Euroasian Journal of Hepato-Gastroenterology

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2022 | July-December | Volume 12 | Issue 2

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Sheikh Mohammad Fazle Akbar, Hasan Ozkan, Mamun Al-Mahtab

The Journal Moving to an Adult State

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ejohg-12-2-iv  |  Open Access |  How to cite  | 


Original Article

Mehmet Can Taşkın, Ahmet Uyanikoglu, Cigdem Cindoglu

Evaluation of HBsAg Seroclearance in Patients with Hepatitis B

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:4] [Pages No:65 - 68]

Keywords: Chronic hepatitis B infection, HBsAg seroclearance/seroconversion

   DOI: 10.5005/jp-journals-10018-1352  |  Open Access |  How to cite  | 


Objective: Hepatitis B surface antigen (HBsAg) seroclearance/seroconversion is regarded as an indicator of the ultimate immune control of hepatitis B virus (HBV) infections. HBsAg loss is the most important endpoint, as it shows deep suppression of HBV replication and viral protein expression. This study was aimed to retrospectively evaluate the HBsAg seroclearance/seroconversion status in patients with acute or chronic hepatitis B (CHB) diagnosis. Materials and methods: Patients diagnosed with acute or CHB at the Harran University Faculty of Medicine Department of Gastroenterology between January 2012 and December 2020 were included in this study. This study was designed as a retrospective historical cohort. Experimental analysis of the data was done with the help of the SPSS version 22.0 package program. Results: Of 1,053 patients with positive HBsAg, 854 patients with sufficient data in their files were included in this study. There were 494 (57.8%) males and 360 (42.2%) females; the mean age was 42.71 ± 14.31 (range 18–88). The mean duration of illness was 86.13 ± 72.92 months. In the 9-year follow-up of 854 patients, 65 (7.9%) of the last HBsAg test were negative and seroclearance had developed. The last anti-HBs test was positive in 49 (75.4%) of 65 patients who developed seroclearance, and it was found that seroconversion had developed. Twenty-seven of 30 (90%) of the patients who developed seroclearance had liver transplantation. Sixteen of 19 (84.2%) of them had acute hepatitis B, 14 of 477 (2.9%) were hepatitis carriers, 5 of 201 (2.5%) had e-negative CHB, 2 of 36 (5.6%) had cirrhosis, and 1 of 43 (2.3%) of them were delta hepatitis who developed seroclearance disease; none of the 38 e-positive CHB patients developed seroclearance. Conclusion: In the 9-year follow-up of patients who were positive for HBsAg at their first admission, approximately one-tenth (7.9%) developed seroclearance, and two-thirds also developed seroconversion. After liver transplantation and acute hepatitis B, almost all patients developed seroclearance, whereas, in approximately 3% of carriers (e-negative CHB and cirrhotic patients) seroclearance developed.


Original Article

Zain Majid, Ghazi Abrar, Syed Mudassir Laeeq, Shoaib Ahmed Khan, Hina Ismail, Ghous Bux Soomro, Nasir Mehmood, Abbas Ali Tasneem, Farina Muhammad Hanif, Rajesh Mandhwani, Nasir Hasan Luck

Clinical Characteristics and Comparison of Different Prognostic Scores in Wilson's Disease

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:4] [Pages No:69 - 72]

Keywords: Child–Turcotte–Pugh score, Dhawan score, Hepatic disease, Kayser-Fleischer rings, Model for End-stage Liver Disease Score, Nazar score, Neurological symptoms, Pakistan, Wilson's disease

   DOI: 10.5005/jp-journals-10018-1379  |  Open Access |  How to cite  | 


Aim: Wilson's disease (WD) is a rare autosomal recessive disease, that can involve any organ of the body, the main ones being the liver and the brain. These patients can have varied presentations, ranging from having no symptoms to having neurological manifestations to features of chronic liver disease (CLD). Those patients that end up having CLD are prognosticated via the Child–Turcotte–Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) score. However, two specific scores exist for prognostication in patients having WD, namely, the Nazar score and the Dhawan score. However, these are yet to be validated nor has their use been implemented in clinical practice. Materials and methods: Our study involved 65 patients with WD, comprising both the pediatric and the adult population. We aimed at evaluating the clinical manifestations the lab parameters and the management of these patients. Furthermore, we tried validating the Nazar and the Dhawan score and later compared them with the CTP and the MELD score, which are well-known prognostic tools in CLD. Results: Our patients were subdivided into the pediatric (more than 50%) and the adult group. The most common presenting complaint noted in both groups was abdominal distension. Values of the urine copper and serum ceruloplasmin did not defer between the pediatric and adult patients. Hepatic involvement is frequently seen in the pediatric age-group. Also, CTP class C was chiefly seen in pediatrics 17/33 (51.5%), while CTP class B was in adults 13/32 (40.6%). The mean Nazar score was 3 ± 3, while the mean Dhawan score was 5 ± 4. The main treatment offered for both groups was zinc along with penicillamine. Conclusion: Our study showed the Dhawan score was comparable to the CTP and the MELD score in terms of predicting the disease severity of WD in our patient population.


Original Article

Shahid Rasool, Sofia Hanif, Aneeqa Ahmad, Umair Shafqat, Ahmad Nawaz Babar

Frequency of De Novo Hepatocellular Carcinoma after Direct-acting Antiviral Therapy for Chronic Hepatitis C: A Prospective Follow-up

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:4] [Pages No:73 - 76]

Keywords: Cirrhosis, Direct acting antiviral, Hepatocellular carcinoma

   DOI: 10.5005/jp-journals-10018-1383  |  Open Access |  How to cite  | 


Background: Chronic hepatitis C (CHC) management has changed tremendously after direct-acting antivirals (DAAs) availability. Sustained virological response (SVR) has improved significantly, but one of the major concerns is the chances of de novo hepatocellular carcinoma (HCC) development after DAAs. The objective of the study is to calculate the frequency of newly diagnosed cases of HCC after antiviral therapy for CHC in Pakistan. Materials and methods: This prospective, interventional research was conducted from June 2017 to September 2020. All patients after antiviral therapy for CHC were followed with an ultrasound abdomen and α-fetoprotein, six monthly. Multiphasic computed tomography (CT) of the abdomen was performed in suspected cases. For quantitative variables, the mean and standard deviations were calculated, whereas the qualitative variables were analyzed by frequencies and percentages. Results: Among 180 patients, 110 were men and 70 were women with a mean age of 45.52 ± 11.71 years. One hundred and twenty-six patients were noncirrhotic, 38 had compensated cirrhosis while 16 had decompensated cirrhosis. One hundred and sixty-four (91.11%) patients achieved SVR, of which 22 (12.22%) patients developed new HCC during follow-up. Compensated cirrhosis group had 10 patients, the decompensated group had 12 patients, and the noncirrhotic group had no new HCC cases. Among patients with the new HCC, 12 achieved SVR. Conclusion: The risk of the development of HCC after antiviral treatment is highly significant among patients with liver cirrhosis. So, a strict surveillance strategy should be adopted in every cirrhotic patient following treatment with DAA agents even if they achieve SVR. Clinical significance: • Chances of developing HCC are still significantly high even after achieving SVR with DAAs in patients with liver cirrhosis. • Patients with liver cirrhosis should be under surveillance for HCC even after achieving SVR after DAAs treatment.



Zain Majid, Shoaib Ahmed Khan, Nishat Akbar, Muhammad Ali Khalid, Farina Muhammad Hanif, Syed Mudassir Laeeq, Nasir Hassan Luck

The Use of Albumin-to-bilirubin Score in Predicting Variceal Bleed: A Pilot Study from Pakistan

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:4] [Pages No:77 - 80]

Keywords: Albumin-to-bilirubin score, Cirrhotic, Variceal Gastrointestinal bleed

   DOI: 10.5005/jp-journals-10018-1378  |  Open Access |  How to cite  | 


Variceal hemorrhage is a serious consequence of patients having chronic liver disease (CLD). Various scores exist that predict the outcome for non-variceal bleed. However, only a few scores evaluate patients with variceal bleed. We, in our study, evaluated 48 cirrhotics who presented with variceal gastrointestinal (GI) bleed over a period of 3 months. Majority of these were males and the most common etiology was hepatitis C infection. The main presenting complaints were hematemesis seen in 39.6% followed by hematemesis and melena in 31.25%. Most bleeding episodes were secured via banding in 62.5% followed by injection of histoacryl in 12.5%. Finally, Child–Turcotte–Pugh (CTP), model for end-stage liver disease (MELD), albumin-to-bilirubin (ALBI), and the ABC score were applied and none correlated with the presence of esophageal varices. However, the ALBI score did correlate with the presence of tachycardia in our study, a pertinent sign of upper GI bleed.



Shah Naveed, Saquib Zaffar Banday, Hasina Qari, Sheikh Zahoor, Azhar Jan Batoo, Mir Abdul Wahid, Mohd Fazl Ul Haq

Impact of the Interval between Neoadjuvant Chemotherapy and Gastrectomy on Pathological Response and Survival Outcomes for Patients with Locally Advanced Gastric Cancer: A Meta-analysis

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:11] [Pages No:81 - 91]

Keywords: Gastric cancer surgery, Neoadjuvant chemotherapy, Overall survival

   DOI: 10.5005/jp-journals-10018-1382  |  Open Access |  How to cite  | 


Background: It is still unknown what is the appropriate time between neoadjuvant chemotherapy (NACT) and gastrectomy in cases of gastric cancer. To comprehend the relationship more clearly between waiting time after NACT before having a gastrectomy and survival results, a meta-analysis was done. Methods: Retrospective and prospective research from the PubMed, Embase, and Cochrane Library databases were thoroughly reviewed. Research examining the impact of delays of 4, 4–6, and above 6 weeks between the conclusion of NACT and surgery in patients with locally advanced gastric cancer qualified as eligible studies. The pathologic complete response (pCR) rate served as the main outcome indicator. Additional outcome metrics were overall survival (OS) and survival free of illness. Results: The meta-analysis showed that patients with locally advanced gastric cancer with a waiting time for surgery of above 4 weeks compared to those with a waiting time for surgery of below 4 weeks saw a significantly higher pCR rate (pCR) [odds ratio (OR): 1.67; 95% confidence interval (CI): 1.07–2.60; p = 0.02]. The meta-analysis found no appreciable OS differences [hazard ratio (HR): 0.93; 95% CI: 0.76–1.13; p = 0.44). Conclusions: Time to surgery (TTS) had no effect on the survival results, according to our data. Only in the group where delaying surgery by more than 4 weeks after the end of NACT improved pathological response, but had no effect on survival.



S Balamurugan, M Mohammed Aslam, D Kadambari, Rajkumar Nagarajan

Closed-bowel Loop Obstruction—An Unusual and Forgotten Complication of Feeding Jejunostomy: Case Report

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:3] [Pages No:92 - 94]

Keywords: Bowel loop obstruction, Complications, Feeding jejunostomy, Gastrointestinal surgery, Laparotomy

   DOI: 10.5005/jp-journals-10018-1377  |  Open Access |  How to cite  | 


Feeding jejunostomy (FJ) is done as a part of significant upper gastrointestinal surgical procedures for patients who cannot tolerate enteral feeds. This procedure is related to different mechanical, infective, and metabolic inconveniences. However, closed-bowel loop obstruction following FJ is rare. We report an unusual complication of closed-bowel loop obstruction in the postoperative period of FJ done for a locally advanced carcinoma of gastroesophageal (GE) junction for enteral access in a 67-year-old male patient. This patient required an emergency laparotomy, to forestall exacerbating of abdomen distension which could have led to gastric ischemia and perforation following obstruction. A redo FJ was done, and the patient had an uneventful postoperative recovery. Therefore, surgeons should have high clinical suspicion for a rarer complication like a closed-loop obstruction in a patient with upper abdominal pain and distension without vomiting following FJ.



Satyam Satyam, Kaustav Jain, Gaurav Pradhan

Necrotizing Colitis with Perforation Proximal to Obstructive Ascending Colon Cancer: A Case Report

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:3] [Pages No:95 - 97]

Keywords: Colorectal cancer, Mucinous adenocarcinoma, Necrotizing colitis

   DOI: 10.5005/jp-journals-10018-1381  |  Open Access |  How to cite  | 


Background: Necrotizing colitis (NC) with perforation is a rare complication of the obstructive cancer of the right colon. Case description: We report here a case of a 45-year-old female patient of mucinous adenocarcinoma of ascending colon, which presented as acute NC with perforation proximal to obstructing colonic carcinoma with their imaging features on computed tomography (CT). The purpose of this article is to highlight the role of CT in distinguishing an ischemic and a tumoral segment in the carcinomas complicated by proximal bowel ischemia. Conclusion: Imaging plays a great role in distinguishing an ischemic and a tumoral segment in carcinomas complicated by proximal bowel ischemia. The identification of NC will help to accurately stage colonic cancer.



Satyam Satyam, Snehal Kose, Sapna Singh, Anjali Prakash, Anju Garg

Multidetector Computed Tomography Angiography Role in Diagnosing Superior Mesenteric Arteriovenous Fistula with Superior Mesenteric Vein Thrombosis: A Case Report

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:4] [Pages No:98 - 101]

Keywords: Computed tomography angiography, Superior artery mesenteric vein thrombosis, Superior mesenteric arteriovenous fistula

   DOI: 10.5005/jp-journals-10018-1380  |  Open Access |  How to cite  | 


Introduction: Arteriovenous fistulas (AVF) of the superior mesenteric vasculature are rare vascular abnormalities. It often occurs due to iatrogenic injuries during bowel resection or abdominal traumas. As the patient exhibits a variety of signs and symptoms and can present late, diagnosis may be difficult. Multidetector computed tomography (MDCT) is the most common modality for imaging the small bowel, vessels, and mesentery in patients with mesenteric ischemia. Case presentation: We present the case of a 25-year-old man who presented with features of acute intestinal obstruction and was operated on in an emergency. Resection of gangrenous small bowel and bowel adhesiolysis with double barrel ileostomy was performed. During exploratory laparotomy, gangrenous bowels were found, but no cause of mesenteric ischemia could be delineated. Finally, on computed tomography angiography (CTA) superior mesenteric arteriovenous fistula (SMAVF) with superior mesenteric vein (SMV) thrombosis was diagnosed. The patient was advised of aggressive anticoagulant therapy. Conclusion: Computed tomography angiography has become the most reliable diagnostic modality to confirm the diagnosis and guide the best treatment strategy.



Himani Narula Khanna, Sushovan Roy, Aqsa Shaikh, Viswanath Bandi

Emerging Role and Place of Probiotics in the Management of Pediatric Neurodevelopmental Disorders

[Year:2022] [Month:July-December] [Volume:12] [Number:2] [Pages:7] [Pages No:102 - 108]

Keywords: Dysbiosis, Gut-brain axis, Neurodevelopmental disorders, Psychobiotics

   DOI: 10.5005/jp-journals-10018-1384  |  Open Access |  How to cite  | 


The current decade has witnessed significant developments with the latest therapeutic agents for managing various infectious diseases to complex hemato-oncological conditions, leading to a decrease in morbidity and mortality, while improving the quality of life (QoL), and increasing the life span. Non-communicable diseases (NCDs), which are on the rise across all age-groups, are being driven by unhealthy lifestyles and improved mental health issues. The current therapeutic agents were found to offer only symptomatic relief of varying efficacy and significant adverse effects, leading clinicians to evaluate other options for the management of both neurodevelopmental and neurodegenerative disorders. The role of gut microbiota has emerged as a potential target for the treatment of both neurodegenerative diseases and neurodevelopmental disorders like attention-deficit hyperactivity disorder (ADHD)/autism spectrum disorders (ASD) as a result of the decoding of the human genome and advances in our understanding of the human gut microbiome, including its interactions with the human brain. This review has been undertaken to understand on date level of understanding of human microbiota and towards identifying probiotic strains with proven efficacy and safety. According to recent investigations, several lactobacillus strains, including L. Paracasei 37, L. Planetarium 128, L. reuteri DSM 17938, and Bifidobacterium longum, have been effective in treating children's neurodevelopmental disorders such as ASD and ADHD. Future clinical studies are nonetheless required to confirm the long-term safety and effectiveness of probiotic strains in managing the primary and comorbid symptoms, hence improving patient and family quality of life.


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