Does Education Have Any Influence on Symptom Score of IBS Patients: A Randomized Controlled Study.

Despite much research, the pathophysiology of IBS remains poorly understood. So it is very difficult to treat. There is no standard treatment for IBS. Because IBS symptoms can be elicited or exacerbated by diet and stress, this suggests that patient education regarding his or her illness might be beneficial to patients in managing their symptoms. This study was done to see the short term effects of outpatient education in relation to change of symptom score in IBS patients. This is a prospective randomized comparative study. In this study a total of 80 patients were included. Forty patients were given only pharmacological management with Mebevarine hydrochloride 135mg thrice daily half an hour before meal and Amitryptline 10mg at night for six months and another forty were given education in addition to the same pharmacological treatment. In both the study group [medical management only versus medical management with education] changes of symptoms and quality of life of patients of IBS were assessed by using previously used, specially designed symptoms scoring system and a validated IBS-QOL instrument. There was no significant difference in severity of symptoms between only drug treatment group (118.973) and education plus drug treatment group (119.57) before treatment. The difference of improvement between the education group and without education group was not statistically significant (P>0.05), though the subsidence of pain in both the group before and after treatment was statistically significant (P<0.01).

Histological Spectrum of Chronic Hepatitis in HBeAg Positive and HBeAg Negative Hepatitis B Virus Infection.

Hepatitis B virus (HBV) is a major cause of chronic liver disease and an important public health issue. This study was conducted with the objective of evaluating the histological features in patients infected with precore and wild-type HBV infection; compare the histological activity and fibrosis stage and early treatment of HBeAg negative hepatitis. Total thirty six (36) patients were selected. Eighteen (18) were HBe(+ve) and another 18 were HBe(-ve). All had persistent or intermittent elevation of SGPT. Histological examination of liver biopsy specimen was done by Haematoxyn and Eosin (H & E) Stain. Histological activity index (Necroinflaminatory score) was calculated in both groups and compared. Among the patients with wild type of HBV the average HAI was 4.5. While patients with pre-core mutant chronic HBV infection the average HAI was 6.3. The difference between the two groups was not statistically significant. Average periportal necrosis among the patients with wild type was 1.88. While patients with precore mutant chronic HBV infection the average was 2.72. The difference between the two groups was statistically significant (P value<0.01). Average intralobular degeneration and local necrosis of the study group among the patients with wild type was 0.88, while patients with precore mutant chronic infection, the average were 7.7. The difference between the two groups was statistically significant (P value<0.5). Average portal inflammation among the patient with wild type was 1.66. While patients with precore mutant HBV infection the average was 2.11. The difference between the two groups was not statistically significant (P value>0.05). We also found that the progression of disease in terms of liver fibrosis rather than disease activity was more significant in PCM infection than in wild-type HBV infection.

Primary extramedullary esophageal plasmacytoma - a case report.

Extramedullary plasmacytomas are very uncommon tumors, may occur commonly in the upper respiratory passages. These are rarely seen in the middle and lower gastrointestinal system and exceptional to originate in the esophagus. We present a novel case of a 65-year old man who presented with dysphagia and weight loss. After taking detailed clinical history and physical examination endoscopy was performed that showed an ulcero-proliferative lesion involving the lower third of esophagus. Histopathological examination revealed sheets of malignant plasma cells, some with prominent nucleoli. Immuno-histochemistry could not be done due to unavailability. A bone marrow biopsy was performed which was negative for involvement. This is a rare case of esophageal plasmacytoma diagnosed on endoscopy in a patient presenting with dysphagia.

Cirrhosis of liver and portal vein thrombosis - a review article.

Cirrhosis is characterized by diffuse hepatic fibrosis and nodule formation which can occur at any age with significant morbidity and is an important cause of premature death. Occlusive portal vein thrombosis (PVT) is common complication of chronic liver disease with prevalence ranging from 1% to 16% of population. The occurrence of portal vein thrombosis is influenced by local factors (cirrhosis with associated liver architectural changes and increased resistance effects), systemic factors (inherited and acquired abnormalities leading to hyper coagulability) and development of hepatocellular carcinoma. The majority of patients with cirrhosis PVT are diagnosed on radiographic studies although in some patients PVT may present with decompensated chronic liver disease but the natural history of PVT in patients with cirrhosis is largely unknown. However patients with cirrhosis and PVT have been shown to have inferior survival in comparison with patients without PVT.

Role of Anthropometric Indices in the Prediction of Non-alcoholic Fatty Liver Disease in a Rural Population of Bangladesh.

Non-alcoholic fatty liver disease (NAFLD) is found in one-fourth of the world population and its prevalence is rising. Screening of NAFLD in general population with ultrasonography (USG) is not a cost- effective approach. Alternative methods for prediction of NAFLD are needed. We conducted this study to assess whether basal metabolic index (BMI), waist circumference (WC), waist height ratio (WHtR) is useful for predicting NAFLD. This study was done in a village of Comilla District, Bangladesh from July 2019 to December 2019. Two hundred and nineteen (219) subjects with NAFLD detected on USG and 100 healthy controls without NAFLD were included in this study. The diagnosis of NAFLD was made on the basis of USG by a radiologist. BMI, WC, WHtR were calculated. The area under the curve (AUC) in the receiver operating characteristic (ROC) was calculated to assess the diagnostic ability of BMI, WC, and WHtR for predicting NAFLD. Sensitivity and specificity with optimal cut-off point was calculated. Data were entered into SPSS16for statistical analysis. Mean age in NAFLD group was 45.11±13.50 years. The AUROC values were 0.832, 0.763 and 0.771 for BMI, WC and WHtR respectively. The Cut-off values were 24.4 for BMI, 75.60 for WC and 0.54 for WHtR. Sensitivity and specificity were 80.24%and 79.12% for BMI, 82.34% and 80.45% for WC, 79.56% and 78.98% for WHtR respectively. ROC for BMI, WC and WHtR were above the diagonal line with high sensitivity and specificity. BMI, waist circumference, waist height ratio is useful for predicting NAFLD in rural Bangladeshi population. We can use these simple anthropometric indices as a screening tool for detection of NAFLD in primary health care set up.

Frequency of Defecation and Form of Stool among General Bangladeshi Population.

Data on stool form and defecation frequency which are a prerequisite for defining normal bowel habit are lacking in Bangladesh. This observational cross sectional study was designed to find out defecation frequency and stool form among general population in Bangladesh. This study was performed in the Department of Gastroenterology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from July 2017 to June 2018. Apparently healthy 1090 respondents were evaluated for predominant stool form (Bristol chart) and frequency. Data on demographic and life-style were collected. The study population consisted of 1090 respondents, among them, 65.13% male and 34.87% female and mean age of them was 40.20±12.39 years. Most of the people 874(80.2%) passed stool between 12-14 times per week followed by 111(10.2%) less than 3 stools per week, 95(8.7%) passed more than 14 stools per week and 10(0.9%) between 3-12 stools per week, p<0.001. Most people passed predominantly Bristol type IV stool- 610(56.0%); followed by type III- 274(25.1%). Other stool forms were: type I- 52(4.8%), type II- 59(5.4%), type V- 31(2.8%), type VI- 33(3.0%), type VII- 31(2.8%), p<0.001. In regard to the physical activity, most of the respondents (70.0%) are physically active whereas about 13.0% are sedentary and about 17.0% are physically intermediate between the two, p<0.001. In the case of dietary habit, most of the participants are non-vegetarian (82.5%) and the remaining are vegetarian (11.1%) and occasional non vegetarian (6.4%), p<0.001. Median stool frequency in the studied population was 14 per week and predominant form was Bristol type IV. Older age was associated with lesser stool frequency, particularly among female subjects.

Study on Endoscopic Retrograde Cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.