INTRODUCTION: IgG4 disease has been characterised by lymphoplasmacytic inflammation, rich in IgG4 plasma cells, elevated serum IgG4 and clinical improvement with steroid therapy. There is limited information about IgG4 p...INTRODUCTION: IgG4 disease has been characterised by lymphoplasmacytic inflammation, rich in IgG4 plasma cells, elevated serum IgG4 and clinical improvement with steroid therapy. There is limited information about IgG4 plasma cells in autoimmune hepatitis (AIH). Aim of this study was to determine IgG4 plasma cells in autoimmune hepatitis and its impact on clinical course and treatment outcome. MATERIAL METHODS: Liver biopsies from 40 patients with AIH before therapy were subjected to IgG4 immunostaining. Clinical history, liver function tests and response to immunosuppressive therapy were recorded. Patients were monitored for 4 weeks. Liver biopsy from 23 non AIH patients served as control. Depending on the presence of IgG4 plasma cells on immunohistochemistry, patients of autoimmune hepatitis were grouped into IgG4 positive (group A) and IgG4 negative (group B). Both groups were compared before and after immunosuppressive therapy for clinicopathological features. RESULTS: Tissue IgG4 plasma cells > 5 per high power field (hpf) were seen in 10/40 (25%) and > 10 per hpf in 4/40 (10%) cases of AIH. None of the cases from control group (non AIH) were positive for IgG4 plasma cells. Group A patients were significantly younger than group B. (p < 0.05). There were no differences in histological severity but liver enzymes, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly higher in group A than group B. Post treatment biochemical improvement was similar in both groups. CONCLUSION: IgG4 positive AIH patients were younger with more abnormal liver enzymes. There was no difference in histology and response to treatment in both groups.
BACKGROUND: This study aims to determine the predictive power of baseline C-reactive protein (CRP) value in cirrhotic patients with ascites, without overt infection, that might lead to spontaneous bacterial peritonitis (...BACKGROUND: This study aims to determine the predictive power of baseline C-reactive protein (CRP) value in cirrhotic patients with ascites, without overt infection, that might lead to spontaneous bacterial peritonitis (SBP)/ cellullitis. METHODS: 152 consecutive cirrhotic patients with ascites, without overt infection were included in the study, after measuring the baseline CRP value. All patients were followed up for a duration of one year, or till development of SBP/cellulitis. RESULTS: Baseline CRP was elevated in 76.8% of the patients. Development of infection was observed in 78 (51.3%) patients. SBP was diagnosed in 54 patients, cellulitis was documented in 15 patients. 9 patients had simultaneous SBP and cellulitis Baseline CRP was 10.2 ± 6.34 mg/dL in the group who developed infection, it was 4.81 ± 4.41 mg/dL in the group who did not develop infection (p = 0.002). Baseline CRP > 9.5 mg/dL, serum albumin < 2.8 g/dL and a previous history of infection were independent predictors of developing SBP/cellulitis. CONCLUSIONS: Along with low serum albumin and previous history of infection, CRP can be used as a predictive tool for early detection of infection, thus enabling to reduce the morbidity and mortality.
INTRODUCTION: Helicobacter pylori (H. pylori) infection causes chronic gastritis and is a major risk factor for duodenal and gastric ulceration, gastric adenocarcinoma, and primary gastric lymphoma. Increased gastric bac...INTRODUCTION: Helicobacter pylori (H. pylori) infection causes chronic gastritis and is a major risk factor for duodenal and gastric ulceration, gastric adenocarcinoma, and primary gastric lymphoma. Increased gastric bacterial density may lead to increased levels of inflammation and epithelial injury. AIMS AND OBJECTIVES: 1) To study the effect of H. pylori density by histological changes in stomach. 2) To study the effect of H. pylori density on the efficacy of standard triple drug eradication treatment. 3) To study the effect of H. pylori density on the complication related to H. pylori. MATERIAL AND METHODS: All the patients visiting gastroenterology OPD with the symptoms of dyspepsia not responding to proton pump inhibitor or having alarm symptoms were subjected to upper GI endoscopy and biopsy. If H. pylori was present they were included in the study. The patients were given standard 14 day triple antibiotic combination for H. pylori eradication. H. pylori eradication was confirmed by urea breath test after six weeks of completion of treatment. RESULTS: Out of 250 patients screened, 120 patients enrolled in the study. On clinical history 41.5% patients had symptoms of heart burn where as 63.3% patients had dyspeptic symptoms. Success rate of anti H. pylori triple drug therapy was 80%. Rate of eradication was significantly lower among the patients with higher H. pylori density (p < 0.05) on histopathology by Sydney classification. Duodenal ulcer, Gastric ulcer and gastric erosion were noted in higher frequencies among the patients with higher H. pylori density (p < 0.05). CONCLUSION: H. pylori density by histopathology correlates with the complication related to H. pylori i.e. duodenal ulcer, reflux esophagitis and antral erosions. It also correlates with the success of the standard triple drug eradication treatment.
A coherent distinction between primary and secondary achalasia is considerably important to clinicians. This is because the therapeutic interventions for the two are entirely different. Whilst pneumatic dilation is the s...A coherent distinction between primary and secondary achalasia is considerably important to clinicians. This is because the therapeutic interventions for the two are entirely different. Whilst pneumatic dilation is the standard treatment in primary achalasia, the same treatment, if instituted in malignant stenosis carries potential risk to the patient and delays appropriate therapy of the underlying disorder. This distinction however, is extremely difficult. None of the available clinical, manometric, endoscopic or imaging criteria can reliably exclude secondary achalasia. However, suspicion may be raised and in such cases, an exhaustive work up including repeat biopsies and even surgery should be considered. In this review, we discuss the various problems in differentiating primary from secondary achalasia.
Ulcerative colitis (UC) results from exaggerated immune response to gut flora in genetically predisposed individuals. Acute exacerbation of UC occurs in 12-58% of patients. About a fifth of these patients do not respond...Ulcerative colitis (UC) results from exaggerated immune response to gut flora in genetically predisposed individuals. Acute exacerbation of UC occurs in 12-58% of patients. About a fifth of these patients do not respond to intra-venous glucocorticoids, which is the standard treatment of this condition. Earlier, patients failing to respond to intra-venous glucocorticoids were treated with colectomy with its consequent disadvantages, such as low preference by the patients, need for surgical expertise, complications and even potential fatal outcome. However, currently these patients are quite effectively managed by immunomodulator treatment such as cyclosporin and biologicals. Since tumor necrosis factor a (TNF-α) is the major pro-inflammatory cytokine involved in the pathogenesis of IBD, monoclonal anti-TNF antibody, such as infliximab, has been studied most in management of IBD, including UC. This paper reviews the current data on biologicals in management of acute UC.
Singh SP, Misra D, Mohapatra MK
… +2 more, Agrawal O, Meher C
Trop Gastroenterol
· 2015 · PMID 26591965
INTRODUCTION: Ultrasonographic demonstration of intra biliary parallel lines or "inner tube sign" is considered diagnostic for biliary ascariasis in regions where ascariasis is endemic. PATIENTS & METHODS: 148 patients w...INTRODUCTION: Ultrasonographic demonstration of intra biliary parallel lines or "inner tube sign" is considered diagnostic for biliary ascariasis in regions where ascariasis is endemic. PATIENTS & METHODS: 148 patients with inner tube sign on ultrasonography were evaluated. In most, diagnosis was confirmed by ultrasonographic demonstration of restitution of normal appearance of bile duct with passage of round worms in vomitus or faeces. RESULTS: Diagnosis was confirmed in 122 of 148 patients. 26 patients were lost to follow-up. Biliary ascariasis was responsible for the sign "parallel lines" in 113 patients. Of the remaining, intrabiliary stents were responsible for the "inner tube sign" in six whereas in three it was due to hydatid membranes following intrabiliary rupture of hydatid cyst. CONCLUSION: Biliary ascariasis is the commonest cause of inner tube sign in the tropics. However, this sign can also be produced by biliary stents and hydatid membranes. Awareness of these possibilities is essential for sonologists in the tropics.
The transrectal approach to draining deep-seated pelvic collections may be used to drain The transrectal approach to draining deep-seated pelvic collections may be used to drain intra-abdominal collections not reached by...The transrectal approach to draining deep-seated pelvic collections may be used to drain The transrectal approach to draining deep-seated pelvic collections may be used to drain intra-abdominal collections not reached by the transabdominal approach. We discuss 6 patients with such pelvic collections treated with transrectal drainage using catheter placement via Seldinger technique. Transrectal drainage helped achieve clinical and radiological resolution of pelvic collections in 6 and 5 of 6 cases, respectively. It simultaneously helped avoid injury to intervening bowel loops and neurovascular structures using real-time visualization of armamentarium used for drainage. Radiation exposure from fluoroscopic/CT guidance was avoided. Morbidity and costs incurred in surgical exploration were reduced using this much less invasive ultrasound guided transrectal catheter drainage of deep-seated pelvic collections.