Objective: Gastrointestinal (GI) endoscopy is an important tool for diagnosis and treatment of GI diseases. However, when endoscopy is indicated during pregnancy, concerns about its safety for mother and fetus often arise. Our objective was to evaluate the safety and efficacy of endoscopic procedures in pregnant patients along with maternal and fetal outcomes. Methods: This study was conducted at the Aga Khan University Hospital after Ethics review committee approval. It was a retrospective study and medical records of all pregnant patients who underwent endoscopy during pregnancy from January 2000 to January 2014 were analyzed. Data regarding the indications and type of endoscopic procedure, use of sedation and radiation were noted; data on any complications during or after pregnancy were recorded as well. Results: A total of 48 pregnant women underwent endoscopic procedures. Procedures that were performed included gastroscopy, sigmoidoscopy, colonoscopy, and endoscopic retrograde cholangio-pancreaticography (ERCP) in 28, 15, 1, and 4 patients, respectively. The major indication for gastroscopy was hematemesis in 16 procedures (57.14%) and screening for esophageal varices was done in 10 (21.42%). The indications of ERCP were choledocholithiasis and cholangitis. However, bleeding per rectum was the main indication for sigmoidoscopy and colonoscopy. Some 34 (70.83%) procedures were diagnostic and the rest were therapeutic. Only one patient had a miscarriage in second trimester. Conclusions: Endoscopic procedures are safe to be performed in pregnant patients in the presence of strong indications without posing major risk to the mother or the fetus. However, further prospective multicenter research studies are strongly recommended.

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Aim The objective of the study was to observe the association of villous atrophy with anti-tissue transglutaminase levels in the identified subjects that met our addressed inclusion criteria. Methods A case series study was conducted among 40 patients presenting with dyspepsia along with signs and symptoms of celiac disease at the Bolan Medical Complex Hospital, Quetta over a period of five months from 25/5/17 to 25/10/17. The patients were referred to undergo tissue transglutaminase antibody serum test. The positive ones underwent biopsies to assess pathological entities including villous atrophy, blunting (focal or total), crypts, Intestinal layers and the number of Intraepithelial lymphocytes. The results collected were analyzed by using IBM SPSS version 20 (IBM Corp., Armonk, NY). Results There was a weak, negative correlation between tTGA and focal villous blunting (r = -0.345, p = 0.029) showing that high levels of tTGA are associated with lower risk of focal villous blunting. Correlation of tTGA and total villous blunting was a weak positive correlation (r = 0.282, p = 0.07) showing that high levels of tTGA are associated with increased risk of total villous blunting. There was a weak, negative correlation between tTGG and focal villous blunting (r = 0.409, p = 0.009) showing thathigh levels of tTGG are associated with a greater risk of focal villous blunting (p < 0.01) while tTGG and total villous blunting was a weak negative correlation (r = -0.330, p = 0.03) showing that high levels of tTGG are associated with lower risk of total villous blunting. Conclusion The study concludes by providing evidence of the absence of tissue transglutaminase antibodies in patients with histology-proven celiac disease. It implies that serology tests may be negative in some of the patients with typical chronic symptoms. Therefore, in such cases, histopathology may be conclusive in defining the status of celiac disease.

Helicobacter pylori is a pathogenic bacterium causing gastric problems such as, peptic ulcers and stomach cancer. H. pylori were isolated from the stomach biopsy specimens (n = 100) of gastric patients by performing polymerase chain reaction (PCR) against cagA (cytotoxin associated gene A) and ureC (Urease subunit alpha) genes. Furthermore, antibiogram studies of the H. pylori isolates were evaluated against the common antibiotics. The overall detection rate of H. pylori was 71% in biopsy specimens of gastric patients. The antimicrobial susceptibility test revealed the resistance rate of H. pylori isolates against metronidazole (50%), clarithromycin (28.33%), tetracycline (21.66%), amoxicillin (18.33%), and ciprofloxacin (11.66%). However, the H. pylori isolates were completely resistant to vancomycin, erythromycin and nalidixic acid antibiotics. Clove oil showed a remarkable antimicrobial effect against H. pylori whereas, mild inhibition (10 mm) was observed in case of curcumin extract. Due to increase incident of resistance and high prevalence of H. pylori in gastric patients, natural antimicrobial like clove oil can be explored as an alternative treatment.