Demographic and Clinical Characteristics of Functional Dyspepsia and Its Subtypes in Adult Patients: An Experience from a Tertiary Care Centre in Bangladesh

Functional dyspepsia (FD) is a common gastrointestinal problem in the world. The Rome III consensus subdivided functional dyspepsia into two groups: meal-related postprandial distress syndrome (PDS) and meal-unrelated epigastric pain syndrome (EPS). Limited data are available regarding FD in Bangladesh. The aim of this study was to investigate the demographic and clinical characteristics of FD and its sub-types. This cross-sectional study was conducted in which we recruited patients who attended the outpatient department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2017 to February 2018. Patients fulfilling Rome III FD criteria and a negative upper GIT endoscopy were included for this study. The patients were then subdivided into 'pure' PDS (i.e. meeting criteria for PDS without EPS symptoms), 'pure' EPS (i.e., meeting criteria for EPS without PDS symptoms), and overlapping PDS-EPS (i.e., symptoms of both PDS and EPS) groups. Total of 368 FD patients (56.0% females, mean age 32.8±8.6 years, BMI: 22.0±2.7), were included in this study. Out of them, 112(30.4%) patients (57.2% females, mean age 33.9±9.3 years, BMI: 22.0±2.7) fulfilled criteria of pure EPS and 64(17.4%) patients (68.8% females, mean age 33.2±7.8 years, BMI: 22.1±2.4) fulfilled criteria of pure PDS. However, the majority of patients [192(52.2%), 52.1% females, mean age 32.0±8.4 years, BMI: 21.9±2.8] had symptoms of overlapping EPS-PDS. More than 40% of patients in our study presented with 3 or more of the four key symptoms of FD. A longer duration of presenting symptoms was seen among patients with overlapping EPS-PDS in comparison to pure EPS and pure PDS (p<0.001). A significant overlap of symptoms of both EPS and PDS was noticed among patients with FD. The value of dividing functional dyspepsia into the subgroups of PDS and EPS is thus questionable. Further research and modification of the diagnostic criteria for FD subtypes are necessary.

Association of Modified Sequential Organ Failure Assessment (MSOFA) Score and C-reactive protein (CRP) With the Outcome of Patients under Mechanical Ventilation

Different scoring systems has been discovered in medical practice, more specifically for ICU treatment, are designed to objectively quantify physiologic derangements and comorbid conditions for estimating mortality, length of stay and ICU resource use. This observational and descriptive study was carried out in the ICU, BSMMU, Dhaka, during March 2014 to May 2016, to determine the association of MSOFA score, CRP level with the outcome of patients on mechanical ventilation as well as compare the MSOFA and CRP combined with MSOFA alone. For this purpose, a total of 60 critically ill patients admitted in the above hospital were included in this study. Patients with an ICU stay of less than 48 hours, readmissions not considered, known case of neuromuscular disease, connective tissue disorder, renal disease and pregnancy and Patients refused to give written consent were excluded from the study. Patients who had MSOFA ≥7, their mean duration of ICU stay were 10.9±6.7 days and mean duration of mechanical ventilation 7.63±5.2 days. Patients who had CRP >11mg/L, their mean duration of ICU stay was 10.8±7.2 days and mean duration of mechanical ventilation was 7.35±5.1 days. Patients who had MSOFA score ≥7 and CRP ≥11mg/L with mean duration of ICU stay was 10.82±7.2 days and mean duration of mechanical ventilation was 7.12±5.2 days. 69.2% patients were CRP status positive (≥11) in death group and 33.3% had alive group. 92.3% patients were Positive (CRP ≥7 or MSOFA ≥11) in death group and 14.3% had alive group. MSOFA identified true positive 32 cases for death, false positive 5 cases, false negative 7 cases and true negative 16 cases confirmed by patient's outcome. CRP level identified true positive 27 cases for death, false positive 7 cases, false negative 12 cases and true negative 14 cases confirmed by patients outcome. Combined (CRP ≥11mg/L and MSOFA score ≥7) identified true positive 33 cases for death, false positive 1 case, false negative 6 cases and true negative 20 cases confirmed by patient's outcome. We concluded that there is a positive correlation (r=0.323; p=0.014) between CRP status with MSOFA score, positive correlation (r=0.402; p=0.002) between MSOFA score with MSOFA score and CRP combined and a positive correlation (r=0.999; p=0.001) between CRP level with MSOFA score and CRP combined.

Prevalence of Organic Colonic Lesions by Colonoscopy in Patients with Irritable Bowel Syndrome Fulfilling Rome III Criteria

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder usually diagnosed by using symptom-based diagnostic criteria. Recent evidence suggests the presence of organic diseases in some patients fulfilling the diagnostic criteria of IBS which may be missed unless investigations are performed. The aim of this cross-sectional study is to find out the prevalence of organic colonic lesions at colonoscopy in patients with IBS fulfilling the Rome III criteria.The study was conducted in the department of Gastroenterology OPD of the North East Medical College, Sylhet, Bangladesh from December 2016 to December 2017. Consecutive 153 patients of IBS diagnosed by validated Bangla version of ROME III criteria were included in this study. Colonoscopy was done for each patient and findings were recorded. Prevalence of colonic disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype. A substantial number of patients 43(28.1%) fulfilling the Rome III criteria were found to have organic colonic lesions at colonoscopy. No significant difference was found regarding colonic lesions among patients with IBS symptoms with or without alarm features (p=0.876). Colonic polyp was the commonest findings in 19(12.1%) subjects at colonoscopy, followed by colonic ulcers in 16(10.5%) subjects. Organic colonic lesions are found to be more common among relatively older age group patients (p=0.011). A significant number of patients with symptoms compatible with IBS exhibited colonic lesions following investigation with a predilection towards older age. Careful clinical evaluation and relevant investigations are necessary to reduce diagnostic uncertainty.

Primary and Revision Lumbar Discectomy: A Four-Year Review from Our Private Practice

The surgical treatment of symptomatic lumbar disc herniation is now focused on nerve root decompression with preservation of the bony and ligamentous stabilizers of the spine. Various techniques of discectomy have been devised in accordance with this principle and irrespective of the technique used; primary disc surgeries have generally known to give good results. This retrospective study was done in different private clinics & hospitals of Dhaka city, Bangladesh from January 2012 to December 2015. Of the 105 lumbar discectomies performed during the study period, 95(90.4%) patients fulfilled the inclusion criteria and were included in the analysis. Of these, 90 patients had primary discectomy, while the remaining 5 were revision surgeries. The follow-up varied from 1-4 years, but the clinical outcomes were evaluated at the end of one year from surgery in all the patients. In the primary surgery group there were 50(55.56%) men and 40(44.44%) women, while the revision group had 01(20%) men and 04(80%) women. The age distribution was similar in both the groups, with the maximum numbers (44% and 42.9%) in the fourth decade of life. Of the 05 patients who underwent revision surgery, 03 belonged to the primary surgery group of this study, while the remaining 02 had undergone their primary surgery elsewhere. Excluding the two residual discs, the remaining 03 patients with recurrences gave a history of complete resolution of symptoms after the primary surgery. Amongst these, 3(60%) had a history of a precipitating event prior to onset of pain, 2 had a definitive history of significant lack of physical activity. The time interval between the primary and revision surgery ranged from three months to 10 years (average 2.6 years).

Recrudescence and reinfection with Helicobacter pylori after eradication therapy in Bangladeshi adults

BACKGROUND & AIMS

In developing countries where Helicobacter pylori infection is widespread, posttherapeutic recurrence rates may be high. Many of the limited studies available have methodological problems and show varied recurrence rates. We determined late recrudescence rates, true reinfection, and ulcer recurrence.

METHODS

One hundred five Bangladeshi patients with H. pylori infection and duodenal ulcer disease were treated with a triple therapy. Follow-up included 13C-urea breath tests, endoscopy, and biopsy-based tests. In reinfected patients, genomic typing compared pretherapeutic and posttherapeutic strains.

RESULTS

Recrudescence, associated with nitroimidazole-based treatment, occurred in 15 of 105 patients (14%) within the first 3 months, but only 8 of 105 patients tested positive 4 weeks after therapy ended. True reinfection was diagnosed in 11 of 105 patients between 3 and 18 months after therapy. The annual reinfection rate was 13%, based on a total follow-up of 84.7 patient years. Ulcer relapse occurred in 2 of 15 (13%) recrudescence cases and in 6 of 11 (55%) reinfection cases, but also in 4 of 73 (5%) H. pylori-negative patients.

CONCLUSIONS

In Bangladesh, late recrudescence of H. pylori after eradication therapy occurs within the first 3 months. The reinfection rate is high and might influence cost-benefit analyses for determining diagnostic and therapeutic procedures.