The Elastic Ligation of Internal Hemorrhoids: Where Are We Now?

Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.

Prevalence of <i>Helicobacter pylori</i>and the Interest of Its Eradication during the Functional Dyspepsia

Functional dyspepsia constitutes by its impact in quality of life and socio-economic impact areal public health problem (40% of the adult population in the Western world). The prevalence of infection with Helicobacter pylori (HP) in patients with functional dyspepsia is about 30% - 70%. The aim of our study is to observe the improvement of functional dyspepsia (FD) after Helicobacter pylori (HP) eradication. Methods: This is a prospective study over a period of 68 months (May 2009 - January 2015). We included all patients aged over 15 years, with functional dyspepsia defined by the Rome III criteria. The diagnosis of HP was made by histology and/or PCR. Patients infected with HP were treated in single-blind: standard triple therapy for 7 days or sequential treatment for 10 days. HP eradication control was made after: 3 months, 6 months and one year of treatment. Results: During the study period, 1190 patients were included of which 250 patients (21%) were in functional dyspepsia according to the Rome III criteria. The average age in patients with functional dyspepsia was 49 years [16 - 80], sex ratio M/F was 0.58 (N = 92/158). 60% of patients were older than 45 years (N = 150). Chronic smoking was found in 20% of patients (N = 50). One hundred and seventy five patients (70%) had HP infection (N = 175). One hundred and sixty five patients received the treatment of Helicobacter pylori (94.28%), 10 patients were lost to follow (5.71%). The eradication of HP was obtained in 98.41% with sequential treatment versus 88.73% with standard triple therapy (p = 0.026). All patients were reviewed at 3 months and 6 months after treatment, 86% were reviewed at 12 months (N = 143). Dyspeptic symptoms was disappeared in 43% of our patients (N = 71) partial disappearance of symptoms in 34.5% of cases (N = 57) persistence of symptoms in 22.42% of cases (N = 37). Conclusion: In our study the prevalence of Helicobacter pylori infection in patients with functional dyspepsia is high: 70%. Sequential therapy is better than the standard triple therapy in the eradication of HP in patients with nonulcer dyspepsia, which improves their symptoms in more than 50% of cases.

Interest of Sclerosing Injections in Hemorrhoidal Pathology: Experience of the Service of Hepato-Gastroenterology of Fez

Hemorrhoids are a clinical and anatomical subject that has not been completely investigated [1]. This benign condition is expressed by intermittent functional manifestations as rectorrhagies and prolapse. while the medical treatments seek to relieve symptoms, the instrumental ones are intended to reposition and hold the hemorrhoids in an anatomically correct position and to reduce their vascularity [1]. Indeed, sclerotherapy seems an effective and safe method in fact. Aim of the Study: To report the results of a moroccan series of patients treated with sclerosing injections, emphasizing short- and long-term efficacy as well as the rate of complications. Methods: This is a descriptive retrospective study of the 148 patients with symptomatic internal hemorrhoids who have been treated with sclerotherapy in the gastroenterology department of the university medical center of Fez over a period of 17 years [2001-2018]. Results: The average age of our patients is 47.1 years [19 - 86]. We notified a large male predominance with a sex ratio M/F 2.58. Rectorrhagies and prolapse were the most frequent reasons for consultation;they were respectively notified in 96% (n = 143) and 83% of patients (n = 123). Anemia was found in 45 cases (30.4%), of which 29 cases required transfusion. Proctologic examination found internal hemorrhoids grade 2 in 83% (n = 124) and grade 1 in 16.2% (n = 24) of patients. Initial success was found in 119 cases (80.4%) after an average of 2.25 sessions (1 - 4). Nine patients (8, 11%) had minor complications dominated by minimal rectorrhagies in 8 cases, resolved spontaneously. In 29 cases (19.5%), the sessions were interrupted following a failure of the technique in 12 cases (41.3%), in 11 cases after change of the stage of hemorrhoids of stage II to III, in 4 cases following the appearance of an anal fissure contraindicating the procedure, and in 2 cases due to severe pain post sclerosis. Among these 29 cases, 13 patients were referred for surgery, while in 16 patients we opted for an instrumental treatment by ligature. The initial evolution was specified with a average follow-up of 3 months (1 - 13 months). The recurrence rate was 22.3% (N: 33 cases) after an average follow-up of 9.5 months (1 - 48 months). In the long term (over one year) and in the short term, the recidivism rate was 6% (n = 9 cases) and 16.2% (n = 24) respectively. Among recurrent patients, the sclerosis protocol was repeated in 20 patients (60.6%) with a success rate of 85%;for the remaining 13 patients, we opted for elastic ligation in 4 patients, and for surgery in 6 patients, while 3 patients were lost to follow-up. Conclusion: Since the end of the XIX century, sclerosis has been an instrumental technique, simple, inexpensive, and effective for the treatment of symptomatic internal hemorrhoids of grades 1 and 2, allowing good results in the long run, with minimal risk of complications.

Is there a correlation between endoscopy and imaging findings in Crohn’s disease

Background and Aims: Crohn’s disease is a chronic inflammatory bowel disease (IBD). Endoscopy and radiology play an important role in the diagnosis and management of this specific disease. The ability of each of these two tests to detect the gastrointestinal involvement (ulceration, stenosis, fistula, polyp, mucosal thickening) varies according to the type of Crohn’s lesions. The purpose of our study was to evaluate the correlation between these two diagnostic methods in the detection of those specific lesions in 70 patients diagnosed with Crohn’s Disease (CD) during the period of 3 years. Methods: In this retrospective study, including 70 patients with Crohn’s disease, Four major characteristic lesions (ulceration, stenosis, fistula and polyps) were studied by endoscopy and radiological exams to evaluate the relationship between endoscopy and imaging findings in the detection of these lesions. The analysis of our results was made by statistical analysis system: EpiInfo and SPSS. Results: The concordance of each of these diagnostic modalities is average for stenosis and fistulas and low diagnostic significance for ulcers and polyps. However, the imaging features of mucosal thickening are sensitive but not specific.

Gastric Atrophy, Intestinal Metaplasia in Helicobacter pylori Gastritis: Prevalence and Predictors Factors

Gastric atrophy and intestinal metaplasia represent the most important premalignant lesions in gastric carcinogenesis. The severity of gastric mucosal inflammation depends on the bacterium Helicobacter pylori (HP), on the host and on environmental factors. The aim of our study is to determine the prevalence and factors associated with Gastric atrophy and intestinal metaplasia in patients infected with Helicobacter pylori. Methods: This is a prospective study over a period of 4 years (May 2009 - January 2015) conducted in the service of Hepatology and Gastroenterology in hospital university Hassan II of Fez in collaboration with microbiology and molecular biology laboratory and epidemiology service of Faculty of Medicine and Pharmacy Fes. We included in our study all patients aged over 15 years, having ulcerative dyspepsia, peptic ulcer disease, gastritis or esophagitis. Results: During the study period, 1190 patients were included of which 70% had HP infection (N = 833). The average age was 48.21 years [16 - 99 years], sex ratio M/F was 1, 11. 60% of patients were older than 45 years. Chronic smoking was found in 12% of patients. Gastric atrophy was observed in 84% (N = 699) of patients infected with HP. Gastric atrophy was localized in 70% in the antrum and 30% in the fundus and 24% in both. The activity of gastritis (p = 0.0001) and the density of the HP (p = 0.005) were factors associated with atrophy. Intestinal metaplasia was observed in 13.5% of patients (N = 112). The density of HP (p = 0.037) and severe atrophy (p = 0.001) were factors associated with metaplasia. Other factors studied: age, sex, smoking, CagA+ genotype were not associated with either gastric atrophy or intestinal metaplasia. Conclusion: In our study, the prevalence of atrophic gastritis and intestinal metaplasia in patients infected with Helicobacter pylori was 84% and 13.5% respectively, which was a high prevalence. The activity of gastritis, and density of HP were factors associated with atrophy. The density of HP and severe atrophy were factors associated with metaplasia.

Role of laparoscopy in diagnosis of peritoneal tuberculosis (About 414 cases)

Peritoneal tuberculosis is still common in Morocco. Its diagnosis is based on several methods. Laparoscopy with directed biopsies is still considered as the referenced method. The aim of our work is to show the place and the importance of laparoscopy in the diagnosis of peritoneal tuberculosis through the study of various endoscopic aspects. Materials and Methods: This is a retrospective descriptive study extended from January 2001 to December 2011. We collected 414 cases of isolated ascites confirmed by ultrasonography. Different parameters were analyzed: epidemiological data, indications of laparoscopy and its results and complications. Results: The average age of our patients was 38 years (range: 8 years - 90 years) with a female predominance (sex ratio F/M: 2.3). Abdominal ultrasound performed in all patients has confirmed the presence of ascites in 100% of cases. Based on clinical data (soft or tense abdomen) and ultrasound (free or partitioned ascites), we performed a standard laparoscopy in 313 cases and open laparoscopy in 101 cases. The presence of granules was noted in 318 cases (76.8%). Peritoneal tuberculosis was found in 81.5% of cases with small whitish granulations distributed homogeneously, while peritoneal carcinomatosis was confirmed in 86.8% of patients with large granules distributed inhomogeneously. The presence of adhesions was observed in 33% of cases with peritoneal tuberculosis, while it was mentioned in only 2.8 cases of carcinomatosis. Conclusion: Despite the development of imaging means, ascitic fluid culture and PCR (polymerase chain reaction), laparoscopy remains indispensable for an early diagnosis of peritoneal tuberculosis and adequate management.