Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: Report of the Indian Society of Gastroenterology Task Force.

Background Gastroesophageal reflux disease (GERD) and its complications are thought to be infrequent in India; there are no data from India on the prevalence of and risk factors for GERD. The Indian Society of Gastroenterology formed a task force aiming to study: (a) the frequency and profile of GERD in India, (b) factors including diet associated with GERD. Methods In this prospective, multi-center (12 centers) study, data were obtained using a questionnaire from 3224 subjects regarding the frequency, severity and duration of heartburn, regurgitation and other symptoms of GERD. Data were also obtained regarding their dietary habits, addictions, and lifestyle, and whether any of these were related or had been altered because of symptoms. Data were analyzed using univariate and multivariate methods. Results Two hundred and forty-five (7.6%) of 3224 subjects had heartburn and/or regurgitation at least once a week. On univariate analysis, older age (OR 1.012; 95% CI 1.003–1.021), consumption of non-vegetarian and fried foods, aerated drinks, tea/coffee were associated with GERD. Frequency of smoking was similar among subjects with or without GERD. Body mass index (BMI) was similar in subjects with and without GERD. On multivariate analysis, consumption of non-vegetarian food was independently associated with GERD symptoms. Overlap with symptoms of irritable bowel syndrome was not uncommon; 21% reported difficulty in passage of stool and 9% had mucus in stools. About 25% of patients had consulted a doctor previously for their gastrointestinal symptoms. Conclusion 7.6% of Indian subjects have significant GERD symptoms. Consumption of non-vegetarian foods was an independent predictor of GERD. BMI was comparable among subjects with or without GERD.

Duodenal angiomyolipoma: a case report.

The authors present a case of duodenal angiomyolipoma. Angiomyolipoma is a benign neoplasm, the most common site being the kidney. Extrarenal angiomyolipomas are rare. Only one case of duodenal angiomyolipoma has been reported. A 66 year old man presented with GI bleeding for two years. Endoscopy revealed a duodenal polyp which on histopathology revealed features of angiomyolipoma. On immunohistochemistry, smooth muscle component was positive for Smooth Muscle Actin. HMB-45 showed mild focal positivity. Patient had no history of tuberous sclerosis. Surgical excision of angiomyolipoma is usually curative with rare cases of local recurrence.

Expression and humoral immune response to hepatitis C virus using a plasmid DNA construct.

PURPOSE: The objective of this study was to clone a c-DNA fragment of hepatitis C virus in a eukaryotic expression vector and to measure the efficacy of humoral immune responses in mice inoculated with this recombinant plasmid. This study was an attempt to lay a foundation for HCV nucleic acid vaccine development in the future. METHODS: A c-DNA fragment of BK146, a clone of HCV type 1b, was sub-cloned into an eukaryotic expression vector pMT3. HepG2 and COS cells were transfected with this construct, named pMT3-BK146. The expression of HCV mRNA and proteins was studied by reverse transcribed polymerase chain reaction, radio Immunoprecipitation (RIPA) and immunofluorescence (IFA). The DNA of this construct was injected into the footpad of BALB/c mice and antibody response was tested by enzyme immunoassay and indirect immunofluorescence. RESULTS: COS and HepG2 cells transiently transfected with the recombinant plasmid pMT3-BK146 showed the expression of HCV proteins by RT-PCR, RIPA and immunofluorescence. This DNA clone when injected into Balb/c mice was able to generate specific antibody response to hepatitis C virus by ELISA and IFA. CONCLUSIONS: A c-DNA fragment of HCV cloned in an eukaryotic expression vector was able to express core protein. This DNA clone was also able to elicit antibody response in mice. This can be an initial step towards the development of a potential DNA vaccine for hepatitis C virus infection.

AIDS cholangiopathy.

A 45-year-old man presented with diarrhea and profound weight loss over one year. His serum alkaline phosphatase was raised and ultrasonography showed dilated intrahepatic biliary ducts and upper part of common bile duct (CBD). ERCP showed papillary stenosis, dilated CBD, stricture at the confluence and saccular dilatation of the left intrahepatic biliary ducts. He was found HIV-positive. Duodenal biopsy, rectal biopsy and stool examination could not identify any opportunistic organism.

Swallowing performance after radiotherapy for squamous cell carcinoma oesophagus.

OBJECTIVE: To consider assessment of swallowing performance status as an alternative to survival in reporting results of treatment in patients with carcinoma oesophagus. METHODS: Twenty five patients of squamous cell carcinoma of oesophagus treated with radiotherapy were evaluated clinically, radiologically and endoscopically, to assess their response to treatment. RESULTS: Two months after radiotherapy, 10 of 25 patients had swallowing score-1. During radiotherapy, oesophagitis involving normal oesophagus and diseased segment was seen in 64% of cases. Fifty six percent of patients developed stricture (24% malignant, 32% benign). At the end of two years, only five patients were alive, two with swallowing score of 2, two with swallowing score of 3 and one with swallowing score of 4. CONCLUSION: As the overall survival in carcinoma oesophagus is poor, the short term criteria for assessing the response of treatment should be swallowing performance status. Radiotherapy treatment can provide substantial palliation for patients debilitated by dysphagia.

Percutaneous catheter drainage in pancreatic pseudocysts.

Percutaneous catheter drainage (PCD) was performed in 12 pancreatic pseudocysts in 11 patients. The procedure was performed under realtime ultrasound guidance adopting a direct transperitoneal approach in all cases. Complete cure was achieved in 9 (75%) of the Pseudocysts drained. Success rate was higher in pseudocysts not communicating with the main pancreatic duct (MPD), 7 of 8 (87.5%) as compared to those with ductal communication, 2 of 4 (50%). The mean duration of catheter drainage was 14.2 days in the first group while it was significantly longer, (42.5 days) in the latter group. No death or major complication related to the procedure was encountered in the study. A single pseudocyst got infected after catheter insertion but it was treated successfully with antibiotics. The follow up period was 3-18 months with a mean of 6.8 months. PCD failed in 2 pseudocysts communicating with MPD and associated strictures in the MPD. In one case having no communication with MPD the procedure failed because the cyst had thick debris which could not be drained properly. PCD may be a safe and effective therapy in the management of pseudocysts with best results in those not communicating with the MPD. Communicating pseudocysts, also having strictures in MPD, should not be subjected to PCD.

Clinical and endoscopic features of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) in India.

Hereditary hemorrhagic telangiectasis (HHT) is an autosomal dominant disease characterized by recurrent epistaxis and telangiectasia of the skin and mucous membranes. Most reports of HHT are from Europe and N. America. In this report of 7 patients from India we postulate that increased skin pigmentation in Asians and Negroids masks the cutaneous manifestations of the disease but without any discernible effect on mucosal lesions. The median hemoglobin value in these patients was 4 g/dl. Endoscopic lesions in the stomach or duodenum were detected in six patients. Most patients in our report (5/7) presented with a chronic iron deficiency anaemia. The treatment of HHT is mainly supportive although our preliminary data shows that low dose ethinyl estradiol therapy decreases transfusion requirement in these patients.

Intestinal metaplasia--its association with gastric cancer.

Endoscopic gastric biopsies from 230 patients and post gastrectomy specimens of 18 patients were evaluated for the presence of intestinal metaplasia (IM) and its association with the gastric lesions. There were a total of 78 malignant and 170 benign lesions. IM was present in 53% of patients with gastric carcinoma (GC) and in 10.6% with benign lesions of the stomach. The IM in association with GC was of type 1 (Small Intestinal) in 58.8%; type II (mixed gastric and small intestinal) in 11.8% and type III (Colonic) in 29.4%. In patients with benign lesions the IM was predominantly of type I (94.5%) except in 1 patient who had type III metaplasia. Our findings indicate that type III IM was significantly more frequent in patient with GC than with benign lesions (29.4% Vs 5.5%; p < .005). Therefore we conclude that patients with type III IM should be kept on surveillance for GC.

Spectrum of gastrointestinal malignancy over a period of 10 years at a tertiary referal center of India.

We studied the frequency of different gastro intestinal malignancies (GIM) diagnosed in a given year, among patients attending gastroenterology department, and changing pattern of their occurrence over a period of 10 years (1984-1993). The records of all patients with histologically confirmed GIM were screened. Out of 83380 outdoor patients registered in the department over 10 years, there were a total of 1751 (2.1%) patients with GIM. The relative distribution of malignancy according to site was esophagus 36.0%, stomach 19.9%, liver secondaries 13.9%, colon 9.8%, periampullary 5.6%, gall pladder 4.5%, duodenum 3.0%, malignant ascites 2.6%, HCC 2.3% and pancreas 1.1%. Mean age for cancer of esophagus was 53.5 +/- 11.4 year, stomach 51.8 +/- 12.9, colon 49.1 +/- 16.7, duodenum 45.3 +/- 11.4, malignant ascites 51.8 +/- 13.1, pancreas 46.9 +/- 15.3 and HCC 52.5 +/- 12 years with an overall mean age of all GIM being 49.7 +/- 13.4 years. All malignancies were common in males except for cancer of gall bladder. The annual distribution of GIM did not confirm to a rising or declining trend with reference to the frequency of occurrence or age and sex distribution over the last decade.

Corrosive injury to the upper gastrointestinal tract.

Corrosive injury to the UGI tract is a common problem and has a wide spectrum of presentations. Unlike in the West, where lye ingestion is more frequent, corrosive injury in India is more commonly due to acids. Depth of the injury is the most important factor which determines the outcome. Endoscopy done soon after corrosive ingestion is safe and is very helpful in assessing the extent and severity of injury and in planning proper management of these patients. At present no therapy has been proven to be effective for prevention of stricture formation. Endoscopic dilatation seems to be the treatment of choice for management of most esophageal strictures with very good short and long term results. Surgery should be considered only when dilatation fails.

Combination of anticholinergic agent and H2 receptor antagonist in duodenal ulcer treatment--a randomized, double blind multicenter study.

BACKGROUND: The acid suppressive abilities of H2 receptor antagonists and anticholinergics have been claimed to be additive. METHODS: A multicenter, double-blind, randomized trial comparing ranitidine (150 mg) plus propantheline bromide 15 mg at bedtime to ranitidine 300 mg alone at bedtime was conducted in 161 patients with endoscopically confirmed uncomplicated duodenal ulcer. RESULTS: After six weeks of therapy, ulcer healing rates in the two groups were comparable ie 80% in the combination group (ranitidine + propantheline) and 79.4% in the ranitidine group. Pain relief after one, two and four weeks of treatment was also comparable in the two groups. Side effects to drugs were minor and comparable in both the groups. CONCLUSION: A combination of 150 mg ranitidine and 15 mg propantheline bromide is as efficacious as 300 mg ranitidine in inducing healing of uncomplicated duodenal ulcers, with similar side-effects but at greatly reduced cost.

Clinical and etiological profile of acute viral hepatitis.

There is a paucity of data on the incidence of sporadic viral hepatitis in Indian children. Clinical, biochemical and etiological profile of 54 patients with acute viral hepatitis was evaluated. Of these, 32 (59.25%) patients had Hepatitis A, 18 (33.33%) had NANB, 2 (3.7%) had Hepatitis B and 2 (3.7%) concurrent Hepatitis A and B infection. It was not possible to distinguish the etiological agents on the basis of the clinical and biochemical profile. Fulminant hepatitis was documented in 8 (14.8%) cases. Children with NANB infection were at a greater risk (p less than 0.05) of developing fulminant hepatitis as compared to Hepatitis A infection.

Magnetic resonance imaging in pancreatic diseases: comparison with other imaging techniques.

Magnetic resonance imaging (MR) was performed in 14 healthy subjects and 16 patients with pancreatic disease. All the 16 patients were subjected to ultrasonography (USG), computed tomography (CT) and MR while endoscopic retrograde cholangiopancreatography (ERCP) was performed in 10 cases. In one patients with adenocarcinoma and two with gastrinoma, MR demonstrated abnormalities while USG and CT were normal. MR was, however, inferior to ERCP in demonstrating ductal abnormalities in chronic pancreatitis. Our initial experience suggests that MR is superior to other imaging modalities in the diagnosis and staging of pancreatic tumors; however, it is inferior to ERCP in the diagnosis of pancreatitis.