We concluded that intravenous midazolam can be used safely in cirrhotic patients of Child-Pugh class A and B undergoing UGE for conscious sedation, but caution should be exercised for patients with advanced liver disease.

Malignancies of gastro-intestinal tract cause stricture formation that leads to intestinal obstruction. In such cases, either surgery or placement of self-expanding metallic stents (SEMS) are options of palliation. For left sided colorectal obstruction, SEMS have been widely used and reported. Luminal stenting is not always an easy task to perform because of altered anatomy of the surrounding structures, specially in the right side of colon and terminal ileum. SEMS placement, particularly in the ileocecal region, is technically difficult. Few studies on SEMS deployment in right sided colon have been reported till now. We report a case of metastatic signet ring cell carcinoma of rectosigmoid junction with malignant terminal ileal stricture palliation done with placement of SEMS.

Objective: To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care centerin Karachi. Data source: Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Design of study: Cross sectional descriptivestudy. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi. Period: May 2008–October 2008. Material andmethods: All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinalbleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two eachfrom antrum and body and one from fundus were taken for histology. Results: A total of 123 dyspeptic patients were included in the study. 76(61.8%) patients were males and 47 (38.2%) were females. H pylori was detected in mucosa of 49 (39.8%) patients. The mean age of thepatients was 41.41 ± 13.15 Years (95%CI; 39.06 to 43.75). Rate of H.pylori infection was not found statistical significant with age, gender,duration of symptoms and BMI. Conclusions: The prevalence of H pylori infection in dyspeptic patients was lower than reported in previousstudies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pyloriin our setup.

Introduction:Infection with Helicobacter pylori is globally prevalent. It is a chronic infection, standard treatment of which includes two antibiotics, amoxicillin and clarithromycin, plus a proton pump inhibitor used for 1 or 2 weeks. However, owing to increased resistance in our country, definitive eradication of H pylori is difficult.We conducted this study to evaluate the efficacy of a regimen using levofloxacin for successful eradication of H pylori infection. Subject and methods:This is a prospective study conducted at a tertiary care hospital. After informed written consent, all patients with proven H pylori infection (either by biopsy or by stool antigen test) were included in this study on the basis of other inclusion and exclusion criteria. Patients were given levofloxacin-based sequential therapy and stool for H pylori antigen was performed as per protocol to assess the eradication rate (ie, efficacy of levofloxacin-based regimen). Patients were required to fill a Performa for assessment of symptoms. Chi-square test was used for analysis. P < 0.05 was considered as significant.Results: A total of 149 patients with active H pylori infection were included. Out of 149 cases, 80 (53.7%) were male and 69 (46.3%) female. H pylori eradication was successfully achieved in 128 (85.9%) patients, 13 (8.7%) patients remained positive after eradication therapy and 8 (5.4%) patients lost follow up. No serious adverse event was observed. Conclusion:Levofloxacin-based sequential therapy was highly effective (85.9%) against chronic H pylori infection.

Colonoscopy is one of the most important modalities to investigate complaintsrelated to lower gastrointestinal tract. Terminal ileum is an essential part of the completecolonoscopic examination. Objectives: To observe the diagnostic yield of ileoscopy in patientsundergoing colonoscopy. Design: Retrospective and observational study. Period: January 2010to May 2014. Setting: Liaquat National Hospital and Medical College. Patients and methods:Patients undergoing colonoscopy fulfilling inclusion and exclusion criteria were enrolled.Terminal ileum was examined and biopsies taken if abnormality present. Statistical analysiswas done by SPSS- 18. Result: A total of 1296 patients were included, 884 (68.2%) were maleand 412 (31.8%) were female. Age ranged from 15-90 years. The commonest indication wasbleeding per rectum (35.6%).1133(87.4%) patients had normal mucosa and 163 (12.6%) hadabnormal mucosa on ileoscopy. Of these 163 patients, 68 had ulcers, 56 had inflammation, 29had nodular mucosa and 10 had polyp. Histopathological examination showed non-specificinflammation in 139 patients; granulomatous inflammation in 7; reactive lymphoid hyperplasiain 8; 3 had normal result; biopsies were not taken in remaining 6 patients. By using chi-squaretest we found a significant statistical relationship between macroscopic abnormality of terminalileum mucosa and age of patients, weight loss, chronic diarrhoea, and abdominal pain. Onlogistic regression, age group, chronic diarrhoea and weight loss retained strong relationshipwith macroscopic abnormality of terminal ileum mucosa. Conclusions: Though a large numberof patients (12.6%) had abnormal terminal ileum mucosa, histopathological analysis did notshow any significant yield of ileoscopy. Terminal ileal abnormality was more common in youngand middle aged patients and in patients presenting primarily with chronic diarrhoea andweight loss.