NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY

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Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) in India varies from 9 to 35%. NAFLD is one of the most common causes of chronic liver disease worldwide. Liver biopsy, which is the gold standard for diagnosing NAFLD is an invasive procedure with potential adverse effects and large inter- and intra-observer variability. Hence, various noninvasive markers are being explored to assist in the diagnosis of NAFLD. Fibroscan measures liver stiffness through estimation of the velocity of propagation of a shear wave through liver tissue. Very few studies have addressed the accuracy of fibroscan versus liver biopsy. Objectives: To grade liver fibrosis in the patients and compare fibrosis score by fibroscan with that of liver biopsy in NAFLD. Materials and Methods: An observational study of 72 subjects who had presented with fatty liver on ultrasound and further subjected to fibroscan at the outpatient department of gastroenterology and have undergone liver biopsy (gold standard) for confirmation in the Department of Pathology, Ramaiah Medical College. The study was done from January 2017 to December 2018. After routine processing, liver biopsies were categorized into four subgroups depending on the fibrosis score such as F1 (perivenular fibrosis), F2 (periportal fibrosis), F3 (bridging fibrosis), and F4 (cirrhosis) and was compared with fibroscan scoring, which was based on the degree of fibrosis. Results: Our study revealed that in the subgroup of NAFLD patients with F1, F2, F3 fibrosis on biopsy, the mean fibroscan values were 11.84 ± 9.23, 16.98 ± 18.85, 21.93 ± 5.85, respectively, which overestimate the fibrosis score (2.5–7.5 Kpa), (7.6–10 Kpa), (10.1–13 Kpa), respectively, and in F4 fibrosis, the mean fibroscan value was 33.41 ± 17.39 and in concordance with the fibrosis score (>13 Kpa). Conclusion: Fibroscan overestimates the fibrosis score in the early stages of NAFLD, whereas, it has high accuracy in detecting advanced fibrosis and cirrhosis. Hence, it can be concluded that transient elastography is a good adjunctive tool in NAFLD patients with advanced fibrosis.

Background: The long-term outcomes of Helicobacter pylori infection ultimately depend on the distribution and extent of gastritis. Three main types of gastritis phenotypes which include pangastritis, antral-predominant gastritis, and corpus-predominant gastritis have been observed. Corpus predominant gastritis is more common in the parts of Asia with a high prevalence of gastric adenocarcinoma. This study was conducted to determine the prevalence of H. pylori-associated gastritis phenotypes in a South-western Nigerian population, a sub-Saharan African population. Materials and Methods: The study was a cross-sectional prospective study which included 267 dyspeptic patients who had esophagogastroduodenoscopy at a tertiary health institution in South-west Nigeria. Five gastric biopsies were taken from each subject, and standard histologic examination was performed on the specimens. Both biopsy sampling and histologic examination followed the Updated Sydney System recommendations. The data generated were statistically analyzed. Continuous variables were presented as means ± standard deviation, whereas associations between the categorical variables were determined by the Pearson Chi-square test or Fisher's exact test. P ≤ 0.05 was considered statistically significant. Results: The mean age was 46.1 (±15.4) years while the age range was 16–84 years. There were 160 (59.9%) female and 107 (40.1%) male participants. All participants had histological gastritis, whereas 79 (29.6%) were positive for H. pylori by histology. H. pylori infection was significantly associated with peptic ulcer disease. Among those who had H. pylori infection, 51 (64.6%) had pangastritis, 26 (32.9%) had antral-predominant gastritis, while 2 (2.5%) had corpus-predominant gastritis. The relationship between H. pylori infection and the gastritis phenotypes showed no statistical significance. Conclusion: The prevalence of corpus predominant gastritis was low in our study population.

Background: Colorectal cancer (CRC) is common in Africa including Nigeria contrary to popular opinion. Screening for CRC is cost-effective and reduces morbidity and mortality. Aim: The aim of the study was to assess the practice of CRC screening among gastroenterology practitioners in Nigeria. Methods: This was a questionnaire-based cross-sectional descriptive study conducted among gastroenterology practitioners attending their annual conference in 2016. Data were analyzed using SPSS version 20. Results: A total of 65 respondents completed the questionnaire. The mean age was 37.68 years. Majority (95%) of the respondents practised in tertiary hospitals. Screening for CRC was practised by 54% of the respondents, with colonoscopy and guaiac fecal occult blood test being the preferred screening modalities. Indications for screening were mostly symptom based with varied protocols and outcomes. Conclusion: The practice of CRC screening among gastroenterology practitioners in Nigeria is variable. There is a need to formulate national guidelines and colonoscopy quality control tools to improve awareness and standardize practice.

Arterioportal fistula (APF) is a rare and potentially fatal cause of portal hypertension. In this case report, we present an unwonted case of a Nigerian with this disorder. As well, this article documents details of successful therapy for such a large APF with transcatheter arterial embolization which was carried out locally. This study is thus a first-of-its-kind for our African subregion. We hope that this article will help to highlight the role and significance interventional radiology services and expertise in an emerging health-care system as the one seen in West Africa – particularly as it relates to its benefits in the field of hepatology.

A case report of a 7-year-old girl who presented with a 4-year history of painless progressive abdominal swelling that became painful 2 weeks before presentation. Examination revealed a girl in painful distress with distended abdomen and a tender palpable firm right upper quadrant abdominal mass measuring 28 cm × 22 cm with well-defined borders. Abdominal ultrasound scan showed a cystic liver mass filling the abdomen which was multilocular. Liver function tests show mildly elevated liver enzymes and mild prolongation of the prothrombin time. She had repeated aspiration of the cyst content in various peripheral hospitals with transient relief of symptoms. She thereafter had abdominal exploration through a right upper transverse incision and was found to have a cystic mass involving segments V, VI, and VII of the right lobe of the liver measuring 30 cm × 26 cm. Marsupialization of the cyst was done and an incisional biopsy of the cyst wall was taken. Histology of the cyst wall showed a mesenchymal hamartoma of the liver (MHL). The aim of this study is to highlight the clinical features, diagnosis, treatment, and differential diagnosis of MHL

Online since 20^th November 2019