Day 2 :
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:
Vomiting in children is common and mostly related to medical condition. However there are surgical conditions associated with vomiting which needs to be acknowledge and diagnosed early. Bilious vomiting is an ominous symptom and needs to be taken seriously. Any baby who vomits bile should be considered as having an underlying intestinal obstruction until proved otherwise.
Learning Objectives:
1: Recognize the difference between vomiting due to medical and that related to surgical pathology
2: Discuss the different causes of surgical vomiting
3: Review the impact of bilious vomiting and its significance
- Gastroenterology | Clinical and Diagnostics | Gastrointestinal Oncology | Gastrointestinal Disorders | Gastrointestinal surgery
Location: Souq
Chair
Aamir Ghafoor Khan
Lady Reading Hospital, Pakistan
Session Introduction
Sanae Reggoug
Al Garhoud Private Hospital, UAE
Title: PPIs long term safety. What should we know as clinicians? What should we tell our patients?
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.
Abdul Qadir Khan
Muhammad Medical College & Hospital, Pakistan
Title: Treatment out come and side effects of directly acting oral anti HCV drugs a single center experience
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.
Saif Ullah
The first affiliated hospital of Zhengzhou University, Zhengzhou, Henan, China
Title: Mucosal loss is the critical mechanism of esophageal stricture after mucosal resection: a pilot experiment in a porcine model
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.
Eyad Gadour
South Manchester University Hospital-UK
Title: Serum Biochemical Markers may predict Post- Percutaneous endoscopic gastrostomy (PEG) mortality: 3 years’ experience in a single stroke center 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
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
Bianca Corozel
University of Oradea, Romania
Title: The Diaphragmatic Hernia- Anatomical and clinical aspects
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.
Bianca Corozel
University of Oradea, Romania
Title: The Diaphragmatic Hernia- Anatomical and clinical aspects
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.
Eyad Gadour
South Manchester University Hospital, UK
Title: Ammonia level may NOT be associated with the severity of Hepatic Encephalopathy: An extensive literature review
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