Khondker K Islam

Bone mineral density among cirrhotic patients awaiting liver transplantation

Osteoporosis is an important and common complication in patients with chronic liver disease. The goal of this study was to determine the bone mineral density (BMD) in different subgroups among pretransplant cirrhotic patients. BMD of the lumbar vertebrae (L) and femoral neck (F) were obtained in 104 consecutive cirrhotic patients. Descriptive and inferential statistics were used to compare the BMD among various groups. The mean BMD in males (n = 54) and females (n = 50) at L were 1.28 ± 0.25 g/cm2 and 1.13 ± 0.20 g/cm2, respectively (P = .001); at F they were 1.03 ± 0.14 and 0.91 ± 0.17, respectively (P < .0001). Among males, BMD at L in Child‐Turcotte‐Pugh class B and C were 1.40 ± 0.21 and 1.13 ± 0.20, respectively (P = .001); at F they were 1.11 ± 0.10 and 0.93 ± 0.13, respectively (P < .0001). Among females, BMD at L in Child‐Turcotte‐Pugh class B and C were 1.27 ± 0.18 and 1.05 ± 0.16, respectively (P = .0003); at F they were 1.02 ± 0.16 and 0.83 ± 0.12, respectively (P = .001). The BMD in premenopausal females (n = 15) and postmenopausal females (n = 35) at L were 1.20 ± 0.19 and 1.11 ± 0.20, respectively (P = .15); at F they were 0.97 ± 0.17 and 0.88 ± 0.16, respectively (P = .12). The BMD in postmenopausal females on hormone replacement therapy (n = 19) and on no hormone replacement therapy (n = 16) at L were 1.07 ± 0.17 and 1.14 ± 0.23, respectively (P = .29); at F they were 0.85 ± 0.15 and 0.91 ± 0.18, respectively (P = .33). The BMD values between etiologic groups were not significantly different. The overall prevalence of osteopenia and osteoporosis were 34.6% and 11.5%, respectively, being significantly higher in females than in males. In conclusion, significant difference in BMD values exists between males and females, as well as between Child‐Turcotte‐Pugh class B and C patients with cirrhosis. In addition, there is no significant influence of menopausal status, hormone replacement therapy, and etiology of cirrhosis on BMD. (Liver Transpl 2004;10:648–653.)

Correlation between fundic and colon polyps and their association H. pylori infection

Purpose: This retrospective study was carried out to identify characteristics of patients with gastric polyp.

Satisfaction survey of patients with GERD with different proton pump inhibitor

Purpose: Gastroesophageal reflux disease (GERD) is notable for its prevalence, variety of clinical presentations and underrecognized morbidity. Currently there are various over the counter H2 blockers and proton pump inhibitors that are used by the patients and physicians to treat this condition. This satisfaction survey was carried out to identify preferences for different acid suppressor medications, response to symptom relief and endoscopic findings.

An uncommon cause of chronic diarrhea

Clinical presentation: A 48 year old African American female was referred to our GI clinic after undergoing an exhaustive series of tests for the work up of chronic diarrhea, upper abdominal pain and microcytic anemia for 2 years. Workup performed by her physicians included negative stool studies, normal ultrasound and MRI of abdomen, upper endoscopy (EGD) that revealed nonerosive gastritis, and a colonoscopy that revealed diverticulosis. She was then referred to our GI clinic for her chronic symptoms and recent abnormal liver enzymes. Her past medical history was significant only for dysmenorrhea. She was not on any medications. She was neither an alcoholic nor a tobacco user. She denied any pertinent family history, nausea, vomiting, hematochezia, or melena. She did report an involuntary weight loss. The physical exam was benign except for a palpable, nontender liver and mild epigastric tenderness. No lymphadenopathy or stigmata of chronic liver disease were appreciated. Laboratory findings included mild microcytic anemia, elevated transaminases (ALT/AST=55/63 iu/l), alkaline phosphatase (501 iu/l) and GGT (495 iu/l). Further laboratory testing revealed a negative HIV test, negative Hepatitis serology, negative autoimmune markers and negative IBD serology panel. However, ACE level (104 iu/l) and ESR (64 mm) were elevated. Chest X-Ray revealed bilateral hilar lymphadenopathy. A repeat colonoscopy was unremarkable and random biopsies were non-diagnostic. A repeat EGD revealed mild gastritis. Biopsies of the gastric mucosa revealed multiple non-caseating granulomas and marked acute and chronic pititis. It also revealed H. pylori organisms. AFB and GMS stains were negative for acid fast and fungal organisms, respectively. In the presence of high ACE levels, cholestatic liver enzyme pattern, gastric noncaseating granulomas and hilar lymphadenopathy, a diagnosis of gastric sarcoidosis was made.

A unique approach to foreign body retrieval

Clinical Presentation: A 46 year old morbidly obese male presented to the emergency room with acute onset of dysphagia to solid food after having lunch. Patient was only able to swallow small quantity of liquid. Patient denied excessive salivation, nausea, vomiting, hematemesis, abdominal pain or chest pain. Past medical history was significant for recent laparoscopic band ligation for weight reduction. There was no previous history of achalasia or reflux symptoms. He was not taking any medications. He was neither an alcoholic nor a smoker. Physical exam revealed a morbidly obese male in no acute distress. Endoscopic examination was performed which revealed mildly dilated esophagus with moderate amount of saliva. A grape was noted in the distal esophagus. It appeared to cause intermittent distal esophageal obstruction. Attempts at pushing the grape through the lower esophageal sphincter (LES) with the scope were hampered by the slithering of the grape along the side of the scope. Attempts to grasp the grape with tripod forceps were unsuccessful due to slippery surface of the grape. A unique approach was adopted to retrieve the grape. An esophageal band ligator was applied to the tip of the scope. The grape was suctioned and anchored into the barrel and removed successfully.