Day 1 :
Biography:
Dr. Mohamad Miqdady is American Board certified in Pediatric Gastroenterology, Hepatology and Nutrition. He is the Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE. Also an Adjunct Staff at Cleveland Clinic, Ohio USA. He is also the Member of the FISPGHAN Council (Federation of International Societies of Pediatric Gastruenterology Hepatology, and Nutrition) Expert member FISPGHAN Malnutrition/Obesity Expert team. Dr. Miqdady completed his Fellowship in Pediatric Gastroenterology at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX, USA. He held the position of Assistant Professor at Jordan University of Science and Technology in Jordan for six years prior joining SKMC. His main research interests include feeding difficulties, picky eating, obesity, procedural sedation, allergic GI disorders and celiac disease.
Abstract:
It’s believed that the prevalence of atopic disorders is increasing worldwide. Gastrointestinal allergic disorders are no stranger to this phenomenon. Over the last two decades a new disease was described called eosinophilic esophagitis which simply means an allergic inflammatory reaction in the esophagus. This could be related to ingested or possibly inhaled allergens. Typically these young children present with difficulty in swallowing and dysphagia and frequently with food impaction with regular food. They have functional obstruction rather than at anatomical obstruction.
During endoscopy an abnormal esophageal mucosa can be noted sometimes with some white spots indicated some eosinophilic abscesses, linear furrows and during formation of the esophagus. Biopsy should be taken to confirm the diagnosis which normally shows increased number of eosinophils. A cutoff point is described to be more than 15 eosinophils per high-power field. Typically these patients they don’t have eosinophilic infiltrates in other parts of the gastrointestinal system.
The mainstay of treatment is elemental diet avoiding the commonest food allergies that includes milk, eggs, wheat, soy, nuts and seafood. In the Middle East allergy to sesame seems to be another common allergen. Also these patients that will require “swallowed topical steroid” in addition to a proton pump inhibitor.
Unfortunately this is a chronic disorder and these patients need to be in diet for a long period of time with the above medications. Dilatation if required can be associated with higher increased risk of perforation.
- Pediatric Gastroenterology and Nutrition | Inflammatory Bowel Disease | Endoscopic Ultrasonography | Gastrointestinal Surgery
Location: Souq
Chair
Amin Gohary
Burjeel Hospital, UAE
Session Introduction
Eyad Gadour
South Manchester University Hospital-UK
Title: Maintaining remission in patients with Inflammatory Bowel Disease (IBD) is well associated with good control of blood glucose level in different Montreal classes of IBD: A retrospective study of 160 (IBD) patients in a large Gastroenterology centre in UK
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.
Emad Aljahdli
King Abdul Aziz University, Saudi Arabia
Title: Pancreatic cysts from diagnosis to management: challenges and updates
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.
Emad Aljahdli
King Abdul Aziz University, Saudi Arabia
Title: Pancreatic cysts from diagnosis to management: challenges and updates
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.
Ali Hasan
Saudi German hospital, UAE
Title: Direct Laparoscopic Approach of Transversus abdominis plane block: New innovation
Biography:
Dr. Ali Hasan has completed his doctorate in medicine from Tishreen University, Syria in 1998, and had postgraduate study in general surgery from Ministry of health in 2003. At 25 years had training in cardiac surgery, acute surgery in heart institute in Syria. worked in many international institute like UNHCR. He had MIS in laparoscopic surgery, and his main surgical field was in laparoscopic abdominal surgery. He is also pioneer in healthcare management started from head of emergency department, to Chief medical officer of Saudi German hospital 2017.
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
Ahmad Almaiman
King Khalid University Hospital, Riyadh, KSA
Title: Intussusception: Highlighted Aspects
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.
Shahram Agah
Iran University of Medical Sciences, Iran
Title: Colon poly-pectomy and endoscopic mucosal resection
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.