Malnutrition is a common but frequently overlooked problem among patients with cirrhosis of liver. Malnourished cirrhotic patients have a higher rate of complications and an overall increased mortality. Identifying these patients is of great clinical importance. This study was carried out to assess nutritional status of cirrhotic patients to identify those who are malnourished and to see the relationship between severity of liver disease and malnutrition. 105 patients were selected by purposive type sampling. Nutritional status was assessed by 3 anthropometric assessment tools-body mass index (BMI), mid upper arm muscle circumference (MAMC) and triceps skin fold thickness (TST). Severity of liver disease was assessed by Child-Pugh (CP) score. Severe malnutrition was defined as MAMC and TST <5th percentile, calculated from standard tables, and as BMI <16. Among 105 patients 18, 49 and 38 were of Child-Pugh group (CP group) A, B and C respectively. Anthropometric assessment revealed that, when assessed by MAMC 63% of the study population were severely malnourished. Based on MAMC, severe malnutrition was present in 39%, 63% and 73% patients in CP group A, B and C, respectively (P<0.05). So, percentage of severely malnourished patient increased with the increase in severity of liver disease. Based on TST, 28%, 34% and 50% patients were severely malnourished in CP-A, CP-B and in CP-C (p>0.05) respectively which showed a trend similar to that by MAMC. Whereas, based on BMI, 0%, 8% and 2% patients were severely malnourished respectively (p>0.05). It showed a decrease in the percentage of severely malnourished patient in CP group C than in CP group B. In this study, nutritional assessment by TST and MAMC revealed that severe malnutrition was common in our study population and assessment by MAMC showed a statistically significant association of severity of liver disease with severe malnutrition.

Helicobacter Pylori a very common worldwide infection is responsible for number of upper GIT lesions like gastritis, peptic ulcer disease, gastric carcinoma and mucosa associated lymphoid tissue lymphoma. On the other hand, dyspepsia is a wide spectrum of nonspecific upper GIT symptoms for which patients very frequently visit gastroenterology clinics. The objective of the study was to find prevalence of Helicobacter Pylori among the patients with dyspeptic symptoms who had gastro-duodenal mucosal lesions on upper GIT endoscopy and also if there is any association between these two variables. 164 cases of dyspepsia were done index upper GIT endoscopy as per inclusion and exclusion criteria from April 2018 to December 2018 in Seikh Sayera Khatun Medical College Hospital, Gopalganj. Two gastric biopsies (from antrum and body) were taken and immediately placed in a commercial RUT (rapid urease test) kit. Positive test (rapid urease test) was indicated by change in the color of the kit from yellow to pink or red within 24 hours. Out of 164 patients, 62 (37.8%) patients had gastro-duodenal mucosal lesions and rest(62.2%) showed normal upper GIT at endoscopy. Among the 62 patients highest (38) number of the patients endoscopy showed gastritis and least (3) showed gastric ulcer. Among 62 patients with endoscopic gastro-duodenal mucosal lesions, 36 patients were infected with Helicobacter Pylori. On the contrary 27 patients out of 102 subjects who had normal upper GIT at endoscopy recorded infected with Helicobacter Pylori. Statistically analysis was done using chi-square test with the help of SPSS software windows version 25. The level of statistical significance was set at 0.05. In our study it was observed that statistically there was significant relation of Helicobacter Pylori with gastro-duodenal mucosal lesions as P value was less than 0.05. In this study, we found that Helicobacter Pylori was significantly associated with gastro-duodenal mucosal lesions among the patients with dyspeptic symptoms. So, our suggestion will be to confirm H. pylori infection if anybody has gastro-duodenal mucosal lesions if a subject does upper GIT endoscopy for dyspeptic symptoms. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 100-104

Loop gastro-Jejunostomy and Roux-en-Y gastro- Jejunostomy, the commonest reconstructions in gastric surgery, are significantly associated with alkaline reflux gastritis and Roux stasis syndrome (RSS) respectively. The Modified Uncut Roux-en-Y (MUREY) technique could be an effective technique in preventing both the conditions. This prospective observational study was designed to evaluate the effectiveness of Modified UREY reconstruction to prevent RSS and Alkaline reflux gastro-esophagitis while avoiding “Staple- line dehiscence”. A total of 47 patients of gastric outlet obstruction, both benign and malignant, undergoing Modified Uncut Roux-en-Y reconstruction with/ without Gastrectomy at BMCH over the span of July 2014 to July 2016, were incorporated in this study. Patients were followed up from the immediate post-operative periods till discharge and postoperatively for 2 months. There was no incidence of bile reflux or bilious vomiting in the follow-up period. There were two (4.3%) incidences of RSS among the 47 patients (P<0.001). Postoperative endoscopy was carried out in 9 patients to assess the integrity of staple line occlusion which revealed normal looking mucosa of upper GIT with an intact staple line occlusion. There was significant decrease in the average Visick score, from 3.5±0.6 (SD) preoperatively to 1.2±0.4(SD) in the post-operative period. Average increase in the body weight at the time of final follow-up was 6.7%±5.1 kg. The Modified “Uncut Roux-En-Y” reconstruction technique is bothfeasible and safe. It is effective in preventing RSS and alkaline reflux gastritis while preventing Staple-line dehiscence and, can be a preferred technique of gastric bypass.J Bangladesh Coll Phys Surg 2018; 36(4): 139-144