Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force.

AIMS: To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS: In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS: Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS: Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.

Human giardiasis. A morphometric study of duodenal biopsy specimens in relation to the trophozoite count in the duodenal aspirate.

We present a morphometric analysis of findings from a histopathologic study of duodenal giardiasis in relation to the trophozoite count in the duodenal aspirate. Of 30 patients with giardiasis whose conditions were studied, a mean trophozoite count of 10(3)/mL or greater was found in 21, and a mean trophozoite count of less than 10(3)/mL was found in nine--these two types of trophozoite counts in these 30 patients represented the acute phase (group 1) and the clearance phase (group 2) of giardiasis, respectively. Group 1 patients had a low mean villus height that was significantly less than that found in the control subjects. Group 2 patients had a high mean crypt depth that was significantly greater than that found in the control subjects. Partial villus atrophy was seen in only seven of the group 1 patients, including five with villus epithelial cell lesions. Groups 1 and 2 showed minor differences of an inflammatory response that was significantly greater than that shown in the control subjects.

Relationship of heartburn with histopathological changes in esophagus and stomach in patients with duodenal ulcer.

Histopathological changes in the esophagus and gastric antrum were studied in 47 patients with duodenal ulcer. Twenty three (49%) patients complained of heartburn. Esophagitis was present in 87% of the patients with heartburn and in 71% of the patients with no heartburn. In the majority, esophagitis was of mild to moderate severity. Gastritis was present in 83% (atrophic type in 22%) of patients with heartburn compared to 96% (25% atrophic type) of patients without heartburn. There was no statistical difference in the incidence of esophagitis and gastritis between the heartburn and no heartburn groups. This study suggests that histologic esophagitis and gastritis occur frequently in patients with duodenal ulcer and the presence of heartburn is not related to these histologic changes.

Primary sclerosing cholangitis with chronic pancreatitis.

We report a patient with primary sclerosing cholangitis and associated pancreatitis. She had exocrine and endocrine pancreatic insufficiency.

Endoscopic management of large bile duct stones by mechanical lithotripsy.

OBJECTIVE: Our experience in treating large common bile duct stones using Olympus basket mechanical lithotripter (BML 2Q) and Soehendra lithotripter is reported. METHODS: Between July 1990 and December 1993, twenty two patients with common bile duct stones too large to be extracted by Dormia basket or balloon were treated with BML lithotripter or Soehendra lithotripter. RESULTS: The stone diameters ranged from 1.5 to 2.8 cm. Fourteen patients required one session of lithotripsy, four patients two sessions each, and two patients three sessions each. BML lithotripter was used in 14 patients. In the remaining eight patients the stones were fragmented with Soehendra lithotripter when the basket got impacted while attempting extraction. Mechanical lithotripsy was successful in 20 patients (91%). Indwelling stent was used in one patient; one patient underwent surgery. CONCLUSION: Mechanical lithotripsy is safe for the treatment of large common bile duct stones, with a success rate above ninety percent.

Severe acute pancreatitis due to hepatitis A virus infection in a patient of acute viral hepatitis.

The commonest causes of acute pancreatitis are cholelithiasis and alcohol. Rare causes include various viral infections, among which mumps is the commonest. Hepatitis A, hepatitis B and, recently, hepatitis E have been reported to cause acute but mild pancreatitis in patients with acute viral hepatitis. This report describes a case of severe acute pancreatitis caused by hepatitis A.

Nucleolar organiser regions in different colonic epithelia.

The argyrophilic technique (AgNOR) was applied to paraffin sections of 10 acute self-limited colitis, 15 ulcerative colitis (UC), 5 ulcerative colitis with indefinite dysplastic change, 10 adenomatous polyps, 20 colorectal adenocarcinomas and 10 normal colorectal mucosa. The mean number of nucleolar organiser regions (NORs) per nucleus ranged between 1.62-2.00 (95% CI 1.77-1.93) for normal colon, 2.47-3.80 (95% CI 2.71-3.21) for acute colitis, 1.66-2.75 (95% CI 2.13-2.44) for UC, 3.60-4.00 (95% CI 3.67-3.94) for UC with indefinite dysplasia, 3.00-4.04 (95% CI 3.41-3.81) for adenomatous polyps and 3.59-6.70 (95% CI 4.04-4.72) for colorectal adenocarcinoma. The differences observed were statistically significant. There was a significant difference of AgNOR counts between adenomatous polyp and UC with indefinite dysplasia in comparison to those observed in regenerative epithelium of acute colitis and UC without dysplasia. Hence the technique may be used as an adjunct to routine histology for delineating dysplastic changes in colonic epithelium.