BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patie...BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.AIM To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.METHODS This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children's Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.RESULTS The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance(potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessionswas 37.2 ± 14.9. Histopathological examination of the specimens showed that 85%of patients had evidence of chronic oesophagitis(group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia(group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients(2%)had mild squamous dysplasia(group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.CONCLUSION The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of postcorrosive oesophageal stricture.展开更多
BACKGROUNDThere has been a worldwide increase in the reported incidence of inflammatorybowel disease (IBD) in children over the past 2-3 decades. The hepatobiliary (HB)manifestations of IBD have been well-studied in c...BACKGROUNDThere has been a worldwide increase in the reported incidence of inflammatorybowel disease (IBD) in children over the past 2-3 decades. The hepatobiliary (HB)manifestations of IBD have been well-studied in children in industrialized anddeveloped countries but are infrequently reported in low- and middle-incomecountries (LMIC) such as Egypt.AIMTo determine the prevalence of the HB manifestations in a cohort of Egyptianchildren with IBD.METHODSThis cross-sectional observational study was carried out over a period of 6 mo(between June 2013 to December 2013, at the Paediatric Hepatology andGastroenterology Units of Cairo University Children's Hospital, which is thelargest paediatric tertiary care centre in the country.RESULTSThe study included 48 patients with confirmed IBD based upon clinical,laboratory, endoscopic and histopathological features, 29 (60.4%) were male.Twenty-four patients (50%) had ulcerative colitis (UC), 11 (22.9%) had Crohn'sdisease (CD) and 13 (27.1%) had unclassified-IBD (IBD-U), which was formerlyknown as indeterminate colitis. The mean age of the patients at the time ofpresentation was 8.14 (± SD 4.02) years and the mean age at the time of studyenrolment was 10.16 (± SD 4.19) years. All patients were screened for HBmanifestations by physical examination, liver function tests, imaging and liver biopsy when indicated. HB disorders were confirmed in 13 patients (27.1%).Transaminases were elevated in 3 patients (6.3%). Two patients (4.2%) hadelevated biliary enzymes (one was diagnosed as primary sclerosing cholangitis(PSC) and the other was diagnosed with PSC/autoimmune hepatitis overlapsyndrome and the third patient had hepatitis C virus infection. Ten patients(20.8%) had bright echogenic liver on ultrasound suggesting fatty infiltration as asequel of malnutrition or medication toxicity.CONCLUSIONThe commonest HB disorders in Egyptian children with IBD were abnormal liverfunction tests, fatty infiltration and PSC. These HB manifestations in paediatricpatients in LMIC may be relatively more common than in industrializedcountries. Therefore, IBD patients in LMIC should be meticulously screened forliver disease to allow prompt diagnosis and management.展开更多
文摘BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.AIM To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.METHODS This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children's Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.RESULTS The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance(potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessionswas 37.2 ± 14.9. Histopathological examination of the specimens showed that 85%of patients had evidence of chronic oesophagitis(group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia(group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients(2%)had mild squamous dysplasia(group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.CONCLUSION The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of postcorrosive oesophageal stricture.
文摘BACKGROUNDThere has been a worldwide increase in the reported incidence of inflammatorybowel disease (IBD) in children over the past 2-3 decades. The hepatobiliary (HB)manifestations of IBD have been well-studied in children in industrialized anddeveloped countries but are infrequently reported in low- and middle-incomecountries (LMIC) such as Egypt.AIMTo determine the prevalence of the HB manifestations in a cohort of Egyptianchildren with IBD.METHODSThis cross-sectional observational study was carried out over a period of 6 mo(between June 2013 to December 2013, at the Paediatric Hepatology andGastroenterology Units of Cairo University Children's Hospital, which is thelargest paediatric tertiary care centre in the country.RESULTSThe study included 48 patients with confirmed IBD based upon clinical,laboratory, endoscopic and histopathological features, 29 (60.4%) were male.Twenty-four patients (50%) had ulcerative colitis (UC), 11 (22.9%) had Crohn'sdisease (CD) and 13 (27.1%) had unclassified-IBD (IBD-U), which was formerlyknown as indeterminate colitis. The mean age of the patients at the time ofpresentation was 8.14 (± SD 4.02) years and the mean age at the time of studyenrolment was 10.16 (± SD 4.19) years. All patients were screened for HBmanifestations by physical examination, liver function tests, imaging and liver biopsy when indicated. HB disorders were confirmed in 13 patients (27.1%).Transaminases were elevated in 3 patients (6.3%). Two patients (4.2%) hadelevated biliary enzymes (one was diagnosed as primary sclerosing cholangitis(PSC) and the other was diagnosed with PSC/autoimmune hepatitis overlapsyndrome and the third patient had hepatitis C virus infection. Ten patients(20.8%) had bright echogenic liver on ultrasound suggesting fatty infiltration as asequel of malnutrition or medication toxicity.CONCLUSIONThe commonest HB disorders in Egyptian children with IBD were abnormal liverfunction tests, fatty infiltration and PSC. These HB manifestations in paediatricpatients in LMIC may be relatively more common than in industrializedcountries. Therefore, IBD patients in LMIC should be meticulously screened forliver disease to allow prompt diagnosis and management.
