NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY最新文献

{"title":"Cirrhotic ascites: A review of pathophysiology and management","authors":"S. Mustapha","doi":"10.4103/NJGH.NJGH_4_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_4_20","url":null,"abstract":"Ascites describes the condition of pathologic fluid accumulation in the peritoneal cavity. Cirrhosis is the most common cause of ascites worldwide, with a half of cirrhotic patients developing ascites within 10 years of diagnosis. The “underfill” and “overflow” theories have traditionally been used to explain the pathogenesis of ascites in cirrhosis. However, with advances in hemodynamic and neurohumoral studies, it has been shown that neither of these theories fully explains the pathophysiologic mechanisms involved. The key roles of portal hypertension and vasodilators such as nitric oxide (NO) in the process of ascites formation have now been recognized. This led to the proposal of the peripheral arterial vasodilatation theory which includes components of both the “underfill” and “overflow” theories. Recently, the role of gut bacteria in the pathogenesis of ascites has been demonstrated. Bacterial translocation is now known to be a key event preceding the onset of ascites. Bacterial DNA and endotoxin have been shown to stimulate NO synthesis. This led to the proposal of a modified version of the vasodilatation hypothesis, “the systemic inflammation hypothesis,” which proposes that translocated bacteria or their products stimulate the release of proinflammatory cytokines which in turn stimulate NO synthesis. Cardiac dysfunction (cirrhotic cardiomyopathy) has also been described in cirrhosis and is believed to contribute to the reduction in effective circulating volume which stimulates renal sodium and water retention. Initial treatment measures include salt restriction and diuretics. Drugs known to reduce glomerular perfusion or directly toxic to the kidneys must be stopped. Initial therapeutic paracentesis should be done in those presenting with tense ascites. There is no need for albumin infusion if the amount of fluid removed is less than 5 liters. For those with refractory ascites, beta-blockers should be stopped. Treatment options include aquaretics; serial large-volume paracentesis with albumin infusion or midodrine in place of albumin; transjugular intrahepatic portosystemic shunt; peritoneovenous shunt; low-flow ascites pump; and liver transplantation.","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124276327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronavirus and gastroenterology practice","authors":"N. Chuks","doi":"10.4103/NJGH.NJGH_13_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_13_20","url":null,"abstract":"","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129476573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal cancer screening guidelines for Nigeria in 2019","authors":"O. Alatise, O. Olasehinde, A. Olokoba, B. Duduyemi, O. Famurewa, O. Adeyemi, E. Agbakwuru, A. Asombang","doi":"10.4103/NJGH.NJGH_15_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_15_20","url":null,"abstract":"Colorectal cancer (CRC) is a major public health issue in Nigeria. The incidence is rising, and majority of the patients diagnosed with CRC, die of the disease burden. CRC is an ideal cancer for screening and early detection. It has been well documented that screening for CRC, by a variety of methods, leads to a sustained reduction in mortality from the disease in two ways: increased detection of early stage with more curable cancer and detection and removal of adenomas, which are known precursors to CRC. Screening has also been shown to be cost-effective in terms of quality-adjusted life-years gained compared to nonscreening. CRC screening can be approached as an organized program or on an opportunistic basis. Opportunistic screening is the only option in systems that lack the resources, infrastructure, and framework needed for an organized approach. A myriad of CRC screening tests exist, which can be divided into two main categories namely biological sample-based tests, which include fecal, blood, and urine tests, and colonic structure-based tests, which include flexible sigmoidoscopy, colonoscopy, and imaging studies such as computed tomography colonography, magnetic resonance imaging colonography, and double-contrast barium enema. The recommendation for CRC screening includes offering patients the opportunity to select test, based on their preference, affordability, and test availability. This decision-making process is personalized and requires an understanding between the patient and doctor. This guideline reviews the available evidence and makes recommendation on the screening method for CRC in Nigeria.","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126802401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic study of colonic polyps in South Western Nigeria","authors":"A. Akere, U. Ezenkwa, A. Oluwasola","doi":"10.4103/NJGH.NJGH_5_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_5_20","url":null,"abstract":"Background and Aim: Colorectal cancer (CRC) is known to be a major cause of morbidity and mortality worldwide. It is believed that CRC develops from adenomas or benign adenomatous polyps. Information concerning this premalignant condition in Nigeria is still relatively scarce. The aim of this study was to describe the clinicopathologic features of colorectal polyps seen in patients who had colonoscopy at the University College Hospital, Ibadan, Nigeria. Patients and Methods: This was a descriptive cross-sectional study carried out at the Endoscopy Unit of the University College Hospital, Ibadan, Nigeria. Colonoscopy was performed on the patients after bowel preparation. Polyps were characterized by their colonic location, size in millimeter, and histopathological diagnosis. The data were analyzed using SPSS version 17.0. Results: The patients comprised 65 (58.0%) males and 47 (42.0%) females. The mean age was 60 ± 12.5 years, with majority being in the age range of 51–60 years. The most common indication for colonoscopy was hematochezia. The location of the polyps was as follows: 41 (36.6%) in the rectum, 30 (26.8%) in the sigmoid colon, and 22 (19.6%) each in the transverse and descending colon. In 51 (45.5%) patients, polyps were <5 mm in size; 5–10 mm in 48 (42.9%) patients; and >10 mm in 13 (11.6%) patients. The most frequent histological diagnosis was adenomatous polyp. Conclusion: Polyps were found more commonly in males and in individuals aged 50 years and above. The most common location is the rectosigmoid colon, and the polyps are majorly adenomatous. Our findings suggest the need for colonoscopy service to be made more widely available across the country so as to contribute to reduction in CRC incidence among Nigerians.","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"541 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131716119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The colon in health and disease","authors":"S. Nwokediuko","doi":"10.4103/NJGH.NJGH_12_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_12_20","url":null,"abstract":"","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"367 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116589471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defecation frequency and stool form in rural and urban african settings","authors":"S. Nwokediuko, U. Ijoma, O. Obienu, E. Young, G. Anigbo, C. Onyia, Ugochukwu Nwoko","doi":"10.4103/NJGH.NJGH_2_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_2_20","url":null,"abstract":"Background: Evaluation of patients who present with diarrhea and constipation requires a good knowledge of what constitutes normal defecation frequency and stool form. This study was designed to determine the normal defecation frequency and normal stool form in adult rural and urban dwellers in Southeast Nigeria. Materials and Methods: This was an observational, descriptive, cross-sectional, questionnaire-based study of adults in rural and urban settings in Southeast Nigeria. Defecation frequency was recorded as number of bowel motions per week, while stool form was determined with the use of the Bristol stool scale. Variables included in the questionnaire were age, sex, occupation, level of education, use of alcohol, cigarette smoking, use of kolanut, use of coffee, and body mass index. Data were analyzed with SPSS v 23. Results: There were 670 participants (61.6% females and 56.7% rural dwellers). The 25 and 75 percentiles of the stool form were Bristol types 3 and 4, while the 25 and 75 percentiles of defecation frequency were 7 and 14. Defecation frequency was higher in males than females (P = 0.006), while stool form was significantly affected by age (P = 0.001), sex (P = 0.041), and place of abode (P = 0.001). Conclusion: In Southeast Nigeria, normal defecation frequency is between 7 and 14 bowel motions per week, while normal stool forms are Bristol types 3 and 4. Age, sex, and place of abode significantly affect defecation frequency and stool form.","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"2000 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126032624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The outcome of modified Heller's myotomy for achalasia: A 3-center study in Nigeria","authors":"N. Anumenechi, S. Edaigbini, Achike Ezeanwu, I. Delia, M. Aminu, I. Alioke","doi":"10.4103/NJGH.NJGH_6_20","DOIUrl":"https://doi.org/10.4103/NJGH.NJGH_6_20","url":null,"abstract":"Background: Achalasia is a rare disease. The present standard treatment is laparoscopic Heller's myotomy. Some centers still use thoracoscopy, thoracotomy, or laparotomy. Newer approaches such as the per-oral endoscopic esophagomyotomy are being evaluated. Objectives: The objective of the study was to review the diagnostic procedures for achalasia cardia and the therapeutic approaches being used in the study centers and to evaluate the dysphagia and reflux esophagitis outcomes and the occurrence of operative complications. Methods: This is a retrospective study over 10 years (2008–2017) from three centers in Nigeria. The clinical and operative records were reviewed. The route and outcome of modified Heller's myotomy for achalasia cardia were reviewed. Results: The total number of cases was 16. The male-to-female ratio was 1:1, and age ranged from 3 to 55 years. Diagnosis was done by clinical features and barium swallow test. Two of the 16 cases were done via the laparotomy approach, while the remaining 14 were achieved via a left thoracotomy. Only in one case was fundoplication done. Perioperative mortality was zero. Overall long-term dysphagia and reflux outcomes were satisfactory. Conclusion: Clinical and radiological features are predominantly used to diagnose achalasia; esophageal manometry was not available. Surgery was predominantly done by the thoracotomy approach, with occasional fundoplication.","PeriodicalId":354969,"journal":{"name":"NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132682514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}