Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 29

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 32

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JRequest::clean() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 33

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 463

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 464

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 465

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 466

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 467

Strict Standards: Non-static method JRequest::_cleanArray() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/environment/request.php on line 468

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 35

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 38

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 39

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 46

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 47

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 50

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 53

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 54

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 57

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/import.php on line 58

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/samehla/public_html/prof/index.php on line 31

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Redefining already defined constructor for class JObject in /home/samehla/public_html/prof/libraries/joomla/base/object.php on line 57

Strict Standards: Non-static method JApplication::getInstance() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/factory.php on line 46

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JApplicationHelper::getClientInfo() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/application/application.php on line 132

Strict Standards: Declaration of JSite::getRouter() should be compatible with & JApplication::getRouter($name = NULL, $options = Array) in /home/samehla/public_html/prof/includes/application.php on line 377

Strict Standards: Declaration of JSite::getPathWay() should be compatible with & JApplication::getPathway($name = NULL, $options = Array) in /home/samehla/public_html/prof/includes/application.php on line 377

Strict Standards: Declaration of JSite::getMenu() should be compatible with & JApplication::getMenu($name = NULL, $options = Array) in /home/samehla/public_html/prof/includes/application.php on line 377

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/registry/registry.php on line 19

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Declaration of JSession::set() should be compatible with JObject::set($property, $value = NULL) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 737

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 19

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Warning: session_start(): Cannot send session cookie - headers already sent by (output started at /home/samehla/public_html/prof/libraries/joomla/import.php:29) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 423

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Warning: session_start(): Cannot send session cache limiter - headers already sent (output started at /home/samehla/public_html/prof/libraries/joomla/import.php:29) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 423

Warning: Cannot modify header information - headers already sent by (output started at /home/samehla/public_html/prof/libraries/joomla/import.php:29) in /home/samehla/public_html/prof/libraries/joomla/session/session.php on line 426

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/html/parameter.php on line 21

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Declaration of JRegistryFormatINI::objectToString() should be compatible with JRegistryFormat::objectToString(&$object) in /home/samehla/public_html/prof/libraries/joomla/registry/format/ini.php on line 281

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JPluginHelper::importPlugin() should not be called statically in /home/samehla/public_html/prof/index.php on line 41

Strict Standards: Non-static method JPluginHelper::_load() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 92

Strict Standards: Non-static method JPluginHelper::_import() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 97

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Redefining already defined constructor for class JPlugin in /home/samehla/public_html/prof/libraries/joomla/plugin/plugin.php on line 75

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Declaration of JEvent::update() should be compatible with JObserver::update() in /home/samehla/public_html/prof/libraries/joomla/event/event.php on line 29

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 138

Strict Standards: Non-static method JDispatcher::getInstance() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 140

Strict Standards: Non-static method JPluginHelper::getPlugin() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 147

Strict Standards: Non-static method JPluginHelper::_load() should not be called statically in /home/samehla/public_html/prof/libraries/joomla/plugin/helper.php on line 41

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/samehla/public_html/prof/libraries/loader.php on line 161

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Esophageal webs & rings
  • Personal information

          

    Prof. of Hepatology & Gastroenterology, Cairo University.

    Consultant of Hepatology,Gastroenterology and Endoscopy

    Management Positions: •

    Chief of Hepatology unit El Manial University Hospital (1994-1998).

    • Chief of Gastroentero ICU in Cairo university hospital (1997-2000)

    • President of the board of AlfaScope GI Specialized center (2004-2014).

    • Head of Endoscopy Unit in Cairo University Hospitals (2005-2010).       

     

     .Read more

     

    استاذ الكبد و الجهاز الهضمى بكلية الطب جامعة القاهرة

    استشارى الكبد و الجهاز الهضمى و المناظير

    دكتوراه امراض الكبد و الجهاز الهضمى من كلية الطب جامعة القاهرة

    الرئيس السابق لقسم الامراض الباطنية بكلية الطب جامعة ٦ اكتوبر

    الرئيس السابق لوحدة مناظير الجهاز الهضمى و مركز الكبد و الرعاية المركزة بقصر العينى

     

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Tuesday, Oct 16th

Last update10:09:06 AM

        

Esophageal webs & rings

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Esophageal webs & rings

Definition:

  • Esophageal web:

A thin mucosal fold that protrudes into the lumen and is covered with squamous epithelium. Webs most commonly occur anteriorly in the cervical esophagus, causing focal narrowing in the post-cricoid area.

  • Esophageal rings: 2 types
  • Mucosal Schatzki rings (B rings):

Mucosal structures at the gastro-esophageal junction that are smooth, thin, and covered with squamous mucosa above and columnar epithelium below. This is the common type.

  • Muscular rings (A rings):

This type is rare, usually seen in children, located within 2 cm of the squamo-columnar junction, and characterized by hypertrophic musculature in the esophageal body.

The caliber of a muscular ring changes during peristalsis, distinguishing it from a peptic stricture or mucosal ring.

Pathogenesis:

 Pathogenesis of mucosal rings is controversial.

 It may be due to either:

  • Chronic damage from GERD.
  • Congenital or developmental.

Pathogenesis of cervical webs is also controversial. It may be congenital or acquired as an extra-cutaneous manifestation of systemic disorders such as Epidermolysis bullosa, Bullous pemphigoid & Pemphigus vulgaris.

Diagnosis:

Esophageal rings and webs cause dysphagia to solids..

Detection is done by fluoroscopy using the full-column technique. This technique will detect 100% of esophageal rings.

Endoscopy is less sensitive in detecting esophageal rings and strictures since they will not be seen unless the lower esophagus is widely distended. Endoscopically, esophageal ring appears as a thin membrane with a concentric smooth contour that projects into the lumen.

Asymptomatic Schatzki rings are found in 6-12% of routine barium studies and in  15-25% of cases of esophageal dysphagia.

An association between mucosal rings & eosinophilic esophagitis has been reported.

Although webs have classically been associated with iron-deficiency (Plummer-Vinson syndrome), at least one epidemiologic study found no correlation between cervical webs and iron deficiency.

TREATMENT

Esophagel webs:

  • They are usually ruptured during diagnostic endoscopy.
  • Esophageal dilation may be necessary.
  • Rarely, they are refractory to standard dilations. These are treated by endoscopic laser division.

Esophageal rings:

  • First line of treatment is dilation with a large bougie (≥50 French).
  •  Dilation can also be done with a balloon dilator that corresponds in size to a large bougie (18 to 20 mm).
  • When rings are dilated, the initial dilator used is large and reflects the goal of ring disruption.
  •  A possible alternative to dilation with a large bougie is disruption of the ring with a biopsy forceps or with electrosurgical incision.
  • Patients with multiple esophageal rings are an exception. Forceful dilation with a large caliber bougie has been associated with deep mucosal tears and esophageal perforation. Such patients should be dilated very cautiously.
  • Prospective studies suggest that symptom recurrence after dilation is probably the rule rather than the exception and should be anticipated after one year. Recurrence also develops following other methods to disrupt the ring.
  • Acid suppression may reduce the risk of recurrence as illustrated in a controlled trial, so it is recommended after dilatation to give long term PPIs.
  • Balloon dilation, steroid injection, surgery, and endoscopic incision, have been proposed to the small number of patients with lower esophageal rings that fail to respond to repeated bougie dilatation.

 

Last Updated on Thursday, 18 May 2017 11:13

 

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  • عنوان: 98 شارع التحرير , ميدان الدقي, القاهرة , مصر
     
  • هاتف: (+202) 376 1111 8

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