma (HCC), and indication for liver transplantation. HCC may arise in non-cirrhotic liver in the setting of NAFLD. The Metabolic syndrome and its components also play a key role in the histological progression of NAFLD, however other genetic and environmental factors may also influence the natural history.

The importance of NAFLD in terms of overall survival extends beyond the liver where evtraintestinal manifestations like cardiovascular disease and malignancy represents additional important causes of death

Biography:

Dr. Ahmad Almaiman received his MBBS from University of Sharjah, College of Medicine in 2017. He conducted his Internship at King Khalid University Hospital in King Saud University Medical City. He will be conducting an Observership in his field of interest Pediatrics in the USA this December, prior to his Residency in the same field in 2019. Subspecialties of interest to him include: Neonatology, Gastroenterology, and Rheumatology. As part of his University Curriculum in Community Based Research, Dr. Ahmad presented a research titled Lifestyle Changes Among Freshmen Students (2014), which was published as an abstract and presented as a poster for the 4th National Conference of Applied Psychology in the UAE in March of 2016.​

Abstract:

Intussusception is a clinical disorder characterized by the telescoping of a proximal part of the bowel into its distal part. The point that invaginates into its adjacent part is known as the "Intussusceptum" (also referred to as the lead point), while the distal segment that receives the folding is known as the ''Intussuscipien''. This is one of the most important causes of acute abdomen in children, particularly infants and toddlers (3 months - 3 years), however it is a rare condition in adults and brings about a variety of symptoms and patterns; be it acute, intermittent, or chronic. This disorder particularly triggers worrisome matters that are deemed target worthy in the clinical setting. One of these matters is managing the possible shock that comes about with the excessive compromise of the mesenteric blood supply, which ends up thickening the intestinal wall leading to fatal complications of ischemia and perforation. Intussusception's diagnostic approach also happens to be its therapeutic approach, which is non-operative reduction (be it air or barium enema). The recurrence risk of Intussusception is one that demands a cautious observation in an in-patient setting, as the reduction management helps in limiting said risk allowing the recurrence to alter between 24 and 48 hours onwards. In recent years, there has been a presentation of this disorder in children who were provided with the Rotavirus vaccine bringing about different post-marketing surveillances to understand the possible risks of developing Intussusception. Along with the general overview on the topic of Intussusception the following highlights will be included: an emphasis on the potential complications of Intussesception, its distinguishing presentation between children and adults, favoring air over liquid enema in reduction management, and Intussesception's increasing risk if/when the Rotavirus vaccine is given.

Biography:

Shahram Agah is the Director of Endoscopy ward and Colorectal Research Center at Rasoule-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, where he works as a Professor in the field of Gastroenterology and Hepatology. His basic education and professional training have been in Iran, however, he attended at Chemnitz hospital, Germany in 2001 and Rush University, Chicago, USA in 2017 for better experience in therapeutic endoscopy and Endosonography. He has traveled to Australia to obtain more experience in advanced endoscopy (EMR and ESD) and some collaborative researches. He is the principle investigator on several clinical trials in gastrointestinal disorder.

Abstract:

About 70%–80% of colorectal neoplasia arises from conventional adenomatous polyps. Polypectomy reduced the risk of colorectal cancer by the order of 75%–90%. 80% to 90% of polyps are smaller than 10 mm. Morphological description (considering Paris classification), Size estimation (smaller or larger than 10 mm), Relation to the surrounding mucosa: (e.g. Saddle distribution over a fold, or an invasive lesion. Safe polypectomy implies the ability to resect and completely remove a polyp while achieving hemostasis and maintaining the integrity of the colonic wall. Polyps of ≤ 6 mm can be safely removed by cold snaring. Electrocoagulation with a blend or cutting setting should be used for polyps> 10 mm. The different snare is using for the polypectomy. Try to put the polyp at 5 to 6 o’clock position at the time of resection. Small, flat sessile polyps, pedunculated polyps with very large pedicles, large flat sessile lesions or laterally spreading tumors are challenging polyps. For the first one, the cold snare is the safest method. For the second one, post-polypectomy hemorrhage is the most problems which can be prevented with endoloop or clip. For laterally spreading tumor or large sessile lesion, EMR is recommended. Injection is recommended in lesion > 10 mm in the right, > 15 mm in the left, and in both parts if a lesion is hidden behind a fold. With moderate expertise, EMR of the lesions occupies more than one-third of the circumference of the colonic wall or maximally crosses over two haustral folds. Submucosal sequential injection and piecemeal resection after 1 to 2 ml saline or gelfusion. Resect most inaccessible first. Consider removal of some normal tissues. Consider snare tip soft coagulation of removed tissues rim for reduction of recurrence.

Biography:

Dr Sanae Reggoug is a board certified gastroenterologist and hepatologist. She has been practicing in Dubai since 2014 and is currently working at Al Garhoud Private Hospital, in Dubai.  After graduation from University Mohamed V in Rabat (Morocco), she completed her gastroenterology and digestive endoscopy fellowship in the University of Rennes in France, one of Europe most renowned excellence center for Hepatology, Proctology and Inflammatory Bowel Diseases. Dr Sanae is also subspecialized in medical and instrumental proctology and holder of a diploma in medico-instrumental proctology from the French Society of Colo-Proctology. She has as well a special interest in digestive oncology and is holding a diploma in digestive oncology delivered from the University of Versailles Saint-Quentin-en-Yvelines (Paris, France). Actively involved in clinical research, Dr Sanae has several articles published in several peer-reviewed journals, such as American Journal of Gastroenterology. 

Abstract:

Proton pump inhibitors (PPI) are amongst the most commonly prescribed medications worldwide. Long term use of PPI is indicated in some clinical situations such as severe gastroesophageal reflux disease and prophylaxis purpose in patients using non-steroidal anti-inflammatory drugs.

PPIS safety profile was considered very good till recent years.  A systematic medical literature search through Pubmed, using keywords PPI, safety, long term and risk, revealed not less than 300 publications related to PPI safety since the beginning of year 2017. These medical publications received considerable attention from media and strongly affected not only patient’s therapeutic compliance but also prescribers practice.

During this evidence-based presentation, the safety of long term use of PPIs will be examined and guidance will be provided on what clinicians need to know and what to tell their patients. A critical and objective analysis of the studies on PPIs safety will be demonstrated, highlighting epidemiological limitations and methodological concerns. 

Biography:

Dr. Abdul Qadir Khan Professor of medicine, Head of Department, Consultant Physician & Gastroenterologist at Muhammad Medical College & hospital Mirpurkhas. He obtained his SSC from Shah Wali Ullah High School Mirpurkhas. He has done HSC from S.A.L College Mirpurkhas. He obtained his MBBS from Liaquat University of Medical and Health Science Jamshoro. He done his fellowship in Medicine in 2005 from CPSP Karachi and Honorary worked in Gastroenterology Department at AKU Karachi. He also has done Masters in Gastroenterology from AIMS Hyderabad. He is Member of Pakistan society of gastroenterology, Pakistan society of Hepatology and Pakistan society for study of liver. He has published many papers in different Pakistani journals and reviewer of articles as well. His main areas of interest are liver diseases specially Hepatitis B & C.

Abstract:

Objective:  To see Treatment out come and side effects of directly acting oral anti HCV drugs.

Study Designs: Single prospective / observational study

Place and duration of study: Liver & GI center new towns Mirpurkhas from August 2017 to August 2108.

Inclusion criteria: All chronic Hepatitis C patients.

Exclusion criteria: Pregnancy, lactating females and Hepatocellular carcinoma   

Methodology:   Outdoor chronic Hepatitis C patient treated with directly acting oral anti HCV drugs were enrolled. Quantitative HCV RNA was tested at week 4, 12 during and week 24 after the treatment, side effects of treatment were asked from the patients during the follow up visits. Data was put on a pre designed Performa

Results:  94 numbers of patients enrolled, out of which 48 were males and 47 were females, male to female ratio was 1:1.

51 (52%) were naïve,     47 (47.9 %) were treatment experienced, out of them 32 (32.6%) were CLD patients, out of them 22 (68.3%)  were Child A cirrhosis, 10 (31%)  were Child B cases.

One patient was co-infected with HBV; their previous treated genotype was 3a (68%).

Quantitative PCR ranges from 1020 IU to 530000 IU/ml.

In all (94) patients HCV RNA was negative at 4 and 12 weeks of treatment. Viral response at 24 weeks after the treatment was different.  Viral clearance in patients With Sofosbuvir and Ribavirin was 83% (50 out of 62). With Sofosbuvir and Daclatasvir response rate was 91% (11 out of 12).  One patient put on Sofosbuvir and Ribavirin stop the treatment by herself due to palpitation and epigastric pain.

While in Decompensated patients put on Sofosbuvir and Ribavirin the response rate was 65 %( 13 out of 20). And patients put on Sofosbuvir and Ribavirin and Daclatasvir the response rate was 83% (10 out of 12). One cirrhotic patient developed HCC during the treatment may be due to disease course not because of the treatment. Mild anemia was noted in 15 numbers (14.7%) of patients that was treated with folic acid and iron, no major side of the DAAs were noted during the treatment.

Conclusion:

New directly acting oral anti HCV (DAAs) is well tolerated and efficacious, further studies are needed in more number of patients to assess the efficacy and side effects  

Biography:

Dr Moeen ul Haq completed his MBBS from Ayub Medical College Abbottabad in 2006. He has worked in Nishtar Hospital Multan and Lady Reading Hospital Peshawar for His Post graduation. He has done his post graduation in Dec 2016. He is now working as Assistant Professor Gastroenterology in Gomal Medical college D I Khan Pakistan. He has published 6 articles in different journals of Pakistan and presented several presentations in international conferences.

Abstract:

The Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. It was proposed that small intestine bacterial overgrowth (SIBO) plays an important role in the pathogenesis of IBS. So this altered intestinal microbial flora in patients with IBS suggests that the best treatment strategy will be to target this altered flora. Recently, the deleterious role of qualitative or quan­titative alterations of gut microbiota at the onset of symptoms has been emphasized. Methodology: In this RCT, the study population was recruited by using Room III criteria of IBS. After taking informed consent from all the participants they were randomized into either of two groups to receive the study drug or placebo for duration of 4 weeks. After the baseline assessment there were a total of three assessments of each participant. At each assessment two things were noted improvement in the IBS symptoms and the compliance of the drugs. Results: A total of the 120 patients having IBS were enrolled in the study, 60 in each group, the number of drop outs in L.Plantarum group were 5 while in the placebo group were 7. At the end of study the L.Plantarum was found to have effect no better than placebo on the abdominal pain frequency (2.7 vs 3.4 p=0.21). After 4 weeks of therapy the severity of abdominal pain has no significant difference in L.Plantarum vs placebo group (5.54 vs 6.69 p=0.15) as compared to the baseline (8.71 vs 7.84 ).  Similarly in the severity of bloating (4.13 vs 3.98 p = 0.34) and the feeling of incomplete rectal emptying (1.21 vs 0.98 p=0.19) the difference in the both the groups was not significant. Conclusion: This RCT failed to show any significant improvement in the IBS symptoms by the use of L.Plantarum when compared with the placebo.

Biography:

Dr. SAIF ULLAH received his bachelors from the School of Medicine of Zhengzhou University, China. He is currently doing MD under kind supervision of Prof. Bingrong Liu, president of GI Hospital , The First Affiliated Hospital of Zhengzhou University, China. Dr. SAIF ULLAH has been carrying out series of animal experiments and clinical research in the endoscopic procedures related to NOTES under the supervision of Prof. Bingrong Liu.

Abstract:

Background and aim: Esophageal stricture is a major complication of large area endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). To date, the critical mechanism of esophageal stricture has not been fully elucidated. Here, we designed this experiment to explore the role of mucosal loss in esophageal stricture after mucosal resection in a porcine model.

Material and Methods: Twelve swine were randomly divided into two groups. Firstly, in all the swine, two submucosal tunnels were made of 5 cm in length and 1/3rd in width on the anterior and posterior wall of the esophageal circumference. After that, the covered mucosa was resected along the lateral edges of the tunnel in the group 1. Meanwhile covered mucosa was incised on the midline of the tunnels in the group 2. The process of stricture formation was evaluated by endoscopy after one, two and four weeks respectively. Anatomical and histological examinations were performed after euthanasia.

Result: Ulcer formation was observed on endoscopy after one week. Group 1(mucosa resected) developed mild to severe esophageal stricture with dysphagia and weight loss, whereas no esophageal stricture was evident in the ones of group 2 (mucosa incised) after two and four weeks respectively. Macroscopic appearance showed severe esophageal stricture and shortening of esophagus in the group 1 while no evident esophageal stricture and shortened esophagus was found in the group 2. Inflammations and fibrous hyperplasia of submucosal layer was observed in both groups, on histological examination.         

Conclusion: The loss of esophageal mucosa might be the crucial factor for esophageal stricture after mucosal resection. Fibrosis followed by inflammation may slightly attribute toward esophageal stricture formation but is not the main mechanism of post-resection stricture. These results have significance for developing a suitable treatment for esophageal stricture.

Biography:

Dr Eyad Gadour is currently senior specialist registrar in training program in Manchester-UK.  He is about to become a Consultant Gastroenterologist with special interest in Hepatology and Hepatobiliary. His MBBS was obtained from The National Ribat University in Sudan. His General medicine training is conducted mainly in Manchester and done Fellowship in Inflammatory Bowel Disease IBD as well as Liver Transplantation at St James’s University Hospital in Leeds. Dr Gadour has publications in Gastroenterology, Hepatology as well as Upper GI Surgery with few international presentations.

Abstract:

Introduction 

Percutaneous endoscopic gastrostomy (PEG) is a commonly used method to insert the gastrostomy tube in patients who experience difficulties swallowing but their guts are working as expected. For a clear analysis of the scenario, we have reviewed the mortality rates between 1st Jan 2015 and 1st Jan 2018 at Fairfield General Hospital. The assessment of the of the outcome of PEG tube placement for inpatient was carried out based on the mortality, morbidity as well as survival that is long term. Many variables have been taken into consideration in this study including serum CRP, serum Albumin level, pervious medical problems like Dementia, Atrial fibrillation, severity of the stroke using NIHSS score as well as development of aspiration pneumonia afterwards.  We have also reviewed our current practice against the BSG Antibiotics recommendation for PEG insertion. 

Methods

An analysis of the primary cause of mortality after the patients underwent PEG insertion  was undertaken for about three years between 1st Jan 2015 and 1st Jan 2018 at Fairfield General Hospital endoscopy unit for clarity and correctness purposes. We studied the best time for PEG insertion as well we patient selection. We used some serum blood tests (CRP and Albumin level) as prognostic factors. We involved variety of patients with difficulty swallowing including dementia patients. The data has been collected from patients’ record using ‘Unifsoft’ and clinical letters as well as the endoscopy unit diary. 

Results

The sample size for the experiment was 68 patients who comprised of both male and female genders, 42 of them were males, and 26 were females which represented 62% and 38% respectively. The majority of the patients (63) had antibiotics given before the PEG insertion 92% as per the BSG guidelines where 7% did not have antibiotics. Among patients who did not have antibiotics before the procedure 40% died within 6 months, 40% still alive (one year after the procedure) and 20% died within one month. All he patients who died after the procedure had significantly high serum CRP level with low serum Albumin level. Patients with dementia were 11% and 87.5% of them were alive 12 months after the PEG insertion. Around 33.8% had severe stroke yet 69.5% of them had good outcome. Whereas patients who had PEG inserted due to non-stroke related dysphagia 33.8% had slightly poorer outcome with only 52% survived the first 12 months. Few patients experienced aspiration pneumonia after PEG insertion 23.5% and there were no Endoscopic complications. When the intention-to-treat analysis applied on the patients above 65 year and below 65 of the sample size, it was realized that the one year survival rate was 20% and 80% respectively. 

Conclusion

From the sample size analysis, it is evident that the endoscopy team at Fairfield Hospital are following the BSG guidelines for antibiotics usage before PEG insertion 92%. The outcome is better when PEG inserted within four weeks from the Stroke if it was inserted for Stroke. The severity of the Stroke was not directly related to the mortality rate after PEG insertion. Dementia should not be a contraindication for PEG insertion. The mortality is higher in the patients who had PEG inserted for non-stroke related dysphagia. CRP and Albumin level may be considered as part of selection as they can predict the pot-PEG mortality 

Biography:

Bianca Maria Corozel is currently studying at University of Oradea - Faculty of Medicine, 3rd year in Romania.

Abstract:

Introduction: A diaphragmatic hernia occurs when one or more of the abdominal organs move upward into the chest through a defect (opening) in the diaphragm.It can be congenial or won.

There are two types of diaphragmatic hernias: Morgagni hernia (rhetro-costo-xifoidiana) and the Bochdalek hernia (postero-lateral).Prenatal diagnosis is done exclusively by 3D sonography, and the postpartum one bythe  X-ray as the first intention.

The confirmation of the diagnosis is made with the digestive tube’s radiography through the contrast substance with frontal and sagittal reconstructions or MRI (also to highlight the discontinuity of the diaphragm). The traumatic hernia may result from injuries, height drops, difficult and prolonged labor, with diaphragm rupture, penetration of one or more abdominal organs into the chest, with compression of the lungs and heart and cardio disturbances – constant breathing.The treatment of diaphragmatic hernias is surgical, both in recent hernias, by removing the respiratory disorders, as well as in latent phase hernias to prevent a dramatic complication. Operative intervention may be urgent or timed.

Conclusions: The diaphragmatic hernia is a severe disease which can endange the pacient’s life if he is not getting the specialized treatment.

Biography:

Bianca Maria Corozel is currently studying at University of Oradea - Faculty of Medicine, 3rd year in Romania.

Abstract:

Introduction: A diaphragmatic hernia occurs when one or more of the abdominal organs move upward into the chest through a defect (opening) in the diaphragm.It can be congenial or won.

There are two types of diaphragmatic hernias: Morgagni hernia (rhetro-costo-xifoidiana) and the Bochdalek hernia (postero-lateral).Prenatal diagnosis is done exclusively by 3D sonography, and the postpartum one bythe  X-ray as the first intention.

The confirmation of the diagnosis is made with the digestive tube’s radiography through the contrast substance with frontal and sagittal reconstructions or MRI (also to highlight the discontinuity of the diaphragm). The traumatic hernia may result from injuries, height drops, difficult and prolonged labor, with diaphragm rupture, penetration of one or more abdominal organs into the chest, with compression of the lungs and heart and cardio disturbances – constant breathing.The treatment of diaphragmatic hernias is surgical, both in recent hernias, by removing the respiratory disorders, as well as in latent phase hernias to prevent a dramatic complication. Operative intervention may be urgent or timed.

Conclusions: The diaphragmatic hernia is a severe disease which can endange the pacient’s life if he is not getting the specialized treatment.

Biography:

Dr Eyad Gadour is currently senior specialist registrar in training program in Manchester-UK.  He is about to become a Consultant Gastroenterologist with special interest in Hepatology and Hepatobiliary. His MBBS was obtained from The National Ribat University in Sudan. His General medicine training is conducted mainly in Manchester and done Fellowship in Inflammatory Bowel Disease IBD as well as Liver Transplantation at St James’s University Hospital in Leeds. Dr Gadour has publications in Gastroenterology, Hepatology as well as Upper GI Surgery with few international presentations.

Abstract:

Introduction:

This literature provides a review regarding the value of checking ammonia level in hepatic Encephalopathy. The research examines the prognosis of Ammonia level in the blood, diagnosis and management of hepatic encephalopathy.

Diagnosis of Hepatic Encephalopathy:

The major clinical characteristics of diagnosis of hepatic Encephalopathy are depressed consciousness level, intellectual impairment and personality changes. During diagnosis, it is essential to detect signs suggesting hepatic encephalopathy among the patients suffering from liver disease and there is no clear indication of other causes to brain dysfunction. Thus, realization of precipitating factors indicated above supports hepatic encephalopathy diagnosis. The prognosis depends on the grade of liver failure, time of delivering effective treatment particularly precipitating factors and comorbidity. The progress of hepatic encephalopathy among patients with cirrhosis is correlated with a worse prediction and might cause frequent and elevated relapses. The patients with obvious hepatic encephalopathy in the hospitals have a 3.9% risk of increased mortality. Approximately 70% of having cirrhosis exhibit restrained symptoms of hepatic encephalopathy ⁽¹⁾. These symptoms are likely to weaken patients.  Obvious hepatic encephalopathy manifests in patients suffering from cirrhosis, and the approximate infection rate is 30 to 45%. About 25 to 53% port systemic shunt surgery patients exhibit the condition.

Management of Hepatic Encephalopathy

The suitable management practices entail early diagnoses, aggressive identification of the precipitating factors and efforts to reduce severity ⁽²⁾. Evasion of some sedative drugs has been proposed as a key management practice. The main approaches suggested in include: checking the level of arterial ammonia during first evaluations in patients hospitalized due to impaired mental function and or cirrhosis. In stable outpatients, ammonia levels are low. Providing prophylactic endotracheal intubation to patients with grade 3 or grade 4 (severe encephalopathy) have aspiration risks in the intensive care unit (ICU). Lactulose and rifaximin use is useful but no superiority and can both be used if needed.

Administration of low-protein diets in cirrhosis patients resulted in deteriorating of established protein-energy malnutrition. Thus, protein restriction is likely to help some patients with immediate effect after episodic hepatic encephalopathy. Certainly, malnutrition is regarded as a serious clinical problem compared to hepatic encephalopathy among the patients.

Conclusion:

Bloods ammonia mainly comes about due to the breakdown of the unabsorbed dietary protein by bacteria in the intestines. Among the hepatic encephalopathy, the levels of ammonia in the brain are higher compared to blood levels. High levels of ammonia in the blood may occur because of gastrointestinal bleeding, acute liver failure and chronic liver disease. The major reasons for testing ammonia levels in hepatic encephalopathy for patient who is presenting for the first time include: checking for success of treatment options, checking for liver condition following severe symptoms like excessive sleepiness and confusion, identifying disorders likely to cause brain damage, help in predicting outcomes from diagnoses carried out prognosis of hepatic encephalopathy, however, for patients who are known to have hepatic encephalopathy, in terms of recurrent admissions or previous diagnosis, checking ammonia is not routinely recommonded and carrying out the psychometric tests may be more useful.

Keywords: Hepatic Encepahlopathy, Ammonia level, psychometric test, Lactulose and refaximin