Clinical spectrum and risk factors associated with asymptomatic erosive esophagitis as determined by Los Angeles classification: A cross-sectional study

BACKGROUND

Gastro esophageal reflux disease (GERD) is a chronic and recurrent disease, and it varies in regions. However, to date, there are no reports available on clinical features and the risk factors for the asymptomatic reflux esophagitis in Nepalese adults.

METHODS

Data were gathered from 142 erosive patients who had undergone endoscopy at Bir Hospital, Kathmandu. Los Angeles classification was used to grade the severity of the disease. Patients were interviewed to find out the presence of various reflux symptoms.

RESULTS

Based on the Los Angeles classification, the severity of the disease assessed was; grade A 31.8% (31/142), grade B 39.4% (56/142), grade C 33.8% (48/142), and grade D 4.9% (7/142). One hundred and twenty six (88.7%) subjects had reflux symptoms. Prevalence of asymptomatic esophagitis was 16(11.3%). Age was independently linked to asymptomatic esophagitis (P<0.05), and the odd of being asymptomatic appeared lower in younger adults (P<0.05; OR: 0.118; CI: 0.014-.994).

CONCLUSION

A low prevalence of asymptomatic reflux esophagitis (RE) was seen. Most subjects experienced mild to moderate RE. Age remained an independent factor associated with reflux esophagitis, and the odds of being asymptomatic was lower in younger age.

Association between Body Mass Index and Gastroesophageal Reflux Symptoms in Nepalese Adult Population. A Single Centered Hospital Based Study

Background & Objectives: Gastroesophageal reflux disease (GERD) is a common disorder, and studies have reported inconsistent association between high BMI and its elevated risk of GERD symptoms. The aim of the present study was to estimate the strength of the association between body mass index and reflux symptoms in Nepalese adults.Materials & Methods: This was a cross-sectional study conducted at National Academy of Medical Science, Bir Hospital, Kathmandu, Nepal. All patients of age 18 years or above who underwent endoscopy and diagnosed to have esophagitis were recruited for the analysis. Symptoms were identified by using a self-administered validated questionnaire regarding GERD that identify the onset for GERD symptoms and grade the frequency and severity of symptoms experienced over a period of one year. BMI data, the cut off points were based on the WHO classification of overweight and obesity. A BMI value ?25–30 represents overweight and BMI >30 indicates obesity. A BMI value <25 is considered as normal. Severity of erosive esophagitis was graded according to the Los Angeles classification.Results: The Among 127 enrolled esophagitis subjects, about 43% were under 20 BMI, 43% overweight and about 24% were obese. Obesity measured by BMI revealed no significant association among age, sex, smoker, alcoholics, hernia and severity grade of esophagitis (p>0.05). Ages with various categories (18-40, >40-60,>60) were significantly associated with the GERD symptoms (P=0.021). We categorize BMI in three categories. A BMI value < 25 (normal), ?25–30 (overweight), and BMI >30 (obesity). Categorical analysis of BMI with GERD symptoms confirmed the absence of any tendency towards an association (p>0.05).Conclusion: The tendency of reflux symptoms towards BMI is null, and weight reduction may not be the adequate justifiable for the symptoms therapy.JCMS Nepal. 2015; 11(2):23-26

Atlantoaxial rotatory fixation in a case of tubercular lymphadenitis

Atlantoaxial fixation is a relatively rare cause of torticollis which may be easily missed in practice. Early diagnosis is important as this indicates a compromised atlantoaxial complex with the potential to cause neural damage or even death. Here, we report a case of atlantoaxial rotatory fixation in a 13 yr old male with torticollis for two years and history of defaulting treatment for tubercular lymphadenitis. In this case, the odontoid peg view revealed asymmetric distance between the odontoid and lateral mass of atlas which was confirmed with Fluoroscopy and Computed Tomography (CT) scan. Magnetic Resonance Imaging (MRI) was also done which showed hyperintensity in alar ligaments with posterior inclination of the odontoid peg along with cervical lymphadenopathy.

High lipemic serum: a case report

Hypertriglyceridemia is the condition in which the triglyceride level in the blood is elevated. Triglycerides (TGs) are the major source of energy stored in the body. In this case a 66 years old gentleman has consumed pork with alcohol. A milky white serum was observed due to high triglyceride level. However, he had no other lipid disorders. The increased triglyceride level was purely of dietary origin last night. The subject was perfectly fine with lipid profile and other biochemical investigations performed one week later.