Showing papers by "Pramod Kumar Garg published in 2002"

Chronic pancreatitis: Asia-Pacific consensus report.

Abstract: Current knowledge about chronic pancreatitis (CP) is limited and there is a particular dearth of information about the entity known as tropical pancreatitis. A consensus working party was convened by the Trustees of the Journal of Gastroenterology and Hepatology Foundation to conduct a systematic investigation into available evidence about the epidemiology, etiopathogenesis, diagnosis and management of CP. A literature search and formal survey of international experts in the field were used to assemble reliable evidence about these issues. The present review summarizes the results of the working party's findings and presents a series of practice guidelines to improve diagnosis, investigation and treatment of patients with CP, particularly those in the Asia-Pacific region. Areas for further research have also been identified.

Electrophysiological and neuropsychological tests for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy.

Abstract: Background: Subclinical hepatic encephalopathy (SHE) features in 30–84% of patients with cirrhosis of the liver. Its clinical significance with regards to progression to overt encephalopathy has however, not been established. Aims: The present study was conducted (i) to compare the diagnostic usefulness of neuropsychological tests with that of electrophysiological (EP) tests in detection of SHE, and (ii) to examine the natural course of SHE. Methods: Seventy-five-nonencephalopathic cirrhotics (11 females, 64 males; mean (± SD) age 43.6 (± 11.7) years; mean (± SD) education 11(± 3) years) were studied using a battery of tests for intelligence and memory, the number connection test (NCT), and EP tests viz. electroencephalogram (EEG) and auditory P300 event related potentials (P3ERP). All the patients were followed up for a period of 6 months to 2 years for development of overt encephalopathy. Results: Thirty-five out of 75(47%) patients were diagnosed to have SHE based on at least one abnormal test result. The P3ERP latencies detected SHE in maximum number of patients (23%) followed by EEG (21%). Nearly 59% of patients with SHE progressed to overt encephalopathy within a mean duration of 4 months. Multivariate analysis showed that prior episode of encephalopathy (RR = 6.3; 95% CI = 2.0–19.7), abnormality on EEG (RR = 7.5; 95% CI = 2.2–25.3), abnormal performance on psychometric battery of tests (RR = 35.2; 95% CI = 4.3–287.3), occurrence of gastrointestinal bleed (RR = 19.3; 95% CI = 4.1–88.9), occurrence of dehydration (RR = 10.7; 95% CI = 2.5–45.4) and infection (RR = 11.4; 95% CI = 2.0–64.4) had significantly higher risk for development of overt encephalopathy. Conclusions: EP methods were more sensitive in detection of SHE. Amongst all the tests used, presence of only an abnormal EEG was significantly associated with development of overt encephalopathy along with the precipitating factors.

Role of anti-Helicobacter pylori treatment in H. pylori-positive and cytoprotective drugs in H. pylori-negative, non-ulcer dyspepsia: results of a randomized, double-blind, controlled trial in Asian Indians.

Abstract: Background: The efficacy of anti-Helicobacter pylori treatment and cytoprotective drugs in H. pylori-positive and -negative non-ulcer dyspepsia (NUD), respectively, is debatable. Methods: In a randomized study, the efficacy of anti-H. pylori treatment versus sucralphate was tested in patients with NUD. One hundred and twelve patients with NUD, 62 positive and 50 negative for H. pylori were studied. Of 62 patients positive for H. pylori, 32 were treated with triple therapy (colloidal bismuth subcitrate, tetracycline and metronidazole) for 2 weeks and the remaining 30 were treated with sucralphate (1 g, q.i.d.) for 4 weeks. Of 50 patients negative for H. pylori, 25 each were treated with either sucralphate (1 g, q.i.d.) or ranitidine (150 mg, b.d.) for 4 weeks. Results: In patients with NUD and H. pylori infection, triple therapy eradicated H. pylori in 88% and was superior to sucralphate in producing symptom relief (81 vs 33%, P = 0.0003) and histological improvement in gastritis (73 vs 30%, P = 0.003). In the H. pylori-negative group, sucralphate was superior to ranitidine with regard to symptom relief (68 vs 36%, P = 0.04) and improvement in gastritis (44 vs 12%, P = 0.09). The symptomatic improvement persisted until 12 weeks after the start of treatment in triple therapy group only. Conclusions: In patients with NUD associated with H. pylori, triple therapy was better than sucralphate in terms of symptomatic and histological improvement. However, sucralphate was superior to ranitidine in providing symptom relief in patients with H. pylori-negative NUD. © 1999 Blackwell Science Asia Pty Ltd

Plummer Vinson syndrome: unusual features.

Abstract: Plummer Vinson syndrome is a constellation of postcricoid esophageal webs, iron deficiency anemia, dysphagia and koilonychia. We describe some unusual manifestations in three patients with this syndrome; these were clubbing instead of koilonychia, tortuous esophagus in addition to presence of esophageal webs, and celiac disease.

Colonoscopic barotrauma treated by conservative management: role of high-flow oxygen inhalation.

Abstract: Most patients with colonoscopy-induced colonic perforation require urgent surgical intervention. Certain patients may, however, recover with conservative management. If the colonic perforation has been induced by barotrauma, there may be an extra-vasation of air which may lead to collection and tracking of air along the tissue planes, involving the retroperitoneum, peritoneal cavity, mediastinum, pleura, pericardium, or even the scrotum. The conservative treatment of colonic perforation includes bowel rest and antibiotics. Absorption of air collected in different body cavities may take some time, and inhalation of high-concentration oxygen may enhance the rate of gaseous absorption. We describe here a patient with colonic perforation induced by barotrauma, who recovered fully on conservative management with inhalation of high-concentration oxygen. We recommend that this approach should be used more frequently in such a situation.