Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
1.
J Assoc Physicians India ; 70(6): 11-12, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35702836

RESUMO

BACKGROUND: Though the risk factors for nonalcoholic fatty liver disease (NAFLD) are the same in diabetic and nondiabetic patients, their exact interrelation and weightage in the pathogenesis are unclear Methods: A total of 130 nondiabetic and 170 diabetic patients with NAFLD [diagnosed on abdominal ultrasound and severity assessed by NAFLD fibrosis score (NFS)] were recruited from 2009 to 2018 and their baseline risk factors [body mass index (BMI), waist circumference (WC), blood pressure, presence of the metabolic syndrome (MS) and insulin resistance (IR) by Homeostasis Model of Assessment for Insulin Resistance (HOMA-IR), fasting blood glucose (FBG) and lipid levels, and hemoglobin A1c (HbA1c) levels] were noted and their interrelationship studied. The nondiabetic patients were prospectively followed up for alteration of glycemic status. RESULTS: There was presence of high BMI (>23) in 66%, central obesity in 86% (of whom 59% had normal body weight), low high-density lipoprotein cholesterol (HDL) in 51%, high triglyceride (TG) in 68%, high low-density lipoprotein cholesterol (LDL) in 46.7%, IR in 86%, hypertension in 54%, and the MS in 57%. Hemoglobin A1c was high in 42.3% of nondiabetics. The prevalence of the MS was significantly higher in patients having IR and vice versa but only the MS and its components as also increasing age determined advanced fibrosis. After mean follow-up 7.3 years, progression from prediabetes (PD) to diabetes mellitus (DM) occurred in 10%, from normal glucose tolerance (NGT) to PD in 6.25%, and progression of NFS occurred in 16.9%. Advanced age, low HDL and high TG were associated with IR and were involved in glycemic progression as also obesity in progression from NGT to PD and central obesity from PD to DM. CONCLUSION: Though IR and MS go hand in hand in the pathogenesis of NAFLD in both diabetic and nondiabetic patients as well as in the glycemic progression of nondiabetic patients with NAFLD, the MS or its components have more weightage in determining the severity.


Assuntos
Diabetes Mellitus , Resistência à Insulina , Síndrome Metabólica , Hepatopatia Gordurosa não Alcoólica , Glicemia , Índice de Massa Corporal , HDL-Colesterol , Diabetes Mellitus/epidemiologia , Fibrose , Seguimentos , Hemoglobinas Glicadas/metabolismo , Humanos , Resistência à Insulina/fisiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/epidemiologia , Obesidade Abdominal , Fatores de Risco , Triglicerídeos
2.
J Assoc Physicians India ; 67(4): 47-52, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31311219

RESUMO

BACKGROUND: The liver, being involved in multiple metabolic processes, not only impacts the endocrine system normally but also become an inevitable target during the course of endocrine disorders. The effects of this intricate relationship which may be disrupted in CLD can only be addressed by simultaneously studying all hormone profiles in such patients and also their relation to etiology and severity of CLD. METHODS: Serum fasting cortisol, insulin, prolactin, testosterone, estradiol, FSH, LH and thyroid hormones (TSH, free T4 & T3) were measured for any abnormality in 100 randomly selected patients of CLD in a cross sectional observational study and their relation to etiology and severity of CLD (estimated by MELD and CTP score) were studied. RESULTS: Cortisol, estradiol and insulin levels were significantly higher in alcoholics, the former two also increased with severity of CLD. There was overt hypothyroidism in 19% and subclinical hypothyroidism 43% patients, especially those with chronic hepatitis C and autoimmune hepatitis. Testosterone levels were lower in males. Other hormonal changes were independent of severity or etiology of CLD. Cortisol and insulin levels were significantly higher in diabetics with CLD. CONCLUSION: Significant alterations of hormonal profile starting early in the development of CLD of any etiology occur which may need treatment or close follow up. ALD may have worse outcome due to disturbed metabolism of sex hormones, cortisol and insulin. The normal endocrine homeostasis of the body may become disrupted in presence of CLD which may also influence outcome.


Assuntos
Hipotireoidismo , Hepatopatias , Estudos Transversais , Humanos , Insulina , Masculino , Hormônios Tireóideos
3.
Indian J Public Health ; 58(3): 186-94, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25116825

RESUMO

BACKGROUND: There is scarce Indian data on time trends of hepatitis, an impediment to formulate an effective public health policy on the matter. OBJECTIVE: The aim was to study secular trends and burden of hepatitis in a railway population. MATERIALS AND METHODS: Outdoor, indoor, endoscopy unit and mortality records of patients attending this hospital from January 2003 to December 2011 were searched manually and relevant parameters of hepatitis patients were noted, especially etiology, clinical features, treatment, and mortality. Cochran-Armitage trend test was used to test significance of any trend in these parameters. Binary logistic regression analysis of various factors was carried out to study their effect on the liver related mortality of hepatitis B and C cases and Kaplan-Meyer survival curves were generated for significant factors. Two-sided P < 0.05 was considered to be significant. RESULT: Chronic liver disease (CLD) due to alcohol showed a significant rising trend with early age (mean 48.4 years) and high percentage of decompensated disease (75%) at presentation and high early mortality (63%). No trend was observed for hepatitis B and C, but significant reduction in mortality was observed when definitive therapy was given. Cryptogenic CLD showed a decreasing trend though overall it still remained the most important etiology and survival was better compared with alcohol even with conservative therapy. Only 4% patients had hepatocellular carcinoma. CONCLUSION: A menace of alcohol related liver disease affecting young productive work force in this part of India is foreseen, which might impact the country's economy and mandates immediate containment policy.


Assuntos
Hepatopatias/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Feminino , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Hepatite Crônica , Humanos , Índia , Estimativa de Kaplan-Meier , Hepatopatias/mortalidade , Hepatopatias Alcoólicas/epidemiologia , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
4.
Indian J Gastroenterol ; 43(3): 652-659, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38158544

RESUMO

BACKGROUND: The global burden of chronic hepatitis B remains high and the best possible treatment remains long-term viral suppression expecting cure. METHODS: Total 154 patients of chronic hepatitis B (48 HBeAg positive, e + ve) treated with oral entecavir (0.5 mg/1 mg per day) were recruited from June 2007 and followed prospectively until December 2022 for persistent HBV DNA negativity, HBeAg and HBsAg loss/seroconversion and other liver and drug-related events in real-life settings. RESULTS: The mean duration of therapy was 6.78 (2-14) years with 1364 person-years of follow-up. All patients were HBV DNA negative by 15 months and remained so until the last follow-up. As many as 16.7% lost HBeAg after eight to 13 years of therapy, but not HBsAg. The mean fall in serum HBsAg level per year was 0.158 log IU/mL, being significantly higher in e + ve patients at baseline and until two years of therapy. The decline was significant until six years in e + ve patients compared to two years in e - ve ones. None had biochemical or virological breakthrough (except eight defaulters), flares or any untoward effects. The incidence of liver-related events, hepatocellular carcinoma and death was 10.4%, 1.9% and 14.3%, respectively, and 5.2% deaths were liver-related whose predictors were presence of cirrhosis (log rank 46.5, p > 0.001) and higher HBsAg level > 4 log IU/mL (log rank 18.15, p < 0.001) at baseline. CONCLUSION: Long-term entecavir therapy provides additional benefits of continuous reduction of serum HBsAg levels beyond suppression of HBV DNA.


Assuntos
Antivirais , Guanina , Antígenos de Superfície da Hepatite B , Antígenos E da Hepatite B , Hepatite B Crônica , Humanos , Guanina/análogos & derivados , Guanina/uso terapêutico , Guanina/administração & dosagem , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/sangue , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Antígenos de Superfície da Hepatite B/sangue , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Antígenos E da Hepatite B/sangue , Fatores de Tempo , DNA Viral/sangue , Estudos Prospectivos , Resultado do Tratamento , Seguimentos , Duração da Terapia , Adulto Jovem
6.
Gut Liver ; 18(4): 578-592, 2024 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-38680110

RESUMO

Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions. Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.


Assuntos
Eixo Encéfalo-Intestino , Humanos , Eixo Encéfalo-Intestino/fisiologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Dor Visceral/fisiopatologia
7.
J Clin Exp Hepatol ; 14(3): 101310, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38264577

RESUMO

Background/Aim: Thalassemia patients are susceptible to hepatitis C virus (HCV) infection due to blood transfusions. Currently, data on treating HCV in thalassemic children with direct-acting antivirals is lacking. This study was performed to determine the efficacy and safety of sofosbuvir-daclatasvir combination therapy in thalassemic children and adolescents. Methods: A nonrandomized, open-label, interventional study was carried out in a tertiary care hospital. Consecutive noncirrhotic treatment-naïve thalassemic patients with HCV infection with viremia, within the age group of 6-18 years, were treated with the combination of sofosbuvir-daclatasvir: 200 mg + 30 mg for age 6-11 years (Group A) and 400 mg + 60 mg for age 12-18 years (Group B). The primary endpoint was sustained virological response at 12 weeks (SVR12). Results: A total of 70 patients (Group A 45, 64% male; Group B 25, 40% male) were recruited. The mean age was 8.5 years and 13.9 years in the two groups. Mean HCV Ribonucleic acid (RNA) levels in Groups A and B were 446906.1 IU/ml and 256187.8 IU/ml, respectively. SVR12 was achieved in 43 of 45 (95.5%) patients on an intention-to-treat basis and 43 of 44 (97.7%) patients on a perprotocol basis in Group A, and all patients in Group B (100%). In both groups, there was a significant improvement in biochemical parameters. Among the two patients who did not achieve SVR12 in Group A, one required termination of therapy due to urticaria. Conclusion: Sofosbuvir-daclatasvir based treatment in noncirrhotic, treatment-naive thalassemic children and adolescents infected with HCV is effective and safe.

8.
J Clin Exp Hepatol ; 13(4): 707-712, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37440944

RESUMO

Introduction: Infantile hepatic hemangioma (IHH) is the most common benign liver tumor in children, and multifocal and diffuse tumors often become life-threatening, necessitating therapy. Propranolol is now considered the first choice of therapy with ample data in Caucasian children. We present a series of nine Indian children with multifocal (n = 5) and diffuse (n = 4) IHH treated with propranolol monotherapy. Methods: This was a retrospective clinical data-based single-center study. Propranolol was used at a median dose of 3.2 mg/kg/day (range 3-3.3 mg/kg/day) for a median duration of 12 months (range 6-32 months). Results: The presentations of IHH (either in isolation or combination) were hypothyroidism in six patients (diagnosed by elevated serum TSH levels), heart failure in three (diagnosed based on clinical and echocardiographic features), and imaging evidence of macrovascular shunting in two patients. A good response to propranolol monotherapy (with a median dose of 3.2 mg/kg/day for a median duration of 12 months) was observed in eight patients, with a poor response in one. One patient experienced recurrence but responded adequately to propranolol retreatment. Conclusions: Our data reiterate the excellent response (88.9% responded) and safety profile with propranolol monotherapy in complicated IHH and strengthen the data in Asian (Indian) children. It includes the maximum proportion of complicated IHH treated with propranolol in East and South Asia, and the largest series from India.

9.
Indian J Pathol Microbiol ; 66(4): 790-798, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38084534

RESUMO

Background: Cholestatic disorders are a significant cause of morbidity and mortality in infants. Characterization of these disorders and differentiating biliary atresia (BA) from other causes of intrahepatic cholestasis is an age-old problem. Objectives: To study the spectrum of different infantile cholestatic disorders in our population, to differentiate BA from other causes of neonatal cholestasis (NC) on a liver biopsy, and validation of the available scoring system for the characterization of these disorders. Materials and Methods: This is an observational cross-sectional study performed over a period of 3 years between 2018 and 2021, done on neonates and infants presenting with cholestatic jaundice. The changes on liver biopsy were evaluated by different histological parameters and available scoring systems to differentiate BA from non-BA causes. Correlation with clinical, biochemical, and imaging findings was done in all cases. Results: This study included 87 cases of NC, of which BA comprised 28 cases (32%), whereas idiopathic neonatal hepatitis (INH) comprised only 12 cases (14%). Portal neutrophilic inflammation (P = 0.000053), ductal cholestasis (P < 0.001), neoductular bile plugs (P < 0.001) and bile ductular proliferation (P < 0.0001) were significantly more in BA, whereas lobular lymphocytic inflammation (P = 0.001) and giant cell transformation of hepatocytes (P = 0.0024) were more frequent in the non-BA group. Using the Lee and Looi scoring system, a histologic score ≥7 was helpful in identifying BA with 85.7% sensitivity, 92.6% specificity, and 90.6% accuracy. Conclusion: BA is the commonest cause of NC in neonates, whereas the frequency of INH is declining. Detailed histomorphologic analysis of liver biopsy, aided with IHC, is the cornerstone for the diagnosis of these disorders.


Assuntos
Atresia Biliar , Colestase Intra-Hepática , Colestase , Lactente , Recém-Nascido , Humanos , Atresia Biliar/diagnóstico , Atresia Biliar/complicações , Atresia Biliar/patologia , Fígado/patologia , Estudos Transversais , Sensibilidade e Especificidade , Colestase/diagnóstico , Colestase/etiologia , Colestase/patologia , Biópsia , Colestase Intra-Hepática/diagnóstico , Inflamação/patologia , Diagnóstico Diferencial
10.
World J Gastroenterol ; 28(40): 5818-5826, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36353204

RESUMO

There is increasing incidence and prevalence of acute and chronic liver diseases (CLDs) all over the world which influence the quality of life and can give rise to life threatening complications. The burden of advanced liver disease due to hepatitis B has been controlled by antivirals but its eradication is difficult soon. Highly effective directly acting antiviral therapy has reduced the burden of hepatitis C but is partially offset by increasing IV drug abuse. Non-alcoholic fatty liver disease pandemic is on and there is recent alarming increase in alcohol related liver disease, both of which have no drug cure apart from control of the risk factors. Genetic factors have been identified in progression of all forms of CLD. Due to better management of complications of CLD, the life span of patients have increased spiking the number of hepatocellular carcinoma (HCC) and patients needing liver transplantation (LT). The present severe acute respiratory syndrome coronavirus pandemic has affected the outcome CLD including LT in addition to causing acute hepatitis. Better diagnostics and therapeutics are available for liver fibrosis, portal hypertension, HCC and post LT management and many drugs are under trial. The present review summarises the current scenario of the epidemiology and the advances in diagnosis and treatment of liver diseases including their complications like portal hypertension, HCC and LT.


Assuntos
Carcinoma Hepatocelular , Hipertensão Portal , Neoplasias Hepáticas , Transplante de Fígado , Hepatopatia Gordurosa não Alcoólica , Humanos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico , Qualidade de Vida , Transplante de Fígado/efeitos adversos , Cirrose Hepática/patologia , Antivirais/uso terapêutico , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Hipertensão Portal/etiologia
11.
J Family Med Prim Care ; 11(12): 7750-7755, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36994016

RESUMO

Aims: To determine the long-term incidence and outcome of gastrointestinal (GI) bleeding in users of aspirin with (dual antiplatelet therapy, DAPT) or without clopidogrel. Settings and Design: Prospective hospital based 12-year study. Methods and Material: There were 1047 patients on either aspirin 150 md/day alone (n = 574, 54.8%) or aspirin 75 md/day + clopidogrel 75 md/day (n = 473, 45.2%) were followed up for any incident GI bleed, rebleed and mortality. Those simultaneously using other drugs known to cause GI bleeding were excluded. Comorbidities, concomitant use of proton pump inhibitors and statins were noted. Results: GI bleed occurred in 11.8% after 8,683 person years of follow up. 56 (45%) patients had lower GI source of bleed [colon 9 (7%), small gut 47 (38%)] and 68 (55%) had upper GI source [duodenum 39 (32.3%), stomach 28 (22.6%) and oesophagus 1 (0.1%)]. Whereas stomach and duodenum were the chief sites in the first year, small gut predominated in later years. The cumulative bleeding rate after 1, 5 and 10 years was 5%, 8% and 11%, respectively, higher in the DAPT group. Bleeding stopped spontaneously in 98% on drug withdrawal, and 7.3% patients rebled in the next 6.2 years. The overall mortality was 33.1% but only 1.6% was due to the bleed being significantly lower in the DAPT group. On multivariate analysis coronary interventions, diabetes mellitus, renal and multiorgan dysfunction were the significant predictors of GI bleed and mortality. Conclusions: Though the incidence and mortality are low, GI bleed increases with longer use of antiplatelet agents predominantly from the lower GI tract.

12.
Cureus ; 14(7): e26494, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35919215

RESUMO

Background Hepatoblastoma (HB) is a rare neoplasm of the liver, accounting for about 1% of all pediatric cancers. The aim of the present study is to report our experience with HBs over a period of five years from a tertiary center in Eastern India. Methodology This is a retrospective observational study. The data of all patients who were diagnosed with HB between August 2015 and December 2020 was reviewed. Results Twenty-three patients who were diagnosed and treated for HB at our center were included in the study. Sixteen (69.5%) of them were male. The median age of presentation was 14 (range, 3-58) months. An abdominal lump (n=23, 100%) and abdominal pain (n=11, 47.8%) were the most common presenting symptoms. The median level of serum alpha-fetoprotein at the time of initial evaluation was 8000 (878-1,280,000) ng/dL. The mean size of the largest focus in its largest dimension was 12.03±3.77 cm. The epithelial variant (n=22, 95.7%) was the most common histological subtype. One (4.3%), 10 (43.4%), 11 (47.8%), and one (4.3%) patient were found to have pre-treatment extent of tumor (PRETEXT) stages 1, 2, 3, and 4, respectively. Fifteen (65.2%) children were classified as standard risk and seven (34.7%) children as high risk. All the patients received neoadjuvant chemotherapy (NACT). The most commonly performed surgery was right hepatectomy (n=12, 52.1%). There were three (13%) cases of perioperative mortality. Four postoperative complications developed in three (13%) patients. Four (17.3%) patients developed chemotherapy-related complications. The median duration of follow-up was 31 (range, 0-58) months. Three (13%) patients developed relapses of the disease. Overall, five-year survival in our series was 73.9%. Conclusion This study shows that the overall outcomes of HB in a resource-limited setting such as ours are good with the adoption of multi-modality treatment. Managing chemotherapy-induced complications and making liver transplantation more feasible will improve the results further.

13.
Int J Colorectal Dis ; 26(5): 635-44, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21063715

RESUMO

BACKGROUND: Inflammatory bowel disease is an emerging problem in Asia including India. Clinical data on this disease from eastern India and on its temporal trends in India is scarce. MATERIALS AND METHODS: Existing Indian data on inflammatory bowel disease were retrieved using PubMed and a comparison of earlier data (up to 1980s) was made with more recent data (1990s and later) and our own data to find any significant differences. Our data included clinical data of 40 and ten consecutive patients with ulcerative colitis and Crohn's disease, respectively, collected prospectively from January 2003 to June 2009. For those whose symptoms started before 2003, data collection was partly retrospective. It included demography, symptoms and duration at presentation, follow-up findings, course, extraintestinal manifestations, treatment outcome and complications. Data were analysed by descriptive and analytical statistics. RESULTS: Sixty-five percent of our ulcerative colitis patients presented with pancolitis, majority had severe clinical, endoscopic and histologic disease commensurate with other recent studies but in contrast to milder presentation in earlier studies. Of our patients, 27.5% developed pseudopolyposis of colon, two within 1 year of disease onset; 10% developed cancer colon for whom disease duration of 10 years or more was the only significant risk factor. Majority of our patients with Crohn's disease had mild inflammatory disease involving small gut which was controlled with aminosalicylates. Obscure lower GI bleed was an important mode of presentation. CONCLUSIONS: Ulcerative colitis is presenting with increasing severity and extent in recent times. Rapid development of colonic pseudopolyposis was observed.


Assuntos
Doenças Inflamatórias Intestinais/epidemiologia , Adulto , Estudos de Coortes , Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Fatores de Risco , Fatores de Tempo
14.
Indian Pediatr ; 57(8): 723-729, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32844758

RESUMO

JUSTIFICATION: Cow's milk protein allergy (CMPA) is increasingly being diagnosed in the West, while there is scant data on the subject from India. There is low awareness among pediatricians about its diagnosis and management; leading to improper diagnosis. PROCESS: A group of experts from the pediatric gastroenterology sub-specialty chapter of Indian Academy of Pediatrics (Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition) met at Mumbai on 26 October, 2018 and discussed various issues relating to the subject. A broad consensus was reached and a writing committee was formed. They met again on 11 August, 2019 at Chennai for a detailed discussion. The statement was sent to the entire group by e-mail and their approval obtained. OBJECTIVE: To formulate a consensus statement enable proper diagnosis and management of Cow's milk protein allergy. RECOMMENDATIONS: Cow's milk protein allergy is most common in the first year of life. Gastrointestinal manifestations are usually non-IgE mediated and therefore skin prick test and specific IgE levels are not useful in diagnosis. Clinical response to elimination diet followed by a positive oral food challenge is diagnostic. In patients with only gastrointestinal manifestations, sigmoidoscopy and rectal biopsy may be considered as an alternative. Management involves strict avoidance of all forms of bovine milk protein. For infants who are artificially fed, an extensively hydrolyzed formula is the first choice. Soy formula is an alternative in those above six months of age. Since most infants outgrow the allergy, elimination diet is only for a limited period and re-evaluation should be done periodically.


Assuntos
Gastroenterologia , Hipersensibilidade a Leite , Animais , Bovinos , Criança , Feminino , Humanos , Índia , Lactente , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/terapia , Proteínas do Leite , Testes Cutâneos
15.
Indian J Gastroenterol ; 38(1): 69-76, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30868452

RESUMO

BACKGROUND: There are scanty data on the long-term outcome of endoscopic variceal band ligation (EVL) for esophageal varices. METHODS: Adult patients suffering from a chronic liver disease (CLD) undergoing EVL of esophageal varices of grade 2 and above between January 2006 and December 2015 were followed up for the recurrence of varices, worsening of portal hypertensive gastropathy (PHG), rebleeding, and mortality. EVL was done as primary prophylaxis of bleeding in 72 and as secondary prophylaxis in 175 patients. All received propranolol after EVL if there was no contraindication. RESULTS: Two hundred and forty-seven CLD patients (mean age 51.83 ± 11.28 years, 179 males) underwent 306 EVL sessions. The most common etiology was alcohol (53%). Sixty-eight percent of patients had grade 3 esophageal varices 76.5% had PHG. There was no immediate post-EVL bleeding or 30-day mortality. Variceal obliteration was achieved in 100% with 19% recurrence within a mean period of 53.74 ± 27.2 months. PHG worsened in 49.7%. Overall, rebleeding occurred in 13.8%, 4.3% from recurrent varices. There was no difference in variceal recurrence (16.7% vs. 20%) and incidence of rebleeding (9.7% vs. 13.7%) between patients undergoing EVL for primary and secondary prophylaxis. Cumulative rebleeding rates after 1, 5, and 9 years were 1.6%, 9.2%, and 11.4%, respectively. The overall mortality was 85%, mostly from progressive CLD, and only 8.6% was due to rebleeding. On subgroup analysis, the factors significantly associated with rebleeding was Child-Pugh class C and worsened PHG those with mortality were alcohol and Child-Pugh class C. CONCLUSION: EVL is effective in the long-term for both primary and secondary prophylaxis of esophageal variceal bleeding.


Assuntos
Endoscopia do Sistema Digestório/métodos , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia/prevenção & controle , Ligadura/métodos , Hepatopatias/complicações , Prevenção Secundária , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
ACG Case Rep J ; 6(4): e00026, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31616725

RESUMO

The author presents a rare case of overlap syndrome associated with myasthenia gravis in the absence of acetylcholine receptor antibody and thymoma. Various liver autoantibodies developed at different times later in the disease course and myasthenia occurred 5 years after the diagnosis of liver disease. The importance of repeating antibody panel later in the disease course for proper diagnosis and timely treatment is highlighted. The exact mechanism of the development of myasthenia gravis in autoimmune liver disease also needs investigation for the possibility of new drug development that might be beneficial to both.

17.
Arq Gastroenterol ; 56(3): 270-275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633724

RESUMO

BACKGROUND: Metabolic risk factors of non alcoholic fatty liver disease (NAFLD) in non diabetic teetotallers who constitute a definite group are not well defined. OBJECTIVE: To identify the metabolic risk factors of NAFLD if any in non diabetic subjects who do not consume alcohol. METHODS: In a cross sectional study the effect of metabolic parameters (BMI, individual lipid levels, hemoglobinA1c (HbA1c), HOMA IR and the metabolic syndrome components) of 150 consecutive non diabetic teetotallers (90 with normal glucose tolerance and 60 prediabetics) on their NFS (quantifiable severity parameter of NAFLD) was studied by linear regression analysis. Similar study was done in the normal glucose tolerance and prediabetes groups separately. These parameters were then compared with those of 75 matched diabetic teetotallers with NAFLD. To analyse further the difference between normal glucose tolerance, prediabetic and overt diabetic groups, binary logistic regression of the factors was carried out taking prediabetes and diabetes as outcome variable. RESULTS: All the metabolic parameters were significantly higher in diabetics compared to non diabetics and in prediabetics compared to those with normal glucose tolerance except high-density lipoprotein cholesterol. Triglyceride, high-density lipoprotein cholesterol and BMI significantly predicted NFS in the overall (adjusted R2 68.7%, P=0.000) and normal glucose tolerance groups (adjusted R2 73.2%, P=0.000) whereas BMI, triglyceride, low-density lipoprotein cholesterol and HbA1c did in prediabetics (adjusted R2 89%, P=0.000). The metabolic syndrome was significantly associated with NFS in the overall and prediabetic groups. High triglyceride (odds ratio1.08), low-density lipoprotein cholesterol (odds ratio1.03) and HbA1c (odds ratio 11.54) were positively associated with prediabetes compared to normal glucose tolerance group. CONCLUSION: In nondiabetic teetotallers dyslipidemias are the prime contributors to the development of NAFLD.


Assuntos
Dislipidemias/metabolismo , Resistência à Insulina/fisiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/metabolismo , Dislipidemias/sangue , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etiologia , Obesidade/metabolismo , Fatores de Risco , Triglicerídeos/sangue
18.
Inflamm Intest Dis ; 4(3): 104-114, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31559262

RESUMO

OBJECTIVES: Recently, the incidence of alcohol-related liver disease has been rising alarmingly in India with late presentation and short survival. Better delineation of factors affecting mortality is needed for optimal utilization of constrained resources like liver transplantation. METHODS: Baseline data of 395 patients with alcohol-related liver disease including age, clinical presentation, alcohol parameters (amount, duration, type), laboratory parameters for detecting organ failure, and prognostic scores were compared between survivor and deceased groups. Further subgroup analysis of deceased patients was done to identify factors associated with early mortality in acute-on-chronic liver failure (ACLF) and cirrhosis groups by multivariate analysis and receiver operating characteristic (ROC) curves. Only best supportive medical therapy was offered to all. RESULTS: 80 (20.3%) patients had alcoholic hepatitis (without cirrhosis) and recovered completely with abstinence. 315 (79.7%) had evidence of either cirrhosis (n = 182, 46.1%) or ACLF (n = 133, 33.6%) at presentation and all died within the next 2 years of follow-up, earlier in the ACLF cases. All deceased patients had been heavy drinkers for long periods (>85 g/day for >17 years). Higher age, amount of alcohol consumption, number of organ failures and discriminant function score predicted severe disease and early mortality, the latter being the best predictor. The European Foundation for the study of chronic liver failure consortium (CLIF-C) score has good applicability in Indian ACLF cohorts. Serum glutamic pyruvic transaminase was normal in 73.8% of deceased patients compared to only 12.5% of survivors. Abstinence did not result in complete normalization of deranged laboratory parameters in those who died. CONCLUSION: Alcohol-related liver disease is serious with high short-term mortality, which has early identifiable but mostly irreversible factors. Urgent measures need to be taken to curb this rising menace.

19.
Indian J Gastroenterol ; 27(1): 22-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18541934

RESUMO

AIMS: To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS: In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS: Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS: Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Adulto , Feminino , Gastroenterologia , Humanos , Índia/epidemiologia , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Estudos Prospectivos , Sociedades Médicas
20.
Trop Doct ; 48(3): 207-213, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29618279

RESUMO

Clinical data of 65 histologically documented ulcerative colitis patients from January 2001 to December 2013 were prospectively recorded till June 2017 and analysed to determine the outcome of long-term maintenance treatment. Drugs used were 5-aminosalicylates, steroids and azathioprine. Primary outcome measure was relapse. Though 73.8% patients relapsed, most occurred within the first five years with mild to moderate severity and were easily controlled with the same medicines. None had progressive disease; drug discontinuation was possible in six cases. Side effects of drugs were negligible. Rates of surgery, colon cancer, complications and disease-related death were very low. Longer disease duration, azathioprine discontinuation and 5-aminosalicylate use in dose < 2.4 g/d were positively associated with relapses. Biologics were not used in any patient. We conclude that long-term effective use of low-cost drugs in India may obviate the need for newer more expensive drugs.


Assuntos
Azatioprina/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Glucocorticoides/uso terapêutico , Mesalamina/uso terapêutico , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite Ulcerativa/fisiopatologia , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Índia , Quimioterapia de Manutenção , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa