Endoscopic findings in patients with persistent dyspepsia in a tertiary care hospital of South Punjab

Background: One of the most common clinical problem encountered by physicians in clinical practice is dyspepsia. This symptom has great impact on quality of life of patients. There are numerous causes of dyspepsia, organic as well as functional. Endoscopy is the diagnostic test of choice in these patients. Aim: The aim of our study was to see the endoscopic findings in patients with persistent dyspepsia. Methods: Retrospective analysis of data of patients who underwent Esophagogastroduodenoscopy (EGD) for persistent dyspepsia was collected and evaluated. Results: There were 495 patients in our study, 244 females and 251 males, with a mean age of 41 years. Almost half of the patients belonged to 21-40 years age group. The most common endoscopic finding in patients with persistent dyspepsia was gastritis (n=219, 44.2%), followed by normal endoscopy (n= 94, 19%), incompetent lower esophageal sphincter (n=67, 13.5%), gastric malignancy (n=48, 9.7%). Ulcer disease was found in just 15 patients (3%). Conclusion: Most common endoscopic finding in patients with persistent dyspepsia was gastritis followed by normal endoscopy. Key Words: dyspepsia, endoscopy

Association between Endoscopic Findings Vs. Serology Findings of Patients with Suspected Celiac Disease

Objective: To determine the association between endoscopic findings vs. serology findings of patients with suspected celiac disease Methods: All the suspected cases (based on their clinical manifestations) of celiac disease were initially recruited having age >14 years and <40 years of both gender. Patients who did not willing to participate, patients already taking gluten diet for more than 3 months, patients with other causes of chronic diarrhea and alternate diagnosis like thyrotoxicosis, whipple’s disease, giardiasis, patients with drug induced diarrhea, patients in whom we cannot perform endoscopy, pregnant women, and patients already diagnosed cases of celiac disease were excluded from this study. Celiac disease was confirmed based on positive anti-tTG antibodies. Endoscopic evaluation of duodenum was performed in all positive cases. Results: A total of 50 patients were recruited for final analysis. Diagnostic accuracy of endoscopy was 34.6%. Young population (31.14±6.07 years) with females predominance (72%, n=36) were more common than males. The most common symptoms were presence of chronic diarrhea (74%, n=37) followed by abdominal pain (52%, n=26), nausea & vomiting (34%, n=17), and least common was presence of constipation (2%, n=1). On endoscopic evaluation, out of 50 positive anti-tTG antibodies cases, 24 had normal mucosa while partial villous atrophy observed in 15 (30%) cases and total villous atrophy observed in 11 cases (22%). Conclusions: Celiac disease was more prevalent in young females and patients usually presents with history of chronic diarrhea. Anti-tTG antibodies have more diagnostic value than duodenal endoscopy. Villous atrophy was found in more than 50% of the patients who were diagnosed with celiac disease.

Endoscopic Findings of Gastro-Esophageal Reflux Disease in Elderly and Younger Age Groups

Objective: To determine and compare the clinical features and endoscopic findings of gastro-esophageal reflux disease (GERD) in elderly and younger age groups.Materials and Methods: The clinical and endoscopic features were evaluated for all patients with GERD between January 2017 and September 2020. The criteria for inclusion were being aged over 65 and under 50 years and having an upper gastrointestinal endoscopy with reflux symptoms resistant to ppi theraphy. The exclusion criteria included prior surgery, age under 18 years, and pregnancy. The diagnosis of GERD was made according to the patients' symptoms. The SPSS 11.0 for Windows pocket program was used for statistical analysis.Results: Two hundred eighty-six patients aged over 65 years and 261 patients aged below 50 years were enrolled in this study. The mean age of the older group was 68.2 ± 4.5 years and the mean age of the young group was 38 ± 7.2 years. The male/female ratio was 5/3 and 2/1 in the young and older groups, respectively. The older patients had less severe and rare typical symptoms than the young patients. However, significantly more serious endoscopic findings were noted in the older patients compared with the younger patients.Conclusion: The older and young patients with GERD were predominantly male and typical reflux problems were less common in older patients with GERD. Older patients had more important endoscopic findings such as hernia, esophagitis, and cancer.

The Yield of Endoscopy and Histology in the Evaluation of Esophageal Dysphagia: Two Referral Centers’ Experiences

Background and Objectives: The initial diagnostic test required to evaluate esophageal dysphagia is upper endoscopy (EGD) to assess the structure of the esophagus and the esophageo-gastric junction (EGJ). Taking biopsies during EGD has become a common practice in patients with dysphagia to rule out eosinophilic esophagitis (EoE). The aims of this study were to evaluate the endoscopic findings of patients who underwent EGD for esophageal dysphagia, to assess the rate of biopsy taking from the esophagus to diagnose/exclude EoE, and to report histology outcomes of these biopsies. Materials and Methods: This was a retrospective multicenter study that included individuals ≥18 years who underwent EGD due to esophageal dysphagia between the years 2015 and2020, (with no other alarm signs, such as weight loss, new iron deficiency anemia, and lymphadenopathy). We obtained data from patients’ electronic files. The endoscopy and histology findings were obtained from endoscopy reports saved in our electronic files. Results: A total of 209 patients were included in the study. The average age was 57.1 ± 17.1 years. The most common endoscopic findings were normal endoscopy in 76 patients (36.4%) and erosive esophagitis in 75 patients (35.9%). Barrett’s esophagus and esophageal malignancy were encountered in 11 patients (5.3%) and 2 patients (0.95%), respectively. Esophageal biopsies were taken in 50.2% of patients, and one patient had histological evidence of EoE (0.5%). On univariate analysis, there was a trend for association between proton pump inhibitors (PPIs) use and a normal EGD, but it was not statistically significant (OR 0.28, 95% CI 0.07–1.11, p = 0.07). Conclusions: Endoscopic findings were prevalent in dysphagia patients even when no other alarm symptoms exist. Neoplastic lesions and EOE were rare in our study.

Endoscopic Evaluation of Dyspeptic Patient in Tertiary Care Hospital

Objectives: To observe the organic change occurs in dyspeptic patient by upper gastrointestinal endoscopy. Methods: The present prospective, observational, cross-sectional study was conducted at Medicine and Gastroenterology department of Sir Salimullah Medical College & Mitford Hospital, over a period of 6 month from 2019 to 2020.The study population was 200with aged18 years and above, irrespective of sex and who were suffering from dyspeptic symptoms for at least 6 months duration. Data regarding the demographic profile of study population nand endoscopic findings were processed and analyzed using software SPSS (Statistical Package for social science) version 26. Results: It was observed that most of the dyspeptic patients 71%were showing normal endoscopic findings and 29% have abnormal endoscopy findingwhere majority of the patient were 51 – 70 years of age.Out of them 41% of male and 26% of female had organic changes. It was also found that 46% of the patients were smoker and among them 34(37%) had abnormal endoscopic finding where 24(22%) non-smokerpatient had abnormal finding, which were statistically significant (p,0.05) between two group. Among abnormal endoscopic finding, 11% gastric erosions, 08% gastric ulcer, 04% duodenal erosions, 03% duodenal ulcer, 02% reflux oesophagitis, and carcinoma stomach rare 01%. Conclusion: The study concludes that majority of patients with complaints of dyspepsia have no organic lesion and can be considered non ulcer dyspepsia. The common abnormal endoscopic findings included gastric erosion and gastric ulcers relating to dyspepsia. The study findings also suggest that smoking is a risk factor for developing organic changes in dyspeptic patients specially in middle age group. Bangladesh J Medicine July 2022; 33(1) : 3-7

A Gastric Metastatic Lesion That Resembled Early-Stage Gastric Cancer on Endoscopy during Treatment for Recurrent Breast Cancer: A Case Report

Breast cancer metastasis to the gastrointestinal tract is relatively rare. Patients with such disease often develop gastrointestinal symptoms, but it is sometimes asymptomatic. Endoscopic findings of gastric metastasis from breast cancer markedly vary from benign to malignant, and even in suspected malignant cases, it is often difficult to differentiate between primary and metastatic disease. We experienced a case in which an endoscopic examination performed during the treatment for metastatic breast cancer resembled an early-stage gastric cancer. A 71-year-old woman underwent curative surgery for right breast cancer 16 years previously. She underwent endoscopic submucosal dissection for early-stage gastric cancer 5 years ago. Two years ago, she developed metastatic disease in the lungs and mediastinal lymph nodes, and endocrine therapy was administered. At the same time, a follow-up endoscopy revealed a new elevated lesion, suspected to be an early-stage gastric cancer. However, histological diagnosis of the biopsy was metastasis of breast cancer. One and a half years later, a follow-up endoscopy revealed a gastric lesion that had reduced in size. She is still alive, having received a variety of systemic treatments. Patients with metastatic breast cancer are experiencing prolonged survival. Thus, follow-up endoscopy should be considered after the diagnosis of gastrointestinal metastasis considering the risk of lethal conditions, such as gastrointestinal bleeding and perforation. Our case serves as a reminder to clinicians how difficult it is to determine whether a gastric lesion is primary or metastatic based on endoscopic findings and the importance of communication with endoscopists and pathologists.