15^th Euro-Global Gastroenterology Conference June 24-25, 2020 Rome, Italy

Biography:

Shima A. Atta, faculty member for Pharmacology currently living in Egypt, the Doctor of Pharmacy Program at Duquesne U. With an expansive resume, no doubt I could make an impact in a project for promoting a new role of pharmacists counseling patients regarding their medications and being reimbursed for their efforts. On January 1st, 2006, the Medicare Prescription Part D Plan was enacted that made this new role a reality. Pharmacists in retail settings began to work with clinics (managed by a nurse practitioner).

Abstract:

Objective: To analyse the phytochemical constituents, and to explore potential protective effect of the methanol extract of Moringa oleifera (M. oleifera) seeds and Egyptian propolis, each alone or concurrently administered on acetic acid-induced ulcerative colitis in rats. 

Methods: Eight groups of 5 rats each were used: Normal control group with distilled water, model group, two groups with M. oleifera seeds (100 and 200 mg/kg), two groups with propolis (50 and 100 mg/kg), one group with concurrent administration of both, and one group with prednisolone (reference drug). Macro-and microscopic picture, ulcer index and lesion scores, oxidative markers, inflammatory mediators, in vitro activity of the inflammatory enzymes and 1, 1-diphenyl-2-picrylhydrazyl free radicals scavenging activity were evaluated. The phytochemical constituents of both extracts were explored by GC-MS analysis.

Results: Both treatments modulated the macro-and microscopic picture, decreased the ulcerative index, lesion score, oxidative markers, and inflammatory mediators, and inhibited the COX-1 and COX-2 enzymes. Propolis appeared to be powerful free radicals scavenger. A powerful synergistic effect of both treatments in modulating the course of the disease was reported. GCMS analysis of methanol extract of M. oleifera seeds and propolis revealed the presence of 50 and 34 compounds, respectively.

Conclusions: M. oleifera seeds and propolis methanol extracts have modulated the course of acetic acid-induced ulcerative colitis. Moreover, both treatments induce a good synergistic effect against the disease. Isolation of the active constituents is recommended.

Biography:

Elssayed Osman Elssayed has graduated from the Faculty of Medicine, Shendi University, Sudan. He has been working as a Sudan Ministry of Higher Education in gastroenterology and Intensive Care.

Abstract:

Introduction: Appendicitis is the most common cause of abdominal pain and a prevalent reason for emergency surgery. Laparoscopic appendectomy is the method of choice, owing to its many advantages, less invasiveness, faster recovery, and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases.

Aim: To evaluate the outcome and complications of laparoscopic appendectomies in Almak Nimir University Hospital Shendi University (Sudan) single centre experience.

Material and Methods: This is a prospective observational hospital base study on patients who underwent laparoscopic appendectomy for acute appendicitis from January to June 2019 in Almak Nimir University Hospital Shendi University (Sudan).143 patients underwent laparoscopic appendectomies for acute appendicitis or suspected acute appendicitis.

Results: Of the 143 patients analyzed, female predominant 124(86.7%) and male were 19 (13.3%). 5 cases (3.5%) were converted to open surgery, intraabdominal abscess encountered in 2 patients 1.4%. Surgical-site infection was observed in 6 patients (4.2%) The study showed statistically significant negative-positive appendectomy (normal appendix but another pathology found).

Conclusions: Laparoscopic surgery can serve as a diagnostic tool for patients with suspected AA specially for female because of its low associated morbidity and mortality and it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.

Biography:

Stoian Marilena is Doctor of Medicine, Medical University Bucharest, Romania, 1989 Romanian internist, nephrologist, and researcher. Lieutenant medical service Romanian Reserve; Member European Dialysis and Transplant Association, European Renal Association, New York Academy of Sciences, International Society Peritoneal Dialysis, Romanian Study of Liver, Romanian Internal Medicine Society.

Abstract:

Aims: To examine the outcome of resection in cases of gastric cancer with distant metastases.

Method and Material: The survival rates of one hundred and eight patients who had undergone resection for primary carcinomas of the stomach, and who had distant metastases according to the TMN classification, were studied.

Results: The 5-year survival rates for patients with metastases to the peritoneum or group 3 nodes were 8.9% and 15.3% respectively and were significantly higher than the survival rates for patients with metastases to the liver (0%), to group 4 nodes (2.2%) or to more than one site among the liver, lymph nodes and peritoneum (3.5%). The 5-year survival rates for patients with metastases to the peritoneum and n3 nodes increased significantly to 29.45 and 24.2%, respectively, when curative surgery was performed.

Conclusions: The present study suggests that metastases to the adjacent peritoneum or group 3 nodes have a greater chance of being cured using radical surgery, and that gastrectomy with extended lymphadenectomy (D2-D3) may be used for advanced gastric cancer if there is no gross evidence of metastasis to the distant peritoneum, liver or group 4 nodes.

Biography:

Prakash S Bisen is currently pursuing his research in the field of medical biotechnology as Honorary Professor with a research project on tuberculosis from Grand Challenges Canada, Govt of Canada in the Centre of Innovative Technology, Vikrant Institute of Technology and Management, Gwalior and School of Biotechnology, Jiwaji University, Gwalior. He has been elected fellow of the National Academy of Sciences, India, for his enormous contributions to the field of General Biology.

Abstract:

There has been a lot of research about the human microbes, some detailed investigations of the gastrointestinal microorganisms and its functions, and the highlighting of complex interactions between the gut, the gut micro biome, and the central nervous system. That acquires the involvement of the micro biome in the pathogenesis of various diseases. The gut micro biota is sensitive to internal and environmental influences, we have speculated that among the factors that influence the formation and composition of gut micro biota during life.  Micro biome in human system is unequally distributed in the body and includes the aggregate of all microorganisms. The most abundant micro biome in our body is gastrointestinal track. Which contain number of species of different microorganisms, among them (adults) Bacteroidetes, Actinobacteria and Firmicutes are dominate. The gastrointestinal micro biota is well studied than other human bacterial communities. There are studies have shown that, how exactly the intestinal micro biota has an impact on the health of its host.

Human gastrointestinal tract showed biggest associations of host, environments, and antigens. During the average human lifetime, tons of food transfer through the gut, with complex of microorganisms from the ambient environment, which poses threat on the intestinal entirety. Gut micro biome play a pivotal role in keeping up the resistance and the metabolic homeostasis effective and are protect against pathogenic microbes. Gut micro biota is a crucial modulator of brain development and subsequent adult behavior, and pathogenic microbes can be a reason of inflammatory diseases of the central nervous system. Epidemiological research has been shown a link between microbial infections early in life and neurological disorders, including autism and schizophrenia.  The gut microbes can change the immune response by activating the immune system or through mediators that are able to penetrate the blood-brain barrier (BBB) or through other chemicals-related substances that have free access to the brain.

The Probiotics microbes offers numerous bonuses to the host, due to physiological capacities such as harvesting energy, strengthening gut integrity or shaping the intestinal epithelium protecting against pathogens and modulating host immune system. Research showed that, Microorganisms which live inside our gut are beneficial for the proper development of the central nervous system, for brain response and the regulation of host physiology, the ecosystem in the human gut is divers, there is potential for these processes to be disordered because of a changed microbial composition, which can be improved by daily up take of probiotic.

Biography:

Rahul Hajare was fortunate enough to be recognized for hard work with scholarships from India Council of Medical Research Ministry of Health Research New Delhi including a centenary post doc National AIDS Research Institute Pune that is presented by Respected Dr. R.S.Paranjape, Immunologist and World Renowned Scientist., Retired Director & Scientist ‘G’ National AIDS Research Institute Pune. His initial journey was a quest to heal with a different kind of highly education and did a sponsorship at the Ana Laboratory in Mumbai. After completing his training, he was privileged to practice in KLE College of Pharmacy Bangalore as a board certified Secretary KLE society Belgavi. He works with a formerly reputed Pune University and services to be recognized by special Investigation team (SIT) for work in education.

Abstract:

A female mind reacts much more and is more stimulated than a male one when aroused. Turns out, a woman's mind is much more complex than a male's when it comes to intimacy. According to a recent Pune University study, a female mind reacts much more and is more stimulated than a male one when transition of morphine to functional morphine. In the study conducted on 20 men and 20 women, each of the individuals was shown erotic film clips while their brain vitals were scanned by two scanners. One of the scanners was an MRI machine that tracked stimulation in their brains.

The other was a heat-seeking camera that measured levels of arousal through participant's genitals. While not massive, the recorded difference between stimulation levels between male and female brains highlighted the consistent disparity between the two counterparts. There were no brain regions in men with stronger brain-genital correlations than in women", the study stated, according to the Independent. While interesting, the sample size for the study was too small, according to researcher Pune University. He further added that more detailed research would be required to draw such certain conclusions. However, he did not deny the complexity of female arousal.

Biography:

Balwant Singh Gill has completed his MD from Dr. MGR Medical University in 2011 and DNB from Delhi from NBE in 2014. He is the Director & Head 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 from July 2014.

He has associated with few national and international associations as follows: 
• Member: ACG (American College of Gastroenterology)

• Member: CAG (Canadian Association of Gastroenterology)

• Member: AASLD (American Association for the Study of Liver Diseases)

• Member: EASL (European Association for the Study of the Liver)

• Life Member: INASL (Indian National Association for Study of the Liver) 

• Member: APASL (Asian Pacific Association for Study of the Liver)

• Life Member: GISI (Gastrointestinal Infection Society of India

Abstract:

Esophageal Varices: 

Esophageal varices are dilated submucosal distal Esophageal veins connecting the portal and systemic circulations. This happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood flow, and increased portal venous blood inflow. The 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, definitive 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 disease. New aspects in epidemiology, pathogenesis, and treatment of varices are reviewed. Sclerotherapy is the first-line treatment for acute haemorrhage. Prevention of first or recurrent bleeding is still unsatisfactory. β-Blockers are slightly superior to sclerotherapy with regard to prophylaxis of first 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 efficacy of prophylactic measures.

Endoscopic Therapy for Esophageal Varices:

Among therapeutic endoscopic options for Esophageal varices (EV), endoscopic variceal ligation (EVL) has proven more effectiveness and safety compared with endoscopic sclerotherapy and 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 A meta‐analysis of endoscopic variceal ligation for primary prophylaxis of Esophageal variceal bleeding: Despite publication of several randomized trials of prophylactic variceal ligation, the effect on bleeding‐related outcomes is unclear. We performed a meta‐analysis of the trials, as identified 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 first 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 first variceal bleed was 0.48 (0.24‐0.96), with NNT of 13; however, there was no effect on either bleed‐related mortality (relative risk [RR], 0.61; confidence interval [CI], 0.20‐1.88) or all‐cause mortality (RR, 0.95; CI, 0.56‐1.62).

Conclusion:

Compared with untreated controls, prophylactic ligation reduces the risks of variceal bleeding and mortality. Compared with β‐blockers, ligation reduces the risk for first variceal bleed but has no effect on mortality. Prophylactic ligation should be considered for patients with large Esophageal varices who cannot tolerate β‐blockers. Subsequent research should further compare ligation and β‐blockers to determine the effect on mortality, and measure ligation's cost‐effectiveness.

Biography:

Kruchinina Margarita Vitalievna has completed her Doctor of Medicine degree from Institute of Internal Medicine SB RAMS, Novosibirsk, Since 2009 to the present time she is leading researcher of Research Institutе of Internal and Preventive Medicine – Branch of Federal State Budget Scientific Institution. The Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia. Kruchinina Margarita Vitalievna is the author of more than 120 publications, including 1 monograph, 5 teaching aids, 8 patents. Areas of scientific interests are gastrointestinal cancer, metabolomics, microcirculation, rheology, membrane disorders in endocrinological, cerebrovascular, cardiovascular pathology, diagnosis of diffuse liver pathology.

Abstract:

Aim:

The aim of the study was to investigate the perturbation of fatty acids (FA) of erythrocyte (RBC) phospholipid membrane and blood serum (BS) in order to find biomarkers which could be used for early screening, determination of progression. The CRC patients (63,2+9,4 years old) included 45 patients with early stage (TNM staging I-II), 55 with late stage (III-IV) and different tumor locations. RBC membrane and BS FA percentages were measured using GC/MS system triple quad Agilent 7000B (USA). A total of 21 differentially expressed FA in RBC membrane and BS were identified. Each FA class demonstrated specific changing trends in CRC progression (down-regulation in SFA, MUSA; up-regulation in PUFA during cancer progression).

Panel 1 containing FA of RBC and BS: C20:2, C20:3, С20:4, С22:4, С22:5, С22:6 - achieved high diagnostic accuracy (0,79) with AUC of 0.86 (sens.0.78, specif.0.87) for differentiating early stage patients from healthy, which was better than the carcinoembryonic antigen biomarker.

The model 2, including С18:1, С20:2, С20:3, С20:4, С22:4, С22:5, С22:6 - showed the best predictive power when comparing the early and  late CRC stages (AUC 0.80, RR11.63).

The model 3 (FA of RBC - С14:0, С16:0, С16:1, С18:1, С20:3, С20:4, С22:4, С22:5, С22:6) allowed us to determine the presence of metastases (AUC0.83, OR=2.29). Probably, FA modifications are essential for correct signaling, including Hh and Wnt pathways, so perturbation of FA are closely associated with carcinogenesis. Created diagnostic panels, including FA of RBS and BS, should be considered promising for screening, early diagnosis, detection of CRC progression.

Biography:

Carlos Eduardo Rey Chaves, is a Medical doctor, graduated from the Universidad del Rosario, in Bogotá, Colombia. In terms of research, he have more than 10 studies that were presented in Colombia, Argentina, and USA and working in Hospital Universitario Mayor Mederi in hepatopancreatobilliary surgery.

Abstract:

Infected pancreatic necrosis as a serious complication of an acute pancreatitis, its a pathology with high rates of mortality and morbility, however, the laparoscopic approach and minimally invasive managements shows an improvement in the results of the managment of this patients. In latinamerica, we don´t have any research, that describes our population, for that reason, we cant tell epidemiologic data of this patology in our country.

Aim:

The first aim of our study, its to describe our experience in the surgical management of the infected pancreatic necrosis, in the period of time between 2014 to 2019. We search in the database of the general surgery service, all the patients with pancreatitis and infected pancreatic necrosis, that undergo surgical drenaige, we use a cuantitative approach, retrospective, in between 2014-2019. We have 320 patients with pancreatitis, and 30 patients with infected pancreatic necrosis (9.3% of incidence vs 10-15% compared with world literature), our mean age was 57 years, 70% of our patients were men. The open approach was 83%, with a high mortality rate with 43%. We observe, in terms of postoperative organ failure, an improvement with the laparoscopic approach (20% vs 4% with open approach).

Conclusion:

We conclude that infected pancreatic necrosis, its still a surgical challenge, however, the laparscopic approach shows incredible results in terms of mortality, total hospital stay, ICU stay, and mortality vs open approach. In our study, we observe, a possible use of procalcitonin as a biomarker to predict mortality in those patients, but, more prospective studies are necessary.

Biography:

Had  undergraduate education from the prestigious Cairo University, Egypt. Secured the highest mark in M.B.B.ch, MSc, and Doctorate degree in Internal Medicine. Working as Professor in Internal Medicine and Hepato- Gastroentrology unit at Faculty of Medicine, Cairo University. Editor on Chief of Clinical Nutrition II and Applied nutrition Books. Had a lot of national and international publications in Non-Alcoholic Fatty liver disease.Vice- President of the Egyptian fellowship of clinical nutrition. Board Member of the Egyptian fellowship of internal medicine & Arab diploma of Ultrasonography.Attended obesity diagnosis and treatment training program in Lyon, France. Life member of many hepatology  socities.

Abstract:

The ancient Egyptians were black Africans, displaced by later movements of peoples, for example the Macedonian, Roman and Arab. Arab invasion, do not seem to account more than15% of modern Egyptians. Because the epidemiology and demographic characteristics of NAFLD vary worldwide, we aimed to identify the risk factors of NAFLD among Egyptians. We had conducted a lot of researches regarding genetic polymorphism of the following: TNF-∂ G238A, PNPLA3, PPAR-gamma, Resistein  & Adiponectin receptors gene liver expression. Also we had worked on insulin resistance in non-diabetic patients with NAFLD, Total lipid profile, conjugated linolenic acid (omega 6), and intestinal microbiota. Our results showed that; Egyptian with different grads of NAFLD identified by NAS score in liver biopsy had significant TNF-∂ G238A, PNPLA3 polymorphism, and Resistein receptors gene liver expression in NASH patients.

In Egypt a high BMI and insulin resistance level in non-diabetic patients with NAFLD, and NASH even highest worldwide. Triglycerides was significantly high, HDL-c  was  low  in NASH patients, and we had low level of conjugated linolenic acid in NAFLD patients getting more worse with the severity of the disease. CD163, and LPS were significantly higher in patients with NASH prove the relation of intestinal dyspiosis and NASH. Egyptians had many genetic polymorphism related to NAFLD incidence and disease severity, in Egyptian obesity, and highest insulin resistance as main risk factors for NAFLD even in non-diabetics, and deficient conjugated linolenic acid had a role in  NASH progression, also modification of intestinal microbiota is a must to improve NAFLD.

Biography:

Dr.Vikash completed his master’s in surgery in the year 2015 and worked as a senior resident in the department of surgical gastroenterology. He is currently pursuing his diplomate in surgical gastroenterology in a tertiary care centre with very high-volume turnover cases in gastric malignancy. His field of interests besides gastroenterology is genomics which made him pursue this academic study.

Abstract:

The prevalence of gastric cancer is high in Asian countries. There is a gross heterogeneity in the clinical outcomes and recurrence patterns due to varied molecular mechanisms driving differences in cancer aggressiveness and treatment outcomes. The developments in next generation sequencing platforms has enabled the genome-scale identification of molecular dysregulations and the possible genomics-guided stratification of tumors for prognosis and eventually targeted therapeutics.

Our aim was to stratify gastric tumours into novel genomic subtypes based on the differential activation of 21 oncogenic signalling pathways and look for its association with histological characteristics and clinical outcomes.

Patients who underwent surgery at Meenakshi Mission Hospital, tumour bits were sent to genetics lab and Genome-wide expression profiling was performed. The tumor samples were then subtyped into eight different groups based on oncogenic signaling pathways. The histopathological features of the samples, intraoperative details were collected along with follow up data for a period of 1 year.

On analysis of these 21 oncogenic signalling pathways, the gastric cancer from 52 gastrectomy samples in south Indian could be subdivided into eight different subtypes. The mortality (V-0.85% & VII -0.88%) and rate of metastasis (0.9% & 0.77%) has been high in genomic subtypes V and VII (p value <0.001 and 0.002 respectively). The local infiltration rate observed intraoperatively was high for the genomic subtype II (0.72%) (p value – 0.002).

Numerous whole-genome profiles decoding the landscape of molecular determinants of gastric tumors have been established from Japan, South Korea, and China. However, such larger profiles of gastric tumors are largely lacking from India. In this study, we profiled 50 gastric tumors from a south Indian cohort, and they were analyzed for any possible clinical correlation.

Biography:

Andrea B. Uy has completed her medical degree at the University of the East Ramon Magsaysay Memorial Medical Center, Inc. She took her post-graduate internship and  subsequent Pediatric Residency Training at the Manila Doctors Hospital.

Abstract:

In a retrospective review of Pediatric patients who were diagnosed with ROME III defined-Functional Gastrointestinal Disorders, the most common diagnosis was Functional Abdominal Pain in 45%. Irritable bowel syndrome is the most encountered sub-type of abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence. This study aims to assess the effect of Lactobacillus reuteri DSM 17938 in functional abdominal pain diagnosed based on Rome Criteria III in children aged 4 to 16 years old through a meta-analysis of Randomized Control Trials (RCTs) utilizing Lactobacillus reuteri DSM 17938 in Functional Abdominal Pain based on ROME Criteria III.

Electronic databases were searched. Qualified studies were reviewed through Revman 5.3. For continuous variables, the data were expressed as a mean difference (MD) or as a standardized mean difference (SMD) at 95% Confidence Intervals. In case of heterogeneity, random effects model was used. The primary outcomes of intensity of abdominal pain was assessed by using the Wong–Baker Faces scale while frequency was monitored through a diary done by either the patient or the parent. Lactobacillus reuteri at 2 x10^8 CFU shows significant reduction in the intensity of pain in 4 weeks. However, overall assessment of frequency of abdominal pain showed no significant difference in 4 weeks. Lactobacillus reuteri DSM 17938 can significantly decrease the intensity of Functional Abdominal Pain at 2 x 10^8 CFU in 4 weeks.

Biography:

I got my PhD in Pharmaceutical Sciences (Pharmacology and Toxicology speciality) from faculty of Pharmacy Cairo University in May 2019. Now, I’m an assistant professor at Pharmacy Practice and Clinical Pharmacy Department, at Misr International University (MIU). This abstract, is from my PhD thesis, that was published in Scientific Reports journal, Nature publisher.

Abstract:

Circulating microRNAs (miRNAs) play a role in modulating the prevalence of fibrosis and have been a target of the cardiac anti-fibrotic effect of carvedilol. However, the impact of miRNAs on the hepatoprotective effect of this non-selective β-blocker has not been yet elucidated. Hence, the current goal is to evaluate the potential role of circulating miR-200a in the hepatic anti-fibrotic pathway of carvedilol. Male Wistar rats were randomized into normal, CCl4 (2 ml/kg, i. P, twice weekly for 8 weeks), and CCl4+Carvedilol (10mg/kg, p. O, daily). Carvedilol over-expressed the circulating miR-200a to modulate epithelial mesenchymal transition (EMT) markers (vimentin, ECadherin).

In turn, carvedilol increased SMAD7 gene expression and protein content to attenuate the pro-fibro genic marker transforming growth factor β1 (TGF-β1) and the inflammatory markers (p-38 MAPK and p-S536-NF-κB p65). The anti-fibrotic potential was reflected on the decreased expression of the mesenchymal product and EMT marker α-SMA, besides the improved histopathological examination, and the fibrosis scores/collagen quantification to enhance liver functions (AST, ALT, ALP, and AST/ platelet ratio index; APRI). In conclusion, circulating miR200a/SMAD7/ TGF-β1/EMT/ MAPK axis is crucial in the hepatic anti-fibrotic mechanism of carvedilol.

Biography:

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Abstract:

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Biography:

Eleazar Suguitan has completed his medical degree at FEU - Dr. Nicanor Reyes Medical Foundation and is currently the chief resident of World Citi Medical Center, Department of Internal Medicine. He has previously presented a poster in an international Rheumatology conference.

Abstract:

Distorted liver architecture and regenerative nodules are histologic hallmarks of liver cirrhosis. A variety of risk factors have been associated with development of cirrhosis, but cryptogenic cases are still reported. A 22-year-old Filipina was admitted in our institution due two episodes of hematemesis with no other associated signs and symptoms. Patient is a never-drinker and had no previous hepatitis infection. Splenomegaly and mild thrombocytopenia were noted on admission. Endoscopically, Grade IV esophageal varices, with signs of recent hemorrhages were noted, and rubber band ligation was done. Liver elastography was consistent with cirrhosis.

ANA screening was non-reactive, but KRT18 was positive. Epidemiology of cryptogenic cirrhosis in young adults is approximately 10%, like that of adult population. However, keratin gene mutation causing cirrhosis is rare, and associations have not been well elucidated. Young adults at early stages of cirrhosis are clinically asymptomatic and liver architecture is minimally destroyed. Complications leading to major morbidity in cirrhosis are hepatic encephalopathy, spontaneous bacterial peritonitis, esophageal variceal bleeding, and ascites in increasing frequency. Thus, we report this case due to the rarity of keratin gene mutation related cryptogenic liver cirrhosis in young adults.