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Aim: Our study aims to provide a more holistic understanding of the available data and predictive risk factors for gastrointestinal bleed (GIB). Materials & methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science Core Collection and calculated relative risk and meta-regression was utilized to evaluate for risk factors in order to assess the effect of covariates. Results: Our meta-analysis reported a pooled prevalence rate of GIB of 24.4%. Meta-regression analysis did not yield a statistically significant association between GIB and risk factors, including age, gender, hypertension, chronic kidney disease and diabetes. Conclusion: Studies investigating larger sample sizes are required for conclusive findings.

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Purpose: Dyssynergia Defecation (DD) is an underrecognized cause of chronic constipation (CC). DD occurs when a patient is unable to coordinate the abdominal wall muscles, puborectalis/anorectal angle, anal sphincter and pelvic fl oor in a manner which allows the normal passage of stool from the rectum. Th ough constipation related complaints such as reduced stool frequency, straining and a sensation of incomplete evacuation are common, DD patients also commonly endorse abdominal symptoms such discomfort, pain, cramping, and bloating. Whether abdominal symptoms improve with biofeedback training in DD patients is unclear. We aimed to assess the impact of biofeedback therapy on abdominal symptoms including discomfort, pain, cramping and bloating in DD patients. Methods: A retrospective analysis of prospectively collected data from 65 manometrically proven DD patients who received biofeedback therapy at a tertiary center between 2008 and 2012. Each patient completed the 12 item Patient Assessment of Constipation (PAC-SYM) symptom questionnaire during their initial and discharge visits. Th e PAC-SYM measures abdominal complaints, rectal and stool domains related in CC patients. Paired sample t-tests were performed on the summations of the PAC-SYM and for each of the 12 individual items. P-values less than 0.05 were considered statistically signifi cant. Results: Th e mean age of the sample was 54 years. Over 70% of participants were female and Caucasian. Bowel related and abdominal symptoms were commonly reported by DD patients. Th ere was a highly signifi cant reduction in initial total PAC-SYM score (22.8) and the PAC-SYM score following PT (12.1) (p<0.001). While all bowel and stool related domains signifi cantly improved, substantial benefi ts for abdominal symptoms were also observed (See Table 1). Conclusion: Patients with dyssynergic defecation commonly report abdominal symptoms. Like bowel related symptoms, abdominal symptoms such as discomfort, pain and bloating signifi cantly improve following biofeedback training.Purpose: Primary non-Hodgkin's lymphoma (PNHL) of biliary tree is an extremely rare condition and it presents as cholangiocarcionma (CC). Diff erentiating between the two entities is particularly important from the point of prognosis and management. Methods: Th e demographic characteristics, clinical, laboratory, radiological and cytological fi ndings of 4 patients diagnosed with PNHL of biliary tree during 1 year are presented and analyzed together with the cases gathered from a review of the English literature. Results: All the cases in literature along with our 4 cases with PNHL mimicked CC clinically. Almost all patients had vague primary presenting symptoms of abdominal pain, weight loss and jaundice. Beginning of symptoms was with in the previous 4-8 weeks. Th e clinical fi ndings that favored PNHL from CC were manifestation of B-symptoms, larger size of the lesion, less occurrence of invasion to the vessels and no distant metastasis at the time of diagnosis. All of our 4 cases had high to e...

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