Background and aim: MicroRNAs (miRs) are now a well-known subject in various tumor genesis and are studied as early diagnostic biomarker. Many arrays of miRs were incorporated in the pathogenesis of HCV-related hepatocellular carcinomas (HCV-HCC). In this respect, we aimed to evaluate the diagnostic role of circulating miR-21, miR-122, and miR-222 in Egyptian patients with HCV-HCC. Patient and methods: Between June 2018 and April 2019, a cross-sectional comparative study was designed to evaluate the circulating miR-21, miR-122, and miR-222 by quantitative Real-Time PCR. For analytical purposes, patients were categorized into three groups: chronic HCV group (CHC-group, n = 22), HCV-related liver cirrhosis (LC-group, n = 22), and HCV-related hepatocellular carcinoma (HCV-HCC-group, n = 54). Results: Serum levels of miR-21 and miR-222 increased with the progressive course from CHC to LC and HCC; p < .001. Serum levels of miR-122 in HCC patients were significantly lower than non-HCC patients (CHC and LC patients, n = 44); p < .001. However, the differences in levels of serum miR-122 between CHC and LC were not statistically significant; P = 0.8. ROC curve analysis showed that the sensitivity and specificity of miR-21 were 61.1% and 95.5%, miR-222 were 71.7% and 93.2%, and miR-122 were 98.2% and 100%. The positive predictive value for miRNA-21, miRNA-122, and miRNA-222 were 13.4%, 93.3%, and 10.5% respectively. The Negative predictive value for miRNA-21, miRNA-122, and miRNA-222 were 94.3%, 97.8%, and 92.7% respectively. Conclusion: MiR-21 and miR-222 could be potential markers for advanced liver damage, while miR-122 had the best diagnostic accuracy and could be a promising marker for detection of HCC.

Background: Regression of fibrosis and improvement of portal hemodynamics after achievement of sustained viral response (SVR) in patients with chronic hepatitis C (HCV) is a subject of debate in different studies. Some studies reported improvement in the degree of fibrosis, while others did not find significant changes. Objective: We aimed to evaluate changes in liver fibrosis, portal hemodynamics and clinical outcomes in patients with chronic HCV-related liver cirrhosis after the achievement of SVR with direct-acting antiviral drugs (DAAs). Patients and methods: In our prospective longitudinal study, a total of 100 patients with chronic HCV infection-related liver cirrhosis were recruited, received DAAs, and completed the follow-up period. Clinical evaluation for assessment of liver disease severity using MELD and Child–Pugh class and scores were done. A noninvasive assessment of liver fibrosis using serum biomarkers (APRI index & FIB4 score) and share wave elastography (SWE) was done. Portal hemodynamic evaluation using Doppler ultrasound was done. All were done at baseline and 3 and 12 months after the end of therapy. Results: A significant reduction in the degree of fibrosis was observed. Share wave elastography (SWE) readings showed 19.79% and 30.45% reduction 3 and 12 months after the end of therapy respectively (P < 0.001). Regarding the FIB4 score, the percentage of score reduction was 19.8% and 26.46% 3 and 12 months after the end of therapy, respectively (P < 0.01). APRI scores showed 22.6% and 41.09% reduction 3 and 12 months after the end of therapy respectively (P < 0.001). Significant improvement in Child–Pugh scores 3 and 12 months after the end of treatment was observed. Doppler ultrasound showed a significant increase in portal vein flow velocity, a significant decrease in time average mean velocity, and cross-section area 12 months after the end of treatment. Conclusion: There was a considerable degree of reduction of liver fibrosis, improvement of portal hemodynamics, and Child–Pugh score in cirrhotic HCV patients who achieved SVR after DAAs. Trial registration: ClinicalTrials.gov, ID: NCT03241823. Registered on 08 May 2017.

Background & aims: Eosinophilic ascites is non-common and challenging disease. This study aimed to describe the clinical presentation and treatment of eosinophilic ascites. Methods: This was a prospective single-center study that included cases with eosinophilic ascites who were admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital, Assiut, Egypt, during the period between May 2020 to May 2023. The clinical presentation, investigations, treatment, and follow-up data of the included patients were collected and analyzed. Results: Seventeen cases of eosinophilic ascites were included in the study. The main presenting manifestations were abdominal pain (47.1%), and abdominal pain with distension (29.4%). Two patients presented with a picture of intestinal obstruction. Moderate ascites was found in 10 patients (58.8%) by ultrasound. Eosinophilia in the peripheral hemogram was detected in 76.5% of the study population. Endoscopic examination showed gastro-duodenitis in 9 patients (52.9%) and duodenitis in 4 patients (23.5%). All patients showed complete improvement and disappearance of ascites after starting steroids within two weeks. Eleven patients (64.7%) relapsed after discontinuation of steroids. Conclusion: Eosinophilic ascites is an uncommon cause of ascites that is often underdiagnosed. The relapse rate after stopping treatment is high but with excellent response to retreatment.

Background: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency with significant morbidity and mortality. Intravenous (IV) route administration of proton pump inhibitors is more commonly used for prevention of bleeding; however, it is more expensive and invasive than the oral route. We, herein, compared between oral and IV omeprazole in patients with high-risk UGIB regarding outcome. Patients and methods: Patients with high risk for rebleeding peptic ulcers were included. All patients initially received IV omeprazole, and then esophagogastroduodenoscopy with hemostatic procedure was done. Thereafter, the patients were allocated to group A, who received oral omeprazole, and group B, who received IV omeprazole. The patients were followed up for 2 weeks for signs of rebleeding. Reendoscopy, angioembolization, or surgery was provided when needed (NCT04170270). Results: The study included 189 patients (96 in group A and 93 in group B). Frequency of rebleeding was higher among patients in group B (40%) compared with those in group A (30%) (P: 0.1). Reendoscopy was more frequently required for patients in group B (16.1%) than those in group A (3.1%) (P<0.001). Surgery was mandatory for three (3.2%) patients in group B, whereas angioembolization was used nearly equally in both groups (31.3% in group A vs. 29% in group B). Admission to ICU was more frequently needed (P: 0.02) and the length of hospital stays was longer (P: 0.003) for patients of group B. Regarding UGIB-related deaths, three (3.1%) patients from each group died. Conclusion: Oral omeprazole is not inferior to IV omeprazole as adjuvant therapy to control peptic ulcer bleeding and to reduce the frequency of rebleeding.

Background and aims: Variceal bleeding is a life-threatening complication of liver cirrhosis, necessitating reliable non-invasive predictors to minimize the use of the more invasive esophagogastroduodenoscopy (EGD). This study evaluates the diagnostic accuracy of liver stiffness measurement (LSM), Doppler ultrasound, and serum biomarkers (FIB-4, APRI, PC/SD ratio) for predicting varices and variceal bleeding. Patient and methods: In this cross-sectional study, we enrolled 144 cirrhotic patients who were divided into 3 groups: I, no varices ( n =  37); II, non-bleeding varices ( n =  41); and III, variceal bleeding ( n =  66). All participants underwent LSM, Doppler ultrasound, and laboratory tests. The diagnostic performance of these non-invasive methods was determined using ROC curves and multivariate logistic regression. Results: LSM (cutoff > 30 kPa) showed high accuracy for predicting variceal bleeding (90% sensitivity, AUC 0.91), outperforming all Doppler parameters (AUC 0.41–0.55). PC/SD ratio (cutoff ≤ 650) also demonstrated high predictive value for variceal bleeding. LSM (cutoff > 20 kPa) and PC/SD ratio (cutoff < 900) showed high accuracy for predicting the presence of varices (AUC 0.90 and 0.84, respectively). Multivariate analysis identified LSM (OR 6.350, p < 0.001), APRI score (OR 2.256, p = 0.047), and PC/SD ratio (OR 2.314, p = 0.048) as the key independent predictors for variceal bleeding. Doppler ultrasound showed low predictive value ( p > 0.05). Conclusions: LSM, APRI, FIB-4, and PC/SD ratio are accurate non-invasive tools for prediction of varices and variceal bleeding, supporting their role in risk stratification of cirrhotic patients and reducing unnecessary EGD. Doppler ultrasound has limited value in this context.

Background: Patients with inflammatory bowel disease (IBD) frequently seek dietary strategies to complement medical therapy, yet evidence supporting popular approaches like the Paleolithic (Paleo) diet remains limited. Objectives: This study aimed to evaluate whether the Paleo diet (which emphasizes whole foods while excluding grains, legumes, and dairy) can improve clinical and nutritional outcomes in active IBD. Patients and methods: This was a single-blind randomized controlled trial, in which 49 adults with mild to moderate Crohn's disease or ulcerative colitis were assigned to either a Paleo diet group (n=29) or a control group continuing their usual diet (n=20). All participants maintained standard medical therapy. Outcomes included changes in quality of life (CUCQ-8), hemoglobin, weight, and inflammatory markers (ESR). Results: The Paleo diet group demonstrated a significant increase in hemoglobin levels (12.79 ± 1.7 g/dL vs. 11.80 ± 0.9 g/dL, p=0.010). Participants following the Paleo diet also experienced significant weight reduction (62.38 ± 2.6 kg vs. 69.80 ± 2.4 kg, p=0.041), whereas control group weight remained stable. Quality of life and inflammatory markers improved in both groups, although differences between groups were not statistically significant. Conclusions: A Paleo diet intervention led to significant improvements in the nutritional status in patients with active IBD, with notable benefits in hemoglobin levels and improved quality of life within the group. These findings provide the first randomized trial evidence supporting the Paleo diet as a valuable adjunct therapy for IBD management.