The current evidence support the promising role of probiotics in improving H. pylori induced histopathological features both in gastric antrum and corpus and for long periods of time. Because increased density of H. pylori on the gastric mucosa is linked to more severe gastritis and increased incidence of peptic ulcers, we can infer that a reduction of the density might help to decrease the risk of developing pathologies, probably the progression toward atrophic gastritis and gastric adenocarcinoma. These effects together with improving the H. pylori eradication rates and amelioration of treatment related side effects might open the door for probiotics to be added to H. pylori eradication regimens.

Background: The accurate non-invasive diagnosis of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis has not been achieved yet. The aim of the study was to obtain an unmistakable diagnosis of SBP using a new simple serum bioscore, made by combined measurement of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which we called the PEC index. This crosssectional analytic study comprised 178 cirrhotic patients with ascites (60 patients with SBP and 118 patients with sterile ascites), after excluding non-SBP infection, during the period from March 2019 until September 2019. In all participants, serum levels of PCT, ESR, and CRP were measured, and PEC index was calculated [PEC index = PCT × (ESR + CRP)]. Results: Patients with SBP (n = 60) had significantly higher serum PEC index than those with sterile ascites (n = 118) (41.0/31.2-93.0 vs. 9.9/5.9-15.0, P < 0.001). PEC index distinguished culture positive cases significantly (P < 0.001). Using receiver operating characteristic (ROC) statistics, the sensitivity and specificity of PCT, at a cutoff value of 0.590 ng/mL, for SBP diagnosis, were 81.67% and 93.33%, respectively (area under the curve [AUC] = 0.879; 95% confidence interval [CI] 0.809-0.948). The sensitivity and specificity of ESR, at a cutoff value of 27.0 mm/hour, were 73.33% and 61.67%, respectively (AUC = 0.679; 95% CI 0.581-0.776). The sensitivity and specificity of CRP, at a cutoff value of 21.0 mg/L, were 93.33% and 51.67%, respectively (AUC = 0.736; 95% CI 0.639-0.833). While, the sensitivity and specificity of PEC index, at a cutoff value of 20, were highest (98.33% and 96.67%, respectively, AUC = 0.977; 95% CI 0.940-0.996). Conclusion: Serum PEC index makes an accurate noninvasive diagnosis of SBP, after excluding other infections.

Background and aim:Interferon-based therapy is associated with significant side effects, including the cardiac complications; these may affect the patients' adherence to therapy and consequently the response rate. The aim of this study was to detect the types and predictors of interferon induced cardiac complications in the Egyptian hepatitis C virus infected patients treated with pegylated interferon/ribavirin combination therapy. Patients and Methods: A total of 194, chronic HCV patients were followed up from the time of receiving treatment till 6 months after the end of treatment, to detect cardiac disorders and to determine the response status. Patients were assessed by through history taking, full clinical examination, full laboratory parameters and cardiac assessment using the standard 12 lead ECG and Transthoracic Doppler Echocardiography. Patients in the final analysis were divided into: Group A (who developed cardiac disorders) and group B (who did not develop cardiac disorders). Results:The baseline clinical features (cardiovascular risk factors and hemodynamics) were comparable in both groups. Patients who developed cardiac disorders had higher baseline ALT level, hepatic fibrosis and histologic activity in the liver biopsy than patients without cardiac disorders (P<0.05). The confirmed cardiac complications represented 18% (n=35) and included left ventricular systolic and diastolic dysfunction, pericardial effusion, arrhythmia and myocardial ischemia. Histological activity in the liver biopsy, ejection fraction (EF) and left ventricular end diastolic dimension (LVEDD) were independent predictors for cardiovascular complications. Conclusion: Pegylated interferon therapy of chronic HCV is associated with many types of cardiac complications, predictors of which were histological activity in the liver biopsy, EF and LVEDD.

Background and aim: Endoscopic variceal ligation (EVL) is one of the best modalities for treatment of esophageal varices. One of the most serious complications after EVL is post-banding ulcer bleeding. In this study, frequency and risk factors of EVL-induced ulcer bleeding were assessed. Methods: One hundred and twenty six patients with liver cirrhosis subjected to EVL, whether done as prophylactic or therapeutic, were followed up for two weeks for detection of occurrence of postbanding ulcer bleeding. A prospective cohort study was performed comparing the patients that bleed after EVL due to post-banding ulcer (bleeder group, n= 10) with those without this complication (non-bleeder group, n= 116). All patients received full medical history taking; complete physical examination; routine laboratory tests; Pelvi-abdominal ultrasonography; Esophago-gastroduodenoscopy (EGD) and EVL; treatment with blood transfusion and pharmacologic agents; re-endoscopy if rebleeding occur after EVL. Results: Frequency of post-banding ulcer bleeding after EVL in patients who have liver cirrhosis was 7.9%, and its mortality within 14 days follow up was 10%. Reflux esophagitis was found to be a risk factor of post-banding ulcer bleeding (P= 0.016, OR= 8). Proton pump inhibitor (PPI) may be a protective factor against occurrence of post-banding ulcer bleeding (P= 0.054). Conclusion: Post-banding ulcer bleeding is an infrequent complication after EVL. Reflux esophagitis is considered an independent risk factor for this complication.

Conclusion: Tuberculosis, typhoid fever, and brucellosis signified the major identified infectious causes for FUO in Port Said governorate/Egypt. Toxoplasmosis can be represented as one of FUO infectious causes. Patients with toxoplasmosis either presented with lymphadenopathy or not, all of them had hepatosplenomegaly, high CRP, leucocytosis, and eosinophilia.

The endoscopic retrograde cholangiopancreatography (ERCP) is considered a main therapeutic intervention in the management of biliary and pancreatic disorders. In the average risk populations it is associated with adverse events. The most common adverse event is post-ERCP pancreatitis. Patients with liver cirrhosis are increasingly seen in ERCP theaters with different indications for the ERCP. Because cirrhotic patients are prone to complications it is expected that they develop more adverse events when operated with ERCP. Bleeding diathesis is the most serious because of the underlying coagulopathy and thrombocytopenia that are commonly encountered among them in particular with advanced Child class. In this mini review we discussed how different is the ERCP among cirrhotics regarding the expected benefits and the reported risks and we showed our experience in dealing with this subgroup of patients. The art of managing cirrhotic patients with ERCP is a team work and not a one man show.

one month (p=0.02). Conclusion: Treatment of intestinal parasites deteriorates the clinical activity of the ulcerative colitis.

Results: Minimal and grade-I hepatic encephalopathy were found in thirty out of the one hundred screened patients (30%). Minimal and grade-I hepatic encephalopathy were more common in Child class C, than in class B and A. Two weeks after Lactobacillus acidophilus intake, patients showed significant improvement in the performance of psychometric tests (P<0.001) while liver function tests and Child classes did not improve (P>0.05). Probiotics improved the clinical grades of hepatic encephalopathy; 96.7% (n=29) of patients showed improvement in clinical grade of hepatic encephalopathy and only one patient (3.3%) did not improve (P<0.05). Conclusion: Probiotics could be used to treat early grades of hepatic encephalopathy. Child classes and liver functions did not improve significantly after probiotic therapy.