Indian Journal of Gastroenterology最新文献

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.

Liver biopsy continues to serve as a cornerstone in the evaluation of diffuse and unexplained liver disease, yet the percutaneous and trans-jugular routes are limited by safety concerns, patient acceptability and sampling variability. Endoscopic ultrasound-guided liver biopsy (EUS-LB) has emerged as a safe and effective alternative, offering real-time access to both lobes and the opportunity to combine tissue acquisition with other endoscopic interventions. This review summarizes current evidence on EUS-LB, with focus on technical considerations including needle design, gauge, number of passes and actuations, suction techniques and specimen handling. Reported diagnostic adequacy consistently meets or exceeds established histologic benchmarks, while adverse event rates are comparable to percutaneous and trans-jugular biopsy. Bleeding is the most notable complication, though it is uncommon and usually self-limiting. Beyond tissue acquisition, the concept of EUS as a "one-stop" platform-integrating biopsy, portal pressure gradient measurement, elastography and therapeutic interventions is gaining importance. With ongoing refinements and accumulating supportive data, EUS-LB is increasingly recognized as a versatile, minimally invasive and comprehensive tool in hepatology.

Background: Oxidative stress is an early step in the cascade of events triggering post-ERCP pancreatitis (PEP). N-acetylcysteine (NAC), a free radical scavenger, can be used to check this oxidative stress for PEP prophylaxis.  METHODS: A systematic search of MEDLINE, EMBASE and Scopus was undertaken from inception to May 30, 2025. The relative risks (RR) of PEP and severe PEP were pooled using a random effects model with the inverse variance method. Funnel plot and Egger's test were used to evaluate publication bias. The quality of studies was assessed using the Cochrane risk of bias tool.  Further sensitivity analysis was undertaken to evaluate oral route dosing and a leave-alone-one sensitivity analysis was done to confirm the robustness of the results (PROSPERO ID CRD420251062268).

Results: The five studies meeting the inclusion criteria included 784 participants of which 388 received NAC and 396 received placebo. PEP occurred in 50 participants in the NAC group as compared to 68 participants in the placebo group with a pooled RR of 0.74 (95% confidence interval [CI] 0.48 to 1.15) with moderate heterogeneity, I² 35%. Severe PEP occurred in none of the participants administered NAC as compared to three participants administered placebo with a pooled RR of 0.27 (95% CI of 0.03 to 2.43), with I² of 0% and no publication bias confirmed by no funnel plot visual asymmetry or Egger's test (p = 0.220). Sensitivity analysis confirmed the robustness of the results.

Conclusion: The pooled results of the meta-analysis suggest that NAC prophylaxis does not prevent the occurrence of PEP or severe PEP as compared to placebo.

Vascular liver diseases (VLD) are a heterogeneous cohort of uncommon hepatic diseases which affect individuals particularly in the reproductive age group. They are typically associated with inherited or acquired thrombophilia. These diseases may influence reproductive health in women through alteration of the menstrual cycle and impact fertility. Pregnancy in this patient group may be complicated by exacerbation of portal hypertension, maternal and fetal complications due to underlying liver disease or drugs used for its management. This review focuses on the known risk factors of VLD in women, along with their prevalence and management. Special situations such as impact and use of anti-coagulants in pregnancy, management of portal hypertension and variceal bleeding, safe contraceptive use in this patient group and safety and risk of in-vitro fertilization are also discussed.

Background: Biliary atresia (BA) is a serious condition and the leading cause for liver transplantation in children. The exact cause for BA is currently unknown, with one suggested mechanism being a viral infection. Cytomegalovirus (CMV) is the most common viral infection in BA patients and was previously known to be associated with worse outcomes, including liver fibrosis. Our study aimed at investigating the association between CMV infection and liver fibrosis in BA patients who underwent the Kasai procedure at our institution.

Methods: This study was a retrospective analysis of medical records from BA patients who underwent the Kasai procedure between January 2019 and July 2024 at our hospital.

Results: Our study involved 15 male and 23 female BA patients. The proportion of CMV-infected patients (n = 11) was lower than that of the non-CMV-infected BA patients (n = 27). The association between CMV infection status and liver cirrhosis (p = 1.0) was statistically insignificant. However, the age at the Kasai procedure showed a statistically significant association with cirrhosis (p = 0.027; odds ratio [OR] = 7.20; 95% confidence interval [CI] = 1.27-40.7). Moreover, a multi-variate analysis revealed a strong association between the age at the Kasai procedure and liver cirrhosis (p = 0.029; OR = 7.37; 95% CI = 1.22-44.42).

Conclusion: Our study's findings suggest that CMV infection might not significantly affect the degree of liver fibrosis in BA patients following the Kasai procedure. Furthermore, the age at which the Kasai procedure is performed might influence the development of liver cirrhosis in these patients. These insights could reshape our understanding of BA and guide future research and clinical practice.

Background and objectives: Recurrent acute pancreatitis and chronic pancreatitis are disorders associated with significant morbidity. Despite increased awareness of quality-of-life impairment in these conditions, data comparing quality of life between chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP) remains limited, particularly in Indian populations. This study aimed at assessing and comparing the quality of life in patients with CP and RAP compared to healthy controls.

Methods: This prospective cross-sectional bicentric study enrolled patients from two tertiary care centers in India between 2019 and 2024. Quality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Demographic characteristics, risk factors, complications and treatments were recorded for all participants. Statistical analysis included a comparison of quality-of-life domains across groups and a reliability assessment of the questionnaire.

Results: The study comprised 216 participants: 54 CP patients (mean age 26.8 ± 9.4 years, 59.3% male), 54 RAP patients (28.4 ± 10.4 years, 79.6% male) and 108 age-matched healthy controls. Idiopathic etiology predominated in both groups (CP: 94.4%, RAP: 68.5%). CP patients demonstrated significantly lower body mass index (BMI) (20.2 ± 2.4 vs. 24.1 ± 4.5 kg/m², p < 0.001) and higher diabetes prevalence (27.8% vs. 9.3%, p = 0.01) compared to RAP patients. Global health status was impaired in CP patients (47.1) compared to RAP patients (64.7) and controls (74.8) (p = 0.001). Emotional functioning showed the most pronounced difference (CP: 56.6, RAP: 75.4, controls: 82.9; p < 0.001). Symptom scales revealed higher burden in CP patients for fatigue, pain and nausea/vomiting. Reliability analysis confirmed strong internal consistency for both patient groups (Cronbach's alpha: RAP = 0.745, 95% CI: 0.644-0.825; CP = 0.847, 95% CI: 0.785-0.895).

Conclusions: Our findings demonstrate significant quality of life impairment in CP patients, particularly affecting emotional and physical functioning domains. The relatively preserved quality of life in recurrent acute pancreatitis patients suggests a critical window of opportunity for intervention before progression to chronic disease.

Background: The esophagogastric junction contractile integral (EGJ-CI) is a manometric parameter used to assess EGJ function. EGJ-CI must be manually calculated using a multi-step process. An earlier metric, the lower esophageal sphincter pressure integral (LESPI), is conceptually similar to EGJ-CI, but has a more straightforward calculation algorithm.

Aims: This study aimed at proposing a new, easier to calculate metric, the modified EGJ-CI (m-EGJ-CI) and to compare its fidelity to EGJ-CI.

Methods: After Institutional Review Board (IRB) approval, we conducted a cross-sectional study. High-resolution manometry studies performed between February 2018 and October 2024 at our center were retrieved. Patients with prior foregut procedures, distal esophageal spasm, hypercontractile esophagus, EGJ outflow disorders, hiatal hernias > 5 cm and lung transplant candidates/recipients were excluded. An experienced interpreter calculated the EGJ-CI and m-EGJ-CI for each study. Correlations were assessed using Spearman's rank coefficient. The complexity of each parameter was estimated based on the calculation time required.

Results: Studies from 84 patients (58 women [69%]; median age, 61 years [IQR 49.5-69.5]) were re-analyzed. A strong positive correlation between EGJ-CI and m-EGJ-CI was found (ρ = 0.839 [95%CI = 0.72-0.96], p < 0.05). The cumulative time for m-EGJ-CI calculations was significantly lower than that for EGJ-CI (15.7 vs. 60.3 min, p < 0.05).

Conclusions: The EGJ-CI calculation as an indicator of EGJ competence may be overly complex and time-consuming. The m-EGJ-CI saves time without compromising fidelity to EGJ-CI and can potentially be automated in future software versions.