Clinical relevance of cagA and vacA and association with mucosal findings in Helicobacter pylori-infected individuals from Chennai, South India.

Helicobacter pylori is associated with a spectrum of severe gastrointestinal conditions. In this study, an attempt was made to correlate endoscopic mucosal patterns with H. pylori infection and examine the pathogenic potential of the strains. Among the 147 dyspeptic individuals studied, 42.2% were H. pylori infected. Association of H. pylori with type 3 and 4 mucosal patterns (P = 0.001) and intestinal metaplasia (P = 0.012) was seen. vacA was associated with histological (P = 0.014) and endoscopy findings (P = 0.009). Association of mucosal patterns with H. pylori infection could be useful for clinicians to decide on the need for eradication therapy.

Overlap syndrome: autoimmune hepatitis with primary biliary cirrhosis.

"Overlap syndrome" is used to describe variant forms of autoimmune hepatitis (AIH) which present with characteristics of AIH and primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). Patients with overlap syndromes present with both hepatitic and cholestatic serum liver tests and have histological features of AIH and PBC or PSC. AIH-PBC is the most common form of overlap syndrome, affecting almost 10% of adults with AIH or PBC. Transitions from PBC to AIH-PBC overlap syndrome have also been reported. Overlap syndromes show a progressive course without treatment, and therapy is empiric. Ursodeoxycholic acid is usually combined with immunosuppressive therapy but end-stage disease requires liver transplantation. We report a case of AIH/PBC overlap with relevant discussion of literature.

Pancreas divisum and choledochal cyst.

Pancreas divisum (PD) is the most common congenital variant of the pancreas, affecting 5% to 14% of the population. The ventral duct only drains the ventral pancreas through the major papilla, whereas the majority of the pancreas drains via the dorsal duct through the minor papilla. We report the case of a 21-year-old woman with recurrent acute pancreatitis who presented with the rare finding of choledochal cyst and pancreas divisum (PD). She underwent minor papilla sphincterotomy and pancreatic duct stenting. Comparable literature findings of PD and choledochal cyst are discussed with regard to the presented case.

Appearance of a double bubble in achalasia cardia: a case report.

INTRODUCTION: Achalasia cardia is characterized by failure of the lower esophageal sphincter to relax in response to swallowing and by an absence of peristalsis in the esophageal body. Absence of a gastric air bubble is a well known radiological finding. Pneumatic balloon dilatation results in reappearance of the gastric bubble. CASE PRESENTATION: We report the case of a 43-year-old Indian man with achalasia cardia whose chest X-ray at the time of presentation showed an air bubble in the gastric region causing a diagnostic quandary. Successful dilatation of the lower esophageal sphincter resulted in the appearance of another air bubble in the gastric region. Proper analysis showed that the first bubble was actually a colonic air bubble of the splenic flexure and the appearance of the second bubble was the anticipated gastric air bubble. CONCLUSION: In patients presenting with achalasia cardia, a colonic air bubble may be seen in the gastric region causing diagnostic difficulty. In these patients, a gastric air bubble may appear after pneumatic dilatation. At the end of the procedure, there will be two air bubbles ("double bubble"): a colonic and a gastric air bubble. To our knowledge, this finding has not been reported in the literature thus far.