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Giri S, Bhrugumalla S, Kamuni A, Mishra D, Pati GK, Agrawal D, Verma G, Wagh R, Chauhan S, Ingle M, Chandnani S, Jain S, Rathi PM, Shukla A, Kale A. Upfront tofacitinib in patients with biological-naïve ulcerative colitis - An Indian multicentric experience. Indian J Gastroenterol 2024; 43:237-243. [PMID: 37726491 DOI: 10.1007/s12664-023-01434-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Tofacitinib is a Janus Kinase inhibitor used for treating moderate to severe ulcerative colitis (UC), mainly after the failure of biological therapy. There is a paucity of data on the outcome of tofacitinib in biological-naïve UC patients. The present study was aimed at analyzing the safety and efficacy of tofacitinib in biological-naïve Indian patients with UC. METHODS The present study retrospectively evaluated consecutive patients with biological-naïve moderate-to-severe active UC from six tertiary care centers in India receiving tofacitinib from September 2020 to September 2022. Clinical remission or response assessment was based on partial Mayo score (PMS) calculated at baseline and weeks eight, 16 and 24. RESULTS Total 47 cases (57.4% male, median age: 32 years) were included. After eight weeks of therapy, 33 (70.2%) achieved clinical remission and eight (17.0%) had a primary failure. The baseline serum albumin at treatment initiation was the only independent predictor of remission at eight weeks (Odds ratio: 11.560, 95% CI: 1.478 - 90.404), but not at 16 weeks. By 24 weeks, 59.6% (28/47) of the patients were in remission and 29.8% (14/47) had stopped tofacitinib either due to failure (27.6%) or adverse events (AEs) (2.1%). Among the 47 patients, 10 (21.2%) cases developed AEs during follow-up, including two tuberculosis (4.2%), one cytomegalovirus (CMV) colitis (2.1%) and one herpes zoster (2.1%). Four patients with infection required temporary drug discontinuations. One required permanent discontinuation (mania). CONCLUSION Upfront tofacitinib is effective in biologic-naïve Indian patients with moderate-severe UC. Further randomized studies are required to validate the study findings.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Sukanya Bhrugumalla
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Abhishek Kamuni
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Debakanta Mishra
- Department of Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 751 003, India
| | - Girish Kumar Pati
- Department of Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 751 003, India
| | - Dhiraj Agrawal
- Department of Gastroenterology, PACE Hospital, Hyderabad, 500 081, India
| | - Govind Verma
- Department of Gastroenterology, PACE Hospital, Hyderabad, 500 081, India
| | - Rohit Wagh
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, 400 022, India
| | - Shamshersingh Chauhan
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, 400 022, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, 400 022, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, 400 008, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, 400 008, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, 400 008, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, 9th Floor, New OPD Building, Parel, Mumbai, 400 012, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, 9th Floor, New OPD Building, Parel, Mumbai, 400 012, India.
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Patel ST, Contractor QQ, Nayak CS, Rathi PM. Synchronous pancreatic and scrotal tuberculosis: Double jeopardy. J Postgrad Med 2023; 69:231-233. [PMID: 36751759 PMCID: PMC10846806 DOI: 10.4103/jpgm.jpgm_558_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023] Open
Abstract
We describe a patient who presented with scrotal swelling followed by non-healing and discharging scrotal sinuses, following local trauma and was initially suspected to have an infected scrotal hematoma. An evaluation revealed it to be scrotal tuberculosis. He also complained of upper abdominal pain and on transabdominal ultrasonography was detected to have a mass in the head of the pancreas. Evaluation of the pancreatic mass revealed it to be pancreatic tuberculosis. Both lesions responded well to anti-tubercular therapy. This is an unusual case of two rare sites of extrapulmonary tuberculosis presenting simultaneously in the same individual. Care needs to be exercised while evaluating any non-healing ulcers or sinuses and mass lesions in countries endemic for tuberculosis as this disease can be a great masquerader.
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Affiliation(s)
- ST Patel
- Department of Gastroenterology, Mumbai, Maharashtra, India
| | - QQ Contractor
- Department of Gastroenterology, Mumbai, Maharashtra, India
| | - CS Nayak
- Department of Dermatology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - PM Rathi
- Department of Gastroenterology, Mumbai, Maharashtra, India
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Bansal S, Jain S, Rathi PM, Chandnani S, Debnath P, Nawghare P. Effects of high bilirubin level in pregnancy in Crigler-Najjar syndrome type 2: An extremely rare but important clinical entity to recognize. Med J Armed Forces India 2023; 79:597-600. [PMID: 37719905 PMCID: PMC10499653 DOI: 10.1016/j.mjafi.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/19/2021] [Indexed: 11/21/2022] Open
Abstract
Crigler-Najjar is a rare genetic autosomal recessive disorder caused by deficiency of enzyme Uridine 5-Diphosphate Glucuronosyl Transferase (UDP-GT). We report the case of a 24-year-old female with two consecutive pregnancies with a high level of total bilirubin level of 15.1 mg/dl and a direct bilirubin level of 0.8 mg/dl during the first pregnancy. As she was diagnosed case of Crigler Najjar type 2, she was on phenobarbitone 60 mg daily. With careful monitoring, she continued with the same dose. We concluded that even with high bilirubin level (15.1 mg/dl) in pregnancy, no adverse effects to the baby and mother were seen.
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Affiliation(s)
- Saurabh Bansal
- TNMC & BYL Nair Charitable Hospital, OPD Building, Mumbai, India
| | - Shubham Jain
- TNMC & BYL Nair Charitable Hospital, OPD Building, Mumbai, India
| | - Pravin M. Rathi
- TNMC & BYL Nair Charitable Hospital, OPD Building, Mumbai, India
| | - Sanjay Chandnani
- TNMC & BYL Nair Charitable Hospital, OPD Building, Mumbai, India
| | - Prasanta Debnath
- TNMC & BYL Nair Charitable Hospital, OPD Building, Mumbai, India
| | - Pankaj Nawghare
- TNMC & BYL Nair Charitable Hospital, OPD Building, Mumbai, India
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Jain S, Udgirkar S, Rathi PM, Thanage R, Debnath P, Junar P, Chandnani S, Contractor QQ. Determinants of Short-term Mortality in Liver Cirrhosis with Acute Kidney Injury: A Prospective Observational Study. Middle East J Dig Dis 2023; 15:107-115. [PMID: 37546506 PMCID: PMC10404089 DOI: 10.34172/mejdd.2023.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/02/2023] [Indexed: 08/08/2023] Open
Abstract
Background: Acute kidney injury (AKI) occurs in 20-50% of patients with cirrhosis and is associated with a poor prognosis. The aim of the study is to identify the baseline factors affecting mortality in these patients at 30 and 90 days. Methods: We enrolled 117 patients with cirrhosis and AKI and followed them up prospectively. Results: Distribution of International club of ascites AKI stages was: 26 (22.03%) stage 1, 59 (50%) stage 2, and 33 (28%) stage 3. Mortalities at 30 and 90 days were 27 (22.8%) and 33 (27.9%) respectively. On multivariate analysis, variables affecting mortality at 30 days were serum creatinine level>2 mg% at 48 hours after AKI development (adjusted OR 7.93, P=0.02) and leukocytosis (total leucocyte count>11000/mm3 ) at admission (adjusted OR 6.54, P=0.002). Only leukocytosis at admission was a predictor of 90 days mortality (adjusted OR 4.76, P=0.01). Though not statistically significant, patients not responding to standard medical treatment had 3 times higher mortality at 30 days, while the maximum AKI stages (2 and 3) had eight times higher mortality at 90 days. Conclusion: In cirrhosis, AKI increases short-term mortality. High serum creatinine at 48 hours affects mortality at 30 days, while leukocytosis at baseline predicts mortality at 30 and 90 days. Progression to a higher AKI stage impacts prognosis.
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Affiliation(s)
- Shubham Jain
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Suhas Udgirkar
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Pravin M Rathi
- Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Ravi Thanage
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Prasanta Debnath
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Parmeshwar Junar
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Sanjay Chandnani
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
| | - Qais Q Contractor
- Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India
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Biradar PA, Tambe AS, Rathi SP, Junare PR, Rathi PM. Spectrum of viral hepatitis in hospitalized children in western India. Trop Doct 2023; 53:109-112. [PMID: 35880293 DOI: 10.1177/00494755221105629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Viral hepatitis is a major public health problem affecting children globally. Clinical presentation varies from asymptomatic illness to hepatitis, and liver failure. Data on clinical features and laboratory parameters were collected and analysed on 300 children, aged 1-12 years, admitted with confirmed viral hepatitis. A small majority (52%) were boys. The mean age of presentation was 6.9 ± 2.8 years with the commonest symptoms being anorexia or vomiting (in 98%), fever (in 89%) and jaundice (in 71.3%). Tender hepatomegaly was seen in 31.7%. Almost all (97.6%) had hepatitis A, though mixed infection (A & E) was seen in 1.7%. Only 8% had serum bilirubin levels >200 µmol/L. Significantly elevated (>20 μkat/L) levels of aspartate transaminase and alanine transaminase were seen in 19% and 25.3% of cases respectively. Coagulopathy (PT >15 s) was present in 11.0% cases. HAV remains the most common cause of viral hepatitis in children in our environment. Public awareness and universal vaccination should be the focus to prevent morbidity and mortality due to these pathogens.
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Affiliation(s)
- Padmaja A Biradar
- Resident doctor, Department of Pediatrics, 29566TNMC and BYL Nair Hospital, Mumbai, India
| | - Anil S Tambe
- Assistant Divisional Medical Officer, Department of Gastroenterology, Jagjivanram Hospital, Mumbai, India
| | - Surbhi P Rathi
- Associate Professor, Department of Pediatrics, 29566TNMC and BYL Nair Hospital, Mumbai, India
| | - Parmeshwar R Junare
- Assistant Professor, Department of Gastroenterology, 29566TNMC and BYL Nair Hospital, Mumbai, India
| | - Pravin M Rathi
- Professor and Head, Department of Gastroenterology, 29566TNMC and BYL Nair Hospital, Mumbai, India
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Chandnani SJ, Jain S, Nawghare P, Debnath P, Rane S, Deshmukh R, Bansal S, Patel S, Thanage R, Junare P, Contractor Q, Rathi PM, Singh AK. Pattern of liver function test variations in COVID-19 infection & its clinical significance: A study from a dedicated COVID-19 tertiary care centre from India. Indian J Med Res 2022; 156:484-499. [PMID: 36751745 PMCID: PMC10101368 DOI: 10.4103/ijmr.ijmr_1468_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background & objectives Coronavirus disease 2019 (COVID-19) affects respiratory, gastrointestinal, cardiovascular and other systems disease. Studies describing liver involvement and liver function test (LFT) abnormalities are sparse from our population. This study was undertaken to estimate the LFT abnormalities in patients with COVID-19 in a tertiary care set up in India. Methods In this retrospective study conducted at a tertiary care centre in Mumbai, India, all consecutive patients with proven COVID-19 by reverse transcriptase-PCR from March 23 to October 31, 2020 were enrolled. Of the 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Results Overall 681 (46%) patient had deranged LFTs. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Advanced age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), lower oxygen saturation levels at admission (P<0.001), higher neutrophil-lymphocyte ratio (P<0.001), history of diabetes mellitus and cirrhosiss were associated with deranged LFTs. Acute liver injury was seen in 65 (4.3%) cases on admission and 57 (3.5%) cases during hospital stay. On multivariate analysis for predicting mortality, age >60 yr serum creatinine >2 mg%, PaO2/FiO2 ratio ≤200 and raised AST >50 IU/l (OR: 2.34, CI: 1.59-3.48, P<0.001) were found to be significant. Interpretation & conclusions In COVID-19, LFT abnormalities were common, and derangement increased as severity progressed. The presence of deranged LFT worsens the clinical outcome and predicts in-hospital mortality.
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Affiliation(s)
- Sanjay J Chandnani
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Pankaj Nawghare
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Siddhesh Rane
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Rahul Deshmukh
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Saurabh Bansal
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Sameet Patel
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Parmeshwar Junare
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxmanrao Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Anupam Kumar Singh
- Department of Medicine, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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Deshmukh R, Shukla A, Chandnani S, Rathi PM, Tibdewal P, Jain S, Ramani N, Junare P, Debnath P, Shinde L, Bagwan A, Meshram M. Normal Values of High-resolution Anorectal Manometry of Healthy Indians. J Neurogastroenterol Motil 2022; 28:401-408. [PMID: 35799233 PMCID: PMC9274462 DOI: 10.5056/jnm21107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background/Aims High-resolution anorectal manometry (HRAM) measures anal sphincter function and anorectal co-ordination. This study aims to provide normal data for HRAM and evaluate the effect of gender, age, and body mass index (BMI) on anorectal functions in healthy Indian subjects. Methods HRAM was performed on 93 healthy volunteers using a 20-channel, water-perfused catheter. We evaluated anorectal pressures, rectal sensation, and balloon expulsion time. Measurements were recorded during rest, squeeze, and simulated defecation (push). Results Median anal resting pressure (88 mmHg vs 94 mmHg, P = NS), anal squeeze pressure (165 mmHg vs 147 mmHg, P = NS) were not significantly different between males and females. Rectal pressure (70 mmHg vs 54 mmHg, P = 0.024) and anal pressure (82 mmHg vs 63 mmHg, P = 0.008) during simulated evacuation without rectal distention, were higher in males. The threshold for the first sensation was lower in females (40 mL vs 30 mL, P = 0.021) but desire to defecate (105 mL vs 90 mL, P = NS) and maximum tolerable volume (160 mL vs 140 mL, P = NS) were not significantly different in males and females. Anal residual pressure (median mmHg 83 vs 71 mmHg, P = 0.025) was higher in subjects < 40 years of age. Maximum anal squeeze pressure (185 mmHg vs 165 mmHg, P = 0.024) and maximum rectal pressure (75 mmHg vs 62 mmHg, P = 0.032) during push higher in BMI < 23 kg/m2. Conclusions The present study provides normal data for the Indian population that can be used for comparison and further work. Age, gender, and BMI affect anorectal parameters in HRAM and should be considered while reporting.
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Affiliation(s)
- Rahul Deshmukh
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Akash Shukla
- Department of Gastroenterology, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Pratik Tibdewal
- Department of Gastroenterology, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Nitin Ramani
- Department of Gastroenterology, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Parmeshwar Junare
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Leela Shinde
- Department of Gastroenterology, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
| | - Asif Bagwan
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Megha Meshram
- Department of Gastroenterology, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
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Patel S, Chandnani S, Gutte A, Rathi PM. Placement of a flow diverter-like stent together with coil embolisation for treatment of pancreatic pseudoaneurysm involving the origin of the gastroduodenal artery. BMJ Case Rep 2022; 15:15/7/e248946. [DOI: 10.1136/bcr-2022-248946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A pancreatic pseudoaneurysm can occur following an attack of pancreatitis. This occurs due to erosion of the pancreatic or peripancreatic artery by the pancreatic enzyme-rich pancreatic secretion pseudocyst. If left untreated, it may cause massive and even fatal haemorrhage. Interventional radiology with coil embolisation of the pseudoaneurysm is the standard of care in such cases. We describe a patient who developed a pseudoaneurysm involving the origin of the gastroduodenal artery (GDA). This was successfully managed by coil embolisation of the pseudoaneurysm along with placement of a flow diverter-like stent in the common hepatic artery across the origin of the GDA leading to exclusion of the diseased segment.
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Patel ST, Rajadhyaksha GC, Junare P, Contractor QQ, Souza RD, Rathi PM. HEPATIC DYSFUNCTION IN MEDICAL INTENSIVE CAREUNIT PATIENTS PREDICTS POOR OUTCOME. Arq Gastroenterol 2022; 59:164-169. [PMID: 35830023 DOI: 10.1590/s0004-2803.202202000-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A large number of patients admitted to the medical intensive care unit (MICU) have abnormal liver function tests (LFT). This includes patients with critical illness with or without preexisting liver disease and patients with acute primary liver injury. There are very few studies which have investigated the spectrum of liver disease, clinical profile and outcome in patients admitted to the MICU. OBJECTIVE To evaluate the occurrence, etiology, clinical profile, laboratory profile and outcome of hepatic dysfunction in patients admitted to the MICU. To evaluate the utility of model for end-stage liver disease (MELD) score on admission as a predictor of adverse short term outcome in patients with hepatic dysfunction admitted in MICU. METHODS It was a prospective observational study, conducted from December 2017 to December 2018 in a tertiary care hospital. Two hundred and two patients admitted to the MICU with LFTs as per the inclusion criteria were analyzed and their short-term outcome at 7 days was studied in relation to various parameters. RESULTS LFT abnormalities were present in 202/1126 (17.9%) of the patients admitted to MICU. Critical illness associated liver dysfunction was found in 172 (85.2%) patients, chronic liver disease in 11 (5.4%) patients and acute viral hepatitis in 19 (9.4%) patients. Most common symptom was fever (68.3%) followed by vomiting (48.0%). Among LFT abnormalities, elevated transaminases, raised international normalized ratio and high MELD score on admission correlated with poor short-term outcome. Requirement for inotropes and mechanical ventilation correlated with poor short-term outcome. Mortality did not differ significantly between patients with chronic liver disease, patients with acute viral hepatitis and patients with critical illness associated hepatic dysfunction. Hepatic dysfunction in MICU was associated with poor outcome and a high short-term mortality of 56.4% (114/202). CONCLUSION Liver function abnormality is common in patients who are admitted to the MICU and its presence is an indicator of poor short-term outcome.
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Affiliation(s)
- Sameet T Patel
- Department of Gastroenterology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India
| | | | - Parmeshwar Junare
- Department of Gastroenterology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India
| | - Qais Q Contractor
- Department of Gastroenterology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India
| | - Rosemarie de Souza
- Department of General Medicine, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, T.N.M.C and B.Y.L Nair Ch. Hospital, Mumbai, India
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Nawghare P, Thanage R, Jain S, Chandnani S, Rathi PM. Takayasu Arteritis Presenting as Intestinal Angina: Unusual Presentation of a Rare Disease. Cureus 2022; 14:e21548. [PMID: 35228916 PMCID: PMC8865879 DOI: 10.7759/cureus.21548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Intestinal angina refers to abdominal pain resulting from reduced mesenteric blood flow. Although atherosclerosis is the most common cause, large vessel vasculitis is emerging as one of the common causes. We have reported a case of an 18-year-old female who presented with classical symptoms of intestinal angina. On evaluation, the patient was found to have an abdominal aortic aneurysm with a compromised mesenteric blood supply. She was started on steroids and methotrexate along with anti-platelets and anticoagulants. She improved following the treatment and didn't have any complaints on follow-up.
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Rane SV, Thanage R, Chandnani S, Rathi PM. Graves' disease associated with cholestatic jaundice and persistent diarrhoea. BMJ Case Rep 2021; 14:e244367. [PMID: 34753719 PMCID: PMC8578937 DOI: 10.1136/bcr-2021-244367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/03/2022] Open
Abstract
Liver involvement in Graves' disease can be seen as a part of autoimmune process or rarely, due to the direct effects of thyrotoxicosis on liver. Hyperthyroidism can also have gastrointestinal manifestations like frequent bowel movements, diarrhoea, even malabsorption with steatorrhoea. We report a 36-year-old man with hyperthyroidism, presenting with cholestatic jaundice and persistent small bowel diarrhoea. He was diagnosed to have Graves' disease and after ruling out more common causes, the cause of cholestatic jaundice was supposed to be Graves' disease. Considering this possibility, the patient was started on treatment with carbimazole. As patient's thyroid function tests started improving, he showed significant clinical and biochemical improvement from liver point of view as well.
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Affiliation(s)
- Siddhesh Vijay Rane
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
| | - Ravi Thanage
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
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Nair SP, Chandnani S, Debnath P, Rathi PM, Junare P, Zanwar V, Kini S. "The Innate Tail": An Unusual Cause of Rectal Bleeding in an Adult Male. GE Port J Gastroenterol 2021; 28:349-353. [PMID: 34604466 DOI: 10.1159/000510783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/12/2020] [Indexed: 11/19/2022]
Abstract
Retrorectal cystic hamartomas or tailgut cysts are infrequent congenital lesions presenting as presacral masses originating from the embryonic hindgut. They are commonly diagnosed in middle-aged women. Physicians must have a high index of suspicion to diagnose this rare tumor. We report a case of retrorectal hamartoma in a 70-year-old male presenting as rectal bleeding instead of the usual compressive symptoms. The utility of imaging modalities and the paramount importance of histopathology has been described. The treatment modality is surgical excision to prevent the potential malignant transformation.
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Affiliation(s)
- Sujit Padmanabhan Nair
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Prasanta Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Parmeshwar Junare
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Vinay Zanwar
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - Sangeeta Kini
- Department of Pathology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
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13
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Singh SP, Wadhawan M, Acharya SK, Bopanna S, Madan K, Sahoo MK, Bhat N, Misra SP, Duseja A, Mukund A, Anand AC, Goel A, Satyaprakash BS, Varghese J, Panigrahi MK, Tandan M, Mohapatra MK, Puri P, Rathi PM, Wadhwa RP, Taneja S, Thomas V, Bhatia V. Management of portal hypertensive upper gastrointestinal bleeding: Report of the Coorg Consensus workshop of the Indian Society of Gastroenterology Task Force on Upper Gastrointestinal Bleeding. Indian J Gastroenterol 2021; 40:519-540. [PMID: 34890020 DOI: 10.1007/s12664-021-01169-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/09/2021] [Indexed: 02/04/2023]
Abstract
Portal hypertensive bleeding is a major complication of portal hypertension (PHT) with high morbidity and mortality. A lot of advances have been made in our understanding of screening, risk stratification, and management strategies for portal hypertensive bleeding including acute variceal bleeding leading to improved overall outcomes in patients with PHT. A number of guidelines on variceal bleeding have been published by various societies in the past few years. The Indian Society of Gastroenterology (ISG) Task Force on Upper Gastrointestinal Bleeding (UGIB) felt that it was necessary to bring out a standard practice guidance document for the use of Indian health care providers especially physicians, gastroenterologists, and hepatologists. For this purpose, an expert group meeting was convened by the ISG Task Force to deliberate on this matter and write a consensus guidance document for Indian practice. The delegates including gastroenterologists, hepatologists, radiologists, and surgeons from different parts of the country participated in the consensus development meeting at Coorg in 2018. A core group was constituted which reviewed all published literature on portal hypertensive UGIB with special reference to the Indian scenario and prepared unambiguous statements on different aspects for voting and consensus in the whole group. This consensus was produced through a modified Delphi process and reflects our current understanding and recommendations for the diagnosis and management of portal hypertensive UGIB in Indians. Intended for use by the health care providers especially gastroenterologists and hepatologists, these consensus statements provide an evidence-based approach to risk stratification, diagnosis, and management of patients with portal hypertensive bleeding.
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Affiliation(s)
- Shivaram P Singh
- Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753 001, India.
| | - Manav Wadhawan
- Department of Hepatology and Liver Transplant, Institute of Liver and Digestive Diseases, BLK Super Specialty Hospital, Delhi, 110 005, India
| | - Subrat K Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, 751 024, India
| | - Sawan Bopanna
- Department of Gastroenterology and Hepatology, Fortis Flt. Lt. Rajan Dhall Hospital, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi, 110 070, India
| | - Kaushal Madan
- Department of Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, 110 017, India
| | - Manoj K Sahoo
- Department of Medical Gastroenterology, IMS and SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, 751 003, India
| | - Naresh Bhat
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore, 560 092, India
| | - Sri P Misra
- Department of Gastroenterology and Hepatology, Moti Lal Nehru Medical College, Allahabad, 211 001, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Amar Mukund
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Anil C Anand
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, 751 024, India
| | - Ashish Goel
- Department of Hepatology, Christian Medical College, Vellore, 632 004, India
| | | | - Joy Varghese
- Department of Hepatology and Transplant Hepatology, Institute of Liver Disease and Transplantation, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Manas K Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India
| | - Manu Tandan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, 500 082, India
| | - Mihir K Mohapatra
- Department of Surgical Gastroenterology, Srirama Chandra Bhanja Medical College, Cuttack, 753 007, India
| | - Pankaj Puri
- Department of Gastroenterology and Hepatology, Fortis Escorts Liver and Digestive Diseases Institute, Okhla Road, New Delhi, 110 025, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, 400 008, India
| | - Rajkumar P Wadhwa
- Department of Gastroenterology, Apollo BGS Hospital, Adichuchanagiri Road, Kuvempunagar, Mysore, 570 023, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Varghese Thomas
- Department of Gastroenterology, Malabar Medical College Hospital, Modakkallur, Calicut, 673 321, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
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Mahajan NN, Kaushal N, Junare PR, Bansal S, Rathi PM, Srivastava V, Bahirat S. Co-infection of SARS-CoV-2 with Malaria or Dengue in 91 Patients at a First Dedicated COVID-19 Hospital in India. J Assoc Physicians India 2021; 69:11-12. [PMID: 34472798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Niraj N Mahajan
- Department of Obstetrics and Gynecology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - Nandita Kaushal
- Department of Obstetrics and Gynecology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - Parmeshwar R Junare
- Department of Gastroenterology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - Saurabh Bansal
- Department of Gastroenterology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - Pravin M Rathi
- Department of Gastroenterology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - Vartika Srivastava
- Department of Obstetrics and Gynecology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - Shubhada Bahirat
- Department of Obstetrics and Gynecology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
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15
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Debnath P, Rathi PM. Vedolizumab in Inflammatory Bowel Disease: West versus East. Inflamm Intest Dis 2021; 6:1-17. [PMID: 33850834 DOI: 10.1159/000512805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022] Open
Abstract
Background Vedolizumab is a humanized immunoglobulin G1 monoclonal antibody, which binds to α4β7 integrin on T lymphocytes, thus disturbing the interaction with mucosal vascular addressin cell adhesion molecule 1 on the intestinal endothelial cells to interfere with lymphocyte trafficking to the gut. Summary Vedolizumab is a safe and effective drug to induce and maintain clinical remission in patients with Crohn's disease (CD) and ulcerative colitis (UC) in both clinical trials and real-world data. Various guidelines recommend vedolizumab as a first- or second-line treatment regimen for steroid-dependent, steroid, or immunomodulator refractory cases of UC and CD; however, it is more effective in anti-TNF-naive patients. The first head-to-head trial (VARSITY trial) comparing the efficacy of vedolizumab to adalimumab has shown better clinical remission and mucosal healing with vedolizumab. Key Messages In this review, we have discussed guidelines recommendation of vedolizumab use, as well as its safety data, use in special population, in presence of extraintestinal complications, therapeutic drug monitoring, data from Asian patients, along with other evolving concepts. Because of its excellent safety data and low immunogenicity, vedolizumab is an impressive option for patients with prior malignancy and less chance of reactivation of tuberculosis; however, cost remains an issue.
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Affiliation(s)
| | - Pravin M Rathi
- T.N.M.C. & B.Y.L. Nair Charitable Hospital, Mumbai, India
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16
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Udgirkar S, Jain S, Chandnani S, Rathi PM, Contractor Q, Kamat R. Non-variceal upper gastrointestinal bleed as first presentation of primary systemic amyloidosis - A case report. Int J Health Sci (Qassim) 2021; 15:50-52. [PMID: 34285688 PMCID: PMC8265301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Gastrointestinal (GI) tract manifestations of amyloid deposition include diarrhea, GI hemorrhage, steatorrhea, or constipation. Here, we report an elderly female presenting with GI hemorrhage due to gastric ulceration and 4-6 polypoidal lesions with intermittent ooze in the duodenum as a first presentation of primary systemic amyloidosis. The bleed was managed with proton-pump inhibitors and hemospray application. She received chemotherapy for multiple myeloma after stabilization. A high index of suspicion is needed to diagnose amyloidosis causing GI hemorrhage.
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Affiliation(s)
- Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Mumbai, Maharashtra, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Shubham Jain, Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India. Mobile: +91-7710915754. E-mail:
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Mumbai, Maharashtra, India
| | - Pravin M. Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Mumbai, Maharashtra, India
| | - Rima Kamat
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch. Hospital, Mumbai, Maharashtra, India
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17
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Jain S, Thanage R, Panchal F, Rathi PM, Munshi R, Udgirkar SS, Contractor QQ, Chandnani SJ, Sujit NP, Debnath P, Singh A. Screening of Family Members of Nonalcoholic Fatty Liver Disease Patients can Detect Undiagnosed Nonalcoholic Fatty Liver Disease Among Them: Is There a Genetic Link? J Clin Exp Hepatol 2021; 11:466-474. [PMID: 34276153 PMCID: PMC8267349 DOI: 10.1016/j.jceh.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) has multifactorial origin. Genetic and environmental factors lead to the biology of this complex disorder. In this study, we screened parents of cases with NAFLD and compared them with parents of cases without NAFLD to see its familial aggregation and the role of patatin-like phospholipase domain containing 3 (PNPLA3). METHOD It was a cross-sectional study. Parents of probands with NAFLD and without NAFLD were screened with abdominal sonography, anthropometry, blood tests, transient elastography, and PNPLA3 polymorphism. RESULTS We had enrolled 303 individuals: 51 probands with NAFLD, 50 probands without NAFLD, and their 202 parents. Parents of the NAFLD group had significantly higher metabolic risk factors as compared with parents of the non-NAFLD group. They had a significantly higher rate of fatty liver (P = 0.0001), mean serum aspartate aminotransferase levels (P = 0.011), mean serum alanine aminotransferase levels (P = 0.001),raised fasting and postprandial blood sugar levels, lower mean platelets (P = 0.033) and serum albumin levels (P = 0.005), and higher mean liver stiffness (P = 0.001) on transient elastography.Frequency of PNPLA3 polymorphism within NAFLD group was higher compared to the non-NAFLD group (mutant GG-13.3 vs 3.3%). Similarly, parents of NAFLD group had mutant GG in 15 % versus 5% in parents of non-NAFLD group, (P = 0.105, odds ratio 6), though it was not statistically significant but may be relevant. In this study, offsprings of parents with nonalcoholic steatohepatitis were likely to have GG homozygous allele. A NAFLD16 score based on parent's parameters was calculated to predict the probability of NAFLD occurrence in an overweight obese individual. CONCLUSION Screening of parents of individuals with NAFLD will help in the identification of undiagnosed NAFLD cases and other metabolic risk factors among them as there is a familial aggregation of NAFLD. One can predict the occurrence of NAFLD in the next generation using the NAFLD16 score.
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Key Words
- ALT, Alanine Aminotransferase
- APRI, AST/Platelet Ratio Index
- AST, Aspartate Aminotransferase
- BMI, Body Mass Index
- FBS, Fasting Blood Sugar
- FIB-4, Fibrosis-4 Index
- HDL, High-Density Lipoprotein
- HOMA IR, Homeostatic Model Assessment of Insulin Resistance
- HWE, Hardy-Weinberg Equilibrium
- I148M, isoleucine to methionine
- IAAT, Intra-Adipose Tissue Thickness
- LSM, Liver Stiffness Measurement
- NAFLD
- NAFLD, Nonalcoholic Fatty Liver Disease
- NAFLD16 score
- NASH, Nonalcoholic Steatohepatitis
- PLBS, Postprandial Blood Sugar
- PNPLA3
- PNPLA3, Patatin-like Phospholipase Domain Containing 3
- SNP, single-nucleotide polymorphism
- TE, Transient Elastography
- USG, Ultrasonography
- WHR, Waist-Hip Ratio
- familial aggregation of NAFLD
- transient elastography
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Affiliation(s)
- Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India,Address for correspondence. Dr.Shubham Jain, Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India.
| | - Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Falguni Panchal
- Molecular Genetic Laboratory, Department of Clinical Pharmacology, Topiwala National Medical College and BYL Nair Ch.Hospital, Dr.AL Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Pravin M. Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Renuka Munshi
- Molecular Genetic Laboratory, Department of Clinical Pharmacology, Topiwala National Medical College and BYL Nair Ch.Hospital, Dr.AL Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Suhas S. Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Qais Q. Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Sanjay J. Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Nair P. Sujit
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra, 400 008, India
| | - Anupam Singh
- Department of Medicine, Santosh Medical College and University, Ghaziabad, (U.P), 201001, India
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Ahire DS, Rathi PM, Banka NH, Shah PK. Utility of Japan Narrow Band Imaging Expert Team Classification Using Narrow Band Imaging for Evaluation of Colonic Polyps. Journal of Digestive Endoscopy 2020. [DOI: 10.1055/s-0040-1714169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Narrow band imaging (NBI) is an advanced endoscopic imaging technique that enhances visualization of the mucosal surface and is used as a screening tool for colonic polyps. Its usefulness is currently explored to a lesser extent in India. So, we assessed the utility of Japan NBI Expert Team (JNET) classification for characterization of colorectal polyps.
Methods A prospective observational study was performed from January 2018 to June 2019 of patients undergoing colonoscopy at a tertiary care hospital. NBI image of polyps was captured followed by either polypectomy/biopsy. Histopathology results were correlated with the pattern revealed by NBI on polyps using the JNET classification.
Results A total of 80 patients, 61(76.25%) male with a mean (standard deviation [SD]) age of 58.41 ± 14.59 years were included. Out of the 90 lesions, 23 (25.5%) had type-1 pattern, 45 (50%) had 2A, 13 (14.4%) had 2B, and 9 (10%) had type-3 pattern. On histopathology, majority 51 (59.3%) were found to be adenomatous with low-grade intramucosal neoplasia. When correlating our results with JNET category type 1 and hyperplastic polyps, the sensitivity was 90%, specificity was 97%, negative predictive value was 97%, positive predictive value was 90%, and diagnostic accuracy was 96%. Correlating type 2A and low-grade intramucosal neoplasia had results of 78, 87, 76, 90, and 82%, respectively. Correlating type 2B and high-grade intramucosal neoplasia had results of 83, 90, 99, 38, and 90%, respectively. Correlating type 3 and deep submucosal cancer had results of 88, 98, 99, 78, and 97%, respectively.
Conclusion NBI shows excellent probability to exclude carcinoma possibilities based on the changes in colonic mucosal features. Owing to slightly lower sensitivity for type 2B, it needs additional investigation using pit pattern diagnosis. We demonstrated the high-diagnostic performance of NBI in making an accurate diagnosis of early colorectal cancers in colonoscopy. Further refinement in the NBI technology might add to the current evidence for characterization of polyps.
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Affiliation(s)
- Dipak S. Ahire
- Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Pravin M. Rathi
- Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Niranjan H. Banka
- Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Parth K. Shah
- Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
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Nair SP, Debnath P, Udgirkar S, Junare P, Chandnani S, Jain S, Pawar VB, Rathi PM. Acute Pancreatitis: A Rare Post-Colonoscopy Sequela. Clin Endosc 2020; 53:611-614. [PMID: 32045963 PMCID: PMC7548147 DOI: 10.5946/ce.2019.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/21/2019] [Indexed: 01/18/2023] Open
Abstract
Abdominal pain is a common but benign symptom after colonoscopy. We report a case of acute pancreatitis that occurred just after an elective screening colonoscopy; this is a rare event with very few reported cases. A healthy, asymptomatic male underwent screening colonoscopy at our center and developed abdominal pain and emesis after the procedure. An abdominal X-ray ruled out perforation but laboratory tests revealed elevated levels of amylase and lipase. The patient had no etiological risk factors for pancreatitis. The presumed mechanism of pancreatitis in this case is mechanical and pressure trauma from excessive insufflation, external abdominal pressure, and repeated withdrawal of the colonoscope due to tight angulation of the splenic flexure, a structure that is in close proximity to the pancreatic tail. Acute pancreatitis should be considered in the differential diagnosis of patients who present with abdominal pain after colonoscopy once more common etiologies have been excluded.
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Affiliation(s)
- Sujit P Nair
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Prasanta Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Parmeshwar Junare
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Vinay B Pawar
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L Nair Charitable Hospital, Mumbai, India
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Pawar VB, Surude RG, Sonthalia N, Zanwar V, Jain S, Contractor Q, Rathi PM. Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal. J Clin Transl Hepatol 2019; 7:304-312. [PMID: 31915599 PMCID: PMC6943207 DOI: 10.14218/jcth.2017.00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 05/28/2018] [Accepted: 02/14/2019] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Psychometric hepatic encephalopathy score (PHES) is used widely for diagnosis of minimal hepatic encephalopathy (MHE). This prospective study aimed to determine the utility of the inhibitory control test (ICT) for the diagnosis of MHE. Additionally, the efficacy of rifaximin and lactulose for reversal of MHE was evaluated. Methods: A total of 180 eligible cirrhotic patients underwent testing for MHE. When PHES was ≤ -5 and ICT lures were ≥ 14, MHE was diagnosed. The 108 patients with MHE were randomized to three groups for treatment with either lactulose, rifaximin, or placebo. Treatment outcomes were measured at the end of 3 months. Results: The 108 patients with MHE diagnosed by PHES and/or ICT accounted for 60%. The diagnosis of MHE was made by both ICT and PHES positivity in 56 patients, by abnormal ICT and normal PHES in 37 patients, and by abnormal PHES and normal ICT in 15 patients. For diagnosis of MHE, ICT had sensitivity of 78.87%, specificity of 66.06% with 60.22% positive predictive value and 82.76% negative predictive value. An area under the curve value of 0.724 (95% CI: 0.653-0.788) was obtained for diagnosis of MHE. Reversal of MHE was seen in 71.42%, 70.27% and 11.11% of patients in the rifaximin, lactulose and placebo arms (p < 0.001). Rifaximin showed better tolerability compared to lactulose. Conclusions: For the diagnosis of MHE, ICT is a simple tool but has lower sensitivity and better specificity than PHES. Rifaximin is as efficacious as lactulose in the treatment of MHE and better tolerated.
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Affiliation(s)
- Vinay B. Pawar
- Correspondence to: Vinay B. Pawar, Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Dr. A.L Nair Road, Mumbai, Maharashtra 400008, India. Tel: +22-23021639, E-mail:
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21
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Jain S, Thanage R, Rathi PM, Udgirkar S, Debnath P, Contractor Q. Diarrhoea, Hyperpigmentation and Hamartomatous Polyposis Syndrome. J Assoc Physicians India 2019; 67:83-84. [PMID: 31571463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cronkhite-Canada syndrome (CCS)is a rare non-hereditary hamartomatous polyposis syndrome of unknown aetiology. It is characterized by diffuse gastrointestinal polyps, dystrophic nail changes, alopecia, cutaneous hyperpigmentation, chronic diarrhoea, anorexia and hypogeusia. It is associated with a high incidence of gastrointestinal malignancies, mortality and morbidity. Early clinical suspicion and treatment is important. We report an elderly male with CCS who showed clinical and endoscopic improvement with long term corticosteroid therapy.
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Affiliation(s)
| | | | | | | | | | - Qais Contractor
- Associate Professor, Topiwala National Medical College and BYL Ch Hospital, Mumbai, Maharashtra
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Sonthalia N, Jain S, Pawar V, Pawar S, Surude R, Rathi PM, Contractor Q. Haemoseal Spray for Nonvariceal Gastrointestinal Bleeding: An Initial Experience from India. Journal of Digestive Endoscopy 2019. [DOI: 10.4103/jde.jde_36_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ABSTRACT
Background and Aims: The aim was to reflect the use and effectiveness of Haemoseal spray as a treatment option in gastrointestinal (GI) bleed in everyday gastroenterology practice. Materials and Methods: This was a single‑center, retrospective observational study conducted over a period of 12 months from January 2016 to December 2016. Consecutive patients of upper or lower GI bleed where haemoseal powder was used either as salvage therapy after a failed hemostasis or as an add‑on to the standard methods or as monotherapy were identified and analyzed. Results: Of 284 patients with GI bleed, haemoseal spray was used in 20 (7.04%) patients. Bleeding was due to duodenal ulcer in 7 (35%), gastric ulcer 3 (15%), esophageal ulcer 2 (10%), colonic postpolypectomy bleed 2 (10%), gastric carcinoma 2 (10%), Mallory‑Weiss tear 1 (5%), postsphincterotomy bleed 1 (5%), gastric antral vascular ectasia 1 (5%), and portal hypertensive gastropathy 1 (5%). The nature of bleed was oozing in 17 (85%) and spurting in 3 (15%). Initial hemostasis when used as monotherapy was seen in 3/3, as add‑on therapy in 6/6, and as salvage therapy in 9/11 patients. Rebleed was seen in 4 (20%) and 30‑day mortality was seen in 2 (10%) patients. Rebleed rate at day 7 was more in monotherapy cases; however, the difference was not statistically significant (33.33% vs. 16.66% vs. 18.18%, P = 0.819). Conclusion: Haemoseal spray is an effective hemostatic agent in various clinical situations with GI bleeding, especially when used as salvage therapy or as add‑on therapy.
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Affiliation(s)
- Nikhil Sonthalia
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
| | - Samit Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
| | - Vinay Pawar
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
| | - Sunil Pawar
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
| | - Ravindra Surude
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
| | - Pravin M. Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL CH Hospital, Mumbai, Maharashtra, India
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23
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Chandnani S, Udgirkar S, Jain SS, Sonthalia N, Contractor Q, Rathi PM, Chapekar A. Massive Lower Gastrointestinal Bleeding Due to Fulminant Necrotizing Amebic Colitis: A Diagnostic and Therapeutic Challenge. J Assoc Physicians India 2019; 67:79-81. [PMID: 31299848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Acute fulminant necrotizing amebic colitis rarely presents with massive lifethreatening lower gastrointestinal bleeding without diarrhea. Diagnosis is difficult as colonoscopy is suboptimal due to active bleeding, stool testing is often negative and a positive serology cannot confirm the diagnosis. We herein report a case of a 39-year-old male who presented with profuse bleeding per rectum, without associated significant antecedent history of fever or diarrhea. Colonoscopy was inconclusive as active bleeding obscured the vision. Computed tomography of abdomen revealed non-specific thickening of the caecum. Emergency laparotomy with right hemicolectomy and temporary ileostomy was performed. Microscopic examination of colonic mucosa revealed Entamoeba histolytica trophozoites with erythrophagocytosis suggestive of fulminant amebic colitis. Intravenous metronidazole was given subsequently and patient recovered completely. Ileocolonic anastomosis was done after closing the ileostomy three months later. This case highlights this exceedingly rare presentation of fulminant amebic colitis which poses a diagnostic challenge and can be life threatening without early surgical intervention.
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Affiliation(s)
- Sanjay Chandnani
- Senior Registrar, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - Suhas Udgirkar
- Senior Registrar, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - Samit S Jain
- Associate Professor,Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - Nikhil Sonthalia
- Assistant Professor, Department of General Surgery, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - Qais Contractor
- Associate Professor,Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - Pravin M Rathi
- Professor and Head of the Department, Gastroenterology,Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
| | - Anirudh Chapekar
- Associate Professor, Department of General Surgery, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra
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24
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Affiliation(s)
- Amey Dilip Sonavane
- Department of Gastroenterology, Bombay Hospital & Institute of Medical Sciences, Mumbai 400 020, Maharashtra, India
| | - Pravin M Rathi
- Department of Gastroenterology, Bombay Hospital & Institute of Medical Sciences, Mumbai 400 020, Maharashtra, India
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Pawar SV, Zanwar VG, Choksey AS, Mohite AR, Jain SS, Surude RG, Contractor QQ, Rathi PM, Verma RU, Varthakavi PK. Most overweight and obese Indian children have nonalcoholic fatty liver disease. Ann Hepatol 2016; 15:853-861. [PMID: 27740518 DOI: 10.5604/16652681.1222101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Background and rationale. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of pediatric liver disease in western countries. Its prevalence in Indian subcontinent is not well studied. MATERIAL AND METHODS In a school based cross sectional study we have screened overweight and obese children in the age group of 11 to 15 years for NAFLD. Ultrasonography, elevated serum transaminases, fibroscan were used for defining NAFLD. Dietary habits, blood pressure, serum lipid profile, blood counts and insulin resistance were recorded. The relation of fibrosis 4 score, pediatric NAFLD fibrosis index, aspartate transaminases to platelet ratio index (APRI) with fibroscan was evaluated. RESULTS Out of 616 students screened 198 were overweight and obese. Hundred students and their parents gave informed consent for the further evaluation. The prevalence of NAFLD was 62% in overweight and obese children. Fatty liver was found in 50 % students on ultrasonography, liver stiffness (≥ 6.1 Kilopascals) in 23% and raised alanine transaminase in 30%. Hypertension, dyslipidemia, diabetes mellitus and insulin resistance were seen in 6%, 18%, 2% and 66% students respectively. Systolic hypertension, serum triglyceride, aspartate transaminase, APRI was significantly higher in the NAFLD group. On binary logistic regression only systolic hypertension was an independent risk factor for NAFLD. CONCLUSION In conclusion NAFLD is common in asymptomatic overweight and obese Indian children. Systolic hypertension is the only independent factor associated with NAFLD. Fibroscan has limited role for screening. We recommend screening for NAFLD in this high risk group with alanine transaminases and ultrasonography.
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Affiliation(s)
- Sunil V Pawar
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Vinay G Zanwar
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Ajay S Choksey
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Ashok R Mohite
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Samit S Jain
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Ravindra G Surude
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Qais Q Contractor
- Department of Gastroenterology & Hepatology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Department of Gastroenterology & Hepatology, Bombay Hospital Institute of Medical Science (BHIMS) and Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Ravi U Verma
- Department of Radio diagnosis, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
| | - Premlata K Varthakavi
- Department of Endocrinology, Topiwala National Medical College & B Y L Nair Hospital, Mumbai, Maharashtra, India
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Sonthalia N, Jain SS, Pawar VB, Zanwar VG, Surude RG, Rathi PM, Munde KK, Bavdekar S. A Child with Debilitating Pruritus. Clin Pract 2016; 6:865. [PMID: 28028430 PMCID: PMC5136740 DOI: 10.4081/cp.2016.865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/28/2016] [Accepted: 09/22/2016] [Indexed: 11/23/2022] Open
Abstract
We describe a case of two-year-old boy presenting with debilitating pruritus, patchy alopecia and jaundice since the age of 6 months. On evaluation he had intrahepatic cholestasis with persistently raised serum alkaline phosphatase, normal Gamma glutamyl transferase and raised serum bile acid levels. His liver biopsy showed bland cholestasis and electron microscopy showed granular bile suggestive of progressive familial intrahepatic cholestasis type I. Medical therapy with ursodeoxycholic acid, cholestyramine, rifampicin with nutritional modification was successful in alleviating the symptoms and correcting the nutritional status. To our knowledge this is only the sixth case of progressive familial intrahepatic cholestasis type I reported from India. Herein we discuss the diagnostic and therapeutic hurdles that one encounters in managing progressive familial intrahepatic cholestasis and also review the literature regarding this rare disorder.
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Affiliation(s)
- Nikhil Sonthalia
- Department of Gastroenterology; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Samit S Jain
- Department of Gastroenterology; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Vinay B Pawar
- Department of Gastroenterology; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Vinay G Zanwar
- Department of Gastroenterology; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Ravindra G Surude
- Department of Gastroenterology; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Department of Gastroenterology; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Kshitij K Munde
- Department of Pediatric Medicine; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
| | - Sandeep Bavdekar
- Department of Pediatric Medicine; Topiwala National Medical College and BYL Nair Ch Hospital , Mumbai, Maharashtra, India
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Zanwar VG, Pawar SV, Gambhire PA, Jain SS, Surude RG, Shah VB, Contractor QQ, Rathi PM. Symptomatic improvement with gluten restriction in irritable bowel syndrome: a prospective, randomized, double blinded placebo controlled trial. Intest Res 2016; 14:343-350. [PMID: 27799885 PMCID: PMC5083263 DOI: 10.5217/ir.2016.14.4.343] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The existence of non-celiac gluten sensitivity has been debated. Indeed, the intestinal and extra-intestinal symptoms of many patients with irritable bowel syndrome (IBS) but without celiac disease or wheat allergy have been shown to improve on a gluten-free diet. Therefore, this study set out to evaluate the effects of gluten on IBS symptoms. Methods We performed a double-blind randomized placebo-controlled rechallenge trial in a tertiary care hospital with IBS patients who fulfilled the Rome III criteria. Patients with celiac disease and wheat allergy were appropriately excluded. The participants were administered a gluten-free diet for 4 weeks and were asked to complete a symptom-based questionnaire to assess their overall symptoms, abdominal pain, bloating, wind, and tiredness on the visual analog scale (0-100) at the baseline and every week thereafter. The participants who showed improvement were randomly assigned to one of two groups to receive either a placebo (gluten-free breads) or gluten (whole cereal breads) as a rechallenge for the next 4 weeks. Results In line with the protocol analysis, 60 patients completed the study. The overall symptom score on the visual analog scale was significantly different between the two groups (P<0.05). Moreover, the patients in the gluten intervention group scored significantly higher in terms of abdominal pain, bloating, and tiredness (P<0.05), and their symptoms worsened within 1 week of the rechallenge. Conclusions A gluten diet may worsen the symptoms of IBS patients. Therefore, some form of gluten sensitivity other than celiac disease exists in some of them, and patients with IBS may benefit from gluten restrictions.
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Affiliation(s)
- Vinay G Zanwar
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Sunil V Pawar
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Pravir A Gambhire
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Samit S Jain
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Ravindra G Surude
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Vinaya B Shah
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Qais Q Contractor
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Ch Hospital, Mumbai, India
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Sonthalia N, Pawar SV, Mohite AR, Jain SS, Surude RG, Rathi PM, Contractor Q. Metronidazole-Induced Encephalopathy in Alcoholic Liver Disease: A Diagnostic and Therapeutic Challenge. J Emerg Med 2016; 51:e79-e83. [DOI: 10.1016/j.jemermed.2016.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/06/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
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Joshi AS, Mohite AR, Varthakavi PK, Rathi PM. Alström Syndrome with Portal Hypertension. J Assoc Physicians India 2016; 64:92-93. [PMID: 27766814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Alstrom syndrome is an autosomal recessive multisystem disorder caused by mutation in ALMS1 (2p13). Very few cases of same are reported so far of same. We report a case of Alstrom syndrome (AS) who presented with type II diabetes mellitus and portal hypertension. Unilateral anorchia with hypergonadotropic hypogonadism is another unique feature of our case.
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Affiliation(s)
| | | | | | - Pravin M Rathi
- Professor and Head of the Department, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Mumbai, Maharashtra
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Rathi PM, Patel PS. Bottle Gourd (Lagenaria Siceraria) Juice Poisoning. J Assoc Physicians India 2016; 64:87-88. [PMID: 27766812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present the case of a young woman who presented to us with multiple episodes of vomiting, followed by hematemesis and abdominal pain after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics and discharged in stable condition. As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only.
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Affiliation(s)
| | - Pinakin S Patel
- Resident Gastroenterologist, Department of Medical Gastroenterology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra
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Sonthalia N, Jain SS, Surude RG, Pawar VB, Udgirkar S, Rathi PM. Primary Esophageal Intramural Squamous Cell Carcinoma Masquerading as a Submucosal Tumor: A Rare Presentation of a Common Disease. Clin Med Insights Gastroenterol 2016; 9:63-66. [PMID: 27721663 PMCID: PMC5045250 DOI: 10.4137/cgast.s40605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 01/12/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) is the commonest primary malignant esophageal tumor, which typically presents as endoscopically visible surface mucosal ulcerations, irregularities, or polyploidal masses. We here report a rare case of primary ESCC with completely intramural growth under a normal looking intact nondysplastic surface squamous epithelium disguising as a submucosal tumor. Upper gastrointestinal endoscopy-guided mucosal biopsy was negative for malignancy. Endoscopic ultrasound (EUS) revealed a heteroechoic solid mass originating from the muscularis propria of the distal esophagus. Cytological study of EUS-guided fine needle aspiration from the mass was suggestive of squamous cell carcinoma, which was confirmed on immunohistochemistry. There was no evidence of metastatic origin of this tumor or continuous cancer involvement from the surrounding structures, including the head, neck, and lungs on bronchoscopy, computed tomography scan, and positron emission tomography scan. Exclusive intramural squamous cell carcinoma with normal overlying mucosa is an exceedingly rare presentation of primary ESCC with only four cases reported in the literature so far. A high index of suspicion is required by the gastroenterologists and pathologists in diagnosing these cases as these tumors closely mimic the mesenchymal submucosal tumors such as lipoma, leiomyoma, and gastrointestinal stromal tumors. EUS is an indispensable tool in making a preoperative diagnosis and therapeutic decision making.
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Affiliation(s)
- Nikhil Sonthalia
- Senior Resident, Department of Gastroenterology, Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Samit S Jain
- Lecturer, Department of Gastroenterology, Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Ravindra G Surude
- Assistant Professor, Department of Gastroenterology, Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Vinay B Pawar
- Senior Resident, Department of Gastroenterology, Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Suhas Udgirkar
- Senior Resident, Department of Gastroenterology, Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Professor and Head of the Department, Department of Gastroenterology, Topiwala National Medical College & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
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Sonthalia N, Jain SS, Surude RG, Mohite AR, Rathi PM. Congenital Esophageal Duplication Cyst: A Rare Cause of Dysphagia in an Adult. Gastroenterology Res 2016; 9:79-82. [PMID: 27785331 PMCID: PMC5040550 DOI: 10.14740/gr711w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/29/2022] Open
Abstract
Esophageal duplication cyst is a rare congenital embryonal gastrointestinal (GI) malformation which is diagnosed most commonly in childhood. In adults, they can present with a variety of symptoms ranging from dysphagia, chest pain, epigastric discomfort, and vomiting to more serious complications including infections, hemorrhage, and ulcerations. A 30-year-old male presented with gradually progressive dysphagia to solids for 4 months without significant weight loss. Clinical examination and routine laboratory examination were unrevealing. Upper GI endoscopy revealed a well-defined submucosal lesion bulging into the esophageal lumen involving the right antero-lateral wall of the distal esophagus. The overlying mucosa was normal with mild luminal narrowing but gastroscope could be negotiated across this narrowing. Differential diagnosis included lipoma, leiomyoma or GI stromal tumors. Contrast-enhanced computed tomography of thorax revealed a 3.5 × 2.3 × 3 cm well-defined homogenous hypodense lesion involving the right antero-lateral wall of the distal thoracic esophagus with likely possibility of submucosal or intramural lesion. Subsequently, endoscopic ultrasonography (EUS) revealed a 3.3 × 2.8 cm homogenous hypoechoic lesion without any vascularity involving the distal esophagus wall suggestive of duplication cyst. The lesion was intramural in location as muscularis propria was seen to go around the lesion. Bronchogenic cyst was excluded due to absence of cartilage and close proximity of the cyst to lumen. Fine-needle aspiration was not attempted in view of high risk of introducing infection. Being symptomatic, the patient underwent complete surgical excision of the cyst with exteriorization of the base which on histopathology confirmed duplication cyst. Esophageal duplication cysts are exceedingly rare congenital embryonal malformations with estimated prevalence of 0.0122% arising from aberration of posterior division of embryonic foregut at 3 - 4 weeks of gestation. This case shows that duplication cysts can rarely masquerade as submucosal tumor in adults and EUS is highly accurate in pre-operative diagnosis and therapeutic decision making. Literature search revealed only a handful of cases of EUS-guided diagnosis of esophageal duplication cyst reported in the literature.
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Affiliation(s)
- Nikhil Sonthalia
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Dr. A.L Nair Road, Mumbai 400008, Maharashtra, India
| | - Samit S Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Dr. A.L Nair Road, Mumbai 400008, Maharashtra, India
| | - Ravindra G Surude
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Dr. A.L Nair Road, Mumbai 400008, Maharashtra, India
| | - Ashok R Mohite
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Dr. A.L Nair Road, Mumbai 400008, Maharashtra, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Ch Hospital, Dr. A.L Nair Road, Mumbai 400008, Maharashtra, India
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Mohite AR, Gambhire PA, Pawar SV, Jain SS, Contractor QQ, Rathi PM. Changing clinical profile and factors associated with liver enzyme abnormalities among HIV-infected persons. Trop Doct 2016; 47:205-211. [PMID: 27342920 DOI: 10.1177/0049475516655068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The spectrum of liver disease among HIV-infected patients is changing. In the era of antiretroviral therapy, opportunistic infections are diminishing and deranged liver function appears to be due usually to drug-induced liver injury, alcohol, non-alcoholic steatohepatitis (NASH) or chronic hepatitis B. To test this hypothesis, 98 HIV-positive patients with deranged liver function were compared with matched HIV-positive patients with normal liver function and likewise matched HIV-negative patients with normal liver function tests.
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Affiliation(s)
- Ashok R Mohite
- Department of Gastroenterology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Pravir A Gambhire
- Department of Gastroenterology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Sunil V Pawar
- Department of Gastroenterology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Samit S Jain
- Department of Gastroenterology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Qais Q Contractor
- Department of Gastroenterology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India
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Sandur V, Murugesh M, Banait V, Rathi PM, Bhatia SJ, Joshi JM, Kate A. Prevalence of gastro-esophageal reflux disease in patients with difficult to control asthma and effect of proton pump inhibitor therapy on asthma symptoms, reflux symptoms, pulmonary function and requirement for asthma medications. J Postgrad Med 2016; 60:282-6. [PMID: 25121368 DOI: 10.4103/0022-3859.138754] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The hypothesis that GER can trigger or exacerbate asthma is supported by several clinical trials that have shown amelioration in asthma symptoms and/or an improvement in pulmonary function after antireflux therapy. AIMS To investigate the prevalence of GER in patients with difficult to control asthma and to determine the effect of omeprazole on asthma symptoms, reflux symptoms, pulmonary function and on the requirement of asthma medications. MATERIALS AND METHODS Patients with difficult to control asthma were recruited into the study. All patients underwent esophageal manometry and 24 hour esophageal pH monitoring. Pulmonary function tests were done before and after treatment. The severity of asthma and reflux was assessed by a 1 week pulmonary symptom score(PSS) and reflux symptom score(RSS) respectively before and after treatment. Those who had an abnormal pH study (pH <4 in the distal esophagus for >5% of the time) underwent anti-GER treatment with lifestyle changes, and a proton pump inhibitor (omeprazole 40 mg, bid) for 3 months. Asthma medications were added or deleted based on severity of asthma. RESULTS Out of 250 asthmatic patients screened, forty patients fulfilled the inclusion criteria. Twenty eight of 40 patients(70%) were diagnosed to have GERD. Of the patients 28 with GER, 8 patients(28.5%) had no reflux symptoms. On 24 hr pH metry, the percentage time pH <4.0 was 10.81 ± 4.72 and 1.11 ± 1.21; Deemester score was 37.65 ± 14.54 and 4.89 ± 6.39 (p-value is 0.0001) in GERD and non-GERD patients respectively.In GERD group, post treatment reflux symptom score(RSS) improved from 22.39 ± 14.99 to 1.04 ± 1.07, pulmonary symptom score(PSS) improved from 27.14 ± 7.49 to 13.82 ± 4.21 and night time asthma symptom score(NASS) improved from 6.71 ± 1.80 to 3.04 ± 1.23 (p-value <0.0001). After treatment, FEV1 and PEFR increased from 1.38 ± 0.57 and 4.14 ± 1.97 to 1.47 ± 0.54 and 5.56 ± 1.72, respectively (p-value 0.00114). CONCLUSIONS PPI therapy improves nocturnal asthma symptoms, daytime asthma symptoms, pulmonary function and decreases requirement of asthma medications in these patients.
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Affiliation(s)
| | | | | | - P M Rathi
- Department of Gastroenterology, TNMC - BYL, Nair Hospital, Mumbai, India
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Rathi PM, Zanwar VG. Non-celiac Gluten Sensitivity (NCGS). J Assoc Physicians India 2016; 64:46-55. [PMID: 27731558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There has been increasing interest in the entity "Non-celiac gluten sensitivity" in recent years which was first of its in 1980s. This "re-discovered" disorder is characterized by intestinal and extra-intestinal symptoms which occur after ingestion of gluten containing food. The number of such patients who neither have celiac disease nor wheat allergy, but appear to benefit from gluten withdrawal is increasing substantially. However it still remains a controversial and its pathogenesis is not well understood. Lack of biomarkers is a major limitation making it difficult to differentiate it from other gluten related disorders. Recent studies have raised the possibility that, beside gluten and wheat amylase-trypsin inhibitors (ATI), low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we will focus on the manifestations of NCGS and evidence for the condition. Also areas of controversy, major advances and future trends will be discussed.
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Affiliation(s)
| | - Vinay G Zanwar
- Resident, Department of Gastroenterology, TNMC & B.Y.L Nair Ch. Hospital, Mumbai
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Pawar SV, Choksey AS, Jain SS, Surude RG, Rathi PM. Prevalence of Overweight and Obesity in 4 Schools of South Mumbai. J Clin Diagn Res 2016; 10:OC01-2. [PMID: 27134909 DOI: 10.7860/jcdr/2016/17624.7383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/16/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The paediatric obesity is on the rise so as the complications of obesity like cardiovascular diseases, liver diseases, dyslipidaemia are increasing. The changing dietary habits and less of outdoor activities are risk factors for obesity. AIM The study was conducted to find out prevalence of overweight and obesity among students in four schools of the Mumbai and compare with studies from rest of the country. MATERIALS AND METHODS It is school based, cross-sectional study conducted in four Schools from class of 5(th) to 10(th). The anthropometric measurements of height, weight were taken of each student. The body mass index was calculated based on the age based Cole et al., criteria (International) as well as Khadilkar et al., criteria which are specially develop for Indian children. The data was analysed with chi-square test. RESULTS Total 1828 students were screened from 4 schools. Out of which 590 were girls and 1238 were boys. The prevalence of overweight and obesity by Cole et al., criteria were 11.3% and 3.3% and by Khadilkar et al., criteria were 17.5% and 7.8 % respectively. CONCLUSION It shows significant difference in obesity between boys and girls and also between government and private schools. There is overall decrease in prevalence of overweight and obesity as age increases. The overweight and obesity among these schools in Mumbai is comparable with the rest of the studies from India.
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Affiliation(s)
- Sunil V Pawar
- Senior Resident, Department of Gastroenterology and Hepatology, Topiwala National Medical College and BYL Nair Ch. Hospital , Mumbai, India
| | - Ajay S Choksey
- Speciality Medical Officer, Department of Gastroenterology and Hepatology, Topiwala National Medical College and BYL Nair Ch. Hospital , Mumbai, India
| | - Samit S Jain
- Assistant Professor, Department of Gastroenterology and Hepatology, Topiwala National Medical College and BYL Nair Ch. Hospital , Mumbai, India
| | - Ravindra G Surude
- Assistant Professor, Department of Gastroenterology and Hepatology, Topiwala National Medical College and BYL Nair Ch. Hospital , Mumbai, India
| | - Pravin M Rathi
- Professor and Head of Department, Department of Gastroenterology and Hepatology, Topiwala National Medical College and BYL Nair Ch. Hospital , Mumbai, India
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Sonavane AD, Sonawane PB, Chandak SV, Rathi PM. Disseminated Histoplasmosis with Haemophagocytic Lymphohistiocytosis in an Immunocompetent Host. J Clin Diagn Res 2016; 10:OD03-5. [PMID: 27134914 DOI: 10.7860/jcdr/2016/15839.7337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/06/2015] [Indexed: 11/24/2022]
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a devastating syndrome due to uninhibited immune activation. Disseminated histoplasmosis is a rare cause of HLH. There have been few case reports and series demonstrating a relation between the two disease entities in immunosuppressed hosts. HLH secondary to disseminated histoplasmosis is even rarer in an immunocompetant host. We report a rare case of HLH triggered by disseminated histoplasmosis in an immunocompetant patient.
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Affiliation(s)
- Amey Dilip Sonavane
- Gastroenterology Fellow, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences , Mumbai, India
| | - Pratibha Balasaheb Sonawane
- Gastroenterology Fellow, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences , Mumbai, India
| | - Sachet Vijay Chandak
- Gastroenterology Fellow, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences , Mumbai, India
| | - Pravin M Rathi
- Consultant Gastroenterologist, Department of Gastroenterology, Bombay Hospital and Institute of Medical Sciences , Mumbai, India
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Shah DK, Jain SS, Mohite A, Amarapurkar AD, Contractor QQ, Rathi PM. Effect of H. pylori density by histopathology on its complications and eradication therapy. ACTA ACUST UNITED AC 2016; 36:101-6. [PMID: 26710478 DOI: 10.7869/tg.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Zanwar VG, Pawar SV, Jain SS, Nayak CS, Rathi PM. Cutaneous lesions in colorectal carcinoma: a rare presentation. Intest Res 2016; 14:102-3. [PMID: 26884742 PMCID: PMC4754514 DOI: 10.5217/ir.2016.14.1.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/06/2015] [Accepted: 10/10/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vinay G Zanwar
- Department of Gastroenterology, T.N. Medical College & B.Y.L Nair Ch Hospital, Mumbai, India
| | - Sunil V Pawar
- Department of Gastroenterology, T.N. Medical College & B.Y.L Nair Ch Hospital, Mumbai, India
| | - Samit S Jain
- Department of Gastroenterology, T.N. Medical College & B.Y.L Nair Ch Hospital, Mumbai, India
| | - Chitra S Nayak
- Department of Dermatology, T.N. Medical College & B.Y.L Nair Ch Hospital, Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, T.N. Medical College & B.Y.L Nair Ch Hospital, Mumbai, India
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Rathi PM, Gautam S, Sharma S. Primary Maligant Melanoma of the Oesophagus. J Assoc Physicians India 2015; 63:74-75. [PMID: 27666909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Primary malignant melanoma of the oesophagus (PMME) is a very rare disease with poor prognosis. The median survival is about 10 months. PMME are highly aggressive biologically and metastasize early via haematogenic and lymphatic pathways. Treatment outcome is poor because malignancy is very advanced at the time of presentation. Here, we present the endoscopic features and management of PMME case.
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Affiliation(s)
| | | | - Sanjay Sharma
- Consultant Gastro-onco Surgeon, Department of Medical Gastroenterology and Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra
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Jain SS, Shah DK, Gambhire PA, Varma RU, Contractor QQ, Rathi PM. Early atherosclerosis in ulcerative colitis: cross-sectional case-control study. J Dig Dis 2015; 16:656-64. [PMID: 26512945 DOI: 10.1111/1751-2980.12297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the extent of early atherosclerosis in ulcerative colitis (UC) patients by measuring carotid intima-media thickness (CIMT) and the correlation between CIMT, serum homocysteine level and homeostasis model assessment-insulin resistance (HOMA-IR) in UC. METHODS We studied 60 UC patients and 60 healthy controls. Individuals with risk factors for atherosclerosis were excluded from the study. Fasting blood glucose, lipid profile, HOMA-IR, erythrocyte sedimentation rate (ESR), serum vitamin B12 and homocysteine levels were measured in all participants. CIMT was measured using a B-mode duplex imaging study. RESULTS UC patients had significantly higher CIMT than controls (P < 0.05). ESR, fasting insulin, HOMA-IR and serum homocysteine levels were also significantly higher in UC patients (P < 0.05). Pearson's correlation coefficient showed significant correlations between: (i) CIMT and patients' age, duration of UC, HOMA-IR, and homocysteine level (P < 0.05); (ii) serum homocysteine and duration of UC, fasting insulin level, HOMA-IR and CIMT (P < 0.01); (iii) HOMA-IR and age, duration of UC, serum homocysteine and CIMT (P < 0.01). Multi-regression models showed that serum homocysteine affects CIMT and duration of UC independently, whereas participants' age and duration of UC affects HOMA-IR independently. CONCLUSIONS Higher CIMT might indicate subclinical atherosclerosis in UC patients. Patients' age, duration of UC, HOMA-IR and homocysteine levels are important factors associated with increased CIMT.
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Affiliation(s)
- Samit S Jain
- Department of Gastroenterology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital
| | - Dharmesh K Shah
- Department of Gastroenterology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital
| | - Pravir A Gambhire
- Department of Gastroenterology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital
| | - Ravi U Varma
- Department of Radiology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai, Maharashtra, India
| | - Qais Q Contractor
- Department of Gastroenterology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital
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Zanwar VG, Gambhire PA, Choksey AS, Rathi PM. Killian-Jamieson Diverticulum: Cervical Oesophageal Diverticulum. J Assoc Physicians India 2015; 63:65-66. [PMID: 29900714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Killian-Jamieson (K-J) diverticulum is an outpouching from the lateral wall of the proximal cervical oesophagus and is less commonly encountered compared to Zenker’s diverticulum (ZD). These diverticulae arise between the fibers of the cricopharyngeus muscle superiorly and longitudinal muscle of the oesophagus inferiorly. In this report we present a case of a symptomatic Killian Jamieson diverticulum and review the clinical presentation, differential diagnosis and radiological findings that distinguish it from the more common Zenker’s diverticulum.
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Shah AS, Rathi PM, Somani VS, Mulani AM. Gastric Schwannoma: A Benign Tumor Often Misdiagnosed as Gastrointestinal Stromal Tumor. Clin Pract 2015; 5:775. [PMID: 26664714 PMCID: PMC4653750 DOI: 10.4081/cp.2015.775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/29/2015] [Accepted: 06/23/2015] [Indexed: 12/13/2022] Open
Abstract
Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.
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Affiliation(s)
- Apurva S Shah
- Department of Gastroenterology, Bombay Hospital and Medical Research Institute , Mumbai, India
| | - Pravin M Rathi
- Department of Gastroenterology, Bombay Hospital and Medical Research Institute , Mumbai, India
| | - Vaibhav S Somani
- Department of Gastroenterology, Bombay Hospital and Medical Research Institute , Mumbai, India
| | - Astha M Mulani
- Department of Obstetrics and Gynaecology, Bombay Hospital and Medical Research Institute , Mumbai, India
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Abstract
Trichuris trichiura (T. Trichiura) is a known parasite infestation among tropical children. Humans acquire Trichuriasis infection after ingestion of embryonated eggs via contaminated food or water. Most of them are asymptomatic. A severe form of trichuris infestation is known as Trichuris dysentery syndrome (TDS). It manifests as mucous diarrhoea, bleeding, malnutrition and stunting, or even life-threatening anaemia. We are reporting an interesting case of a 7-year-old girl who presented with bloody diarrhoea for 2 years. Her growth was stunted as she was not gaining weight. Severe inflammatory bowel disease was suspected clinically. Physical examination revealed marked pallor, pedal oedema and koilonychia along with sparse and hypopigmented hair. On evaluationT. Trichiurahelminths were seen on stool examination and massive worm load was visualised directly on colonoscopy. A diagnosis of TDS was made. She was successfully treated with oral Albendazole (400 mg) and blood transfusion.
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Affiliation(s)
- Vinay G Zanwar
- Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
| | - Sunil V Pawar
- Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
| | - Samit S Jain
- Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
| | - Surabhi P Rathi
- Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
| | - Qais Q Contractor
- Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Topiwala National Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
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Pawar SV, Zanwar VG, Gambhire PA, Mohite AR, Choksey AS, Rathi PM, Asgaonkar DS. Unusual complication of amebic liver abscess: Hepatogastric fistula. World J Gastrointest Endosc 2015; 7:916-919. [PMID: 26240693 PMCID: PMC4515426 DOI: 10.4253/wjge.v7.i9.916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/27/2014] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Amebic liver abscess is a parasitic disease which is often encountered in tropical countries. A hepatogastric fistula secondary to an amebic liver abscess is a rare complication of this disease and there are only a handful of reported cases in literature. Here we present a case of an amebic liver abscess which was complicated with the development of a hepatogastric fistula. The patient presented with the Jaundice, pain and distension of abdomen. The Jaundice and pain improved partially after he had an episode of brownish black colored increase in frequency of stools for 5 to 6 d. Patient also had ascites and anemia. He was a chronic alcohol drinker. Esophagogastroduodenoscopy performed in view of the above findings. It showed a fistulous opening with bilious secretions along the lesser curvature of the stomach. On imaging multiple liver abscesses seen including one in sub capsular location. The patient was managed conservatively with antiamebic medications along with proton pump inhibitors. The pigtail drainage of the sub capsular abscess was done. The patient improved significantly. The repeat endoscopy performed after about two months showed reduction in fistula size. A review of the literature shows that hepatogastric fistulas can be managed conservatively with medications and drainage, endoscopically with biliary stenting or with surgical excision.
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Pawar SV, Zanwar VG, Jain SS, Rathi PM. A Lumpy Bumpy Liver. Gastroenterology Res 2015; 8:279-280. [PMID: 27785309 PMCID: PMC5051047 DOI: 10.14740/gr676w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sunil V. Pawar
- Department of Gastroenterology, 7th Floor OPD Building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
- Corresponding Author: Sunil Pawar, Department of Gastroenterology, 7th Floor OPD Building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Dr. Anandrao Nair Road, Mumbai Central, Mumbai, Maharashtra, India.
| | - Vinay G. Zanwar
- Department of Gastroenterology, 7th Floor OPD Building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Samit S. Jain
- Department of Gastroenterology, 7th Floor OPD Building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
| | - Pravin M. Rathi
- Department of Gastroenterology, 7th Floor OPD Building, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India
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Shah DK, Jain SS, Somani PO, Rathi PM. Biliary sphincteroplasty facilitates retrieval of proximally migrated plastic biliary stent. ACTA ACUST UNITED AC 2014; 35:103-6. [PMID: 25470872 DOI: 10.7869/tg.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Mallaiyappan M, Sawalakhe NR, Sasidharan M, Shah DK, Rathi PM, Bhatia SJ. Retrospective and prospective validation of model for end-stage liver disease (MELD) score in predicting mortality in patients of alcoholic liver disease. ACTA ACUST UNITED AC 2014; 34:252-8. [PMID: 25046888 DOI: 10.7869/tg.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Patients with alcoholic hepatitis and alcoholic cirrhosis have significant morbidity and mortality. The model for end-stage liver disease (MELD) score is used to predict mortality in patients with liver disease. Our study aimed to validate the utility of MELD score versus Child Pugh Turcotte (CPT) and modified CPT (CPT+creatinine; CPTC) scores in predicting mortality among alcoholic liver disease (ALD) patients. METHODS We examineda retrospective (n=110; mean age 44.5years; 109 men) and a prospective (n=96; mean age 45 years; 92 men) cohort of patients suffering from ALD, with varying disease severity, and compared the ability of MELD, CTP and CPTC scores to predict the 1-, 3- and 6-month mortality using concordance (c-) statistics. RESULTS The median MELD, CPT and CPTC scores were 21, 10 and 11 in the retrospective group and 21, 10 and 10 in prospective groups, respectively. The 1-month, 3-month and 6-month mortality was 41 (37.3%), 59 (53.6%) and 81 (73.6%) in the retrospective group and 27 (28.1%), 41 (42.7%) and 65 (67.7%) in the prospective group. The predictive ability of MELD, CPT and CPTC was 0.72, 0.67, 0.68 for 1-month mortality, 0.73, 0.70, 0.68 for 3-month mortality and 0.83, 0.75, 0.73 for 6-month mortality in retrospective group and 0.86, 0.56, 0.63 for 1-month mortality, 0.80, 0.57, and 0.60 for 3-month mortality, and 0.88, 0.51, and 0.64 for 6-month mortality in the prospective cohort, respectively. The predictive accuracy of MELD was significantly better than CPT and CPTC scores in the prospective group. CONCLUSIONS MELD is a valid prognostic score compared to CPT and CPTC scores for predicting short-term mortality in patients of alcoholic liver disease.
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Somani PO, Contractor Q, Chaurasia AS, Rathi PM. Diastolic dysfunction characterizes cirrhotic cardiomyopathy. Indian Heart J 2014; 66:649-55. [PMID: 25634400 DOI: 10.1016/j.ihj.2014.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/16/2014] [Indexed: 12/13/2022] Open
Abstract
AIM Present study aims to study the occurrence of cirrhotic cardiomyopathy and its correlation to hepatorenal syndrome by assessing the cardiac status in patients with cirrhosis of liver and healthy controls. METHODS Thirty alcoholic cirrhotic, thirty non-alcoholic cirrhotic and thirty controls were enrolled for the study. Cardiac parameters were assessed by color doppler echocardiography. Patients were followed up for twelve months period for development of hepatorenal syndrome. RESULTS Mild diastolic dysfunction was present in 18 cirrhotic patients (30%): grade I in fifteen patients and grade II in three. Diastolic dysfunction was unrelated to age; sex and etiology of cirrhosis. Among all the echocardiographic parameters, only deceleration time was found to be statistically significant. Echocardiographic parameters in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies. At one year follow-up, no significant differences were found in survival between patients with or without diastolic dysfunction. Hepatorenal syndrome developed in only two patients and its correlation with diastolic dysfunction was not statistically significant. CONCLUSIONS Present study shows that although diastolic dysfunction is a frequent event in cirrhosis, it is usually of mild degree and does not correlate with severity of liver dysfunction. There are no significant differences in echocardiographic parameters between alcoholic and non-alcoholic cirrhosis. HRS is not correlated to diastolic dysfunction in cirrhotic patients. There is no difference in survival at one year between patients with or without diastolic dysfunction. Diastolic dysfunction in cirrhosis is unrelated to circulatory dysfunction, ascites and HRS.
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Affiliation(s)
- Piyush O Somani
- Lecturer, Department of Gastroenterology, BYL Nair Ch Hospital & Topiwala National Medical College, Dr A L Nair Road, Mumbai Central, Mumbai, Maharashtra 400008, India.
| | - Qais Contractor
- Associate Professor, Department of Gastroenterology, BYL Nair Ch Hospital & Topiwala National Medical College, Dr A L Nair Road, Mumbai Central, Mumbai, Maharashtra 400008, India
| | - Ajay S Chaurasia
- Professor and Head, Department of Cardiology, BYL Nair Ch Hospital & Topiwala National Medical College, Dr A L Nair Road, Mumbai Central, Mumbai, Maharashtra 400008, India
| | - Pravin M Rathi
- Professor and Head, Department of Gastroenterology, BYL Nair Ch Hospital & Topiwala National Medical College, Dr A L Nair Road, Mumbai Central, Mumbai, Maharashtra 400008, India
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Jain SS, Somani PO, Mahey RC, Shah DK, Contractor QQ, Rathi PM. Esophageal tuberculosis presenting with hematemesis. World J Gastrointest Endosc 2013; 5:581-583. [PMID: 24255751 PMCID: PMC3831201 DOI: 10.4253/wjge.v5.i11.581] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/14/2013] [Accepted: 10/16/2013] [Indexed: 02/05/2023] Open
Abstract
Esophageal tuberculosis is rare, constituting about 0.3% of gastrointestinal tuberculosis. It presents commonly with dysphagia, cough, chest pain in addition to fever and weight loss. Complications may include hemorrhage from the lesion, development of arterioesophageal fistula, esophagocutaneous fistula or tracheoesophageal fistula. There are very few reports of esophageal tuberculosis presenting with hematemesis due to ulceration. We report a patient with hematemesis that was due to the erosion of tuberculous subcarinal lymph nodes into the esophagus. A 15-year-old boy presented with hemetemesis as his only complaint. Esophagogastroduodenoscopy (EGD) revealed an eccentric ulcerative lesion involving 50% of circumference of the esophagus. Biopsy showed caseating epitheloid granulomas with lymphocytic infiltrates suggestive of tuberculosis. Computerised tomography of the thorax revealed thickening of the mid-esophagus with enlarged mediastinal lymph nodes in the subcarinal region compressing the esophagus along with moderate right sided pleural effusion. Patient was treated with anti-tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 6 mo. Repeat EGD showed scarring and mucosal tags with complete resolution of the esophageal ulcer.
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