Background and study aim: Hepatocellular carcinoma (HCC) accounts for 70-80% of all liver cancers and the 5-year survival is only 3-5%. This bad prognosis is due to the lack of an effective method for early diagnosis. So, only 30-40% of patients with HCC are suitable for curative treatments at the time of diagnosis. Thus, there is a great need for tools to diagnose HCC early especially in cirrhotic patients. The aim of this work is to assess the validity of serum DKK1 as a diagnostic marker for HCC and to assess prognostic value of serum DKK1 in predicting treatment response, complication and survival in HCC patients. Patients and Methods: This study included 60 Patients divided into two groups. Group A: consisted of 30 patients with post hepatitic C and/or B liver cirrhosis. Group B: consisted of 30 patients with HCC on top of post hepatitic C and/or B liver cirrhosis. Group B patients underwent either radiofrequency ablation or ethanol injection. Clinical assessment, routine laboratory evaluation, CT studies and measurement of serum alpha-fetoprotein (AFP) and DKK1 were performed to all patients and repeated to group B patients 1 and 3 months after treatment. Results: The optimum cut off value of DKK1 for diagnosis of HCC was 4.3 ng/mL (AUC 0.89, sensitivity 66.7% and specificity 96.6%) (P<0.001). While, the optimum cut off value for AFP was > 101 ng/mL with 90% sensitivity and 75.9% specificity (p<0.001). Testing of both DKK1 and AFP increased the diagnostic accuracy for HCC (AUC 0.901, sensitivity 93.3%, and specificity 75.9) (P<0.001). Serum DKK1 level significantly decreases after HCC treatment with either radiofrequency ablation or ethanol injection (P<0.001). Conclusion: Testing of both DKK1 and AFP significantly increased the diagnostic accuracy for HCC. Meanwhile, DKK1 can be used alone for HCC diagnosis even in HCC with inconclusive AFP. DKK1 has a promising prognostic value and can be used for follow up of HCC patients who underwent loco-regional treatment.

Backgroundand study aim: Microscopic colitis is an increasingly recognized cause of chronic watery nonbloody diarrhea. The diagnosis of microscopic colitis is mainly based on pathological examination of colonic biopsy from patients with chronic diarrhea and apparently normal colonoscopy examination. This study aimed at estimating frequency of microscopic colitis among patients with chronic watery non-bloody diarrhea and determining the role of some risk factors for its occurrence. Patients and Methods:This study included 60 patients with chronic watery non-bloody diarrhea. Colonoscopy examination was done for all patients and biopsy was taken for histopathology. All patients also evaluated by stool analysis, complete blood count, liver functions, kidney functions, thyroid functions, glycosylated hemoglobin, tissue transglutaminase and pelviabdominal ultrasound. Results:Microscopic colitis was diagnosed in 13 patients with 9 patients having lymphocytic colitis and 4 patients having collagenous colitis. The mean age of patients diagnosed with MC was about 45.7 ± 7.78 years and most of them were females (69.2 %). Patients with microscopic colitis suffered from diarrhea for longer durations. Microscopic colitis was more significant in patients with history of proton pump inhibitors and non-steroidal anti-inflammatory drugs use. Conclusion:Prevalence of microscopic colitis among studied patients was about 21.7% (15% lymphocytic colitis and 6.7% collagenous colitis). microscopic colitis was more common among females .

Background and study aim: Metabolic associated fatty liver disease (MAFLD) is an increased serious clinical concern .Novel physical parameter, based on the properties of ultrasonic signals acquired by the Fibroscan®, is called the controlled attenuation parameter (CAP). This study aimed at assessing the role of CAP in disease staging in MAFLD patients.Patients and Methods: This is a comparative cross sectional study conducted on 84 patients diagnosed as having fatty liver by abdominal ultrasonography and, features of MAFLD according to international consensus guideline. Patients classified as MAFLD with chronic liver disease, HCV, HBV (Group 2) and MAFLD without other chronic liver disease (Group 1). Results: Most patients had marked hepatic steatosis. The diagnostic accuracy of CAP in disease staging in MAFLD patients was 88% at cut off value of >297 dB/m with sensitivity 88.5% and specifity 82.8%.The diagnostic accuracy of combined CAP and FLI(Fatty liver index) for diagnosis liver steatosis was 95% with sensitivity 96.2% and specifity 87.7%. Conclusion: CAP may be used as a promising noninvasive tool for assessment and quantifying of steatosis in MAFLD patients. Combination of both noninvasive imaging technique (CAP) and laboratory score (FLI) may improve the diagnostic accuracy in assessing steatosis in MAFLD patients .

Background and study aim:There is a constant debate about the most appropriate intervals between endoscopic variceal ligation (EVL) sessions that can help achieve variceal obliteration with minimal complications. This study aims to compare 2-weekly and 4-weekly EVL schedule as regards achieving variceal obliteration and prevention of recurrent variceal bleeding.Methods: This study included 204 patients with first attack variceal bleeding randomly allocated in two groups; group I: included 102 patients who underwent 2weekly EVL schedule and group II: included 102 patients who underwent 4weekly EVL schedule. Both groups were followed up till either obliteration or recurrence of bleeding occurred.Results: Group I had significantly higher rate of variceal obliteration at both week 8 (17.5 % vs 0 % P < 0.001) and in week 12 (40 % vs 6.2 % P < 0.001). The overall rate of rebleeding was higher in group II (9.8 % vs 21.6 % p < 0.001). There were no significant differences between the studied groups as regards any of the post banding symptoms, complication, and rehospitalization. Conclusion:The two weekly EVL schedule can help achieve variceal obliteration in shorter duration than 4 weekly schedule and lower overall rate of rebleeding without any significant increase in the post banding symptoms, complication and rehospitalization.

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