Showing papers in "Indian Journal of Gastroenterology in 2004"

Efficacy of omega-3 fatty acids, atorvastatin and orlistat in non-alcoholic fatty liver disease with dyslipidemia.

Abstract: AIM To evaluate the efficacy and safety of three hypolipidemic agents in patients with non-alcoholic fatty liver disease associated with hyperlipidemia. METHODS Patients with dyslipidemia (Fredrickson type IIb), asymptomatic persistent transaminasemia lasting 24 weeks, and evidence of hepatic fat infiltration on ultrasonography and liver biopsy were studied. Those with predominant hypertriglyceridemia received omega-3 fatty acids (5 mL thrice daily) (Group A), those with predominant hypercholesterolemia received atorvastatin 20 mg/daily (Group B), and overweight patients received orlistat 120 mg thrice daily before meals (Group C). After 24 weeks of treatment, serum transaminase and lipid levels and liver ultrasonography were repeated. RESULTS Serum transaminase levels decreased significantly (p< 0.001) in all groups but the decrease was more marked in Group C (AST 75 [16] to 31 [7] IU/L; ALT 120 [38] to 41 [10] IU/L) than in Group A (AST 70 [14] to 41 [6]; ALT 110 [20] to 68 [12]) or Group B (AST 68 [13] to 46 [9]; ALT 115 [22] to 76.6 [13]). After treatment, ultrasonography showed resolution of fatty liver in 35% of patients in Group A, 61% in Group B, and in 86% in Group C (p< 0.001, Group C vs. A). CONCLUSIONS A decline in transaminase levels and normalization of ultrasonographic evidence of fatty liver were observed on treatment with omega-3 fatty acids in patients with hypertriglyceridemia, with atorvastatin in those with hypercholesterolemia, and orlistat in overweight patients with hyperlipidemia.

Hepatitis E virus is responsible for decompensation of chronic liver disease in an endemic region.

Abstract: Background: Hepatitis A virus infection in patients with previously stable chronic liver disease is associated with liver decompensation. Whether infection with hepatitis E virus (HEV) also does so is not known. Methods: We studied 32 patients with decompensated liver disease and definite evidence of underlying cirrhosis for evidence of recent HEV infection. Results: Of 32 patients, 14 (44%) had detectable IgM anti-HEV in their serum. In comparison, only 3 of 48 (6%) patients with stable cirrhosis and no recent decompensation had such antibodies (p<0.0001). Of the 14 patients with evidence of recent HEV infection, 11 had history of prodrome. The etiology of cirrhosis in these patients was: hepatitis B 6, hepatitis C 2, both hepatitis B and C 2, Wilson's disease 1, autoimmune 1 and cryptogenic 2. Two of these 14 patients died. Twelve patients survived, as compared to 9 of 18 patients without evidence of recent HEV infection (p<0.01). Conclusion: HEV infection is a frequent cause of decompensation in patients with liver cirrhosis in HEV-endemic regions.

Treatment of appendiceal mass: prospective, randomized clinical trial.

Abstract: Background Appendiceal mass may be treated in several ways. However, no randomized trial has been conducted to find the best option. Objective To compare the three most commonly used methods for treating appendiceal mass. Methods Over a three-year period, 60 consecutive patients with appendiceal mass were randomly allocated to three groups: Group A--initial conservative treatment followed by interval appendectomy six weeks later; Group B--appendectomy as soon as appendiceal mass resolved using conservative means; Group C--conservative treatment alone. Short-term outcome measures included operative time, operative difficulty, postoperative complications, length of hospital stay, and duration of time away from work. Long-term outcome measures were: number of hospital visits made, presence of severe incisional pain, scar appearance, and patients with recurrent appendicitis. Results Baseline characteristics were comparable in the three groups. In patients in Group A, operative time was less, adhesions were encountered less frequently, the incision had to be extended less often and post-operative complications were fewer, as compared to Group B. Patients in Group C had the shortest hospital stay and duration of work-days lost; only 2 of 20 patients in this group developed recurrent appendicitis during a follow-up period of 24-52 (median 33.5) months. Conclusion Of the three treatment modalities compared, conservative treatment without subsequent appendectomy appears to be the best.

A randomized trial of oral refeeding compared with jejunal tube refeeding in acute pancreatitis.

Abstract: BACKGROUND Relapse of pain during refeeding in acute pancreatitis may have a relation to the route of refeeding. AIM To compare the efficacy of oral refeeding with jejunal tube refeeding in patients with acute pancreatitis, and determine the frequency of refeeding pain and factors associated with it. METHODS Consecutive patients with acute pancreatitis, severe enough to stop oral feeding for 48 hours, were randomized to receive either oral or jejunal tube refeeding. The feeds were similar in calorie, lipid and protein content (400 Kcal on day 1, 1000 Kcal on day 2, 1400 Kcal on day 3, 1500 Kcal on day 4, and 1700 Kcal on day 5). Clinical and biological factors (serum amylase, lipase, C-reactive protein) and Balthazar CT severity index were recorded. Frequency of pain relapse and factors associated with it were analyzed. RESULTS 28 patients with acute pancreatitis (biliary 14, alcohol 9, idiopathic 3, post-ERCP 2) were included. Fifteen patients received oral and 13 received enteral tube refeeding. Four patients in the oral group and none in the enteral tube group had relapse of pain (p=0.06). The factors associated with refeeding pain were longer duration of initial pain (p<0.02) and higher CT severity index (p<0.02). Pain relapse increased the total hospital stay (p<0.004) and hospital stay after the first attempt at feeding (p<0.001). CONCLUSIONS Jejunal tube refeeding may reduce the frequency of pain relapse as compared to oral refeeding although the difference was not significant in this study. Longer duration of pain and higher CT severity index score were associated with occurrence of refeeding pain.

Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study.

Abstract: Background Palpation and percussion are standard bedside techniques used to diagnose hepatomegaly. Ultrasonography is a noninvasive and accurate method for measurement of liver size, but many patients in developing countries have limited access to it. We compared the accuracy of palpation and percussion in a rural population in central India, using ultrasonography as a reference standard. Methods The study design was a blinded, cross-sectional analysis of a hospital-based case series. Three physicians, blind to clinical data and to each other's results, independently used palpation and percussion to detect hepatomegaly. Diagnostic accuracy was measured by computing sensitivity, specificity, and likelihood ratio values. Inter-physician agreement was assessed using the kappa statistic. Results Of the 180 study patients, 36 (20%) had enlarged liver on ultrasonography. The likelihood ratios for findings at both palpation (2.2, 3.0, and 2.5 for the three physicians, respectively) and percussion (1.1 for all three physicians) as predictors of true hepatomegaly were low. The kappa values for inter-observer agreement between three physicians for the presence of hepatomegaly at palpation (=0.44-0.53) and percussion (=0.17-0.33) were low, indicating poor reliability of these techniques. Conclusion Clinical assessment of hepatomegaly by palpation and percussion lacks both accuracy and reliability.

Superimposed acute hepatitis E infection in patients with chronic liver disease.

Abstract: BACKGROUND: The natural history of infection with hepatitis E virus (HEV) in patients with chronic liver disease (CLD) is not well described. Our study aims to document the presentation, course and outcome of HEV superinfection in patients with CLD. METHODS: Over an 18-month period, ten patients with CLD were diagnosed to have HEV superinfection by detection of anti-HEV IgM antibodies in a setting of acute worsening. These patients were tested for HBsAg, IgM anti-HBc, anti-hepatitis C virus antibodies and IgM anti-hepatitis A virus antibodies, and were followed-up. RESULTS: The etiology of underlying CLD in the 10 patients (9 men; mean [SD] age 42.4 [10.3] years) was alcohol in five patients, hepatitis B in two, hepatitis C in one and cryptogenic in two. Seven patients presented for the first time with recent-onset liver decompensation (median duration 27 days, range 7-45). All 10 had ascites and 7 had hepatic encephalopathy. Four patients developed renal failure during the course of illness. The median (range) bilirubin, ALT and albumin levels at presentation were 18.6 (4.9-32.6) mg/dL, 105 (28-6610) IU/L and 32 (29-41) g/L, respectively. At 8 weeks, only one patient had normalization of serum bilirubin or ALT levels. Three patients (30%) died, including two of renal failure and one of massive upper GI bleed. CONCLUSIONS: Superinfection with HEV in patients with CLD causes severe liver decompensation, which is frequently complicated with hepatic encephalopathy and renal failure. Acute hepatitis E in these patients has a protracted course with high morbidity and mortality.

Etiological spectrum of sporadic malabsorption syndrome in northern Indian adults at a tertiary hospital.

Abstract: Background: The etiology of malabsorption syndrome (MAS) may differ in different geographical regions. Limited data are available on the etiological spectrum of MAS among Indian adults. Methods: Ninety-nine consecutive adult patients with MAS (urine d-xylose or =7 g/24 h) were evaluated for cause of MAS using standard criteria. Past medical records were examined to know the nature of treatment received. Results: The etiology of MAS was: tropical sprue 39, celiac disease 9, Crohn's disease 9, giardiasis 8, small intestinal bacterial overgrowth in absence of another cause of MAS 8, panhypogammaglobulinemia 2 (one with strongyloidiasis), intestinal lymphangiectasia 1, intestinal tuberculosis 4, idiopathic 15, acquired immunodeficiency syndrome 2, and amyloidosis 2. Twenty-eight patients had received anti-tubercular treatment earlier. Conclusions: Tropical sprue, celiac disease and Crohn's disease are common causes of MAS in Indian adults. Inappropriate anti-tubercular treatment is common in them and needs to be discouraged.

Risk factors for esophageal cancer in Coimbatore, southern India: a hospital-based case-control study.

Abstract: Background Cancer of the esophagus is common in India. The risk factors predisposing to cancer in southern Indian patients are not known. Aim To determine the role of smoking, alcohol and their combination, and diet factors in the etiology of cancer of the esophagus. Methods Risk factors like alcohol consumption, smoking, tobacco chewing, and pre-illness diet details in 90 patients with cancer of the esophagus were compared with those in age- and sex-matched control subjects. Results The risk for esophageal cancer was 3.5 times higher with alcohol consumption, 2.5 times higher for tobacco users, and 2.8 times higher each for betel nut chewers and smokers. The calculated odds ratio for the social habits and diet factors was significant amongst cases of cancer esophagus. Conclusion Alcoholism, smoking, and chewing of tobacco are factors predisposing to esophageal cancer in southern India.

Surgical management of corrosive strictures of stomach.

Abstract: Background Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. Methods Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. Results The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. Conclusions In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.

Psychological abnormalities in patients with irritable bowel syndrome.

Abstract: Irritable bowel syndrome (IBS) is a group of functional bowel disorders with different pathophyiological mechanisms but some common clinical features. It can be conceptualized within the biopsychosocial model of illness as a dysregulation of brain-gut axis and its relationships with psychosocial and environmental variables. Using advanced neuro-imaging techniques, it has been found that some brain centers (anterior cingulate cortex, limbic system, locus ceruleus) are active in mediating gut signals and that visceral hyperalgesia mediates perceptual sensitivity. Using new criteria for diagnosing psychosocial components of somatic illnesses, persistent somatization has been found as one of the main psychological factors that contributes to persistence of symptoms and poor treatment outcome in patients with IBS. Other psychological variables influencing symptom reporting have been identified in the constructs of health-care seeking, abuse, somatosensory amplification, and alexithymia. From a psychological viewpoint, IBS may be conceived as an abnormal cognitive processing of emotional and visceral stimuli, a tendency to perceive somatic stimuli as evidence of symptoms of disease, and to seek repeated and often unnecessary medical care.

Assessment of insulin resistance and effect of metformin in nonalcoholic steatohepatitis--a preliminary report.

Abstract: Introduction Insulin resistance plays a major role in the pathogenesis of nonalcoholic steatohepatitis (NASH). Insulin-sensitizing drugs like metformin may have a role in the treatment of this disease. Objective To determine insulin resistance and the role of metformin in the treatment of NASH. Methods We prospectively studied 25 patients with NASH over a period of one and a half years. In addition to clinicopathological profile, we studied the insulin resistance by insulin tolerance test in 10 of them; seven of them, who did not respond to 3 months of low-calorie, low-fat diet, exercise, weight reduction and ursodeoxycholic acid (UDCA), were treated with metformin for six months. Results were compared with control groups. Results All 10 patients with NASH tested had low insulin sensitivity; there was significant difference in the rate constant for insulin sensitivity (Kitt) between patients with NASH and normal volunteers. Thirteen (52%) patients responded to dietary restriction, exercise, weight reduction and UDCA. Four of 7 patients treated with metformin had normalization of ALT. Conclusion Patients with NASH have insulin resistance. Metformin may have a role in the treatment of these patients.

Comparison of enzyme-linked immunosorbent assay and indirect immunofluorescence assay in the diagnosis of human strongyloidiasis.

Abstract: BACKGROUND An enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence assay (IFA) were evaluated for serological diagnosis of human strongyloidiasis. METHODS Serum specimens obtained from 46 individuals infected with Strongyloides stercoralis, 37 healthy persons and 381 persons with other parasitic infections were tested using an IgG-ELISA that used crude antigen of S. stercoralis filariform larvae and an IFA. Test sera were pre-incubated with antigens from Ascaris, Toxocara and hydatid protoscolices to remove non-specific antibodies. RESULTS The sensitivity, specificity, positive predictive value and negative predictive value for ELISA were 93.5%, 96.1%, 72.9% and 99.2%, respectively, and those for IFA were 87%, 90.1%, 49.4% and 98.4%, respectively. Both assays showed false positivity in hydatidosis, ascariasis and toxocariasis; however, this was less common with ELISA. CONCLUSION ELISA method using filariform larval antigen may be a sensitive and specific test for human strongyloidiasis, and may be preferable to IFA.

Spleen-preserving distal pancreatectomy following neoadjuvant chemotherapy for papillary solid and cystic neoplasm of pancreas.

Abstract: Papillary solid and cystic neoplasm (PSCN) is a rare neoplasm of the pancreas with low-grade malignant potential and favorable prognosis. We report an 18-year-old girl with PSCN presenting with advanced disease. The tumor regressed with six cycles of gemcitabine and cisplantin-based neoadjuvant chemotherapy; spleen-preserving distal pancreatectomy was then done. She is disease-free at 13 months' follow-up.

Enterobiasis mimicking Crohn's disease.

Abstract: We report a 20-year-old man who presented with abdominal discomfort for 2 months. Colonoscopy showed skip areas with ulceration, resembling Crohn's disease. Biopsies showed chronic inflammation and a non-necrotizing granuloma. An adult pinworm was found in the lumen from an uninvolved segment. The patient responded to mebendazole.

Portal hypertensive jejunopathy: a case control study.

Abstract: BACKGROUND: Small bowel mucosa is a recognized potential source of bleeding in portal hypertension. However, the frequency of its involvement is not known. AIMS: To document the nature, severity and frequency of endoscopic and histologic changes in the jejunum in patients with portal hypertension. METHODS: Forty consecutive patients with portal hypertension and 43 patients with non-ulcer dyspepsia (controls) underwent push enteroscopy and jejunal, duodenal and gastric biopsies. Biopsies were randomized and examined by a blinded pathologist for inflammation and vascular dilatation, which was quantified by morphometry. RESULTS: Endoscopic jejunopathy was observed in 6 patients and none of the control subjects. All patients with jejunopathy had portal hypertensive gastropathy (PHG) and 5 had duodenopathy. Vascular dilatation was observed in 15 patients and 25 control subjects (p = ns). The degree of vascular dilatation was similar in both groups. Inflammatory changes were observed in 24 patients and 25 control subjects (p = 0.05). CONCLUSIONS: Endoscopic jejunopathy was present in 15% of patients with portal hypertension. These changes were mild in 83% of them. All patients with jejunopathy also had PHG. Histologic changes were similar in patients and control subjects.

Transcatheter hepatic artery embolization for spontaneous rupture of amyloid liver.

Abstract: Spontaneous rupture of amyloid liver is a fatal complication. A 48-year-old man with systemic amyloidosis secondary to multiple myeloma presented with acute hemoperitoneum. Emergency angiogram showed extravasation of contrast from the liver into the sub-hepatic space, which was successfully stopped by embolization of the right hepatic artery.

Transcatheter embolization as primary treatment for visceral pseudoaneurysms in pancreatitis: clinical outcome and imaging follow up.

Abstract: BACKGROUND Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and mortality associated with surgical management is high. Transcatheter embolization is a definitive minimally invasive form of treatment. AIM To review our experience with transcatheter embolization as a therapeutic modality for pseudoaneurysms complicating pancreatitis. METHODS This retrospective analysis included data of 30 patients (mean age 37 years, range 25 to 65; 24 men) with visceral pseudoaneurysms secondary to pancreatitis, who underwent diagnostic angiography and transcatheter embolization, during the period March 1993 to February 2003. RESULTS In 29 patients the pseudoaneurysms were successfully isolated from the circulation, and hemostasis was achieved. Re-bleeding occurred in one patient, for which re-embolization was done. Twenty-nine patients improved clinically. One patient in whom the pseudoaneurysm was successfully embolized died due to septicemic shock. CONCLUSION Endovascular embolization is a safe and effective non-surgical modality of treatment for visceral pseudoaneurysms complicating pancreatitis.

Natural course of asymptomatic pancreatic pseudocyst: a prospective study.

Abstract: Aim To study the natural course of asymptomatic pseudocysts of the pancreas. Methods Thirty patients (age range 18-68 years, mean 44; 24 men) with asymptomatic pseudocysts of the pancreas were enrolled between December 2001 and December 2003, and were followed up every month. Those who developed symptoms due to pseudocyst (increasing pain or features of obstruction such as vomiting or jaundice) were subjected to an endoscopic or surgical drainage procedure. End point of the study was either spontaneous resolution of pseudocyst or drainage procedure. Results Eighteen (60%) of 30 patients had resolution of the pseudocyst over an average duration of 5 months. Maximum diameter of less than 7.5 cm and cyst volume less than 250 mL were significantly more frequent in patients with resolution of pseudocyst than in those without (14/18 vs 2/12 [p=0.001] and 15/18 vs 2/12 [p=0.0003], respectively). Presence of internal debris was associated with non-resolution (9/12 vs 2/18; p=0.001). Conclusion Pseudocysts with less than 7.5 cm diameter, volume less than 250 mL, and absence of internal debris were associated with spontaneous resolution within an average duration of 5 months.

Non-biliary mishaps during laparoscopic cholecystectomy.

Abstract: BACKGROUND The most important complications of laparoscopic cholecystectomy (LC) are biliary tract injuries. Non-biliary complications can be equally devastating, but have received less attention in literature. METHODS The case files of 1748 patients who underwent LC over a period of seven years (1997-2003) in our department were retrospectively reviewed to identify non-biliary complications and their management. RESULTS Nine patients (0.5%) sustained significant non-biliary injury while undergoing LC. The commonest was duodenal perforation during dissection of the Calot's triangle (3 cases). Other complications included diaphragmatic injury (2 cases), and small bowel injury while inserting the umbilical port, right external iliac artery injury during insertion of Veress needle, portal vein injury during dissection, and liver laceration while using a delivery system to extract the gall bladder (1 each). All these complications were detected and managed intra-operatively. During the same period, 10 patients sustained biliary injury. CONCLUSION Intra-operative non-biliary injuries during LC occur as frequently as biliary injuries, and can be life-threatening and difficult to manage.

Randomized, double-blind trial comparing topical nitroglycerine with xylocaine and Proctosedyl in idiopathic chronic anal fissure.

Abstract: OBJECTIVE To compare symptomatic relief, healing, and changes in maximal anal resting pressure with the use of topical formulations in patients with chronic anal fissure. METHODS Sixty-four consecutive patients with chronic anal fissure were randomized into 4 groups that received, in a double-blind manner, a topical ointment that contained 0.2% nitroglycerine (GTN), 5% xylocaine, Proctosedyl (hydrocortisone acetate, heparin, framycetin sulfate, esculoside, ethoform, butoform) or petroleum jelly (Vaseline), to be applied twice daily. Patients were reviewed at 2-week intervals for 6 weeks. Anal manometry was done before, and 20 minutes after, the first application of the ointment. RESULTS There was significant (p < 0.0001) reduction in mean anal resting pressure after application of GTN, but not any other ointment. Of 16 patients receiving GTN, complete pain relief occurred in 6 and 15 patients after 2 and 4 weeks of treatment, respectively; this was more frequent than in the other 3 groups. At 6 weeks also, complete pain relief occurred more often with GTN than with Vaseline or xylocaine. After 4 weeks of treatment, 3 patients on GTN had complete healing of fissure as compared to one each in the xylocaine and Proctosedyl groups and none in the Vaseline group. At 6 weeks, healing of fissure had occurred in 15 of 16 patients receiving GTN as compared to 4 receiving Vaseline, 11 receiving xylocaine, and 12 on Proctosedyl. CONCLUSIONS Topical nitroglycerine produces 'chemical sphincterotomy' with reduction in mean anal resting pressure. Pain relief and healing of fissure occurred earlier with GTN than with other treatments. GTN should be considered as the treatment of choice for the non-surgical management of patients with chronic anal fissure.

Ectopic pancreas as a cause of gastric outlet obstruction in an infant.

Abstract: A six-year-old boy presented with abdominal pain and vomiting five days after accidental ingestion of a sewing needle. The presence of the needle in the right iliac fossa on plain roentgenogram along with signs of appendicular inflammation on clinical and laboratory evaluation provided a clue to the diagnosis. Surgical exploration revealed inflamed appendix with the ingested needle in its lumen. The child recovered after appendectomy, and is well six months later.

Gastric zygomycosis--an unusual cause of massive upper gastrointestinal bleed.

Abstract: We report a 62-year-old man with cardiac failure and acute renal failure, who had massive hematemesis. Upper GI endoscopy showed a large gastric lesser curvature ulcer. Billroth II gastrectomy specimen showed fungal invasion. He received amphotericin B postoperatively, and recovered uneventfully.

Early morphological and functional changes in pancreas following necrosectomy for acute severe necrotizing pancreatitis.

Abstract: INTRODUCTION Morphological and functional changes in the pancreas after surgical pancreatic necrosectomy have not been studied extensively. AIMS To study morphological changes in the pancreas, and exocrine and endocrine pancreatic function following pancreatic necrosectomy. METHODS Eighteen adult patients surviving at least one month after pancreatic necrosectomy for acute necrotizing pancreatitis were followed up. Contrast-enhanced computed tomography was done every six months. Stool fat was estimated at 3-month intervals, and need for and response to enzyme supplements were recorded. Blood sugar was measured every fortnight; in patients with hyperglycemia, need for oral hypoglycemic agents or insulin was recorded. Additional pancreatic imaging was done in some cases. RESULTS Six weeks after surgery, nine of 18 patients had exocrine insufficiency. Thirteen patients developed endocrine insufficiency, including 5 who also had exocrine insufficiency. At the end of the study, 13 patients had endocrine insufficiency and 2 had exocrine insufficiency. Pancreatic size was subnormal in all patients at the end of six months. Pancreatography in three cases did not reveal any ductal abnormality. CONCLUSIONS Necrotizing pancreatitis affects pancreatic exocrine or endocrine function in more than half the patients.

Relationship between endoscopic nodular gastritis and Helicobacter pylori infection in children.

Abstract: INTRODUCTION The specificity of relationship of endoscopic evidence of nodular gastritis with Helicobacter pylori infection is unclear. AIM To assess the relationship of endoscopic nodular gastritis and H. pylori infection among children. METHODS 124 children (median age 8.2 years, range 1-15) undergoing upper GI endoscopy for abdominal pain underwent urease test and histological examination of gastric mucosa to determine the presence and density of H. pylori infection, and presence and severity of gastritis. RESULTS H. pylori infection was detected in 57 (46%) children. Endoscopic nodular gastritis was present in 46 of these 57 patients (81%) and in 24 of 67 (36%) H. pylori-negative patients (36%). The frequency of endoscopic nodular gastritis was related to increasing age (p< 0.0001), presence of H. pylori, grade of histologic gastritis, and H. pylori density (p< 0.0001). CONCLUSION Endoscopic finding of nodular gastritis is associated with presence of H. pylori infection and active chronic gastritis in children.

Prevalence of gastrointestinal symptoms and signs in northwestern Tabriz, Iran.

Abstract: OBJECTIVE To determine the prevalence of gastrointestinal (GI) signs and symptoms in the general population in the northwestern area of Tabriz, Iran. METHODS During May 2000, 4225 subjects were randomly chosen from a general population of approximately 230,000 individuals, and invited to a questionnaire interview and a clinical examination. RESULTS Of the subjects invited, 3983 (94.2%) participated in the study. Among them, 569 (14.3%) reported one or more GI symptoms in the last 2 weeks, and 96 (2.4%) had GI signs. Abdominal pain (5.1%), constipation (3.6%), heartburn (3.0%), dyspepsia (2.9%), a mass prolapsing from the anus (2.1%), bloating (1.5%), and hematochezia (l%) were the most common GI symptoms. Abdominal tenderness on deep palpation was the commonest clinical sign (1.2%). CONCLUSION The prevalence of GI symptoms in the population studied was lower than that reported from other populations.

Testicular choriocarcinoma with gastric metastasis presenting as hematemesis.

Abstract: We report a 28-year-old man who presented with hematemesis due to choricarcinoma of testis metastatic to the stomach. Gastroscopy showed a polypoidal lesion. Testicular wedge biopsy confirmed mixed germ cell tumor, the choriocarcinomatous portion alone getting metastasized to the stomach. He was initiated on chemotherapy with actinomycin-D, etoposide and methotrexate, but died due to multiple metastases to the lung and brain.

Extraintestinal manifestations of idiopathic ulcerative colitis in northwestern India.

Abstract: Objective To determine the frequency of extraintestinal manifestations in patients with idiopathic ulcerative colitis. Methods 46 patients underwent detailed clinical, biochemical and radiological evaluation. Results One patient (2%) had peripheral arthritis and two patients (4%) had ocular involvement in the form of anterior uveitis. No patient had mucocutaneous, vascular, or hepatobiliary manifestations, or sacroiliitis. Conclusions The frequency of extraintestinal manifestations in patients with IUC in northwestern India is low.

Duodenal metastases from squamous cell carcinoma of the lung: endoscopic management of bleeding and biliary and duodenal obstruction.

Abstract: Intestinal metastases from cancer of the lung are rare. We report a 65-year-old man with duodenal metastases from squamous cell cancer causing GI bleeding and biliary and duodenal obstruction; these were managed endoscopically.