14^th Euro-Global Gastroenterology Conference July 08-09-2019 Zurich, Switzerland

Biography:

Sara Lotfy Asser is a Lecturer in Microbiology and Immunology in Faculty of Medicine of Alexandria University. My passion in virology has always driven me to explore their clinical effects and research into the treatment outcome and their immune evasion strategies. I wish to research more into novel strategies to prepare vaccines and precede these ultramicroscopic bugs in their resistance mechanisms.

Abstract:

HCV direct-acting antivirals revolutionized the treatment outcomes especially in areas considered to be highly endemic as Egypt, where the government adopted a National Treatment Program and successfully reached a large sector of the HCV patients population. High response rate to treatment with Sofosbuvir and Daclatasvir necessitated confirmation of total cure through excluding HCV occult infection. Our aim was to estimate the occurrence of occult HCV in patients treated with Sofosbuvir and Daclatasvir, by detecting HCV RNA in their PBMCs. Quantitative estimation of HCV viral load in serum samples and PBMCs of 40 patients undergoing treatment with Sofosbuvir and Daclatasvir, was done using COBAS AmpliprepTM/COBAS TaqManTM. At the start of treatment serum samples were positive for HCV RNA (ranged from 2.50x10³ – 6101.0x10³). After one month of the treatment our data revealed that serum HCV RNA was negative by PCR. After three months, HCV RNA was detected in PBMCs in 10 out of 40 via RT-PCR. Comparison between the results of HCV RNA in serum and PBMCs by PCR after three months of treatment, showed statistically significant difference of p= 0.001. This reveals the high prevalence of HCV RNA in PBMCs denoting occult HCV infection after combined treatment with Sofosbuvir and Daclatasvir. It also signifies that although the combined treatment was effective in eliminating the virus from the serum, it is less effective in its elimination from the PBMCs. These results also highlight the importance of testing for HCV RNA in PBMCs after end of treatment to confirm total HCV elimination.

Figure:

c², p:  c² and p values for Chi square test for comparing between the two groups

*: Statistically significant at p ≤ 0.05 b

Biography:

Abstract:

Fatty liver is the most common liver disease worldwide. Hyperglycemia and hyperinsulinemia induce lipogenesis, thereby increasing the hepatic pool of fatty acids[1]. Nutritional consultations and lifestyle modification are important in the treatment of non-alcoholic fatty liver disease (NAFLD) [2]. The usual management of NAFLD includes lifestyle counseling to achieve a gradual weight reduction and an increase in physical activity. An intensive lifestyle intervention focused on diet, exercise and behavior modification with a goal of 7–10% weight reduction that leads to significant improvement in liver histology in patients with NASH [19]. Indeed, weight loss improves steatosis [20], reduces hepatic inflammation and hepatocellular injury [21], [22] and improves cardiovascular risk profile. [23]. Several changes in dietary intake have occurred in the past few years, including increased energy intake (24%), and increases in added sugars, flour and cereal products, fruit, added fats and total fat intake[42]. Fatty liver disease in humans is an insulin-resistant condition and the liver over-produces glucose and triglycerides due to impaired insulin action[45]. Fatty liver is an independent predictor of diabetes and cardiovascular disease[46]. There are three major sources for increased liver fat accumulation: excessive delivery of free fatty acids from lipolysis of superficial and visceral fat depots (60%), increased de novo hepatic lipogenesis (30%), and increased nutritional intake (10%)[47].

Biography:

Abstract:

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) is an immune-mediated chronic intestinal disorder with an unknown etiology. The overexpression of proinflammatory factors such as proinflammatory cytokines is believed to have pivotal role in development of UC. Among them tumor necrosis factor alpha (TNF-α) is identified as a key cytokine. Also it has indicated that the levels of expression of NF-κB reflect development and progression of UC.It has no cure until now and the purpose of treatments are to alleviate signs, lengthening remission and improvement in quality of life in these patients. Different mechanisms for the effects of vitamin D on inherent and acquired immune systems are supposed to reduce inflammation, promote immunological tolerance, and increase the intestinal epithelial integrity. Thus this study was designed to determine the effects of vitamin D supplementation on TNF-α, serum hs-CRP and NF-κB in patients with UC.

Materials and Methods:

In this randomized, double-blind, placebo-controlled study, 50 patients with UC were divided into two groups which the case group received two pearls of vitamin D (2000IU) once/day for 12 weeks and the control group received one placebo capsule and one pearl of vitamin D (1000IU) per day. Serum inflammatory markers, serum hs-CRP and NF-κB were assessed at baseline and the end of the study. Dietary intake and physical activity of patients assessed by a valid questionnaire. Anthropometric and diet measurements were assessed in this study. The SPSS was used for data analysis.

Results:

In this study, 24 patients in case group and 22 in control group Among 50 participants completed the intervention. At the beginning of study, no significant differences were seen in baseline variables between two groups. At the end of 12 weeks there were no significant differences in serum hs-CRP, TNF-α between the case and control group after adjustment for confounders. The level of NF-κB  in both groups increased, but this increase in the low dose group was statistically significant at the end of the study comparing to the beginning( P value = 0.006).

Conclusion:

Supplementation with 2000IU vitamin D daily for 12 weeks made no changes in serum hs-CRP. Serum TNF-α, remained with no change in both groups after adjustment. We recommend supplementation of vitamin D with appropriate dosage in all patients with UC in order to to take advantage of it’s great therapeutic benefits.

Biography:

Shailesh Kumar is a Professor of PGIMER at Dr. Ram Manohar Lohia Hospital, India. His research interests focus on Bariatric Surgery, Diabetes Control after Bariatric surgery along with Diabetes and Obesity.

Abstract:

A 46 years old menopausal female presented to surgical OPD with the complaints of recurrent pain abdomen with vomiting and fever off and on. Pt was a treated case of Koch’s abdomen. Th ere was no history of jaundice and other co- morbidities. On examinations, she had tenderness in Right hypochondrium (RHC) on deep palpation. Rest of the parameters were normal. On Investigation, ultrasonography of abdomen revealed multiple gallstones with Normal CBD. Rest of the abdomen and pelvis were normal. Her blood and urinary examinations were within normal limits. X-ray chest revealed features suggestive of healed tuberculosis. Pt was posted for laparoscopic cholecystectomy. After pneumo-peritoneum, 10 mm optical port was placed in periumbilical area. On diagnostic laparoscopy, whole of the colon was densely adhered to the pariety. Liver, gall bladder and spleen were nor not visible. As falciform ligament and liver was not visible, two working port were inserted in the mid clavicular line both side around 3 inches below the costal margin in an anticipation to de-parietization of the transverse colon to assess the feasibility to proceed. We broke the adhesion between the transverse colon and pariety in the midline and preceded to de-parietisation the whole transverse colon with the help of ultrasonic scissor. After that we could visualised the Liver and Gall bladder and preceded with the laparoscopic cholecystectomy abdominal cavity is the sixth most common extra peritoneal site of tuberculosis. Th ere are diff erent studies that support the crucial role of diagnostic laparoscopy in the diagnosis of abdominal tuberculosis. Th e diagnostic laparoscopy revealed ascetic fluid, violin string adhesion of peritoneum and omental thickness. Peritoneal involvement is a common features and more than half of the patients presents with ascites, lymphadenopathy and stranding of the mesenteric fat. Laparoscopy is normally accepted as an accurate and prompt diagnostic tool in case of suspected abdominal tuberculosis.
Recent Publications
1. Sharma M P and Bhatia V (2004) Abdominal Tuberculosis. Indian J. Med. Res. 120:305-315.
2. D Mistikas, T Kapp and Montmollin de (2016) Laparoscopic diagnosis of abdominal tuberculosis. HippoKratia.
20(2):175.
3. Sinant T, Sheikh M, Ramadan S, Sahwney S and Behbehani A (2002) CT- features in abdominal Tuberculosis: 20
years’ experience. BMC Med imaging. 2:3.

Biography:

Abstract:

Introduction:Acute cholangitis(AC)is a pathological condition characterized by an ascending bacterial infection of the biliary ductal system with the obstruction caused by varies etiologies.Endoscopic retrograde cholangiopancreatography (ERCP) is performed as a therapeutic procedure for biliary drainage in acute cholangitis but associated with higher rates of complications respective to other endoscopic procedures. These complications include pancreatitis, bleeding, trauma, and cardiopulmonary problems.

The aim of this study is the detection of any significant relationship between the Tokyo guideline 2018 staging of acute cholangitis and the complicationsassociated with the ERCP modality.

Material and methods :283 patients had been diagnosed with acute cholangitis and underwent ERCP, between January 2015 and February 2018 encountered at the Gastroenterology and Hepatology Department of Timisoara Emergency County Hospital, 43% of the patients are males (n=122), 57% of the patients, are females (n=161).The minimal age of the patients which is 17 years old and the maximal one being  92 years old, the average age of the patients involved in the study is 64 years old.The severity assessment and the staging of all acute cholangitis cases were based on the TG13/18 ; “Grade I” (Mild )comprises 179 patients (63% of the patients), “Grade II” (Moderate) comprises 63 patients (22 % of the patients), whereas “Grade III”(severe) comprises 41 patients (15% of patients).Inclusion in the study was based on the diagnosis of “Acute cholangitis” in the patient’s medical charts. Subsequently, the required data were extracted from the patient’s medical charts. Furthermore, the patients that did not undergo therapeutic ERCP were excluded

Results :ERCP complications are reported only in 34 patients (12%) out of 283 which underwent ERCP . The most common complication was post-sphincterotomy hemorrhage, observed in 17 patients (6% of the patients), acute pancreatitis in 14 patients (5.3% of pacients), other complication in 3 patients (1.06%).

According to TG18 , 11 from 41 Pacients with severe AC had Post ERCP complications (26.8%), 8 from 63 pacients with moderate  AC (12.6%) and 15 from 179 pacients with mild AC (8.3%)

Conclusion : ERCP is the gold standard and first line therapy for acute cholangitis in the department of gastroenterology and hepatology of the county hospital Timisoara but it remains a procedure with many complications. The TG18 could predict higher risk of complication according to the severity of AC

Biography:

Abstract:

Background and Aims: Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD) of unclear etiology that cause substantial morbidity and predispose to colorectal-cancer (CRC). There are two isoforms of STAT3—a and b; STAT3a is pro-inflammatory and anti-apoptotic, while STAT3b has opposing-effects on STAT3a. We determined the contribution systemically of STAT3 to UC and CD pathogenesis by comparing disease severity caused by dextran sodium sulfate (DSS; UC model) or 2, 4, 6-trinitrobenzenesulfonic acid (TNBS; CD model) in mice expressing only STAT3a (D^b/D^b) and in wild-type (WT) mice treated with TTI-101, a small-molecule inhibitor of both isoforms of STAT3.                                                                                                               

Methods: Seven days following administration of DSS in drinking water or two days following a single intra-rectal administration of TNBS, D^b/D^b mice, cage-control (+/+) mice, and WT mice given TTI-101 or vehicle were examined for IBD manifestations; their colons were evaluated for apoptosis of CD4⁺ T cells, levels of STAT3 activation, IL-17A protein expression, and transcriptome alternations.  

Results: IBD manifestations were increased in D^b/D^b transgenic vs. cage-control WT mice and were accompanied by decreased apoptosis of colonic CD4⁺ T cells. Complementing and extending these results, TTI-101 treatment of WT mice prevented IBD, markedly increased apoptosis of colonic CD4⁺ T cells, reduced colon levels of IL17A-producing cells, and down-modulated STAT3-gene targets involved in inflammation, apoptosis-resistance, and colorectal-cancer metastases.

Conclusions: STAT3, especially in CD4⁺ T cells, contributes to the pathogenesis of UC and CD and its targeting may provide a novel approach to disease treatment.

Biography:

Abstract:

Planning and scheduling is one of the critical component for a procedure area to work efficiently. It allows the effective utilization of material and human resource during the given period of time to bring outcomes. Therefore, We streamline the existing booking system by allowing medical teams to manage their case scheduling according to their assign slots. The new system encourages transparency while keeping in mind both doctor’s and patient’s satisfaction.

Initially, the appointment booking for all three procedure rooms were done under one room in the system. As a result, it creats high dis satisfaction among patient and health care provider due t system kiosk.

Juran’s problem solving trilogy was used as quality improvement methodology was devised to run the project. A new booking system was introduced to manage the endoscopy booking system. The system allows to assign the no. of feasible slots to the medical team to schedule their cases at any point of time.It’s also facilitate to accommodate walk-inn patients during available open slots  time. It also helped to allow equal no. of distribution to all no.of attendings.

In 2016, the monthly avg. no show of endoscopy suite was 28%. After the implementation in Feb 2017, the no show for the year 2017 and 2018 came down to 24% and 20% respectively. There is a significant change in yearly no-show rate. This has also strengthened system’s booking capacity with increase of 67%. Hence, Booking was increase in 2017 and 2018 as compared to base year with 4.5% & 3.05% respectively. There is magnificent space created in system to accommodate walk-in patients any day as per the patient convenience as we have reduced walk-in cases from 47% in 2017 and 2018.

This process confirms the sustainability of the new appointment booking system. Findings showed that there is a significant decrease in number of no shows as we were able to capture them before time and other un-booked patients’ number has decreased, resulting in efficient utilization of resources. The staff will be working in a healthy environment with an equal distribution of work. Therefore, they will not be exhausted and get overburdened with delivering good quality care to patients. Lastly, an increase in the revenue will be beneficial for the department.

Biography:

Balwant Singh Gill has completed his MD from Dr. MGR Medical University, India. He is the Director of Swami Ji Gastroenterology Center (India) an Advanced Endoscopy Center. He has published more than 5 papers in reputed journals and has been serving as a consultant Gastroenterologist, Hepatologist & Interventional Endoscopist at their center of gastroenterology. He is also associated with few national and international associations.

Abstract:

Esophageal varices: Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. Th is happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood fl ow and increased portal venous blood infl ow. Th e most common fatal complication of cirrhosis is variceal rupture; the severity of liver disease correlates with the presence of varices and risk of bleeding.
Bleeding esophageal varices: No single treatment for bleeding Esophageal varices is appropriate for all patients and situations. An algorithm for management of the patient with acute bleeding is presented in this article. The options for long-term, defi nitive therapy and the criteria for selection of each are discussed.Pathophysiology and management of esophageal varices: Esophageal varices are one of the most common and severe complications of chronic liver diseases. New aspects in epidemiology, pathogenesis and treatment of varices are reviewed. Sclerotherapy is the fi rst-line treatment for acute hemorrhage. Prevention of first or recurrent bleeding is still unsatisfactory. β-Blockers are slightly superior to sclerotherapy with regard to prophylaxis of fi rst bleeding.β-Blockers or sclerotherapy may be used for prophylaxis of recurrent bleeding. However, prophylactic treatment regimens do not have a major impact on survival. Combination treatment, new drugs or new devices may help to improve the effi cacy of prophylactic measures. Endoscopic therapy for esophageal varices: Among therapeutic endoscopic options for Esophageal varices (EV), Endoscopic variceal ligation (EVL) has proven more eff ectiveness and safety compared with endoscopic sclerotherapynd is currently considered as the first choice. In acute EV bleeding, vasoactive therapy (either with terlipressin or somatostatin) prior to endoscopy improves outcomes; moreover, antibiotic prophylaxis has to be generally adopted. Variceal glue injection (cyanoacrylates) seems to be effective in the treatment of esophageal as well as in gastric varices. Prevention of rebleeding can be provided both by EVL alone or combined with non-selective β-blockers. Moreover, EVL can be adopted for primary prophylaxis, with no differences in mortality compared with drugs, in subjects with large varices and unfi t for a β-blocker regimen. A meta‐analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding: Despite publication of several randomized trials of prophylactic ariceal ligation, the effect on bleeding‐related outcomes is unclear. We performed a meta‐analysis of the trials, as identifi ed by electronic database searching and cross‐referencing. Both investigators independently applied inclusion and exclusion criteria and abstracted data from each trial. Standard meta‐analytic techniques were used to compute relative risks and the number needed to treat (NNT) for first variceal bleed, bleed‐related mortality and all‐cause mortality. Among 601 patients in 5 homogeneous trials comparing prophylactic ligation with untreated controls, relative risks of fi rst variceal bleed, bleed‐related mortality and all‐cause mortality were 0.36 (0.26‐0.50), 0.20 (0.11‐0.39) and 0.55 (0.43‐0.71), with respective NNTs of 4.1, 6.7 and 5.3. Among 283 subjects from 4 trials comparing ligation with β‐blocker therapy, the relative risk of fi rst variceal bleed was 0.48 (0.24‐0.96), with NNT of  13; However, there was no eff ect on either bleed‐related mortality (relative risk [RR], 0.61).

Biography:

Essam Soliman has completed his education from Fayoum University, Egypt. He has published 8 papers in reputed journals. Currently he is working as an Associate Director of GIT at Foyoum University. His research interest mainly lies in the fi elds of Topical Medicine and Liver.

Abstract:

Colorectal cancer (CRC) represented the second cause of mortality among cancer patients. Long noncoding RNAs and microRNAs (miRNAs) serve as non-invasive biomarkers for CRC surveillance and introduce new therapeutic approaches. LINC00657 and miR-106a expression levels play a pivotal role in CRC. Th is study included 190 Egyptian subjects and the expression levels of LINC00657 and miR-106a in serum were measured by using quantitative real-time polymerase chain reaction. We found that upregulation of LINC00657 and downregulation of miR-106a are signifi cantly associated with the development of CRC. Also, a positive correlation was detected between their serum levels. In addition, serum LINC00657 can distinguish adenomatous polyposis (AP) patients and/or ulcerative colitis (UC) patients from controls. Also the miRNA-106a expression level discriminates AP but not UC from healthy individuals. Our study cited new diagnostic biomarkers for CRC, AP and UC among Egyptians in addition to be non-invasive screening tools for CRC in both healthy subjects and those having precancerous lesions.