Biography:

Arabic University of Beirut since year 2005. Diploma in Hepato-biliary and transplant surgery : University of Paris -6- / France in year 2003 Fellow in the American college of Surgeons since year 2011. 

Abstract:

Abstract

Background: Rapid weight loss is a recognized risk factor for cholelithiasis. The incidence of gall stone formation after gastric bypass and gastric banding had been studied. To our knowledge, in the literature, there are no studies to analyze the incidence of symptomatic gall stones requiring cholecystectomy developed after sleeve gastrectomy.

Methods:  A retrospective chart review of patients who underwent LSG between January 2009 and May 2012 at two bariatric centers in Lebanon. Patients who had concomitant cholecystectomy, previous bariatric surgery or documented gall stones before surgery were excluded from the study. The outcome measure was the development of symptomatic gallstones requiring cholecystectomy.

Results: A total of 370 LSG was done in the study period, of which 292 met the inclusion criteria. 23 patients developed symptomatic gall stones requiring cholecystectomy.

Conclusion: The overall incidence of cholecystectomy after sleeve gastrectomy is 7.9%. Concomitant cholecystectomy should not be done as a routine viewing the low incidence of symptomatic gall stone after sleeve gastrectomy. Abdominal ultra-sound may not be a necessary part of the preoperative work up.

Biography:

Solovyova Maria O., born in 1983.She graduated from Volgograd State Medical University, medical faculty шт 2007. From 2007 to 2008 passed internship on "Surgery" at the emergency hospital. In 2008-2010 she studied in the clinical internship on a specialty "Surgery" St. Petersburg State University, Faculty of Medicine. From 2008 to 2010 she worked as a general surgeon.

Since 2012 works as an operating surgeon at The Federal State Budgetary Institute «The Nikiforov Russian Center of Emergency and Radiation Medicine», Saint-Petersburg, Russia. 32 scientific works published. She has Ph.D. degree and is a member of the International Federation of Surgery of Obesity (IFSO), a member of the Russian Society of Bariatric Surgeons. The point of interest: bariatric surgery, re-do bariatric procedures, mini-gastric bypass, complications of bariatric procedures.                                    

Abstract:

One of the possible complications after bariatric surgery is bleeding. In the majority of cases bleeding in the later stages of the postoperative period are intraluminal, with clinical manifestations of high gastrointestinal bleeding. Among all bariatric procedures, the development of this complication is more common after Roux-en-Y gastric bypass. Upper endoscopy is the diagnostic and treatment method of choice, but only bleeding in the gastric pouch or in the gastroenteroanastomosis can be stopped in this way. If localization of bleeding is in the remnant stomach or duodenum and small intestine, it is necessary to use more advanced endoscopic procedures.

Male patient, 44 years old with BMI 43 kg/m2 and comorbidities (Diabetes Mellitus type 2, decompensated in a patient receiving hypoglycemic drugs), was undergone laparoscopic Roux-en-Y gastric bypass in October 2014. During the year %EWL was 81%, there was compensation of diabetes without medication (HbA1 4,9%).

In January 2015 he was hospitalized in a clinic in St. Petersburg with signs of upper gastrointestinal bleeding. He has a history of melena during the last 5 days with an episode of syncope in the hospital day. Hemoglobin was 88 g/l. Upper endoscopy and colonoscopy were performed without identification of a source of bleeding. Drug therapy was conducted. A few days later the patient was transferred to our hospital with no signs of ongoing bleeding. Balloon-assisted enteroscopy was performed. Duodenal ulcer with no signs of bleeding was visualized. Endoscopic hemostasis wasn’t needed. The patient was discharged the next day. The course of anti-ulcer therapy performed. During follow-up, there was no recurrence of bleeding.

Conclusions: The use of a balloon-assisted enteroscopy is possible to identify the unidentified sources of bleeding by upper endoscopy. This method allows viewing distal small intestine and all parts excluded of gastrointestinal digestion. It also allows performing therapeutic measures if necessary. 

Biography:

Baris Cankaya graduated from Ankara University Medical Faculty in 2000. He has been working as Anaesthesiology Specialist at Marmara University Training Hospital. He has attended academic meetings, nationally and internationally. His academic interest includes microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia. Some of his certificates are: EPLS provider Berlin 2015, NLS provider Athens 2015 and MECOR Level I October 2014. He attended international workshops like ECMO workshop 2015, Leicester and Airway workshop, ICISA 2014, and Tel Aviv. He also attended symposiums, namely: International intensive care symposium Ä°stanbul 2015, ESA Focus Meeting on Perioperative Medicine: The paediatric patient 2014 and other symposiums at national and international level.

Abstract:

Adiposis has gained a surgical treatment option and we can discuss this situation on the basis of the severity of disease or failure of daily life management. Body Mass Index (BMI) over 40 or BMI over 35 plus co-morbidities are indications for bariatric surgery. Bariatric surgery improves quality and extension of life for patients with extreme obesity. But, informed consent is very important because this surgery helps limiting underlying factors but does not eradicate the disease. The partification of the patient for peri-operative process is mandatory. The medical history and clinical findings for preoperative anesthetic evaluation are important because of many co-morbidities as smoking, hypertension, thrombo-embolism, limited functional status, sleep apnea, hypo-albuminemia, coronary artery disease, stroke, bleeding disorder, dyspnea, chronic corticosteroid use, pulmonary hypertension, liver disease, congestive heart failure, cardiac arrhythmia, increased respiratory resistance, increased work of breathing, reduced lung volumes, increased resting heart rate, increased resting cardiac output, increased ventricular wall thickness. Anesthesia induction requires three main objectives: airway management, ventilation and pharmacotherapy. Masking the patient during induction may be difficult. Because there is a high risk for gastro-esophageal reflux fast track intubation is preferable. Supine positioning makes the diaphragm push towards lungs and makes situation worse for ventilation. The most profound reduction in lung parameters is the expiratory reserve volume. This will predispose small airway closure during normal breathing and lead to ventilation–perfusion mismatch and hypoxia. Pharmacokinetics is changed in obese population. We have to calculate the dosages of anesthetic drugs according to lean body weight for avoiding complications. Extracellular volume is also increased. Protein binding is reduced. Uptake and elimination of inhalation anesthetics is decreased due to impaired lung mechanics. Thrombosis is a very important peri-operative risk factor risk associated with obesity because of increase in plasma levels of plasminogen activator inhibitor-1, increased pro-coagulants and endothelial dysfunction.

Biography:

Nagendra Prasad is a consultant GI surgeon and advanced laparoscopic surgeon heading the Department of laparoscopic and GI surgery at Maxcure Hospitals, Hyderabad, India. He has vast experience of more than 10 years in the field of GI surgery and laparoscopy. He is well versed with many advanced techniques in laparoscopy and is expertise in minimally invasive upper GI surgeries.

Abstract:

Laparoscopic cholecystectomy is one of the most commonly performed laparoscopic surgeries worldwide. The spectrum of the disease ranges from simple symptomatic cholelithiasis with minimal edema, adhesions in calots triangle, ruptured and gangrenous gallbladder with dense adhesions involving stomach, transverse colon and anterior abdominal wall to Mirrizzi Syndrome. There is no uniform consensus as to predictors of preoperative difficult GB and conversion to open cholecystectomy. Few indicators have been proposed but they are not applicable in all the cases leaving a room for intra-operative surprises. Few of the preoperative indicators established from various studies in literature are thickened gall bladder wall (> 4 mm), presence of palpable tender mass and raised TLC along with deranged LFT in my experience of more than 400 cases, few other indicators as predictors of preoperative difficulty and possible conversion to open cholecystectomy have been noticed. Male gender, multiple attacks and increasing periodicity of attacks, presence of cholangitis and gall stone pancreatitis, post ERCP, presence of elevated liver enzymes, initial severe first attack and palpable tender mass are predictors on history and examination. Raised temperature >100°F; elevated TLC>10000; altered LFT, pericholecytic fluid and free fluid in Morrison’s pouch (however minimal), contracted GB, cirrhotic liver, impacted stone at Hatmann’s pouch are suggestive of difficult laparoscopic cholecystectomy. A previous surgery only increases the difficulty for entering abdomen but actually does not mean difficult GB dissection. All said and done, even in the absence of above findings, one might encounter difficult gall bladder dissection, hence every case has to be treated on its individual merit and one should always be ready for a difficult dissection.

Biography:

Mahmoud Saad Berengy is currently working in Al-Azhar University, Egypt

Abstract:

Purpose: Endoscopic approaches to obesity may help fulfill the unmet need of over half the most adult population who would benefit from therapy for obesity but are not receiving it. Endoluminal approaches have the potential to be more efficacious than anti-obesity medications and have a lower risk-cost profile compared with bariatric surgery. This session outlines the current state of primary endoscopic weight loss and metabolic therapies and sheds light on the challenges faced towards making endoscopic bariatric therapies 'ready for prime time'.

Recent Findings: Endoscopic approaches to obesity are being increasingly modeled on the proposed mechanisms contributing to the benefits of bariatric surgery. Therapies targeted at the stomach induce weight loss with only a proportional benefit to underlying metabolic disorders. Therapies targeting the proximal small bowel appear to modulate various neuro-hormonal pathways resulting in an improvement in metabolic profile in excess to that accounted for by weight-loss itself.

Summary: Rigorous scientific assessment of endoscopic approaches to obesity is necessary to allow its integration into the treatment algorithm of obesity. The endoscopic armamentarium against obesity continues to evolve with the Endoscopist poised to be a key player in the management of this disease.

Biography:

Abstract:

Biography:

Monir H Bahgat has done his specialization in Internal Medicine in the year 1995. Currently, he is a Professor of Hepatology and Gastroenterology (Internal Medicine department), Mansoura University, Egypt. He is a member of EASL and IASL

Abstract:

Background & Aim: Treatment for HCV infection is undergoing a rapid evolution, offering new hope to both naïve and treatment-experienced patients. Numerous highly effective, but expensive, direct acting antiviral (DAA) drugs active against different targets are now available. The aim of this study is to investigate the efficacy and safety of DAAs with and without PEG-IFN-α 2a, and /or ribavirin in treating chronic hepatitis C patients in Mansoura Specialized Medical Hospital.

Material & Methods: This observational study involved 181 patients with chronic hepatitis C presented to our Viral Hepatitis Outpatient Clinic at Mansoura Specialized Medical Hospital for anti-viral therapy over an 18 months period from January 2015 to June 2016. A total of sex different regimens were used depending on the national and international changing guidelines. All patients were thoroughly assessed and followed up for SVR and side effects. Investigations involved Fibroscan & FIB-4 score for non-invasive assessment of liver fibrosis, and serial HCV RNA assay by PCR.

Results: SVR12 for regimen 1 (PEG-IFN-α 2a + Sofosbuvir + Ribavirin) was 37/50 (74%), regimen 2 (Sofosbuvir + Ribavirin) was 40/56 (71%), regimen 3 (Sofosbuvir + Simeprevir) was 16/19 (78.9%), regimen 4 (Sofosbuvir + Daclatasvir ± Ribavirin) was 23/25 (92%), regimen 5 (Sofosbuvir + Ledipasvir) was 23/25 (92%), and regimen 6 (Paritprevir + Ombitasvir + Ritonavir) was 5/6 (83.3%). Commonly reported side effects (>10%) included fatigue (66%), flu like symptoms (48%), dyspnea (40%), psychiatric changes (30%), anemia (30%), cough (28%), nausea (24%), hypersensitivity (20%), rash (10%) for regimen 1.  For regimen 2, fatigue (28.7%), cough (26.8%), and anemia (26.8%). For regimen 3, fatigue (26.3%), hypersensitivity (26.3%), and rash (15.8%). For the other 3 regimens fatigue was the only dominating side effect.

Biography:

Asma Shabbir has a passion towards research & concerned for better prognosis of the illnesses (especially cancer patients). Her primary area of expertise is diagnostic pathology & also adores to teach the medical students. Her dissertation work involoved evaluation of Her-2/neu in gastric & colorectal adenocarcinomas. The basis of which arised from the use of targeted therapy (α-Her-2) in breast cancer patients. Similarly, α-Her-2 therapy in gastric & colorectal cancer might give another treatment option for better prognosis to these patients in this new era of personalised medicine.

Abstract:

Background: Human Epidermal Growth Factor (Her-2/neu) has strong therapeutic implications in certain cancers like breast and gastric cancer. Literature on its frequency in colorectal cancer is scarce. In this study we have investigated the frequency of Her-2/neu expression in colorectal adenocarcinomas and its association with various clinicopathological variables.

Methods: A total of 95 patients who underwent colonoscopic biopsy or colectomy were studied after institutional ethical approval. Hematoxylin & eosin (H&E) staining was performed on all the tissue sections. Expression of Her-2/neu was investigated by immunohistochemistry using α-Her-2 antibody. In order to quantify Her-2/neu expression, three criterias were applied that includes the pattern of staining, intensity of staining and percentage of tumor cells stained. Furthermore, its association was seen with various clinicopathological variables including age, gender, histopathological type, grade and stage of the tumor. Data was entered and analyzed using SPSS version 21. A p-value of < 0.05 was considered as significant.

Results: From the total of 95 cases, 75 (78.9%) cases showed Her-2/neu expression. Pattern of Her-2/neu staining was significantly associated with the grade (p-value = 0.030) & type of colorectal cancer (p-value = 0.024). We also observed a significant association between percentage of cells stained & tumor type (p-value = 0.006).

Conclusion: Her2/neu is considerably expressed in colorectal adenocarcinoma in Pakistani population. Our findings indicate a significant strong association of cytoplasmic Her-2/neu expression with low grades and membranous Her-2/neu expression with high grades of colorectal cancer. 

Biography:

Min Ju Kim is an Abdominal Radiologist with an expertise in evaluation of gastrointestinal disease. She has reviewed about rectal ultrasonography and inflammatory bowel disease and there are many articles about gastrointestinal diseases, especially in inflammatory bowel disease or rectal MRI for evaluation of rectal cancer. She is at present a Professor of Korea University Medical School in Seoul, Korea and is teaching gastrointestinal radiology.

Abstract:

Background: The accurate evaluation of disease activity in Crohn’s disease is important in treatment of the disease and monitoring the response. CT enterography is a useful imaging modality reflecting the enteric inflammation as well as extramural complications.

Objectives: To evaluate the correlation of CT enterographic findings of active Crohn’s disease with the Crohn’s Disease Activity Index (CDAI) and CRP.

Patients & Methods: 50 CT enterorotraphys in 39 patients with Crohn’s disease in the small bowel were enrolled in our study. CDAI was assessed through clinical or laboratory variables. Multiple CT parameters including mural hyper-enhancement, mural thickness, mural stratification, comb sign and mesenteric fat attenuation were examined with four-point scale. The presence of enhanced lymph nodes, fibro-fatty proliferation, sinus or fistula, abscess and stricture were also assessed. Two gastrointestinal radiologists independently reviewed all CT images. The inter-observer agreement was also examined. Correlations between CT findings, CRP and CDAI were assessed using Spearman’s rank correlation and logistic regression analysis. To assess the predictive accuracy of the model, receiver-operating characteristic curve analysis for sum of CT enterographic scores was used.

Results: Mural hyper-enhancement, mural thickness, comb sign, mesenteric fat density, fibro-fatty proliferation, fistula and abscess were significantly correlated with CDAI (p<0.05). Mesenteric fat density was correlated with CRP (r=0.32; p=0.02). The binary logistic regression model demonstrated that mesenteric fat density (p=0.02) had an influence on the severity of CDAI. The AUROC of CTE index for predicting disease activity was 0.85. Using cut-off value of 8, the sensitivity and negative predictive value were 95% and 94%.

Conclusions: Most CTE findings are correlated with CDAI and CRP in patients with active Crohn’s disease.

Biography:

Ali Al Ghrebawi is currently working in Colorectal Surgery Department, Meppen-Germany.

Abstract:

Biography:

Amal A Hunjur has obtained her MBBS in May 2016. She has a passion in improving patients’ quality of life and health awareness. She attended the “Medical Emergencies: Updates and Practice Management Symposium 2015” and research methodology course in 2015. She participated in the Taif’s 1^st Trauma course, Breast Cancer Awareness Campaign in 2011, AIDS Awareness Campaign in 2012, ADHD awareness Campaign in 2015 and Breast Cancer Awareness Campaign in 2016. She presented in the 7^th Saudi Students’ Scientific Conference 2016. She believes that clinical researches are the basic key and the cornerstone for clinical development. She has published in the World Journal of Neuroscience under the title of “Siblings with Autism, Mental Retardation & Convulsion in Tuberous Sclerosis”  She is currently working on improving her research experience, clinical practice and medical knowledge, aiming for giving the best to her mission as a physician.

Abstract:

Introduction & Aim: The aim of this study was to find out if laparoscopic cholecystectomy for acute cholecystitis is also an adequate surgical procedure in patients with a status post previous abdominal surgeries.

Material & Methods: Between 1.4.2010 till 31.8.2013, 858 patients underwent surgery for chronic cholecystitis (n=595) or acute cholecystitis (n=245). 788 of the patients had their surgeries done minimal invasively. 56 of the patients had a history of a previous abdominal surgery. 32% of all previous surgeries were upper abdominal and 68% lower abdominal. All patients with a history of lower abdominal laparotomy had their camera trocar supraumbilically introduced, whereas in patients with previous upper abdominal surgeries the location of the camera trocar was variable and a function of the previous abdominal incision. The introduction of the other trocar ports was after careful adhesiolysis under optical vision in the usual abdominal wall locations.

Results: A laparoscopic cholecystectomy was possible in all 245 acute cholecystitis patients. The conversion rate in acute cholecystitis after previous abdominal surgery (n= 18) was 5.5% and the median duration of surgery was 95 minutes (69 to 235 minutes). The median hospital stay was 8 days (4 – 18 days) which was not much longer than in laparoscopic cholecystectomy in patients no  previous abdominal surgeries.  

Conclusion: Laparoscopic cholecystectomy for acute cholecystitis is also an adequate procedure in patients with a history of previous abdominal surgeries associated with low rate of complication.

Biography:

Hemant Atri has completed his MBBS from P.D.U. Medical College, Rajkot, Gujarat and currently pursuing Post-graduation in DNB Surgery at Fortis Escorts Hospital, Faridabad, India.

Abstract:

Introduction: Necrotizing soft tissue infections is used to encompass infections not only of fascia, as in necrotizing fasciitis, but also of other soft tissue affected. Necrotizing fasciitis is a progressive, fulminant bacterial infection of subcutaneous tissue that spreads rapidly through the facial   planes causing extensive tissue destruction.. NSTIs are rare but potentially fatal condition. In the United States, there is an estimated annual incidence of 0.04 cases per 1000 annually. Early reports of mortality were variable with rates ranging from 46 to 76% but outcomes have been improving over time. The mainstay of treatment is early and complete surgical debridement, combined with antimicrobial therapy, close monitoring, and physiologic support. Total debridement of all necrotic material must be performed until the skin and subcutaneous tissue can no longer be separated from deep fascia. Novel therapeutic strategies, including hyperbaric oxygen and intravenous immunoglobulin, have been described, but their effect is controversial. Identification of patients at high risk of mortality is essential for selection of patients that may benefit from future novel treatments and for development and comparison of future trials.

Study: Retrospective

Aim: To analyze clinical profile, effect of associated co-morbidities, trauma and duration of symptoms before admission on hospital stay

Study group: 25cases of NSTIs who reported to our hospital during January to December 2015(formula used-ME=z∗Sqrt((p(1-p))/N)

Exclusions: deaths (two)

Co-morbidities included: Diabetes mellitus, Chronic liver disease, Respiratory disease, Respiratory disease, Vascular disease, Dyselectrolytemia

(No patient was found to have any renal disease)

Results: study showed that the disease is more common in males (80%) and in patients with age group 51-60 years (48%), more in patients with diabetes mellitus (60%),traumatic injuries(32%) and in patients with other co-morbidities(40%). 40% patients had a history of 10-15 days of illness before presenting to hospital.44% patients had less than 4 days of hospital stay. There is no correlation between duration of symptoms before admission or hospital stay in patients with associated co-morbidities and trauma. There is no correlation between duration of symptoms before admission and hospital stay. There is increased hospital stay in patients with associated co-morbidities especially in liver pathology or electrolyte imbalance compared to other comorbidities

Biography:

Emad Salem is currently working in Hepatology Unit, Mansoura General Hospital, Egypt

Abstract:

Background & Aim:  Hepatic steatosis in hepatitis C virus (HCV) infected patients have been shown to enhance the progression of liver fibrosis and decrease the response to antiviral therapy. The current study is designed to investigate the impact of hepatic steatosis on the outcome of pegylated interferon and ribavirin combination therapy in patients with chronic hepatitis C genotype 4.

Patients & Methods: A total number of 200 patients were selected from 270 patients who were referred to HCV Treatment Unit of New Mansoura General Hospital from February 2012 to August 2013 after taking an informed consent. There were 129 males and 71 females with their ages ranged from 25 to 55 years (mean value, 35.5±15.2). They had proven chronic hepatitis C virus based on history of exposure, clinical manifestations, positive anti-HCV antibody, positive HCV viremia and liver biopsy findings suggestive of chronic hepatitis C.

Results: Group I included 100 patients (70 men and 30 women; mean age of 42.9±12 years) without liver steatosis. Group II included 100 patients (59 men and 41 women; mean age of 45.23±11 years) with liver steatosis. In terms of steatosis grading using the NAS and METAVIR scoring systems, 50% had no steatosis while 8.5% had mild steatosis, 18.5% had moderate steatosis and 23% had severe steatosis. Body mass index of patients receiving interferon is significant between both groups. Hepatomegaly shows significant values between both groups. Platelets count, ALT, AST, s-cholesterol and s-triglycerides levels has statistically significant differences between group I (non-steatotic) and group II (steatotic). There is statistically significant difference between both groups on necro-inflammatory activity grades, high statistical significant difference between grading of steatosis and necro-inflammation and between grading of steatosis and fibrosis stages. Statistical significance difference between both groups at SVR and steatosis has a negative effect on SVR by comparison to non-steatotic group. High degree of hepatic steatosis has a negative impact on pegylated interferon and ribavirin therapy in chronic HCV genotype 4 minimizing sustained virological response of rates.

Conclusion: Our study confirms that hepatic steatosis correlates with BMI, s-cholesterol, s-triglycerides, fibrosis, necro-inflammatory stages and has a negative impact on response to antiviral therapy.

Biography:

Ali Al Ghrebawi is currently working in Colorectal Surgery Department, Meppen-Germany

Abstract:

Aim: Since there are very limited data on patients with spina bifida treated by sacral neuromodulation, we report a case of a 22 year old women with combined fecal (grade III) and urinary overflow incontinence based on a follow-up of 28 months. Urinary overflow incontinence manifested itself in frequent urgency episodes along with the necessity of clean intermittent self catheterization.

Methods: Peripheral nerve evaluation (PNE) was performed as a diagnostic approach, since all conservative therapies to treat the fecal incontinence had been exhausted. Computed tomography images were recorded beforehand in order to ensure access to the sacral nerves. After a test period of three weeks bowel and urinary conditions improved more than 50%, so that in a second step the permanent electrode and the neurostimulator (Medtronic models 3889 and 3058) were implanted under local anesthesia.

Results: There was a significant improvement in fecal incontinence as well as urinary symptoms up to a follow-up of 28 months. The decrease of symptoms correlated favourably with a significant improvement in her quality of life, since she was now able to finish her apprenticeship.

Conclusion: Sacral neuromodulation is an effective and safe treatment modality for complex combined bowel and urinary disorders subject to spina bifida. Local anesthesia should be preferred because motor responses might be missing as in the current case.

Biography:

Faheem A. Elbassiony is currently working in Kasr El Aini Hospital, Egypt. 

Abstract:

Hiatal hernia is a common surgical finding particularly with GERD. However the size of the hiatus is sometimes too big and can accommodate most of stomach and even other abdominal viscera (Type4 HH). Huge defects can also be congenital that may present early in infancy and childhood or otherwise the presentation can be delayed to adulthood. It can also be the result of trauma where the diaphragmatic injury can pass unnoticed especially in blunt trauma and can present long time after the original event. Complications in huge diaphragmatic defects are common (upto 45%) and mortality is high if neglected (upto 50%). Complications include obstruction, volvulus, strangulation, bleeding, and perforation in addition to pulmonary and nutritional complications. Surgical intervention is the only option to manage these cases and in every case the application of a mesh should be considered due to the big size of the defects and/or to prevent recurrence. Short esophagus is another problem that should be solved especially in longstanding HH. In this work we present our experience in managing such cases with video clips

Biography:

Khaled Abdelwali completed his MBBCh in 2005, Faculty of Medicine, Assuit University. He then worked in Assuit University hospital for 1year, and later-on in Manshyet Elbakry hospital in Cairo, Egypt in the department of gastroenterology and liver diseases. He then joined as a part time Physiology Lecturer in Misr International University. He finished his Diploma in Internal medicine and Gastroenterology in 2014 at Ain Shams University, Egypt. He then moved to the Department of Gastroenterology and liver diseases in Sheikh Zayed Al Nahyan general and specialized hospital, Cairo.

Abstract:

Background: Gastro esophageal reflux disease (GERD) is the reflux of gastric contents into the esophagus, leading to esophagitis, reflux symptoms sufficient to impair the quality of life and increased risk of long-term complications. GERD is divided into erosive (ERD) and non-erosive (NERD) reflux disease, NERD has been regarded as reflux symptoms with the absence of mucosal breaks in the esophagus at endoscopy. However, NERD has been divided into normal and minimal changes based on endoscopic finding.

Objectives: To evaluate the clinical significance of minimal changes at endoscopy and examine whether such changes have diagnostic value in gastro esophageal reflux disease (NERD) or not.

Methods: 60 patients were recruited in this study, they were divided into 2 groups, Group I: included 30 patients with GERD symptoms in form of hurt-burn and/or regurgitation more than twice a week with minimal duration of 8 consecutive weeks and troublesome symptoms affecting the daily life activities who were identified by specific questionnaire but negative mucosal breaks at upper GI endoscopy (NERD) as patient group. Group II: included 30 patients without GERD   symptoms attending for upper GI endoscopy for any other reason as a control group. Both of them were subjected to Full history taking. Full clinical examination with special stress on BMI (weight/height) 2.(Normal 19-25, Over weight >25) and diagnostic upper GI endoscopy by expert endoscopists after patient consent.

Results: We identified two of the six minimal change esophagitis endoscopically as being more common in the patient group with GERD symptoms compared with the other findings which are erythema and white turbid discoloration.

Conclusion: According to our study there is no clinical relevance in the diagnosis of NERD depending on endoscopic minimal change esophagitis.

Biography:

Assem shaik is working in Ain Shams Universit, Egypt

Abstract:

Gastro-intestinal complaints and disorders are common in women of all ages, including women in their childbearing period, and thus, often occur during pregnancy, while hepatic, biliary, & pancreatic disorders are relatively uncommon but not rare during pregnancy. For example, about 3 per 100 women develop serum liver function test abnormalities during pregnancy, and about 1 per 500 women develop potentially life threatening hepatic diseases during pregnancy that endanger fetal viability. Hepatic, biliary, and pancreatic disorders are often complex and these complaints and disorders, in addition to gastro-intestinal disorders present unique clinical challenge during pregnancy.

First, the differential diagnosis during pregnancy is extensive. Aside from gastrointestinal disorders unrelated to pregnancy, their complaints may be caused by obstetric or gynecologic disorders related to pregnancy or other intra-abdominal diseases incidental to pregnancy. Moreover, some gastro-intestinal conditions, such as hyperemesis gravidarum are unique to pregnancy.

Second, the clinical presentation and natural history of gastro-intestinal & hepatic disorders can be altered during pregnancy as in the case of appendicitis. Indeed, some disorders, as intrahepatic cholestasis of pregnancy, are unique to pregnancy.

Third, the diagnostic evaluation is altered and constrained by pregnancy. For example, radiologic tests and invasive examinations raise concern about their fetal safety during pregnancy.

Fourth, the interests of both the mother and the fetus must be considered in therapeutic decisions during pregnancy. Usually these interests do not conflict, because what is good for the mother is generally good for the fetus. Sometimes, however, maternal therapy must be modified to substitute alternative but safer therapy because of concerns about drug teratogenicity. Rarely, the maternal and fetal interests are diametrically opposed, as in the use of chemotherapy for maternal cancer, a therapy that can be life-saving to the mother, but life-threatening to the fetus.

These conflicts raise significant medical, legal, and ethical issues.

The obstetrician and gynecologist, as well as the Hepatologists, Gastroenterologist and surgeon, should be familiar with the medical and surgical gastro-intestinal conditions, hepatobiliary and pancreatic disorders that can present in pregnancy and how these conditions affect and are affected by pregnancy.

In this article, we are going to revise hepatic, biliary, pancreatic and gastro-intestinal symptoms and disorders during pregnancy, with a focus on aspects of these disorders unique to pregnancy.