Hasil untuk "Diseases of the digestive system. Gastroenterology"

Yujen Tseng, Jiayinaer Bolatihan, Xiao Li et al.

Abstract Background & objective Small bowel diverticulum (SBD) is an outpouching of the small intestinal wall and is often neglected in clinical practice due to its undiscerning location. Majority of SBD can be asymptomatic but can also be associated with life-threatening complications. We hereby performed a clinical analysis to investigate the characteristics associated with SBD. Patients and methods This retrospective case series analyzed clinical data from two tertiary referral centers. Clinical data including baseline characteristics, clinical presentation, diagnostic methods and treatment were systematically collected and reviewed. Subgroup analysis based on distinct location of the SBD, such as the duodenum, jejunum and ileum were also performed. Results A total of 149 cases of SBD were ultimately included in the present study analysis. Among 114 duodenal SBD cases, 42 (36.8%) were asymptomatic, while 58 (50.9%) presented with pain/discomfort. In contrast, jejunoileal SBD (n = 35) were predominantly symptomatic: 21 (60.0%) required surgical intervention due to complications such as obstruction (n = 8), bleeding (n = 12), or perforation (n = 5). Endoscopic modalities (DBE/VCE) achieved a diagnostic accuracy of 92.3% for jejunoileal SBD, surpassing radiological methods (CT/BaFT) at 38.5% (p < 0.001). Distinctive case highlights also provided examples of SBD found at different locations. Conclusion Small bowel diverticular (SBD) disease is often overlooked in clinical practice, due to its discrete location and limited access. With continuous diagnostic advancements, including endoscopic techniques, the detection of SBD is expected to rise, gaining clinical awareness amongst gastroenterologists.

Xinri Wu , Quan Chen, Caiqin Zhang et al.

Abstract Background The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance and has been linked to metabolic disorders. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, particularly among older adults. The association between long-term changes in TyG levels and the risk of incident MASLD remains unclear. This study aimed to investigate the relationship between TyG index trajectories and the development of MASLD in the elderly. Methods We conducted a prospective cohort study involving 28,535 older adults who underwent annual health checkups from 2018 to 2021 with complete triglyceride and fasting blood glucose data. Group-based trajectory modeling was used to identify three distinct TyG trajectories: the low-stable, moderate-stable, and high-stable groups. MASLD incidence was assessed during follow-up visits in 2022 and 2023. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MASLD across the trajectory groups. To minimize confounding, sensitivity analyses were conducted by excluding participants with a baseline body mass index (BMI) > 28 kg/m2 and those using antihypertensive, antidiabetic, or lipid-lowering medications. Additionally, restricted cubic spline regression was applied to examine the dose-response relationship between baseline TyG index and MASLD risk. Results A total of 28,535 participants was included, comprising 13,456 males (47.16%) and 15,079 females (52.84%). The incidence rates of MASLD were 7.10% in the low-stable group, 16.10% in the moderate-stable group, and 23.20% in the high-stable group, increasing significantly with rising TyG trajectories (P < 0.001). After adjusting for age, sex, blood pressure, BMI, and lipid profiles, Cox regression models showed that the moderate-stable and high-stable groups had significantly higher risks of MASLD compared to the low-stable group, with HRs of 1.847 (95% CI: 1.699–2.008) and 2.361 (95% CI: 2.116–2.634), respectively (P < 0.001). A nonlinear dose-response relationship was also observed, with a sharp increase in MASLD risk when TyG index exceeded 8.54. Conclusion Consistently elevated TyG trajectories are associated with a significantly increased risk of incident MASLD, with the risk escalating progressively as TyG levels rise.

Shehab Yaser, Hatem Yaser, Hazem E. Mohammed et al.

Abstract Background Metabolic dysfunction-associated steatotic liver disease (MASLD) affects children and is increasingly prevalent alongside rising childhood obesity. The MASLD spectrum spans from simple hepatic steatosis to metabolic-associated steatohepatitis (MASH), fibrosis, and cirrhosis. Despite this rising prevalence, the optimal pharmacotherapy for pediatric MASLD remains uncertain. Objective This systematic review and network meta-analysis aimed to evaluate the efficacy of different pharmacotherapies in managing pediatric MASLD. Methods Included in this meta-analysis were randomized controlled trials. The diagnosis of MASLD was established using medical imaging techniques such as ultrasonography or magnetic resonance imaging, or via liver biopsy, provided that patients had no other chronic liver diseases or secondary causes of liver steatosis. A systematic search of five electronic databases was conducted up to August 2024. Data were synthesized using a random-effects model, with results expressed as pooled mean differences (MDs) for continuous outcomes or relative risks (RRs) for categorical outcomes, each with a 95% confidence interval (CI). Results This analysis included 26 trials involving 1503 patients. The mean age of patients across studies ranged from 7.41 to 14.06 years. Vitamin D demonstrated the best ranking in managing MASLD, significantly reducing NAFLD Activity Score (NAS) and improving lipid profiles by reducing low-density lipoprotein (LDL) and total cholesterol, while increasing high-density lipoprotein (HDL) levels. Besides, vitamin D combined with docosahexaenoic acid (DHA) showed the strongest effect in reducing triglycerides. Vitamin E was associated with more patients achieving nonalcoholic steatohepatitis (NASH) resolution. Regarding liver transaminases, Cysteamine Bitartrate Delayed Release (CBDR) most effectively reduced ALT levels, AST levels, and fibrosis score. Conclusions Our NMA suggests pharmacotherapy holds promise for pediatric MASLD, with vitamin D and vitamin E presenting the most consistent benefits across histologic and laboratory outcomes. Future well-designed RCTs integrating standardized MASLD diagnosis and lifestyle interventions are warranted.

M.H. Mohamed-Chairi, A.B. Vico-Arias, N. Zambudio-Carroll et al.

Introduction and aim: The Milan criteria have been the subject of discussion in recent years due to their restrictive nature. Expansion of the criteria and the use of locoregional therapies to downstage patients and increase the number of transplant candidates have been proposed. Our study analyzed the results of patients that underwent transplant due to hepatocellular carcinoma, comparing those that met the Milan criteria and those that exceeded them. Materials and methods: A retrospective, observational, single-center study was conducted on liver transplantations due to hepatocellular carcinoma, within the time frame of 2010−2021. Demographic and clinical variables, overall survival, and disease-free survival were analyzed. The Student’s t test or Mann–Whitney U test were applied for the quantitative variables and the Fisher’s exact test for the categorical variables. The survival function was estimated through the Kaplan–Meier method and the log-rank test was applied for comparing the groups. Results: Of the 96 transplanted patients, 78 met the Milan criteria and 18 exceeded them. Patients that did not meet the Milan criteria had a higher number of nodules (1.6 vs. 3.5 nodules; p = 0.000), larger main lesions (24.38 vs. 38.55 mm; p = 0.000), a higher bilobar hepatocellular carcinoma rate (21.79% vs. 72.22%, p = 0.000), and higher tumor burden. There were no significant differences regarding overall survival, but there was a lower rate of disease-free survival in the group exceeding the criteria. Conclusion: Downstaged patients that received locoregional therapies had lower disease-free survival rates than patients that met the Milan criteria, but there were no significant differences regarding overall survival. Resumen: Introducción y objetivos: Los criterios de Milán han sido discutidos debido a su carácter restrictivo. Se ha propuesto su ampliación, y el empleo de terapias locorregionales que infraestadifiquen y aumenten los candidatos a trasplante. Nuestro estudio analiza los resultados de los pacientes trasplantados por carcinoma hepatocelular que cumplían criterios de Milán y aquellos que los excedían. Materiales y métodos: Estudio observacional, retrospectivo y unicéntrico sobre trasplantados hepáticos por carcinoma hepatocelular entre el 2010−2021. Se analizaron variables demográficas, clínicas y supervivencia global y libre de enfermedad. Se aplicó la prueba t-Student o la de U de Mann-Whitney para variables cuantitativas; para categóricas el test exacto de Fisher. Se estimó la función de supervivencia mediante el método de Kaplan-Meier y se aplicó el log rank para comparar entre grupos. Resultados: De los pacientes 96 trasplantados, 78 cumplían criterios de Milán y 18 los excedían. Los pacientes que no cumplían los criterios de Milán presentaban mayor número de nódulos (1,6 vs. 3,5 nódulos (p = 0,000)), mayor tamaño de las lesiones principales (24,38 vs. 38,55 mm, p = 0,000) y mayor tasa de carcinoma hepatocelular bilobular (21,79% vs. 72,22%, p = 0,000), así como mayor carga tumoral. No hubo diferencias significativas en cuanto a la supervivencia global, aunque sí en cuanto a la supervivencia libre de enfermedad, siendo menor en el grupo que excedía los criterios. Conclusión: Los pacientes infraestadiados con terapias locorregionales presentan tasas de supervivencia libre de enfermedad menores a los pacientes que cumplen los criterios de Milán, sin diferencias significativas en cuanto a la supervivencia global.

N. B. Gubergrits, N. V. Byelyayeva, K. Y. Linevska et al.

In his doctoral thesis, young M. D. Strazhesko described a number of important physiological patterns in the activity of the dog’s intestines. M. D. Strazhesko was one of the first authors in world literature to present information about the nature of the juice in different parts of the colon, especially in the caecum. At the same time, his attention was drawn to another new question about the specific sensitivity of the intestinal mucosa. «The specific sensitivity of the mucous membrane at the end of the small intestine is very different from the sensitivity of the mucous membrane in the large intestine», he noted. «While the mucosa of the former has a very high sensitivity, the mucosa of the colon is not very sensitive». M. D. Strazhesko described the symptom complex of the mobile caecum and the observation of hemorrhagic pancreatitis with a retroperitoneal abscess, which was common at that time. The well‑known clinical manual «Fundamentals of Physical Diagnosis of Abdominal Diseases», which went through four editions, was published. In this manual, a separate lecture is devoted to the study of the pancreas. M. D. Strazhesko described in detail the technique of abdominal examination and percussion, palpation of the pancreas, pain zones and spots, and the interpretation of the X‑ray examination results in its pathology. In 1924, V. P. Obraztsov’s monograph «Diseases of the Stomach, Intestines, and Peritoneum» was published, in which some chapters were completed by M. D. Strazhesko. After that, in the years 1927 and 1928, he wrote monographs about the clinical picture of colitis and peptic ulcer. With his great observation skills as a thoughtful clinician, M. D. Strazhesko described the intravital diagnosis of occlusion of the right branch of the portal vein (1934). The breadth of scientific interests of M. D. Strazhesko was truly extraordinary. In addition to research in gastroenterology and cardiology, he fruitfully studied the peculiarities of the clinical course of infectious diseases and metabolic disorders, diseases of the respiratory and urinary organs, problems of gerontology, fatigue, shock, and clinical hematology. On his initiative, the Ukrainian Institute of Clinical Medicine was created. Physiological orientation dominated all the works of the institute. M. D. Strazhesko published more than 200 works. He devoted a number of articles to the history of medicine, the role of outstanding medical figures. A great merit of Mykola Dmytrovych was his popularization activity. He is known not only as a lecturer covering general medical topics, but also as the author of more than 20 articles published in newspapers and non‑medical journals. His organizational skills also gained general recognition. He created a clinical school. Under his supervision, 18 candidate theses were completed. Mykola Dmytrovych was the scientific supervisor of 17 doctoral students. Two of his students — B. X. Vasylenko and D. F. Chebotaryov became academicians of the Academy of Medical Sciences of the USSR

Lu-Lu Lv, Han-Bo Xu, Sheng-Li Li et al.

Abstract Background Budd-Chiari syndrome (BCS) results when the outflow of the hepatic vein (HV) is obstructed. BCS patients exhibiting an accessory HV (AHV) that is dilated but obstructed can achieve significant alleviation of liver congestion after undergoing AHV recanalization. This meta-analysis was developed to explore the clinical efficacy of AHV recanalization in patients with BCS. Materials and methods PubMed, Embase, and Wanfang databases were searched for relevant studies published as of November 2022, and RevMan 5.3 and Stata 12.0 were used for pooled endpoint analyses. Results Twelve total studies were identified for analysis. Pooled primary clinical success, re-stenosis, 1- and 5-year primary patency, 1- and 5-year secondary patency, 1-year overall survival (OS), and 5-year OS rates of patients in these studies following AHV recanalization were 96%, 17%, 91%, 75%, 98%, 91%, 97%, and 96%, respectively. Patients also exhibited a significant reduction in AHV pressure after recanalization relative to preoperative levels (P < 0.00001). Endpoints exhibiting significant heterogeneity among these studies included, AHV pressure (I2 = 95%), 1-year primary patency (I2 = 51.2%), and 5-year primary patency (I2 = 62.4%). Relative to HV recanalization, AHV recanalization was related to a lower rate of re-stenosis (P = 0.002) and longer primary patency (P < 0.00001), but was not associated with any improvements in clinical success (P = 0.88) or OS (P = 0.29) relative to HV recanalization. Conclusions The present meta-analysis highlights AHV recanalization as an effective means of achieving positive long-term outcomes in patients affected by BCS, potentially achieving better long-term results than those associated with HV recanalization.

Susan S Schiffman, H Troy Nagle

Heejoon Jang, Won Kim

Zhibin Bu, Xianghua Ye, Bin Huang et al.

The causes of irritable bowel syndrome remain unknown. Studies and meta-analyses revealed that intestinal microbiota disturbance was one of the causes of irritable bowel syndrome, but the results remained controversial. Therefore, we performed a systematic review and meta-analysis to identify the association between them. We performed a systematic meta-analysis of case–control studies from January 2000 to December 2020 to compare fecal microbes based on polymerase chain reaction and bacterial cul- ture between adult irritable bowel syndrome patients and healthy controls. The standardized mean difference value and a 95% CI were calculated. Two professional researchers used Newcastle–Ottawa Scale to reassess selected literature and extract high- quality studies. Six studies were included in our analysis. When all eligible studies were pooled into the meta-analysis, compared with healthy controls, the standardized mean differences of Bifidobacteria (standardized mean difference = −1.01, 95% CI =: −2.01 to −0.01) in irritable bowel syndrome patients decreased significantly, whereas the standardized mean differences of Enterococcus, Enterobacter, Lactobacillus, Bacteroides, and Escherichia coli did not change significantly in irritable bowel syndrome patients. However, heterogeneity was significant to perform sensitivity analysis and stratified analysis in all these special intestinal microbes. In summary, this study indicated that only Bifidobacteria was decreased in irritable bowel syndrome patients compared with healthy controls using Newcastle–Ottawa Scale standards to extract high-quality literature. Future studies are warranted to further dem- onstrate the relationship between them.

Ala I. Sharara, Maher Malaeb, Matthias Lenfant et al.

Background: Endoscopic remission is an increasingly recognized important therapeutic endpoint in the management of patients with UC. Summary: The Mayo Endoscopic Score (MES) remains the most common endoscopic index recommended in guidelines and widely used in clinical trials and in clinical practice. The MES is easy, simple, and practical but is suboptimal at providing an accurate depiction of segmental healing and/or at measuring a substantial but incomplete response across the spectrum of endoscopic inflammation. Other endoscopic scores have been proposed but have not received wide recognition or adoption.

Albert Martin-Cardona, Josep Lloreta Trull, Raquel Albero-González et al.

Abstract Background SARS-CoV-2 may produce intestinal symptoms that are generally mild, with a small percentage of patients developing more severe symptoms. The involvement of SARS-CoV-2 in the physiopathology of bowel damage is poorly known. Transmission electron microscopy (TEM) is a useful tool that provides an understanding of SARS-CoV-2 invasiveness, replication and dissemination in body cells but information outside the respiratory tract is very limited. We report two cases of severe intestinal complications (intestinal lymphoma and ischaemic colitis) in which the presence of SARS-CoV-2 in intestinal tissue was confirmed by TEM. These are the first two cases reported in the literature of persistence of SARS-CoV-2 demonstrated by TEM in intestinal tissue after COVID 19 recovery and SARS-CoV-2 nasopharyngeal clearance. Case presentation During the first pandemic peak (1st March–30th April 2020) 932 patients were admitted in Hospital Universitari Mútua Terrassa due to COVID-19, 41 (4.4%) required cross-sectional imaging techniques to assess severe abdominal pain and six of them (0.64%) required surgical resection. SARS-CoV-2 in bowel tissue was demonstrated by TEM in two of these patients. The first case presented as an ileocaecal inflammatory mass which turned to be a B-cell lymphoma. Viral particles were found in the cytoplasm of endothelial cells of damaged mucosa. In situ hybridization was negative in tumour cells, thus ruling out an oncogenic role for the virus. SARS-CoV-2 remained in intestinal tissue 6 months after nasopharyngeal clearance, suggesting latent infection. The second patient had a severe ischaemic colitis with perforation and SARS-CoV-2 was also identified in endothelial cells. Conclusions Severe intestinal complications associated with COVID-19 are uncommon. SARS-CoV-2 was identified by TEM in two cases, suggesting a causal role in bowel damage.

Shiwei Wang, Haofeng Xiong, Changling Luo et al.

Background and Aims. Acute-on-chronic liver failure (ACLF) is common in patients with end-stage liver disease and chronic hepatitis B (CHB) or hepatitis B virus- (HBV-) related cirrhosis. To date, no uniform definition and management strategy are available for ACLF. Although a considerable number of studies on ACLF has been published, there are few reports on ACLF in pregnant women with CHB. This study retrospectively reviewed five patients who were diagnosed with ACLF during pregnancy in the past 10 years. We aimed at investigating their clinical characteristics, treatment, biochemical test results, and maternal and fetal outcomes. Results. Asthenia, anorexia, and jaundice were the main initial clinical manifestations in these patients during the second or third trimester of pregnancy. All patients received antiviral therapy. None of the pregnant women died after treatment. Patient #4 was treated with an artificial liver support system, and patients #2 and #5 underwent transfusion therapy. The acute insult in all patients was HBV DNA reactivation. Except for patient #3, who chose an actively induced vaginal delivery because of intrauterine fetal demise, the remaining four patients underwent a preterm delivery via a cesarean section. The four neonates were alive, although all were small for gestational age. Conclusion. Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health.

Dedy Indra Praja, Helena Helena, Bogi Pratomo

Background: Colorectal cancer is the third most common cancer according to American Cancer Society. It is also the third most common cause of death in men and women in US. Colorectal cancer encompasses 5% of all cancer and 29% of gastrointestinal cancer with men and women ratio is about 3:1. More than 1/3 of colorectal cancer occur below the age of 45 years. Mutation in Kirsten rat sarcoma (KRAS) gene was found in 30-50% of colorectal cancer in which it was suggested to associated with increase proliferation and decrease apoptosis. This study aimed to analyze the association between diet profile and KRAS gene mutation. Method: This study was a cross sectional study. Data was collected from medical records of colorectal cancer patient in Dr. Saiful Anwar General Hospital, which included KRAS gene mutation analysis. Results: There were 12 subjetcs included in this study. Four subjects (33.3%) had gene mutation with 3 subjects (75%) had positive KRAS mutation and 1 subjects (25%) had positive Neuroblastoma rat sarcoma (NRAS) mutation. In non-mutation group, it had been found a higher frequency of green leaf vegetables diet, in comparison with mutation group (p = 0.023). There was positive correlation between green leaf vegetables diet with gene mutation. Conclusion: Mutation of KRAS and NRAS mutation in colorectal carcinoma were found in 33.3% of subjects. Data analysis showed positive association between low green leaf vegetables diet with KRAS and NRAS mutation.

Tao Li, Feng Liu, Lixin Zhang et al.

Background/Aims: The optimal duration of nucleos(t)ide analogs (NAs) therapy in chronic hepatitis B (CHB) patients remains unsatisfactory. Previous studies have confirmed the important role of host genetic factors in determining the outcome of HBV infection. This study tries to determine the role of host genetic factors in predicting response status in CHB patients discontinuing NAs according to stringent cessation criteria. Patients and Methods: Participating patients came from a prospective NAs- discontinuation cohort since June 1999. Six single-nucleotide polymorphisms (SNPs) were selected according to previous report. SNaPshot assay was used for DNA SNPs analyses. Results: Seventy-six CHB patients were enrolled in our study, of which 61 patients were HBeAg-positive and 15 patients were HBeAg-negative. rs1883832 in the Kozak sequence of CD40 displayed an AUROC of 0.778 in predicting response status in CHB patients with HBeAg seroconversion and a genotype of CT was associated with sustained response in this subpopulation. The diagnostic performance of combinative index (rs1883832, age, and HBsAg at discontinuation) seemed to be better than that of rs1883832, but no statistical difference was observed. rs1883832 was also evaluated as an independent factor for response status by multivariate logistic regression. For HBeAg-negative CHB patients, rs9277535 at HLA-DP presents a Spearman correlation coefficient of 0.582 (P = 0.023) with virological relapse after discontinuation of NAs. Conclusions: rs1883832 serves as a valuable predictive factor for CHB patients with HBeAg seroconversion. rs9277535 at HLA-DP might also be a valuable predictive factor for CHB patients with HBeAg-negative, however, further verifications are recommended due to study limitations.

M. V. Mayevskaya, R. M. Mayevsky

Aim of the clinical case presentation. To discuss the principles of the correct and healthy nutrition, which are the universal and applicable for the most of overweight and obese patients and obesity-related disorders, exemplified by clinical case. Summary. Obesity has multifactorial adverse effect on human body i.e.: predisposition to diabetes mellitus, cardiovascular diseases, excessive musculoskeletal load, cosmetic defect, etc. It represents serious problem for the majority of economically developed European countries, USA and Russia. Presented principles will help healthy people to maintain active longevity by prevention of cardio-vascular diseases, Alzheimer's disease and some other disorders. The data is presented in the form of a clinical discussion in which on the example of the young patient with morbid obesity all aspects of effective medical communication are analyzed in detail. Specific recommendations which the patient has to receive from the doctor are discussed: motivations for lifestyle modification, optimum daily caloric food load, amount of physical activity, optimum nutritional pattern.

A. I. Ulyanin, Ye. A. Poluektova, O. S. Shifrin et al.

Daniel K. Podolsky

The forces that are reshaping the delivery of health care through much of the developed world are especially acute within academic centers that carry the responsibility for delivering that care while advancing medical knowledge and ensuring well-trained physicians. Gastroenterology will not be spared any of those forces, and in some ways represents the leading edge of their impact. Though the dynamics vary within the context of the health-care delivery and scientific enterprise of individual countries, common elements are demands for greater accountability and transparency in how academic medical centers demonstrate their value while assuring broad access to their expertise. In the United States, underlying many forms of change in the payment scheme are the common elements that will increasingly place the risk for the cost of care on providers rather than on the payers, be it government or private, as has historically been true. At the same time, academic medical centers, with gastroenterology responsible for addressing the burden of digestive diseases, must remain the stem cells for health care integrating all their missions and providing the foundation of medical advances which will ultimately improve human welfare. What will academic gastroenterology units look like if they are able to effectively respond to these forces? Gastrointestinal (GI) divisions and faculty will own new roles including responsibility for system success in caring for patients. They will evolve their training programs to provide the next generation with skills needed to succeed, including the discipline of system improvement, team leadership and others. And there will be new models that will drive the organization of research that are not as conventionally self-contained within the gastroenterology units, but fostering research teams that have hubs and spokes. The vitality of GI divisions will depend on the willingness to seize ownership of the new value proposition of disease management ensuring that each patient achieves the best outcome with the most effective use of resources and endeavor within their systems to capture some of that value to invest in their training and research missions. In the course of that evolution, gastroenterology will be well served by rebalancing the dependence on existing modalities. If procedural gastroenterology becomes the sole value proposition, it will lead to an increasingly narrow view of the field.

Wandong Hong, Yunfei Zhu, Yanyan Dong et al.

Background/Aims: Endoscopic biliary stent drainage plays an important role in the palliative treatment of malignant biliary obstruction. The aim of this study was to investigate predictors of occlusion of first metal inserted stent in patients with malignant biliary obstruction. Patients and Methods: The retrospective analysis was performed in 178 patients with malignant biliary obstruction. Factors associated with stent occlusion were analyzed by Cox regression analysis. Results: Median overall stent patency was 178 days. Total cumulative obstruction rate of the first stents during the follow up was 33%, 57%, 83%, and 96% at 90, 180, 360, and 720 days. Multivariate analysis revealed that hilar obstruction (hazard ratio [HR] =3.26, 95% confidence interval [CI, 2.31–4.61), metastasis cancer (HR = 2.61, 95% CI, 1.79–3.80), and length of stent (HR = 1.74, 95% CI, 1.24–2.46) were independent predictors of stent occlusion. Conclusions: Hilar biliary stricture, metastatic cancer, and length of stent were important predictors of occlusion of first-inserted metal stent in patients with malignant biliary obstruction.

Sunday Chinenye, Andrew E Uloko, Anthonia O Ogbera et al.

Background: Diabetes Mellitus is the commonest endocrine-metabolic disorder in Nigeria similar to the experience in other parts of the world. The aim was to assess the clinical and laboratory profile, and evaluate the quality of care of Nigerian diabetics with a view to planning improved diabetes care. Materials and Methods: In a multicenter study across seven tertiary health centers in Nigeria, the clinical and laboratory parameters of diabetic out-patients were evaluated. Clinical parameters studied include type of diabetes, anthropometry, and blood pressure (BP) status, chronic complications of diabetes, and treatment types. Laboratory data assessed included fasting plasma glucose (FPG), 2-h post-prandial (2-HrPP) glucose, glycated hemoglobin (HbA1c), urinalysis, serum lipids, electrolytes, urea, and creatinine. Results: A total of 531 patients, 209 (39.4%) males and 322 (60.6%) females enrolled. The mean age of the patients was 57.1 ± 12.3 years with the mean duration of diabetes of 8.8 ± 6.6 years. Majority (95.4%) had type 2 diabetes mellitus (DM) compared to type 1 DM (4.6%), with P < 0.001. The mean FPG, 2-HrPP glucose, and HbA1c were 8.1 ± 3.9 mmol/L, 10.6 ± 4.6 mmol/L, and 8.3 ± 2.2%, respectively. Only 170 (32.4%) and 100 (20.4%) patients achieved the ADA and IDF glycemic targets, respectively. Most patients (72.8%) did not practice self-monitoring of blood glucose. Hypertension was found in 322 (60.9%), with mean systolic BP 142.0 ± 23.7 mmHg, and mean diastolic BP 80.7 ± 12.7 mmHg. Diabetic complications found were peripheral neuropathy (59.2%), retinopathy (35.5%), cataracts (25.2%), cerebrovascular disease (4.7%), diabetic foot ulcers (16.0%), and nephropathy (3.2%). Conclusion: Most Nigerian diabetics have suboptimal glycemic control, are hypertensives, and have chronic complications of DM. Improved quality of care and treatment to target is recommended to reduce diabetes-related morbidity and mortality.

Hiroaki Shiba, Yoshinobu Mitsuyama, Ken Hanyu et al.

Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.