BACKGROUND: Dyspepsia is a common symptom in residents of Leh, a high-altitude region in Ladakh, India. Helicobacter pylori related gastritis is a common cause of such symptoms. However data regarding this association at...BACKGROUND: Dyspepsia is a common symptom in residents of Leh, a high-altitude region in Ladakh, India. Helicobacter pylori related gastritis is a common cause of such symptoms. However data regarding this association at high altitudes is sparse. AIM: To investigate the demographic, endoscopic and histopathology findings in patients presenting with dyspeptic symptoms in the high-altitude region of Leh. Methods: A cross-sectional study was done in 84 patients with dyspeptic symptoms, attending the outpatient department of local government hospital in Leh. Demographic details, endoscopy, histopathology of upper gastrointestinal biopsies and microbiology culture of gastric/duodenal aspirates were studied. RESULTS: The mean age was 38.4 years with 42% being males. Indigenous foods with high-salt content were consumed by 75% of patients. Epigastric pain was the most frequent symptom (in 96%) and pain radiating to the back was another peculiar symptom seen in 49% of patients. The predominant finding on endoscopy was antral gastritis in 71% of patients. Nodular gastritis was seen in 18% of patients. H. pylori was documented in 93% and histopathology revealed mild-to-moderate inflammation in 93% and mild-to-moderate atrophy in 90% of patients. Colonization with Gram-negative bacilli was observed in gastric/duodenal aspirate cultures. CONCLUSION: Dyspepsia at high-altitude commonly presents as pain radiating to the back with a very high (90%) prevalence of H. pylori, endoscopic findings of antral gastritis and nodular gastritis, and atrophic gastritis in biopsies. Further investigations are needed to determine whether these observations are related to the high-altitude or the high-salt content in their diet and also whether these further translate to carcinogenesis.
BACKGROUND: Hepatic artery pseudoaneurysms (HAPs) are uncommon entities. With the development of interventional techniques, their management has evolved from conventional (surgical) to non-surgical minimally invasive ima...BACKGROUND: Hepatic artery pseudoaneurysms (HAPs) are uncommon entities. With the development of interventional techniques, their management has evolved from conventional (surgical) to non-surgical minimally invasive image-guided interventional techniques. METHODS: Fifteen cases of HAPs who had undergone non-surgical interventional management in our department were reviewed. All patients were comprehensively evaluated for demographic information, morphology of pseudoaneurysm, indication for intervention and means of intervention, approach (endovascular or percutaneous), follow up and complications. RESULTS: Trauma and iatrogenic injury were most common causes of HAPs. Most of the HAPs (9 out of 10 in whom long follow up was available) managed with image-guided interventional techniques had favorable outcome. CONCLUSION: Minimally invasive image-guided interventional management is the preferred modality for HAPs.
Rakesh PS, Sherin D, Hari S
… +3 more, Subhagan S, Shaji M, Salila K
Trop Gastroenterol
· 2014 · PMID 26349168
BACKGROUND AND AIM: Hepatitis B virus (HBV) infections have been consistently reported over the last few years from the two wards of Thrikkaruva, Kollam district, Kerala, southern India. This study was conducted to deter...BACKGROUND AND AIM: Hepatitis B virus (HBV) infections have been consistently reported over the last few years from the two wards of Thrikkaruva, Kollam district, Kerala, southern India. This study was conducted to determine the risk factors associated with HBV transmission in Thrikkaruva. METHODS: This was a community based, case-control study, enrolling HBsAg positive cases diagnosed since January 2010. Controls were age (+5 years) and sex matched neighbourhood individuals. Data was collected using a questionnaire and all subjects were investigated for HBsAg, anti-HBs and anti-HBc. Local healthcare institutions serving the community were surveyed for infection control practices. Statistical analysis for HBV associated factors was carried out. RESULTS: A total of 49 cases and 49 controls were included in the final analysis. Logistic regression revealed close personal contact with of a case of hepatitis B (adjusted OR: 3.09, 95% CI: 1.13-9.40) as a significant risk factor in the community. Qualitative examination of infection control practices at private clinics, barber shops and dental clinics revealed conditions conducive for HBV transmission in the community. CONCLUSIONS: Our study reveals active horizontal person-to-person HBV transmission in the village. Comprehensive action including vaccination of all susceptible contacts, promotion of infection control at health care institutions, and raising public awareness are recommended in this region.
BACKGROUND AND AIM: In spite of the overwhelming emphasis on motor symptoms in Parkinson's disease(PD), a number of studies have revealed that the non-motor symptoms including gastrointestinal, psychiatric and sleep symp...BACKGROUND AND AIM: In spite of the overwhelming emphasis on motor symptoms in Parkinson's disease(PD), a number of studies have revealed that the non-motor symptoms including gastrointestinal, psychiatric and sleep symptoms have a greater influence on the quality of life of many patients. This study aimed to determine the frequencies of gastrointestinal symptoms in PD patients in comparison to healthy controls and to evaluate the relationship between these GI symptoms and severity of PD. METHODS: This cross-sectional study was conducted over a 2-year period. Consecutive new patients of Parkinson's disease were recruited at the neurology clinics of Aminu Kano Teaching Hospital (AKTH) and Murtala Muhammad specialist hospital (MMSH).Healthy age and sex matched volunteers constituted the control group. A structured, pre-tested, close-ended questionnaire inquiring about common gastrointestinal symptoms as well as demographic, and PD characteristics was administered to all cases and controls. PD severity was assessed using the Hoehn and Yahr scale (H and Y). RESULTS: A total of 80 patients and 80 controls were recruited during the study period. Their age ranged between 39 and 80 years. The mean age of the patients and controls were 61.1 ± 8.5 and 61.0 ± 8.4 years, respectively. The male to female ratio was 5:2. The most common gastrointestinal symptoms were constipation (48.8%), sialorrhea (18%), dysphagia (16.2%), difficulty in mastication (12.5%), and choking/aspiration (12.5%).When compared with age and sex-matched controls the differences in the occurrence of these symptoms were statistically significant.Constipation, dysphagia, difficult mastication, sialorrhea, and aspiration/choking were found to be more severe on the H and Y scale. CONCLUSION: Significant features of gastrointestinal dysfunction in PD include constipation, sialorrhea, dysphagia, difficult mastication and choking. These symptoms were significantly associated with increasing severity of Parkinson's disease.
BACKGROUND AND AIM: Postoperative gastroesophageal reflux (GER) is one of the causes of post-cholecystectomy syndrome (PCS). Reports studying the effect of cholecystectomy on GER show conflicting results and only a few s...BACKGROUND AND AIM: Postoperative gastroesophageal reflux (GER) is one of the causes of post-cholecystectomy syndrome (PCS). Reports studying the effect of cholecystectomy on GER show conflicting results and only a few studies have used the more sensitive technique of combined impedance-pH monitoring. This study aimed to study the effect of laparoscopic cholestectomy on GER (acid/non-acid reflux) using impedance-pH monitoring. METHODS: Sixty three consecutive patients of symptomatic cholelithiasis were evaluated. All patients underwent esophageal mannometry and 24-hour impedance-pH monitoring pre- and postoperatively. Frequency scale for the symptoms of GERD (FSSG) scoring was also done in each patient pre- and postoperatively. RESULTS: Out of sixty three patients, four developed symptoms of reflux postoperatively as detected by FSSG scoring. However, no significant changes were observed in lower esophageal sphincter (LES) characteristics, acid and non-acid reflux characteristics, total number of reflux episodes, or in the physical character of the refluxate following laparoscopic cholecystectomy. Significant decrease in the proximal acid reflux episodes was observed. CONCLUSION: The chemical characteristics (acid or non-acid reflux) as well as physical properties (liquid, gas or mixed) of reflux episodes remain unaffected following laparoscopic cholecystectomy. Cholecystectomy itself doesn't increases GER.
Non alcoholic fatty liver (NAFLD) is a common cause of liver disease worldwide with prevalence ranging from 10-30%. It encompasses a spectrum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) which ca...Non alcoholic fatty liver (NAFLD) is a common cause of liver disease worldwide with prevalence ranging from 10-30%. It encompasses a spectrum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis and hepatocellular carcinoma (HCC) in some patients. The diagnosis of hepatic steatosis can be made reliably by imaging. Differentiating simple steatosis from NASH usually requires liver biopsy although various non-invasive methods are under evaluation. Similarly, liver biopsy is the gold standard for staging of fibrosis but NAFLD fibrosis score and transient elastography are now validated for non-invasive assessment of fibrosis in patients with NAFLD. Liver biopsy should be reserved for patients at high risk of having NASH or advanced fibrosis, those needing evaluation of competing diagnoses or those enrolled in therapeutic trials. Treatment can be directed against various pathophysiological aspects of NAFLD and includes management of obesity, insulin resistance, hyperlipidemia and oxidative stress, suppression of inflammation and modulation of gut bacteria. Lifestyle modification with diet, exercise and weight loss is the cornerstone of therapy. Pharmacological treatment of NAFLD is still evolving with vitamin E and pioglitazone being the only approved drugs as of now. Bariatric surgery can lead to improvement in NASH in morbidly obese patients. Optimal therapy of NAFLD includes a multidisciplinary approach involving management of metabolic syndrome and cardiovascular disease. Management of NASH related cirrhosis and HCC is like that of other etiologies. Indications and outcomes of liver transplantation in patients with NASH are same as for other etiologies of liver disease.
Chronic pancreatitis is a common disorder caused by various etiological factors. It usually manifests with abdominal pain and exocrine (steatorrhea, malnutrition) or endocrine insufficiency (diabetes mellitus). Abdominal...Chronic pancreatitis is a common disorder caused by various etiological factors. It usually manifests with abdominal pain and exocrine (steatorrhea, malnutrition) or endocrine insufficiency (diabetes mellitus). Abdominal pain is the dominant symptom in these patients. Medical, endoscopic and surgical modalities are available for therapy. This review focuses on the pharmacological approaches to manage pancreatic pain. Before embarking on medical management of pain it is prudent to exclude complications like pancreatic cancer, pseudocysts, inflammatory mass, biliary or duodenal obstruction which may contribute to abdominal pain. Pharmacological measures for pain relief include central analgesics, enzyme supplements and antioxidants. Other measures include endoscopic and surgical therapy which are not discussed here. Appropriate management of exocrine and endocrine insufficiency and successful control of diabetes are also important in the management of chronic pancreatitis.