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

Biography:

Mary Es Beaver MD FACS is the director of the Texas Center for Voice and Swallowing in Houston Texas, a division of Texas ENT Specialists which is the fourth largest otolaryngology group in the United States. She has published previously on causes of chronic laryngotracheitis in numerous peer reviewed journals. She is a reviewer for the Laryngoscope and is a frequent contributor to the literature regarding pathology that affects the larynx.

Abstract:

A retrospective case series of 518 patients was performed to determine the prevalence of pharyngeal reflux in patients with chronic laryngotracheitis (CLTR). Patients were included if they presented with chief complaint of hoarseness, sore throat, difficulty swallowing, cough, reflux or lump in throat for greater than six weeks and received a 24 hour Restech pharyngeal pH study. Patients with > 4 events of ph < 5.5 at pharynx were considered positive and those with zero events at the pharynx were considered negative for reflux. SPSS was used to analyze pharyngeal reflux pattern in the entire study sample, each symptom group and symptom duration category (1-3 months, 4-6 months, 7-9 months, 10-12 months and > 12 months). The overall prevalence of pharyngeal reflux for patients with symptoms of CLTR was 63%. There were significantly more exclusively nocturnal/supine pharyngeal reflux patients (70%) than upright or mixed (30%) reflux pattern among positive studies. 60 % of patients had pharyngeal reflux in 1-3 months duration of illness group compared to 74% in 4-6 months duration (p = 2.36). There was no significant difference in prevalence of pharyngeal reflux among different symptom groups. 68% of patients presenting with hoarseness and 69% of patients with chronic cough had positive Ph studies. The prevalence of pharyngeal reflux in patients with CLTR is significant more common at night in supine position and symptom type and duration does not predict the presence of reflux to pharynx.

Biography:

Li na had her PhD training at University of Louisville, USA. She then completed her gastroenterology and hepatology training at North Shore LIJ medical center. She worked with a renown hepatologist Dr. David Bernstein and developed strong clinical interests on viral hepatitis and metabolic liver disease. She is currently a clinical assistant professor at Ohio State University. She looks forward to conducting more clinical studies on these hepatology fields and collaborating with field experts.

Abstract:

Hepatitis B virus (HBV) infection is a global epidemic with estimated mortality 0.5-1.2 million deaths a year. Long-term goal of treatment on patients with chronic hepatitis B infection (CHB) is to reduce cirrhosis, hepatocellular carcinoma, and ultimately improve survival. The decision on initiating viral therapy can be complex because not all the patients with CHB derive significant clinical benefits from current medical therapies. Elevated HBV DNA level is a strong independent risk predictor of liver-related disease outcomes. Up to date, many studies have demonstrated improved clinical outcomes with successful viral suppression in CHB patients. Hepatic disease activity, assessed by histology and less accurately by alanine aminotransferase (ALT), is another major decision-making factor on initiating anti-viral therapy in patients with CHB. As in immune tolerance phase of CHB, characterized by high HBV DNA level, normal ALT, and no/minimal hepatic inflammation, disease progression is negligible. Treatment on these patients is therefore unlikely to alter long-term clinical outcomes. However, close monitoring of ALT level is highly recommended during immune tolerant phase as transition to immune clearance phase may occur. Anti-viral therapy is often required during immune clearance phase due to rapid disease progression. In patients with low HBV DNA and normal ALT, as seen in inactive carrier, medical therapy is typically not beneficial in long-term outcomes due to minimal risk of developing hepatic complications.

Biography:

Dr.Vikas Leelavati Balasaheb Jadhav has completed Postgraduation in Radiology in 1994. He has a 19 Years of experience in the field of Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonography. He has four Indian Patents & an International Patent published on his name in the field of Gastro-Intestinal Tract Sonography & the Radiology, since 2008. He has delivered many Guest Lectures in Indian as well International Conferences in nearly 20 countries as an Invited Guest Faculty, since 2000. He is a Consultant Radiologist & the Specialist in Unconventional Gastro-Intestinal Tract Ultrasound

Abstract:

TransAbdominal Sonography of the Small & Large Intestines can reveal following diseases. Bacterial & Viral Entero-Colitis. An Ulcer, whether it is superficial, deep with risk of impending perforation, Perforated, Sealed perforation, Chronic Ulcer & Post-Healing fibrosis & stricture. Polyps & Diverticulum. Benign intra-mural tumours. Intra-mural haematoma. Intestinal Ascariasis. Foreign Body. Necrotizing Entero-Colitis. Tuberculosis. Intussusception. Inflammatory Bowel Disease, Ulcerative Colitis, Cronhs Disease. Complications of an Inflammatory Bowel Disease – Perforation, Stricture. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature. Enlargement of the involved segment seen. Shouldering effect at the ends of stricture is most common feature. Primary arising from wall itself & secondary are invasion from adjacent malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant Gastro-Intestinal Tract lesions, so should be the investigation of choice.

Biography:

Abstract:

High soft drink consumption has been linked with asthma. Anecdotal evidence links highfructosecorn syrup with asthma. Th e receptor of advanced glycation end products (RAGE)has emerged as a mediator of asthma. Th e objectives of the present study were toassess the correlation between intake of beverages containing excess free fructose (EFF beverages) and asthma in children and epidemiologically test the mechanistic hypothesis that intake of high EFF beverages such as apple juice or beverages sweetened with highfructose corn syrupis associated with increased risk of asthma. Th is hypothesis is based on the possible eff ect of increases in the in situ intestinal formation of advanced glycation end products (enFruAGE) with EFF which may be absorbed and play a role in RAGEmediated asthma. We examined crosssectionalassociations between beverage intake and selfreportedcurrent or history of asthma. Exposure variables were EFF beverages including apple juice (AJ), nondietsoft drinks (ndSD) and fruit drinks (FD). Orange juice (OJ) not an EFF beverage was included as a comparison. RaoScott χ2 analysis was used for prevalence diff erences and logistic regression for associations adjusted for age, sex, race/ethnicity, BMI and total energy intake. Data are from the National Health and Nutrition Examination Survey 2003-2006, a nationally representative survey. US children (n=1961) aged 2-9years with complete responses on the dietary frequency questionnaire. Intakes of EFF beverages were signifi cantly associated with asthma in 2-9yearolds. Adjusted odds of asthma in children consuming EFF beverages ≥5 times/week was more than fi ve times that in children consuming these beverages ≤1 time/month (OR=5.29, P=0.012). Children consuming AJ ≥5 times/week vs. ≤1 time/month adjusted for the other beverages were more than twice as likely to have asthma (OR=2.43, P=0.035). In contrast, there was a tendency for OJ to beprotective. Th ese results support the hypothesis that intake of high EFF beverages including AJ and beverages sweetened with high fructose corn syrup is associated with asthma in children aged 2-9 years. Results support the mechanistic hypothesis that enFruAGE may be an overlooked.

Biography:

Abstract:

Algorythms of care in patients with acute appendicitis have changed in the last 20 years due to the introduction of new surgical techniques and to the increasing importance given to antibiotic therapy. A 14 years experience on 1354 appendicites has allowed the proposal of an algorithm based on clinical variables and a selection between treatment with antibiotic therapy alone, open appendectomy, laparoscopic appendectomy or single-port appendectomy. We have treated 336 patients with conservative therapy alone, 923 patients with laparoscopic appendectomy (with a rate of conversion of 10.1%), 75 patients with open appendectomy, 20 patients with single-port appendectomy. Our clinical practice has changed in time also in relationship with the upcoming evidencebased criteria from randomized controlled studies or systematic reviews. The clinical choice between different approaches is today standardized in a clinical flow-chart based upon blood exams (leukocytes, CRP, pregnancy test), imaging (US or CT-scan), serial physical examination and explorative laparoscopy.

Biography:

P Vodicka graduated at the Medical Faculty, Charles University, Prague and in 1986 obtained PhD in Biochemistry. He worked as Postdoctoral Fellow at the Finnish Institute of Occupational Health, Helsinki, Finland (1987-1990) and as Visiting Scientist at Karolinska Institute, Huddinge, Sweden (1990-1993). Since 2002 he heads the Department of Molecular Biology Cancer, Institute of Experimental Medicine, Academy of Sciences of Czech Republic, Prague, Czech Republic. He has published more than 150 (more than 3000 citations a HI 32) articles. Since 2004, his main research topics are focused on the DNA and chromosomal damage and DNA repair functional tests in humans and on transient biomarkers in the onset of gastrointestinal cancers. In 2012 he edited the special issue in Mutagenesis, Colorectal Cancer- Current Insights into Susceptibility.

Abstract:

Colorectal carcinogenesis (CRC), as a complex process, involves a plethora of events resulting in both genomic and chromosomal instabilities. Th e theories underlying carcinogenic process point out either the role of somatic mutation or the surrounding microenvironment. However, neither of them explains all features of cancer. Uncontrolled proliferation and genomic instability point to the DNA repair and DNA damage response are the key players. In the present study, we will overview several biomarkers in mapping heterogenous complex CRC disease and providing prognostic information. Variants in genes involved in several important pathways, such as DNA repair, cell cycle control, folate metabolism and methylation, insulin resistance and obesity, ABC transporters, selenoprotein genes, genes involved in infl ammatory/immune response have shown various degree of association with CRC risk. We also present the data on mutations in high risk genes involved in colorectal carcinogenesis. Gene expression levels were determined in relevant pathways and complemented with other important parameters, such as epigenetic regulators of transcription by methylation. Additionally, the role of post-transcriptional regulation via miRNA or lncRNA was investigated in relation to the risk of CRC and the effi cacy of chemotherapy. We have discovered several genetic and epigenetic markers aff ecting independently the prognosis of CRC. Functional DNA repair tests (complex phenotype) have been implemented as markers of individual susceptibility to sporadic CRC and its prognosis. An application of the whole set of various biomarkers, covering genetic, epigenetic and functional aspects is inevitable to defi ne the phenotypic landscape of the disease and to delineate the individual response to the therapy.

Biography:

Mrinal Pahwa did his MBBS - Maulana Azad Medical College, New Delhi 2003. MS(General Surgery) - Maulana Azad Medical College, New Delhi 2008. DNB (UROLOGY) - Sir Ganga Ram Hospital, New Delhi, 2013. Working As Consultant Urologist At GNH Hospitals, Gurgaon

Abstract:

Introduction: ESWL has become the preferred tool in the Urologist’s armamentarium for treatment of urinary calculi in appropriate cases because it is simple, eff ective and minimally invasive technique. Effi cacy of ESWL besides other factors also depends on cooperation of the patient throughout the procedure. Several diff erent techniques along with analgesic drugs have been used for ESWL procedure including general, regional and local anesthesia as well as monitored anesthesia care. Th e aim of our study was to compare safety and effi cacy of performing ESWL under intravenous (IV) anesthesia as compared to local anesthesia. Material & Methods: A prospective study was carried out in a tertiary care centre in New Delhi from March 2013 till April 2014 on 60 patients with renal or upper ureteric calculus less than 2cm. Patients were divided into two groups of 30 each: Group I included patients who underwent ESWL under IV anesthesia & group II patients underwent ESWL under local anesthesia. Preoperative, intraoperative details, complications, number of sessions required and the cost incurred in the procedure were recorded and analyzed. Th e patients in group A were given fentanyl, midazolam and propofol infusion whereas patients in group B were given IV/intramuscular analgesia along with local application of EMLA cream (eutectic mixture of prilocaine and lignocaine hydrochloride). Results: Th e study groups were comparable for age, gender and stone size. Th ere was signifi cant diff erence in the number of sessions required (1.06 vs. 2.2), average intensity of shock waves (4.33 vs. 3.53), postoperative score (p 0.0001 ), average shockwaves used (3800 vs. 5967), the cost of the procedure (Rs.3270 vs. 2140) and the time taken for clearance (1.53 vs. 2.4 months). Th ere was no morbidity or side eff ects attributable to I.V anesthesia. Conclusion: We conclude that ESWL under total intravenous anesthesia is highly eff ective, safe and cost eff ective for solitary renal and upper ureteric stones and leads to complete and early stone clearance than ESWL under local anesthesia.

Biography:

Abstract:

Chronic hepatitis C is a major cause of cirrhosis, hepatocellular carcinoma and HCV-related end stage liver disease in many countries it is the first cause of liver transplantation.The infection is often asymptomatic but chronic infection can lead to scarring of the liver and ultimately to cirrhosis which is generally apparent after many years establishing accurate staging of liver disease is very important for enabling both therapeutic decisions and prognostic evaluations.A liver biopsy is considered the gold standard for assessing the stage of hepatic fibrosis but it has many limitations. During the last decade, several non-invasive markers for assessing the stage of hepatic fibrosis have been developed. Some has been well validated and are comparable to liver biopsy. This paper focused on some non-invasive biochemical markers used to stage liver fibrosis.The aim of this study was to evaluate some serum biochemical markers for diagnosing liver fibrosis in patients with CHC.The study was conducted on 50 patients who were divided into two groups: Group 1 included 25 patients with F1 liver fibrosis; group 2 enrolled 25 patients with F2 liver fibrosis (according to metavir scoring system) and fit for the combination therapy (Pegyalatedinterferon+ribavirin).Serum HA, SHASTA index were significantly higher in patient with grade2 fibrosis than grade F1 patients.From the previous study, we can conclude that these parameters could be useful non-invasive markers of liver fibrosis and cost-effective alternative to other serum markers for staging liver fibrosis and for determining the timing of HCV treatment

Biography:

Nisreen E Mahmoud, currently holds the position of a professor in the department of parasitology in the University of Cairo since 2004. Her fi eld of specialization is Fish Parasitology. She joined as an Assistant Lecturer from 1990 to 1994. Lecturer of Parasitology since 1994.Assistant Professor of Parasitology since Sept.1999.Prof. of Parasitology since 2004. She had received her MVSc (Parasitology, fi sh parasites) in 1990 and PhD (Parasitology, fi sh parasites) from Cairo University in 1994.She is the chair and member of the following commitees & associations:Charing in the project of Biotechnological control of ticks in Egypt ( from 1995-1996).Charing in the project of Geographical imfomation systems (GIS) and controlof snail borne diseases. Member of the Egyptian Vet. Med. Assoc. Member of the zoological society A. R. Egypt. Member of fi sh committee of the general organization for veterinary services, Egypt.(G.O.Vet.S.) Member of the fi sh committee for the solution of Lake Naser fi sh helminth problems in G. O. Vet. S. Egypt. Attemptin a training course on fi sh Parasites in General Authority for Fish Resources Development 2002. Member of the Egyptian Society of Veterinary Parasitology. Member of the Egyptian Society of Parasitology. Charring in the Project Comparative study of Lime Borreliosis Vectors/ Pathogenesis (Egyptian/US Project # 930312. from 1999-2002). Member of the Egyptian Society of Environment and Aquatic Animal Health.

Abstract:

Worldwide, humans suff er from numerous parasitic food borne zoonoses. Th e parasitic zoonoses of concern in this workshop are those mostly helminthic diseases caused by trematodes, cestodes and nematodes that transmitted from freshwater, brackish and marine fi sh causing gastroenteritis and other health problems. In the past, these diseases were limited mostly to populations living in developed, low- and middle-income countries, but the populations at risk are now expanding and changing due to many factors .Th e World Health Organization and the Food and Agriculture Organization of the United Nations estimate that more than18 million persons were infected with fi sh-borne zoonotic trematodes in 2002 and the World Health Organization recently added fi sh-borne zoonotic trematodes infections to its list of emerging infectious diseases. Th e recognition of the public health signifi cance of these zoonoses, their links to poverty and cultural traditions, with the lack of tools for control is also increasing. In addition, many developed countries recognized meat-borne zoonoses such as trichinellosis and cysticercosis, but fewer are acquainted with fi sh-borne parasitic zoonoses like intestinal trematodiasis, anisakiasis or diphyllobothriasis. Th e aim of this workshop is to draw attention to the problem of these zoonoses and, hopefully, inspire greater eff orts to acquire reliable global impact assessments and to develop scientifi c basis for designing their prevention and control programs. We will focus on fi sh-borne parasitic zoonoses that are currently considered the most signifi cant and also present references to others that occur in various regions. Th e emphasis is on basic biological and epidemiological features so as spot light on gaps that need greater research investment, eff ective prevention and control strategies.

Biography:

Department of Anatomyy, College of Medicine & King Khalid University Hospital, King Saudi Univesity, Riyadh, Saudi Arabia.

Abstract:

Ulcerative colitis (UC) is one of chronic inflammatory diseases primarily affecting colon with unknown etiology. Some researches papers mentioned the possibility of the use of drugs that affect the angiotensin II in reducing the complication of ulcerative colitis. The aim of the present study is to evaluate the potential protective and therapeutic effects of captopril and valsartan on ulcerative colitis induced experimentally in rats using acetic acid. The results were assessed by histological assessment of colonic tissues and measurement of malondialdehyde (MDA), tumor necrosis factor (TNF-α), transforming growth factor (TGF-1), angiotensin converting enzyme (ACE), reduced glutathione (GSH) and platelet activating factor (PAF) levels in colonic tissues. Oral pretreatment with captopril or valsartan in a dose of 30 mgkg-1 body weight for 2 weeks before induction of colitis (prophylactic groups) and continuously for 2 weeks after induction (therapeutic groups) significantly reduce MDA, TNF-α, PAF, TGF-1 & ACE levels in colonic tissues as compared to acetic acid control group. Also, a significant increase in GSH level was observed in colonic tissues. Captopril and valsartan attenuated the macroscopic and microscopic colonic damage induced by acetic acid. These results suggest that either captopril or valsartan may be effective as prophylactic or treatment of UC through inhibition of ACE and scavenging effect on oxygen-derived free radicals.

Biography:

Ramadan El Gharbawy is Professor of Anatomy and Embryology, Faculty of Medicine, Beirut Arab University, Lebanon. Professor of Anatomy and Embryology (en secondment), Faculty of Medicine, AlexandriaUniversity, Egypt. Consultant of General Surgery, Egypt. Ex-scholar at the Centers for Surgical Anatomy and Technique, Emory University, USA

Abstract:

BACKGROUND Driven by organ shortage, the liver transplant community has introduced liver bipartition to augment the number of grafts for transplantation. However, split liver transplantation has not yet reached its full potential application and results not even in the centers that do high volume splitting. This probably – in part - due to the high rates of complications associated with it. Based on the knowledge gleaned from an intricate anatomical study I present two theoretical techniques for tripartition of the deceased’s liver that might overcome the complications associated with ischemic or congested grafts and expand the deceased donor pool. MATERIALA AND METHODS The techniques proposed here have been based on data obtained from the dissection of 18 normal fresh livers of adult cadavers at the Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia, USA. The livers were obtained from Emory’s Body Donor Program after ensuring the adherence of the research project to ethical guidelines. The livers were injected differentially with colored latex; dissection casts were prepared; and the intricate architecture at the sheath ramifications’ level was studied. Proposed techniques The liver might be split into three grafts by one of two ways. First, the liver parenchyma is transected immediately right to the falciform ligament and the middle hepatic vein. The procured grafts will be composed of: a left lateral section, a left medial section- Caudate lobe’s left part, and a right lobe. The left lateral section graft will be drained by the left hepatic vein. Through inferior vena cava split and maintaining the middle hepatic vein with the left medial section- caudate lobe’s left part and the necessary reconstruction of its tributaries from segments 5 and 8 the other two grafts would be effectively drained. The left lateral section is procured with the artery and the bile duct of the section and with a venous portal patch formed by the left half of the umbilical part of the left portal branch that would be reconstructed. The celiac trunk, left portal vein branch, and left hepatic duct would be maintained with the medial segment- Caudate lobe’s left part graft. The bile duct, right branch of the hepatic artery, and main portal vein trunk would be maintained with the right lobe graft. Second, the liver parenchyma is split on the right sides of the falciform ligament and middle hepatic vein to procure a graft composed of the inferior part of the left medial section (S4b) and the major superficial fraction of its superior part (S4a). The left parenchymal incision starts superiorly inferior to the junction of the left and middle hepatic veins. The right parenchymal incision starts superiorly distal to the middle hepatic vein’s tributary from segment 8. The superior parenchymal incision runs between the superior ends of the right and left parenchymal incisions and is deepened, aiming at the hilar plate. This graft is drained by the middle hepatic vein transected below the confluence of its major tributary from segment 8 and by the umbilical fissure’s vein in case the latter is/more than 5 mm in diameter. The graft’s artery is the artery of segment 4 and its duct constantly begins at the corner formed by the umbilical and transverse portions of the left portal vein. This segment 4 graft is procured with venous patch formed by the right half of the umbilical part of the left portal vein. The second graft is composed of the left lateral section, caudate lobe’s left part, and the deep part of S4a. The celiac axis and left hepatic duct are maintained with the graft. The third graft is composed of the right lobe, the part of caudate lobe located deep to the inferior vena cava and caudate process. The bile duct, right branch of the hepatic artery, and main portal vein trunk are maintained with the graft. The inferior vena cava is split: the left aspect of the cava is maintained with the second graft; the anterior and right aspects of the cava are maintained with the third. CONCLUSION Our anatomical results suggest that tripartition into viable grafts might be feasible. The techniques are complex; however, as the learning curve is mastered they would be gainable.

Biography:

Ahmed Ellakany is working as a Lectrer at Military Medicine Academy, Egypt. His interests include gastrointestinal disease diagnostics and treatment.

Abstract:

Eosinophilic esophagitis is a clinicopathologic disease characterized by upper intestinal symptoms and the fi nding of more than 15 or 20 eosinophils in the esophageal epithelium. Lack of awareness to EoE among some gastroenterologists made the disease under recognized. Patients with eosinophilic esophagitis should be referred to both an allergist and gastroenterologist for optimal management which may include dietary modifi cations, pharmacologic agents, ingested fl uticasone and its role in EOE will be discussed in this study. Th is study was conducted at faculty of medicine,Alexandria University, Internal Medicine Department. Th e study was conducted on twenty patients who were complaining from recurrent dysphagia and done upper GIT endoscopy and diagnosed histopathologically as EOE. Th e 20 patients was randomly assigned to receive either placebo (n=10) or swallowed fl uticasone (n=10). Treatment lasted for four weeks and follow up extended up to 8 months. Aft er 4 weeks treatment, clinical symptoms and histological changes were evaluated. Histologic improvement in the form of full histological remission was seen in seven patients in the fl uticasone group compared with one patient who achieved remission in the placebo group. In conclusion, the study highlights the problems of diagnosis and lack of awareness and understanding of the etiology and pathogenesis of the disease. Th e use of ingested fl uticasone showed improvement of symptoms and histological pattern.