SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 38 SAGES CONGRESS 2022 ABSTRACTS inflammation could connote the contributions of H. Pylori in the aetiopathogenesis of GCA. Therefore, preventive measures and screening programs should be guided accordingly. USE OF SERUM CYTOKINES AS MARKERS OF TREATMENT RESPONSE TO ANTI-TNF AGENTS: A PILOT STUDY. Author Dr Ernst Fredericks, S Fortuin, A Holthausen, S Gabriel, A Loxton Background Biological therapy has revolutionized the treatment of inflammatory bowel disease. TNF-antagonists are often the first biologics to be introduced when conventional therapy fail. However, 30% of patients experienced primary non-response (PNR) at induction of anti-TNF agents. Furthermore, 50% of patients experienced secondary loss of response (SLR) within 12 months of starting therapy. There is currently no reliable way to predict treatment response with anti-TNF agents. Method Patients failing conventional therapy, requiring escalation of therapy to anti-TNF agents were recruited into the study. Blood for serum cytokines, inflammatory markers and faecal calprotectin were taken prior to commencement of biologic therapy and every 8 weeks following thereafter. Patients experiencing PNR were switched to a second anti-TNF or underwent surgery. All patients were followed for a year. Results Fourteen patients (9 Crohn’s disease and 5 ulcerative colitis) and 10 healthy controls were enrolled. Five patients (2 UC and 3 CD) experienced PNR. Two patients underwent colectomy. Patients with PNR had significantly elevated TNFα and NFkB levels at baseline and at time of failure. On the other hand, patients who responded to treatment had lower levels of TNFa and NFkB on subsequent testing. Other cytokine markers were expressed at surprisingly low level on subsequent following testing. Conclusion Persistently elevated levels of TNFα and NFkB are remarkably reliable predictors of treatment failure in IBD patients as early as 2 weeks into therapy. We suspect that the same serum markers may be useful in predicting SLR for anti-TNF therapy. AN 8-YEAR RETROSPECTIVE REVIEW OF PYOGENIC LIVER ABSCESSES AT GROOTE SCHUUR HOSPITAL, CAPE TOWN, SOUTH AFRICA. Author Dr Nieleshen Govender 1 1 University of Cape Town Background Pyogenic liver abscess (PLA) is the most common abdominal solid organ abscess with significant associated morbidity and mortality (2-30%). High variance in the causative organism exists therefore identifying the responsible pathogens and providing targeted therapy is needed for optimal outcomes. This study aims to describe patient variables, outcomes and the local microbiome to guide future empiric antibiotic protocols. Methods We performed a retrospective review of 121 patients with PLA from 2012 to 2020 at Groote Schuur Hospital. We analyzed patient demographics, microbiology results from cultures of PLA (bile, percutaneous aspiration or intra-operative sampling) and blood samples, empiric antibiotic regimens used, interventions and outcomes. Results The five most common organisms cultured were Escherichia coli [26 (21%)], Klebsiella pneumoniae [24 (19.8%)], Pseudomonas aeruginosa [12 (9.9%)], Anaerobic organisms Isolated [11 (9%)] and Enterobacter cloacae Complex [7 (5.1%)]. Twenty different regimens were used to treat PLA. Primary intervention (antibiotics alone, percutaneous drainage, open surgery) was successful in 72 patients (60%). Further intervention was required in 49 patients (40%). Open surgical drainage was required in 16 patients (13%). 30-day mortality was 9.1% (n=11). Biliary sepsis was the most common cause of PLA (31%). Our study showed Gentamicin [52 isolates (65%)], Ciprofloxacin [49 isolates (61%)] and Co- Amoxiclav [46 isolates (46%)] to be the most effective in covering the five most common isolates. Conclusion Optimal PLA management remains challenging with multiple combinations of empiric antibiotic regimens initiated. Local data on the topic is sparse and this research is hypotheses generating for future research to improve outcomes. PEP ‘TIK’ ULCERS: SUBSTANCE ABUSE AND PERFORATED PEPTIC ULCERS IN THE CAPE METRO WEST- A PROSPECTIVE REVIEW. Author Dr Catherine Keen 1 , Dr Shreya Rayamajhi 1 New Somerset Hospital, 2Univeristy of Cape Town Introduction Over the last 20 years there has been an increase in the use of crystal methamphetamine (colloquially known as ‘tik’) in the Western Cape. There have been links made between the use of ‘tik’ and peptic ulcer disease and importantly perforated peptic ulcers, few studies are available to support this. The aim of this study is to ascertain if there are direct associations with substance abusers, specifically ‘tik’ use, and the rate of peptic ulcer disease in the Cape West Metro. Methods This is a prospective multicentre study set in the Western Cape Metro West surgical departments. Data will be drawn from the Emergency laparotomy/laparoscopy Audit Cape Town (EL2AC) database (HREC/ REF R042/2020). It incorporates all patients in the Cape Metro West that underwent emergency abdominal surgery between 28/1/2021 and 31/1/2022. SAGES CONGRESS 2022 ABSTRACT eji l NF- eatment nset of its for the eir d atients eir py ribution ications 40.4 64.4 35.6 2:1 for was 79.4% t cases cal pared d and TRENDS IN PROCEDURAL OUTCOMES AT ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. Author Doctor Sayuri Naidu 1 , Doctor Frank Anderson 1 1 IALCH Introduction Endoscopic retrograde cholangiopancreatography (ERCP) has evolved largely into use for therapeutic purposes. This has been assisted by advancement in other diagnostic modalities viz MRI and Endoscopic Ultrasound. Failures at ERCP may be due to an inaccessibl ampulla of Vater, f ilure cannulate th ducts or in the intended therapy (v z failure to ex ract stones or deploy stents). There m y be normal findings or an unnecessary proc ure. Unnecessa y ERCP should be limited as the complications of acute pancreatitis, perf ration and ble di g may be fatal. Methods A re rospective view of electron c records of ERCP performed by a surgical team on a single day in week from 2011 to 2017 was performed. Demographic information, indications for ERCP, success and failure ates and non- eutic procedures were analyzed. Ethical approval was obtained fr m the UKZN ethic com ittee. Results All patients wer referred from six regional hospitals. Six hundred and fifty procedures were revi wed from 2011 to 2017. The mean age in this population was 55 years with a standard deviation of 17 years. There were 191 (29.9%) males and 447 (70.1%) females. Gallstones, 295(45%), bile duct strictur , 167(26%), periampull ry mass, 72(11%) and pseudocyst, 22(3%) were the commonest ndications. The average cannulation rat over the period was 88.5% which improv d o 92% when a pre-cut papillotomy was performed. Ther was failure to achieve therapeutic intent in n av rage 12(13%) and success in 67(72%) of patients. In a average 14(15%%) of patients there was no pathology at the time pf ERCP. Complications of ERCP were not analyzed a patients were repatriat d to their referring institution a d these were not routinely evaluated. Conclusion The cannulation rate when the ampulla was identified was simil r to other studi s. H wever, great r than 10% of procedur s which wer un ecessary at th time of ERCP and th should be further eval ated a d lim ted. TUBERCULOUS LIVER ABSCESS. Author Dr Yonela Qubekile 1 1 Department of Gastroenterology, Nelson Mandela school of medicine, University of Kwa-Zulu Natal, Inkosi Albert Luthuli Central Hospital Introduction Tuberculosis (TB) is common in South Africa but tub rcu ous liver ab cess (TLA) is extremely rare with a prev lence of 0.35%. Focal TB of the l ver can be manifested by single or multiple tuberculous abscesses. These occur more frequently in immu ocompromised