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  Most popular articles (Since September 22, 2020)

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Renal dysfunction in chronic liver disease: Current concepts, classification, and management
Rohan Yewale, Balakrishnan S Ramakrishna
January-March 2021, 1(1):2-10
Renal dysfunction is not uncommon in patients with cirrhosis, particularly as disease advances and the liver function decompensates. This review discusses the various types of renal dysfunction that may occur, the current classification of these kinds of kidney injury, and the rational management of these disorders based on the pathophysiology of these conditions.
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Probiotics in gastroenterology
L Thayumanavan, M Tarakeswari, K Muthukumaran
January-March 2021, 1(1):11-16
Probiotic bacteria have become increasingly popular in the last two decades because of expanding scientific evidence pointing to their beneficial effects on human health. Currently it has become an attractive area of research in communicable and non communicable diseases. Their benefits are not only seen in GI diseases which are expected, but also seen in life style diseases like NAFLD and Cancer. This article provides a review of available information and summarizes the recent knowledge on the effects of prebiotics, probiotics and synbiotics on human health.
  1,056 99 -
GHEP: The launch of a new journal
BS Ramakrishna, Velusamy Balasubramanian, J Ubaldhus
January-March 2021, 1(1):1-1
  950 109 -
Safe sedation practices in acute liver failure in resource-constrained settings: A viewpoint
T. J. Vadivukkarasi, S. Kandasamy, K. P. P. Abhilash, Uday Zachariah, Ashish Goel, C. E Eapen
January-March 2021, 1(1):17-21
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Toll-like receptor gene polymorphisms in Indian patients with inflammatory bowel disease
Kirankumar Baskaran, Srinivasan Pugazhendhi, Balakrishnan Ramakrishna
January-March 2021, 1(1):22-27
Background: Defective innate immune recognition of gut microbes may be one reason for the genesis of inflammatory bowel disease (IBD). Genetic defects in IBD show considerable variation between populations. This study evaluated three single-nucleotide polymorphisms (SNP) in the toll-like receptor (TLR) genes in patients with IBD and healthy controls. Methods: DNA isolated from peripheral blood of 200 IBD patients (100 Crohn’s disease and 100 ulcerative colitis) and 100 healthy controls were subjected to polymerase chain reaction and restriction enzyme digestion for three SNPs in TLR4 (D299G, rs4986790), TLR5 (392 stop codon, rs5744168) and TLR9 (-1486 T/C, rs187084) genes, and genotypes assigned according to the restriction fragment length polymorphism pattern. Results: Minor allele frequencies for the 3 polymorphisms were not significantly different between IBD patients and healthy controls. The TLR4 rs4986790 minor allele (G) frequency was 27/200 in controls compared to 48/400 in IBD (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.52–1.44, P = 0.6007). The TLR5 rs5744168 minor allele (T) frequency was 19/200 in controls compared to 45/400 in IBD (OR 1.20, 95% CI 0.63–2.12, P = 0.5132). The TLR9 rs187084 minor allele (C) frequency was 71/200 in controls compared to 129/400 in IBD (OR 0.88, 95% CI 0.61–1.26, P = 0.4261). Conclusion: These three polymorphisms in the TLR genes were not associated with IBD in the Indian population.
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Norovirus infection in renal transplant patients with chronic diarrhea: A report of four cases and review of the literature
Sarojini Ashok Parameswaran, B Subba Rao, S Balasubramaniam, Ashok Parameswaran, Anil Tarigopula
January-March 2021, 1(1):28-33
Diarrhea is not uncommon in immunocompromised patients We report here four renal transplant patients in whom a molecular testing panel for gastrointestinal pathogens revealed positive test for norovirus.
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Cap polyposis in a child: A rare cause of rectal bleeding
S Arulprakash, Tarun George, Malathi Sathiyasekaran
January-March 2021, 1(1):34-36
Inflammatory cap polyposis (CP) is a uncommon, non-malignant condition characterized by the presence of sessile and pedunculated polyps in the colon and rectum. The histology of these polyps reveals a “cap” of inflammatory granulation tissue with fibrinopurulent exudate that covers the polyps, hence the name “inflammatory cap polyposis”. The pathogenesis of this non-malignant condition is poorly understood and while several associations have been made, causality has yet to be elucidated. The mainstay of initial treatment is conservative, however complicated and refractory cases usually benefit from endoscopic or surgical intervention followed by close surveillance for disease recurrence and progression. We present a 12 yr old girl with a large cap polyposis which was resected successfully by EMR and literature review.
  414 41 -
Stones and abdominal pain – Not the usual suspects
Rajeeb Jaleel, Girish Desai, Amit Kumar Dutta
January-March 2021, 1(1):44-44
  386 45 -
Duodenal tuberculosis
S Palaniappan, Manoj Munirathinam, A Murali
January-March 2021, 1(1):37-39
Tuberculosis (TB) of the gastrointestinal tract is common in India. The most common site is the ileocecal region. TB involving the duodenum is rare. It can present as duodenal ulcer, gastric outlet obstruction, and rarely with periduodenal lymph nodal involvement and bile duct erosion. Here, we report a patient who presented with pain abdomen and significant weight loss. Evaluation revealed a duodenal ulcer with paraduodenal nodal mass with probable contained perforation. Endoscopic ultrasound with fine-needle aspiration cytology of the nodal mass revealed the diagnosis of TB. She was started on anti-TB therapy and responded well with complete resolution. This case report emphasizes the need for having TB as a differential diagnosis for duodenal ulcer in an endemic country like India.
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Giant abdominoscrotal hydrocele in decompensated liver disease
Jacob Nikhil Thomas, Joy Varghese
January-March 2021, 1(1):43-43
  394 34 -
Metastatic adenoid cystic carcinoma – An unusual neoplastic lesion of the liver
Ashish Tapadia, Karattupalayam Sampath Mouleeswaran, Jacob Nikhil Thomas, Joy Varghese
January-March 2021, 1(1):40-42
Adenoid cystic carcinoma (ACC) is an uncommon tumor of the salivary glands and is known for its delayed presentation of distant metastasis. However, delayed presentation of metastatic ACC in the liver without primary recurrence is rare, and literature is limited. In this case report, we present a case of metastatic ACC involving the liver without primary recurrence 6 years after radical excision of submandibular ACC.
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Low-volume plasma exchange and low-dose steroid to treat severe liver injury
Uday Zachariah, Santhosh E Kumar, Vijay Alexander, Lalji Patel, Ashish Goel, CE Eapen
April-June 2021, 1(2):47-54
High-volume plasma exchange (PLEX) to treat acute liver failure is now categorized as a Category I indication (i.e., first-line treatment as a stand-alone treatment or with other treatment modalities) by the American Society for Apheresis after a randomized controlled trial of 183 patients demonstrated survival benefit by this treatment. In this review, we provide an introduction to PLEX to treat acute liver failure syndromes for hepatologists and gastroenterologists. From our recent experience of treating 188 patients with acute liver failure syndromes with low-volume PLEX and low-dose steroid, we present five illustrative case histories of patients who benefitted from this management protocol. We discuss some postulated mechanisms how PLEX benefits patients with acute liver failure syndromes. PLEX appears to provide survival benefit in patients with acute liver failure syndromes (severe acute liver injury, acute liver failure, and acute-on chronic liver failure) and may be a nontransplant treatment option for some of these patients, especially in resource-constrained settings.
  226 27 -
Pelvic floor physiotherapy rehabilitation for dyssynergic defecation: An approach tailored to an Indian setting
Umamakeswari Venkatesa, M Srinivas, Mayank Jain, Jayanthi Venkataraman
April-June 2021, 1(2):82-85
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High-resolution esophageal manometry in clinical practice – An Indian perspective
Mayank Jain
April-June 2021, 1(2):75-81
High-resolution esophageal manometry (HREM) is a technique to determine the function of esophageal musculature and the integrity of the lower esophageal sphincter. This test is commonly used for evaluation of nonobstructive dysphagia, assessment of peristaltic reserve before anti-reflux surgery, symptoms of regurgitation, and noncardiac chest pain unexplained by endoscopic evaluation. The current review deals with the spectrum of esophageal motility disorders in India and reviews the technique and reporting of HREM. The clinical utility of HREM in Indian setting with special reference to challenges faced has been discussed in detail.
  143 13 -
Pulmonary nocardiosis: Life-threatening complications of antitumor necrosis factor-α treatment for Crohn's disease
Hemanta Kumar Nayak, Manas Kumar Panigrahi, Srujana Mohanty, Chandan Kumar, Subash Chandra Samal
April-June 2021, 1(2):72-74
Nocardia is an emerging infection in the era of biological therapy with a fatal outcome without treatment. Risk of dissemination and multisystem involvement demands an early diagnosis from the treating physician. We share our experience of such opportunistic infection (pulmonary nocardiosis) in a young male with Crohn's disease on injection adalimumab. The patient was managed with appropriate antibiotics and after therapy, prophylaxis with cotrimoxazole was initiated. Adalimumab was re-introduced, as he developed flare-up of the perianal disease on follow-up. Atypical opportunistic infection requires a meticulous approach to reach early diagnosis to prevent poor outcomes.
  124 16 -
Acute obstructive suppurative pancreatic ductitis secondary to intraductal stones
Avinash Bhat Balekuduru, Bongu Shruti Sagar, Satyaprakash Bonthala Subbaraj
April-June 2021, 1(2):66-68
Pancreatic sepsis secondary to infected necrosis or pancreatic abscess is a well-known clinical entity. Acute obstructive suppurative pancreatic ductitis (AOSPD) in the setting of chronic calcific pancreatitis is a rare complication that is seldom reported. We report two cases of AOSPD who underwent successful pancreatic endotherapy.
  128 9 -
In this issue of the journal
BS Ramakrishna
April-June 2021, 1(2):45-46
  122 10 -
Percutaneous endoscopic gastrostomy: A prospective study
Doraiswami Babu Vinish, Gautham Krishnamurthy, Arulprakash Sarangapani, Kayalvizhi Rajini, Balakrishnan Siddartha Ramakrishna
April-June 2021, 1(2):62-65
Introduction: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure for establishing enteral access for nutrition. There is a paucity of literature on PEG from the Indian subcontinent. With the rate of complications in the literature showing a downward trend, we aimed to analyze the same in our institute following a standard procedure of PEG tube placement. Methods: The prospective study was conducted including patients referred for PEG placement from August 2017 to December 2019. Data were recorded on a proforma. The primary aim of the study was to determine the rate of complications in patients undergoing PEG, whereas the secondary aim was to determine whether early feeding was associated with increased rate of infection or other complications. Patients were reviewed after 3 days, 1 month, and every 3 months thereafter later with clinical examination. Results: Sixty-seven (83.75%) males and 13 (16.25%) females with a median age of 51 years (range 1–85) were included in the study. Forty-one (51.25%) patients had comorbidities with hypertension being the most common (n = 28). Postoperative placement of the PEG tube was done in 47 (58.75%) patients. Seventy-four patients had underlying neurological or neurosurgical conditions. At the time of PEG placement, 59 (73.75%) had tracheostomy. All procedures were performed in the endoscopic suite, of which two were performed as day care procedures. There were no intraprocedural complications. Feed was started within 2 h in 45 (56.25%) patients and all tolerated feed well. There were no major postprocedural complications. Thirteen patients had clinically suspected PEG site infection, of which 11 patients had a culture-positive organism. All responded to conservative management. Thirty-two patients were on follow-up at a median follow-up period of 2 years. Conclusion: The incidence of complications following PEG tube placement is low. With the standardization of the PEG technique, no major complications were seen in our study. Early PEG feeding was not associated with an increase in the rate of complications.
  120 10 -
Ampullary stone in chronic pancreatitis causing obstructive jaundice and cholangitis
Sandheep Janardhanan, Allwin James, Alagammai Palaniappan, Ramesh Ardhanari
April-June 2021, 1(2):69-71
Cholangitis is very rarely caused by impaction of a pancreatic stone in the papilla. An elderly male presented with obstructive jaundice and cholangitis that was caused by an impacted pancreatic stone. He presented as fever of 2 weeks duration and was referred as case of periampullary neoplasm for palliative stenting. However, an endoscopic retrograde cholangiopancreatogram was done which revealed the impacted stone. Precut papillotomy was done to release the stone, which led to the resolution of cholangitis.
  106 13 -
Comparison of complete rockall score, Glasgow–Blatchford score, and AIMS 65 score for predicting in-hospital mortality in patients presenting with upper gastrointestinal hemorrhage at a Tertiary Care Hospital in Southern India
Anand Totagi, Usha Srinivas, Piramanayagam Paramasivan, Sankaranarayanan Krishnan, Kallipatti Ramasamy Palaniswamy, AT Mohan, Sarojini Ashok Parameswaran, Ubal Dhus, Muthuswamy Hariharan, MS Revathy, Natarajan Murugan, Karunakaran Premkumar, Seshadri Venkatesh, Preethi Mahalingam, Santhosh Kumar
April-June 2021, 1(2):55-61
Background: Multiple risk assessment scores are available to triage and stratify patients presenting with upper gastrointestinal (GI) hemorrhage. This study was conducted to compare the accuracy of complete Rockall score (CRS), Glasgow–Blatchford score (GBS), and AIMS65 score (AIMS65-albumin, INR >1.5, impaired mental status, systolic pressure <90 mm Hg, and age >65) in predicting in-hospital mortality in patients presenting with upper GI hemorrhage to the gastroenterology department at a tertiary care hospital in Southern India. The secondary objectives were to compare these three scores in predicting the need for blood transfusion, any intervention (endoscopic or radiological or surgical intervention), or rebleeding in patients presenting with upper GI hemorrhage. Materials and Methods: This was a retrospective analysis of prospectively recorded data which included 207 patients with acute upper GI hemorrhage admitted at a tertiary care hospital at Chennai over 2 years. Demographic, clinical, laboratory, and endoscopic parameters were recorded. CRS, GBS, and AIMS65 scores were calculated. Data regarding in-hospital mortality, need for blood transfusion, endoscopic intervention, radiological intervention, surgical intervention, and rebleeding were collected. Area under receiver operating characteristic curve (AUROC) was compared between the three scores in predicting in-hospital mortality, need for blood transfusion, intervention, and rebleeding. Results: AIMS 65 score >3 (AUROC 0.92) was a better predictor of in-hospital mortality than GBS (AUROC 0.77) and CRS (AUROC 0.69). AIMS65 was a better predictor of rebleeding (AUROC 0.804) than GBS (AUROC 0.676) or CRS (AUROC 0.623). GBS was a better predictor for need of blood transfusion (AUROC 0.785) than AIMS65 (AUROC 0.691) or CRS (AUROC 0.629). Conclusion: AIMS 65 score (>3) was a better predictor of in-hospital mortality than GBS or CRS in patients presenting with acute upper GI hemorrhage due to either variceal and nonvariceal etiology. AIMS 65 was also a better predictor of risk of rebleeding. GBS was a better predictor of need for blood transfusion and need for intervention.
  108 9 -