9^th Euro-Global Gastroenterology Conference October 24-25, 2016 Valencia, Spain

Biography:

Maxwell M. Chait is a practicing gastroenterologist and assistant professor of medicine Columbia University College of Physicians and Surgeons in New York City.  He is a Fellow of several prestigious organizations, including the American College of Physicians, American College of Gastroenterology, American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. He has authored numerous publications and serves on the editorial board of several journals. He is the editor-in-chief of the Journal of Liver Disease and Transplantation.

Abstract:

Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the older patient. Although older patients with GERD may have fewer symptoms, they can have more severe esophageal and extra esophageal complications that may be potentially life threatening. These complications include the esophageal complications of erosive esophagitis, esophageal stricture, Barrett’s esophagus, adenocarcinoma of the esophagus and the extra esophageal complications of atypical chest pain, ENT manifestations such as globus sensation and laryngitis, dental problems and pulmonary problems such as chronic cough, asthma, and pulmonary aspiration. A more aggressive approach may often be warranted in the older patient, because of the higher incidence of severe complications. The evaluation and management of GERD are generally the same in both younger and older patients. However, there are specific issues of causation, evaluation and treatment that must be addressed when dealing with the older patient, such as cognitive impairment, comorbidities and medication side effects.

Biography:

Steven Teich, M.D. graduated from The State University of New York at Buffalo College of Medicine. He completed a general surgery residency at George Washington University Hospital and a Pediatric surgery fellowship at the University of Pittsburgh. He is board certified in General Surgery, Pediatric Surgery, and Surgical Critical Care. He was Director of the Surgical Neuromodulation Program at Nationwide Children’s Hospital, Columbus, OH. He has published 57 peer-reviewed papers and 16 book chapters and edited a book entitled Reoperative Pediatric Surgery. He serves on the editorial board of two journals and is an ad hoc reviewer for many journals. 
 

Abstract:

Electrical stimulation of the gastrointestinal tract has been touted as a possible therapy for intestinal motor dysfunction since 1963 when Bilgutay, et al., reported the use of transluminal electrical stimulation to induce peristalsis. In the late 1960’s and 1970’s the myoelectrical activity of the gastrointestinal tract was elucidated along with its relationship to gut contractility. Out of this initial research several clinical applications of gastrointestinal electrical stimulation have arisen. These include gastric electrical stimulation (GES) for treatment of gastroparesis, sacral nerve stimulation (SNS) for treatment of fecal incontinence and constipation, and electrical strimulation of the lower esophageal sphincter (LES) for treatment of severe gastroesophageal reflux disease (GERD). GES is a low energy, high frequency system that stimulates the nerves that innervate the gastric antral muscle. GES improves nausea and vomiting, decreases medical costs, decreases hospital days, and improves quality of life in patients with gastroparesis refractory to dietary and pharmacological interventions.  SNS is a low energy, high frequency system that directly stimulates the third sacral nerve root. SNS significantly improves severe fecal incontinence and constipation compared with optimal medical therapy. Electrical stimulation of the LES for treatment of GERD is the newest electrical stimulation therapy. Studies published in the last 2 years demonstrate sustained improvement in GERD outcome and GERD-HRQL, elimination of the need for daily GERD medications, and sustained normalization of esophageal acid exposure compared to standard medical therapy for severe GERD. Electrical stimulation of the gastrointestinal tract continues to have great potential for many GI disorders.

Biography:

Khalil N Bitar PhD AGAF is Professor of Regenerative Medicine, Gastroenterology, Physiology and Biomedical Engineering. He is the director of Gastroenterology program at the Wake Forest Institute for Regenerative Medicine. He has published more than 100 papers in high impact journals and has been funded by NIH for more than 30 years. He is a fellow of the American Gastroenterolgy Association

Abstract:

Tissue engineering and regenerative medicine aim to restore, repair, or regenerate the function of the tissues. Gastrointestinal tissue engineering is a challenging process given the specific phenotype and alignment of each cell type that colonizes the tract. These properties are critical for proper functionality. Regeneration of the neuromuscular apparatus is of critical importance. New materials are emerging. Regeneration can be divided into acellular approaches such as decellularized matrices, synthetic and natural scaffolds as replacements to reconstruct the gut, or cell-based approaches such as tissue specific cells (smooth muscle cells, neural progenitor cells, and epithelial cells), gut derived organoid units, and stem cells (organ buds). New stem cell strategies for in vitro modelling and in vivo therapies are emerging.

Biography:

Amanda Brisebois is a Internal Medicine and Palliative Care Specialist, who works in Edmonton, Alberta, Canada. She undertook her undergraduate education and Masters degree at Queen’s University in Kingston, Ontario Canada. She completed her medical school training in Calgary, Alberta, and her General Medicine Specialty at the Mayo Clinic Rochester Minnesota, University of Calgary in Calgary, Alberta, and University of Alberta, in Edmonton. Since 2000, she has been practicing General Internal Medicine in both inpatient and outpatient settings. She also is a certified Palliative Care Specialist. She has a keen interest in Medical Education, and has won over 15 major teaching awards since starting her practice. Her focused area of research and interest is now in non-cancer palliative care. She has created an outpatient non-cancer palliative care clinic at the University of Alberta, and sees patients with severe symptoms in the major areas of cardiology, pulmonary, renal, and cirrhosis care. She has published in this space, and is collaborating on multiple research projects in these areas. Dr. Brisebois has a keen interest in interdisciplinary and inter-specialty collaboration, with aims to improve transitions in care when navigating our health systems. Dr. Brisebois is currently an Associate Clinical Professor at the University of Alberta, and the Medicine Facility Chief at the Grey Nuns Hospital in Edmonton.

Abstract:

Cirrhosis is a chronic progressive illness that affects from 4.5% to 9.5% of the population, and an estimated 50 million adults worldwide. Alcohol, NASH and viral hepatitis are reported to be the most common causative factors. HCV is carried by an estimated 170 million people worldwide and approximately 3-4 million new cases occur a year. In 2001, cirrhosis ranked as the 14th and 10th leading cause of death in the world and in developed countries, respectively¹. Projections suggest that growth in the cirrhosis population is rapid, and is expected to rise to the 12th leading cause of death worldwide in 2020. Despite high mortality rates, frequent hospitalizations, low rates of advance care planning, and high symptom burden, discussions surrounding these issues are infrequent. In an Edmonton, Alberta, Canada Cirrhosis Care Clinic, only 15% of patients have ACP discussions and resulting goals of care designations (GCD), few have clear documentation and management of symptom burden, and Palliative Care specialists are infrequently involved. An outpatient non-cancer Palliative Care clinic, has been in operation since 2012, and data has been collected for the 45 patients seen with cirrhosis. Retrospective analysis of local inpatient experience has also been published. Within these settings, a multi-disciplinary group at the University Hospital in Edmonton has undertaken multiple research and clinical initiatives, to heighten the awareness of palliative principles applying to the care continuum of patients with cirrhosis. Three ongoing initiatives will be described: 1) Work expanding knowledge translation and utilization with respect to Advance Care Planning in cirrhosis patients. 2) Outpatient non-cancer palliative clinic outcomes in cirrhosis patients describing symptom burden, success of symptom management, ACP utilization and issues in transitions of care. 3) Burden of pain in the cirrhosis population, difficulties with therapy, and utility of non-pharmacologic therapies, including an ongoing study in mindfulness intervention. For all initiatives, educational pamphlets have been created and testing is underway. The multi-disciplinary group is involved in local, Canadian and international education regarding the integration of palliative principles into regular cirrhosis care.

Biography:

Alexander Fisher, MBBS, PhD, Doc Med. Sci, FRACP, is a Senior Consultant, Department of Geriatric Medicine, Australian National University Medical School and The Canberra Hospital. 

Abstract:

This review summarizes the benefits, risks and appropriate use of acid-suppressing drugs (ASDs), proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), particularly in the elderly, advocating a rationale balanced and individualized approach aimed to minimize any serious adverse consequences. It focuses on current controversies on the potential of ASDs to contribute to infections - bacterial, parasitic, fungal, protozoan and viral, comprehensively and critically discusses the growing body of observational literature linking ASD use to a variety of enteric, respiratory, skin and systemic infectious diseases and complications (Clostridium difficile diarrhoea, pneumonia, spontaneous bacterial peritonitis, septicaemia and other). The pathogenic mechanisms of ASD-associated infections (related and unrelated to the inhibition of gastric acid secretion, alterations of the gut microbiome and immunity), agent-specific side effects and drug-drug interactions are also described. However, accumulating data on the complexity of ASD effects involving important defense systems and resulting in dysbiosis and increased risk for infections, particularly in the elderly, should not invalidate their use as long as it is evidence based. Both probiotics use and correcting vitamin D status may have a significant protective effect decreasing the incidence of ASD- associated infections. The importance of individualized therapy and caution in ASD use considering the possible spectrum of adverse events, the balance of benefits and potential harms, factors that may predispose to and actions that may prevent/attenuate adverse effects is evident. A six step practical algorithm for ASD therapy based on the best available evidence is recommended.

Biography:

Bing-Rong Liu has completed his MD in 2002 from Chongqing Medical University. He appointed as the director of gastrointestinal department of the Second Affiliated Hospital of Harbin Medical University in June 2004. He has developed so many endoscopic new techniques and published more than 20 papers in reputed journals

Abstract:

Background and aims: Successful closure of gastrointestinal (GI) wall defects is the key procedure following endoscopic full-thickness resection (EFR). To describe a new endoscopic closure method for gastrointestinal wall defects after EFR procedure similar to hand-sewn double-layer suture technique－endoscopic double-layer suture (EDS) and evaluated the safety and efficacy of this method.

Methods: We retrospectively analyzed 15 patients who presented at our institute between April 2011 and September 2015 with GI tumors (13 of gastric subepithelial tumors, 2 of colonic lateral spreading tumors) and who underwent EFR, with the resulting full-thickness wall defects being closed using EDS technique. The seromuscular and mucosal layers of wall defects were sutured separately by using endoclips with or without endoloops assistance during EDS procedure. Tumors characteristics, en bloc resection rates, suturing procedures and complications were evaluated in all patients.

Results: Successful en bloc resection and closure of wall defects

Biography:

Dr. Golan is a clinician-scientist currently conducting translational laboratory research while also serving as the Medical Director. Her clinical interest is in patients with pancreatic cancer. She is developing an innovative model based on primary tumour cells obtained from patients’ ascites. Dr. Golan’s career goals include expertise in clinical medicine, translational laboratory research and drug development.

Abstract:

Pancreatic ductal adenocarcinoma (PDAC) continues to pose a challenge globally and is expected to represent the second most common cause of cancer deaths in the next two decades.

Familial clustering is found in about 10-15% of PDAC cases (FPC) with an apparent autosomal dominant pattern of genetic transmission, suggestive of an inherited cancer syndrome. An estimated 5% of FPC cases have DNA repair pathway aberrations. BRCA1 and BRCA2 deficient tumors, particularly in BRCA1/BRCA2 germline mutation carriers, have a distinct clinical outcome and responsiveness to cisplatin-based therapy. PARPi may offer therapeutic promise in these cases and a phase III clinical trial is currently underway.

Another familial subset resembles the BRCA- mutant clinical phenotype (displaying sensitivity to cisplatin therapy and improved prognosis) and maybe referred to as having DNA repair deficiencies (DDR), although their underlying genetic mutation is undefined. Recent whole genome sequencing studies have indicated that a subset of PDAC cases with genomic instability is enriched with BRCA1, BRCA2 or PALB2 mutations and a signature of DNA damage repair deficiency. These subtype of patients who display remarkable clinical response to DNA damaging agents, thus suggesting that the potential therapeutic effects of PARPi extend beyond germline BRCA 1/2 mutation carriers.

PALB2, Rad51, ATM, RPA1, FANCM, REV1L, XRCC and HUWE1 GAs lead to DNA repair defects and may represent potential targets for PARPi. Unfortunately, targeting of these genotypes in the clinical setting is complicated by lack of validated assays. Next generation sequencing (NGS) may identify many of these genetic aberrations, but the low incidence of these genetic aberrations and high costs of testing makes NGS impractical as a screening tool at the present time. Therefore, it is critical that we identify novel functional and cost-effective tools to identify high-risk DDR cases without the necessarily interrogating each of these genetic aberrations individually. Our group is studying this specific subgroup with clinical and translational studies.

Biography:

Maitham Khajah has completed his B. Pharm degree from Faculty of Pharmacy, Kuwait University in 2003 and obtained his Ph.D degree (through a scholarship from Kuwait University) in December, 2009 from the University of Calgary, Canada (Gastrointestinal science & immunology). He is currently an Assistant Professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology & Therapeutics since January 2010. His research interest is to study new molecular targets for the treatment of inflammatory bowel disease (IBD), and the mechanisms responsible for immune cell chemotaxis. He is also interested in studying the mechanism of cancer cell invasion and metastasis specifically by using various endocrine resistant breast cancer cell lines.

Abstract:

Background: The role of angiotensin II (Ang II) in the pathogenesis of  inflammatory bowel disease (IBD) is well documented but little is known of its more recently identified counter-regulatory peptide Ang1-7 and its signaling pathway ACE2/Ang 1-7/mas. Enhanced ACE2 expression has been observed in patients with IBD suggesting a role in its pathogenesis.

Aim: to determine the role of Ang 1-7 in modulating colitis severity in vivo using the mouse DSS colitis model, and its effect on immune cell functions in vitro.

Methods: DSS (3.5% w/v) was used to induce colitis in BALB/C mice and its severity was determined by gross and histological assessments, daily weight changes, and differential WBC counts. Plasma levels of several cytokines and chemokines was measured by proteome profiler kit from R&D systems. Colonic protein level for Ang II, ACE2, mas receptor, P-ERK1/2, P-p38MAPK, and P-Akt was determined by western blotting and immunofluorescence. Immune cell chemotaxis, apoptosis, and superoxide release was determined using the under agarose assay, Annexin-V/7AAD assay, and  luminol oxidation kit respectively.

Results: Enhanced AngII, ACE2, and MasR1 expression was observed in the colon of mice after DSS treatment. Daily i.p injections with Ang 1-7 (0.01-0.06 mg/kg, at both prophylactic and treatment approaches) significantly reduced colitis severity at gross and histological level, reduced phosphorylated levels of ERK1/2, p38, and Akt in the colon, and significantly reduced plasma levels of various cytokines and chemokines. Also, Ang 1-7 treatment significantly reduced neutrophil chemotaxis and superoxide release in response to WKYMVm (fMLP-peptide) stimulation, and  increased neutrophil and mononuclear cell spontaneous apoptosis.

Conclusion: Ang 1-7 is a promising future therapeutic approach to control colitis severity in part through modulating the activity of various inflammatory signaling molecules, levels of various cytokines and chemokines, and immune cell functions which all are  important for the inflammatory process.

Biography:

Associate Professor in Department of Medical and Surgical Sciences for Children and Adults

Abstract:

Today neoadjuvant chemoradiation for T2 and T3 rectal cancers is widely adopted. Surgery is usually performed after 5-6 weeks from the beginning of the therapy and it is our policy to perform a restaging of the tumor at that moment, in order to obtain its down-staging, to discover possible complications related to the treatment, to confirm or adjust a surgical strategy, to evaluate risks for possible recurrence, and to schedule an adequate follow-up (1-3). For this, we have implemented a classification of the tumor down-staging, mainly based on radiological imaging results, contrast-enhanced computed tomography and magnetic resonance, and inspired to the current TNM scheme (Table 1). Neoplastic regression inside rectal walls and mesorectum have been considered of prominent significance, and, therefore, discriminating in surgery. Besides, these aspects correlate well with the biological attitude of rectal cancer to regress following a centripetal way, starting from the most peripheral and recent zones of infiltration toward the central core of the tumor, where the tissue involvement is more marked. Interestingly, in our experience of 38 cases observed in the years 2012-2015, the down-staging score appears inversely correlated with the histological grading of the tumor, but directly with the Dowrak’s tumour regression. Certainly our classification needs to be confirmed by further clinical studies, which will have to consider also the different molecular characteristics of rectal cancer.

Biography:

Vijay Kumar is a Professor and Head of Dept. of Pediatric Surgery in Kasturba Medical College, Manipal University. He had 41 scientific articles in various international and national journals. He presented 12 scientific papers at various international conferences held at Bangkok, Malaysia, Srilanka, Nepal, Dubai, UK, USA, etc. He presented more than 60 scientific papers at various national conferences, workshops held in different parts of India. He gave more than 30 scientific deliberations at various national, international conferences, workshops, scientific congresses, medical associations and chapters. He attended 15 pediatric surgery and pediatric urology workshops at national and international level as a resource person. He is an active member and office bearer in many social organizations. He organized and participated in many free medical camps in the community. He gave many talks on health awareness in the Radio and TV shows.

Abstract:

Chronic pancreatitis is a chronic inflammatory disease characterized by fibrosis and destruction of exocrine pancreatic tissue. It is prevalent in many parts of the world with varying epidemiological profiles in different areas. There is a relatively high prevalence of such disorders in southern India. In most series, the etiologies are trauma, biliary tract distension are unknown. In majority of CP in children, medical therapy alone suffices and surgical intervention is reserved for complications. This study was conducted to establish the clinical profile of pancreatic disorders in pediatric patients ranging in age from 1 to 19 years in a tertiary care hospital in southern India. The records of the patients upto 19 years of age diagnosed to have pancreatitis at our institution for the last 12 years were reviewed with a proforma to record the following parameters: Age, gender, presenting complaints, examination findings, investigations, management with medical treatment, surgical intervention or both and complications.There were 50 patients ranging from age group 3 to 19 years, out of which 30 were males and 20 were females. 41 patients were between the ages of 11-19 years, 5 were between the age of 6-10 years, and 4 were between the ages of 1-5 years. 28 patients presented with acute on chronic pancreatitis and 22 patients had calcific chronic pancreatitis. The etiology of CP in 42 patients was idiopathic, in 4 was biliary tract disease, 2 were alcoholic, and 2 were congenital (pancreatic divisum). Complications like pseudo cyst was seen in 19 patients, ascites in 4, diabetes in 3, pleural effusion in 3, splenic thrombosis in one, acute necrotizing pancreatitis in one, retroperitoneal abscess in one and acute renal failure in one patient. Apart from medical line of management, 12 patients underwent stenting of pancreatic duct and 10 underwent surgical treatment for complications. Among the complications, acute relapses of chronic pancreatitis were the most common. 38% of the patients had pseudocysts, 44% had calcific pancreatitis, 6% developed diabetes, 8% had ascites, 6% had pleural effusion and there were 3 deaths due to sepsis.

Biography:

Rasha has completed her MSc from Al-Mustansiriyah University and worked as a lecturer at University of Kufa college of Medicine/Iraq. She has published 4 papers in college of medicine journals. She is currently a second year PhD student at Sheffield Hallam University/ UK.

Abstract:

 In order to develop an in vitro 3D cell culture model which mimics the natural environment of the small intestine, pNIPAM-Laponite hydrogel system was investigated. Human colonic adenocarcinoma cell lines: Caco-2 and HT29-MTX have been widely used in in vitro 3D culture system as these cells have the ability to differentiate into enterocyte-like cells and mucus producing goblet cells respectively; and exhibit the properties of intestinal epithelia. For these reasons each cell line and co-cultures were investigated in suspension and layered cultures using the novel pNIPAM hydrogels, cultures were maintained under static culture or dynamic culture for up to 8 weeks. Cell viability was assessed using Alamar Blue assay, and histological stains: H&E, Alcian Blue-Periodic Acid Schiffs (PAS) were used to investigate cellular morphological and matrix production. Scanning electron microscopy (SEM) was also used to assess the morphology of cells within the hydrogel. Both cell types remained viable and those cultured in layered cultures under dynamic culture formed villus like structures and produced both acidic and neutral mucins. SEM analysis showed the presence of cells within/on the surface of the hydrogel, where cells formed circular clusters of cells forming mosaics with each cell having microvilli. We conclude that the pNIPAM-Laponite hydrogel could provide a novel 3D intestinal in vitro model.

Biography:

Steve Harakeh received his BSc and MSc from the American University of Beirut (AUB). He was awarded his PhD degree in Microbiology from the University of Surrey, UK. He spent two years as a Postdoctoral Research Fellow in the Microbiology and Immunology Department, School of Medicine, at Stanford University, USA, and then he was appointed as a Research Associate (Research Assistant Professor) in the same department. He joined the Linus Pauling Institute for Science and Medicine where he worked and published with Professor Pauling who is the only holder of two unshared Noble prizes in the world. After that he was appointed as a Professor of Microbiology at the AUB. Then he worked as a research professor at Dr. Rath Research Institute in California, USA. Currently, he is a Professor at the Special Infectious Agents Unit – Biosafety Level 3 (SIAU). He is the Vice Chairman of the KFMRC Quality Control and Biosafety Committee, member of infectious disease research group. He has recently been appointed as a member of "Yousef Abdullatif Jameel Research Chair for Prophetic Medicine" and is already engaged with them in several ongoing research projects. He is the recipient of several awards and research grants and published over seventy papers in peer reviewed journals and contributed to publishing chapters in many international scientific books. 

Abstract:

Background & Objectives: Gastric ulcers are among the most common diseases affecting humans. This study aimed at investigating the gastro protective effects of manuka honey against ethanol-induced gastric ulcers in rats. The mechanism by which honey exerts its antiulcer potential was elucidated.

Methods: Four groups of rats were used: control, ethanol (ulcer), omeprazole, and manuka honey. Stomachs were examined macroscopically for hemorrhagic lesions in the glandular mucosa, histopathological changes, and glycoprotein detection. The effects of oxidative stress were investigated using the following indicators: gastric mucosal nitric oxide (NO), reduced glutathione (GSH), lipid peroxide (MDA, measured as malondialdehyde) glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase. Plasma tumor necrosis factor-α, interleukin-1β, and IL-6 were also measured.

Results: Manuka honey significantly decreased the ulcer index, completely protected the mucosa from lesions, and preserved gastric mucosal glycoprotein. It significantly increased gastric mucosal levels of NO, GSH, GPx, and SOD. Manuka honey also decreased gastric mucosal MDA and plasma TNF-α, IL-1β, and IL-6 concentrations.

Conclusion: Manuka honey likely exerted its antiulcer effect by keeping enzymatic (GPx and SOD) and non-enzymatic (GSH and NO) antioxidants as well as inflammatory cytokines (TNF-α, IL-1β, and IL-6) in a reduced form, inhibited lipid peroxidation (MDA), and preserved mucous glycoproteins levels. 

Biography:

Khaled Abdelwaly completed his MBBCh in 2005, Faculty of Medicine, Assuit University and then worked in Assuit University Hospital for 1 year, after that he started working in Manshyet Elbakry Hospital in Cairo, Egypt in the Department of Gastroenterology and Liver Diseases, and then a part time Physiology Lecturer in Misr International University. He finished his Diploma in Internal Medicine in 2014 at Ain Shams University, Egypt. He moved to the Department of Gastroenterology and Liver Diseases in “Sheikh Zayed Al Nahyan” General and Specialized Hospital, Cairo. Now, he is resident in the Department of Gastroenterology and Liver Diseases, Ibn Sina University Hospital, Rabat, Morocco.

Abstract:

Background: Gastro esophageal reflux disease (GERD) is the reflux of gastric contents into the esophagus, leading to esophagitis, reflux symptoms sufficient to impair the quality of life, and increased risk of long-term complications. GERD is divided into erosive (ERD) and non-erosive (NERD) reflux disease, NERD has been regarded as reflux symptoms with the absence of mucosal breaks in the esophagus at endoscopy. However, NERD has been divided into normal and minimal changes based on endoscopic finding.

Objectives: To evaluate the clinical significance of minimal changes at endoscopy and examine whether such changes have diagnostic value in gastro esophageal reflux disease (NERD) or not.

Methods: 60 patients were recruited in this study, they were divided into 2 groups, Group I: Included 30 patients with GERD symptoms in form of heartburn and/or regurgitation more than twice a week with minimal duration of 8 consecutive weeks and troublesome symptoms affecting the daily life activities who were identified by specific questionnaire but negative mucosal breaks at upper GI endoscopy (NERD) as patient group. Group II: Included 30 patients without GERD symptoms attending for upper GI endoscopy for any other reason as a control group. Both of them were subjected to full history taking. Full clinical examination with special stress on BMI (weight/height); (normal 19-25 and over weight >25); and diagnostic upper GI endoscopy by expert endoscopists after patient consent was done.

Results: We identified two of the six minimal changes in esophagitis endoscopically as being more common in the patient group with GERD symptoms compared with the other findings which are erythema and white turbid discoloration.

Conclusion: According to our study, there is no clinical relevance in the diagnosis of NERD depending on endoscopic minimal change esophagitis.

Biography:

Anjana Vasudevan has completed her MBBS at Chettinad University in the year 2014. She worked at Apollo Speciality Hospital, Perungudi, Chennai, India for almost a year and currently pursuing her Post-graduation at Sri Ramachandra University in the Department of General Surgery. She was accepted by the ICMR to do MS, PhD integrated course. She has published one article, participated and presented in several national and international conferences.

Abstract:

Gastrointestinal mesenchymal tumors comprise of gastrointestinal stromal tumors (GIST), leiomyomas, leiomyoscarcomas and schwannomas, histologically all appear as spindle cells. Of these, GIST is the commonest occurring and about 60 to 70% are seen in the stomach. On the other hand, schwannomas occur frequently in the head and neck region, about 0.2%, of which 4% are seen in the stomach. Both gastric schwannomas and GISTs grossly appear similar and are spindle shaped cells in microscopic examination.

 Hence the aid of immune histo chemistry is required to differentiate the two. Both are frequently encountered among middle aged people, with no distinct clinical features. Difference between the two is their prognosis, excellent prognosis is seen in gastric schwannomas as they are mostly benign and GISTs have a 10 to 30% malignant potential. Here we present a 25 year old married, nulliparous female from west Bengal on fertility treatment diagnosed as GIST based upon her UGI scopy and CECT abdomen reports. She was taken up for gasterectomy D2 resection followed by gastrojejunostomy, jejunojejunostomy and a feeding jejunostomy. HPE reports revealed the tumor to be a gastric schwannoma.

Biography:

Chief of endoscopy service of hospital estadual adão pereira nunes. Coordinator of bariatric endoscopy service, in gastroendo serviços médicos gastroenterologist formed by federal university of estate of rio de janeiro. Research Interest is Endoscopy & Surgey.

Abstract:

The development of silicone gastric balloon filled with saline has significant results in treatment of obesity and, recently, it shows to be effective in pre-obese patients. To evaluate the safety and efficacy of Silimed Gastric Balloon (SGB) in pre-obese patients and patients with different grades of obesity. From september of 2007 to january of 2009, 84 patients who were unable to lose weight using clinical treatment were treated with SGB. The balloon was filled with 700 ml of a saline solution and 2% methylene blue, and was positioned on gastric fundus, under sedation. atients were divided among the body mass index (BMI) in 4 grades: pre-obese (BMI < 30 Kg/m2), obesity grade 1 (BMI 30-34.9), obesity grade 2 (BMI 35-39.9) and obesity grade 3 (BMI ≥ 40). They were followed in a multidisciplinary clinic setting for 5 to 7 months. Informed consents was obtained. The paired t test was used to evaluated the effectiveness of the proposed treatment. To compare the relative weight loss between the different grades of obesity we used the ANOVA one way. 81 patients completed the study. 2 patients were excluded because of spontaneous balloon deflation. 1 patient complicated with gastric laceration treated with surgery. Patients mean age was 38 (18-68) year and 61 was female (75.3%).The initial mean weight and mean BMI, respectively, were 100 Kg (range 69-171) and 36 Kg/m2 (range 27.6-65.6). The final mean weight and BMI were, respectively, 90.6 Kg (range 58-151) and 32.6 Kg/m2 (range 22.8-52.2). There were significant weight loss at the final of the treatment, mean absolute weight loss was 9.37 Kg (9.18% of initial weight) (p= 0.0001). When we evaluated the different groups of obesity we observed that there were significant weight loss in all groups, with no significant difference at the relative weight loss at the groups (p=0.061)(table 1). There were no endoscopic complications or failed balloon extractions. The SGB is a safe and effective alternative to the treatment of weight loss. All patients loose weight despite of the grade of obesity. There were only 2 cases of balloon deflation, but without bowel obstruction. The only major complication occurred in one alcoholic patient that omit this information.

Biography:

Student Research Cycle at the Chair of Patophysiology and Endocrinology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Europe, Poland.

Abstract:

Proper rules of dietary habits should be present in most of households and known by every adult people, particulary among parents raising their children and educating them how to eat healthy. Regular nutritional habits are an elementary factor to achieve good growth and human health. Our main assumption of this research was to determinate through anonymous questionnaire the level of knowledge of proper nutritional habits among parents of children attending some primary Schools in Poland (Silesian and Opole Voivodeship). This research is a follow-up of our previous study, which were focused on the assessment of dietary habits among children going to Primary Schools (in the age od 6-13 years old). Our last study consisted of nearly 1000 respondents living in rural and urban areas. The results were alarming – approximately 20% of all studied children have overweight and the same percent revealed obesity. Proper body mass was shown only among 40% of populated study group. These findings persuaded us to go ahead and broaden this results. We want to know, which factors determine this disturbances most. Thnaks to our present resarch we would have a possibility of a wider analysis of the thema connected with diet. We could analyse the results looking at the nutritional principles having at family home – the most important factor in creating children dietary habits. Our results of present study are still in progress. We alread have  about 1000 questionnaires sent to the parents and now we are preparing the results. We trurly hope that the esearch will be interesting and could improve the knowledge about society orientation about nutrition.

Key words: proper dietary habits, knowledge, awareness, parents of children

Biography:

Bing-Rong Liu has completed his MD in 2002 from Chongqing Medical University. He appointed as the director of gastrointestinal department of the Second Affiliated Hospital of Harbin Medical University in June 2004. He has developed so many endoscopic new techniques and published more than 20 papers in reputed journals.

Abstract:

1. Endoscopic retrograde appendicitis therapy (ERAT):
Inspired by the success of emergency endoscopic retrograde cholangio pancreatography (ERCP) in treating acute cholangitis, we developed a minimally invasive method named ERAT to diagnose and treat acute appendicitis. We first reported this technique in DDW 2011. At present, there are more than 20 medical centers in China to carry out the ERAT technique. ERAT provide a new procedure for the treatment of acute appendicitis with rapid pain relief and short recovery time.

2. Liu peroral endoscopic myotomy (Liu-POEM):
Peroral endoscopic myotomy (POEM) has emerged as one approach to treat esophageal achalasia. Tunnellization and the myotomy are the key procedures. Submucosal tunneling requires one-third to one-half of the total operation time. For improvement of POEM procedure, we performed myotomy and tunneling as one step and then closed the entry site as before. We performed the modified procedure more than 60 cases.

3. Endoscopic Fenestration:
The treatment of pancreatic pseudocyst is challenging and difficult. Although endoscopic therapy of pancreatic pseudocyst is considering first line therapy, there are some cases requiring surgical intervention or repeated endoscopic drainage procedures. We described endoscopic fenestration for treatment of large pancreatic pseudocyst in 3 cases. Endoscopic fenestration could be obtaining sufficient drainage which avoids pancreatic pseudocyst recurrence. The pseudocyst cavity was gradually reduced and healed after endoscopic fenestration.

4. Transrectal Gallbladder-Preserving Cholecystolithotomy (TRGPC):
Transcolonic NOTES was not used in human cases due to the fecal contamination. We have developed a detachable balloon to keep the distal colonic cavity sterile and performed cholecystolithotomy and polypectomy with gallbladder preserved in 36 patients by the end of May 2016. Transrectal NOTES gallbladder-preserving operation provides a novel alternative approach of treating gallbladder polyps and stones.

5. Endoscopic submucosal dissection for losing weight:
The gastric endoscopic submucosal dissection (ESD) as a new bariatric technique can affect weight gain. Previous animal experimental study suggested that ESD of one thirds of the stomach fundus can effectively and durably decrease the volume of stomach, thus significantly affect weight gain.

Biography:

Amanda Brisebois is a Internal Medicine and Palliative Care Specialist, who works in Edmonton, Alberta, Canada. She undertook her undergraduate education and Masters degree at Queen’s University in Kingston, Ontario Canada. She completed her medical school training in Calgary, Alberta, and her General Medicine Specialty at the Mayo Clinic Rochester Minnesota, University of Calgary in Calgary, Alberta, and University of Alberta, in Edmonton. Since 2000, she has been practicing General Internal Medicine in both inpatient and outpatient settings. She also is a certified Palliative Care Specialist. She has a keen interest in Medical Education, and has won over 15 major teaching awards since starting her practice. Her focused area of research and interest is now in non-cancer palliative care. She has created an outpatient non-cancer palliative care clinic at the University of Alberta, and sees patients with severe symptoms in the major areas of cardiology, pulmonary, renal, and cirrhosis care. She has published in this space, and is collaborating on multiple research projects in these areas. Dr. Brisebois has a keen interest in interdisciplinary and inter-specialty collaboration, with aims to improve transitions in care when navigating our health systems. Dr. Brisebois is currently an Associate Clinical Professor at the University of Alberta, and the Medicine Facility Chief at the Grey Nuns Hospital in Edmonton.

Abstract:

Introduction: Patients with chronic illnesses such as cirrhosis, often have significant symptoms, psychosocial needs, and desires for heightened knowledge about their illness. Historically, cirrhosis management has focused on controlling or modifying cirrhosis progression, and complications of liver dysfunction. Work has started to focus on a parallel pathway of care, involving symptom management, early advance care planning, and other interventions aimed at improving a patient’s ability to cope with chronic illness. Discussion: A recent paper was published August 2016 (Brisebois and Tandon 2016), suggesting various ways to heighten cirrhosis care early in the disease trajectory. This discussion will provide detailed strategies for GI specialists to integrate palliative principles into cirrhosis care early in the disease trajectory. Principles to be outlined include modern definitions of palliative care, how palliative principles can be integrated during acute decompensations, how non-palliative specialists can provide this type of care, and how Palliative Care services can aid the Family Practitioners and Gastroenterology Specialists at various stages of the cirrhosis disease trajectory. This discussion will aim to provide tools for non-palliative care practitioner to heighten patient support in these areas. Evidence for this care approach will be provided, based on the current literature.

Conclusion: Evidence is increasing for integration of palliative principles early in the cirrhosis disease trajectory. With continued work, perhaps interdisciplinary collaborations can heighten inclusive patient care and result in increased patient preparedness for the challenges that come with progressive decline in hepatic function.

Biography:

Maxwell M Chait is a Practicing Gastroenterologist and is an Assistant Professor of Medicine Columbia University College of Physicians and Surgeons in New York City. He is a Fellow of several prestigious organizations, including the American College of Physicians, American College of Gastroenterology, American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. He has authored numerous publications and serves on the Editorial Board of several journals. He is the Editor-in-Chief of the Journal of Liver Disease and Transplantation.

Abstract:

Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder. Esophageal and extra esophageal complications are common and may be potentially life threatening. Esophageal complications include erosive esophagitis, esophageal stricture, Barrett’s esophagus and adenocarcinoma of the esophagus. Although, the evaluation and management of GERD is generally the same in the majority of patients, there are specific issues of causation, evaluation and treatment that must be addressed when dealing with patients when GERD complications arise. These include a variety of factors, such as patient age, cognitive impairment, comorbidities, medication side effects and esophageal or extra esophageal organ involvement.

Biography:

Khalil N Bitar, PhD, AGAF, is a Professor of Regenerative Medicine, Gastroenterology, Physiology and Biomedical Engineering. He is the Director of Gastroenterology program at the Wake Forest Institute for Regenerative Medicine. He has published more than 100 papers in high impact journals and has been funded by NIH for more than 30 years. He is a fellow of the American Gastroenterological Association.

Abstract:

Background & Aim: Internal Anal Sphincter (IAS) dysfunction can lead to fecal incontinence (FI). The objective of this study was to demonstrate sustained restoration of fecal continence using monomeric recordings in a rabbit model of passive fecal incontinence after implantation of the Bio Sphincter.

Methods: The methodology followed in this study include: (1) New Zealand female white rabbits underwent IAS injury with hemi-circumferential IAS sphincterectomy; (2) Bio Sphincters were engineered using autologous IAS smooth muscle and enteric neural progenitor cells. Rabbits were randomized: Control untreated group and Bio Sphincter treated group. In the treated group, 4 autologous engineered Bio Sphincters were implanted 6-8 weeks following the sphincterectomy surgery; and (3) Anorectal manometry was used to measure resting anal pressure and recto-anal inhibitory reflex (RAIR) at baseline, 6 weeks post sphincterectomy, and at 3 months and 6 months after Bio Sphincter implantation.

Results: In the control untreated group, deterioration in fecal hygiene, decreased resting tone and loss of RAIR were observed post sphincterectomy in all rabbits. Autologous Bio Sphincters were successfully implanted into the donor rabbits without complications. Survival rate was 100%. In the Bio Sphincter treated group, restoration of basal tone (37±3 mmHg, p<0.05) and RAIR (60±4%, p<0.05) were observed at 3 months was sustained for 6 months following Bio Sphincter implantation.

Conclusions: This study provides proof of concept of safety and efficacy of Bio Sphincters and restoration of IAS integrity and function and fecal continence in a large animal model. A regenerative medicine approach to restore impaired IAS function offers a safe and long-term treatment for passive fecal incontinence.

Biography:

Azra Husic-Selimovic is an Associated Professor Chair of Internal Medicine, Medical Faculty, University of Sarajevo, Bosnia and Herzegovina and Sub-specialist in Gastroenterology and Hepatology from 2010. She received Doctor of Medical Science with research interest in Hepatology and Viral Hepatitis. She obtained Master of Science in Medicine with scientific area: Hepatology and Alcoholic Liver Disease.

Abstract:

Introduction: Renin-angiotensin system (RAS) is frequently activated in patients with chronic liver disease. Angiotensin-II (AT-II), produced by angiotensin converting enzyme (ACE), has many physiological effects, including an important role in liver fibrogenesis. Combined antiviral therapy with PEG-IFN and ribavirin besides its antiviral effect also leads to a reduction in liver parenchyma fibrosis.

Aim: Determining the value of ACE in serum of patients with chronic hepatitis C before and after combined antiviral therapy, as well as the value of ACE activities in sera of the control group.

Materials & Methods: We studied 50 patients treated at Gastroentero-Hepatology Department, in the time-period of four years. Value of ACE in serum was determined by Olympus AU 400 device with application of kit “Infinity TN ACE Liquid Stable Reagent”. HCV RNA levels in sera were measured by real time PCR. HCV RNA test was performed with modular analysis of AMPLICOR and COBAS AMPLICOR HCV MONITOR test v2.0, which has proved infection and was used for quantification of the viruses and monitoring of the patients' response to therapy. Liver histology was evaluated in accordance with the level of necroinflammation activity and stage of fibrosis.

Results: Serum activities of ACE in chronic hepatitis C patients is statistically higher than the values in the control group (p=0.02). Antiviral therapy in chronic hepatitis C patients statistically decreases serum activities of ACE (p=0.02) and indirectly affects fibrogenesis of the liver parenchyma. Correlation between ACE and ALT activity after the therapy was proved (0.3934).

Conclusion: Our findings suggest that the activity of ACE in serum is a good indirect parameter of the liver damage and could be used as an indirect prognostic factor of the level of liver parenchyma damage. Serum activity of ACE can be used as a parameter for non-invasive assessment of intensity of liver damage. 

Biography:

Steve Harakeh received his BSc and MSc from the American University of Beirut (AUB). He was awarded his PhD degree in Microbiology from the University of Surrey, UK. He spent two years as a Postdoctoral Research Fellow in the Microbiology and Immunology Department, School of Medicine at Stanford University, USA, and then he was appointed as a Research 

Abstract:

Background: Obesity is a modern global epidemic and is a risk factor for diabetes and cardiovascular diseases (CVD). The prevalence of overweight and obesity in Saudi Arabia is on the rise, placing a huge burden on health and economic resources. Recently, gut microbiota has been reported to be involved in the pathogenesis of many metabolic disorders and diseases, including obesity, diabetes, and CVD.

Objective: The objective of this study was to identify obesity-associated gut microbiota dysbiosis and their relationship to body mass index (BMI) among healthy Saudis with different degrees of obesity.

Methodology: A total of 56 healthy individuals with different degrees of obesity were recruited. All those filled out a questionnaire related to their nutritional habits, health conditions and demographics. Their height, body weight, hip and waist circumference were measured (BMI and age). Stool samples were collected and genomic DNA was extracted from those samples. The DNA samples were sequenced via next generation sequencing (MiSeq), sequencing reads were quality trimmed, analyzed and assigned to taxonomic units using 16S Meta genomics app (Illumina Base Space). One way ANOVA was used to find whether there is a significant between BMI in relation to microbial species

Results: The results indicated the presence of various bacteriological species. Porphyromonas circumdentaria, Fervidobacterium islandicum and Desulforhopalus singaporensis were found in the underweight group, while Lysobacter soli, Anoxybacillus eryuanensis and Anoxybacillus flavithermus were present in the obese group.

Conclusion/Recommendations: The results indicated that 1538 species were detected. There is some difference among the different species in relation to BMI. Work is in progress to include more human subjects and find the bacteria involved with obesity. 

Biography:

Maitham Khajah has completed his B. Pharm degree from Faculty of Pharmacy, Kuwait University and obtained his Ph.D. degree from the University of Calgary, Canada. He is currently an Assistant Professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology & Therapeutics since January 2010. His research interest focuses on studying new targets for the treatment of inflammatory bowel disease. He published various abstracts and peer reviewed manuscripts in international journals. He co-supervised many students for the M.sc Molecular Biology Program. Since he joined Kuwait University, he got various grants as PI and Co-I. He was awarded the Best young researcher award by Kuwait University for the year 2013 – 2014. 

Abstract:

Background:

GM-CSF is a well-established priming agent and exerts proliferative effects for hematopoietic cells. Recent evidence suggests a potent chemotactic property towards neutrophils in vitro.

Aim:

To examine the role of GM-CSF in neutrophil recruitment to the colon in vivo and its effect on modulating colitis severity using the 2, 4, 6-trinitrobenzene sulphonic acid (TNBS) model in mice.

Methods:

Colitis was induced by a single intra rectal injection of TNBS (4mg, 20% ethanol) at day 1. Animals were treated with a single i.p injection of neutralizing anti-GM-CSF antibody (100 µg/mouse) on day 1, or multiple injections on day 1,2,3, and 4, and sacrificed on day 5 post-induction of colitis. Control mice were injected with i.p saline (vehicle) plus TNBS. On another experimental setup, colitis was induced in GMCSFRβ^-/- and compared to wild type (WT) mice. Results: enhanced GM-CSF expression (at both gene and protein levels) was observed in colonic tissues at day 3 and 7 post colitis induction. A single injection of GM-CSF antibody did not modulate colitis severity, while multiple injections significantly reduced colonic MPO activity and colitis severity. In the GMCSFRβ^-/- mice, colonic MPO activity was significantly reduced post colitis induction but no improvement in colitis severity was observed compared to WT mice. 

Conclusion:

Anti-GM-CSF therapy significantly reduced neutrophil recruitment to the colon leading to reduced colitis severity.  

Biography:

Tomasz Pniewski has completed his PhD from the Institute of Bioorganic Chemistry PAS and Postdoctoral studies from Thomas Jefferson University, USA. He has worked in the Institute of Plant Genetics PAS since 2003. He is the Head of Biotechnology Department and for two years also worked in the Wielkopolska Centre of Advanced Technologies as an Expert for organization and equipment. He has published more than 25 papers in reputed journals and has gained 6 patents on plant-derived vaccines.

Abstract:

The continued HBV high prevalence coupled with deficiencies in vaccination programs stimulate research on a new type of vaccines. Potential orally administered plant-based vaccine is highly attractive regarding efficacy, cost-effectiveness and availability of mass hepatitis B prevention. Freeze-dried oral formulations facilitate elimination of complex purification steps, size reduction and better stability during storage, as well as ensure controlled administration regime in minimized medical facilities. The aim of presented study was to develop a lyophilization protocol facilitating successful processing of lettuce leaf tissue containing S-HBsAg formed into VLPs (Virus-Like Particles). Several drying profiles and excipients as well as effects of freezing rate and post-process residual moisture were analyzed. The profile of 20 ºC for 20 hours for primary and 22 ºC for 2 hours for secondary drying as well as sucrose proved the most efficient stabilization of S-HBsAg during freeze-drying. The process was highly reproducible (86-97%) and provided a product with VLP content up to 200 µg per g DW. Atmosphere of nitrogen proved to preserve S-HBsAg VLPs for minimum one year at temperatures up to 37 °C. Animal trials confirmed immunogenicity of processed tissue powder with S-HBsAg, used as an oral booster vaccine. Low-dosed (5-200 ng) preparation elicited anti-HBs response at level of commercial injection vaccine (around 1000 mIU/ml), together with growth population of specific B and T lymphocytes and only slightly increased population of Tregs. As a result, a plant-derived semi-product with good long-term stability and immunogenicity of S-HBsAg was obtained for the definite formulation of oral booster vaccine against HBV.

Biography:

Anjana Vasudevan has completed her MBBS at Chettinad University in the year 2014. She worked at Apollo Speciality Hospital, Perungudi, Chennai, India for almost a year and currently pursuing her Post-graduation at Sri Ramachandra University in the Department of General Surgery. She was accepted by the ICMR to do MS, PhD integrated course. She has published one article, participated and presented in several national and international conferences.

Abstract:

Embryologically the ventral bud develops into primitive foregut and tracheobronchial tree. Any malformation in this would cause a cystic lesion along the tracheobronchial tree or the foregut. The incidence of this occurring is about 1 case per 68,000 populations. Here, we present a case of sublingual swelling in a 22 year young female, with no other complaints. Her history was impeccable. All routine investigations were normal. MRI head and neck suggested a ranula. She was planned and taken up for surgery. The excised specimen was sent to histopathological examination which revelled the swelling to be a bronchogenic cyst. Bronchogenic cysts are an embryological anomaly and are found anywhere along the foregut. They can present in both adults and children. 7 to 1 % of all foregut cysts are bronchogenic cysts says literature. These cysts are generally asymptomatic but have a 10% chance of turning malignant.

Biography:

Zekuan Xu has completed his PhD at the age of 38 years from Nanjing Medical University. Now, he is the director of General Surgery, the First Affiliated Hospital of Nanjing Medical University. He has published more than 40 papers in reputed journals and has been serving as reviewers of Oncotarget, Tumor Biology and so on.

Abstract:

Objective The aim of this study was to investigate the safety and feasibility of laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy for gastric cancer.
Methods The clinical data of 92 patients performed laparoscopic uncut Roux-en-Y anastomosis in the Department of Gastric Surgery, the First Affiliated Hospital of Nanjing Medical University from June 2014 to June 2016 were analyzed retrospectively.
Results The operations were performed successfully for all patients. The mean operation duration, anastomosis time, blood loss and the number of lymph nodes dissection during the surgery were (178.67±29.12) min, (30.84±7.41) min, (48.78±35.64) ml and 34.43±9.84 respectively. The time spent before gastrointestinal motility, liquid-diet intake, out-of-bed ambulation and the average hospitalization days after operation were (76.40±21.47) hours, (5.30±1.25) days, (48.14±20.25) hours and (9.19±3.09) days respectively. Postoperatively, 6 patients experienced complications, including gastrointestinal bleeding (2 patients), duodenal stump fistula (1 patient), Chylorrhea (1 patient)，Roux-Y stasis syndrome after gastrectomy (2 patients)，all of the complications were cured conservatively. None of the other complications occurred, such as anastomotic fistula, anastomotic stenosis, infection of incision, etc.
Conclusion The laparoscopic uncut Roux-en-Y anastomosis is safe and feasible in the distant gastrectomy with D2 dissection for gastric cancer, with advantages of less trauma, faster recovery and so on.
 

Biography:

Inna is an experienced doctor (Pediatrician), Researcher with more than 23 years practical experience in treatment, diagnosis and prevention of various diseases of children and adolescents. In 2006, Inna received academic degree of PhD in Medical Sciences (main specialty Pediatrics). Until April 2014, she worked as a Researcher at the Institute of Children and Adolescents Health Care of National Academy of Medical Sciences of Ukraine. She has more than 60 scientific publications in various journals, eight Innovations and three Methodological recommendations for practical public health. Living in Luxemburg she works in an Economic Advisory Company as a Business Development Manager and as a Researcher of new methods of diagnosis and treatment in the field of medicine.

Abstract:

The aim of the present study is improving prophylaxis and treatment of chronic gastroduodenal pathology in adolescents on the basis of determining clinical, endoscopic, and morphological peculiarities of said pathology. A total of 155 adolescents 11 to 18 years of age with inflammatory-destructive diseases of the upper gastrointestinal tract and Connective Tissue Disorders (CTD) were studied. The traits of the CTD, including the Marfan syndrom, were determined  relying on the Ghent criteria.
Morphological peculiarities are represented by high frequency of reflux-gastritis (77%) and a reduction in the level of interstitial collagens type 3 and type 1 in the lamina propria of gastric and duodenal mucosa. The form of mucosal lesions is a chronic non-atrophic (surface) gastritis with simultaneous inflammation in the antral and fundal parts. Duodenal ulcer was detected in 12% only and it was accompanied by detection of Helicobacter pylori. The connective tissue matrix of the mucosa is characterized by structural transformation of collagen fibrils (wrong orientation, focal sclerosis, immaturity). It is accompanied by decrease in a mucosa functional ability with development of the valve-sphincter  failure.  The role of CTD in the development of gastroduodenal pathology in puberty has been established. A genetically dependent insufficiency of interstitial collagens is a major cause of development bile reflux, which is a leading factor of gastroduodenal pathology formation in adolescents with CTD. The work provides grounds for employing in adolescents with CTD rehabilitation measures, connected with a prevention of reflux-gastritis progression and stimulation of the collagen synthesis.  
 

Biography:

Dr. Paul has completed PHD in 1980 from Indian Institute of Technology, Kharagpur and after a brief post doctoral assignment serving Jawaharlal Nehru University as a scientist professor since 1987. She has more than 50 publications in peer reviewed journals. Her research domains are to study the various factors contributing in the pathogenesis of IBD, molecular epidemiology of enteric diseases especially Amoebiasis, an endemic disease in India. She has served as reviewer in several peer reviewed journals. She has supervised 10 Ph.D theses so far and mentored many postgraduate dissertations. She is teaching Core Microbiology and Advanced Microbial Physiology to Postgraduate and M.Phil students

Abstract:

Ulcerative Colitis (UC) is a type of inflammatory bowel disease, considered as an important disease of gastrointestinal tract having a huge impact on the health of the patient. Prolonged inflammation of colon in UC patients increases the risk of developing colorectal cancer. MiRNA are reported as a connecting link between inflammation and cancer. The current study was performed to dissect out the site specific miRNA expression in the colon biopsy samples of UC patients from Northern India. Biopsy samples were collected from UC patients and healthy controls from Rectosigmoid area (RS) and Ascending Colon (AC). MiRNA expression was compared between patients with RS and AC using a microarray platform. Differential expression was further validated by Real Time PCR analysis.  
Upon analysis of data generated on a micro array platform and qRT PCR revealed that the expression of six miRNAs hsa-miR-146b-5p, hsa-miR-335-3p, hsa-miR-342-3p, hsa-miR-644b-3p, hsa-miR-491-3p, hsa-miR-4732-3p were downregulated in patients where RS was involved as compared to AC. The expression of hsa-miR-141-3p was upregulated in patients where RS region was involved as compared to AC. Analysis of the registered UC patient’s database from the hospital revealed that the site of CRC was predomimnantly the rectosigmoid region of the colon in most of the cases. This is the first study to show the differential expression of miRNA involving different sites of colon in UC patients. Taking our data and previous reports into consideration, we propose that differential miRNA expression during UC perhaps contribute in the development of UC associated CRC at the rectosigmoid area.
 

Biography:

Anjana Vasudevan have completed my MBBS at Chettinad University in the year 2014.  I’ve worked at Apollo speciality hospital, perungudi, Chennai, India for almost a year and I’m now doing my post-graduation at Sri Ramachandra University in the department of general surgery. I’ve been accepted by the ICMR to do MS., PhD intergrated course. I’ve published one article, participated and presented in several national and international conferences.

Abstract:

Embryologically the ventral bud develops into primitive foregut and tracheobronchial tree.  Any malformation in this would cause a cystic lesion along the tracheobronchial tree or the foregut. The incidence of this occurring is about 1 case per 68,000 populations.  Here we present a case of sublingual swelling in a 22 year young female, with no other complaints. Her history was impeccable. All routine investigations were normal. MRI head and neck suggested a ranula. She was planned and taken up for surgery. The excised specimen was sent to histopathological examination which revelled the swelling to be a bronchogenic cyst. Bronchogenic cysts are an embryological anomaly and are found anywhere along the foregut. They can present in both adults and children. 7 to 15 % of all foregut cysts are bronchogenic cysts says literature. These cysts are generally asymptomatic but have a 10% chance of turning malignant

Biography:

M.B.B.CH of Medicine 1996,MCS.General surgery 2003,(Endoscopicsurgery)Phd. General Surgery 2010.(Colorectal).Postdoctoral research TUM,Munich,Germany.2011

Abstract:

Surgical treatment of umbilical hernia in cirrhotic patients is still the focus of many studies to achieve the best method for treatment in consideration to the surgical and medical risk. In this study ,we experience a simple, safe and effective new technique which is independent of common risk factors. Methods. Forty cirrhotic patients with uncomplicated umbilical hernia included in study through collaboration between General Surgery Department with Tropical Medicine and Gastroenterology Department, Assuit University Hospital, Assuit, between April 2013 to April 2014. Patients was categorized according to severity of cirrhosis and subjected to an elective hernioplasty after adjustment of disturbed medical and biochemical factors.The surgical as well the postoperative outcome were evaluated in the three different groups. Results. highly significant relation in comparison between 3 groups according to operative time, Hospital stay, and Prothrombine (time and concentration) as p.value <0.05. where the three parameters were more longer in group C than in B than in A.No sever complication recorded only one of forty cases, no recurrence after 6 months follow-up and no morbidities or deaths.

Conclusion. Button hole hernioplasty is a new simple surgical technique with no significant complication rate

Biography:

Abdurrahman SIMSEK
gulhane mılıtary medıcal academy
Gastrointestinal Surgery

Abstract:

Familial adenomatous polyposis (FAP) is a hereditary disease which potentially predisposes affected individuals to colorectal, duodenal and thyroid cancers. Total colectomy and proctocolectomy are two options used to eliminate the risk for development of colorectal cancer in patients with FAP. Here we share our experience as a video clip with a young female FAP patient who underwent pure laparoscopic total colectomy and ileorectal anastomosis at our institute. With the patient in the modified lithotomy position, the procedure begins using five-trocar technique. Dissection of mesocolon continues clockwise starting at cecum with division of ileocolic and right colic vessels, followed by division of middle colic artery, takedown of splenic flexure, division of inferior mesenteric artery and vein. Once the entire colon is freed from the retroperitoneal and peritoneal attachments, the bowel is cut at the rectosigmoid junction using laparoscopic lineer stapler. The right-lower quadrant trocar site is widened to remove the specimen. Anvil is placed into the ileum extracorporeally. The ileorectal anastomosis is created in a side-to-end fashion laparoscopically with the circular stapler placed through the anus. Fascia closure is necessary only for 3 cm right-lower quadrant trocar site. The patient can be given oral diet POD 1. In this case, the length of procedure was four hours and the patient was discharged home on POD 6 uneventfully.

In conclusion, we believe laparoscopic approach is a good option for patients with FAP undergoing colectomy, and can enhance recovery postoperatively.

Biography:

Dr. Muhammad Idrees obtained Ph. D. in Molecular Virology and worked for his post-doctoral research at DVH-CDC Atlanta. Currently he is the Director of Centre for Applied Molecular Biology, a premier Molecular Biology organization. He is also Head Division of Molecular Virology. His contribution in Molecular Virology has been recognized at home and abroad and his research work has been published in 107 peer reviewed research papers in international scientific journals with an overall impact factor of more than 200 of citation of more than 1300. He is the editor of several Internal Scientific Journals.

Abstract:

Chronic HCV infection frequently leads to liver cirrhosis and is associated with an elevated risk for progression into hepatocellular carcinoma (HCC). Several host and viral factors are assumed to play a role in this process. The aim of this study was to evaluate the role of IL28B and HCV genotypes in the development HCC in chronic HCV infected Pakistani patients.

Total 161 subjects with HCC were included in this study. Liver biopsy was performed on 145 of the patients. Sixteen patients were excluded because they failed to fulfill the inclusion criteria. qPCR was performed for HBV and HCV. Samples positive for HCV RNA were genotyped using genotype specific PCR and confirmed by 5’NCR sequence analysis. RFLP and direct sequencing were performed for the genotyping of Single nucleotide Polymorphism rs12979860 of IL28B.
Chronic HCV infection was identified a major risk factor (63.44%) for the development of HCC. The time from HCV infection to appearance of cancer was 10-50 years. In the HCC patient population, broader distributions of genotypes were present with genotype 3a as the predominant genotype. Sixty-six percent of treated patients with cirrhosis had an end of treatment response, but unfortunately they relapsed quickly when the treatment was discontinued, and HCC developed during a median 3.8 years. The statistically higher T allele frequency >80% was observed in patients with HCC as compared to the C allele frequency <20% in patients who did not develop HCC (p<0. 001). Based on the results of this study, a strong association was observed between chronic HCV-3a infection, IL28B TT genotype and HCC in Pakistan
 

Biography:

Professor Dr.Mohamed Alshekhani has completed his PhD at the age of 37 years from Arabic comittee for medical specialties in internal Medicine. He is the director of Iraqi Board of medical specialties in internal medicine in Sulaimani-Iraqi Kurdistan-Iraq.He has published more than 20 papers in reputed journals

Abstract:

Background: Hemorrhoids are prolapse and laxity of the collections of submucosal, fibrovascular & arteriovenous sinusoids that are part of the normal anorectum. The current thesis is to evaluate the role of flexible endoscopic band ligation in the treatment of symptomatic internal hemorrhoids using forward viewing approach.

Aim of study: To evaluate the role of flexible endoscopic band ligation in the treatment of symptomatic internal hemorrhoids using forward viewing approach.

Methodology: A prospective cohort study carried out in the Endoscopy unit of Kurdistan center for gastronetrology & hepatology , Shar hospital- and the private clinic of the supervisor all in Sulaimani city.

One hundred patients with symptomatic internal piles were evaluated. All patients were managed by flexible endoscopic band ligation using the forward or antegrade viewing approach. The patients were followed up by for 6 months. Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis.

Result: Mean age of hemorrhoid patients was 32±9 years, 39% of them were in 30-39 years age group. Male to female ratio as 2.7:1. The common presenting symptom of hemorrhoid patients was bleeding per rectum (BPR) (55%); followed by feeling of anal mucosal protrusion (48%). About half of studied patients (45%) had second degree internal hemorrhoid, 38% of patients had third degree and 17% of them had first degree internal hemorrhoid. Mild anal pain represented 77.1% of postoperative complications. Six month postoperatively, 69% of studied patient’s perceived cure, 20% improved, 8% unchanged and 3% perceived worsening. A significant decline in third degree was observed after RBL for hemorrhoid patients (p=0.04).
Conclusion: Rubber band ligation is good and safe non-surgical technique for management of internal hemorrhoids with high degree of patient's satisfaction.

Key words: Hemorrhoid, RBL
 

Biography:

Mohammed Omer Mohammed had Medicine in the University of Baghdad in 1981- 1987. after graduation he finished internship in Sulaimani .  He had Military service from 1988-1991.
He had been accepted by the Iraqi Board for Medical Specialization- Ministry of Higher Education From 1991-1995, Also during this period he got High Diploma In Internal Medicine  from College Of Medicine-University of Baghdad. Since 1995 he started teaching  as a Lecturer in College of Medicine University of Sulaimani. In 2007 promoted to Assistant Professor of Medicine. In 2009 Accepted AS Member of European Association for Studying Diabetes( MEASD). In 2012 provided Honorary  FRCP ( London) By Royal College of Physician.
Also, In 2012 promoted by Ministry of Health as Consultant Gastroenterologist. In 2013 Accepted AS Member of European Association for Studying Liver ( MEASL). Since 13-1-2013 he is as Professor of Medicine.
 

Abstract:

Background: The burden of Non-Alcoholic Steatohepatitis (NASH) is growing and current pharmacologic treatments are limited by side effects and inconsistent efficacy. Pilot studies suggest that Pentoxifylline (PTX) and vitamin E can reduce degree and pattern of fatty liver, liver enzyme and inflammatory marker in patients with NASH.

Objectives: To evaluate the clinical, biochemical and ultrasonographic effects of life style modification (LSM), PTX, and vitamin E in patients with NASH, and to develop a pharmaceutical care plan for patients included in this study.

Methods: This is a double blind placebo control study. A total of 110 participants with NASH, diagnosed by ultrasonography (U.S) and raised aminotransferase level were included. Demographic data, anthropometric measures such as Body Mass Index(BMI), waist/hip ratio were taken, liver function test, lipid profile, blood glucose, and High sensitivity C - reactive protein (Hs-CRP). The patients were divided into three comparable groups in age, gender and BMI. All enrolled participants were treated by LSM but pharmacologically they were randomly divided into three groups, receiving Placebo, vitamin E or PTX for 6months.

Results: Out of 110 participants, only 90 participants (48 male, 42 female) completed this study. All the three groups showed decreased steatosis by U.S and significant reduction in aminotransferase levels, Hs-CRP, v profile, blood glucose, blood pressure and waist circumference compared to baseline. All changes were more significant among vitamin E and PTX than placebo group.

Conclusions: PTX or vitamin E with dietary modification and exercise led to significant improvement in hepatic steatosis, reduction in aminotransferase levels and improved inflammatory marker (Hs-CRP).

Keywords: NASH, Lifestyle, Pentoxifylline, Vitamin E, Pharmaceutical care, Sulaimani
 

Biography:

MS. Seyedeh Azra Shamsdin is currently a PhD student of Immunology doing her course at clinical Microbiology Research Center of Shiraz University of Medical Sciences and has published more papers in reputed journals.
 

Abstract:

Introduction: Studies of gastric metaplasia and neoplasia in mouse models have informed us about the pathway to gastric carcinogenesis. VEGF and ERp57 were identified as markers for gastric metaplasia.

Aim: To investigate the expression of VEGF and ERp57 in gastric metaplasia and adenocarcinoma in humans.

Methods: 224 paraffin-embedded tissues from 112 patients with gastric cancer were stained for ERp57and VEGF by horseradish peroxidase immunohistochemical technique, in which VEGF or ERp57 quantification score is obtained.

Results: The level of VEGF expression was significantly higher in metaplasia and adenocarcinoma than that in normal gastric mucosa (p≤0.01).VEGF score revealed significant differences in differentiation degree, and histological type of the gastric carcinoma and depth of invasion (p≤0.05).ERp57 staining significantly increased in normal gastric mucosa, compared with that in cancer and metastases (p≤0.05).ERp57 expression correlated with greater depth of tumor and advanced stages (p≤0.01).

Conclusion: High VEGF expression and low ERp57 expression are correlated with the progression of gastric cancer. Therefore, VEGF and ERp57 are prognostic markers for such patients.
 

Biography:

Imane ENNIMA  is a PhD student from the Faculty of sciences, University Mohammed V of Rabat, Morocco. She’s a young reasearcher on virology and molecular biology, especially on isolation of bovine Rotavirus strains which will be used for the development of Vaccines  against Rotavirus in Morocco. She contributes to the optimization of a new protocol of RVA isolation and carried out the molecular characterization in order to develop a vaccine using the local strain representing the dominant serotype in Morocco and this in collaboration with the Society Biopharma, Rabat, Morocco. She has published 2 papers in reputed journals and communicate their studies in many national and international congress

Abstract:

Group A rotaviruses (RVA) are the main cause of neonatal calve diarrhea (NCD) in Morocco. Until now, no reports are available regarding isolation and cultivation of RVA in clinical samples from Moroccan domestic animals or children with acute gastroenteritis (AGE) and burden due to this infection in animals remain unknown. Hence, this study aims to isolate RVA strains from NCD clinical samples in order to support RVA disease control in Morocco. This isolation process constitutes a first step toward vaccine development. Thirteen fecal samples were obtained from calves with a single episode of neonate calf diarrhea at three different dairies and two samples were collected from field during a severe NCD outbreak. Diagnosis of RVA infection was based on fecal immune-chromatographic rapid test and further evaluated for their hemagglutination (HA) activity. RVA isolation was carried out on MA104 cells after inoculates were treated with different concentrations of trypsin TPCK. All RVA isolates were confirmed by LSI VetMAX™ Triplex Ruminant Rotavirus & Coronavirus Real-Time PCR kit. RVA isolation was achieved for nine clinical samples following one or two passages (60%) and was properly depended on HA activity and trypsin treatment of inoculates. The first sign of CPE detected consisted of increased cell granularity, obscure cell boundaries, cell rounding, and eventual degeneration and detachment of cells. These results constitute a crucial and a necessary step allowing preventive and veterinary medicine to support RVA disease controls in the country.

Key words:

Bovine Rotavirus;  isolation; Morocco.