Biography:

Dr. Vito Annese achieved his MD in 1981 and subsequently the CCST in Internal Medicine and Gastroenterology at the Catholic University of Rome Italy. He has over 30-years of experience in gastroenterology, with specific interest in functional and inflammatory bowel disorders. He authored more than 250 peer reviewed publications. In the last 10-years he has been head of Gastroenterology at the Research Hospital of S. Giovanni Rotondo and at the University Hospital Careggi of Florence and aggregate professor at the University of Foggia and Florence in Italy. Since September 2016 is Consultant Gastroenterologist at the Valiant Clinic of Dubai.  

Abstract:

The introduction of anti-tumor necrosis factor alpha (anti-TNFa) antibodies about two decades ago, has revolutionized the management of inflammatory bowel disease (IBD). However, they are also expensive and their cost can lead to restricted access for many patients. Inflximab has been the first anti-TNFα agent to be used and the first to lose the patent, whereas CT-P13 (Celltrion) has been the first infliximab biosimilar to be available. The clinical trial program of CT-P13 have been performed in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Both were randomized, double-blind, multinational trials with 30 weeks of treatment, subsequently followed-up to 54 weeks with a further open-label 48-week extension and switch from infliximab to CT-P13. All these studies have demonstrated pharmacokinetic equivalence and clinical efficacy in both AS and RA up to 102 weeks, also after switching. The indication of CT-P13 has been extended since 2013 by EMA and more recently by FDA and Health Canada also to IBD.

So far no controlled trials are available in IBD, therefore we have made an extensive review of the available open label case series of IBD patients treated across the world. More than 600 IBD patients were evaluated, 39 in paediatric age, and 183 switched from inflximab. In most cases, only a clinical evaluation was performed. The mean efficacy was 72%, the rate of adverse events 10.4%, and the rate of infusion reactions was 5.5%. These findings are very much comparable to the experience with infliximab, waiting for the data of the controlled trials.  

Biography:

I have been working as a surgeon, initially as a Senior House Officer (SHO) and subsequently as a Consultant, since 2001. My multi-annual work at Greece’s biggest hospital (“Evangelismos” Hospital in Athens) provided me with extensive experience and offered me outstanding surgery skills, in particular in the field of Laparoscopic Surgery. My internships in various prestigious Hospitals in Paris and London as well as my work as a full time Surgeon at the Department of Gastrointestinal Surgery-European School of Laparoscopic Surgery, Saint-Pierre University Hospital in Brussels, Belgium, have further enhanced and improved my surgery skills in Laparoscopic Surgery offering me with considerable expertise and excellent command of a series of techniques. More recently, I have been also started working on Intensive Robotic Surgery and have been already certified as a Console Surgeon.

Abstract:

Sleeve gastrectomy is traditionally performed with the aid of 5 to 7 abdominal trocars. We aim to present our experience concerning laparoscopic sleeve gastrectomy for morbid obesity, with a more minimal invasive approach, using three ports- trocars. Laparoscopic Sleeve Gastrectomy (LSG) is traditionally performed using 5 to 7 abdominal trocars. By reducing the number of trocars, parietal trauma, pain and hernia risks can be minimized.We present our 3-year experience concerning LSG for morbid obesity using three trocars, with emphasis on a simple suture-based trocar-free liver retractor. Methods: We retrospectively analyzed 65 patients who underwent LSG for morbid obesity, from May 2014 to December 2016. Three trocars are typically used: one 10-mm periumbilical optical trocar and two 12-mm trocars on the midclavicular lines. A suture is percutaneously inserted and fixed to the right crus of the diaphragm. Careful traction lifts the left hepatic lobe offering better surgical field and access to the gastroesophageal junction. A gauze is used to protect liver parenchyma from possible injury. Furthermore, sectioning and stapling of the stomach is performed before the gastroepiploic division, reducing the need of another left sided trocar. Results: All the patients had an uncomplicated recovery. No liver injury or wound problem was mentioned. Conclusions: The placement of a suture at the right crus of the diaphragm can reduce the number of trocars, leading to less postoperative pain, risk of hernia and better cosmetic outcome without compromising the safety of the operation or the rate of postoperative complications.

Biography:

Chu Woon Ng is a general surgery Principal House officer at Bundaberg Base Hospital in Queensland, Australia. She obtained her bachelor's degree in MBBS from Queensland University in 2015. Chu is also an associate lecturer at The University of Queensland Faculty of Medicine.

Abstract:

Objective

To determine differences in procedure duration, length of stay, outcomes and cost based on types of surgery in the year 2004-5 and 2014-15.

Methods

The study design was a 10 year interval retrospective study conducted in a district hospital in Queensland, Australia. Data were extracted from hospital record for the years 2004-5 and 2014-

15.  Incomplete and inaccurate data were excluded from the study and a total of 247 records were included in final analysis. Fischer’s exact test, Chi-square test and Mann-Whitney U test with 0.05 level of significance were used. Odds ratio with 95% confidence interval were also calculated.

Results

Patients treated with laparoscopic surgery had significantly shorter hospital stay than those treated with mini-open surgery (p<0.001), and it was consistent for both time period. Antibiotic use and postoperative complications were significantly higher in mini open cholecystectomy cases (p<0.05). In both time period, laparoscopic cholecystectomy showed significantly less inpatient complications compared to mini open cholecystectomy. Lack of cost components restricts direct comparison of cost, however increased complication, antibiotic use and longer stay suggests high indirect cost in patients treated with mini open cholecystectomy.

Conclusion

Laparoscopic cholecystectomy has become the preferred management of acute cholecystitis. This research provides evidence on improved intraoperative and postoperative outcome in laparoscopic cholecystectomy compared to mini open cholecystectomy. Shorter hospital stay, less postoperative complications and less antibiotic use make this technique more cost-effective. However, longitudinal study using cost effectiveness analysis in future will provide robust conclusion.

Biography:

Mohammed  Noufal B has completed his MBBS and MD internal medicine from The Tamilnadu  Dr MGR Medical University. He is currently pursuing his post graduate course,DM  in medical gastroenterology at  the Madras Medical College Chennai,India.He has published  papers in reputed journals and conducting various research studies.

Abstract:

Introduction: Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken  the lower  esophageal sphincter by tearing its muscle fibers by generating radial force which is done endoscopically  without fluoroscopic control using  a low-compliance balloon such as  Rigiflex dilator . It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing.

Aim: To study the series of cases of  achalasia  cardia, managed  by pneumatic dilatation and observe their efficacy, outcomes and complications presenting  in our centre during the period of July 2015 to 2017

Methods: 27 cases of achalasia cardia  which presented to our centre during July 2015 to 2017  and  managed by endoscope guided  pneumatic dilatation were retrospectively analysed and their outcomes were observed.

Results: 25 of 27 patients with achalasia presented with dysphagia for solids or liquids. 20 patients had regurgitation and vomiting. Weight loss of more than 5 Kg was observed in 10 patients. History of  nocturnal cough was present in 7 patients. 35 dilatations were performed in 27 patients. All patients had  relief of dysphagia and regurgitation within 24 hours. Barium swallow within a week of dilatation  showed a decrease in the maximum  diameter of the oesophagus from 42.4 + 11.4 mm to 30.5 + 10.5 mm and increase in the diameter of the narrowed lower segment  from 2.45 + 1.5 mm to 11.4+ 2.2 mm. None of the patients  showed a hold up of  barium after dilatation. 20 patients complained of retrosternal  pain during  procedure but none persisted for 24 hours. No perforations were encountered during the study. There was no procedural mortality .

Conclusion: Endoscope-guided PD is an efficient and safe nonsurgical therapy with results comparable to other treatment modalities.

Biography:

Dr. Thinakarmani has completed his MBBS at 23 years of age from pondicherry university and MD internal medicine from Manipal university (Gold medal with award for best outgoing students ), currently working us senior resident( Final year DM post graduate ) at institute of medical gastroenterology at Madras medical college, chennai, tamilnadu, india. He has presented many papers at national conferences all around India.

Abstract:

This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Biography:

I.Y.M. has completed her Saudi Board (PhD) of iternal medicine ,currently at the end of second year in gastroenterology fellowship .

H.A.J. Assistant Professor ,internal medicine department KAAUJ.

L.K.A Assistant Professor,  radiology deparment KAAUJ.

Abstract:

Background: Sigmoid volvulus is a very rare condition causing intestinal obstruction in pregnancy associated with extremely high rate of morbidity and mortality for both mother and fetus, early diagnosis based on clinical judgment and use of modern imaging modalities are required for achieving better results and avoiding any surgical intervention. Case report: We report the case of a 23-week pregnant lady, present with severe abdominal distention and constipation, diagnosis was achieved using magnetic resonance image, emergency flexible sigmoidoscopy with detorsion of volvulus done successfully with no complication to the mother or fetus, she was maintained on stool softener and remained well on follow-up. Discussion: We have reviewed the available literature on this topic, as of 2017, less than 100 cases had been reported since first reported case in 1885, most of them ended by surgical resection of gangrenous part of the colon and the need for colostomy. One case had been managed by endoscopy is reported in Brunei. Sigmoid volvulus is the most cause of intestinal obstruction during pregnancy accounting for up to 44% of reported cases. Delay in diagnosis usually goes back to similarity between common gastro-enteric symptoms in pregnancy that can mask truly obstructive one, and also hesitate in use of radiologic image for evaluation.

Conclusions: Effective management represents a challenge, as a delayed presentation and diagnosis will lead to catastrophic feto-maternal complications. A high incidence of clinical suspicion and timely intervention are the key to a favourable outcome.

Biography:

I,m Dr.Radhakrishnan.N.I, doing my D.M.,final year in MEDICAL GASTROENTEROLOGY in Institute of Medicalgastroenterology,Madras Medical college and RGGGH,Chennai,India. I have completed my masters,M.D.,in INTERNAL MEDICINE from the same institute few years back.I have sent 3 papers for my National conferences in Gastro-ISGCON and got accepted.(Up to 100 words)      
 

Abstract:

Introduction

Portal vein thrombosis(PVT) has become an increasingly recognisable disorder during evaluation of cases of abdominal pain with usage of widespread imaging techniques.PVT can result due to various clinical conditions like Chronic liver disease,Infections,malignancies and hypercoagulable states. The objective of this study is to observe the clinical presentation and to do the etiological work up of cases of PVT in a tertiary care centre.This can aid in early diagnosis and expert intervention thereby reducing the morbidity in cases of PVT.

Patients and Methods

The study is a cross- sectional observational study done on patients having PVT,who presented to Institute of Medical Gastroenterology,MMC & RGGGH,during the period of Jan 2016 - July 2017were taken up for the study.The clinical presentation of the above patients were observed and their etiological work up done.

Results

Totally 45 cases were taken into study.

27 were males and 18 were females.

Clinical presentation--The main symptoms were,abdominal distension(18 patients,51%),abdominal pain(10 patients,27%) pain associated with diarrhoea and vomiting(5 patients,14%) pain with nausea and anorexia(3 patients,8%).

Etiological work up showed—Chronic liver disease(24 patients,54%)prothrombotic states(9 patients,20%) local factors,prothrombotic risks and idiopathic causes(12 patients,26%).

Detection of PVT were done mostly by Portal vein Doppler(32 patients,72%) computed tomography(13 patients,27%).

Conclusions

Higher incidence of PVT were seen among patients with chronic liver disease.Prothrombotic  states like myeloproliferative disorders and coagulation defects were the next common causes detected.PVT presenting as plain abdominal pain, pain associated with nausea, vomiting and diarrhoea  were seen in patients as well,thereby suggesting that PVT is an important differential diagnosis in patients presenting as abdominal pain with a negative work up for common causes.With the help of widespread and improved Imaging techniques,earlier diagnosis of PVT can be achieved  and early intervention can greatly reduce the morbidity of patients.

Biography:

Sibithooran K has completed his under-graduation from Sri Devaraj Urs Medical College, Kolar and his Masters in Internal Medicine from the Manipal University. He is currently a Resident of Gastroenterology at Madras Medical College, Chennai.

Abstract:

Materials & Methods: All the patients who underwent ERCP procedure for pancreatic diseases during August 2015 to July 2017 were included in the study and the details were analyzed.

Results: A total of 83 patients underwent ERCP for pancreatic diseases. The indications were symptomatic pancreatic pseudocysts (21), symptomatic pancreatic duct strictures in CCP (17), Intra ductal calculi (15), Pancreatic ductal leak with pancreatic ascites (12), pancreatic divisum with F/O CCP (11) and Traumatic pancreatitis (7). About 15 Patients of Pseudocysts, 14 with pancreatic ductal strictures, 9 with intra ductal calculi, 8 with pancreatic duct leaks eventually required surgical intervention either due to failed procedure or persistent symptoms. However, among the 18 patients who had pancreatic divisum and traumatic pancreatitis only two ended up requiring surgical intervention with 16 of them being successfully treated with ERCP.

Discussion: ERCP’s main benefit is the minimally invasive nature in the management of pancreatic and biliary diseases. However, the complex nature of the technique demands a long learning curve. ERCP is done increasingly for pancreatic diseases in our centre and the results are very encouraging especially pancreatic divisum and traumatic pancreatitis where the cure rate approaches 90%. There is a 66% cure rate among the patients who have pancreatic ductal leaks with pancreatic ascites. Among the other indications for ERCP in pancreatic diseases the cure rates are less than 40% and most of them required a surgery at the end.

Conclusion: ERCP proved to be an effective minimally invasive technique among patients who had pancreatic divisum and traumatic pancreatitis.

Biography:

Hameed Ur Rehman Habib Ur Rehman, a core medical trainee working in Gastroenterology department at Chesterfield Royal Hospital in East Midlands,  UK. 

Abstract:

We report a case of a 59-year-old male, with no past medical history and foreign travel, who presented with a 1 week history of left arm weakness and numbness followed by an inability to contract his biceps for duration of 48 hours. These symptoms occurred after eating Pork Ribs at a local restaurant 2 weeks ago. On presentation, he was jaundiced and his liver function tests demonstrated a hepatitis-like picture. He had a positive hepatitis E PCR result. His diagnosis was brachial neuritis secondary to acute hepatitis E infection. Viral hepatitis E infection has been reported in 10% of patients with brachial neuritis. According to the most recent case report, an article published in April 2017 in the Journal of NeuroVirology, only 9 such cases have been reported in the UK. We therefore possibly reported the 10^th case of hepatitis E associated brachial neuritis in the UK in a non-immunocompromised patient without any past medical history. This case again reminds us to consider hepatitis E infection in a patient presenting with neurological signs and deranged liver function tests.

Biography:

Gülen Arslan Lied is a consultant gastroenterologist and professor at the Haukeland University Hospital, Department of Gastroenterology in Bergen, Norway. She has engaged in active research since 2001 and she supervises many PhD candidates and master students in field of gastroenterology and human and clinical nutrition. Her fields of interests include clinical trials in interactions between nutrition and gut microbiota, inflammation, functional gastrointestinal disorders (irritable bowel syndrome) including nutritional and allergo-immunological aspects, food allergy and intolerance (food hypersensitivity), and experimental studies (food allergy model in mice and colitis models induced by DSS or TNBS in rats).

Abstract:

Majority of the patients with perceived food hypersensitivity have irritable bowel syndrome (IBS), and a significant proportion of IBS patients also attribute their gastrointestinal complaints to food items. Different factors such as disturbed intestinal fermentation, enteric dysmotility, post-infectious changes and altered microbial flora in the colon as well as psychological disturbances likely play a role in the pathophysiology and symptoms generation in patients with food hypersensitivity. The management of these patients should be interdisciplinary.

The results of our more than 10 years’ interdisciplinary research program dealing with such patients showed that food allergy was seldom diagnosed despite extensive examinations. The majority of the patients fulfilled the diagnostic criteria for irritable bowel syndrome. In addition, most suffered from several extraintestinal health complaints and had considerably impaired quality of life. However, psychological factors could explain only approximately 10% of the variance in the patients’ symptom severity and 90% of the variance thus remained unexplained. Intolerance to low-digestible carbohydrates was a common problem and abdominal symptoms were replicated by carbohydrate ingestion. A considerable number of patients showed evidence of immune activation by analyses of B-cell activating factor, dendritic cells and “IgE-armed” mast cells. In addition, a number of other studies in these patient groups indicate that local, systemic and mucosal immune systems are activated. During the presentation, the role of these potential factors including management of these patients will be  reported in patients with perceived food hypersensitivity.