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Research Article
The Long-term Outcomes of Patients with Ulcerative Colitis Treated with First Trial of Biological
Issue:
Volume 9, Issue 1, June 2025
Pages:
1-8
Received:
29 November 2024
Accepted:
17 December 2024
Published:
7 January 2025
DOI:
10.11648/j.ijg.20250901.11
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Abstract: Introduction: The advent of biologicals and small molecules have changed treatment strategies in ulcerative colitis (UC) as therapies now aim for complete mucosal healing. Real-world data on the outcome of UC patients after first trial of biologics is still lacking and is investigated here. Materials and Methods: UC patients treated with at least one biological at Tampere University Hospital between January 2009 and January 2020 were identified and reviewed from patient records. Results: A total of 192 patients were included. The median follow-up was 3.8 years (range 0-11 years). Seventy-four (40%) of the 185 patients treated with tumour necrosis factor α (TNFα) inhibitors (anti-TNF) and four out of the seven treated with vedolizumab continued treatment after follow-up with no need for treatment enhancement or colectomy. Seventy (36%) of all patients needed at least one consecutive treatment and 58 (30%) required surgery with median time of 1 year (range 0-5 years) from initiation of first biological to colectomy. Of the operated patients 34% had at least two different treatment trials with biologicals or janus kinase inhibitors (JAKs) prior to surgery. There was no significant difference in the persistence of different treatments nor between treatment with infliximab alone or in combination with immunomodulator. When analysing predictive factors for colectomy females and patients treated prior the year 2015 had slightly higher colectomy rates. Conclusion: Two fifth of the patients benefitted from the first trial of biological. However, in third subsequent treatment trials merely postponed colectomy while patients suffered from prolonged symptoms. Means are needed to identify patients benefitting from surgery early on.
Abstract: Introduction: The advent of biologicals and small molecules have changed treatment strategies in ulcerative colitis (UC) as therapies now aim for complete mucosal healing. Real-world data on the outcome of UC patients after first trial of biologics is still lacking and is investigated here. Materials and Methods: UC patients treated with at least o...
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Case Report
Case Report: Atypical Surgical Technique for Crohn's Disease of the Duodenum
Issue:
Volume 9, Issue 1, June 2025
Pages:
9-14
Received:
7 December 2024
Accepted:
31 December 2024
Published:
17 January 2025
DOI:
10.11648/j.ijg.20250901.12
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Abstract: Crohn’s disease (CD) is an idiopathic chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract (GIT), though it most commonly involves the terminal ileum and colon. Duodenal involvement is rare, accounting for only 0.5%–4% of cases, and isolated duodenal CD is even less common, occurring in fewer than 0.07% of patients. This report describes a 37-year-old female with a long history of CD presenting with progressive duodenal stenosis and associated symptoms such as epigastric pain, weight loss, and vomiting. Despite medical therapy with biologics, including adalimumab and ustekinumab, the disease progressed, leading to the need for surgical intervention. The patient underwent an innovative surgical procedure involving antrectomy, resection of the first, second, and third portions of the duodenum, Roux-en-Y gastrojejunostomy, cholecystectomy, and total pancreas preservation. Histopathological analysis confirmed the diagnosis of CD with chronic transmural inflammation, non-caseating granulomas, and lymphoid follicle formation. Postoperatively, the patient experienced significant clinical improvement, with good nutritional recovery and no recurrence of symptoms during follow-up. This case highlights the challenges in managing rare and severe manifestations of CD, particularly when medical therapy is insufficient. Surgical intervention is often reserved for complications such as obstruction, perforation, or intractable symptoms. The described surgical approach deviated from traditional methods like Whipple’s procedure, focusing instead on preserving the pancreas and minimizing GIT disruption. This innovative technique proved effective, underscoring the importance of tailoring surgical strategies to individual patient needs.Given the rarity of duodenal CD and the paucity of literature on its management, this report adds valuable insights into the potential for conservative surgical approaches to improve outcomes while reducing morbidity. Further studies are warranted to explore optimal strategies for treating this uncommon presentation of CD.
Abstract: Crohn’s disease (CD) is an idiopathic chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract (GIT), though it most commonly involves the terminal ileum and colon. Duodenal involvement is rare, accounting for only 0.5%–4% of cases, and isolated duodenal CD is even less common, occurring in fewer than 0.07% of patie...
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Research Article
Clinical Profile of Filipino Elderly Patients with Upper Gastrointestinal Bleeding Admitted in a Tertiary Hospital: A Retrospective Cohort Study
Issue:
Volume 9, Issue 1, June 2025
Pages:
15-24
Received:
26 March 2025
Accepted:
2 April 2025
Published:
28 April 2025
Abstract: Background of the Study: Upper Gastrointestinal bleeding (UGIB) remains to be a significant clinical concern for geriatric patients due to their prolonged hospital stay and higher mortality and morbidity rates. The clinical profile of the geriatric patients are important aspects to consider, given that there is limited data in elderly population. Objective: The study is aimed to determine the clinical profile of elderly patients with UGIB admitted in a Tertiary Hospital from January 2024 to June 2024. Methods: This is a retrospective cohort study among elderly Filipino patients aged 60 years and above; admitted as UGIB and underwent esophagogastroduodenoscopy (EGD). Baseline Demographic, clinical presentation, laboratory results, endoscopic findings, prognosis and predictors of mortality were evaluated. Statistical analysis involved the application of Pearson’s chi-square, Fisher’s exact test, T-test and univariate and multivariate logistic regression analysis. Results: Among 102 admitted elderly patients with UGIB, 67 of them underwent EGD, thus were included in the study; 43 (64.18%) were male and 24 (35.82%) were female with the median age of 69.66 (±7.40) years. The prevalence rate of UGIB among elderly Filipino is 8.90%. 50 of those patients (74.63%) had comorbidities, the most common were: hypertension 38 (56.72%), diabetes mellitus 19 (28.36%) and chronic kidney diseases (13.43%). Patients presented mostly with melena (67.16%), generalized body weakness (53.73%) and 19.40% had abdominal pain. During endoscopy, (47.76%) was due to gastritis and gastric ulcer (19.40%). Mortality rate was higher in patients admitted at the ICU. No association was noted between the patients’ mortality and their sex, age, comorbidities, medications used, clinical findings, INR, BUN, hemoglobin, blood transfusion, and endoscopic findings. Conclusion: The present study reported that elderly patients with UGIB were male, with hypertension as the most common comorbidity. EGD findings showed gastritis as the most common cause of UGIB. Mortality rate is higher in patients admitted at the ICU. None of the variables showed significant differences in terms of predictors of mortality.
Abstract: Background of the Study: Upper Gastrointestinal bleeding (UGIB) remains to be a significant clinical concern for geriatric patients due to their prolonged hospital stay and higher mortality and morbidity rates. The clinical profile of the geriatric patients are important aspects to consider, given that there is limited data in elderly population. O...
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Research Article
Causal Role of Immune Cells in Inflammatory Bowel Disease: A Mendelian Randomization (MR) Study
Heng Shi
,
Qin Peng*
Issue:
Volume 9, Issue 1, June 2025
Pages:
25-31
Received:
26 March 2025
Accepted:
10 April 2025
Published:
29 April 2025
Abstract: The present Mendelian randomization study investigated the potential causal relationship between immunophenotypes and inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Results demonstrated that immunophenotypes, such as CD28 on CD39+ resting Treg and CD25 on IgD+ CD24− showed nominal significant protective effects on CD and UC, respectively. Conversely, specific immunophenotypes also exhibited nominal significant risk effects on CD and UC, including CD39 on CD39+ CD8br and IgD on IgD+ CD38dim, respectively. Collectively, our findings highlight the potential role of immune cell phenotypes in the development of CD and UC as evidenced by data analysis from the FinnGen database. Therefore, the present study contributes to understanding the genetic basis of IBD and highlights the significance of immune cell phenotypes in disease pathogenesis.
Abstract: The present Mendelian randomization study investigated the potential causal relationship between immunophenotypes and inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Results demonstrated that immunophenotypes, such as CD28 on CD39+ resting Treg and CD25 on IgD+ CD24− showed nominal significant protecti...
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Research Article
Frequency and Bacterial Profile of Small Intestinal Bacterial Overgrowth in Patients with IBS D and IBS M in an Academic Hospital
Issue:
Volume 9, Issue 1, June 2025
Pages:
32-36
Received:
7 April 2025
Accepted:
18 April 2025
Published:
19 May 2025
Abstract: Background: Small intestinal bacterial overgrowth (SIBO) is a condition often associated with irritable bowel syndrome (IBS), particularly IBS-D (diarrhea-predominant) and IBS-M (mixed-type). The relationship between SIBO and IBS subtypes remains poorly understood, despite its potential impact on treatment and symptom management. Methods: This observational cross-sectional study was conducted at the Department of Gastroenterology, Dhaka Medical College Hospital, from September 2018 to August 2019. A total of 104 adult patients diagnosed with IBS based on Rome IV criteria were enrolled. Duodenal aspirates were collected during upper gastrointestinal endoscopy, and SIBO was diagnosed using quantitative aerobic culture on blood agar and MacConkey agar plates, with ≥105 CFU/mL considered diagnostic. Demographic and clinical data were analyzed using SPSS software. Results: Of the 104 participants, 36.5% tested positive for SIBO. Among IBS-D patients, 53.3% were SIBO-positive, while only 13.7% of IBS-M patients showed positive results. The majority of isolates in the SIBO-positive group were Pseudomonas (78.9%), followed by E. coli (21.1%). A significant correlation was observed between SIBO and IBS-D, with higher colony counts in the SIBO-positive group. Conclusion: The study highlights a higher frequency of SIBO in IBS-D compared to IBS-M. Pseudomonas was the predominant bacterium isolated in patients with SIBO. These findings suggest the need for targeted management of SIBO in IBS-D patients.
Abstract: Background: Small intestinal bacterial overgrowth (SIBO) is a condition often associated with irritable bowel syndrome (IBS), particularly IBS-D (diarrhea-predominant) and IBS-M (mixed-type). The relationship between SIBO and IBS subtypes remains poorly understood, despite its potential impact on treatment and symptom management. Methods: This obse...
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Case Report
Stercoral Ulcers with Visible Vessel Presenting as Massive Lower Gastrointestinal Bleeding
Issue:
Volume 9, Issue 1, June 2025
Pages:
37-40
Received:
3 April 2025
Accepted:
14 April 2025
Published:
24 May 2025
Abstract: Background: Lower gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality, with incidence rising with age. Stercoral ulcers, which are mucosal lesions in the colon or rectum, develop due to pressure from hardened or impacted fecal material. They primarily occur in elderly individuals with chronic constipation, dementia, or prolonged immobility, though they may also affect younger patients with psychiatric disorders. These ulcers can lead to bleeding or even perforation. While stercoral ulcers typically present with mild bleeding, massive GI haemorrhage is a rare but serious complication. Only a few reported cases describe stercoral ulcers with a visible vessel causing life-threatening lower GI bleeding. Case presentation: A 65-year-old woman with a history of hypertension, type 2 diabetes mellitus, and a recent ischemic stroke (resulting in left hemiparesis) on antiplatelet therapy presented with worsening chronic constipation and acute onset hematochezia. On examination, fecal impaction was suspected. Initial management with fluid resuscitation, blood transfusion, and manual fecal disimpaction was done. Subsequent sigmoidoscopy revealed multiple rectal ulcers of varying shapes and sizes, with one ulcer exhibiting a non-bleeding visible vessel. The lesion was successfully treated with endoscopic gold probe electrocoagulation, followed by haemostatic clip application to secure the vessel. The patient had no further bleeding episodes post-intervention. Conclusion: This case underscores the importance of proactive constipation management in elderly, bedridden patients, particularly those with multiple comorbidities and on antiplatelet therapy. Early recognition and intervention for stercoral ulcers are essential to prevent life-threatening complications such as massive gastrointestinal hemorrhage or perforation. Endoscopic therapy, including electrocoagulation and clipping, can be an effective approach for achieving hemostasis in such scenarios.
Abstract: Background: Lower gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality, with incidence rising with age. Stercoral ulcers, which are mucosal lesions in the colon or rectum, develop due to pressure from hardened or impacted fecal material. They primarily occur in elderly individuals with chronic constipation, dementia, or ...
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Case Report
Successful Use of Haloperidol for Persistent Hiccups Unresponsive to Baclofen After Esophageal Stenting
Issue:
Volume 9, Issue 1, June 2025
Pages:
41-44
Received:
8 May 2025
Accepted:
19 May 2025
Published:
18 June 2025
DOI:
10.11648/j.ijg.20250901.17
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Abstract: Background: Hiccups are common and typically self-limiting condition but can become persistent or intractable in certain conditions. Hiccups commonly occur due to rapid gastric distension, which is often triggered by quickly eating a large meal or consuming carbonated drinks. Other contributing factors include alcohol intake, spicy foods, smoking, and various irritants affecting the gastrointestinal or respiratory systems. Oesophageal stenting is a recognized, though rare, cause of persistent hiccups, usually managed effectively with baclofen. Case Presentation: We report a case of a 64-year-old man with a refractory corrosive oesophageal stricture who developed persistent hiccups following placement of a fully covered self-expandable metallic stent (fcSEMS) for oesophageal stricture management. Despite treatment with proton pump inhibitors, prokinetics, baclofen, and chlorpromazine, his symptoms persisted. Initiation of oral haloperidol (1 mg three times daily) led to rapid and complete resolution of hiccups within 36 hours, with no recurrence. Haloperidol continued for two weeks, then gradually tapered over the following two weeks before being discontinued. The stent was removed after four weeks, revealing successful stricture dilatation. Conclusion: Haloperidol may be considered as a therapeutic option for managing persistent hiccups induced by oesophageal stenting when baclofen fails. To the best of our knowledge, this is the first reported case of successful haloperidol use in such a scenario.
Abstract: Background: Hiccups are common and typically self-limiting condition but can become persistent or intractable in certain conditions. Hiccups commonly occur due to rapid gastric distension, which is often triggered by quickly eating a large meal or consuming carbonated drinks. Other contributing factors include alcohol intake, spicy foods, smoking, ...
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Research Article
Acute Kidney Injury Among Hospitalised Patients with Cirrhosis – Burden and Risk Factors
Sandeep Menon*,
Sunil Kumar Kandiyil,
Sithara Balagopal,
Kadavanoor Sreejith,
Sandesh Kolassery
Issue:
Volume 9, Issue 1, June 2025
Pages:
45-53
Received:
4 May 2025
Accepted:
19 May 2025
Published:
19 June 2025
DOI:
10.11648/j.ijg.20250901.18
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Abstract: Background and Objectives: Acute Kidney Injury (AKI) in cirrhosis is a major determinant of morbidity and mortality. This study aims to assess the proportion, common predisposing factors and the mortality rate of hospitalised patients with AKI and cirrhosis. Methods: A single-center, longitudinal study was done in our setting including 186 patients with cirrhosis hospitalized to ward or ICU. AKI was diagnosed and staged as per ICA-AKI criteria. The proportion of AKI was calculated in percentage. Risk factors for AKI were recorded and their association was tested by chi-square test. Patient outcome (in terms of survived or deceased) was recorded and mortality rate was calculated in terms of percentage. Results: Proportion of AKI in hospitalized patients with cirrhosis was 39.7% (74/186). Alcoholic liver disease, NAFLD & hepatitis-B related cirrhosis comprised more than 90% of cirrhosis. Most patients with AKI had advanced stages of cirrhosis (CTP-A: 8, CTP-B: 18, CTP-C: 48). The common predisposing factors for AKI in cirrhotic patients were variceal bleeding (44.6%) and SBP (29.7%), while less common risk factors were infections like UTI (7%), LRTI (4%) and cellulitis (1.4%), along with large volume paracentesis (9.5%), recent over diuresis (8%), nephrotoxic drug intake (2.7%) and dehydration (1.4%). Most of the patients with cirrhosis who developed AKI had early stages of AKI. The mortality rate among hospitalized patients with cirrhosis and AKI was 32.4%. AKI was found to have a significant association with patient’s survival in cirrhosis. Conclusion: Burden of AKI, in terms of prevalence, morbidity as well as mortality among hospitalized patients with cirrhosis is significantly high in our region. Patients with definite predisposing factors require close monitoring for early detection of renal impairment.
Abstract: Background and Objectives: Acute Kidney Injury (AKI) in cirrhosis is a major determinant of morbidity and mortality. This study aims to assess the proportion, common predisposing factors and the mortality rate of hospitalised patients with AKI and cirrhosis. Methods: A single-center, longitudinal study was done in our setting including 186 patients...
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