4^th International Conference on Gastroenterology July 20-22, 2015 Florida, USA

Background. Carcinoid tumors are rare but considered to be one of the commonest tumors in the appendix. Their incidence has been shown to vary in different studies. Aimes, Setting & Design. This seminal study was carried out to determine the incidence and clinico-pathological profile of appendiceal carcinoids in a cohort of patients undergoing emer¬gency appendicectomies for clinically suspected acute appendicitis in Emirate of Sharjah. Materials and methods. The study included the retrospective data of 964 patients operated for clinically suspected appendicitis, the resected specimens of whom were received in the Pathology laboratory of Al-Qasmi hospital Sharjah from January 2010 to December 2010. Results. Out of the 964 patients 9 (0.93%) were found to have appendiceal carcinoids. The mean age was 28.7 years with a male to female ratio of 2:1. Eight tumors were located near the tip of appendix with mean diameter of 3.3 mm. All tumors were found to be positive for chromogranin A, synaptophysin and neuron-specific enolase on immunohistochemistry (IHC). None of the patient’s had recurrence or any reportable complications in the short follow up period (12-26 months). Conclusions. Our study found higher incidence of appendiceal carcinoids in pa¬tients undergoing emergency appendectomy for acute appendici¬tis in Emirate of Sharjah compared to two previous studies from the same geographical region. Moreover, tumors were found more commonly in young males in contrary to previous studies and all the tumors were positive for common neuroendocrine markers.

Endoscopic retrograde cholangiopancreatography (ERCP) is widely performed as an initial surgical treatment for patients with acute cholecystitis complicated by hyperbilirubinemia. This procedure carries a significant risk of complications, and needs to be performed by a highly experienced professional. The objective of our study was to evaluate effectiveness of less dangerous, in our view, surgical approach to this clinical problem. First, we performed laparoscopic cholecystectomy on two hundred and forty-eight patients with acute cholecystitis complicated by hyperbilirubinemia followed by T-tube cholangiography on third postoperative day (1996-2009). Signs of compression of Common Bile Duct (CBD) by inflamed and swollen ligaments were seen intraoperatively in 68 patients (67.8%). Gallstones under 1 cm and CBD around 1 cm were found in 44 patients (17.7%). Gallstones over 1 cm and CBD of 1.5 cm were found in 11 patients (4.4%). In cases where gallstones were found, they were removed by ERCP (less than 1 cm) or by classic methods (greater than 1 cm). If no biliary obstruction were seen, drainage was removed in the following two days. Other causes of hyperbilirubinemia (pancreatitis, strictures, etc.) were found in 25 patients (10%). Only two of them required surgical attention. T-tube cholangiography, performed on third day after cholecystectomy, showed that 184 patients (74.1%) had no biliary flow obstruction and normal bilirubin levels; as a result ERCP was not indicated. Taking this into account, we recommend first to perform cholecystectomy, with placement of external drainage and perform T-tube cholangiography on the third postoperative day, followed by ERCP if indicated.

Background: Patients with irritable bowel syndrome (IBS) often report symptoms following lactose ingestion. We found that in spite of similar frequency of lactose malabsorption (LM) and breath hydrogen levels, patients with IBS developed symptoms more commonly than healthy controls, which might be due to visceral hypersensitivity. Hence, we aimed to study; level of serotonin and SERT polymorphism among patients with IBS who developed symptoms following lactose ingestion compared to those who did not develop it. Method: 150 patients with IBS (Rome III criteria) were evaluated for symptom development following lactose ingestion. Serotonin was estimated on rectal biopsy (ELISA) and SERT polymorphism studied on DNA extracted from venous blood (PCR). Results: Of 150 patients (age 36.7+11.8-y, 114 [76%] male), 62 (41.3%) developed symptoms following lactose and 88 (58.7%) did not. Serotonin level in rectal tissue was higher among patients with IBS who developed symptoms compared to those who did not (144.8+40.9-pmol/mL vs. 122.7+36.3-pmol/mL, p=0.001). Also, patients with IBS who developed symptoms following lactose ingestion had higher frequency of deletion/deletion (s/s) SERT genotype compared to those who did not [s/s 48/62 (77.4%), s/l 8/62 (12.9%), l/l 6/62 (9.7%) vs. s/s 41/88 (46.6%), s/l 36/88 (40.9%), l/l 11/88 (12.5%), p=0.003, respectively]. Patients with IBS who had deletion/deletion genotype had higher level of serotonin in rectal tissue compared to deletion/insertion and insertion/insertion genotypes (151.1 ± 37.3 vs. 105.0 pmol/mL ± 20.9 vs. 100.9 ± 28.0 pmol/mL, p < 0.001, respectively). Conclusion: Symptom development in patients with IBS following lactose ingestion is related to higher serotonin level in rectal tissue and SERT gene polymorphism.

Abstract: Background: Colorectal cancer is one of the commonest malignant tumors worldwide, Life style factors may contribute to the etiology of colorectal cancer as they are modifiable, a better understanding of the associations between lifestyle related factors and colorectal cancer risk may be of importance in order to develop novel strategies for prevention of the disease. This study aimed at studying some risk factors of developing colorectal cancer and also the validity of carcinoembryonic antigen as screening test for colorectal cancer. Subject and methods: Nested case-control study, hospital-based study, 25 cases and 100 controls investigated by colonoscopy and confirmed histologically between October 2011 and March 2013. Results: The study revealed, All cases were adenocarcinoma among them 18 (72%) cases were well to moderately differentiated carcinoma. The majority of the cases were diagnosed as pT1 (80%); whereas the minority were pT3 (12%). There was a significant association between history of diabetes mellitus, high BMI (>30), smoking and dietary habits (p < 0.05),while age, sex of participant and family history of colorectal cancer, physical activity and NSAID intake were not significantly associated with colorectal cancer (p > 0.05). The best combined sensitivity and specificity of CEA was at cutoff 5.5 mcg/dl.Conclusion: From this study, the exposure to personal and environmental risk factors were thought to play an important role in the development of colorectal cancer.

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) usually mandate management within an intensive care unit (ICU).Some current ICU prognostic models [Acute Physiology and Chronic Health Evaluation (APACHE), Organ System Failure (OSF) and Sequential Organ Failure Assessment (SOFA)] were used to stratify cirrhotics into risk categories, but few cirrhotics were included in the original model development. Liver-specific scores [Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD)] could be useful in this setting. The aim of this presentation will be evaluation whether ICU prognostic models perform better compared with liver-disease specific ones in cirrhotics admitted to ICU, and it is possible to outline the best prognostic tool.

Purpose: To prospectively evaluate the diagnostic performance of Computed Tomographic Colonography with limited bowel preparation for the depiction of colorectal polyps, by using conventional colonoscopy as the gold standard technique. Material and Methods: Study included forty five consecutively registered patients referred for conventional colonoscopy for colorectal cancer screening or for evaluation of colorectal symptoms; they were scheduled to undergo MDCT examination on the same day at Radiology Department in our institution, before the conventional colonoscopy examination. All patients underwent limited preparation. Main outcome measures: Sensitivity, specificity, positive and negative predictive value of CTC versus CC in each group and overall. Results: A total of 60 polypoid lesions were detected with colonoscopy in 45 patients over all sensitivity of CTC in polyp detection was 85.71%, specificity 71.24, PPV 96.77 and NPV 33.33, as regarding CTC performance in each group. Conclusion: This study proved that CTC with limited cathartic bowel preparation and iodinated agents for faecal tagging can obtain high sensitivity and PPV values results for <5 mm polyps comparable to those obtained with conventional preparation with laxatives. Furthermore, this method could really improve the acceptance of CTC for colorectal cancer screening.

Dr Faizan Rathore had his primary schooling done in Saudi Arabia & Pakistan, He then obtained his primary medical degree from University of Oradea, and then went on to complete his Basic Specialist Training in General Internal Medicine from the Royal College of Physicians of Ireland, He has an active interest in Research and has various publications and presentations about different topics in Internal Medicine, He holds post graduate degrees in Cardiology & Syncope, his main career interest is in Cardiac Electrophysiology.

This study was carried out from Jan 12- Dec 12 to assess current practice in Kerry General Hospital against the age related indicators for colonoscopies. A total of 1474 colonoscopies were performed, 1177 (79.9%) were diagnostic and 297 (20.1%) were therapeutic, patients were divided into 4 age groups under 75, 75-80, 81-85, 86+. The trend analysis revealed an increase in diagnostic colonoscopies and decrease in therapeutic colonoscopies with age. 664 (45.04%) of colonoscopies were reported normal which made up the majority of the total diagnoses, 1330 (90.2%) of colonoscopies occurred without any complications. Main complications were patient discomfort being the highest, present in 112 (7.6%) of patients, and lowest being urticaria around the IV site present in 1 (0.1%) of the cases. Patient discomfort was higher in younger patients as evidenced by 98 cases aged <75, followed by 11 cases aged 75-80, 2 cases aged 81-85 and 1 case aged >86. Highest percentage of poor tolerance was found in 14 (1.1%) of total patients <75, 1 (0.8%) of total patients aged 75-80, 1(1.7%) of total patients in age group 81-85 and none (0%) in age group >86. We have established the safety of colonoscopy, low rate of complications and a better tolerance in the elderly from this study, however, its utility; especially in presence of other co-morbidities in elderly is questionable.

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. The pathogenesis of HCC is not completely understood but it is thought to be a multistage process with the complex interactions of various risk factors. Genetic polymorphism existing in the human genome plays an important role in the development of cancers. Disturbances in the control of cell cycle play an important role in cancer formation. Cyclin D1 is a key regulatory protein in the cell cycle playing a critical role in the transition from G1 to S phase of the cell cycle. We investigated the association between G870A polymorphism in the CCND1 gene and hepatocellular carcinoma (HCC) risk in Egyptian patients by extracting the peripheral blood samples from 30 patients with chronic HCV and hepatic cirrhosis and 30 HCC patients and 60 healthy age and gender matched controls. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and direct DNA sequencing were performed to detect the polymorphism. We observed a nearly 18 fold increase in HCC risk associated with the CCND1 870 AG variant genotypes compared with the CCND1 870GG genotype among HCV individuals. In conclusion, the CCND1 G870A polymorphism may play a role in the development of HCC among HCV-positive individuals in the Egyptian population.

Objective: We report the first clinical application in medicine with virtual reality scenarios (Cyber-therapy) to decrease anxiety, visceral pain and reduction of medication during gastrointestinal endoscopic procedures. Methodology: 100 patients used a Spiderman game with a Head Mounted Display (HMD) and 100 did not use it since October 2004 to June 2007 at the Pisanty Clinic of the ISSSTE in Mexico City. Results: Pain decreased by 50%, anxiety by 75% and lidocaine in spray by 100%. Conclusions: If a simple entertainment game, such as Spiderman, reduced important metabolic response like anxiety, pain and medication, it is possible, that in the future, using serious games or virtual reality scenarios designed for medicine, metabolic responses in different medical procedures could be reduced.

Objective: To determine the prevalence and implication of coeliac disease (CD) among adult Saudis and compared to those with diagnosed irritable bowel syndrome. Subjects and methods: This prospective study was conducted among 980 adults from September 2010 to September 2011. 482 adults were randomly selected as a control from aged between 20 and 59 from students and employees in two Riyadh Colleges of Health Sciences. Another 498 cases are randomly selected group diagnosed with irritable bowel syndrome from Al-Iman Hospital at Riyadh, Saudi Arabia. Both cases and control were tested for serological markers of coeliac disease (tissues transglutaminase (tTGAs) and endomysial autoantibody (EMAs) and was confirmed by histopathology test. All the positive for cases of coeliac disease were screened for iron deficiency anaemia, Vitamin D deficiency, and osteoporosis and weight assessment. Results: The percentage of coeliac disease in control subjects and patients diagnosed with irritable bowel syndrome (IBS) were found to be 1.9% and 9.6% respectively, about 38% of the total coeliac disease patients are among females in middle age (20 – 39- years) and 16% of the males on the same age range. Whereas, 20% and 25% of all coeliac disease cases with ages of 40 -59 were remarked in females and males respectively. Conclusion The identical nature and overlap of symptoms of the two conditions could possibly result in misdiagnosis of coeliac diseases or over-diagnosis of irritable bowel syndrome. The findings of the study might also give considerable in implications of the disease in nutritional level which also noticeable.

Background and aim:Norovirus genogroup I (NV GI) and NV GII sapovirus (SaV) genogroups I, II, IV, and V , human rotavirus A(HRV), adenovirus serotypes 40 and 41 (AdV) , and human astrovirus (AstV) are the most common causes of viral gastroenteritis and result in large outbreaks of viral diarrhea. An estimated 1.8 million children die each year from largely preventable enteric illnesses, with the large majority of these mortalities occurring in developing countries. Gastroenteritis is a major cause of morbidity and mortality in children worldwide. Astroviruses and norovirus are the major viral pathogens responsible for gastroenteritis. In this study performs to determine the prevalence of astrovirus and norovirus in fecal specimens of children with gastroenteritis. Material and methods: In this study 2490 stool samples from children less than five years with gastroenteritis from five cities of Iran were collected. The prevalence of human astroviruses and norovirus was tested in patients with acute gastroenteritis by using conventional duplex reverse transcription (RT) -PCR and electrophoresis. Result: RT-PCR was evaluated with 2490 stool samples containing 2.96% Norovirus-positive(3.21% Tehran, 3.55% Tabriz, 1.23% Mashhad, 4.5% Shiraz, 4.11% Bandar Abbas). In both retrospective and prospective setting, the RT-PCR was equally sensitive and specific in detecting Norovirus and astrovirus was detected in 1.6% of samples. There is no relation between age, sex and type of virus. There is no relation between age, sex and type of virus. Conclusion: Astroviruses and norovirus are an important viral agents of gastroenteritis in Iran. Because of co-infection of astrovirous, improved personal hygiene will reduce the incidence of co-infections.

Background and objectives: Gastric cancer is the fourth most common malignancy in the world. It was demonstrated that IL-11 is increased in human gastric cancer; however, there are opposing results of the association between IL-11 expression and different gastric disorders. In this study we evaluated, the expression levels and the role of IL-11 and IL-11Rα in this disorders. Methods: A consecutive series of 85 tissue specimens were collected from patients who underwent diagnostic endoscopy. Specimens divided to two groups [neoplastic and non-neoplastic] based on endoscopic and histo-pathologic assessments. The non-neoplastic samples were further classified into four groups: normal Oesophago-gastro-duodenoscopy (NEGD), gastritis, duodenal ulcer (Du) and Gastro esophageal Reflux disease (GERD) .The histological grade of the gastric cancer was determined on the basis of differentiation. Real- Time PCR was performed to detect gene expression. Results: IL-11 and IL-11Rα expressions were 2.1-fold (p=0.008) and 1.8-fold (p=0.013) higher in gastric adenocarcinoma vs. benign disorders. Expression of these two genes was significantly enhanced in Gastric adenocarcinoma and Du by 3.5-fold (p=0.001) and 2.6-fold (p=0.014), respectively. Elevated expression of IL-11Rα but not IL-11 was seen in GERD group. There was no significant difference in IL-11and IL-11Rα expressions among various grades. Conclusion: High IL-11 and IL-11Rα expressions revealed the role of this cytokine not only in gastric cancer development but also in gastric ulceration. IL-11 and IL-11Rα may not play role in tumor differentiation.

Gastric cancer (GC) is associated with aberrant expression of miRNAs and deregulation in signaling pathways. We perform in silico predictive analysis to know which miRNAs could be regulating the PI3K/AKT/mTOR pathway and could play an important role in the development of GC. We found that miR-125b, miR-451 and miR-101 could target the mRNA of PI3K and AKT (miR-125b), TSC1 (miR-451), and mTOR and PI3K (miR-101), all members of this pathway. The aim of this study was to evaluate the transcriptional and protein expression of the most important components of PI3K/AKT/mTOR pathway in tissues and GC cell lines and associate their expression with the expression of miR-125b, miR-451 and miR-101. Methods: The expression of PI3K, AKT, PTEN, TSC1, mTOR, P70S6K1, 4E-BP1 and eIF4E genes and expression of miR-125b, miR-451 and miR-101 were analyzed in 25 advanced GC tissues and their 25 paired non-tumor tissues (NT), and in AGS, MKN28 and MKN45 GC cell lines by qRT-PCR. The protein expression of PI3K/AKT/mTOR was performed by IHC in TMAs of 142 gastric tissue samples (71 advanced GC and 71 paired non-tumor tissues). The proteins studied were PI3K, PTEN, AKT, phospho-AKT, mTOR, phospho-mTOR, p70S6K1, phosphop70S6K1, 4E-BP1, phospho-4E-BP1, eIF4E and phospho-eIF4E. Clinical and pathological data of patients was used. Results: Increased protein expression was found by IHC for PI3K, AKT, phospho-AKT, phospho-mTOR, p70S6K, phospho-p70S6K, phospho-4E-BP1, eIF4E and phospho-eIF4E in tumor tissues compared with non-tumor tissues (p<0,05). Conversely, levels of PTEN were higher in non-tumor tissues (p <0.001). Moreover, Kaplan-Meier analysis showed a poor survival in those patients with low expression of 4E-BP1(p=0,03). The gene expression of PI3K, AKT, mTOR, P70S6K1 y eIF4E in AGS, MKN28 andMKN45 cell lines was significantly higher compared with non-tumor cells. PTEN was downregulated in these 3 cell lines. Decreased expressions of miR-125b (p=0,039), miR-451(p=0,0013) and miR-101(p=0,0005) were found in GC tissues compared with NT. Also, lower expressions of miR-451 and miR-101 were found in the three GC cell lines (p<0,0001 for all). Mean while, miR-125b was found decreased only in AGS and MKN45 cell lines (p<0,0001 both). Conclusion: This study has shown that PI3K/AKT/mTOR pathway is activated in tumor

ABSTRACT Objective: Gastrointestinal dysfunction induced by bacterial peritonitis contributes to the incidence of systemic inflammatory response and multiple organ dysfunction syndromes. This study utilized a rat model of bacterial peritonitis to investigate morphological changes in the enteric nerve-interstitial cells of Cajal (ICC) network and the pathogenesis of small intestine motility dysfunction . Methods: We established a rat model of bacterial peritonitis and then studied gastrointestinal motility using myoelectric recording of the frequency and amplitude of small intestine slow waves, analyzed using AcqKnowledge 3.7.1 software. In specimens of small intestine, we performed double labelling immunofluorescence of c-Kit, Vasoactive intestinal peptide (VIP) and Substance P(SP), analyzed the imaging data using Leica imaging software. Results: Compared with normal control rats treated with PBS, rats with bacterial peritonitis exhibited lower slow wave frequency and amplitude, significantly fewer ICC/VIP /SP positive nerve fibers, and less immunofluorescence intensity of the enteric nerve-ICC network. Furthermore, we identified poor connections between ICC and VIP-positive nerve fibers/SP-positive nerve fibers, and disorganized enteric nerve-ICC network structure (P< 0.01) in the rats with bacterial peritonitis. Conclusion: Our results indicate that bacterial peritonitis can cause gastrointestinal motility dysfunction in this rat model. Morphological changes associated with bacterial peritonitis in the enteric nerve-ICC network might be responsible for clinical symptoms of gastrointestinal motility dysfunction in bacterial peritonitis.