Open Journal of Gastroenterology and Hepatology <p>ISSN:2637-4986<br>DOI:10.28933/OJGH</p> eSciPub LLC en-US Open Journal of Gastroenterology and Hepatology 2637-4986 POST-VAGOTOMY GASTROPARESIS – A CASE REPORT <p>We present Mr M.A. a 27 year old Nigerian of the Yoruba tribe who has been having recurrent dyspeptic symptoms for 5 years but not previously endoscopically evaluated for peptic ulcer disease who now presented with six days history of abdominal pain which was initially epigastric but later became generalized associated with four episodes of vomiting and a day history of abdominal distension and fever. He was acutely ill-looking and dehydrated. The Abdomen was moderately distended, does not move with respiration, generalized tenderness with guarding and rebound tenderness, intra-abdominal organs were difficult to palpate due to the guarding. Bowel sound was absent. Examination of the other systems was not remarkable. A provisional diagnosis of Generalized peritonitis likely secondary to perforated peptic ulcer was made. He had an emergency exploratory laparotomy under general anaesthesia. He was commenced on intravenous fluids and parenteral proton pump inhibitor(PPI) and antibiotics. Intra-op findings include 2 liters of bilious peritoneal fluid, Multiple fibrous adhesions, a 2.5cm x 2cm gastric perforation at the anterior wall of the antrum and a grossly normal bowel. The surgical operation performed was a Graham Omental patch closure of the gastric defect with Bilateral Truncal Vagotomy and Peritoneal lavage. Post-operative state was satisfactory and he was later discharged. He presented at the gastroenterology out-patient clinic eight months later with complaints of early satiety, feeling of indigestion and episodes of vomiting. Vomitus is usually offensive / foul smelling and contains undigested or partially digested stale food substances. Abdominal examination revealed a positive succussion splash. Other clinical examination findings were not remarkable. A Provisional Diagnosis of suspected Gastric outlet obstruction probably secondary to a chronic duodenal ulcer was made. Endoscopy findings revealed copious fluid and food debris in the stomach cavity which had an offensive smell with remnants of partially digested stale food substances seen. There was poor peristaltic activity and the stomach was poorly distensible. There were multiple areas of mucosa erosions seen in the gastric cardia and corpus. No corporal or antral lesion seen. The pyloric ring was normal and the duodenum was normal. Diagnosis- (1) Endoscopic features of Gastroparesis likely secondary to previous Bilateral Truncal Vagotomy. No evidence of mechanical obstruction of the Gastric outlet. (2) Gastric Cardia and Corporal mucosa lesions likely secondary to Stasis Gastritis. Histology of biopsy specimens showed acute on chronic non-specific gastritis and acute duodenitis. He was commenced on empirical first line Helicobacter pylori eradication triple therapy (PPI, Amoxycillin and Clarithromycin) and a prokinetic drug (Domperidone). He had made significant clinical improvement with resolution of the symptoms by the time he was seen in the clinic three weeks later. He was tolerating oral food intake adequately and he had no new complaints. He was counselled on dietary modification and placed on long term prokinetic agent (Domperidone) and long-term PPI therapy with regular clinic follow-up. The initial management of post-vagotomy gastroparesis should be conservative as many symptoms resolve with time, this occurs possibly because the enteric nervous system is able to adapt to the loss of vagal input. Modification of dietary habits, such as regular intake of small meals, and use of prokinetic drugs bring about symptomatic relief in most patients.</p> Oguntoye Oluwatosin Oluwagbenga1, Yusuf Musah1, Olowoyo Paul1, Erinomo Olagoke2, Omoseebi Oladipo2, Soje Michael Osisiogu1,Oguntoye Oluwafunmilayo Adenike3, Fatudimu Oluwafemi4 Copyright (c) 2020-04-01 2020-04-01 3 2 33 33 10.28933/ojgh-2020-02-2306 EPIPHRENIC OESOPHAGEAL DIVERTICULUM – A CASE REPORT <p>Epiphrenic oesophageal diverticulum is rare world-wide and account for less than 10% of all oesophageal diverticula. We present Mrs O.E. a 64-year old Nigerian of the Yoruba tribe who presented with early satiety and upper abdominal discomfort of five months duration. The early satiety was of insidious onset and had been progressive. This initially made her to reduce the size of her meal intake but eventually progressively led her to taking just a meal per day. This is in contrast with her premorbid intake of three meals per day. She has associated history of regurgitation worse in the recumbent position which she described as containing undigested food. She has no abdominal swelling, odynophagia or dysphagia. No history of haematemesis or melaena. She has weight loss and easy fatigability. The upper abdominal (epigastric) discomfort is characterized as a feeling of peppery, burning sensation which radiates to the back and had no association with meals or with time of the day. It has no relation to posture and said to be worse with consumption of peppery or spicy food substance. Minimally relieved with the use of antacids. No other significant contributory history. Review of systems was also not contributory. Clinical examination was not remarkable. A provisional diagnosis of a suspected Gastric Tumour was made likely a Gastric Lymphoma or Adenocarcinoma to rule out Gastrointestinal Stromal Tumour(GIST). Barium swallow revealed a Distal (Epiphrenic) oesophageal diverticulum. Findings at upper GI Endoscopy include: (1) Distal (Epiphrenic) oesophageal diverticulum (2) Reflux oesophagitis (3) Gastric Atrophy; probably age-related to rule out chronic Helicobacter pylori-infection. Histology revealed Reflux oesophagitis, Mildly active chronic corporeal gastritis with mild atrophy and Chronic non-specific antral gastritis. She was managed conservatively with long term proton pump inhibitor therapy, modification of dietary habits and liberal oral fluid intake with significant clinical improvement and resolution of her symptoms within eight weeks of treatment. She is presently on regular follow-up at our out-patient department. Distal (Epiphrenic) oesophageal diverticulum is rare in our environment. The diagnosis can only be made through radiographic or endoscopic studies. Patients may present with non-specific or dyspeptic symptoms similar to those of acid peptic disorders. In view of this, it is important to carefully evaluate patients with dyspepsia or non-specific upper gastrointestinal symptoms and investigate them in order to ascertain the cause. A delay in the diagnosis and treatment of epiphrenic oesophageal diverticulum may lead to complications which could have been prevented if diagnosed early.</p> Oguntoye Oluwatosin Oluwagbenga1, Yusuf Musah1, Olowoyo Paul1, Erinomo Olagoke2, Omoseebi Oladipo2, Soje Michael Osisiogu1, Oguntoye Oluwafunmilayo Adenike3, Fatudimu Oluwafemi4 Copyright (c) 2020-04-01 2020-04-01 3 2 34 34 10.28933/ojgh-2020-02-2305 UPPER GASTROINTESTINAL ENDOSCOPY IN IDO-EKITI, NIGERIA: A FOUR-YEAR REVIEW <p>Background: Upper gastrointestinal complaints are common, and the underlying diseases varies widely. Upper gastrointestinal endoscopy is the gold standard investigation for upper gastrointestinal symptoms. It helps in the proper diagnosis and the appropriate management of the underlying lesions.</p> <p>Aim: To determine the characteristics of the patients undergoing upper gastrointestinal endoscopy in a rural community in south-western Nigeria.</p> <p>Methods: This was a retrospective cohort study of all patients who had upper gastrointestinal endoscopy between February 2016 and February 2020 (a period of 4 years). The Age, Gender, Indication and the Endoscopy findings were obtained from the Endoscopy Register. A total of 181 upper gastrointestinal endoscopies had been performed over the period. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics used included frequency tables, means and standard deviations.</p> <p>Results: A total number of 181 Oesophagogastroduodenoscopies (OGDs) were performed during the period under review, out of which 95 (52.5%) were males and 86 (47.5%) were females with a male to female ratio of 1.1 to 1. The age range of the patients was 9 to 89 years with a mean(±SD) of 52.4(±1.69) and median of 52.0 years. The highest number of OGDs were performed on individuals within the age bracket of 50-59 years whom were mostly females.</p> <p>Dyspepsia constituted the commonest indication for OGD (51.9%) followed by symptoms of upper gastrointestinal bleeding (haematemesis/melaena) 16.0%, unexplained persistent vomiting 6.6% and clinical suspicion of a gastric tumour 5.5%.</p> <p>The commonest endoscopic abnormality detected from this study was Gastritis 28.2% followed by Gastric erosions 12.2%, Duodenal ulcers 8.8%, Gastric tumours 8.3% and Oesophagitis 7.2%. Normal endoscopy findings were found in 24.9% of the patients. Gastritis was also the commonest endoscopic finding (constituting 40.4%) in patients who had OGD done on account of dyspepsia followed by Duodenal ulcers (8.5%) and Gastric erosions (6.4%). Gastric erosions constituted the commonest cause of upper gastrointestinal bleeding in this study (44.8%) followed by Duodenal ulcers (13.8%).</p> <p>Conclusion: The commonest indication for upper gastrointestinal endoscopy in this study was dyspepsia while the commonest endoscopic diagnosis was gastritis. Gastric erosion was most commonly seen in patients with upper gastrointestinal bleeding. From this study, Acid-Peptic disorders were the commonest underlying gastrointestinal pathologies of patients’ symptomatology necessitating endoscopic evaluation. The findings from this study conducted in a rural community in Nigeria were similar to those conducted in urban communities in the country. Therefore, a national guideline on the endoscopic evaluation of upper gastrointestinal disorders can be universally applied irrespective of the location of practice in Nigeria.</p> Oguntoye Oluwatosin Oluwagbenga1, Yusuf Musah1, Olowoyo Paul1, Erinomo Olagoke2, Omoseebi Oladipo2, Soje Michael Osisiogu1, Oguntoye Oluwafunmilayo Adenike3, Oguntade Hameed Banjo3, Ariyo Olumuyiwa Elijah3, Atolani Segun Alex3 Copyright (c) 2020-04-28 2020-04-28 3 2 35 35 10.28933/ojgh-2020-04-0905 Polypoid Collagenous Colitis: A Microscopic Colitis with a Macroscopic Appearance <p>Collagenous colitis is a type of microscopic colitis which was originally named based on specific histologic features and the lack of macroscopic abnormalities in the colon. However, there are reports in the literature that describe various macroscopic findings on colonoscopy in patients with histologically confirmed microscopic colitis. We report a case of collagenous colitis that was characterized by a diffusely polypoid colonic mucosa on gross examination of a right hemicolectomy specimen that was performed for a benign neoplasm in a 72 year old man. It is important for endoscopists to be aware of the various macroscopic abnormalities that may be present in this “microscopic” disease.</p> David Gay, MD1, Darcy Broughel-Baer, DO2, Rachel Hudacko, MD3 Copyright (c) 2020-05-18 2020-05-18 3 2 36 36 10.28933/ojgh-2020-04-2805​ Clinical Picture of Celiac disease: Experience from a health care provider in Arabia <p>Background: Most studies describing clinical features and associations of celiac disease come from the studies conducted in the western world. Our aim was to determine the clinical features and associations of Celiac disease from our centre serving a Middle East population in Saudi Arabia.</p> <p>Methods: This retrospective study was conducted in a health care provider serving the Eastern Province of Saudi Arabia. All patients with biopsy-confirmed celiac disease receiving health care at our centre between April 2002 and December 2018 were identified. Individual case records were reviewed. In addition, the Slicer Dicer function was also used from the Electronic medical health record [EPIC] for analysing the clinical features and associations.</p> <p>Results: We analyzed the clinical features of 149 patients with Celiac disease. 66% of these were females. There was progressively increased yield of confirmed Celiac disease over the study period. This was paralleled by an increase in TTG antibody tests performed year by year. 77 (51.6%) patients had gastrointestinal symptoms. 26% of patients had iron deficiency anemia. 24 patients (16%) had diabetes, of which 46% were type 2. 18 (12%) patients had osteoporosis or osteopenia, and 28 (19%) had various skin diseases.</p> <p>Conclusion: In Saudi Arabia, celiac disease is being increasingly recognized, largely because of increased awareness and increasing TTG antibody testing. Many patients present with non-gastrointestinal symptoms. Knowledge about the varied clinical features and the targeted use of celiac serology should lead to even earlier recognition of the disease.</p> Diamond Joy, MD, MSc, FRCP (UK)1, Fuad Y Maufa, MD1, Nassir Al Hayaf, MD1, Martin Diamond2,3, Sayed Z Haji, MD2, Carole A Merriwether4 Copyright (c) 2020-05-25 2020-05-25 3 2 37 37 10.28933/ojgh-2020-05-1305