BACKGROUND: There is limited information on the bone mineral metabolism in patients with chronic pancreatitis (CP). METHODS: 103 patients with CP (all males: mean age 38.6 ± 20.64 yrs) and 40 age matched control males (m...BACKGROUND: There is limited information on the bone mineral metabolism in patients with chronic pancreatitis (CP). METHODS: 103 patients with CP (all males: mean age 38.6 ± 20.64 yrs) and 40 age matched control males (mean age: 36.7 ± 20.70 yrs) were prospectively studied. Serum levels of 25 (OH) Vitamin D3, alkaline phosphatase (ALP), and parathyroid hormone (PTH) were measured. Bone mineral density (BMD) was measured using adual-energy X-ray absorptiometry (DEXA) scanner. RESULTS: Seventy two (70%) patients had alcohol related chronic pancreatitis (ACP), 30 (29.1%) patients had idiopathic chronic pancreatitis (ICP) and one patient had post-traumatic chronic pancreatitis. Fifty nine (59.8%) patients had chronic calcific pancreatitis (CCP) and 39 (37.8%) patients were diabetic. Steatorrhea was noted in 21 (20.4%) patients. On comparison with controls, patients with chronic pancreatitis had significantly lower 25 (OH) Vitamin D3 levels (p = 0.01). On evaluation of bone mineral density (BMD) at lumbar spine, 46% patients were osteopenic and 12% patients were osteoporotic. On evaluation of BMD of femur, 30.1% patients were osteoporotic and 39.8% patients were osteopenic. No significant difference was found in the frequency of metabolic osteopathy between alcoholic and idiopathic groups (p = 0.108), calcific and non-calcific groups (p = 0.410), diabetic and non-diabetic groups (p = 0.126). smokers and non-smokers (p = 0.198), and patients with and without history of steatorrhea (p = 0.265) and indifferent severity groups ofupancreatitis (p = 0.910) CONCLUSIONS: Majority of patients with both ACP and ICP had low BMD and similar frequency of bone changes between various groups suggests that systemic inflammation may play an important role in its pathogenesis. Further detailed metabolic studies are necssary to define the pathogenic mechanism of metabolic osteopathy associated with chronic pancreatitis.
BACKGROUND AND AIM: Proximal migration of biliary stents presents a technical challenge for the therapeutic endoscopist. It may require multiple, complicated corrective procedures resulting in significant morbidity to th...BACKGROUND AND AIM: Proximal migration of biliary stents presents a technical challenge for the therapeutic endoscopist. It may require multiple, complicated corrective procedures resulting in significant morbidity to the patients. In this study we evaluated the utility of balloon biliary sphincteroplasty with CRE (Controlled Radial Expansion) Balloon Dilator on retrieval of proximally migrated biliary stents. METHODS: We identified patients from our ERCP database who presented with proximal migration of biliary stent, between August 2011 and October 2013. Patients in whom the stent could not be retrieved with conventional methods, balloon sphincteroplasty was performed with a 12 mm CRETM Balloon Dilator (Boston Scientific). Stent removal was attempted with extraction balloon or basket thereafter. RESULTS: We identified 28 patients with proximal migration of biliary stents, placed for benign diseases of the common bile duct. Stent removal was successful in 18 patients (64.28%) with help of an extraction balloon or basket. Of the remaining 10 patients, balloon sphincteroplasty was successfully followed by stent removal in eight patients. CONCLUSIONS: Balloon biliary sphincteroplasty increases the success rate of retrieving proximally migrated biliary stents. The procedure is safe, technically easy and yields a good success rate in our experience.
Chinnaswamy S, Das K, Bairagya BB
… +9 more, Bhattacharyya C, Shalimar, Duseja A, Amarapurkar D, Rosangluaia, Chowdhury S, Konar A, Majumder PP, Chowdhury A
BACKGROUND AND AIM: IL28B gene polymorphisms have been associated with treatment-response (sustained virological response, SVR) in genotype 1 hepatitis C virus (HCV)-infected patients, but only with early phase of viral...BACKGROUND AND AIM: IL28B gene polymorphisms have been associated with treatment-response (sustained virological response, SVR) in genotype 1 hepatitis C virus (HCV)-infected patients, but only with early phase of viral decline (rapid virological response, RVR) with genotype 3 HCV-infected patients. Association between IL28B variants and SVR in genotype 3 HCV- infected patients is unclear. Our study aimed to replicate the association of IL28Bsingle nucleotide polymorphism (SNP) rs8099917 with SVR and to validate its association with RVR in genotype 3 HCV-infected patients. METHODS: 72 patients receiving combination therapy (interferon-alpha and ribavirin) at different Indian centers were retrospectively recruited and their genotype atrs8099917 was determined. The association with RVR and SVR was tested taking in to account the variation in relevant covariates such as age, gender, baseline HCV RNA copy number and liver enzymes. RESULTS: The minor allele frequency (MAF) in the pooled samples was 0.17 at rs8099917 (G allele). 68% had TT, 29% had GT and 3% had the GG genotype. SVR was achieved in 71% of patients. A significant association ofrs8099917 with both RVR (p = 0.026) and SVR (p = 0.016) was observed with none of the covariates showing any significant association. The relapse rate was high (20%) but no association of rs8099917 was observed with relapse (p = 0.420). CONCLUSION: An IL28B SNP associates with both early phase of viral decline and sustained response in a cohort of genotype 3 HCV-infected patients from India.
BACKGROUND: Disease of hepatic portion of the inferior vena cava (IVC) now renamed hepatic vena cava syndrome (HVCS) is an insidious onset chronic disease characterized by recurrent acute exacerbations and development of...BACKGROUND: Disease of hepatic portion of the inferior vena cava (IVC) now renamed hepatic vena cava syndrome (HVCS) is an insidious onset chronic disease characterized by recurrent acute exacerbations and development of cavo-caval collaterals. In adults it is complicated by high incidence of liver cirrhosis. Aim of this study was to assess the incidence of liver cirrhosis in children with HVCS and discuss its pathogenesis. METHOD: One hundred and seventy eight children with HVCS were followed up with ultrasonography (USG), routine hematology and liver tests. During acute exacerbations, cultures of blood and ascitic fluid for aerobic microorganisms were also done. Diagnosis of liver cirrhosis was based on transformation of the liver parenchymal echo-texture from normal to uniformly coarse with rounded edges in follow-up USG It was confirmed by direct inspection of the liver or by biopsy in six. The duration from disease onset to detection of liver cirrhosis was also assessed. RESULTS: HVCS was seen in children from poor socio-economic background. Forty nine patients (27.5%) developed liver cirrhosis within a few months to a few years of onset of the disease. Development of cirrhosis was related to frequency or severity of acute exacerbations and not to duration of illness or severity of the caval lesion. CONCLUSION: The cause of cirrhosis in HVCS was the ischemic injury of the hepatocytes and sinusoids following thrombosis of the IVC and/or intra-hepatic veins during severe acute episodes or exacerbations precipitated by bacterial infection. Since such acute exacerbations are amenable to medical treatment, HVCS may be a cause of preventable liver cirrhosis in developing countries.
Ghosh T, Banerjee M, Basu S
… +5 more, Das R, Kumar P, De S, Ghosh MK, Ganguly S
Trop Gastroenterol
· 2014 · PMID 25470869
BACKGROUND AND AIM: The internal diameter of the portal vein varies with age and anthropometric parameters. The caliber of the normal portal vein in adults has been extensively studied but little is known about portal ve...BACKGROUND AND AIM: The internal diameter of the portal vein varies with age and anthropometric parameters. The caliber of the normal portal vein in adults has been extensively studied but little is known about portal vein dimensions in the growing child. This study was conducted to establish standards of portal vein diameter by ultrasonography in healthy Indian children based on age, gender and anthropometric parameters. METHODS: Total 306 healthy children between the age of < 1 month and 12 years, visiting our outpatient departmentor accompanying their siblings were enrolled in the study. The children were distributed into ten age-groups. Each group was further divided in two sub-groups based on gender. Anthropometric parameters including weight, height and chest circumference were measured.Portal vein diameter was assessed by ultrasonography. RESULTS: The portal vein diameter increases with age, height, weight and chestcircumference. But the values are similar in boys and girls. Multiple logistic regression (adjusted R- square: 0.922) revealed age (p = 0.002), height/length (p < 0.0001), weight (p = 0.011), and chest circumference (p < 0.0001), as independent determinants of portal vein diameter. However, height/length emerged as the most consistent determinant (coefficient of regression: 1.536; p < 0.001; 95% confidence interval: 0.066-0.092). CONCLUSION: Our results provide a normal range of portal vein diameter according to age, gender and anthropometric parameters. We conclude that portal vein diameter strongly correlates with age and anthropometric variables like height, weight and chestcircumference,with height being the strongest determinant.
There has been an increasing interest in non-celiac gluten sensitivity (NCGS) in recent years. The condition is characterized by both gastrointestinal and extra-intestinal symptoms that respond to gluten withdrawal. Most...There has been an increasing interest in non-celiac gluten sensitivity (NCGS) in recent years. The condition is characterized by both gastrointestinal and extra-intestinal symptoms that respond to gluten withdrawal. Most of the symptoms are subjective and for many years such patients remain in a diagnostic dilemma. Although symptomalogy is similar to irritable bowel syndrome (IBS), NCGS is now regarded as a distinct clinical entity. However, the disease pathology is not well elucidated and our knowledge of NCGS is still very rudimentary. This review highlights the importance of this new clinical entity, outlines its pathological mechanisms and suggests a diagnostic algorithm for its management.
Cryptogenic cirrhosis is a clinical entity which has the potential for better diagnosis of actual underlying maladies with future advancements in medicine. Current understanding of CC is rapidly undergoing transformation...Cryptogenic cirrhosis is a clinical entity which has the potential for better diagnosis of actual underlying maladies with future advancements in medicine. Current understanding of CC is rapidly undergoing transformation (Figures 1 & 2). In the light of available evidence of frequent disappearance of fat in NASH-associated cirrhosis, CC explants showing steatosis, allografts demonstrating the full blown recurrence of NASH in CC, and the association of CC with diabetes and obesity, suggests CC to be more proximately linked with NAS than believed until now (Figure 2). However, there are subsets of patients within CC that appear to emerge from other etiologies. With increasing clarity of NASH pathogenesis, a useful biomarker might soon be available. Advancements in diagnostics and our understanding of NASH are likely to elucidate NASH-associated cirrhosis as the predominant cause of cryptogenic cirrhosis.