Indian Journal of Gastroenterology最新文献

{"title":"Inhibition of bile acid reabsorption as a treatment for constipation.","authors":"B S Ramakrishna","doi":"10.1007/s12664-025-01736-0","DOIUrl":"https://doi.org/10.1007/s12664-025-01736-0","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of acute pancreatitis in elderly are comparable to those in adults in India: A propensity score-matched analysis.","authors":"Gauri Kumbhar, Sudipta Dhar Chowdhury, Ashish Goel, A J Joseph, Ebby George Simon, Amit Kumar Dutta, Reuben Thomas Kurien","doi":"10.1007/s12664-024-01734-8","DOIUrl":"https://doi.org/10.1007/s12664-024-01734-8","url":null,"abstract":"<p><strong>Background and objectives: </strong>The ageing population is increasing in India and there is hardly any information on outcomes of acute pancreatitis (AP) in the elderly in India. Hence we studied the comprehensive clinical characteristics and outcomes of AP in elderly patients.</p><p><strong>Methods: </strong>This study included patients admitted with AP to a tertiary care centre from October 2018 to October 2022. Patients with the first episode of AP presenting within 14 days of disease onset were eligible for inclusion. The elderly population was defined as age ≥ 60 years. Recurrent AP, chronic pancreatitis and AP presenting after 14 days of disease onset were excluded. Propensity score matching was performed based on etiology and severity to compare elderly and non-elderly groups. Primary outcome was serious adverse outcome (SAO: in-hospital mortality or discharge in critical state). Secondary outcomes included organ failures, local complications, necrosis, mesenteric vascular thrombosis (MVT), length of hospital stay, intensive care unit (ICU) admission and infections.</p><p><strong>Results: </strong>Of 630 eligible patients, 120 were > 60 years of age. Among the elderly, 72 (60%) were males. The median age was 68 (IQR 63-74) years. The most common etiology was biliary 76 (63.3%) followed by idiopathic 25 (20.8%) and alcohol eight (6.7%). Mild AP was seen in 72 (60%), while 21 (17.5%) had moderately severe and 27 (22.5%) had severe AP. Organ failures occurred in 27.5%, necrotizing pancreatitis in 15.2%, local complications in 27.6% and MVT in 3.3%. Infections affected 28.3%. Median hospital stay was four days (IQR 1-28), with 12.5% requiring ICU admission. SAO occurred in 8.3% of elderly patients, comparable to 11.4% in the non-elderly (p = 0.334). Bedside index for severity in acute pancreatitis (BISAP) score (adjusted OR 2.7, 95% CI 1.05-6.96, p = 0.04) and Charlson comorbidity index (without age) (adjusted OR 1.94, 95% CI 1.07-3.51, p = 0.03) independently predicted SAO in the elderly.</p><p><strong>Conclusion: </strong>The outcomes of AP in the elderly in India are similar to patients < 60 years. Charlson comorbidity index and BISAP score predicted serious adverse outcomes in the elderly.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of elobixibat in patients with chronic constipation-A randomized, multicenter, double-blind, placebo-controlled, parallel-group study from India.","authors":"Piyush Agarwal, Brajesh Kumar Jha, Jaganmohan Somagoni, Srinivas Shenoy B, Vipul Modh, Sanketh Kumar Chakilam, Vinay Kumar, Mukewar Shrikant Vasantrao, Mukesh Kalla, Anumula Kavitha, Omesh Goyal, Ashima Bhatia","doi":"10.1007/s12664-024-01719-7","DOIUrl":"https://doi.org/10.1007/s12664-024-01719-7","url":null,"abstract":"<p><strong>Background: </strong>Elobixibat is a locally acting ileal bile acid transporter (IBAT) inhibitor that relieves functional constipation in patients by accelerating colonic transit. In this study, we aimed at determining the efficacy and safety of elobixibat for short-term treatment (two weeks) of chronic constipation in Indian patients.</p><p><strong>Methods: </strong>The present study was a randomized, double-blind, parallel-group, placebo-controlled, phase III study to evaluate efficacy and safety of elobixibat. The study planned to enroll patients with chronic constipation of at least six months' duration, satisfying Rome IV criteria for functional constipation. Following a run-in of approximately 14 days to confirm eligibility and determine baseline frequency of spontaneous bowel movements (SBMs), eligible patients were randomized 1:1 either to elobixibat or to placebo groups. The change in weekly frequency of spontaneous bowel movements (SBMs) at the end of treatment (week two) over baseline was the primary efficacy endpoint in this trial. Primary efficacy analyses were based on the modified intention-to-treat (mITT) population. This trial is registered at CTRI (Clinical Trial Registry of India).</p><p><strong>Results: </strong>Between April 2023 and December 2023, 150 patients were randomized into the two-week trial. In mITT population (n = 146 [elobixibat = 75 and placebo = 71]), the least square mean (LSM) difference between elobixibat (3.83) and placebo (2.68) was 1.15 (95% CI, 0.31, 1.99) demonstrating a statistically significant improvement (p = 0.008) in weekly frequency of SBMs (week two over baseline) with the use of elobixibat. The proportions of patients with a complete spontaneous bowel movement (CSBM) \"response\" was significantly higher with elobixibat (49.33%) compared to the placebo (26.76%) treatment (difference 22.57% [95% CI, 8.36%, 36.78%] [p = 0.005]). The most common adverse event (AE) was abdominal pain (elobixibat = 6 patients [7.89%] vs. placebo = 3 patients [4.05%]).</p><p><strong>Conclusions: </strong>Elobixibat was well tolerated and improved bowel movement frequency within two weeks of treatment in Indian patient population with chronic constipation.</p><p><strong>Clinical trial registry number: </strong>CTRI/2022/10/046690.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Khan et al., Critical Insights: ABC score is a better predictor for 30-day mortality in upper gastrointestinal bleeding: A prospective single-center study.","authors":"Vikas Pemmada, Athish Shetty, Ganesh Bhat","doi":"10.1007/s12664-025-01750-2","DOIUrl":"https://doi.org/10.1007/s12664-025-01750-2","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines.","authors":"Anupam Kumar Singh, Deepak Gunjan, Nihar Ranjan Dash, Ujjal Poddar, Pankaj Gupta, Ajay Kumar Jain, Deepak Lahoti, Jamshed Nayer, Mahesh Goenka, Mathew Philip, Rakesh Chadda, Rajneesh Kumar Singh, Sreekanth Appasani, Showkat Ali Zargar, Sohan Lal Broor, Sandeep Nijhawan, Siddharth Shukla, Vikas Gupta, Vikram Kate, Govind Makharia, Rakesh Kochhar","doi":"10.1007/s12664-024-01692-1","DOIUrl":"https://doi.org/10.1007/s12664-024-01692-1","url":null,"abstract":"<p><p>The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS FNAC without rapid on-site evaluation is comparable to EUS FNB with macroscopic on-site evaluation in evaluation of intra-abdominal masses.","authors":"Mohd Rafiq Najar, Monika Jain, Gurwant Singh Lamba, Sawan Bopanna","doi":"10.1007/s12664-025-01741-3","DOIUrl":"https://doi.org/10.1007/s12664-025-01741-3","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic ultrasound-guided tissue acquisition (EUS TA) has become the mainstay for tissue diagnosis of abdominal mass lesions. Two widely used and accepted methods for obtaining diagnostic material, namely fine needle aspiration cytology (EUS FNAC) and needle core biopsy (EUS FNB), have distinct advantages and disadvantages. We compared the diagnostic accuracy of EUS FNAC without on-site pathology and EUS FNB taken within the same endoscopic session in evaluation of intra-abdominal masses.</p><p><strong>Methods: </strong>In this prospective observational study, we included patients undergoing EUS FNAC and EUS FNB for the diagnosis of solid intra-abdominal masses. Sample size was calculated based on the available literature. Location, origin, dimensions of the intra-abdominal masses and number of passes taken were recorded. EUS-guided FNAC followed by EUS-guided FNB was done back-to-back during the same endoscopic session. FNAC smears were prepared and air dried and alcohol-fixed slides were prepared. Adequacy of the FNB specimen was judged visually. The diagnostic accuracy of FNA and FNB specimens was then calculated based on the final diagnosis and compared.</p><p><strong>Results: </strong>Of the 58 patients included, 50% of patients were females with a mean age of 53.91 ± 17.16 years. Nineteen pancreatic masses (32.7%), three gastric mass lesions (5.1%), one adrenal mass (1.7%), one liver mass (1.7%), three gallbladder masses (5.1%) and 31 lymph nodal masses (53.4%) were sampled. With EUS FNB, malignancy was diagnosed in 38/58 (65.5%), benign diseases in 19/58 (32.7%) and 1/58 (1.7%) was inconclusive. Number of passes was more in the EUS FNAC group compared to EUS FNB, but not statistically significant. Sensitivity and specificity of EUS FNAC without rapid on-site evaluation (ROSE) were found to be 92.4% and 100%, respectively. Diagnostic accuracy of EUS FNAC was 93.1% and when compared with EUS FNB with macroscopic on-site evaluation (MOSE), no statistically significant difference was noted.</p><p><strong>Conclusion: </strong>EUS FNAC and EUS FNB are comparable for the diagnosis of intra-abdominal masses in terms of diagnostic accuracy, sample adequacy, number of passes and safety. In resource-constraint settings, either EUS FNAC or EUS FNB alone may be sufficient for diagnosis with EUS FNB being preferred in select cases where maintained tissue architecture is needed.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute liver failure and liver transplantation.","authors":"Dinesh Jothimani, Navin Kumar Marannan, Mohamed Rela","doi":"10.1007/s12664-024-01708-w","DOIUrl":"https://doi.org/10.1007/s12664-024-01708-w","url":null,"abstract":"<p><p>Sudden and rapid deterioration of hepatic function leading to jaundice, coagulopathy and encephalopathy defines acute liver failure (ALF). Timing of jaundice to encephalopathy classifies ALF into hyperacute, acute and sub-acute liver failure and prognosticates outcome. There exists a significant geographical heterogeneity in the etiology of ALF; paracetamol toxicity is the most common cause in the west, whereas viral hepatitis predominates Asian countries. Hepatitis A is the leading cause for ALF in India. ALF due to yellow phosphorus poisoning is observed commonly in southern India. Clinical outcomes of ALF have improved significantly over the last theee decades and attributed improvement in critical care services, better understanding of the disease and timely initiation of appropriate organ support. Thus, a majority of patients with ALF recover with medical management, in particular hyperacute liver failure. However, patients with seronegative hepatitis, non-paracetamol drug toxicity and sub-acute liver failure are more likely to require liver transplantation (LT). Patients with ALF should be managed in a higher centre with transplant set-up. Emergency LT is a life-saving procedure in ALF, but selection of patients for LT may be a challenge. Various prognostic models have been evaluated to identify those with increased chance of death in the absence of LT. King's College criteria is an extensively studied prognostic model, time tested and used widely across several centres, but has a lower sensitivity missing out on some patients who may benefit from LT. ALF-Early Dynamic (ALFED) being a dynamic model may have better predictability but needs more validation. Timely availability of cadaver organ in ALF patients waitlisted for 'supra-urgent' LT may be an issue. Lower organ donation rates in India and other Asian countries have innovated living donor liver transplantation. Auxiliary partial orthotopic liver transplantation (APOLT) is an exclusive surgical technique in selected patients with ALF allowing regeneration of native liver eliminating the need for long-term immunosuppression. One and five-year survival following LT in ALF patients is around 80% and 70%, respectively, and has significantly improved compared to previous era.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-cultural study translating and validating the COMPAT-SF pain questionnaire in Telugu, Bengali and Hindi.","authors":"M Unnisa, A Agarwal, C Peddapulla, V Sharma, S Midha, S Jagannath, R Talukdar, A E Phillips, M Faghih, J Windsor, S S Olesen, P Garg, A M Drewes, L Kuhlmann","doi":"10.1007/s12664-025-01737-z","DOIUrl":"https://doi.org/10.1007/s12664-025-01737-z","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic pancreatitis (CP) is a fibroinflammatory disease causing functional injury. Abdominal pain is the predominant symptom negatively impacting the quality of life. The Comprehensive Pain Assessment Tool (COMPAT-SF) questionnaire, designed and validated to assess pain in CP, was previously only available in English and Danish. Given the high prevalence of CP in India, translating and validating COMPAT-SF into different languages becomes crucial.</p><p><strong>Methods: </strong>The COMPAT-SF underwent translation into three Indian languages (Hindi, Telugu and Bengali) and was back-translated to English to ensure cross-cultural equivalence. Validation was conducted at two tertiary care centers in India. As Hindi is the most widespread language, bilingual CP patients answered the COMPAT-SF in Hindi and English at a three-week interval. All sub-group answers were compared with patient data from the US. Structural equation modeling and confirmatory factor analysis were employed for validation.</p><p><strong>Results: </strong>Total 64 patients (19 Hindi-speaking,15 Telugu and 30 Bengali) were included and compared with 91 English-speaking patients. Translation adequacy was confirmed with > 85% concordance. Despite modest Cronbach alpha values in reliability analysis, structural equation modeling demonstrated high consistency with the original COMPAT-SF study. Some cultural differences in responses were observed, but the responses were comparable overall. Confirmatory factor analysis on the pooled data indicated an acceptable model fit and the Hindi version showed good accordance with the English version.</p><p><strong>Conclusion: </strong>The translated COMPAT-SF versions proved to be valid and reliable pain assessment tools for CP patients. The study underscores the importance of addressing pain comprehensively.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective prevention of hepatitis B transmission from pregnant women to babies in a real-life setting in India.","authors":"Surender Singh, Manjulata Verma, Abhishek Yadav, Ajay Kumar Mishra, Harshita Katiyar, Radha Krishan Dhiman, Amit Goel","doi":"10.1007/s12664-025-01748-w","DOIUrl":"https://doi.org/10.1007/s12664-025-01748-w","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia in inflammatory bowel disease-A comprehensive review.","authors":"Amit Kumar Dutta, Hemanth Chinthala, John Titus George, David Mathew Thomas, Anjilivelil Joseph Joseph","doi":"10.1007/s12664-024-01735-7","DOIUrl":"https://doi.org/10.1007/s12664-024-01735-7","url":null,"abstract":"<p><p>Anemia is a frequent complication in inflammatory bowel disease (IBD) patients. The etiology is multifactorial, with iron deficiency and anemia of chronic disease being the main reasons. Other causes include vitamin B₁₂ and folate deficiency, hemolytic anemia and medications such as azathioprine and sulfasalazine. Apart from physical symptoms, it is associated with several negative outcomes, including poor quality of life, increased risk of hospital admission, increased risk of surgery and higher treatment costs. Diagnostic evaluation aims to identify the underlying cause and severity to determine the appropriate therapeutic strategy. Investigations include a complete blood count, iron indices, inflammatory markers and vitamin B₁₂ and folate levels. Patients with iron deficiency need adequate replacement therapy to improve hemoglobin and replenish iron stores. Those with moderate to severe anemia and/or active disease need intravenous iron, while mild anemia can be treated with oral iron. Multiple parenteral iron formulations are available which differ in dose and frequency of administration. Traditional oral iron supplements are available in ferrous forms, which, although effective, are associated with gastrointestinal side effects. Newer oral iron formulations have helped reduce these adverse effects but are expensive. Anemia of chronic disease is mainly driven by the effects of inflammatory mediators on iron metabolism and erythropoiesis and treatment requires control of disease activity. Relapse of anemia after therapy is frequent; hence, patients need to be closely followed up for early detection and appropriate management. Significant advances have been made in understanding the pathophysiology of anemia in IBD and better and safer iron formulations are available. However, a significant proportion of IBD patients with anemia go undetected or untreated and there is a need for improved recognition and better management practices. This review discusses various aspects of anemia in IBD and the current approach to diagnosis and management.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}