Abstract:Pancreatitis is a common non-bacterial inflammatory disease caused by activation, interstitial liberation and auto digestion of pancreas by its own enzymes. Common causes of acute pancreatitis are gall stones, alcohol, drugs, trauma, viral infections and hypertriglyceridemia. Much is known about the causes of pancreatitis but huge experimental data available about understanding of its pathogenesis is still incomplete. Hypercalcemia as a cause of pancreatitis is rarely reported. Hypercalcemia is usually the result of Primary hyperparathyroidism (PHPT) and the most common cause of PHPT is parathyroid adenoma. It is thought that the increased calcium concentration in pancreatic juice resulting from hypercalcemia may prematurely activate proteases. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. Here we present a case of recurrent acute pancreatitis resulting from hypercalcemia due to parathyroid adenoma in a 38-year-old man. Hyperparathyroidism was suspected when despite severe pancreatitis calcium level remained high and parathormone level was grossly raised
Background: Clarithromycin resistance globally has challenged the success of conventional Clarithromycin based triple therapy for Helicobacter Pylori eradication. Levofloxacin has primarily been considered as a second-line treatment but may also be used as primary therapy. Recently, some studies have evaluated its efficacy as a valid alternative to standard antibiotics as first-line therapy for H. pylori infection. This study was intended to assess the eradication success of Levofloxacin based first-line triple therapy and also to see it’s compliance & adverse effect profile. Materials and methods: This non-randomized single-arm clinical trial was carried out in the Department of Gastroenterology, BSMMU from March 2016 to March 2017 involving 123 H. pylori-positive patients with endoscopically proven peptic ulcer disease to assess the eradication success of levofloxacin based first-line triple therapy and also to see its compliance and adverse effect profile. H. pylori status were detected by urea breath test. Patients were treated with amoxycillin 1 gm 12 hourly, levofloxacin 500 mg 12 hourly and omeprazole 20 mg 12 hourly for 14 days and were followed-up at 2 months after completion of therapy for repeat urea breath test. Results: A total of 97 patients returned for followup. Male proportion was 63.41% and female was 36.58% with the median age of 57 years. On intention-to-treat analysis, the eradication rate of H. pylori was 65.85% and on per-protocol analysis, it was 83.50%. Total 15.44% patients developed adverse effects, all were mild to moderate in nature. One patient discontinued treatment because of epigastric pain and vomiting. Conclusion: Levofloxacin-based therapy was effective, well-tolerated and compliance was excellent; but the eradication rate was not satisfactory. JCMCTA 2020 ; 31 (1) : 102-107
Background: Upper gastrointestinal endoscopy is the most common procedure performed in Gastroenterology department for numerous indications and ulceration of the upper GI tract is one of the major pathological findings during endoscopy. Early diagnosis of upper GI ulcers with definite cause is the mainstay of therapy for patient’s cure and prevention of complications. Different clinical features are observed in different types of ulcer. Objective: The objective of this study is to find out the causes of different types of ulceration in the upper gastrointestinal tract along with their clinical presentation. Methods: This cross-sectional study was conducted in the Department of Gastroenterology, BSMMU, Dhaka, Bangladesh during the period of July 2016 to April 2017. Patients referred for upper GI endoscopy for different indications were primarily selected. Consecutive 220 patients having ulcers anywhere in the upper GIT were finally included in the study. Ulcer diseases were diagnosed through analysis of morphology of the ulcers, histopathology of biopsy materials, relevant clinical history and further investigations if required. All the findings were documented in predesigned data collection sheet. Any association between various types of ulcers with age, gender, BMI, lifestyle, location of ulcer, different signs and symptoms was assessed. Results: Out of 220 patients duodenal ulcer was found in 45.9%, gastric ulcer in 30.0%, oesophageal ulcer in 7.7%, ulceration at multiple sites in 13.6%, and stomal ulcer in 2.7% cases. Among the aetiologies H. pylori infection (62.8%), NSAIDs (14.6%) and malignant ulcers (9.1%) were found in majority of cases. Less common causes were tubercular ulcer, lymphoma, GIST, Crohn’s disease and caustic injury. Aetiology could not be identified in 6.8% cases. Among various presenting complaints epigastric pain, early satiety, anorexia, vomiting and GI bleeding were the symptoms that differ significantly in patients with ulcers ...........
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