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1.
J Gastroenterol Hepatol ; 39(3): 489-495, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38095156

RESUMO

BACKGROUND AND AIM: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no-biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti-tissue transglutaminase antibody (anti-tTG ab) titer is ≥10-fold upper limit of normal (ULN) and have a positive IgA anti-endomysial antibody (EMA); the data for anti-tTG Ab titer-based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti-tTG Ab titer ≥10-fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD. METHODS: We recruited 937 adult patients with positive anti-tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository. The diagnosis of definite CeD was made on the basis of a positive anti-tTG Ab and the presence of villous abnormalities of modified Marsh grade ≥2. RESULTS: Of 937 adult patients with positive anti-tTG Ab, 889 (91.2%) showed villous abnormalities of modified Marsh grade ≥2. Only 47.6% of 889 adults with CeD had anti- tTG Ab titers of ≥10-fold. The positive predictive value (PPV) and specificity of anti tTG Ab titer ≥10-fold for predicting modified Marsh grade ≥2 were 99.8% and 98%, respectively. At anti-tTG Ab titer ≥11-fold, specificity and PPV were 100% for predicting villous abnormalities of modified Marsh grade ≥2. CONCLUSIONS: Approximately 50% of adults with CeD may benefit from the no biopsy pathway, reducing the health burden and risks of gastroscopy/anesthesia.


Assuntos
Doença Celíaca , Adulto , Humanos , Autoanticorpos , Doença Celíaca/patologia , Proteínas de Ligação ao GTP , Imunoglobulina A , Proteína 2 Glutamina gama-Glutamiltransferase , Estudos Retrospectivos , Sensibilidade e Especificidade , Transglutaminases
2.
Am J Gastroenterol ; 111(1): 115-23, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26729543

RESUMO

OBJECTIVES: Although celiac disease (CeD) affects 1% of people in the northern part of India, it is believed to be uncommon in the southern and northeastern parts because of significant differences in dietary pattern and ethnicity. We estimated the prevalence of CeD in these three populations. In a subset, we also investigated differences in the prevalence of HLA-DQ 2/8 allelotype and dietary grain consumption. METHODS: A total of 23,331 healthy adults were sampled from three regions of India-northern (n=6207), northeastern (n=8149), and southern (n=8973)-and screened for CeD using IgA anti-tissue transglutaminase antibody. Positive tests were reconfirmed using a second ELISA. CeD was diagnosed if the second test was positive and these participants were further investigated. A subsample of participants was tested for HLA-DQ2/-DQ8 and underwent detailed dietary evaluation. RESULTS: Age-adjusted prevalence of celiac autoantibodies was 1.23% in northern, 0.87% in northeastern, and 0.10% in southern India (P<0.0001). Prevalence of CeD and latent CeD, respectively, was 8.53/1,000 and 3.70/1,000 in northern, 4.66/1,000 and 3.92/1,000 in northeastern, and 0.11/1,000 and 1.22/1,000 in the southern part. The population prevalence of genes determining HLA-DQ2 and/or -DQ8 expression was 38.1% in northern, 31.4% in northeastern, and 36.4% in southern India. Mean daily wheat intake was highest in northern (455 g) compared with northeastern (37 g) or southern part (25 g), whereas daily rice intake showed an inverse pattern. CONCLUSIONS: CeD and latent CeD were most prevalent in northern India and were the least in southern India. The prevalence correlated with wheat intake and did not reflect differences in the genetic background.


Assuntos
Doença Celíaca/epidemiologia , Adolescente , Adulto , Dieta , Grão Comestível , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
3.
Curr Gastroenterol Rep ; 16(3): 376, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24562469

RESUMO

Oral rehydration solution (ORS) was established as the cornerstone of therapy for dehydration secondary to acute infectious diarrhea approximately 40 years ago. The efficacy of ORS is based on the ability of glucose to stimulate Na and fluid absorption in the small intestine via a cyclic AMP-independent process. Despite the establishment that ORS is the primary reason for the substantial reduction in morbidity and mortality from diarrhea in children in developing countries, the use of ORS has lagged for many reasons. This review highlights efforts to establish a major reformulation of ORS following the demonstration that short-chain fatty acids (SCFA) stimulate colonic Na and fluid absorption by a cyclic AMP-independent mechanism. The addition of high-amylose maize starch (HAMS), a microbially-fermentable (or 'resistant') starch, to ORS results in delivery of non-absorbed carbohydrate to the colon where it is fermented to SCFA. To date, three randomized controlled trials with a HAMS-ORS in south India have demonstrated a substantial decrease in diarrhea duration in both adults and children hospitalized for acute diarrhea. Significant efforts are now underway to establish this dual-action, modified HAMS-hypoosmolar ORS solution as the standard ORS for the treatment of dehydration from acute diarrhea.


Assuntos
Diarreia/terapia , Hidratação/métodos , Soluções para Reidratação/uso terapêutico , Doença Aguda , Química Farmacêutica , Ácidos Graxos Voláteis/fisiologia , Hidratação/tendências , Humanos , Soluções para Reidratação/química
4.
Indian J Med Res ; 139(1): 19-26, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24604038

RESUMO

Probiotics are defined as live microorganisms which, when ingested in adequate amounts, confer health benefits on the host. Chronic diseases such as diabetes, non-alcoholic fatty liver disease, coronary artery disease, a variety of chronic inflammatory disorders with an immune basis, and some forms of cancer are increasing in incidence around the world and in India, and may be attributable in part to rapid changes in our lifestyle. There is considerable public interest in India in the consumption of probiotic foods. This brief review summarizes the background of the gut microbiota, the immunological reactions induced by these, the evidence linking the microbiota to health outcomes, and the evidence linking the use of probiotics for amelioration of chronic lifestyle diseases.


Assuntos
Bifidobacterium/metabolismo , Doença Crônica/prevenção & controle , Trato Gastrointestinal/efeitos dos fármacos , Probióticos/uso terapêutico , Doença Crônica/epidemiologia , Efeitos Psicossociais da Doença , Alimentos , Trato Gastrointestinal/microbiologia , Humanos , Índia , Estilo de Vida , Microbiota/efeitos dos fármacos
5.
Trop Gastroenterol ; 35 Suppl 1: S9-11, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25735120

RESUMO

The first attack of ulcerative colitis can be acute and severe in 2-50% of patients. Acute severe colitis needs to be distinguished from various other conditions including severe infective colitis and ischaemic colitis. In those treated traditionally with intravenous corticosteroids, 30-40% require colectomy within a period of 6 months. The use of rescue therapies has modified this paradigm. Cyclosporine use averts early colectomy but most of these patients eventually require colectomy. The use of infliximab also averts early colectomy, but its long-term efficacy remains uncertain. Data suggests that the colectomy rate has reduced in recent years. Whether this is due to the increasing use of early aggressive therapy or whether or is part of the natural evolution of the disease, remains to be determined.


Assuntos
Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença Aguda , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Colectomia , Ciclosporina/uso terapêutico , Diagnóstico Diferencial , Progressão da Doença , Fármacos Gastrointestinais/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infliximab , Fatores de Risco
6.
Rheumatol Int ; 33(8): 2149-52, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22258457

RESUMO

The aim of our study was to determine whether the pattern of arthropathy in patients with suspected enteropathic arthritis bore any relation to their gut histology and specifically to chronic nonspecific gut inflammation. Records of 39 patients with suspected enteropathic arthritis from rheumatology clinic between January 2006 and December 2008 who had undergone ileocolonoscopic biopsy were analyzed retrospectively. Patients were grouped into 3 categories, namely those with normal bowel histology, those with mild nonspecific chronic changes, and those with histology suggestive of inflammatory bowel disease. Patients with nonspecific chronic gut inflammation had higher occurrence of axial involvement with or without peripheral articular involvement as compared to those with normal gut histology (8/9 vs. 10/21, P = 0.049), and this pattern was similar to that in patients with IBD. Wrist joint involvement was more common in patients with normal bowel histology (12/21) than the other two groups (P = 0.003). All groups had fared well on follow up while taking treatment with sulphasalazine and methotrexate.


Assuntos
Doenças Inflamatórias Intestinais/patologia , Intestinos/patologia , Artropatias/patologia , Adulto , Feminino , Humanos , Índia , Doenças Inflamatórias Intestinais/complicações , Artropatias/complicações , Masculino , Pessoa de Meia-Idade
7.
Indian J Gastroenterol ; 41(5): 483-507, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36214973

RESUMO

In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiopathogenesis and pathophysiology; 5 on clinical manifestations, differential diagnosis, and predictors; and 15 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservations was 80% or higher, the statement was regarded as accepted. The members of the consensus team consider that this guideline would be valuable to inform clinical practice, teaching, and research on SIBO in the Asian-Pacific region as well as in other countries.


Assuntos
Gastroenteropatias , Síndrome do Intestino Irritável , Humanos , Intestino Delgado/microbiologia , Testes Respiratórios , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Gastroenteropatias/terapia
8.
Indian J Pathol Microbiol ; 64(Supplement): S8-S31, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34135135

RESUMO

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.


Assuntos
Doença Celíaca/diagnóstico , Consenso , Intestino Delgado/patologia , Patologistas/educação , Patologistas/organização & administração , Patologia Clínica/educação , Biópsia , Feminino , Gastroenterologia/educação , Gastroenterologia/métodos , Gastroenterologia/organização & administração , Humanos , Índia , Masculino , Patologia Clínica/métodos
9.
ACG Case Rep J ; 7(1): e00299, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32309493

RESUMO

Metastases from pancreatic malignancy are commonly known to occur in the regional lymph nodes, liver, lung, and peritoneum. Synchronous or metachronous metastasis from the pancreas to the colon is rare, with only 6 cases reported in the literature. We report a man who was found to have adenocarcinoma on biopsies from synchronous lesions in the colon and the pancreas. The immunohistochemistry report revealed the diagnosis of a primary pancreatic malignancy with synchronous colonic metastases.

10.
Br J Surg ; 96(10): 1205-9, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19731315

RESUMO

BACKGROUND: Foot ulcer is a significant cause of morbidity in diabetics. Genetic make-up can determine inflammatory and healing responses. This study examined the hypothesis that specific polymorphisms of the heat-shock protein 70 gene could predispose to the severity of diabetic foot ulceration. METHODS: Some 106 consecutive diabetic patients (101 evaluable) with foot ulceration admitted to a tertiary care hospital were managed according to a standard protocol. DNA was extracted from venous blood and examined by polymerase chain reaction-restriction fragment length analysis for two specific polymorphisms: G1538A in the HSPA1B and C2437T in the HSPA1L gene. RESULTS: HSPA1B genotyping showed that 70 patients were AG and 30 GG (one not amplified). The AG genotype was significantly associated with the severity of foot ulceration (Wagner grade) (P = 0.008, chi(2) test), need for amputation (relative risk 2.02, 95 per cent confidence interval 1.02 to 4.01; P = 0.025) and median length of hospital stay (8 versus 5 days for GG; P = 0.043). HSPA1L genotypes (78 TT, 22 CT, one CC) did not show any significant association with these parameters. CONCLUSION: The HSPA1B genotype, was associated with the severity of diabetic foot ulceration, need for amputation and duration of hospitalization in these patients.


Assuntos
Pé Diabético/genética , Proteínas de Choque Térmico HSP70/genética , Polimorfismo de Fragmento de Restrição/genética , Idoso , Amputação Cirúrgica , Pé Diabético/cirurgia , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Mutação/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Índice de Gravidade de Doença , Resultado do Tratamento
11.
Scand J Immunol ; 69(3): 181-7, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19281529

RESUMO

Epithelial cells participate in the innate immune response to pathogenic bacteria by elaborating chemokines. This study examined the effect of Vibrio cholerae and Lactobacillus rhamnosus GG on inflammatory chemokine gene expression in the HT29 human intestinal epithelial cell line. HT29 cells were exposed to V. cholerae 0139, Lactobacillus or both for 2 h and cultured further thereafter for 4 h. RNA was extracted from the cells and expression of genes for chemokines and related molecules was quantitated by real time PCR using a pathway-focused PCR array. TLR4 was silenced using shRNA and output of interleukin-8 (IL-8) into the media quantitated with and without V. cholerae exposure. NFkappaB and p38 MAP kinase activation were determined by immunoblotting for IkappaBalpha and phosphorylated p38. Vibrio cholerae significantly upregulated gene expression for the neutrophil chemoattractant CXCL chemokines, IL-8, CXCL and CXCL in HT29 cells, while downregulating the expression of macrophage-attracting C-C chemokines. TLR4 silencing did not reduce IL-8 output from HT29 cells in response to V. cholerae. IkappaBalpha degradation was noted in the HT29 cells soon after exposure to V. cholerae and this recovered over time after removal of bacteria. p38 MAP kinase activation was not noted. Vibrio cholerae upregulated the expression of neutrophil attractant chemokines, most prominently IL-8, in HT29 cells, but downregulated macrophage-attracting chemokines. Probiotic lactobacilli modulated the IL-8, but not the other chemokine gene changes, in response to V. cholerae.


Assuntos
Quimiocinas/biossíntese , Quimiocinas/genética , Cólera/imunologia , Lacticaseibacillus rhamnosus/imunologia , Vibrio cholerae/imunologia , Western Blotting , Quimiocinas/imunologia , Cólera/genética , Cólera/microbiologia , Regulação para Baixo , Ativação Enzimática , Expressão Gênica , Células HT29 , Humanos , NF-kappa B/metabolismo , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Receptor 4 Toll-Like/metabolismo , Regulação para Cima , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
12.
Indian J Med Res ; 130(2): 170-8, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19797815

RESUMO

BACKGROUND & OBJECTIVE: The intestinal epithelium is part of the innate immune system responding to contact with pathogenic or commensal bacteria. The objective of this study was to compare innate responses of intestinal epithelial cell lines to pathogenic bacteria and to lactobacilli. METHODS: Two human intestinal epithelial cell lines, HT29 (enterocyte-like) and T84 (crypt-like), were exposed to pathogenic bacteria representative of non invasive (Vibrio cholerae O1 and O139), adherent (enterohaemorrhagic Escherichia coli, EHEC) or invasive (Salmonella Typhimurium and Shigella flexneri) phenotypes and to non pathogenic Lactobacillus rhamnosus GG or Lactobacillus plantarum. Interleukin-8 (IL-8) was measured in culture supernatant by ELISA, while mRNA from cells was subjected to quantitative reverse transcriptase PCR for several other chemokines (CXCL1, CCL5 and CXCL5) and for Toll-like receptors (TLR) 2, 4, 5 and 9. RESULTS: V. cholerae, S. Typhimurium, S. flexneri and EHEC induced IL-8 secretion from epithelial cells into the medium. Salmonella, Shigella and EHEC, but not V. cholerae, significantly increased mRNA expression of CXCL1. None of the pathogens induced CCL5 or CXCL5. Salmonella and Vibrio significantly increased TLR4 expression, while Vibrio and EHEC decreased TLR5 expression. EHEC also decreased TLR9 expression. Lactobacilli attenuated the IL-8 response of the cell lines to V. cholerae, Salmonella, and EHEC but did not significantly change the IL-8 response to Shigella. INTERPRETATION & CONCLUSION: Distinct patterns of epithelial cell chemokine responses were induced by the bacterial pathogens studied and these were modulated by commensal lactobacilli. Alterations in TLR expression by these pathogens are likely to be important in pathogenesis.


Assuntos
Quimiocinas/metabolismo , Colo , Células Epiteliais , Mucosa Intestinal , Lactobacillus/imunologia , Receptores Toll-Like , Animais , Linhagem Celular , Quimiocinas/imunologia , Criança , Colo/citologia , Colo/microbiologia , Escherichia coli Êntero-Hemorrágica/imunologia , Células Epiteliais/citologia , Células Epiteliais/imunologia , Células Epiteliais/microbiologia , Humanos , Interleucina-8/imunologia , Interleucina-8/metabolismo , Mucosa Intestinal/citologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/microbiologia , Salmonella typhimurium/imunologia , Shigella flexneri/imunologia , Receptores Toll-Like/genética , Receptores Toll-Like/metabolismo , Vibrio cholerae O1/imunologia , Vibrio cholerae O139/imunologia
13.
Trop Gastroenterol ; 30(2): 76-85, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19760989

RESUMO

There is resurgent interest in the use of probiotics to maintain gastrointestinal and systemic health, driven by recent advances in knowledge of bacterial interactions with the epithelium and innate immune system of the intestine. The effects of probiotic bacteria on the intestinal epithelium and their downstream consequences are reviewed. Probiotics prevent pathogen adherence and invasion of the epithelium, partly by blocking adherence sites but also by upregulating gene expression of MUC2 and of antimicrobial peptides. Metabolic effects of probiotics on the intestinal epithelium include production of short chain fatty acids which influence epithelial cell metabolism, turnover and apoptosis. Bacterial metabolism of unabsorbed dietary constituents with production of free radicals and phenolic metabolites can lead to DNA damage and cancer; probiotics restore eubiosis and potentially prevent this. Probiotics alter expression and redistribution of tight junction proteins and reduce intestinal permeability limiting absorption of noxious molecules from the gut lumen. Most studied are the effects of probiotics on epithelial cells which are the first line of innate immune-capable cells that encounter luminal flora. Probiotics, through secreted molecules, influence the innate inflammatory response of epithelial cells to stimuli from the gut lumen, and reduce mucosal inflammation. Through effects on dendritic, and possibly epithelial, cells they influence naïve T cells in the lamina propria of the gut and thus influence adaptive immunity. These varied effects of probiotics have implications for the treatment of several gastrointestinal diseases including antibiotic-associated colitis, acute gastroenteritis, inflammatory bowel disease, colon cancer, and irritable bowel syndrome.


Assuntos
Gastroenteropatias/prevenção & controle , Mucosa Intestinal/microbiologia , Probióticos/uso terapêutico , Gastroenteropatias/microbiologia , Gastroenteropatias/patologia , Humanos
15.
Indian J Radiol Imaging ; 29(2): 111-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31367083

RESUMO

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn's disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

19.
Indian J Gastroenterol ; 26(4): 190-1, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17986753

RESUMO

Eosinophilic cholangiopathy is an unusual and benign form of biliary disease characterized by peripheral blood eosinophilia and cholangitis. Dramatic response to steroids is the hallmark of the disease. We present two cases of eosinophilic cholangiopathy.


Assuntos
Colangite/diagnóstico , Eosinofilia/diagnóstico , Abscesso Hepático/diagnóstico , Adolescente , Adulto , Biópsia por Agulha , Colangiopancreatografia Retrógrada Endoscópica , Colangite/terapia , Eosinofilia/terapia , Humanos , Masculino
20.
Indian J Gastroenterol ; 36(6): 487-508, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29307029

RESUMO

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients with suspected or known Crohn's disease. These 29 position statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.


Assuntos
Doença de Crohn/diagnóstico por imagem , Medicina Baseada em Evidências , Gastroenterologia/organização & administração , Intestino Delgado/diagnóstico por imagem , Imageamento por Ressonância Magnética , Guias de Prática Clínica como Assunto , Radiologia/organização & administração , Sociedades Médicas/organização & administração , Adolescente , Criança , Feminino , Humanos , Índia , Masculino , Tomografia Computadorizada por Raios X
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