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Irritable Bowel Syndrome (IBS) patients and Somatization Symptom Disorder (SSD) patients experience somatization symptoms relative to their corresponding processes. IBS patients may also have a diagnosis of both IBS and SSD. Somatization symptoms cause significant psychological, emotional and social distress. Conversely, stress in any form is believed to contribute to IBS symptoms. Whether stress mediated somatization symptoms in patients with IBS provide a pathway for these IBS symptoms is not as well understood. This cross-sectional study was performed at Shifa International Hospital, Islamabad between March 1st, 2023, and January 14th, 2024. Purposeful sampling was done to recruit study participants from three different populations as somatization is common in all three populations. As a result, there were three different samples in the study. Participants were eligible to participate if they had a diagnosis of IBS, somatic symptom disorder (SSD), or IBS with somatization (IBS-SSD) and were currently receiving treatment at the gastroenterology outpatient clinic and/or psychiatric outpatient clinic. Patient Health Questionnaire (PHQ-15) and Somatic Stress Response Scale (SSRS) were used to assess somatic symptoms and their association of stress-related somatic symptoms. Data was entered and analyzed using descriptive and inferential statistics. Data was self-reported by the participants. The largest sample size 67(100%) was from the IBS patient population. Two other samples were small i.e., there were 21 (100%) participants in SSD sample, and a very few numbers of participants 12 (100%) in the IBS diagnosis with a comorbidity of SSD sample. Majority of the patients were young i.e., 50≤ (77.7%), (71.4%), (74.99%); and male (59.7%), (66.6%), (50.0%) from the IBS, SSD, and IBS-SSD samples. Majority of the participants in the IBS (56.7%) and SSD (61.9%) samples had a high school diploma or the equivalent. In the IBS-SSD sample, the largest percentage (41.7%) of participants had more than a bachelor's degrees. M = 85.67 (+/-23.26) for SSRS scores and M = 17.81(+/-5.28) for PHQ-15 scores in SSD patients. M = 75.21 (+/-19.59) for SSRS scores and M = 14.76 (+/-5.07) for PHQ-15 scores in IBS patients. M = 75.17 (+/-20.55) for SSRS scores and M = 14.92 (+/-6.27) for PHQ-15 scores in IBS-SSD patients. Many participants had somatization symptoms in the severe range (≥ 15) i.e., 34(50.7%), 17(81.0%), 6(50.0%) in IBS, SSD, and IBS-SSD samples respectively. Considering the PHQ scores by age in the IBS sample, highest mean scores were observed for the highest age group (60–69 years) i.e., 16.50 (+/- 5.68) despite fewer number of participants in this age group. PHQ scores also significantly differed by education groups i.e., significant differences were observed between education group 1 and 2 as well as group 2 and 3, p<0.05. On simple linear regression, PHQ-15 scores significantly predicted variations in SSRS scores, p <0.05, R2 = 69.6% for IBS sample, R2 = 68.7% for the SSD sample, and R2 = 66.0% for patients with IBS, SSD and IBS with somatization respectively. Stress related somatic symptoms are positively correlated with somatization complaints in IBS patients. Increased somatization scores were observed in the elderly. Targeted psycho-social interventions could help mitigate the negative effects of somatization in IBS patients. [ABSTRACT FROM AUTHOR]

Objective: There are different clinicopathological features between early and late onset colorectal cancer. We aimed to characterize the histological features of colorectal cancer (CRC) at different age groups in our institution. Methods: Total 232 patients with histologically proven colorectal cancer between ages 13-99 were included. This is retrospective study. Data collected from tumour registry Shifa International Hospital from January 1st 2018 to December 31st 2020. Pearson Chi square test was used for significance of categorical variables. P-values less than 0.05 were considered significant. Results: Mean age at diagnosis was 55.49+/-16.43 years. Out of total 232 patients 58.6% were male and 41.3% were females (p value= 0.16). 150 (64.9%) were aged > 50 years and 81 (35.1%) were age < or equal to 50 years (p value = 0.44). Most common histological subtype was adenocarcinoma that was found in 188 (81%) cases. One hundred fifty five (66.8%) patients had Grade-II tumor, 67(28.9%) with Grade-III and 10 (4.3%) with Grade-I tumor. Fifty eight (25%) patients presented with metastatic disease. A significantly higher percentage of patients with signet ring cell cancer presented with a high-grade tumor when compared with patients with adenocarcinoma and mucinous carcinoma (93.7% vs 21.8%, p-value- <0.001%; 93.7% vs 39.2%, p-value <0.001). A significantly higher percentage of patients with mucinous adenocarcinoma and signet ring cell carcinoma presented at age less than 50 as compared to those with adenocarcinoma (60.7%, 56.2% and 30.8% respectively; p-value <0.05). Conclusion: This study signifies that mucinous and signet ring cell type CRC present at an early age and with a higher proportion of patients with high tumour grade. Early diagnosis is key to help improve outcomes in these patients. [ABSTRACT FROM AUTHOR]

Background: The early identification of esophageal varices in patients with chronic liver disease (CLD) is important in order to mitigate the risk of variceal hemorrhage and mortality. Many noninvasive predictors have been studied for esophageal varices (EVs). Objective: This study investigated the relationship of gallbladder wall thickness (GBWT) with the presence of EVs in patients with HCV-related CLD. Study type, settings & duration: This cross-sectional study was conducted at the Department of Gastroenterology, Shifa International Hospital Ltd., Islamabad, Pakistan from February to August 2024. Methodology: In this study 145 patients were considered and were categorized into Variceal (Group 1) and non-variceal groups (Group II). Group I is further divided into Group 1a (non-advanced /low-risk varices: Grade-I EVs) and Group 1b (Advanced/High-risk varices: Grade II/III EVs). After detailed history, examination laboratory investigations, EGD and ultrasound abdomen were performed. Results: The median age of patients was 54±10.13 years. 89 patients were male (61.4%), and 56 were female (38.6%). 86.9% of patients had EVs Group 1) and 27.6% had no EVs (Group II). GBWT at a cutoff value of 3 mm predicted EVs in patients with HCV-CLD with a sensitivity of 79.37%, specificity of 89.47%, PPV of 98.04%, NPV of 39.53%, diagnostic accuracy of 80.67% with AUC of 0.882. GBWT at 3.7mm predicted advanced/high-risk varices with a sensitivity of 80.65%, specificity of 75.76%, PPV of 90.36%, NPV of 58.15%, and diagnostic accuracy of 79.37% with AUC of 0.813. Conclusion: GBWT demonstrated a significant association with the presence of EVs and advanced grades of EVs. [ABSTRACT FROM AUTHOR]

Background: Pancreatic neuroendocrine tumors (P-NETs) constitute a subset of pancreatic mass lesions characterized by diverse clinical presentations. Despite their inherent malignant potential, the timely identification and treatment of these tumors are critical for achieving favorable clinical outcomes. This study aims to shed light on the heterogeneous tumor biology of P-NETs and the management strategies employed at a tertiary care center in Pakistan. Method: A retrospective study encompassing all patients with a biopsy-confirmed diagnosis of P-NETs at Shifa International Hospital between January 1st, 2016, and June 30th, 2021, was conducted. Meticulous data extraction from pathology records and thorough searches of medical records were performed to gather relevant demographic and clinical information. Results: A total of 24 patients were retrieved from our database, with 13 (54%) female patients. The mean age was 49.5 ± 16.3 years. Eight out of the 24 patients presented with abdominal pain. Most patients (14 out of 24) had lesions in the pancreatic head region. In three cases, lesions exhibited multicentricity. The mean lesion size measured 4.4 ± 2.3 cm. Three of the 24 patients displayed distant liver metastasis at the presentation time. 19 out of the 24 patients underwent surgical resections, while endoscopic ultrasound (EUS)-guided biopsy was performed in 4 out of 24 cases. EUS-guided tissue biopsy yielded accurate diagnoses in all four cases. Conclusion: Most P-NETs are non-functional, and there is an almost equal distribution between male and female patients. Solitary lesions predominate, and metastasis is uncommon at initial presentation. EUS-guided fine needle biopsy stands out as a dependable diagnostic modality for P-NETs. [ABSTRACT FROM AUTHOR]

Background: Significant morbidity can arise from acute bacterial cholangitis. Key to improving outcomes is the implementation of aggressive antibiotic therapy and prompt biliary decompression through either endoscopic or percutaneous means. However, the challenge in treating these infections is amplified by the evolving patterns of antimicrobial resistance, particularly when determining the appropriate empiric therapy. Methods: The present study was conducted at Shifa International Hospital in Islamabad. The patients with the diagnosis of Acute bacterial cholangitis between July 2016 and June 2022 were included. Data was analyzed using SPSS-26.0 to identify any significant associations or correlations among the study variables. Results: A total of 144 patients with a diagnosis of acute bacterial cholangitis were included in the study. 51 of these patients had a positive blood culture. The most commonly identified organism was E. coli, followed by Klebsiella pneumonia, Pseudomonas aeruginosa, Proteus, Enterococcus spp and others. Antibiotic sensitivity pattern revealed resistance to Ceftazidime in 87%, Piperacillin-Tazobactam in 63.7%, Ertapenem in 34.4%, Meropenem in 26.1%, Imipenem in 25.0% and Colistin in 16.1%. Conclusion: A high resistance pattern for antibiotics was observed in our study. This might, in turn, represent the prior judicious use of antibiotics in our community hospitals before these patients are referred to a tertiary referral center. [ABSTRACT FROM AUTHOR]

In the United States, the seroprevalence rate for hepatitis E virus (HEV) is ≅20%. This study examined HEV seroprevalence in persons with and without chronic liver disease. Our data indicate [...]

Granular cell tumors (GCT) are benign, submucosal tumors derived from neural or Schwann cells. They are commonly found in the oral cavity, skin, breast and tongue. Less commonly, they can also occur in the gastrointestinal tract, usually in the esophagus. We describe two cases of esophageal GCT which were discovered by upper endoscopy (EGD). Case one underwent endoscopic ultrasound (EUS) guided fine needle aspiration and biopsy and case two underwent biopsy of a submucosal nodule. Both biopsies were histologically diagnosed as GCT with supportive S100 positive immunostaining. GCTs are an important diagnosis for physicians to consider in their differential of esophageal nodule or lesion. Though benign, they may rarely show malignant transformation. Therefore, it is essential to have surveillance with EGD/EUS every two to three years if they are not surgically resected. [ABSTRACT FROM AUTHOR]

Background The mainstay for the definitive diagnosis of pancreatic lesions is endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). However, there is evidence that EUS-FNA has low sensitivity in the setting of chronic pancreatitis (CP). This single-center retrospective study aimed to compare and analyze the diagnostic yield of EUS-FNA for solid pancreatic lesions in the presence and absence of CP, and to further investigate strategies for overcoming the low diagnostic yield in the setting of CP. Methods This study identified patients who underwent EUS-FNA at Sanford USD Medical Center (SD, USA) for a solid pancreatic lesion between July 15, 2011, and November 30, 2017. Data on demographics, clinical features, cross-sectional imaging findings, EUS findings, cytology/ pathology, and clinical follow up were collected. Results The final diagnosis was adenocarcinoma in 156 patients (67%), neuroendocrine tumor in 27 (12%), lymphoma in 6 (3%), metastatic malignancy in 8 (4%), and benign etiologies in 35 (15%). CP was identified in 44/234 (19%) patients. The overall diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for EUS-FNA were 92.9%, 97.1%, 99.5%, 70.8%, and 93.5%, respectively. The sensitivity (80% vs. 95%, P=0.020) and accuracy (86% vs. 95%, P=0.043) were significantly lower in patients with CP compared to those without CP. Conclusion CP can significantly affect the EUS-FNA diagnostic yield of solid pancreatic neoplasms. A high index of clinical suspicion is required in these cases to make a definitive diagnosis. [ABSTRACT FROM AUTHOR]

IgG4-related disease (IgG4RD) is a chronic immune mediated condition primarily affecting the hepato-pancreatico- biliary system. We report a case of IgG4RD with extensive pancreatic and hepatic involvement masquerading as metastatic pancreatic malignancy posing a diagnostic and therapeutic dilemma. [ABSTRACT FROM AUTHOR]

A 43-year-old woman, with an unremarkable past medical history, presented with a three-week history of generalized itching, jaundice, and abdominal pain. Initial workup showed amorphous, regionally invasive, and obstructing soft tissue mass in the region of the hepatic hilum. The middle third of the main bile duct was subsequently found to harbor a polypoid mass on endoscopic retrograde cholangiopancreatograph. Biopsy revealed nests of neoplastic cells that was subsequently identified as well-differentiated neuroendocrine tumor. A search for a possible primary neuroendocrine tumor was performed and included imaging of the chest, abdomen, and pelvis, a colonoscopy, capsule endoscopy, and an octreotide scan; however, no primary tumor outside of the liver was identified. Surgical debulking was performed, during which intraoperative exploration and ultrasound failed to reveal any extra-hepatic tumor sanctuaries. A few months later, patient underwent endoscopic ultrasound (EUS) for evaluation of recurrent abdominal pain which revealed a small lesion in the pancreas. It was unclear, however, whether it was primary or a metastatic lesion. This case represents a diagnostic challenge and emphasizes the potential utility of EUS in the preoperative work up for any presumable primary hepatobiliary neuroendocrine tumor. [ABSTRACT FROM AUTHOR]