ABSTRACT
The human gut is home to a variety of microbes, including bacteria, viruses, fungi, eukaryotes, and archaea, which together form a complex structure. In general, the microbiota that colonizes the gastrointestinal (GI) tract plays a significant role in maintaining human health and has been implicated in the pathogenesis of a number of GI illnesses. The structural integrity and metabolic processes of the alimentary canal are physiologically influenced by the dynamic interactions between the gut and bacteria. GI dysbiosis is a result of an imbalance brought on by a decline in microbial diversity, the loss of helpful bacteria, and an increase in pathobionts. It is crucial to restoring the gut microbiota. In order to regain the eubiotic state of the microbial flora, varied methods are being researched and implemented. The use of probiotics is one strategy for re-establishing healthy gut flora. Probiotics are "living microorganisms" that improve the health of the host when provided in adequate quantities. There are two types of probiotics-bacteria and yeast-based. The review will look at and summarize the information for yeast-based Saccharomyces probiotics regarding their effectiveness and safety in treating a variety of patient diseases, particularly irritable bowel syndrome (IBS), antibiotic-associated diarrhea, and Heliobacter pylori (HpSA) infection. The only commercially accessible yeast probiotic, the Saccharomyces strain, which consists of Saccharomyces cerevisae (S. cerevisiae) and Saccharomyces boulardii (Sb), provides a number of benefits over bacterial probiotics. The significance of Sb as a potent biotherapeutic medication that may be utilized to prevent or treat a variety of GI disorders has been substantiated by several experimental studies and clinical trials.
Subject(s)
Gastrointestinal Diseases , Probiotics , Humans , Bacteria , Diarrhea/therapy , Fungi , Gastrointestinal Diseases/therapy , Probiotics/therapeutic use , Saccharomyces cerevisiaeABSTRACT
INTRODUCTION: Giardia intestinalis is a flagellated protozoan, frequently documented as an agent for enteric illness worldwide. Laboratory procedures for diagnosis include stool examination, antigenic detection assays and, at times, mucosal biopsy. We hypothesised that the formalin fixative used as a preservative for mucosal biopsy can be a good diagnostic sample for detecting surface mucosal and luminal infective agents such as giardia. The aim of the study was to find out the utility of processing the remaining formalin fixative as a complementary diagnostic method for detecting giardia. METHODS: This study included 200 cases of duodenal biopsies sampled over 6 months. The biopsies were picked up using clean forceps and the remaining fixative was processed using standard cytospin protocol. The cytospin preparation and formalin-fixed paraffin-embedded tissue sections were examined by two pathologists independently blinded to each others findings. RESULTS: On cytology, trophozoites of giardia were detected in 23 out of 200 cases (11.50%). The cytomorphology of pear-shaped organism with paired flagella and nuclei is very diagnostic. One case also showed presence of cryptosporidium spores. No other intestinal parasite was seen. Out of the 23 positive cytology samples, only 12 (6%) corresponding formalin-fixed paraffin-embedded tissue sections showed presence of giardia. CONCLUSION: Concurrent examination of duodenal biopsy and the formalin fixative cytopreparation in cases with high index of clinical suspicion of giardiasis proved to be a useful adjunct to biopsy diagnosis of giardiasis, which was statistically significant (P < .0001). This approach adds negligible cost and effort but with good diagnostic yield. We recommend that the formalin cytopreparation be used as a complementary technique to biopsy for cases suspected of intestinal parasitic infection.
Subject(s)
Duodenum/parasitology , Fixatives/chemistry , Giardia lamblia/isolation & purification , Giardiasis/diagnosis , Biopsy/methods , Cytodiagnosis/methods , Formaldehyde/chemistry , Giardiasis/parasitology , Humans , Prospective Studies , Specimen Handling/methodsABSTRACT
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asian Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection, and prevention of latent TB infection and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised two parts: (i) risk of TB infection during anti-TNF therapy and (ii) screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
Subject(s)
Adalimumab/therapeutic use , Antibodies, Monoclonal/therapeutic use , Consensus , Gastroenterology/organization & administration , Inflammatory Bowel Diseases/drug therapy , Infliximab/therapeutic use , Risk Assessment , Tuberculosis/etiology , Adalimumab/adverse effects , Antibodies, Monoclonal/adverse effects , Asia , Drug Therapy, Combination , Humans , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/complications , Infliximab/adverse effects , Tuberculosis/diagnosis , Tuberculosis/prevention & control , Tumor Necrosis Factor-alpha/immunology , Tumor Necrosis Factor-alpha/physiologyABSTRACT
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised three parts: (3) management of latent TB in preparation for anti-TNF therapy, (4) monitoring during anti-TNF therapy, and (5) management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
Subject(s)
Adalimumab/therapeutic use , Antibiotics, Antitubercular/administration & dosage , Antibodies, Monoclonal/therapeutic use , Consensus , Gastroenterology/organization & administration , Inflammatory Bowel Diseases/drug therapy , Infliximab/therapeutic use , Tuberculosis/drug therapy , Tuberculosis/etiology , Adalimumab/adverse effects , Antibiotic Prophylaxis , Antibodies, Monoclonal/adverse effects , Asia , Drug Therapy, Combination , Humans , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/complications , Infliximab/adverse effects , Treatment Outcome , Tuberculosis/diagnosisABSTRACT
BACKGROUND AND AIM: Tuberculosis (TB) is a well-recognized iatrogenic adverse event following administration of biologic therapy given for a variety of clinical indications. There is paucity of data on the development of TB following the use of biologics from countries with a high prevalence of TB. The aim of this study was to determine the risk of development of TB following biological therapy in a country, which is highly endemic for TB. METHODS: The article retrospectively analyse data from three referral inflammatory bowel disease centers to evaluate the risk of development of TB following biological therapy for patients with ulcerative colitis. RESULTS: Of the 79 patients with ulcerative colitis treated with infliximab, seven (8.8%) developed TB at a median interval of 8 weeks after the first exposure despite screening for latent TB. Three of the seven (42%) patients developed disseminated disease, whereas pulmonary disease was documented in four patients (57%). All patients were successfully treated with anti-tuberculous drugs for a period of 6-13 months. In contrast to data from the West, none of the patients in our study had a fatal outcome. None of the patients required a colectomy after a median follow up of 2 years following cessation of the infliximab therapy. CONCLUSIONS: These data suggest that despite the significantly higher prevalence, the outcome of TB after infliximab therapy is quite sanguine in the Indian subcontinent.
Subject(s)
Colitis, Ulcerative/drug therapy , Infliximab/adverse effects , Infliximab/therapeutic use , Tuberculosis/epidemiology , Tuberculosis/etiology , Adult , Antitubercular Agents/therapeutic use , Colitis, Ulcerative/complications , Female , Follow-Up Studies , Humans , India/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , Risk , Time Factors , Treatment Outcome , Tuberculosis/drug therapyABSTRACT
Background: Variceal bleeding is an important cause of mortality in patients with chronic liver disease (CLD). The gold standard for detection and grading of oesophageal varices (EV) is upper gastrointestinal endoscopy. However, it is expensive, time-consuming and invasive. Objectives: This study aimed to find any association between splenic shear wave velocity (SWV) measured by acoustic radiation force imaging (ARFI) and the presence of EV. Method: The quasi-experimental study included 50 patients with CLD and 50 subjects without CLD as the control group. Both underwent upper abdominal ultrasonography followed by elastographic assessment on a Siemens Acuson S2000TM ultrasound system. A comparison of the findings was made between the control and patient groups. Results: Both groups had similar hepatic size while patients with CLD had larger splenic size and area (p < 0.05). The CLD patients had higher mean hepatic and splenic SWV compared with the control group (p < 0.05). The mean splenic size and splenic SWV were higher in patients with varices than in those without varices (p < 0.05). Conclusion: Chronic liver disease causes significant increase in liver and splenic stiffness with splenic SWV values being higher for patients with varices emphasising the role of elastography as a non-invasive predictor for the presence of EVs. Splenic SWV had the highest sensitivity and specificity, which was augmented by a combination of hepatic and splenic SWV. Thus, splenic SWV alone or in combination with hepatic SWV is a useful technique for prediction of the presence of EVs. Contribution: This study aims to find an alternative non-invasive and cost-effective technique for screening of EV.
ABSTRACT
Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.
Subject(s)
Colitis, Ulcerative , Colitis , Herpes Zoster , Pyrimidines , Adult , Female , Humans , Aged , Colitis, Ulcerative/drug therapy , Consensus , Piperidines/adverse effects , Herpes Zoster/chemically induced , Herpes Zoster/drug therapyABSTRACT
Jaundice in patients with AIDS can be a result of diverse conditions ranging from opportunistic infections to drug-related hepatotoxicity. With the advent of antiretroviral therapy (ART), the prevalence of AIDS cholangiopathy as a cause of jaundice has decreased; on the other hand, ART-related hepatotoxicity has become one of the commonest causes of jaundice in these patients. AIDS cholangiopathy is a rare condition of extrahepatic biliary obstruction in patients with advanced HIV infection, usually due to opportunistic infections. Vanishing bile duct syndrome (VBDS) is an acquired disorder characterized by progressive destruction and loss of interlobular bile ducts causing intrahepatic cholestasis. Herein, we report co-occurrence of fatal cytomegalovirus (CMV)-induced VBDS along with papillary stenosis, as a component of AIDS cholangiopathy, which to the best of our knowledge has not been documented earlier. This is perhaps the third case of VBDS in a patient with AIDS, and the second in association with CMV infection. VBDS in AIDS has a poor outcome, and liver transplantation may be considered only in a suitable candidate.
ABSTRACT
BACKGROUND: Duodenal involvement occurs frequently in gallbladder cancer (GBC) as a result of the proximity of the duodenum to the gallbladder. METHODS: The study group included 74 GBC patients assessed between August 2009 and March 2011 in whom computed tomography (CT) of the abdomen indicated suspicion for duodenal involvement. RESULTS: Of 172 patients with resectable GBC, 74 (43.0%) had suspected duodenal involvement on imaging. Of these, 51 (68.9%) had suspected duodenal involvement on upper gastrointestinal endoscopy (UGIE). Symptoms of gastric outlet obstruction (GOO) were present in only 14 (18.9%) patients. Thirteen (17.6%) patients underwent staging laparoscopy alone. Of the 61 patients who underwent laparotomy, 31 (50.8%) were found to have actual duodenal involvement. The positive predictive value (PPV) of CT of the abdomen for duodenal involvement was 50.8% (31 of 61 patients). The addition of UGIE increased the PPV to 65.9% (27 of 41 patients). In the subgroup with evidence of duodenal mural thickening or mucosal irregularity on CT of the abdomen (n= 9) or duodenal mucosal infiltration on UGIE (n= 14), the PPV increased to 100%. A total of 33 (44.6%) patients underwent curative resection. The resectability rate was significantly lower in patients with symptoms of GOO [two of 14 (14.3%) vs. 31 of 60 (51.7%); P= 0.010], CT findings of duodenal mural thickening or mucosal irregularity compared with only loss of the fat plane [two of 12 (16.7%) vs. 31 of 62 (50.0%); P= 0.032], and UGIE evidence of duodenal infiltration compared with extrinsic compression or normal endoscopic findings [three of 16 (18.8%) vs. 18 of 35 (51.4%) and 12 of 23 (52.2%), respectively; P= 0.027 and P= 0.036, respectively]. CONCLUSIONS: Overall, CT of the abdomen demonstrated a PPV of 50.8% in detecting duodenal involvement, which increased to 65.9% with the addition of UGIE. The combined presence of GOO symptoms, CT findings of duodenal mural thickening and mucosal irregularity, and UGIE findings of infiltration of the duodenal mucosa significantly decreases resectability but does not preclude resection.
Subject(s)
Duodenum/pathology , Gallbladder Neoplasms/pathology , Intestinal Mucosa/pathology , Duodenum/diagnostic imaging , Duodenum/surgery , Endoscopy, Gastrointestinal , Female , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Humans , Intestinal Mucosa/diagnostic imaging , Intestinal Mucosa/surgery , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Predictive Value of Tests , Preoperative Care , Prognosis , Prospective Studies , Stomach/pathology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: We aimed to compare the frequency of myelosuppression in patients initiating azathioprine (AZA) at full dose versus those undergoing gradual dose escalation. METHODS: Forty patients with inflammatory bowel disease were recruited over one year and randomized into two groups of 20. Group A initiated AZA at a full dose of 2 mg/kg, while group B started at 1 mg/kg with subsequent dose increases at regular intervals. RESULTS: Seventeen patients from each group were included in the final analysis. During follow-up, two patients (11.8%) from group A and four patients (23.5%) from group B experienced relapses (p=0.65). Myelosuppression occurred in two patients (11.8%) from each group. Absolute neutrophil counts in group A tended to have lower median values than those in group B, particularly four weeks after AZA initiation. Univariate analysis identified serum proteins, albumin, and bilirubin as significantly associated with leukopenia, but these factors were not significant according to multivariate analysis. CONCLUSIONS: The incidence of myelosuppression was similar between the groups. Patients with full-dose initiation of AZA had numerically fewer relapses during the follow-up period.
Subject(s)
Colonic Diseases/etiology , Intestinal Fistula/etiology , Pancreatic Fistula/etiology , Pancreatic Pseudocyst/etiology , Pancreatitis, Alcoholic/complications , Adult , Colonic Diseases/diagnostic imaging , Colonoscopy , Humans , Intestinal Fistula/diagnostic imaging , Male , Pancreatic Fistula/diagnostic imaging , Pancreatic Pseudocyst/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Citrulline is regarded as a biomarker for celiac disease (CD). Its utility for assessment and evaluation of additive predictive value for latent, potential CD and first degree relatives (FDRs) needs exploration. METHOD: Consecutive 558 index cases diagnosed as per European Society for Pediatric Gastroenterology and Nutrition (ESPGHAN) 2012 guidelines and their 1565 FDRs were evaluated over five and half year period. Serology negative FDRs at initial visit and follow ups were served as controls. HLA typing for DQ2 and DQ8 genotypes, along with plasma and dried blood spot (DBS) filter paper citrulline were evaluated. RESULTS: Median plasma citrulline values were 20.1 and 37.33 µMol/l in cases and controls (P < .001). Cut off values for Marsh grade 3a, 3b, and 3c were 35.0, 32.8, 25.26 µMol/l in CD patients and 36.51, 30.10, 25.26 µMol/l in biopsy proven FDR. Increasing trends of plasma citrulline levels with decreasing tTG-IgA levels were observed on follow up. Low plasma citrulline levels were observed with HLA DQ 2.5 genotype (P < .05). Agreement between DBS and plasma citrulline was 94.8%. CONCLUSION: Citrulline is a good surrogate biomarker for identification of histopathological grade of damage, extent of mucosal recovery and has negative correlation with tTG-IgA. It identifies the silent and latent phase of CD. DBS citrulline provides adequate information and can be used for monitoring CD patients at remote locations.
ABSTRACT
BACKGROUND AND AIM: Endoscopic biopsy is standard for the diagnosis of esophageal malignancy. However, few cases present with smooth stricture with repetitive negative biopsy results. We aimed to use linear endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) in the diagnosis of biopsy-negative suspected malignant esophageal strictures. METHODS: We retrospectively analyzed the data from August 2017 to December 2018 of biopsy-negative esophageal strictures. All adult patients with twice-negative biopsies and with smooth overlying esophageal mucosa on endoscopy were included. Clinical, epidemiological, endoscopic, imaging, and EUS findings were noted and analyzed. RESULTS: Eighteen patients underwent EUS for suspicion of malignant esophageal stricture. Seven were excluded as they were submucosal tumors. Eleven patients showed the presence of malignancy on EUS FNA samples. Nine were males. Computed tomography showed esophageal wall thickening in eight (16-38 mm) and esophageal mass in three patients. EUS showed loss of a normal five-layered wall structure of the esophagus in all patients. Fine-needle aspiration cytology demonstrated squamous cell carcinoma (n = 4), adenocarcinoma (n = 4), poorly differentiated carcinoma (n = 2), and neuroendocrine carcinoma (n = 1). There were no complications. CONCLUSION: EUS with FNA is effective and safe for the diagnosis of biopsy-negative malignant esophageal strictures.
Subject(s)
Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Esophagus/pathology , Pancreatic Pseudocyst/complications , Pancreatic Pseudocyst/pathology , Barium , Dilatation, Pathologic/pathology , Esophageal Achalasia/complications , Esophageal Achalasia/pathology , Esophagoscopy/methods , Gastroscopy/methods , Humans , Male , Young AdultABSTRACT
Introduction Peritoneal tuberculosis (PTB) is a paucibacillary disease with poor mycobacterial yield in ascitic fluid. The Xpert® MTB/RIF assay (Gene Xpert) is a new tool for the diagnosis of tuberculosis (TB) and has not yet been studied on peritoneal tissue. The present study aimed to investigate the yield of the Xpert® MTB/RIF assay on peritoneal tissue obtained at peritoneoscopy. Methods This is a retrospective study and the data were collected from hospital records. The patients who underwent peritoneoscopy along with Xpert® MTB/RIF assay on peritoneal tissue were included in this study. Those with proven PTB were considered as cases while those with other diagnoses as controls. Using the reference standard of TB diagnosis, sensitivity, specificity, and accuracy of Xpert® MTB/RIF assay were calculated. Results Total of 36 patients was analyzed in this study: 28 as cases and eight as controls. Peritoneoscopy was carried out for diagnosis and biopsy. Histopathology in cases revealed caseating granulomas in 16 while 11 had non-caseating granulomas. Nine patients showed acid-fast bacillus positivity on peritoneal tissue. The most common finding on peritoneoscopy was tubercles with adhesions (n = 14, 50%), followed by tubercles only (n = 12, 42.9%). Xpert® MTB/RIF assay was positive in 17 (60.7%) patients with a sensitivity of 60.71%, specificity of 100%, and an accuracy of 69.44%. Two patients expressed rifampicin resistance. Conclusion Xpert® MTB/RIF assay on peritoneal tissue has fair sensitivity and excellent specificity. The multidrug resistance and the ability to provide results rapidly make it clinically useful.
ABSTRACT
The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.
Subject(s)
Gastroenterology/standards , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/therapy , Practice Guidelines as Topic , Adult , Antacids/therapeutic use , Consensus , Diet/adverse effects , Esophagitis/epidemiology , Esophagitis/etiology , Female , Gastroesophageal Reflux/etiology , Helicobacter Infections/complications , Helicobacter pylori , Histamine H2 Antagonists/therapeutic use , Humans , India/epidemiology , Male , Prevalence , Proton Pump Inhibitors/therapeutic use , Societies, MedicalABSTRACT
BACKGROUND AND AIMS: Liver biopsy may be considered in patients with hepatitis C virus (HCV) infection to assess the severity of liver injury and stage of fibrosis, thereby guiding therapeutic decisions. In addition, advanced stage also necessitates surveillance for hepatocellular carcinoma. The aim of this study was to assess whether transaminase (alanine transaminase [ALT]) levels and RNA titers correlate with the histological activity index (HAI) and fibrosis (F) stage in asymptomatic patients with incidentally detected HCV (IDHCV). PATIENTS AND METHODS: Retrospective evaluation of liver biopsies was done in 113 patients with IDHCV, diagnosed during routine screening. Decision of liver biopsy was made on the basis of age, genotype, acceptable clinical, hematological, and biochemical profiles, and willingness of the patients to undergo treatment. Serum ALT levels, HCV RNA titers, and genotypes were correlated with HAI and F stage. RESULTS: Genotyping was done in 77 of the 113 patients, of which genotype 3 was seen in 43 and genotype 1 in 25 patients. A higher fibrosis stage (Ishak's >F2) was noted in 23.8% of the biopsies. Serum ALT showed a significant correlation with the HAI score on liver biopsy (P = 0.01) but not with the stage of fibrosis (P = 0.52). HCV RNA titers did not reveal any correlation with HAI score or fibrosis stage. CONCLUSION: Serum transaminases and HCV RNA titers are poor predictors of disease severity and fibrosis. Since HCV shows a slow disease progression, higher stage may predict a worse prognosis irrespective of the low viral RNA load. Liver biopsy may help guide therapeutic decisions in IDHCV infection.
Subject(s)
Disease Management , Hepatitis C, Chronic/diagnosis , Hepatitis C/diagnosis , Liver Cirrhosis/pathology , Liver/pathology , Adolescent , Adult , Aged , Alanine Transaminase/blood , Asymptomatic Infections/epidemiology , Biopsy , Female , Genotype , Hepacivirus/genetics , Hepacivirus/isolation & purification , Hepatitis C/classification , Hepatitis C/pathology , Hepatitis C/virology , Humans , Incidental Findings , Liver/virology , Liver Cirrhosis/classification , Liver Cirrhosis/diagnosis , Liver Function Tests , Male , Middle Aged , RNA, Viral/blood , Retrospective Studies , Viral Load , Young AdultABSTRACT
BACKGROUND AND AIM: Esophageal involvement in tuberculosis (TB) is rare and is usually secondary. Data on esophageal TB are scarce. We aimed to analyze clinical and endoscopic features and outcomes of treatment in esophageal TB. METHODS: We retrospectively identified patients with esophageal TB from January 2014 to December 2016 at GB Pant Hospital. Well-defined granuloma with or without caseation and/or acid-fast bacilli on staining either from esophageal biopsy or the adjacent mediastinal lymph node fine-needle aspiration cytology (FNAC) specimen, along with clinical features and response to antitubercular therapy (ATT), were collectively considered to diagnose definite TB. Treatment received and response to therapy were documented and analyzed. RESULTS: A total of 19 patients had definite esophageal TB, and the median age of patients was 39 years (14-65 years) and 10 (52.6%) patients were female. The most common presenting symptom was dysphagia (n = 16, 84%) followed by odynophagia (n = 8, 42%). On endoscopy, the mid-esophagus was the most common site of involvement, and findings included ulcers (n = 17), elevated lesions (n = 9), and fistulae (n = 4) in patients. The mediastinal lymphadenopathy was present in all patients, with parenchymal lesions seen in three patients. The endoscopic mucosal biopsies were diagnostic in 11 patients, and in the remaining 8 patients, endoscopic ultrasound-guided FNAC from the mediastinal lymph nodes was diagnostic. A total of 18 patients completely responded to ATT, and 1 patient had partial response with persistent fistulae requiring additional treatment. CONCLUSION: Esophagus involvement is rare in TB; endoscopic mucosal biopsy and EUS-guided FNAC is diagnostic, and the response to ATT is excellent.
ABSTRACT
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
ABSTRACT
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.