The International Journal of Gastroenterology and Hepatology Diseases - Volume 1, Issue 2, 2022

Brucellosis is highly endemic in the Mediterranean Basin, including Egypt. Despite attempts to control the disease in Egypt, there are still significant problems with diagnostic accuracy. The prevalence and incidence of Brucellosis are unknown and we have uncertain predictive prognostic tests for Brucellosis treatment results. Identification of the actual epidemiological burden of Brucellosis in Egypt, and levels of the Brucellosis antibody titer among rural and urban populations is critical to the evaluation of combined treatment approaches that achieve lesser relapse rates.

To determine the current prevalence of Brucellosis infections in Egypt and changes in its epidemiological pattern.

We compared the available diagnostic yield, sensitivity, specificity, accuracy, cost, and time consumption of serological tests with those from quantitative polymerase chain reaction (qPCR) to establish their ability to meet the diagnostic criteria. Also, we conducted surveillance of the rates of Brucellosis infection in both humans and animals.

The enzyme-linked immunosorbent assay (ELISA) and blood cultures were less sensitive diagnostic methods for the detection of Brucellosis. These approaches are technically challenging and have a high likelihood of false negatives. Therefore, they are best reserved for suspected cases with negative standard agglutination test (SAT).

A more practical approach to the diagnosis of Brucellosis depends on epidemiological testing for risk factors, clinically suspected cases, and SAT titers ≥ 1/320. Strategies to prevent relapsing include: 1) Health education of patients, 2) Long-term triple therapy, e.g., three months, with possible extension to six months in severe or recurrent cases or when complications occur.

Angiodysplasia, also known as angioectasia, is the most common vascular malformation of the gastrointestinal tract, most often found in patients above the age of sixty. Patients with cirrhosis are at increased risk of bleeding and re-bleeding of these lesions. Angiodysplasias can be found throughout the gastrointestinal (GI) tract and are uncommonly found in the esophagus. The recommended treatment for these lesions is Argon Plasma Coagulation (APC); however, there are numerous mechanical and medical strategies that can also be used to treat angiodysplasia.

This is a case of a 65-year-old woman with decompensated alcoholic cirrhosis and a history of recurrent GI bleeding complicated by hemorrhagic shock presented for anemia. Esophagogastroduodenoscopy (EGD) following her hospitalization was remarkable for bleeding esophageal and gastric angiodysplasias that were successfully treated with APC. The patient returned months later with a recurrent upper GI bleed with EGD, colonoscopy, and video capsule remarkable for angiodysplasias throughout the gastric body, small bowel, and colon without recurrence of the esophageal angiodysplasia.

The purpose of this case is to demonstrate a rare but possible cause of upper GI bleed in patients with decompensated cirrhosis. While angiodysplasia can occur commonly in the stomach, small bowel, and colon, esophageal angioectasia can occur and contribute to a recurrent GI bleed. These should be considered in the differential diagnosis of upper GI bleed and anemia.

Celiac diseases are found to be associated with other autoimmune diseases such as autoimmune thyroiditis, type I diabetes, Addison’s disease, primary biliary cirrhosis, and inflammatory bowel disease (IBD). In literature, only a few cases were described simultaneously presenting both conditions in the same patient.

A 23-year-old Indian male presented with a one-month history of loose motion 10-12 times per day, having watery stool, and nocturnal diarrhea. The patient had pallor, weakness, fatigability, and anorexia/weight loss. The patient also had a history of periumbilical pain abdomen and black-colored stools. In our study, both conditions are clinically symptomatic in the same patient, as proved by endoscopic changes and histopathologically. Esophagogastroduodenoscopy (EGD) examination shows severe scalloping of duodenal folds and nodularity, indicating celiac disease changes. A colonoscopy examination was performed, which revealed multiple linear longitudinal ulcerations, friability, erosions and absent vascularity, which indicates Crohn’s disease. Duodenal biopsy shows celiac disease (Marsh IIIa), and Colonic biopsy shows Crohn’s disease. The patient was treated with improvement in abdominal pain, weight, and anemia.

Celiac and Crohn’s both conditions are clinically symptomatic in the same patient, as proved by endoscopic and histopathological changes.