12^th Euro-Global Gastroenterology Conference September 11-12, 2017 Paris, France

Thi-Ut Nguyen is a Pediatrician. She has been working as Gastroenterologist in Gastroenterology Department of the National Pediatric Hospital. She has conducted several studies on Helicobacter pylori antibiotics resistance of gastritis and peptic ulcer among children

Statement of the Problem:
Helicobacter pylori (H. pylori) antibiotics resistance is the major cause of failure in eradicating H. pylori. Recent studies have showed that the virulence genes associated with H. pylori antibiotics resistance have been isolated from adult peptic ulcer patients. To date, however, there is still lack of evidene about this in Vietnamese pediatric children. The objective of this study is to evaluate the association between H. pylori antibiotics resistance and the presence of cagA and vacA genes in pediatric patients.

Methodology & Theoretical Orientation:
150 samples of H. pylori isolated from 150 infected pediatric patients whose antimicrobial susceptibility showed a resistance to at least 1 of 3 antibiotics: amoxicillin, clarithromycin and metronidazole. The cagA and vacA genes were detected by using multiplex PCR (Polymerase Chain Reaction), between January, 2012 through September, 2013 in National Hospital of Pediatrics, Hanoi, Vietnam.

Findings:
The result showed that the cagA gene was detected in 34% H. pylori strains. The rate of vacAs1, vacAs2, vacAm1, vacAm2, vacAs1/m1, vacAs1/m2 and vacAs2/m2 were 39.3%, 14.7%, 37.3%, 23.3%, 16.7%, 11.3% and 6.6% respectiverly. 8% strains harboured three virulence genes cagA, vacAm1 and vacAs1.

Conclusion & Significance:
The prevalence of cagA and the vacA alleles distribution didn’t show a significant difference between susceptible and antibiotics resistance groups. Recommendations therefore, it may not be necessary to administrate different treatment regimens for children who are infected by antibiotics resistance of H. pylori with cagA, vacA positive.

Eda Yaldirak is a 4th year medical student at University of Dokuz Eylul. She has participated in research on evaluation of the satisfaction of patients' relatives in anesthesia intensive care unit (Published in Dokuz Eylul University Magazine). She has also worked in research on ethic and quality standards about informing customers (Workshop, EMSA) and in research and workshop program about contraception methods at Dokuz Eylul University. Analyzing Helicobacter pylori is her recent and focus point.

Statement of the Problem:
Helicobacter pylori cause serious health problems including gastritis, peptic ulcer disease, gastric cancer and MALT-lymphoma. Although many researches have been indicated animal originated raw foods contain H. pylori, still people continue their eating habits. Mainly they are aware of the problem but don’t realize how serious it is. Previous researches indicate that prevalence of H. pylori is very high in Turkey and it is also very high among university students (63%). The purpose of this study is to indicate the perspective of people for eating animal originated raw food.

Methodology:
Survey is conducted with 193 participants above age 10, and all living in Ä°zmir. Chi-square test has been conducted to analyze relation between demographic information (age interval, sex and education level) and eating habits and information about eating uncooked red meat, egg, milk and chicken meat.

Findings:
There is no significant correlation between demographic information of people (sex, age interval and education level) and eating uncooked red meat, egg, milk and chicken meat. Ratio of eating foods including uncooked meat (cow and sheep) is very high, even though most of them think that it is unhealthy. This is the case also for raw egg. Ratios are better for raw chicken meat and raw milk. There is a statistically significant relation between information about eating animal originated raw foods and eating habits (except red meat). However there is no relation between education levels and awareness of health problems regarding consumption of animal originated raw foods.

Conclusion:
Threat of H. pylori should be announced clearly to change food consumption habits. This survey indicates that education level does not have significant relation on food consumption habits for raw red meat, milk, egg and chicken meat. A complementary education method should be sought to increase the awareness.

Ji Hyun Moon works as an Assistant Professor for the Department of Family Medicine at Jeju National University Hospital, Korea.

Abstract:
Only a few studies suggest an association between colorectal adenoma and obesity and their results remain controversial. Previous studies are primarily focused on obesity caused by increasing fat. However, wasting of muscle also causes obesity. The role of decreased muscle mass and strength in the development of colorectal polyps is yet unknown. We propose that not only an increase in fat, but also decreased muscle mass and/or strength can affect the development of colorectal adenomas. We investigated the association between colorectal adenomas and hand grip strength, which is an easy way to assess muscle condition. Our cross-sectional study included 957 subjects who underwent colonoscopy at Jeju National University Hospital between 2015 and 2016. Grip strength was measured twice on the left and right hand alternately, and the grip strength was evaluated as the maximum value of the arm used. The adenoma group was classified as those showing histologically confirmed colorectal adenoma while the adenoma free group (control group) included those with an unremarkable abnormal finding on colonoscopy, including colitis and hyperplastic polyps. Colorectal adenomas were found in 249 men (42.6%) and 85 women (22.8%). In men, hand grip strength was 42.48 kg in the control group, 41.12 kg in the adenoma group and in women 23.87 kg in the control group and 22.77 kg in the adenoma. Additionally, there was no significant difference in body fat percentage between the control and adenoma groups when assessed using bioelectrical resistance measurement in both sexes. After adjusting for age, smoking status, and exercise frequency, log-transformed grip strength and colorectal adenoma were found to show no significant correlation. The odds ratio (OR) was 1.24 [95% confidence interval (CI) 0.60-2.58, P=0.560] in men and 1.05 (95% CI 0.27-4.03, P=0.946) in women. There was no significant relationship noted between hand grip strength and colorectal adenoma.

Hadis Sabour is currently working as Assistant Prof. in Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences (2016 to date). He has worked as Researcher, Diet Consultant, Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences (2006- to 2015) and Researcher, Endocrine and Metabolism Research Center, Tehran University of Medical Sciences (2005-2007). He has completed his PhD (2011) in Nutritional Sciences from Tehran University of Medical Sciences, Tehran and MD in 2000 from Tabriz University of Medical Sciences, Tabriz, Iran

Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in Iran. The disorder is being recognized increasingly in the uniformly obese and no obese people. However, the lack of specific reversal agents has made the management of (NAFLD). Rose hip has been used traditionally to treat a range of conditions including diabetes based on anti-insulin effect of rosehip. This study on 25 patients illustrates the role of rosehip in improving patient Non-alcoholic fatty liver disease while highlighting the importance of information and education about the availability and appropriate use of this herb in treatment of fatty liver.

Ning Pu is persuing Masters at Fudan University at Zhongshan Hospital. He has published Articles on Pancreatic cancer in divergent journals. He has under graduation at Yangzhou University.

Purpose:
To identify risk factors for overall survival (OS) of pancreatic ductal adenocarcinoma (PDAC) patients with no distant metastasis, and formulate a novel nomogram for prognostic prediction of these patients.

Patients & Methods:
Data from surveillance, epidemiology, end results (SEER) database of PDAC patients with no distant metastasis between 2010 and 2014 as the primary cohort, and Zhongshan Hospital, Fudan University of resected patients between 2012 and 2015 as the validation cohort were enrolled. The Cox proportional hazards regression model was used in univariate and multivariate survival analyses to identify significant independent prognostic factors. The prognostic nomogram integrating all independent risk factors for predicting OS was established to achieve superior discriminatory ability. The performance of the constructed nomogram was further evaluated by the concordance index (C-index), calibration curve and decision curve analysis.

Results:
A total of 12343 patients from SEER database and 127 patients from Zhongshan Hospital, Fudan University were finally analyzed. In the univariate and multivariate analysis with the primary cohort, age, differentiation, TNM stage, surgery of primary site and regional lymphocyte node (LN) surgery were identified as independent prognostic indicators for OS, which were integrated to formulate a prognostic nomogram. The constructed nomogram showed excellent performance according to the C-index and calibration curve. Compared with the TNM staging system of the AJCC 7th edition, the nomogram exhibited superior predictive accuracy for OS. All these results were further verified in the validation cohort.

Conclusion:
The nomogram formulated in this study revealed excellent discrimination capability to predict OS of PDAC patients with no distant metastasis. One more advanced and accurate predictive model will be obtained to assist in risk stratification via the constructed nomogram.

Roberto Menicagli has completed his PhD at the age of 25 years from Milan University Postdoctoral studies in biochemistry and molecular genetics, at the faculty of biology at Milan University. He is the director of Roma Biomed Research Lab a Private Medical Service Organization. He has published more than 20 papers in reputed journals, some also with impact factor. He is also the principal author of 4 international patents, in the field of the environment, and biomarkers, and has been serving as an editorial board member of two magazines concerning the medical sciences.

Abstract
Several studies demonstrated that many foods may provide a large number of bioactive peptides into the gastrointestinal tract, as for example, the beta-casomorphin-7, an opioid like peptide produced by casein. Recent studies have established that the production of these opioid peptides is experimentally associated with autism. Autism is a developmental disorder with a possible connection between dietary components and triggering or worsening of symptoms. An altered intestinal permeability might allow absorption of in-completely digested peptides (gluten and casein) that could produce opioid-like activity on the brain, causing significant changes in behaviour. It is also showed ,that phenomenon ,of the formation of the opioid peptides , strongly stimulates intestinal mucin production in ex vivo and in vitro models ,in particularly , these effects were associated with a higher expression of intestinal mucins (gel forming), MUC2, the principal constituent of Gut Protective Layer The Over Expression of MUC 2 ,contrary to what one might think, does not strengthen the intestinal protective layer, but rather tends to altering the continuous layer, in a succession of bubbles, separated by channels, which allow for greater permeability, facilitating the cycle of the opioid peptides and the free radicals The effect is twofold:: inhibition of nerve receptors & formation of, cerebral micronuclei .The purpose of this study is to propose research to evaluate, the biochemical process for inhibit the MUC2 Over –Expression, in autism ,using for example enzyme as the sialidase

Aritra Banerjee is pursuing his MD Anatomy from All India Institute of Medical Science (AIIMS), New Delhi, India. He has completed his MBBS from Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. He has experience of 1-year non-acad. residentship in Dept. Of Cardiology, Nil Ratan Sircar Medical College, Kolkata and 3 years teaching and research experience (medical as well as paramedical students) as a Junior Resident in Dept. of Anatomy, AIIMS, New Delhi. He is now doing his research work on “morphological study of neurons in human fetal pancreas” based on immune-histochemistry and enzyme.

Introduction:
The Pancreas is a well innervatedgland with the autonomic nervous system (ANS) in various species. The neurons are distributed singly or in the form of ganglia which are predominantly cholinergic. Sympathetic innervation is necessary for the formation of the pancreatic islets of Langerhans and for their functional maturation. The autonomic nervous system has a role in blood glucose levels regulation. The numerous nerve ganglion seen in the developing human pancreas in the inter lobular connective tissue from 14WG and in the intra lobular connective tissue from 16WG onward. Typical adult type islets were detected from 25–27 WG onward. Pancreatic innervations have been considered with enormous interest regarding pancreatic pain. The enteric nervous system (ENS) differs both structurally and functionally from other divisions of peripheral nervous system (PNS) and capable of functioning independently from the brain and spinal cord, hence called as ‘Second Brain’ of vertebrates. Conventional anatomical studies in human cadavers have provided only partial insight. The lack of information about the structure and the course of development of neuronal cells and intrapancreatic ganglions make this study persuasive.

Aim:
The aim of this work is to study the morphological changes in the innervation of human fetal pancreas at various gestational ages.

Materials & Methods:
The present study was performed on human fetuses (n=13) of different gestational ages. The sample collection was started after getting ethical permission from the Human Ethical Clearance Committee of All India Institute of Medical Sciences, New Delhi. Fetal weight, crown rump length (CRL), foot length, biparietal diameter (BPD) were taken. With the help of these parameters fetal age was determined. Pancreatic tissue samples (Head, body and tail) from aborted foetus aged 13–40 weeks of gestation (WG) were processed for enzyme histochemistry and immunohistochemistry. The neurons were visualized using NADPH-d and ChAT.

Observation:
The number of neurons in human fetal pancreas was appeared to be reduced with increasing gestational age in the head, body and tail of the pancreas. The amount of the mesenchyme tissue is gradually decreasing with increasing gestational age. Numerical density of cholinergic neural tissue is more in tail than body and head, whereas, the nitrergic neuronal tissue is more in head than body than tail in human fetal pancreas. Though the results were not statistically significant. Regarding the size of neurons, there was no statistically significant correlation between the head, body and tail of the pancreas.

Conclusion:
The knowledge of the development of the innervation of different parts of the pancreas in human fetuses from 13 to 40 WG may help in understanding the pathophysiology of various congenital disorders related to the innervation of the pancreas.

As specialists in General Surgery and Oncology, Maksim A. Evseev, Alexey L. Vladykin, Andrey V. Ustimenko and Yulia L. Podberezina the greatest part of their practical work and research dedicated to the problem of abdominal cancer surgery. The main areas of research are: technical aspects of advanced surgical procedures including advanced lymphadenectomy, laparoscopic techniques in oncology, optimization of nutritional support in patients and the choice of an optimum variant of adjuvant chemotherapy. A significant number of patients with locally advanced gastric cancer are the cause of intense interest of researchers to study the possibility of expanding operations in the stomach as a remote, and the early results. One of these observations describes this work

Abstract

In regard of permanent discussion about necessity and possibility of multi visceral resections in advanced malignancy, we present a clinical case Multi visceral resection – total gastrectomy, pancreatoduodenal resection and the extended right colectomy. A woman 39 years was examined about the violation of gastric emptying and symptoms of gastric bleeding, appeared 2 months prior to treatment. After the examination stomach cancer (poorly differentiated adenocarcinoma, antrum and body, Borrmann III) with the spread to duodenum, invasion of pancreatic head, with involvement of perigastral lymph node without distant metastases was diagnosed. At intraoperative examination circular tumor of stomach with involvement of antrum, body, subcardia, spreading to proximal part of duodenum and Invasion of pancreatic head, right flexure of the colon, right Para colon and mesocolon with middle colic vessels, metastatic lesion of lymph node in groups 3, 4d - 7, 15 were detected (oT4N1M0, fT4N2M0 (R0)). Total gastrectomy, pancreatoduodenectomy, extended right colectomy with regional lymphadenectomy D2-3 (lymph nodes of groups 1 - 13, 14v, 15, 16b1 were removed) were performed. Reconstructive phase of surgery included the formation of nutritional and biliopancreatic loops of the small intestine by Y-en-Roux. In time of the alimentary loop formation esophagoenterostomy and Iliodescendostomy were performed. In the biliopancreatic loop have been performed invaginated pancreaticoenterostomy and hepaticoenterostomy. Surgery was completed insertion of transnasal feeding tube in the alimentary loop and 4 drainages in the abdominal cavity. Postoperative period has been executed according to ERAS with enteral nutritional and physical activation at 1 day after surgery. There were no complications in the postoperative period. Final diagnosis was. The patient was discharged on day 10 in a good condition for adjuvant chemotherapy (XELOX). Within 12 months of observation after 6 months of the adjuvant treatment no local or metastatic progression of tumor and no dyspeptic symptoms have been identified.

Marwa Ibrahim was graduated from Faculty of medicine, Alexandria University, Egypt as Medical Doctor 2005, with the specialties including Tropical Medicine, Hepatology, Gastroenterology and infectious diseases with 3 years of residency in Alexandria main university hospitals as an intern of tropical medicine, Gastroenterology and Hepatology and Master degree in tropical medicine from the University of Alexandria 2010. Later on she worked as an assistant lecturer of Tropical medicine, Faculty Of Medicine, Alexandria University Egypt 2010-2014 till she obtained her MD from University of Alexandria in non-surgical treatments of hepatocellular carcinoma and then started working as a Lecturer Of Tropical Medicine, Alexandria University, faculty of medicine, Egypt 2014-till now as well as University co-supervisor on fever hospital center for treatment of hepatitis C, where she has continued her research

Background:
Hepatorenal syndrome (HRS) is the development of progressive renal failure in patients with advanced chronic liver disease, occasionally fulminant hepatitis, who have marked circulatory dysfunction, the definitive treatment for Hepatorenal syndrome is Liver transplantation, and all other therapies can best be described as bridges to transplantation. Systemic vasoconstrictors are the most promising pharmacologic agents in the management of HRS.

Objectives:
The aim of the work was to evaluate the precipitative factors in cirrhotic patients who developed Hepatorenal syndrome and to evaluate the role of Terlipressin in the treatment of Hepatorenal syndrome (type 2)

Patients and Methods:
the study was conducted on 40 cirrhotic patients with Hepatorenal syndrome (type II), randomized into two groups: Group I consisted of 20 patients who were given Terlipressin, 1mg/8h, intravenous infusion (3mg/day) for 7days, in additional to conventional treatment of Hepatorenal syndrome (intra venous albumin 1g/kg/day up to 100gm/day).Group II consisted of 20 patients who were given only conventional treatment of Hepatorenal syndrome (intra venous albumin) and was considered as a control group. All patients were subjected to the following: Detailed history taking and proper clinical examination. - Arterial blood pressure and urine output. - Laboratory investigations (complete urine analysis, complete blood count, liver function tests (ALT, AST, serum albumin, prothrombin time and activity, serum bilirubin (total and direct), renal function tests (blood urea and serum creatinine), serum Na, K, Urinary Na and ascitic fluid analysis. - Ultrasound examination of abdomen. Blood urea and serum creatinine, serum Na, K, Urinary Na were re-evaluated after 7 days of treatment.

Results:
The result of the present study showed that few patients had evident precipitating factors for HRS including hematemesis in three patients and spontaneous bacterial peritonitis in one patient. After follow up for 7days renal function improved in patients with Terlipressin treatment (fall in serum creatinine below 1,5 mg\dl), there was no change in renal functions in control group. There were no ischemic side effects in patients with Terlipressin treatment.

Conclusions:
Terlipressin improves renal functions in patients with Hepatorenal syndrome (type 2).The use of Terlipressin as a therapeutic option in patients with Hepatorenal syndrome was not associated with significant short term adverse effects. Most of patients with type 2 Hepatorenal syndrome have no identifiable precipitative factors.