Preoperative esophagogastroduodenoscopy findings and effects on laparoscopic Roux-en-Y gastric bypass in area with high prevalence of Helicobacter pylori infection: multi-center experience in Iran.

Aim: The current study aimed to evaluate EGD findings effects on laparoscopic Roux-en-Y gastric bypass (RYGB) plan and time in areas with a high prevalence of Helicobacter pylori infection. Background: Esophagogastroduodenoscopy (EGD) and Helicobacter pylori testing are routine parts of preoperative assessment of bariatric surgery at many centers. Methods: This was a crosssectional study of all patients underwent EGD and histopathological examination before laparoscopic RYGB in three gastroenterology centers in Iran between January 2018 and December 2020. Results: In total, 637 patients (52.4% female) were enrolled, of which 46.8% had no abnormal mucosal appearance. In 1.7%, surgery was canceled (gastric adenocarcinoma, gastric intestinal metaplasia, GIST, and esophageal varices). The prevalence of H. pylori was 61.5%, and there was no statistical difference between groups of normal and abnormal EGD; however, surgery was postponed after H. pylori eradication in both groups. Overall, 44.4% of patients with esophagitis (any grade), peptic ulcer disease, erosive and non-erosive gastritis/duodenitis, and short segment Barret's esophagus needed medical management. Small- or medium-sized sliding hiatal hernias were seen in 18.7% of patients with no effect on surgery. Moreover, 88.8% of patients with normal mucosal appearance were asymptomatic, but 92.6% in the group with abnormal EGD were symptomatic (p=0.01). Changes in surgical plan and time occurred in 63.6%, but after eliminating H. pylori eradication, it was 15.4%. Conclusion: Considering gastric cancer and the high prevalence of H. pylori in Iran, using EGD and histopathological examination as an investigation in the preoperative assessment would have a significant impact on patients undergoing RYGB surgery.

Gastric Kaposi sarcoma presenting as an upper gastrointestinal bleeding in a non-AIDS patient.

BACKGROUND: Majority of the patients affected by Kaposi sarcoma (KS) have human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART) lessened the incidence of AIDS (acquired immunodeficiency syndrome)- related KS. Cutaneous signs are the most common, but involving the gastrointestinal (GI) tract is very important and dangerous because of serious complications including perforation and bleeding. CASE PRESENTATION: This report is a rare case of gastric-KS presenting as melena in a non-AIDS 67-year-old woman. We describe the diagnosis and management of this rare complication. CONCLUSION: GI-KS is often asymptomatic with different endoscopic appearances, and maybe present without cutaneous lesions. Thus, a high diagnostic suspicion is needed and we should attend these GI complications.

Comparing the Effect of Two Low-dose and High-dose Four-drug Regimens of Furazolidone in Eradicating Helicobacter Pylori.

BACKGROUND Antibiotic resistance is a major cause of Helicobacter pylori (H. pylori ) treatment failures. The increased resistance to clarithromycin and metronidazole has reduced the ability of this therapeutic regimen and prompted researchers to look for other drugs. One of the antibiotics of interest in this regard is furazolidone because of its low drug resistance. The aim of this study is compare two-drug regimens including low-dose and high-dose furazolidone in the treatment of H. pylori. METHODS This study is a clinical trial in which the studied subjects were categorized into two groups. The first group underwent treatment with amoxicillin 1000 mg-BD, furazolidone 100 mg-BD, omeprazole 20 mg-BD, and bismuth subcitrate 240 mg-BD for two weeks (low-dose OFAB). The second group received furazolidone 200 mg-BD (high-dose OFAB). Then eight weeks after completion of the treatment, they were examined in terms of eradication via the UBT test. RESULTS 85 participants completed the study in each group. The response to treatment was 76% and 83% in the low and high-dose groups, respectively, based on intention to treat analysis. Based on per protocol analysis the response to treatment was 78% and 84%, respectively, if excluded patients had completed their protocol and had response to treatment, and 72% and 79%, respectively, if excluded patients had completed their protocol and did not have response to treatment (p = 0.298). In the low-dose and high-dose groups, 16.5% and 24.7% of the participants suffered the complications of treatment with furazolidone (p = 0.18), respectively. Three patients in the high-dose group and one in the low-dose group did not complete the treatment because of the medication's bad taste (p = 0.03). CONCLUSION Low doses of furazolidone had a comparable therapeutic effect compared with high doses, but patients experienced significantly lower levels of bad taste, which was a major cause of reluctance to continue treatment. Therefore, we think four-drug low-dose furazolidone treatment is a good choice in eradicating H. pylori.

Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran.

AIM: The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars. BACKGROUND: Bezoars are compact masses formed by the accumulation of dietary fiber, undigested food, hair, or medications. The majority of bezoars are asymptomatic, but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction, or perforation. METHODS: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15,830 endoscopy records (0.68%). RESULTS: A total of 103 patients (52.4% male) were enrolled in this study. Mean patient age was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2%), diabetes mellitus (21.3%), hypothyroidism (15.5%), trichophagia (5.8%), and anxiety disorders (2.9%), respectively. The most common endoscopic findings were peptic ulcers (34.9%), erosive gastritis/duodenitis (12.6%), and reflux esophagitis (10.6%). While bezoars were most commonly observed in the stomach (84.4%), the majority of them were phytobezoars (92.2%). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4%. CONCLUSION: The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications.

Levofloxacin-containing triple therapy versus bismuth-based quadruple therapy as regimens for second line anti- Helicobacter pylori.

BACKGROUND: Although the prevalence of Helicobacter pylori infection decreased following the hygiene promotion and application of proper anti- H.pylori treatments, unfortunately gradual increase is reported in treatment failure; hence, application of a proper treatment regimen as a second-line therapy is of great importance. METHODS: In the current randomized, clinical trial, a total of 120 patients with peptic ulcers who failed to respond to treatment were enrolled. In the OLA group, a regimen of omeprazole 40 mg/day, levofloxacin 1 g/day, and amoxicillin 2 g/ day was prescribed; however, a regimen of omeprazole 40 mg/day, bismuth sub-citrate 480 mg/day, furazolidone 400 mg/day, and amoxicillin 2 g/day was administered to the OFAB group. Both groups were treated for 2 weeks, and 6 weeks after the treatment, the urea breath test (UBT) was performed in the subjects. Collected data were analyzed with SPSS Version 18. At the end, 58 patients in group OLA and 57 patients in the OFAB group were analyzed. RESULTS: According to the results of the current study, 96.7% of the subjects in the OLA and 95% in the OFAB groups completed the treatment course and the eradication rates were 86.7% and 78.3% in the OLA and OFAB groups, respectively (P=0.23). Treatment side effects were observed in 51.7% and 11.7% of the subjects in the OLA and OFAB groups, respectively (P<0.01). CONCLUSION: Both regimens were applicable as the second-line therapy due to insignificant difference between the results of the 2 groups; however, OLA regimen was superior to OFAB, due to lower side effects.

Hem-o-Lok Clip in the First Part of Duodenum after Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) and common bile duct exploration (LCBDE) have become the standard surgical procedure for cholecystolithiasis and choledocholithiasis. During the operation, cystic duct and vessels are usually controlled by Hem-o-Lok clips. We report a case with a complaint of severe abdominal pain for the previous 20 days. Her medical history was unremarkable except for laparoscopic cholecystectomy 8 months ago. In upper gastrointestinal endoscopy, two Hem-o-Lok clips at anterior wall of the first part of duodenum were detected. Therefore, the clip can migrate during postoperative period and Hem-o-Lok is not a very safe ligation method during laparoscopic cholecystectomy.