Mariam Salah Zaghloul

Since the emergence of the novel corona virus (SARS-Cov-2) in the late 2019 and not only the endoscopy practice and training but also the health care systems around the globe suffers. This systemat...

Esophageal motility disorders (EMDs) are the main etiology of nonobstructive dysphagia (NOD), but they are underestimated in Egypt. High-resolution manometry (HRM) with Chicago Classification version 3.0 (CC v3.0) is the current gold standard diagnostic modality to assess EMD in patients with NOD. In this HRM-based study, we aimed to classify EMD among Egyptian patients and explore the relationship between the severity of symptoms and the various groups of EMD. From January 2020 to January 2021, patients with dysphagia were subjected to diagnostic workup, which included symptom questionnaire for Eckardt score, esophagogastroduodenoscopy, barium esophagogram, and HRM. All patients were categorized based on the HRM results using CC version 3.0 after exclusion of those with obstructive esophageal lesions. Of 252 patients with dysphagia, 55 patients with NOD were analyzed according to CC version 3.0. Achalasia was diagnosed in 31 patients (56.4%) (type I: 18 [58.06%]; type II: 9 [29.03%], and type III: 4 [12.9%]), 3 patients (5.5%) with esophagogastric junction outflow obstruction, 2 patients (3.6%) with absent contractility, 4 patients (7.3%) with distal esophageal spasm, 7 patients (12.7%) with ineffective esophageal motility, and 8 patients (14.5%) with normal manometry. Patients with achalasia experienced significantly high regurgitation (96.8% vs 70.8%; P = .016) compared with those without achalasia. Achalasia was the most common EMD in Egyptian patients with NOD. Eckardt score was higher in patients with outflow obstruction and major motor disorder, but it could not differentiate different categories of CC of EMD. HRM is effective in characterization of EMD.

Background and Aim: Little is known about the persistence of symptoms after clearance of SARS-CoV-2 infection. Our study aimed to assess persistent symptoms in COVID-19 patients after clearance of SARS-CoV-2 infection. Methodology: A multi-center survey was conducted on first wave COVID-19 patients with confirmed SARS-CoV-2 infection. Sociodemographic and clinical characteristics, including presenting symptoms and persistent symptoms after viral clearance and possible factors contributing to persistence of such symptoms, were collected using an online multicomponent questionnaire. Descriptive and inferential statistical analysis was performed to detect the most persisting symptoms and factors contributing to their persistence. Results: Overall, 538 patients were enrolled. Mean age was 41.17 (±SD 14.84), 54.1% were males, and 18.6% were smokers. Hypertension and diabetes were the most reported co-morbidities. Mild symptoms were reported in 61.3% of patients, 51.3% were admitted to hospital and 6.5% were admitted to the intensive care unit. Our study identified 49 types of persisting symptoms. Fatigue (59.1%), sense of fever (46.5%), anorexia (24.3%) and diarrhea (24.3%) were the most commonly reported persisting symptoms followed by loss of taste and smell (22.3%), headache (21.4%), cough (20.8) and dyspnea (21%). The use of hydroxychloroquine, azithromycin and multivitamins were significantly associated with persistence of symptoms (OR = 8.03, 8.89 and 10.12, respectively). Conclusion: Our study revealed that in COVID-19 recovered patients, many patients reported persistence of at least one symptom, particularly fatigue and sense of fever. Follow-up of patients after discharge from hospital is recommended until complete resolution of symptoms.

Background/aims: We prospectively evaluated the role of endoscopic ultrasound (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom trans-abdominal ultrasound (TUS) could not demonstrate the cause of dilation as a proper second step in the diagnostic workup of patients with obstructive jaundice compared to magnetic resonance cholangiopancreatography (MRCP). Methods: This study was conducted on patients with obstructive jaundice admitted to the inpatient ward or the outpatient endoscopy unit of Theodor Bilharz Research Institute (TBRI) during the period between January 2019 and August 2019. A patient with obstructive jaundice and TUS showed CBD dilatation with internal diameter ≥ 7 mm and biliary stricture. Results: During the period between January 2019 and August 2019, 136 were recruited; 8 patients who were pregnant and 3 patients who had gastric bypass surgery were excluded. Sixty-five patients were diagnosed confidently by TUS as biliary stones and were excluded from the analysis. Sixty patients with obstructive jaundice and indefinite etiology on TUS were included in the final analysis. The final diagnosis of patients was 38 patients (63.33%) of malignant etiology [26 pancreatic cancer (43.33%), 4 cholangiocarcinoma (6.66%), and 8 with ampullary cancer (13.33%)] and 22 patients (36.67%) of benign etiology [10 calcular obstruction (16.66%), 8 benign stricture (13.33%), and 4 pancreatitis (6.66%)]. The sensitivity and specificity values for malignant stricture detected by EUS were 100% and 86.36%, respectively, with positive predictive value of 92.68%, negative predictive value of 100%, and accuracy of 95%, while MRI showed 82.14% sensitivity and 25% specificity with positive predictive value of 79.31 and accuracy of 69.4%. EUS supported correct diagnosis in 57 patients (95%: CI 86.08 to 98.96%) while MRI did it in 36 patients (69.44%: CI 51.89% to 83.65%).Only 43 (71.7%) patients needed endoscopic retrograde cholangiopancreatography (ERCP) for management of obstructive jaundice, sparing 17 patients (28.3%) unnecessary invasive procedures. Conclusions: EUS is a minimally invasive method with low incidence of complications with high diagnostic accuracy in patients with dilated CBD and normal MRCP.

Proper early detection of GI lesions is the key factor for improving patients’ prognosis and improving quality of care. It is our duty as a gastroenterologist offering endoscopic screening and diagnostic services to do the best for our patients care. In clinical studies, IEE outperformed conventional white-light endoscopy in diagnosing lesions and identifying their morphologies. Large-scale studies on various lesions for standardization of findings and training are needed. It is also hoped that every center could adopt the technology of IEE for better outcomes and quality.

Alpha fetoprotein (AFP) level is the gold standard diagnostic tool for detection and monitoring hepatocellular carcinoma (HCC) but with low sensitivity. Thus, the identification of alternative or combined serum markers of HCC is highly needed. Therefore, the aim of this work was to verify the value of serum midkine (MDK), Dickkopf-related protein 1 (DKK1), and alpha-L-fucosidase (AFU) in detection of HCC. We recruited 244 subjects to the present study; 89 with liver cirrhosis, 86 cirrhotic hepatitis C virus (HCV) induced HCC, and 69 apparently healthy volunteers as controls. Serum AFP, MDK, DKK1, and AFU were measured by ELISA. Patients with HCC showed significantly higher serum MDK, DKK1, and AFU levels compared with those patients with liver cirrhosis and healthy controls (X ² = 179.56, 153.94, and 90.07 respectively) (P < .001 in all). In HCC cases, neither of MDK, DKK1, or AFU was correlated with tumor number. On the other hand, only serum DKK1 was significantly higher in lesions >5 cm, those with portal vein thrombosis and advanced HCC stage. Receiver operator characteristic (ROC) curve analysis showed that serum MDK levels discriminated between cirrhosis and HCC at a sensitivity of 100%, a specificity of 90% at cut-off value of >5.1 ng/mL. Although our results showed that serum MDK, DKK-1, and AFU are increased in HCC cases only MDK may be considered as the most promising serological marker for the prediction of the development of HCC in cirrhotic HCV patients.

Background: Studies indicate that in most patients with chronic hepatitis C, viral RNA is present not only in plasma but also in Peripheral Blood Mononuclear Cells (PBMC). Furthermore, the PBMC compartment may be a preferred site for HCV, which is able to reinitiate viral replication after HCV treatment, even if clearance occurred. The aim of this study was to detect the persistence of hepatitis C viral RNA in both serum and PBMCs at 12 and 24 weeks of treatment in chronic hepatitis C virus (CHC) patients with sofosbuvir based therapy. Methods: 75 CHC patients were tested for HCV- RNA in serum at 0, 12 & 24 weeks of treatment, and for HCV- RNA in PBMCs on the 12 & 24 weeks. Results: At week 12 of treatment all patients had no HCVRNA in their serum; however, 8 cases were positive for HCV RNA in their PBMC. After 24 weeks of treatment, HCV RNA was re-examined in both serum and PBMCs for all patients. Six out of the eight cases that were found having positive HCV RNA in their PBMCs turned positive HCV RNA in the serum. While the other two cases still negative for HCV RNA in the serum. Interestingly, another two cases out of the sixty-seven cases that were found having negative HCV RNA in their PBMC turned positive HCV RNA in the serum. Conclusions: Absence of HCV RNA in PBMC is a better predictor of good response after treatment of CHC patients with DAAs, than its absence in the serum.

Background: Studies indicate that in most patients with chronic hepatitis C, viral RNA is present not only in plasma but also in Peripheral Blood Mononuclear Cells (PBMC). Furthermore, the PBMC compartment may be a preferred site for HCV, which is able to reinitiate viral replication after HCV treatment, even if clearance occurred. The aim of this study was to detect the persistence of hepatitis C viral RNA in both serum and PBMCs at 12 and 24 weeks of treatment in chronic hepatitis C virus (CHC) patients with sofosbuvir based therapy. Methods: 75 CHC patients were tested for HCV- RNA in serum at 0, 12 & 24 weeks of treatment, and for HCV- RNA in PBMCs on the 12 & 24 weeks. Results: At week 12 of treatment all patients had no HCVRNA in their serum; however, 8 cases were positive for HCV RNA in their PBMC. After 24 weeks of treatment, HCV RNA was re-examined in both serum and PBMCs for all patients. Six out of the eight cases that were found having positive HCV RNA in their PBMCs turned positive HCV RNA in the serum. While the other two cases still negative for HCV RNA in the serum. Interestingly, another two cases out of the sixty-seven cases that were found having negative HCV RNA in their PBMC turned positive HCV RNA in the serum. Conclusions: Absence of HCV RNA in PBMC is a better predictor of good response after treatment of CHC patients with DAAs, than its absence in the serum.

Bilharziasis (Schistosomiasis) is the third devastating tropical disease globally and is endemic in many countries including Egypt. The pathology of chronic colonic schistosomiasis results from egg‐induced immune response, granuloma formation, and associated fibrotic changes that may manifest as bloody diarrhea, cramping, and, eventually, inflammatory colonic polyposis. Huge polyps complicating schistosomiasis are not frequently reported in the literature. Also, huge polyps as a sole manifestation of intestinal bilharziasis are rather rarely reported. Here, we report an Egyptian male patient who presented with bleeding per rectum with a huge polyp on colonoscopy, with morphological traits that mimicked colon cancer and proved to be of bilharzial etiology after surgical excision.

Helicobacter pylori (H pylori) infection is the most frequent infection worldwide and it has been postulated that it predisposes to multiple enteric pathogens and diarrheal diseases. Salmonella infection is common in tropical and under developed communities and is associated with wide range of diseases from gastroenteritis to typhoid fever. This study aimed at detecting the impact of H pylori infection on the incidence of salmonella infections. The study participants were sampled from cohorts of patients in four university hospitals in different Egyptian Governorates. Their age ranged from 20 to 59 years and followed up for a rising Widal test. Case patients (n = 109) were subjects who visited the outpatient clinic because of diarrhea and typhoid like illness. They were either positive for H pylori stool antigen (n = 53) or negative to it (n = 56). All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, abdominal ultrasonography, H pylori stool antigen detection, and serial Widal test assay. The proportion of salmonella-infected subjects was lower among case patients with H pylori infection (22.6%) than among those negative for H pylori (33.9%) albeit not statistically significant (adjusted odds ratio [OR], 0.57; 95% confidence interval [CI], 0.24–1.33; P = .21). The association persisted nonsignificant after adjusting for sociodemographic variables (adjusted OR, 0.5; 95% CI, 0.18–1.39; P = .18). In a multivariate analysis that adjusted for sex, dietary habits, socioeconomic status, and educational level subjects who eat outdoors were associated with a significantly greater risk of salmonella typhi infection. Our findings suggest that there is no association between H pylori infection and salmonella infection in patients presented with typhoid fever or typhoid like illness.