Video capsule endoscopy: Initial experience from a tertiary care center in Sri Lanka

Background: Since its global introduction in 2000, capsule endoscopy (CE) has revolutionized the evaluation of small bowel disease. Aims and Objective: The aim of this study was to share our experience with CE including the findings and its diagnostic yield. Materials and Methods: A retrospective study was carried out at Colombo South Teaching Hospital of Sri Lanka. Data of patients who underwent CE from its initiation in 2017 until June 2020 were obtained from the hospital computer database. These included the patient demographics, indications for the study, quality of bowel preparation, and its findings. Results: The study included 54 patients with a mean age of 55 years. Mean gastric time and small bowel transit time were 52 and 272 min, respectively. Forty-five CE studies were done for the evaluation of small bowel bleeding and an abnormal study was found in 26 (57.78%) patients. Small intestinal ulcers and erosions were the most frequently found abnormality (n=16, 35.56%) followed by tumors (n=5, 11.11%). Active bleeding was evident in 14 (31.11%) patients. Overall diagnostic yield was higher in those with a history of overt bleeding (n=15, 71.43%) compared to occult bleeding (n=11, 45.83%). Most patients who were evaluated for abdominal pain and diarrhea had normal CE except for two who had small intestinal ulcers and subepithelial lesions. Only one case was complicated with capsule retention. Conclusion: CE is a useful investigation for the evaluation of small bowel disease, particularly in suspected small bowel bleeding. In contrast to western population, ulcers and erosions were the more frequently found abnormalities seen in local setting.

Intestinal ulcers in a patient with myelodysplastic syndrome: a case report

Background Trisomy 8 positivity myelodysplastic syndrome with Behçet's disease is rare. Isolated trisomy 8 is a frequent cytogenetic abnormality in the MDS, but the characteristic of trisomy 8 and the association between trisomy 8 positivity myelodysplastic syndrome and Behçet's disease is unclear. Case presentation Here, we reported a 63‐year‐old man, who presented with fever, abdominal pain and hematochezia. Imaging studies revealed bowel wall thickening and mural hyperenhancement of terminal ileum and cecum. Colonoscopy found multiple round ulcers in terminal ileum, ileocecal valve and multiple yellow dotted pseudomembranous attachments throughout the colon. Capsule endoscopy also revealed multiple irregular ulcers in lower ileum. Serum C-reactive protein levels and fecal calprotectin were abnormally high. The clostridium difficile toxin A and B was positive. However, the patient's intestinal ulcers did not resolve after two weeks course of vancomycin. Considered that the patient was diagnosed as MDS-RAEB2 with a karyotype of 47 XX, + 8. And detailed inquiry of medical history revealed epifolliculitis and frequently recurrent oral ulcers 2 months before admission. A diagnosis of trisomy 8 positivity MDS with BD was made. Then he received glucocorticoid along with the 5th course of azacytidine. The follow-up endoscopy showed significantly improved intestinal ulcer 2 months after treatment. we report a rare disease and provide the diagnose and treatment ideas. Conclusions We highlight the challenges and the process of thinking about of the diagnosis. This may provide a new idea for the diagnosis of intestinal ulcers.

DEVELOPMENT AND VALIDATION OF ANALYTICAL METHOD FOR SIMULTANEOUS ESTIMATION OF CLIDINIUM BROMIDE, RABEPRAZOLE, CHLORDIAZEPOXIDE AND DICYCLOMINE HYDROCHLORIDE

Clidinium bromide, rabeprazole sodium, chlordiazepoxide and dicyclomine hydrochloride(COLIWIN-R) drug combinations are used for the treatment of gastric acidity, anxiety, intestinal ulcers, abdominal cramps, irritable bowel syndrome and abdominal pain. A high performance liquid chromatographic method has been developed and validated for the simultaneous determination of clidinium bromide, rabeprazole sodium, chlordiazepoxide and dicyclomine hydrochloride in capsules dosage forms using WATERS C18 column (50 mm × 4.6 mm, 5 µm) with mobile phase consisting of methanol, acetonitrile and phosphate buffer 40:30:30 (V/V) (0.05M, pH 4.0 adjusting with 0.5% ortho phosphoric acid) at a flow rate of 1.0 mL/ min monitoring the effluents at 220 nm. The retention times of clidinium bromide, rabeprazole sodium, chlordiazepoxide and dicyclomine hydrochloride in capsule formulation were found to be 2.9 min, 3.5 min, 4.7 min, and 8.0 min, respectively. The method was validated according to the ICH guidelines for specificity, LOD, LOQ, precision, accuracy, linearity, ruggedness and robustness. The method show good reproducibility and recovery with % RSD less than 2. The proposed method was found to be simple, specific, precise, accurate and linear. Hence, it can be applied for routine analysis of clidinium bromide, rabeprazole sodium, chlordiazepoxide and dicyclomine hydrochloride in pharmaceutical combined dosage forms.

Mortality from malignant neoplasms of the digestive system in the cities of the Chelyabinsk region affected by radiation accidents

Introduction. Due to the long-term radioactive contamination of a part of the territory of the Chelyabinsk region, much attention is paid to the analysis of the health status of the population. One of the adverse effects of radiation is the occurrence of neoplasms. The highest doses of radiation as a result of many emergencies were received by the digestive organs. Material and methods. The study of adult mortality in the cities Kasli and Kyshtym over 50 years from 1947 to 1996. The following age groups were studied: 20-29, 30-39, 40-49, 50-59, 60-69, 70 years, and older. Results. An increase in the mortality rate from malignant neoplasms of the esophagus, stomach, intestines, and other digestive organs in the adult population over 50 years was found. The growth of indices has been observed since 1952. The maximum mortality values from esophageal and gastric ulcers were recorded from 1962 to 1971, from intestinal ulcers from 1972 to 1981. Several waves of increasing mortality were recorded: in the early 50s, after 1957, after 1967, in the late 70’s - early 80‘s of the XX century. The increase in mortality from malignant neoplasms of the digestive organs of all localities in the studied cities among women and people of the elderly (60-69 yrs) and (70 yrs and older) age, as a rule, began five years earlier. Among the population under 50 years of age, differences in cancer mortality from control values were poorly expressed. Conclusion. Mortality rates from malignant neoplasms of the esophagus, stomach, intestines, and other unspecified digestive organs in the adult population, especially in the ages of 50-59, 60-69, and 70 and older, in the cities of Kasli and Kyshtym in some periods significantly exceed the control values.

The Detective Value of Magnetically Controlled Robotic Capsule Endoscopy in Patients With Suspected Small Intestinal Disease

Objective: To explore the detective value of magnetically controlled robotic capsule endoscopy (MCRCE) in patients with suspected small intestinal disease.Patients and Methods: In total, 1,802 patients with suspected small intestinal disease and negative gastroenteroscopy from Shanghai Jiao Tong University Affiliated Sixth People's Hospital were examined with MCRCE, and the data were collected for further analysis.Results: Among the 1,802 patients who were examined with MCRCE, 974 were diagnosed with small intestinal disease, reaching a positive detection rate of 54.1%. The five most common conditions that were detected include non-specific enteritis in 722 cases (40.1%), small intestinal ulcers in 87 cases (4.8%), abnormal small bowel evacuation in 45 cases (2.5%), small intestinal bleeding in 33 cases (1.8%), and small intestinal yellow spots in 31 cases (1.7%). The running time of the capsules in the small intestine ranged from 85–437 min, with an average of 210.24 ± 89.08 min. No complications, such as intestinal obstruction or capsule retention, were observed in all patients.Conclusion: MCRCE is a safe and non-invasive endoscopic examination with a highly accurate detection rate for small intestinal diseases.

Clinical Features of Intestinal Ulcers Complicated by Epstein-Barr Virus Infection: Importance of Active Infection

Clinical characteristics of intestinal ulcers complicated with Epstein-Barr virus (EBV) infection remain poorly studied. This study is aimed at providing further insight into clinical features of this patient cohort. The presence of serum EBV DNA was assessed in 399 patients with colonic ulcers, of which 30 cases were positive. In EBV-positive patients, the EBV-encoded RNA (EBER) was detected in intestinal tissues of 13 patients (EBER-positive group). The test was negative in 17 patients (EBER-negative group). Acute EBV infection rate in patients with colonic ulcer was 7.52%. Age and sex differences between two groups were not statistically significant. Fever, abdominal lymph node enlargement, and crater-like gouged ulcer morphology were more common in the EBER-positive group ( P < 0.05 ). The albumin level in the EBER-positive group was significantly lower compared to that in the EBER-negative group ( P < 0.05 ). The copy count of EBV DNA in the blood of patients from the EBER-positive group was higher, and the prognosis was worse ( P < 0.05 ). Clinical manifestations were more severe in the EBER-positive group. Endoscopic, histopathological, and biochemical findings were also more serious in this group of patients. The findings point to the importance of assessing the EBER expression in patients with intestinal ulcers of various etiology. EBER positivity should be viewed as a diagnostic marker of more severe condition requiring more aggressive treatment.

Effect of Yttrium-90 transarterial radioembolization in patients with non-surgical hepatocellular carcinoma: A systematic review and meta-analysis

Background Recently, the use of Yttrium-90 transarterial radioembolization in non-surgical hepatocellular carcinoma was suggested but the evidence supporting its use is unclear. Methods We searched Medline, Embase, Web of Science and Cochrane CENTRAL from inception up to April 14, 2020 for randomized controlled trials comparing Y90-TARE to standard of care in non-surgical HCC patients. Our primary outcome was overall survival (OS). Our secondary outcomes were progression-free survival, time to progression, disease control rate, grade ≥3 adverse events and rates of gastro-intestinal ulcers. Hazard ratios (HR) and risk ratios (RR) with random-effects model were used for our analyses. The risk of bias of the included studies was assessed using Cochrane’s RoB 2 tool. Results Of 1,604 citations identified, eight studies (1,439 patients) were included in our analysis. No improvement in overall survival were noted when Yttrium-90 transarterial radioembolization was compared to standard treatments (HR 0.99 [95% CI 0.81–1.21], 6 studies, I2 = 77.6%). However, Yttrium-90 transarterial radioembolization was associated with fewer grade ≥3 adverse events (RR 0.64 [95% CI 0.45–0.92], 7 studies, I2 = 66%). No difference was observed on other secondary outcomes. Discussion In non-surgical HCC patients, Yttrium-90 transarterial radioembolization was not associated with significant effect on survival, progression-free survival, time to progression, disease control rate and the incidence of gastro-intestinal ulcers but was however associated with significantly lower rates of grade ≥3 adverse events. Further randomized controlled trials are warranted to better delineate optimal treatment.