In this issue of Gastroenterology Update, I have focused on common issues of gastroenterology and endeavored to bring you an update on these issues.
Haemospray(TC-325): once sprayed on the bleeding surface, it swells with moisture and stimulates platelet aggregation. Primary haemostasis has been reported in 85% of ulcer and variceal bleeding. I have used this agent recently and is now available in both Pindara and Allamanda private hospitals and presumably also in the public hospitals.
Ovesco Clips: otherwise known as “Bear Claw”: I have successfully used to close a duodenal fistula. Its success has also been reported in refractory or major upper gastrointestinal bleeding(1).
Screening for Barrett’s should be targeted for overweight males who drink alcohol and smoke tobacco and are equal to or older than 50 years of age. Barrett’s with high grade dysplasia should be treated initially with endoscopic mucosal resection of the area of dysplasia (usually high grade) followed by ablation of the rest of area of Barrett’s with radiofrequency ablation. Surveillance for Barrett’s is considered to be adequate every 3 years(2). However, if high grade dysplasia has been treated then follow up endoscopy every 3 to 6 months may be required for the first year.
Eosinophilic Oesophagitis (EOE)
The entity of PPI responsive oesophageal eosinophilia-ROE) throws a spanner in the works of EOE. There is no symptomatic, endoscopic or histological difference between the two entities except that PPI-ROE does respond to PPI while EOE does not. Hence, it is recommended , that all cases of EOE should receive an initial trial on PPI. Failing they should receive swallowed fluticasone or betamethasone or oral steroid (3).
For serological diagnosis, while antitransglutaminase is adequate, the specificity can be improved by adding on deamidated gliaden antibody or anti-endomysial antibody. Duodenal biopsies still remains the bedrock for confirmation of the diag- nosis. It takes 1-2 years for small intestinal mucosa to heal on strict gluten free diet.
Inflammatory Bowel Disease
In the nurses health study(4),it was noted that there is increased chance of getting Crohn’s disease if women are or were on oral contraceptive pills in the past. It also was noted that there is increased risk of developing ulcerative colitis if women smoked tobacco in the past.
Chronic Liver Disease
Protein calorie malnutrition (PCM) can be an issue in the management of chronic liver disease. Protein calorie malnutrition is an independent risk factor for the first bleeding episode and mortality from varices secondary to portal hypertension. Vitamins A and D deficiencies have been seen in greater than 50% patients with cirrhosis (5).
Serrated Polyposis syndrome
Over the last couple of years, I have come across 3 patients with this syndrome all of whom are young females. Female gender and tobacco smoking are risk factors. These polyps were misdiagnosed as benign hyperplastic polyps in the recent past until the histological features separating serrated polyp/adenoma from hyperplastic polyps were described. They are found in 2-8% of individuals. Account for 15-30% of all colorectal cancers. These tumours exhibit high microsatellite instability, can run in families, linkage found in chromosome 1p and 2q but candidate gene has not been located. Management involves yearly colonoscopy and surgery for those whose polyp burden is not controlled with polypectomies. One of my patients had more than 80 polyps removed over 3 colonoscopies with only 10 small ones found last time.
- Sung J.Y.ASGE, Annual postgraduate course 2014 7-8.
- Fennerty B.M, Annual postgraduate course 2014,16-17
- Yaxley J and Chakravarty B:Eosinophilic oeophagitis: a guide for primary care, in Press with Australian Family Physician,2015
- Zapata L B etal:Contraception 2010 July;82(1):72-85
- Arteh J etal: Dis Dis Sci 2010 Sept;55(9):2624-8
- Stoffel E M et al: Clin Gastroenterol Hepatol 2014,12(7):1059-1068