Indian Journal of Gastroenterology最新文献

{"title":"EASL-CLIF, NACSELD and APASL definitions for identification of acute-on-chronic liver failure and its outcome in a non-transplant setting.","authors":"Philip Abraham, Suman Talukdar, Devendra Desai, Tarun Gupta, Pavan Dhoble","doi":"10.1007/s12664-025-01769-5","DOIUrl":"https://doi.org/10.1007/s12664-025-01769-5","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic liver diseases (CLD) may progress to cirrhosis, decompensation and death. An intervening insult may lead to acute decompensation (AD); patients with AD may fulfil criteria for acute-on-chronic liver failure (AD-ACLF). While the outcome of ACLF and priority for liver transplantation have been studied, data on outcome in a non-transplant setting is sparse. We evaluated three international consensus criteria for definition of ACLF to determine the number of patients satisfying these definitions and their accuracy in predicting mortality and compare mortality in a non-transplant setting.</p><p><strong>Methods: </strong>Total 341 consecutive patients with CLD of any etiology were enrolled and followed up. All significant clinical events and changes in laboratory data were noted to classify patients into no AD, AD-ACLF and AD-non-ACLF.</p><p><strong>Results: </strong>Total 150 (44%) patients had non-alcoholic fatty liver disease as etiology. As many as 197 (57.8%) patients had AD; of these, 54 (27.4%) met at least one definition of ACLF: 50 (92.6%) fulfilled EASL-CLIF criteria, 31 (57.4%) NACSELD and 22 (40.7%) APASL. The most common precipitating event (59.2%) was infection. Forty-six (13.5%) patients died during the study period - 52% of those with AD-ACLF and 12.6% with AD-non-ACLF (p < 0.00001). The accuracy of EASL-CLIF, NACSELD and APASL definitions in determining mortality was 79.7%, 86.3% and 77.7%, respectively.</p><p><strong>Conclusion: </strong>Total 16% of patients with CLD developed AD-ACLF by any definition; one-half of them died. EASL-CLIF criteria identified maximum number of patients with AD-ACLF, but NACSELD criteria had highest accuracy for predicting mortality in AD-ACLF. These findings may help prioritize patients with ACLF for intensive care in the absence of easy access to liver transplantation.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119571","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":"Japanese narrow band imaging expert team classification of colorectal polyps: A validation study from India.","authors":"Kayal Vizhi Nagarajan, Amit Yelsangikar, Anupama Nagar Krishnamurthy, Hima Bindu, Arun Patted, Vinay Bhat, Tripti Kaur, Naresh Bhat","doi":"10.1007/s12664-025-01784-6","DOIUrl":"https://doi.org/10.1007/s12664-025-01784-6","url":null,"abstract":"<p><strong>Background: </strong>Japanese narrow band imaging expert team (JNET) classification has a diagnostic accuracy above 90% in differentiating neoplastic from non-neoplastic colonic polyps as well as estimating the depth of invasion in colorectal cancer. However, its validation outside Japan is limited to expert centers and requires magnifying endoscopes.</p><p><strong>Aims and methods: </strong>This study aimed at validating the JNET classification prospectively in a real-world setting in India using magnifying endoscopes with dual focus. We analyzed consecutive patients with colonic polyps detected via these endoscopes. The JNET classification was compared with histopathology, the gold standard and its diagnostic accuracy was assessed.</p><p><strong>Results: </strong>Total 203 consecutive patients with colonic polyps underwent examination using a magnifying endoscope with dual focus. In real time, 331 polyps were identified and classified based on the JNET classification. Among them, 15 polyps could not be retrieved, leaving 316 polyps for histopathological comparison in the study. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each JNET classification type, along with their 95% confidence intervals, are as follows. For Type-1 JNET classification, the values are 78% (69-86), 97% (94-99), 92% (84-97), 92% (87-95) and 92% (88-94), respectively. Type-2 A JNET classification has corresponding values of 92% (86-96), 84% (78-89), 82% (75-88), 93% (88-97) and 88% (84-91). For Type-2B JNET classification, the values are 45% (24-68), 97% (95-99), 56% (31-78), 96% (93-98) and 93% (90-96). Lastly, Type-3 JNET classification has values of 95% (87-99), 98% (96-100), 94% (85-98), 99% (97-100) and 98% (96-99), respectively.</p><p><strong>Conclusions: </strong>The JNET classification has good accuracy in characterizing colonic polyps using magnifying endoscopes with dual focus. Large-volume, multicentric data is necessary to validate the findings in our study.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110580","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":"Stool multiplex PCR assay versus conventional stool tests for detecting gastrointestinal infection as a cause for flare of inflammatory bowel disease.","authors":"Manek Kutar, Devendra Desai, Philip Abraham, Tarun Gupta, Pavan Dhoble","doi":"10.1007/s12664-025-01773-9","DOIUrl":"https://doi.org/10.1007/s12664-025-01773-9","url":null,"abstract":"<p><strong>Background: </strong>In inflammatory bowel disease (IBD), a flare can be due to natural history of disease or due to gastrointestinal infection. Infection is conventionally diagnosed by stool microscopy and culture. Stool multiplex polymerase chain reaction (PCR) assay or Biofire® FilmArray^® GI Panel is a sensitive and rapid test for detecting infection, but is expensive; its impact on management and cost-effectiveness has not been studied in IBD.</p><p><strong>Aims: </strong>To compare stool PCR assay and conventional tests during IBD flare for detection of infection, impact of detection on treatment and cost-effectiveness of the tests.</p><p><strong>Methods: </strong>Sixty-five patients with IBD flare underwent conventional stool tests (microscopy, culture and Clostridioides difficile toxin assay) and stool PCR assay simultaneously.</p><p><strong>Results: </strong>We prospectively enrolled 65 consecutive patients presenting with disease flare: ulcerative colitis (58 patients, 28 women, mean age 41.1 years) and Crohn's disease (seven patients; three women; mean age 36.1). Stool PCR detected organisms in 36 (55.4%) patients as compared to six (9.2%) by conventional tests (p < 0.0001). The organisms detected by the PCR assay were enteroaggregative (EAEC) (22 patients), enteropathogenic (EPEC) (12), enterotoxigenic Escherichia coli (ETEC) (5), Plesiomonas shigelloides (4), C. difficile (3), norovirus (3), enteroinvasive E. coli (2), rotavirus (2) and G. lamblia, cryptosporidia, cyclospora, Sapovirus, adenovirus and Entamoeba histolytica (one each). PCR organism detection resulted in management change in 13 (20%) patients as compared to five (7.6%) by conventional tests (p < 0.02). Cost to achieve one positive result on stool PCR that led to management change was INR 60,000 (USD 690, EUR 638) as compared to Indian Rupees (INR) 54,600 (United States Dollar [USD] 627, EUR 580) for conventional tests. The incremental cost-effective ratio (ICER) was INR 63,375 (USD 728, EUR 674).</p><p><strong>Conclusion: </strong>In an IBD flare, stool PCR or Biofire® FilmArray^® GI Panel detected more organisms and led to more frequent management change as compared to conventional tests. The ICER was INR 63,375 (USD 728, EUR 674). This test should be considered first-line investigation in an IBD flare.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077819","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":"PCR-based stool testing for enteric infections in flares of inflammatory bowel disease: Is more data worth the cost?","authors":"Abhishek Dimopoulos-Verma, Jordan E Axelrad","doi":"10.1007/s12664-025-01793-5","DOIUrl":"https://doi.org/10.1007/s12664-025-01793-5","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077818","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":"Underwater endoscopic mucosal resection for sessile colorectal polyps: A promising endoscopic treatment method.","authors":"Jia-Xing Ma, Jun Liu","doi":"10.1007/s12664-025-01785-5","DOIUrl":"https://doi.org/10.1007/s12664-025-01785-5","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985949","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":"Masked hypertension in irritable bowel syndrome: A cause for concern?","authors":"Gurpreet Singh Wander, Akash Batta","doi":"10.1007/s12664-025-01791-7","DOIUrl":"https://doi.org/10.1007/s12664-025-01791-7","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977904","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":"Endoscopic sub-mucosal dissection for large esophageal carcinosarcoma-Is R0 resection curative enough!","authors":"Biswa Ranjan Patra, Chetan Saner, Sidharth Harindranath, Nupur Kenkre, Akash Shukla","doi":"10.1007/s12664-025-01781-9","DOIUrl":"https://doi.org/10.1007/s12664-025-01781-9","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999077","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":"Overlapping disorders of gut-brain interaction -More may not be so merry!","authors":"Eamonn M M Quigley","doi":"10.1007/s12664-025-01782-8","DOIUrl":"https://doi.org/10.1007/s12664-025-01782-8","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963458","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 comment on \"Abbreviated anorectal biofeedback therapy is beneficial in symptomatic improvement of functional defecatory disorder\".","authors":"Stephan Benny, Noble Varghese Mathews, Rajeeb Jaleel","doi":"10.1007/s12664-025-01786-4","DOIUrl":"https://doi.org/10.1007/s12664-025-01786-4","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984786","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":"Endoscopic interventions for managing pancreatic fluid collections associated with acute pancreatitis: A state-of-the-art review (with videos).","authors":"Randeep Rana, Soumya Jagannath Mahapatra, Pramod Kumar Garg","doi":"10.1007/s12664-025-01755-x","DOIUrl":"https://doi.org/10.1007/s12664-025-01755-x","url":null,"abstract":"<p><p>Acute pancreatitis is an acute inflammatory disease, which may be associated with pancreatic and peri-pancreatic necrosis and development of (peri)pancreatic fluid collections (PFCs). Interventions in acute pancreatitis have evolved over the years with a paradigm shift from open surgical drainage and necrosectomy to minimally invasive approaches. Depending on the presence of necrosis, the PFCs may be acute necrotic collections or acute pancreatic fluid collections, which evolve over a period of three to four weeks to walled-off necrosis and pseudocysts, respectively. Patients with symptomatic and infected PFCs require drainage. In general, drainage should be delayed beyond three to four weeks when the collection wall has matured and the necrotic debris is liquefied. However, some patients may merit early drainage (within the first three to four weeks), if they have suspected infected pancreatic necrosis and worsening organ dysfunction despite antibiotics and supporting therapy. Endoscopic transmural drainage and necrosectomy have now emerged as the most favored treatment modality in suitable pancreatic collections located predominantly in the lesser sac. Being minimally invasive, per-oral endoscopic direct necrosectomy is as effective as surgical necrosectomy in patients with infected necrotic collections but with fewer adverse events. Percutaneous endoscopic necrosectomy is an important addition to our armamentarium for laterally placed collections as an effective alternative to surgical video-assisted retroperitoneal debridement. The current review provides an overview of the evolution, indications, approaches, techniques and outcomes of endoscopic interventions in the management of pancreatic fluid collections associated with acute pancreatitis. Future direction for better outcomes has been highlighted.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984792","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}