Patients with Specific Gastrointestinal Motility Disorders are Commonly Diagnosed as Functional GI Disorders in the Early Stage by Community Physicians due to Lack of Awareness.

BACKGROUND: Data on specific gastrointestinal (GI) motility disorders, such as gastroparesis (GP), chronic intestinal pseudo-obstruction (CIPO), and colonic inertia (CI), as well as awareness among doctors about these disorders are scanty in Asia. METHOD: Prospectively maintained records of 60 patients were retrospectively analyzed, and knowledge, attitude, and practice (KAP) of 66 Indian physicians were surveyed electronically. RESULTS: A total of 60 (age 37.7 ± 18.4 years, 25 female) patients were included in the study (13 [21.7%] GP, 25 [41.7%] CIPO, 14 [23.3%] CI, and 8 [13.3%] overlap of GP and either CIPO [5] or CI [3]), of whom 40 had primary disorders and 20 had secondary disorders due to diabetes mellitus (n = 6), systemic sclerosis (n = 4), paraneoplastic (n = 2), infection (n = 3), Parkinson's disease (n = 1), hypothyroidism (n = 1), hyperparathyroidism (n = 1), celiac disease (n = 1), and amyloidosis (n = 1). Primary disorders were more often misdiagnosed as functional GI disorders, causing diagnostic delays and complications, than secondary disorders. More patients in the primary disorder group underwent surgery compared with those in the secondary group (25/40, 62.5% vs 1/20, 5%). A few rare infectious causes of GI motility disorders due to Strongyloides stercoralis, herpesvirus, and unidentified viruses were found. Of four patients treated with pyridostigmine with (n = 3) or without prucalopride (n = 1), three responded. Awareness about GI motility disorders, particularly the primary disorders, among 66 doctors participating in the KAP survey was inadequate. CONCLUSION: Awareness regarding specific GI motility disorders among physicians is lacking, which leads to delay in diagnosis and results in more complications in patients, such as surgery, particularly in those with primary disorders.

Gastric tuberculosis mimicking liver abscess - A case report.

Tuberculosis of the stomach is quite rare, both as a primary or secondary infection. It has varied presentation ranging from non-specific abdominal pain and constitutional symptoms to hematemesis, gastric outlet obstruction and pyrexia of unknown origin. Here, we report a rare, interesting case of locally advanced gastric tuberculosis, which morphologically mimicked liver abscess initially in a young, immunocompetent patient presenting with fever and abdominal pain. The disease was diagnosed by GeneXpert MTB/RIF assay, and responded well to antituberculosis medication without surgery. Clinicians must bear in mind that, even in the absence of immunodeficiency, as in this case, tuberculosis can involve any site in the gastrointestinal tract and may present with a variety of presentation and infiltrating adjacent organ that might be mistaken as malignancy. This is first case report of gastric tuberculosis, which is locally advanced with adjacent liver infiltration initially thought to be left lobe liver abscess.