Oral Presentation Finalists

Analytical and Cohort Studies

Significance: Refeeding syndrome (RFS) is a potentially life-threatening metabolic complication that can occur in malnourished individuals who are rapidly reintroduced to nutritional support. Unfortunately, there is scarce data on the incidence of RFS among them. We aim to determine the incidence of RFS and aid clinicians in identifying its possibility using practical clinical parameters.

Methodology: In this prospective, analytical study conducted between October 2022 to December 2023, 217 patients were evaluated for risk of developing RFS. Patients were grouped into RFS and non-RFS groups based on the occurrence of hypophosphatemia. All significant factors for the development of RFS were subjected to binary logistic regression and were aggregated to develop a new risk scoring model. The Cox and Snell R Square was used to determine the goodness of fit of the model and the receiver operator characteristic curve (AUROCC) was used to determine its overall accuracy.

Results: Among 217 patients, 32% were at risk for malnutrition. RFS occurred in 20%. Binary logistic regression analyses showed that predictors of RFS include lower magnesium, potassium and albumin levels and lower total protein delivered (p<0.05). Using the predictive model, the AUROCC recorded an overall accuracy rate of 77.6% which is considered an acceptable discriminating power to determine the likelihood to develop RFS.

Conclusion: The incidence of RFS among malnourished patients in this institution is high. The risk prediction model has acceptable predictive effects and clinical utility which may be used as a reference for screening for RFS risk in malnourished patients.

Significance: The global incidence of acute pancreatitis has increased over the past decade, but data in the Philippines remain limited, with the latest local study conducted before the Atlanta classification.

Methodology: A retrospective cohort study was conducted at a tertiary hospital in the Philippines, involving adult patients with acute pancreatitis admitted from January 2019 to December 2023. The primary outcome was in-hospital mortality, with secondary outcomes including predictors of mortality, organ failure, and underlying etiologies. A minimum sample size of 385 participants was computed.

Results: In total, 409 patients were included in the study, with a mean age of 47.35 ± 16.29 years and 48.17% being males. The severity of acute pancreatitis was mild in 60.9%, moderately severe in 10.2%, and severe in 28.9%. The most common etiology was gallstone (67.96%) followed by alcohol (23.23%) and infections (4.89%). The in-hospital mortality rate was 13.2%, rising to 35.15% for necrotizing pancreatitis. Renal failure was the most common organ involvement at 26.16%. Multivariate analysis identified older age (OR: 1.04), alcohol etiology (OR: 2.48), necrotizing subtype (OR: 4.00), higher Modified Marshall score (OR: 1.26), longer duration of symptoms before presentation (OR: 1.27), and lower serum albumin levels (OR: 0.46) as predictors of mortality.

Conclusion: Acute pancreatitis is associated with significant morbidity and mortality, particularly in patients with severe disease. Gallstone disease is the most common identified etiology, followed by alcohol and infections. Utilizing clinical predictors may identify patients who require aggressive resuscitation to reduce the risk of death.

Significance: Liver cirrhosis, particularly in its decompensated state, poses significant mortality risks globally, necessitating accurate prognostic tools. Established metrics like the MELD and Child-Pugh scores have limitations in predicting short-term mortality. Sarcopenia, being an established complication of Cirrhosis, can be reflected by the Psoas Muscle Index (PMI), has emerged as a potential marker for mortality in liver disease. This study aims to evaluate PMI’s reliability as a prognostic marker for 30-day mortality in patients with decompensated liver cirrhosis.

Methodology: A 5-year retrospective, observational, cohort, analytic study was conducted at a tertiary hospital. Patients aged 18 and above with confirmed decompensated liver cirrhosis and available CT or MRI scans were included. Those with confounding conditions affecting muscle mass were excluded. PMI, along with demographic and clinical data, were analyzed. Mortality within 30 days of admission was the primary outcome. Statistical analysis employed STATA v15, with logistic regression and ROC curve analysis to determine associations and PMI cutoff values.

Results: Among 48 patients, mortality was 37.5%. Decreased PMI scores were significantly associated with higher mortality (p=0.001). PMI showed high sensitivity (88.89%) but low specificity (33.33%) in predicting mortality. Child-Pugh scores demonstrated superior overall diagnostic accuracy compared to PMI and MELD.

Conclusion: PMI is a sensitive but nonspecific marker for short-term mortality in decompensated liver cirrhosis, warranting its integration as a supplementary tool alongside established scores. Limitations include the small sample size and single-center design. Future studies should validate findings in larger cohorts.

Significance: The clinical value of colonoscopy is contingent on optimal bowel preparation. Sodium picosulfate/magnesium oxide/citric acid (SPMC), polyethylene glycol (PEG), and lactitol monohydrate are commonly used agents, each with distinct efficacy and tolerability profiles. Conflicting evidence about their relative effectiveness necessitates further investigation.

Methodology: A single-center, prospective, randomized controlled trial conducted between July 2024 and January 2025. Randomization was performed using sealed envelopes and computer-generated allocation, with blinding of outcome assessors. Patients aged ≥18 years scheduled for elective colonoscopy were included. Exclusion criteria included prior bowel resection, chronic kidney disease, and emergency indications. Participants were assigned to receive SPMC, PEG, or lactitol monohydrate, with adjunct 20mg bisacodyl. The Boston Bowel Preparation Scale (BBPS), Colon Endoscopic Bubble Scale, and cecal intubation rate were assessed. Data were analyzed using SPSS v28, employing Tukey HSD and chi-square tests.

Results: A total of 213 patients were randomized to SPMC(N=71), PEG(N=71) and Lactitol Monohydrate(N=71), with no drop-outs reported. There were no differences in baseline characteristics between the 3 groups. The mean BBPS scores were 8.16 (SPMC), 7.98 (PEG), and 7.74 (lactitol), with no significant differences among groups (p > 0.05). Bubble scores were 0.38 (SPMC), 0.32 (PEG), and 0.42 (lactitol) (p > 0.05). Cecal intubation success rates were 100% for lactitol and 94% for both SPMC and PEG (p > 0.05).

Conclusion: SPMC, PEG, and lactitol monohydrate exhibited comparable efficacy, with no significant differences in bowel cleanliness, bubble formation, or cecal intubation rates. These findings may expand our bowel preparation options based on individual patient preferences, tolerability, and cost.

Significance: Micronutrient deficiencies are common in patients with liver cirrhosis. These deficiencies are exacerbated by malnutrition, poor digestion, and diuretic use. This study aimed to determine the micronutrient status of adult Filipino patients with liver cirrhosis, focusing on the prevalence of deficiencies and their association with clinical outcomes.

Methodology: This was a single-center single-arm retrospective cohort study conducted among adult cirrhosis at the NKTI. Micronutrient levels were reported, and prevalence of micronutrient deficiencies was determined. Univariate logistic regression was done to determine the association between specific micronutrient deficiencies and clinical outcomes, with odds ratios and corresponding 95% confidence intervals reported. Missing data were neither replaced nor estimated.

Results: Out of 461 patients assessed, 234 (50.76%) had at least one deficiency, with vitamin D and zinc being the most common deficiencies. Other deficiencies included iron deficiency, hypocalcemia, hypophosphatemia, and hypomagnesemia. Vitamin B12 deficiency was rare. Vitamin D deficiency was significantly associated with poorer outcomes, with 351% increased odds compared to those without deficiency. Calcium and phosphorus deficiencies were associated with 48% and 82% decreased odds of poorer outcomes, respectively. Zinc, iron, and magnesium deficiencies did not exhibit any statistically significant associations with clinical outcomes.

Conclusion: Vitamin deficiencies are common among patients with liver cirrhosis, and routine screening and monitoring of vitamin D levels are warranted. However, further research is needed to clarify these associations. The study’s limitations include a small sample size, and not all patients have a complete set micronutrient panel.

Descriptive and Cross-Sectional Studies

Significance: AFP is the most commonly used serum biomarker for HCC, with elevated levels linked to early recurrence, advanced stages, and poor prognosis. PIVKA-II, a newer biomarker, has shown higher sensitivity in detecting HCC and correlates with tumor size and Barcelona Clinic Liver Cancer (BCLC) Stage. This study aims to investigate the relationship between AFP, PIVKA-II, and clinicopathologic features of HCC to further understand their clinical utility.

Methodology: This cross-sectional study reviewed records from adult HCC patients at a tertiary hospital. Data on AFP, PIVKA-II, demographics, liver function tests, tumor characteristics, presence of portal vein thrombosis (PVT), and metastasis were collected. Statistical comparisons involved the Kruskal-Wallis test, Dunn’s post hoc test, and Receiver Operating Characteristic (ROC) analyses to evaluate the diagnostic performance of AFP and PIVKA-II.

Results: Among the 92 patients in the study, viral hepatitis-related HCC showed significantly higher AFP levels (p=0.010), but not PIVKA-II (p=0.071). Both biomarkers correlated with larger tumor size (p=0.009 for AFP, p=0.002 for PIVKA-II) and greater tumor number (p=0.010 for AFP, p<0.001 for PIVKA-II). Both levels also increased with advancing BCLC stages (p=0.010 for AFP, p=0.002 for PIVKA-II). PIVKA-II outperformed AFP as a predictor of lymph node metastasis (AUC 0.711, p<0.001 vs AUC 0.622, p=0.063), with 72% sensitivity at a threshold of 2,960.50 mAU/mL, and an 86% negative predictive value. Neither biomarker showed strong predictive value for PVT or distant metastasis.

Conclusion: AFP and PIVKA-II are correlated with tumor burden and advanced HCC stages, with PIVKA-II providing moderate predictive value for lymph node metastasis.

Significance: Esophageal varices are a common complication of liver cirrhosis, associated with increased mortality. Hence, early detection is vital to avoid catastrophic events. Esophagogastroduodenoscopy (EGD) is the gold standard for detecting varices, but its invasiveness and costs have brought about a need to develop more accessible means of diagnosis. Scoring systems using only laboratory parameters have been emerging as prospective alternatives, particularly in resource-limited settings. The aim of the study was to determine the accuracy of the Albumin-Bilirubin-Platelet (ALBI-PLT) Score in diagnosing the presence of esophageal varices in Filipino adults with liver cirrhosis.

Methodology: This is a single center cross-sectional analytical study. Participants included Filipino adults ≥ 18 years old, who underwent screening endoscopy for esophageal varices, and tested for serum albumin, bilirubin, and platelet count.

Results: A total of 156 patients were included in the study. Receiver Operating Characteristic (ROC) curve for ALBI-PLT score showed an area under the curve of 0.68 (p=0.001) signifying a significant predictive ability for varices. Best cut-off value determined was > 3. At this cut-off, sensitivity was noted to be 86.494% and specificity of 47.56%. Finally, there was noted to be a direct correlation between the ALBI-PLT score and the size of varices, with a correlation coefficient of 0.337, p value 0.0001.

Conclusion: The ALBI-PLT score has shown to have a significant ability to predict the presence of esophageal varices; and a significant direct correlation with their size. Despite its low specificity, it still shows potential as a simple and accessible tool for screening and early detection of varices as part of a holistic diagnostic approach to patients with cirrhosis.

Significance: Currently, there is only one local study on manometric patterns in patients who underwent esophageal manometry over six years, highlighting the high prevalence of weak peristaltic disorders and the need for further research on their pathophysiology and management. This study aimed to provide prevalence data and manometric patterns to raise awareness of these underrecognized disorders and enable more tailored therapies. Additional research from other regions could help establish pooled prevalence data. Notably, only three centers in the country, including our institution, have this technology.

Methodology: This was a descriptive retrospective study. All patients referred for HREM at the De La Salle University Medical Centre from December 2022 to December 2024 were included in the study. Descriptive statistics of the patients’ demographic data (age, sex, BMI) were calculated. The frequency distributions of patients’ symptoms were calculated along with the abnormal and normal esophageal manometry test. The mean and standard deviation for the various groups were also determined.

Results: A total of 68 patients underwent HREM, with demographic and clinical data collected. Esophageal motility was assessed using the Chicago Classification v4.0, and bolus transit, lower esophageal sphincter (LES) function, and pressurization patterns were analyzed.

The mean age of patients was 45 ± 15.86 years, with a female predominance (63.24%). Dysphagia (76.47%) was the most common symptom, followed by regurgitation (8.82%) and reflux (2.94%). Comorbidities were present in 32.35%, most commonly hypertension (11.76%) and diabetes (8.82%). Esophagogastroduodenoscopy (EGD) findings were consistent with achalasia in 48.53%, and esophagogram abnormalities were found in 32.35%, though more than half (54.41%) had no documented abnormalities.

HREM findings revealed impaired esophageal motility in most patients, with a median distal contractile integral (DCI) of 805 mmHg•s•cm and incomplete bolus transit in 39.71%. Primary achalasia was the most common disorder, affecting 52.94% (Type I) and 16.18% (Type II), while ineffective esophageal motility (14.71%) and absent peristalsis (7.35%) were also frequently observed. Failed peristalsis was documented in 67.65% of supine wet swallows, 62.69% of multiple rapid swallow tests, and 34.85% of upright swallow tests.

This study highlights the high prevalence of esophageal motility abnormalities in patients with non-obstructive dysphagia, with primary achalasia being the most common diagnosis. The findings emphasize the importance of HREM in detecting esophageal dysfunction and guiding clinical management.

Conclusion: The study demonstrates that esophageal motility disorders, especially primary achalasia, are common in patients with non-obstructive dysphagia. Manometric abnormalities, including failed peristalsis and incomplete bolus transit, were prevalent among patients. These findings, classified using the Chicago Classification v4.0, emphasize the critical role of HREM in diagnosing and tailoring treatment for esophageal motility disorders.

Significance: In a setting where resources are limited, identifying patients who have severe cholangitis in a fast and economic manner is of advantage. Patients with severe cholangitis is a priority to abrupt biliary drainage, due to its high mortality. We investigated then the diagnostic value of neutrophil-lymphocyte ratio (NLR) in identifying patients with non-severe and severe cholangitis. Cut-off level of NLR which will differentiate the two groups was also determined.

Methodology: We retrospectively evaluated 108 patients from January 2021 to December 2023 using simple random sampling. Inclusion criteria: 1). Patients with Charcot’s Triad, 2). Elevated Bilirubin and Alkaline Phosphatase, 3). Presence of ectasia in an imaging. Exclusion criteria: 1) Less than 18 years old, 2) Had concurrent inflammatory diseases such as acute pancreatitis, liver abscess, pneumonia, or acute cholecystitis. Using the formula to estimate the difference of 2 proportions, a minimum of 40 samples per group (non-severe and severe) were collected. Descriptive statistical analyses were used for the demographic profile of respondents using SPSS version 23.0. Pearson r Moment of Correlation was used to determine the relationship of NLR values and Severity of Cholangitis thru Tokyo Grading 2018. Receiver Operating Characteristic curve was used to determine the specificity and sensitivity of NLR in determining Severe Acute Cholangitis. Area Under Curve (AUC) was used to quantify the overall ability of the test to discriminate the severity of the disease.

Results: The mean NLR of patients classified as non-severe was 8.27 ± 10.23. While the mean NLR of patients categorized as severe was 29.08 ± 20.00. A significant relationship (0.004) of NLR values and Tokyo Severity Grading 2018 of Acute Cholangitis was noted at significance level of 0.01. NLR is a good model of predicting cholangitis given an AUC of 0.781. Using the cutoff value of 13.7 the sensitivity and specificity in predicting severe cholangitis using NLR level were 47.5% and 82.4%, respectively.

Conclusion: NLR has an ability to detect severe cases of Cholangitis, comparable to Tokyo Severity Grading of Acute Cholangitis 2018. The higher the NLR is the higher the possibility of having a severe cholangitis.

Significance: Colon cancer is the fourth leading cause of cancer-related deaths in the Philippines, particularly affecting individuals aged 50 and above. Colonoscopy remains the gold standard for screening, but in resource-limited areas, a risk scoring system may help prioritize individuals who need further evaluation. This study aims to validate the Modified Asia-Pacific Colorectal Screening (APCS) score in predicting the risk of advanced colorectal neoplasia among asymptomatic Filipino adults.

Methods: This prospective study included 391 asymptomatic adult patients, aged 45-75, who underwent screening colonoscopy at St. Luke’s Medical Center. Patients with prior colorectal procedures or diseases were excluded. The Modified APCS score, based on factors such as age, sex, body mass index (BMI), family history, and smoking history, was used to assess the risk of advanced colorectal neoplasia. Colonoscopy and histopathological findings were collected, and the study calculated the sensitivity, specificity, and predictive values of the Modified APCS score.

Results: A total of 391 patients were included in the study, with the majority aged 55-64 years and a higher proportion of females. The most common lesions were tubular adenomas smaller than 10 mm (36.6%), followed by tubulovillous adenomas (3.6%), with a higher prevalence in males and those with a BMI over 23 kg/m2. The Modified APCS score, using a cutoff of >3, demonstrated 75% sensitivity (CI: 53.29% to 90.23%) but low specificity (33.24%, CI: 28.44% to 38.32%), suggesting it may be effective at ruling out advanced neoplasia but less reliable in identifying true positives. The score performed differently based on age: it had higher sensitivity in patients 50 years old and above (75%) and greater specificity in those under 50 (54.69%), with both age groups showing high negative predictive value (NPV) of 95.31% (CI: 90.92% to 97.63%), but low positive predictive value (PPV). These findings suggest that the modified APCS score may have utility in ruling out advanced colorectal neoplasia.

Conclusion: The modified APCS score may have limited applicability in asymptomatic adult Filipinos due to its low specificity and PPV, reducing its ability to accurately predict advanced colorectal neoplasia. However, its high sensitivity and NPV make it useful for identifying low-risk individuals, helping to prioritize higher-risk patients for further evaluation.

Meta-Analysis

Significance: Large choledocholithiasis is associated with higher rates of failed extraction with conventional endoscopic techniques and pose significant risks. Biliary stenting may serve as a temporary measure, with the goal of facilitating a reduction in the size of the stone, potentially making it amenable to subsequent ERCP and successful extraction. However Biliary stenting alone , may not always achieve complete stone removal on retained stones and addition of choleretic agents such as ursodeoxycholic acid (UDCA) and terpene preparations may promote CBD stone size reduction that could enhance stone clearance. Limited evidence comparing the efficacy of biliary stenting alone versus stenting combined with UDCA and terpene treatment highlights the need for further investigation into their comparative outcomes.

Methodology: Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of biliary stenting alone versus biliary stenting combined with UDCA and terpene treatment published from 2011 to 2024 in PubMed, Elsevier Science Direct, and Google Scholar. The primary outcomes were stone clearance from the CBD, . The secondary outcome includes recurrence rates and adverse events. The study adhered to the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: Six RCTs with 374 participants were included. The that biliary stenting combined with UDCA and terpene treatment had a higher stone clearance rate (88.9%) compared to biliary stenting alone (78.7%). Although recurrence rates were slightly lower in the combination group (9.8% vs. 10.7%), the group was associated with more adverse events (41.3%) compared to stenting alone (16.3%).

Conclusion: The study concludes that combining biliary stenting with UDCA and terpene treatment yields better stone clearance and slightly reduced recurrence rates, but the higher incidence of adverse events necessitates further study.

Significance: Endoscopic mucosal resection (EMR) is a crucial technique in the removal of precancerous and early-stage cancer lesions within the gastrointestinal tract. Hot snare EMR (H-EMR) and cold snare EMR (C-EMR) techniques are widely debated regarding their efficacy and safety in the resection of large non-pedunculated colorectal polyps (>20mm). This meta-analysis aims to compare the outcomes of H-EMR and C-EMR, focusing on technical success, risk of perforation and bleeding, and rate of polyp recurrence.

Methodology: Relevant studies were identified through systematic searches of PubMed, MEDLINE, Cochrane, and Google Scholar databases. Out of 173, four eligible studies (2 randomized controlled trials and 2 retrospective studies) were included in the analysis. A quality assessment was performed using the Cochrane Risk of Bias tool for the randomized controlled trials and the Newcastle-Ottawa scale for the retrospective studies.

Results: There is no statistically significant difference in the technical success rate of C-EMR compared to H-EMR for removing large nonpedunculated colonic polyps (OR 2.11, 95% CI [0.14-31]; I²=67%). Additionally, there is no significant difference in the risk of perforation between the two methods (OR 0.23, 95% CI [0.04-1.30]; I²=0%). H-EMR has a higher risk of postpolypectomy bleeding compared to C-EMR (OR 0.2, 95% CI [0.07-0.56]; I²=0%). In contrast, C-EMR has been shown to have a higher rate of polyp recurrence compared to H-EMR (OR 2.56, 95% CI [1.40-4.70]; I²=43%). Additional subgroup analysis of the included randomized controlled trials for rate of polyp recurrence showed consistent findings (OR 2.70, 95% CI [1.62-4.49]; I2=80%).

Conclusion: C-EMR is non-inferior to H-EMR in the resection of large nonpedunculated colonic polyp, with both methods showing similarly low perforation rates. C-EMR has a higher rate of polyp recurrence compared to H-EMR. Meanwhile, H-EMR has a higher risk of postpolypectomy bleeding compared to H-EMR. Cost-effective analyses to compare C-EMR and H-EMR are recommended.

Significance: Diet and lifestyle modifications are the cornerstones of obesity treatment. However, weight loss is challenging to achieve and maintain over the long term while there aren’t many reliable medical interventions that can lead to significant weight loss. 3 GLP-1 receptor agonists are important therapeutic agents for treating type 2 diabetes mellitus (T2DM), and at the same time help in managing obesity. Semaglutide, Dulaglutide, and Liraglutide are medications that imitate the function of GLP-1, a hormone involved in glucose metabolism and appetite control.

Methodology: An electronic search was done was done on August 2024 in MEDLINE via Pubmed, Cochrane Library, Embase, ClinicalKey, Scopus, Google Scholar, and Herdin, using the search terms: (Semaglutide OR Dulaglutide OR Liraglutide) AND (Weight OR BMI OR obesity). We included randomized interventional studies which compared at least any two of these three medications for weight loss. Pooled mean difference for change in weight was computed using Random Effects Meta-analysis while pooled risk ratio was used for adverse events. The RevMan 5.4 software was used for statistical analysis.

Results: Seven studies were included in the meta-analysis. The pooled mean difference showed significantly higher mean weight loss in semaglutide compared to dulaglutide (MD=2.71 kg, 95%CI=1.85 to 3.58, p<0.00001) and in semaglutide compared to liraglutide (MD=2.53 kg, 95%CI=0.98 to 4.07, p=0.001). The pooled risk ratio showed no significant difference in risk for adverse events between those given semaglutide versus dulaglutide (RR=1.33, 95%CI=0.92 to 1.91) and between those given semaglutide versus liraglutide (RR=1.08, 95%CI=0.99 to 1.18). No studies were found comparing dulaglutide versus liraglutide.

Conclusion: Semaglutide showed higher magnitude of weight loss compared to Dulaglutide and Liraglutide. Semaglutide, Dulaglutide, and Liraglutide are equally safe for use among patients for weight loss. Further studies are recommended to determine the differences in effectiveness across different dosing regimens of GLP-1 receptor agonists.

Significance: Helicobacter pylori infection has affected approximately 50% of the world’s population with rates being higher in developing countries than in developed ones. Conventional proton-pump inhibitors (PPIs) are widely used as first-line treatments but have notable limitations which include slow onset of action, short plasma half-life of 60–90 minutes, dependence on acidic conditions for activation and suboptimal nighttime acid suppression. In contrast, potassium- competitive acid blockers (P-CABs) were recently developed which may offer beneficial effects, offering a promising alternative to PPIs.

Methodology: Randomized Controlled Trials (RCTs) involving adult patients with H. pylori infection treated with PCAB-based or PPI-based therapies were included. Exclusion criteria included RCT not using PPIs or PCABs, studies lacking sufficient data, and duplicates. Systematic searches were conducted on PubMed, Cochrane CENTRAL, Google Scholar, and HERDIN for studies published between 2013 and 2023, using keywords such as “H. pylori,” “Potassium Competitive Acid Blocker,” and “Proton Pump Inhibitor.” No language restrictions were applied. Quality assessment used the Modified Cochrane risk-of-bias tool, and statistical analysis was performed using ReviewManager 5.4.1 Effect sizes were expressed as risk ratios (RR) with 95% confidence intervals (CI) using a fixed-effects model. Heterogeneity was evaluated using Cochran’s Q test and I² statistics.

Results: Fifteen RCTs with 4129 participants who received H pylori eradication therapy comparing potassium competitive acid blockers (Tegoprazan, Vonoprazan, and YH808) with proton pump inhibitors were analyzed. H. pylori eradication rate of potassium competitive acid blocker-based therapy was higher than that of PPI-based triple therapy RR 1.04, CI 1.10-1.18, P < 0.05. Subgroup analysis showed that PCAB- based regimens had significantly higher eradication rates than PPI in treatment-naive patients (RR 1.14, 95% CI 1.1-1.18, pP < 0.05 ) and that Vonoprazan-based regimen in particular, had superior eradication rates compared to PPI-based regimen (RR 1.16 95% CI 1.12-1.20 P < 0.05). No significant differences were seen between the Tegoprazan and YH4808 groups compared to the PPI group. Adverse events were also lower in the PCAB group compared to the PPI group.

Conclusion: Our study shows that Potassium channel acid blockers are effective and have significantly higher eradication rates compared to PPIs, with lower incidence of adverse events. Clinical practice may benefit from integrating PCABs as first-line options for H. pylori management.

Significance: Managing tumoral bleeding poses significant challenges due to mucosal invasion and the limitations of traditional endoscopic tools, such as clips and heat-probes. Hemostatic powder sprays offer an innovative solution by forming a mechanical barrier to achieve hemostasis. This meta-analysis evaluates the efficacy and safety of Hemostatic powder sprays compared to standard endoscopic treatments in malignancy-related gastrointestinal bleeding (MRGB).

Methodology: Studies were included if they were randomized controlled trials (RCTs) comparing Hemostatic powder sprays with standard endoscopic treatments in MRGB and excluded if they lacked malignancy-specific outcomes or were case reports. A comprehensive search using terms like “Hemostatic powder,” “Hemospray,” and “malignancy-related gastrointestinal bleeding” was conducted in PubMed, Scopus, and Web of Science. Articles were assessed for quality using the Cochrane Risk of Bias tool, and disagreements were resolved by consensus among reviewers. Statistical analyses, including pooled odds ratios (ORs) and heterogeneity (I² statistic), were conducted using RevMan software with a random-effects model.

Results: Three RCTs involving 162 patients met our inclusion criteria. Hemostatic sprays significantly reduced the rebleeding rates (OR 0.36, 95% CI 0.15-0.84, p=0.01) compared to standard endoscopic treatments. A non-significant trend favoring Hemostatic powders for all-cause mortality was observed (OR 0.40, 95% CI 0.19-0.83, p=0.09). Adverse events were rare and comparable between groups. Funnel plots and sensitivity analyses indicated no publication bias.

Conclusion: Hemostatic powder sprays significantly reduce rebleeding rates and exhibit comparable safety to conventional treatments, supporting their role as an alternate intervention for malignancy-related gastrointestinal bleeding as bridge to surgery or interventional radiologic treatment. Further RCTs are warranted to refine protocols and validate their long-term outcomes.

Case-Reports

Background: Autoimmune hepatitis (AIH) is a rare, chronic liver disease that affects individuals of all ages and ethnic groups, with a higher prevalence in females. Seronegative AIH is even rarer, accounting for only 7% of cases. Diagnosing AIH can be difficult due to its overlap with other conditions, such hemochromatosis. Liver biopsy is essential for histopathologic confirmation.

Clinical Presentation: A 58-year-old male with hypertension and diabetes presented with persistently elevated liver enzymes for three months and developed jaundice and dark-colored urine but no abdominal pain or fever. Laboratory tests revealed elevated AST (172 U/L), ALT (248 U/L), alkaline phosphatase (232 U/L) and total bilirubin (2.47 mg/dL), while albumin level (3.54 g/dL) is normal. Ultrasound showed fatty liver without biliary obstruction. Abdominal MRI suggested the possibility of hemochromatosis. Iron studies showed elevated iron (200 μg/dL), TIBC (300 μg/dL), and ferritin (3,182 ng/mL), with a transferrin saturation of 60%. Other findings included elevated serum IgG (312 IU/mL) and GGT (225 U/L). ANA, AMA, and ASMA were negative, while the direct antiglobulin test was positive. Viral hepatitis panel was negative. Liver elastography indicated cirrhosis (20.41 kPa, F4). A liver biopsy revealed chronic hepatitis with interface activity, moderate lobular inflammation, mild steatosis, periportal fibrosis with focal septa, and negative Perl’s stain in the hepatocytes. The HFE gene mutation test was normal. These laboratory and histologic findings confirmed the diagnosis of autoimmune hepatitis. The patient was started on steroid therapy, achieving clinical and biochemical remission, including normalization of iron saturation levels. He is currently maintained on mycophenolate mofetil for long-term remission.

Conclusion: AIH can present with a variety of clinical symptoms, including unexplained liver dysfunction and elevated iron levels, making it challenging to distinguish from iron overload syndrome or hemochromatosis. Prompt diagnosis and treatment with steroids achieves biochemical remission, including normalization of iron overload.

Background: Joubert Syndrome (JS) is a rare neurodevelopmental disorder with an estimated prevalence of 1 in 80,000 to 100,000 live births. It is characterized by cerebellar ataxia, hypotonia, developmental delay, and the hallmark “molar tooth sign” (MTS) on brain imaging. Even rarer is JS with hepatic defects (JS-H), which occurs in 6% to 14% of cases and is typically associated with congenital hepatic fibrosis (CHF). This report documents the first genetically confirmed case of JS-H in the Philippines, highlighting the importance of recognizing this condition in patients with unexplained liver disease and neurological symptoms. Early genetic testing and multidisciplinary care are crucial for improving patient outcome.

Clinical Presentation: A 19-year-old male from Cebu, with developmental delay, dysarthria, ataxia, jaundice, and abdominal distention, presented at the emergency department with massive hematemesis and melena. Family history revealed a younger sibling with similar neurological symptoms but no signs of liver involvement. Other family members were clinically well. Laboratory results showed severe anemia, pancytopenia, elevated liver enzymes, and coagulopathy, indicating liver dysfunction. Imaging confirmed liver cirrhosis, splenomegaly, and ascites. Esophagogastroduodenoscopy revealed type 1 gastroesophageal varix. A cranial CT scan demonstrated the hallmark MTS. Genetic testing identified pathogenic variants in the TMEM67 gene (NM_153704.6:c.2086C>T and NM_153704.6:c.431del), confirming JS-H. A comprehensive work-up excluded other potential causes of advanced liver fibrosis, such as viral, metabolic, autoimmune, hematologic, and structural conditions. The patient was managed with blood transfusions, octreotide, beta-blockers, prophylactic antibiotics, diuretics, and nutritional support. Due to equipment limitations in our setting, endoscopic management was not performed, and medical management was optimized. The patient was discharged in improved condition. Genetic counseling was provided and regular screening for hepatocellular carcinoma was advised.

Recommendation: Future research should explore the pathophysiology of TMEM67 mutations and the epidemiology of JS-H in the country to improve early diagnosis and intervention.

Background: Banti’s Syndrome is marked by elevated portal pressure without liver disease or portal vein obstruction. Its cause remains unclear, though factors like arsenic exposure and hypervitaminosis A are implicated. This case highlights diagnostic and management challenges in a young patient with gastrointestinal bleeding.

Clinical Presentation: A 23-year-old male with no known co-morbidities presented with melena. Physical examination revealed a large palpable mass in the left upper quadrant, with no signs of chronic liver disease. Endoscopy showed grade 3 esophageal and gastric varices. Work up indicated preserved liver function and pancytopenia. Investigations revealed F0 in Fibroscan, and no thrombosis on Doppler. CT showed a normal liver, extrahepatic portosystemic shunt, gastric varices, and minimal ascites. Liver biopsy was normal, and tests for autoimmune, hypercoagulable, and myeloproliferative disorders, as well as schistosomiasis, were negative. Findings confirmed Banti’s Syndrome. Splenectomy and devascularization was advised however the patient declined. Hence, Balloon-Occluded Retrograde Transvenous Obliteration with splenic artery embolization was performed. Gastrorenal shunt was not identified, hence splenic artery embolization was proceeded. The procedure was successful with no development of splenic abscess. Two months later, CBC was normal and endoscopy revealed significant resolution of the varices. The patient had no complaints thereafter.

Conclusion: This case highlights the complexity of Banti’s Syndrome, a rare cause of non-cirrhotic portal hypertension. Absence of hepatic fibrosis and exclusion of secondary causes were essential in establishing the diagnosis. Multidisciplinary management is crucial for optimal outcomes. Further research is needed to better understand the pathophysiology and refine treatment strategies for Banti’s Syndrome.

Background: Autoimmune hepatitis – primary biliary cirrhosis (AIH-PBC) overlap syndrome represents a significant yet underrecognized variant of autoimmune liver disorders, accounting for less than 10% of cases. Patients present with a mixed hepatocellular and cholestatic pattern of liver injury. The diagnosis is often delayed, particularly when drug-induced liver injury (DILI) is being considered, as it exhibits a similar pattern of liver test abnormalities.

Clinical Presentation: A 22-year-old female presented with a 4-month history of jaundice and pruritus after starting anti-tuberculosis therapy (ATT) for pulmonary tuberculosis. Three weeks into treatment, she developed jaundice and generalized pruritus, prompting discontinuation of the ATT. She was initially given silymarin and phospholipids, but her symptoms did not improve. She eventually consulted at our institution due to worsening symptoms and liver tests . Initial laboratory investigations revealed a mixed hepatocellular and cholestatic pattern of liver injury, raising suspicion for underlying chronic liver disease. MRCP showed a normal liver and biliary tree, and while ANA was positive, AMA, anti-LKM-1, and anti-SMA were negative. A liver biopsy revealed portal inflammation, ductular reaction, and interface hepatitis. She was treated with ursodeoxycholic acid and prednisone, resulting in clinical improvement and resolution of jaundice within weeks.

Conclusion: AIH-PBC overlap syndrome poses a diagnostic challenge, particularly when it mimics DILI. This case highlights the importance of excluding a chronic liver disease in cases of persistent liver injury even after discontinuing the suspected drug. Prompt recognition and initiation of immunosuppressive therapy and UDCA are crucial for improving outcomes and preventing disease progression.

Background: Eosinophilic gastrointestinal disease (EGID) is a rare inflammatory condition characterized by eosinophilic infiltration of specific segments and layer of the gastrointestinal tract, leading to diverse symptoms. In our patient, multiple GI segments were involved which is a rare and complex presentation of EGID, leading to her varied symptoms. Likewise, the presence of ascites suggests deep eosinophilic infiltration to the serosal layer, which is the least common layer affected, further adding to the unusual presentation of the case.

Clinical Presentation: The patient is a 53 year old female who presented with reflux, heartburn, bloating, epigastric pain, vomiting, and loose watery stools. Her symptoms affected both the upper and lower gastrointestinal tracts. These symptoms persisted despite initial treatment for GERD and infectious diarrhea. Investigations revealed significant eosinophilia in peripheral blood and whole abdominal ultrasound showed ascites. Analysis of the ascitic fluid also revealed significant eosinophilia. This suggests deep eosinophilic infiltration to the serosal layer, which is the least common layer affected. Endoscopy and colonoscopy were done with multiple biopsies, and eosinophilic infiltration was confirmed in the esophagus, stomach, small intestine, and colon. She was managed as a case of EGID after initial poor response with treatment for GERD and infectious diarrhea. Investigations revealing eosinophilia in the mucosa of various different segments of her GI tract as well as ascitic fluid confirmed the diagnosis. After establishing the diagnosis, she was treated with montelukast and corticosteroids, which resulted in rapid and marked improvement of all her symptoms.

Conclusion: This case contributes knowledge to the literature that despite multiple segments and bowel wall layer involvement, the condition is very responsive to therapy, emphasizing the importance of awareness of this condition among clinicians for early diagnosis and appropriate treatment.