Tropical Gastroenterology
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Item Left Paraduodenal Hernia: A Surgical Conundrum - A 3 Case Series Analysis and Review Literature(The Digestive Diseases Foundation, 2024-01) Bhargav, Kavuluri Ramesh; Acharya, Bidyapati; Pusty, BiswajeetItem An Unusual Presentation of Vitamin B-12 Deficiency: Acute Diarrhoea and A Dialysis Requiring Acute Kidney Injury(The Digestive Diseases Foundation, 2024-01) Jaryal, Ajay; Vikrant, Sanjay; Kumar, Bhupender; Sharma, Kapil; Chander, Subhash; Chandel, ShivaniItem Seroprevalence of Celiac Disease in Tribal Population of High Altitude Area in Northern India(The Digestive Diseases Foundation, 2024-01) Sharma, Brij; Sharma, Neetu; Bodh, Vishal; Chauhan, Ashish; Sharma, Rajesh; Singh, Alka; Sharma, Sidhant; Sachdeva, AmitBackground: While celiac disease (CeD) is known to occur in many regions on the plains, there is a lack of data on its prevalence in high altitude area of India. Methods: We screened serum samples of 332 participants in Lahaul and Spiti district of (mean altitude >4000 meter) Himachal Pradesh, for the estimation of prevalence of CeD in high altitude area. The screening of CeD was done using commercially available IgA human anti-tissue transglutaminase antibody (anti-tTG Ab) ELISA kit. Results: Of 332 samples (mean age 31.5±15.9 years) screened, two were found to have a positive anti-tTG Ab at low titre, suggesting a seroprevalence of 0.6%. Conclusions: The seroprevalence of CeD in high altitude area is 0.6%, almost equal to the rest of the country. The physicians working in high altitude areas need to be aware about CeD in their communities.Item A Cross-Sectional Study of One-Year Analysis of Fundus First and Calot’s First Approaches of Laparoscopic Cholecystectomies in a Tertiary Care Centre(The Digestive Diseases Foundation, 2024-01) Reddy, Eppa Vimalakar; Musham, Raju; Shroff, Gourang; Ganta, Vishnu Vardhan RaoBackground: Laparoscopic cholecystectomy is routinely approached in two ways: the Calot’s first approach (CFA) and the fundus first approach (FFA). CFA is routinely used when the critical view of safety can be established safely, fundus first approach is useful when the anatomy is obscured due to frozen Calot’s. Methods: This is a prospective record of all laparoscopic cholecystectomies performed in Sunshine Hospitals, from 2019-2020. Intraoperatively, routinely Calot’s first approach was used and resorted to the fundus first method when difficulties were encountered with exposure of Calot’s triangle. Data was analyzed using a student’s t test and Pearson correlation. Results: Out of the 151 patients, 64 patients (44%) underwent fundus first and 87 patients (56%) had Calot’s first approach. Mean operative time for FFA (60.23mts ± 25) was similar to CFA (57.18mts ± 25) (P-Value-0.9). Bleeding during surgery was more for FFA (9%) than CFA (7%), though not statistically significant. There were no bile duct injuries, bowel injuries, or conversions. The mean hospital stay was 1.2 days (1-4 days) for FFA and 1.3 days (1-4 days) for CFA. Though, post-operative complications were more with FFA than CFA, [minor bile duct leak (CFA-2% vs FFA-4%), intra-abdominal collection (CFA-3% vs FFA-4%)] the difference was not statistically significant. Conclusion: Calot’s first method is a useful approach in elective cases, with well-defined anatomy, but it is difficult in cases with severe inflammation in Calot’s, or adhesions leading to frozen anatomy. Fundus first approach was extremely useful in these conditions and could avoid subtotal cholecystectomies, cholecystostomies, and open conversion without bile duct injuries.Item Prevalence and Characteristics of Venous Thromboembolism in Outpatients of Ulcerative Colitis: A Single-Center experience(The Digestive Diseases Foundation, 2024-01) Sharma, Brij; Sharma, Neetu; Sharma, Vineeta; Bodh, Vishal; Sharma, Rajesh; Kumar, Rajesh; Sharma, Sidhant; Thabal, Harmandeep Singh; Chauhan, AshishBackground: Venous thromboembolism (VTE) is a known complication in patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC). This study aimed to investigate the prevalence and clinical characteristics of VTE in patients with UC, and to identify potential risk factors for VTE in this population. Methods: This was a single-centre retrospective cohort study involving 167 patients with UC from 2015 and 2022. Patient demographics, disease characteristics, medication history, and VTE events were extracted from outpatient records. Results: The study included 167 patients, of which 58.68% were males. The prevalence of VTE in outpatients with UC was 3% (n=5), with four patients having deep venous thrombosis (DVT), two having cerebral venous thrombosis (CVT) and one patient having both CVT and DVT. The mean age of patients with VTE was 48 ± 18.75 years and all patients were females. Four patients had history of acute severe colitis in past and were treated with steroids. There was no mortality in patients with VTE during the study period, and none underwent colectomy. Prothrombotic work up was negative in all the patients (4/4). The median duration of follow-up was five years, and median duration between IBD diagnosis and occurrence of VTE was three years. Conclusion: This study found a prevalence of 3% in a cohort of UC patients with milder disease. Past history of acute severe colitis and steroid use were seen in patients with UC who developed VTE (4/5), though no statistically significant association could be found due to small sample size.Item Challenges for Women in Gastroenterology- A Reflection of their Societal Status!(The Digestive Diseases Foundation, 2024-04) Jain, MayankItem Eosionophilic Colitis Presenting as Sigmoid Volvulus(The Digestive Diseases Foundation, 2024-01) Muduganti, Srinivas; Kothakota, Sunil Raviraj; Nistala, SrinivasItem Gastric Pneumatosis in Acute Pancreatitis: A Diagnostic Dilemma(The Digestive Diseases Foundation, 2024-01) Agarwal, Juhi; Putta, TharaniItem Rare Case of Spontaneous Lumbar Hernia(The Digestive Diseases Foundation, 2024-04) Siva, Sangeetha; N, Sathish; Alur, Sunil KumarItem Gastrointestinal Manifestations of COVID-19: An Evidence-based Review(The Digestive Diseases Foundation, 2024-01) Khanna, Deepanshu; Kar, PremashishThe first cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection were reported in December 2019, triggering a global health crisis with a coronavirus pandemic-19 (COVID-19). Fever, a dry cough, and shortness of breath are the most common symptoms. GI symptoms, on the other hand, have been found to be an essential clinical finding in the course of the disease. Furthermore, though the pathophysiology of these symptoms is still being researched, the relationship between SARS-CoV-2 and Angiotensin-Converting Enzyme type 2 (ACE2), which is expressed in both the respiratory and gastrointestinal systems, is implicated in viral pathogenesis as a key clinical finding in the progression of the disease. Gastrointestinal manifestations of disease has turned out to be a distinct entity and there is a need to update ourself on this issue as we need high index of suspicion to rule out this infection when patients initially present with gastrointestinal manifestations.Item Revealing the Unseen: A Huge Gall Bladder Neuroendocrine Tumor: A Rare Case Report(The Digestive Diseases Foundation, 2024-04) Bhayani, Priyansh Deven; Kumar, Gilbert Jeba; Krishnamurthy, Suganthi; Chatterjee, Pritam; P, Seshadri Venkatesh; Anand, SanthoshItem Non-Hepatotropic Viruses Causing Viral Hepatitis: Current Perspectives(The Digestive Diseases Foundation, 2024-01) Devarbhavi, Harshad C; Patil, Mallikarjun; Kurien, Sunu Sara; Shafiq, SyedHepatitis due to non-hepatotropic viruses is an important often under recognized cause of liver disease. Failure to diagnose or delayed diagnosis results in poor outcome. Majority of the non-hepatotropic viruses that cause hepatitis are Dengue viral hepatitis (DENV) and viruses in the herpesviridae family such as Herpes Simplex virus (HSV), Epstein Barr virus (EBV), Cytomegalovirus (CMV) and Herpes Zoster virus (HZV). Others include adenovirus associated hepatitis, and COVID-19 virus. Although it occurs more commonly in immunosuppressed individuals, immunocompetent individuals are not exempt from the conditions, although the disease is milder in them. The spectrum of liver disease can vary from asymptomatic liver biochemistry abnormalities to severe acute hepatitis sometimes leading to acute liver failure that can result in death or the need for liver transplantation, particularly for HSV and DENV-induced hepatitis. While mild abnormalities in liver biochemistry is common as a part of systemic infection in the aforementioned viruses, subtle clues that aid diagnosis in severe disease particularly mimicking acute liver injury/failure from HSV and DENV include the presence or ongoing history of fever with marked rise in aminotransferases with minimal or no rise in bilirubin and mild coagulopathy. Timely diagnosis is the key to provide appropriate treatment such as acyclovir for herpes simplex virus or ganciclovir for cytomegalovirus hepatitis and supportive care in others. The pathogenesis of liver injury could be secondary to a bystander effect on the liver from the systemic immune reaction to a robust extrahepatic antiviral response or to a direct hepatocyte cytopathic effect as demonstrated by immunohistochemistry to specific viral antigen. This review will focus on the current knowledge on hepatitis caused by DENV, HSV, EBV, CMV, VZV, COVID-19 and indeterminate hepatitis in children.Item Leiomyomatosis Peritonealis Disseminata(The Digestive Diseases Foundation, 2024-01) Gupta, Archit; Perwaiz, Azhar; Singh, Amanjeet; Chaudhary, AdarshItem Visceral Larva Migrans Presenting as Multiple Liver Abscesses(The Digestive Diseases Foundation, 2024-04) Maharshi, Sudhir; Yadav, Sumit; Bhatia, Abhishek; Sharma, Kamlesh Kumar; Mangalhara, Naresh Kumar; Pokharna, Rupesh; Nijhawan, Sandeep; Sharma, Shyam SunderBackground and Objectives: Visceral larva migrans (VLM) is a systemic presentation of migrated nematodal larvae through human viscera. It is usually under diagnosed and not kept as a differential diagnosis of hepatic space-occupying lesions (SOL). Only a few case reports and short case series are available in the literature. Majority of these cases are still managed as amoebic or pyogenic hepatic abscesses. Here, we report six cases diagnosed as VLM. Methods: We analyzed six patients who presented to us with non-resolving fever and pain in the abdomen and had atypical SOL on ultrasound abdomen. Appropriate blood investigations and relevant serologies were sent. Magnetic resonance imaging (MRI)/triple-phase computed tomography (CT) of the abdomen was done to characterize the lesions. The liver SOL underwent ultrasound-guided fine needle aspiration cytology (FNAC) for histopathological examination. Results: All the six patients had peripheral eosinophilia. MRI abdomen revealed multiple conglomerated T1 hypointense and T2 hyperintense cystic lesions with diffusion restriction, suggestive of abscesses. FNAC and histopathological examination revealed eosinophilic abscesses along with Charcot Leyden crystals. Toxocara canis serology was positive in all six patients, establishing hepatic VLM. All six patients had an excellent response to medical therapy. Conclusion: Hepatic VLM should be contemplated as one of the differential diagnoses of multiple liver nodules or abscesses. MRI abdomen, cytology/histology, serology and clinical-radiological correlation help in diagnosis.Item Small Intestinal Bacterial Overgrowth(The Digestive Diseases Foundation, 2024-04) Dutta, Amit Kumar; George, John Titus; Koppolu, SumanthSmall intestinal bacterial overgrowth (SIBO) denotes an increase in the concentration of bacterial population in small intestine. There are several mechanisms such as acid secretion in the stomach, motility of gastrointestinal tract and immune response which prevent overgrowth of bacteria in healthy individuals. Breakdown of this mechanism predisposes to the development of SIBO. Conditions associated with increased risk of SIBO include diabetes mellitus, intestinal strictures and blind loops, post gastrectomy status, gastrointestinal dysmotility, chronic opioid or proton pump inhibitor use, immune deficiency states, etc. Usual symptoms of SIBO are non- specific and include bloating, diarrhoea and flatulence. Quantitative culture of duodenal/jejunal aspirate is the gold standard test for diagnosing SIBO. Breath tests are alternative diagnostic tools and are more frequently used in clinical practice due to their simplicity and non-invasive nature but are not very accurate. Recent developments such as availability of next generation sequencing and capsule breath test devices to diagnose SIBO appear promising for clinical application in future. Treatment of SIBO includes a short course of antibiotics, correction of nutritional deficiencies and treatment of predisposing factors. This review discusses the risk factors and clinical features of SIBO and provides an update on the diagnostic tests and management.Item A Holistic, Evidence-Based Approach to Preventing Colorectal Cancer with a Focus on Early Detection, Risk Factor Management, Diet, and Lifestyle Modification with an Emphasis on Oral Dysbiosis, Chemoprevention, and Immunoprevention(The Digestive Diseases Foundation, 2024-04) Madugula, Sowndarya; D, Prabu; R, Sindhu; Dhamodhar, Dinesh; M, Rajmohan; V, Bharathwaj V; S, Sathiyapriya; Devdoss, Premkumar; Jayaraman, YuvarajBackground: Colorectal cancer is the third most commonly diagnosed and second most deadly cancer in 2020. Although the incidence of disease has decreased among older adults, recently there has been an alarming emergence of early-onset colorectal cancer among people <50 years of age. 9.4% of cancer-related deaths globally occured due to colorectal cancer in 2022. The critical shift in health-care focus from treatment to disease prevention necessitates the development of a well-thought-out integrative prevention strategy that is both practical and evidence-based. The study's goal is to provide a holistic, wellness-oriented disease prevention strategy to reduce the incidence of both early-onset and late-onset colorectal cancer. Materials and Methods: A systematic search from databases (PubMed, Wiley, Elsevier, and Google Scholar) for articles published in the past 7 years in peer-reviewed journals was conducted, aiming at articles regarding risk factors and modification, screening and early detection with biomarkers, diet and lifestyle, traditional and modern chemo-preventive compounds, immunoprevention, and oral dysbiosis. All of the authors independently assessed the quality of the studies. Results: 32 studies, including 13 systematic reviews, 3 cohorts, 3 randomized control trials, 1 case-control, 3 in vitro, 2 in vivo, and 7 reviews. Evidence synthesis is presented as an integrated preventive strategy for colorectal cancer, focusing on different aspects of prevention. Conclusion: A holistic approach to CRC prevention should include improved screening, early detection, dietary and lifestyle changes, good communication to perceive risk, need-based nutrition supplementation, and stress management.Item Hepatitis B Viral Load has No Relation with Degree of Liver Fibrosis in Patients with Chronic Hepatitis B Infection(The Digestive Diseases Foundation, 2024-04) Mahapatro, Arupam; Jena, Susanta Kumar; Behera, Manas Kumar; Maji, Prabir; Behera, Sanatan; Mishra, Partha Sarathi; Parida, Gyana Ranjan; Patra, Umesh ChandraBackground: Fibrosis is the most important predictor of prognosis in patients with Chronic hepatitis B (CHB) related liver disease. Detecting early fibrosis is vital to reduce complications of CHB like cirrhosis and HCC. High viral load is an important predictor of fibrosis. There are many studies reporting the association of hepatitis B (HBV) viral load with degree of liver fibrosis, but results are inconsistent. Hence, this study was undertaken to assess the relationship of HBV DNA titre with liver fibrosis. Methods: We recruited all newly detected treatment naive CHB patients between May 2021 to January 2023 at Department of Hepatology SCB medical college Cuttack. HBVDNA quantification and fibrosis assessment using 2D shear wave elastography (SWE) were done. The primary endpoint was the relation between HBVviral load and liver fibrosis stage and the estimation of HBV DNA cut off levels for advanced fibrosis ?F3. Results: Ninety-eight patients were enrolled (mean age: 46.05±13.21 years, male to female ratio-2.76:1). HBV DNA levels were higher in patients with advanced fibrosis LSM ?8kpa (F3) although the difference was statistically not significant (P=0.6). HBV DNA levels were also higher in CHB patients with significant fibrosis than those with less degree of fibrosis, in both HBeAg positive and HbeAg negative individuals, although this difference did not achieve statistical significance (p=0.655 and p=0.685). Age, serum albumin, serum ALT levels, total platelet count, CTP score and MELD-Na score were significant predictors of fibrosis on univariate analysis. But on multivariate analysis, platelet count (OR=0.999, CI=0.981-0.997, p=0.006) and MELD-Na score (OR=1.064, CI=1.01-1.198, p=0.024) were independent predictors of liver stiffness. A cut off HBV DNA of 17500 (IU/ML) with sensitivity of 51 % and specificity of 41% had a poor diagnostic accuracy to predict F3 fibrosis. Conclusion: There was no significant correlation between HBV DNA levels and stage of liver fibrosis.Item The Solid State of Blood Cancer: A Solid Masquerade Causing Recurrent Subacute Intestinal Obstruction(The Digestive Diseases Foundation, 2024-04) Misra, Sunayana; Badwal, Sonia; Khosla, Aanchal; Mishra, Navneet; Singh, Jasjit; Rao, SeemaItem Factors Affecting Non-adherence to Medications in Patients with Inflammatory Bowel Disease-Ulcerative Colitis(The Digestive Diseases Foundation, 2024-04) Kumar, Surender; Gupta, Rishabh; Sharma, Hitesh Kumar; Maharshi, Sudhir; Sharma, Kamlesh Kumar; Tak, Vijyant; Pokharna, Rupesh KumarBackground / Aim: Non-adherence to treatment is an important determinant of relapses and complications in Inflammatory bowel disease-ulcerative colitis (IBD-UC). We assessed the adherence to treatment advised in IBD-UC and reasons for non-adherence in tertiary government hospital. Methods: This cross-sectional study included patients with histologically confirmed IBD-UC admitted indoor as well as those visiting outdoors between December 2020 and August 2023. Non-adherence to treatment was assessed on the basis on questionnaire and defined as medicine intake less than 80% in last two weeks. Results: A total of 178 participants completed the questionnaire, mean age (34.17±12.3 years), average disease duration was 3.47±2.7 years, and 56 (31.5%) patients were adherent to treatment. The adherence to oral mesalamine, salfasalazine, azathioprine, oral prednisolone, tofacitinib and topical mesalamine were 38.2%, 31.3%, 66.7%, 77.8%, 83.3% and 33.3% respectively. 78 patients were receiving treatment free-of-cost, among them 31 (39.7%) were adherent. The primary reasons for non-adherence among patients were cost and unavailability (33.1%), feeling better without medications (22.9%) and forgetfulness (12.7%). Univariate analysis revealed significant association of adherence with satisfaction (p=0.001), number of hospital visits (p=0.001) and disease awareness (p=0.014). Factors such as demographics, disease characteristics and bearing treatment-cost showed no statistically significant association. Regression analysis identified patient-satisfaction as the sole predictor of medication adherence (p = 0.001). Conclusion: One-third of patients with UC adhered to medication regimens. Adherence was significantly associated with patient satisfaction, number of hospital visits and disease awareness while education, socioeconomic status, and disease characteristics showed no association. Free-of-cost treatment did not make a difference in adherence.Item Influenza-associated Pancreatitis(The Digestive Diseases Foundation, 2024-04) Sahajwani, Priyanka; Nalwalla, Zahabiya; Shah, Ira