Introduction: Isolated terminal ileal ulcers (ITIUs) are being frequently encountered by the clinicians with the increasing numbers of ileal intubation during colonoscopies. This study was aimed at finding the etiologies of these ulcers in symptomatic patients and their association with various clinical features. Methods: This was a hospital based prospective, observational, descriptive study performed on all consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 July 2018 and 30 June 2019. Clinical, endoscopic and histopathological findings were analyzed to determine the etiology of ITIUs in symptomatic patients. Statistical analysis was done by SPSS 20. Results: Among 60 (7.67%) of 782 symptomatic patients who had ITIUs on ileocolonoscopy, specific etiologies were established in 28 (46.67%) of them. Intestinal TB was the most common specific diagnosis, which was seen in 18 (30%) patients. Chronic abdominal pain with or without chronic diarrhea was the most common indication for ileocolonoscopy. Conclusions: Specific etiologies like tuberculosis, Crohn’s disease, NSAID-induced ulcer and intestinal spirochetosis were seen in 28 (46.67%) of patients with isolated terminal ileal ulcers. The most common clinical features were chronic abdominal pain (65%) and abdominal pain with diarrhea (16.7%). No clinical presentation was significantly associated with any specific etiology, thus emphasizing the need for routine ileal intubation and tissue sampling for histopathological examination in all symptomatic patients undergoing colonoscopy.
IntroductionGastrointestinal (GI) varices are abnormally dilated submucosal veins in the digestive tract caused due to portal hypertension. Esophagus and stomach are common locations of varices induced by portal hypertension. Their presence correlates with the severity of the liver disease. Endoscopic variceal band ligation is one of the preferred methods for bleeding and nonbleeding large varices to decrease bleeding risk. Tissue adhesives such as N-butyl-2-cyanoacrylate have been used for gastric variceal obturation. MethodsThis descriptive study was conducted in the Department of Gastroenterology, National Academy of Medical Sciences, Kathmandu, Nepal, from March 2014 to January 2020. The endoscopic detection of esophageal and gastric varices was observed. Endoscopic variceal ligation (EVL) was done for esophageal varices and injection of N-butyl 2-cyanoacrylate for gastric varices. ResultsEsopahageal varices were detected in 1266 patients (8%) and gastric varices were in 36 patients (0.2%) among 15,657 patients undergoing upper gastrointestinal (UGI) endoscopy. Nine hundred seven (71.6%) were male. Large esophageal varices were endoscopically detected in 54.8% patients, small varices in 31.4% and both (large and small varices) in 13.4%. EVL was done in 30.7% and EVL with cyanoacrylate glue injection in 35 patients (2.7%). ConclusionEsophageal and gastric varices are seen commonly in patients with chronic liver disease. This study was conducted to describe the different types of GI varices in patients undergoing UGI endoscopy. Variceal band ligation for esophageal varices and glue injection for gastric varices are viable options of management.
Chronic pancreatitis is a disease condition characterized by progressive inflammation and fibrosis of pancreas. It manifests with pain abdomen, endocrine and exocrine dysfunction. Diagnosis is often difficult and is relied mostly on radiological examination. The aim of this study was to identify associated risk factors and correlate the clinical presentation with various radiological changes of the pancreas.We conducted a prospective hospital based observational study in patients presenting with abdominal pain and evaluated the etiology, clinical presentation and radiological changes of pancreas among 68 chronic pancreatitis patients visiting Gastroenterology Unit, Department of Medicine, National Academy of Medical Sciences, Bir Hospital during 1 year period (November 2019 to October 2020 AD). The results showed mean age of 35.75 ± 11.43 years with predominant male patients (76.4%). Pain abdomen was present in all patients with mean duration of 16.5 months, followed by diabetes in 27.9%. Alcohol was the major risk (n=42, 61.8%) and no cause was identified in 22 (32.3%) patients. Pancreatic parenchymal calcification in 65 (95.6%), duct dilation in 61 (89.7%) and gland atrophy in 39 (57.3%) were major structural changes detected in computed tomography scan, more reliably than ultrasonography. One third of patients had diabetes mellitus, which was significantly higher in female (63.2%) and had major radiological changes of chronic pancreatitis at diagnosis. Alcohol was the common risk of chronic pancreatitis. Structural changes suggestive of disease was demonstrated better by computed tomography.
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