Indian Journal of Gastroenterology最新文献

Introduction: Percutaneous endoscopic gastrostomy (PEG) is an established method for providing long-term enteral nutrition. While its clinical utility is well recognized, its impact on health-related quality-of-life (HRQoL) in both patients and caregivers, particularly in India, remains insufficiently characterized. This study aims to assess HRQoL in Indian patients undergoing PEG placement and their caregivers using both generic and PEG-specific assessment tools.

Methods: This prospective observational cohort study was conducted at a tertiary center in Bengaluru, India, from July 2021 to March 2023. Total 80 patients undergoing PEG placement and their primary caregivers were enrolled. HRQoL was assessed pre-procedure and at eight to 12 weeks post-procedure using the EuroQol-5D-3L questionnaire for both patients and caregivers. Additionally, patients completed the PEG-specific NutriQoL questionnaire at Day 3 post-procedure and at eight to 12 weeks.

Results: A majority of patients (81.3%) had head and neck cancers, while others had neurological dysphagia. Patients with head and neck cancer demonstrated a statistically significant decrease in EuroQol Index post-procedure (mean difference: -0.10, 95% CI: -0.13 to -0.07, p < 0.001), whereas patients with neurological dysphagia showed improvement (0.62 to 0.67, p = 0.004). NutriQoL scores showed statistically significant improvement across all patient groups over two to three months post-PEG (mean score change from -15.55 to 18.54; p < 0.001). Caregivers exhibited a statistically significant decline in EuroQol Index post-procedure (0.98 to 0.93; p < 0.001), with employed caregivers reporting lower HRQoL compared to unemployed caregivers.

Conclusion: PEG placement appears to have differential impact on generic HRQoL depending on the underlying clinical condition, while nutritional quality of life appears to improve over time in our cohort of patients. In caregivers, generic HRQoL declined over time especially among those balancing caregiving and employment. These findings underscore the need for comprehensive pre-procedure counselling, structured caregiver support and indigenous, culturally tailored nutritional interventions to optimize outcomes in the Indian context.

Background: Ineffective esophageal motility (IEM) is observed in patients with gastroesophageal reflux disease (GERD) and healthy individuals, yet its underlying pathogenesis remains poorly understood. The esophagogastric junction contractile integral (EGJ-CI) is a recently introduced metric designed to assess the contractile function of the esophagogastric junction (EGJ) barrier. This study aimed at assessing the function of the EGJ complex in patients with IEM to understand its role in disease pathogenesis.

Methods: Total 157 participants who underwent high-resolution manometry (HRM) were selected and diagnosed based on the Chicago Classification version 4.0. Of these, 34 participants were assigned to the IEM group and 34 were included in the normal motility group using propensity score matching. HRM metrics, including the EGJ-CI, were compared between groups and a correlation analysis was performed to evaluate relationships between EGJ-CI and other HRM metrics.

Results: Patients in the IEM group, with higher reflux burden on gastroscopy and reflux monitoring, exhibited a significantly lower average distal contractile integral (DCI) than those in the normal motility group. The EGJ-CI was also reduced in the IEM group compared to the normal motility group when excluding participants with GERD (37.96 [16.14, 49.36] mmHg·cm vs. 45.81 [33.07, 63.09] mmHg·cm). Furthermore, a positive correlation was identified between average DCI (r = 0.275), median integrated relaxation pressure (IRP) (r = 0.627) and EGJ-CI.

Conclusions: Patients with IEM demonstrated a reduced EGJ-CI, independent of reflux burden, indicating an impaired EGJ complex barrier that may contribute to IEM pathogenesis.

Background: Incretin-based therapies are essential in diabetes management, with semaglutide receiving attention due to its oral formulation and benefits in cardiovascular health, renal function and weight loss. However, rodent studies have shown that long-term Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) exposure can induce proliferative changes, including thyroid C-cell tumors and epithelial cell hyperplasia, through GLP-1R-mediated pathways, raising concerns about potential mitogenic effects in other tissues. This study evaluates the association between semaglutide and bile duct cancer using pharmacovigilance data.

Methods: A disproportionality analysis was conducted using VigiBase, the WHO's global safety database. Individual Case Safety Reports from January 1, 2009, to July 31, 2023, were analyzed, focusing on neoplasms classified under System Organ Classes. Signal detection was assessed using the lower 95% credibility interval limit for the Information Component (IC025), Proportional Reporting Ratio (PRR025) and Reporting Odds Ratio (ROR025). Patient demographics, drug dosage, treatment duration and severity of reported cases were reviewed qualitatively.

Results: Among 75,497 adverse events from 28,403 patients, 442 (0.58%) were linked to benign and malignant neoplasms. Pancreatic cancer (70 cases) was the most frequent, followed by breast (28 cases), thyroid (14 cases) and medullary thyroid cancer (15 cases). Six cases were identified in VigiBase-four as 'bile duct cancer' and two as 'cholangiocarcinoma'-potentially indicating overlapping diagnoses. Disproportionality analysis for bile duct cancer (n = 4) showed an OR₀₂₅ of 2.30, IC₀₂₅ of 0.23, and PRR₀₂₅ of 2.30, exceeding thresholds for signal detection.

Conclusion: While this study identifies a potential safety signal between semaglutide use and bile duct cancer, causality cannot be established. These findings underscore the importance of ongoing pharmacovigilance and the need for long-term observational studies and randomized controlled trials.

Background and objectives: Functional dyspepsia (FD) is a common disorder with multi-factorial pathophysiology. It has two sub-types, post-prandial distress syndrome (PDS) and epigastric pain syndrome (EPS), which frequently overlap. Emerging evidence suggests that low-grade inflammation, particularly duodenal eosinophilia (DE), may play a pathogenic role in FD. However, Indian data on this subject remains scarce. This study aimed at evaluating the prevalence and clinical correlates of DE in patients with refractory FD.

Methods: In this prospective, cross-sectional study, Rome- IV defined FD patients with refractory symptoms and normal esophagogastroduodenoscopy (EGD) were enrolled. Age and sex-matched non-dyspeptic controls with normal EGD were also recruited. Standardized duodenal biopsies from cases and controls were independently assessed by two blinded histopathologists for eosinophil counts and degranulation. Symptom profiles and health-related quality of life (HRQoL) were evaluated using validated questionnaires.

Results: Of 274 patients with refractory dyspepsia screened, 189 patients with normal EGD (mean age 41.4 ± 15.2 years; 54.5% males) were enrolled, along with 96 controls. The mean duodenal eosinophil count in controls was 8.2 ± 1.5 per high-power field (HPF). Applying the mean + 3 standard deviation criteria, DE was defined as ≥ 13 eosinophils/HPF. DE was identified in 65.3% (123/189) of refractory FD patients (65.7% in EPS, 52.5% in PDS and 69.1% in the overlap group, p > 0.05). Duodenal eosinophil counts correlated positively with PDS symptom severity (r = 0.376; p < 0.0001), overlap symptom severity (r = 0.3; p = 0.031) and worse HRQoL (r = 0.21; p = 0.010). Furthermore, patients with eosinophilic degranulation (24.3%) had significantly higher PDS scores and worse HRQoL scores, compared to those without degranulation.

Conclusions: Up to two-thirds of the refractory FD patients exhibited duodenal eosinophilia, which was associated with increased symptom severity in PDS and overlap sub-types and poorer HRQoL. These findings support the incorporation of duodenal mucosal assessment in the diagnostic algorithm for refractory FD.

Aim: Hepatic encephalopathy (HE) is a serious complication in patients with liver cirrhosis and is strongly associated with morbidity and mortality. Melatonin, a neuroprotective hormone secreted by the pineal gland and enterochromaffin cells of the gastrointestinal tract is involved in the sleep cycle in normal people. This may be disrupted in cirrhotic patients. We aimed at evaluating the role of serum melatonin in cirrhotic patients with HE.

Methods: A prospective observational study was conducted in hospitalized patients with liver cirrhosis after meeting the inclusion and exclusion criteria. Morning melatonin levels were measured in patients categorized into three groups based on their progression of HE according to West Haven criteria (WHC) as group 1 (no HE), group 2 (WHC grades I and II) and group 3 (WHC grades III and IV). Biochemical measurements were done using standardized procedures.

Results: Fifty-two patients underwent morning melatonin levels, with a mean age of 55.46 ± 12.26 years old, and nine (17.3%) patients were women. The morning melatonin levels (pg/mL) of healthy volunteers and liver cirrhosis patients were 23.88 (range, 12.54-31.32) and 190 (range, 30.53-300) pg/mL. Among cirrhotic patients, group 1 (n = 11), group 2 (n = 27) and group 3 (n = 14), the morning melatonin levels were (pg/mL) 45.62 ± 15.09, 214.01 ± 107.78 and 280.98 ± 52.74 (p < 0.001), respectively. The correlation coefficient (r) between morning melatonin levels and the grades of HE was 0.797 (p < 0.001). A serum melatonin level of ≥ 85 pg/mL predicted HE with a sensitivity of 86.96%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.43% and accuracy of 90.16%. The area under the receiver operating characteristic curve (AUROC) for melatonin in predicting HE was 0.94 (p < 0.001).

Conclusion: Serum melatonin levels are significantly higher in HE patients with liver cirrhosis, with the highest levels measured in patients with the most severe grade of HE. A melatonin level of ≥ 85 pg/mL was associated with HE and level ≥ 248.95 pg/mL was associated with severe HE. Prospective large studies are required to validate the role of melatonin as a prognostic marker.

Chronic liver disease (CLD) poses a growing public health burden in India, with hepatitis B virus (HBV) remaining a preventable contributor despite the nation's expanding immunization and screening frameworks. This narrative review critically appraises programme-level preventive strategies for HBV-related CLD in India, structured across three tiers of prevention: public awareness, vaccination and screening. Evidence was synthesized from 26 eligible studies, incorporating national surveys, cohort studies, policy reports and qualitative analyses. Findings reveal substantial deficits in HBV-related knowledge, particularly among socio-economically disadvantaged and rural populations, where stigma, mis-information and poor health literacy impede timely diagnosis and care-seeking. Although hepatitis B vaccination is part of India's Universal Immunization Programme, birth-dose coverage remains sub-optimal due to labor-room workflow challenges, cold chain fragility and provider hesitancy, especially in high-fertility states. Uptake among healthcare workers and medical students is also inconsistent, highlighting gaps between theoretical knowledge and preventive behavior. Screening efforts, primarily through the National Viral Hepatitis Control Programme, remain fragmented, with significant inter-state disparities in antenatal HBsAg testing and limited penetration in tribal and remote regions. While decentralized, community-led models have shown promise; broader scale-up is hampered by logistical and infrastructural constraints. The review underscores the urgent need for culturally tailored awareness campaigns, cold chain automation, subsidized adult vaccination and robust digital linkage-to-care models. Generating rural-specific cost-of-illness and willingness-to-pay data will be vital for evidence-informed policymaking. A life-course approach anchored in equity, digital health and decentralization is essential to achieving HBV elimination goals and reducing the burden of chronic liver disease in India.

Background: Sarcopenia, characterized by progressive skeletal muscle loss, is associated with poor outcomes in various diseases. Traditional methods for assessing muscle cross-sectional area using computed tomography (CT) scans are manual, time-consuming and prone to variability.

Aim: This study comprehensively validates a deep-learning (DL) pipeline for accurate and reproducible sarcopenia detection on computed tomography across diverse disease abdominal conditions and imaging protocols.

Methods: We utilized the publicly available Sparsely Annotated Region and Organ Segmentation (SAROS) CT dataset (n = 550 CT scans, 6516 slices) for model training. Testing was conducted on 601 CT scans from public (SAROS, Cancer Imaging Archive [TCIA] , WAW-TACE) and in-house multi-center datasets representing varied clinical conditions (acute pancreatitis, inflammatory bowel disease, gallbladder cancer and distal bile duct obstruction). The implemented pipeline integrated TotalSegmentator for L3 vertebral segmentation, automated L3 slice extraction and skeletal muscle segmentation using nnU-Net. Performance evaluation included expert qualitative scoring, Dice scores, intersection over union (IoU) and diagnostic accuracy metrics for sarcopenia detection.

Results: The DL pipeline demonstrated consistent segmentation accuracy across diverse datasets, with mean Dice scores ranging from 0.9287 to 0.9701 and mean IoU values up to 0.9423. Expert evaluation confirmed reliable L3 vertebral segmentation (78%-85% rated as complete) and skeletal muscle segmentation (90%-92.6% rated as excellent). Sarcopenia detection was consistent across varied patient populations, with sensitivity (0.94-0.97), specificity (0.84-0.97) and AUC values up to 0.92. Importantly, sub-group analysis confirmed comparable performance across varying disease conditions, CT protocols, contrast usage and radiation doses.

Conclusion: This study demonstrates that a deep-learning pipeline can achieve consistent and reliable performance for skeletal muscle segmentation and sarcopenia detection across heterogeneous abdominal CT protocols and diverse clinical conditions.

Background: Crohn's disease (CD) is characterized by recurrence following surgical resection. We assessed the post-operative recurrence rates, plausible risk factors and the prophylactic measures for prevention of the same.

Methods: This retrospective cohort included CD patients who underwent ileocolic resection from 2005 to 2021 with ≥ 1 year follow‑up to evaluate the association between post-operative endoscopic surveillance and recurrence‑free survival. Surveillance patients were matched 1:1 to non‑surveillance controls using nearest‑neighbor propensity scores estimated from a logistic regression model that included age, sex, smoking, disease behavior and location, surgical approach, appendectomy history, prior anti-tubercular therapy and pre-operative prophylaxis (caliper = 0.20 SD of the logit; no replacement). Recurrence-free survival was analyzed by Kaplan-Meier curves, log-rank test and adjusted hazard ratios from multi-variable Cox regression.

Results: Of 90 patients (60% male; median follow‑up 45 months, interquartile range (IQR) 20.75-72), ileal stricturing disease predominated; clinical recurrence occurred in 51% (median recurrence‑free survival 61 months). One and three‑year clinical recurrence rates were 23.3% and 36.3%, respectively; one and three‑year endoscopic recurrence rates were 30.1% and 42.8%, respectively. In the propensity‑matched cohort, endoscopic surveillance was associated with a 34% relative reduction in the hazard of clinical recurrence (HR 0.66; 95% CI 0.32-1.38). Surveillance‑guided prophylaxis achieved 81.3% recurrence‑free survival at 24 months. Active smoking independently increased endoscopic recurrence risk (HR 2.96; 95% CI 1.18-7.38; p < 0.001).

Conclusion: Endoscopy-driven post-operative surveillance with timely initiation or escalation of prophylaxis and smoking cessation was associated with longer recurrence‑free survival.