Indian Journal of Gastroenterology最新文献

Background: Women with disorders due to psychoactive substance use (PSU) are at an increased risk for liver disease; however, liver fibrosis is rarely assessed in psychiatric settings. This study aimed at assessing the prevalence of liver fibrosis using non-invasive indices among women hospitalized for PSU dependence, evaluate hepatology referral patterns and explore association between fibrosis severity and socio-economic indicators.

Methods: We conducted a retrospective analysis of liver fibrosis using the Fibrosis-4 Index (FIB-4) and aspartate aminotransferase (AST) to platelet ratio index (APRI) in women hospitalized for PSU dependence in two separate years, 2019 and 2024. Standard cut-offs were applied. Demographic, psychiatric and biochemical data was reviewed and hepatology referral rates were analyzed. Association between fibrosis severity and socio-economic factors was also explored.

Results: Total 199 women were included (median age 50.1 years, interquartile range [IQR] 39.8-59.5); 91.5% had documented alcohol dependence. Psychiatric comorbidities were frequent, including personality, anxiety and stress-related and adjustment disorders. Based on FIB-4, 43 patients (21.6%) were at intermediate risk and 14% (7.0%) at high risk of fibrosis and only 12.3% were referred to hepatology. APRI identified 20 patients with significant fibrosis or probable cirrhosis, with a referral rate of 15%. FIB-4 scores differed significantly across education levels (p = 0.004), showing a bimodal distribution.

Conclusions: Despite the availability of simple non-invasive tools, many women at risk for liver disease were not referred for specialty care. Raising awareness and integrating fibrosis screening into psychiatric care are keys to identifying liver disease early and addressing social vulnerability in at-risk patients.

Background and aims: Although more women are entering gastroenterology and related fields (GI practice) in India, gender gaps remain in training, leadership and career growth. This Indian Society of Gastroenterology-Women in GI Forum (ISG-WGF) study examines the challenges women face in GI and hepatology and suggests practical steps to improve equity and inclusion.

Methods: A structured, online questionnaire was disseminated to 4140 members of the ISG, including trainees and practising gastroenterologists. The questionnaire assessed six domains: socio-demographic data, GI training experiences, family support, current GI practice, work-life balance and gender-related career trajectory in men and women GI professionals.

Results: Of 185 respondents (response rate 4.5%), women represented 46.5%, although they comprised only 10.7% of ISG members. Women reported greater work-life imbalance (65.0% vs. 43.8%; p = 0.023), more family-related career disruptions (43% vs. 21%; p < 0.001) and higher perceived gender discrimination (36% vs. 11.1%; p < 0.001). Women respondents were younger than men (42.4 ± 16.7 years vs. 47.3 ± 13.4, p = 0.032) and only 24.4% of women respondents held leadership positions compared to 45.5% of men (p = 0.004). Women scientists face career barriers such as inadequate mentorship, inflexible work schedules, limited family and institutional support and ergonomic issues in endoscopy. Solutions include mandated gender equity policies, structured mentorship, leadership opportunities, innovations in endoscopy practice and inclusive institutional reforms.

Conclusion: Addressing gaps in GI training and practice by implementing mentorship, gender-sensitive policies and workplace equity initiatives may help improve professional satisfaction, reduce career lag and increase female involvement in GI leadership roles.

Gastrointestinal (GI) cancers remain a leading cause for global cancer-related morbidity and mortality, affecting both-men and women. Recent research highlights significant differences between the sexes in terms of incidence, development and treatment outcomes. The interplay between genetic, environmental, diet and lifestyle, and hormonal factors such as estrogen, progesterone and androgens forms a pivotal axis influencing various GI cancer development and therapeutic responses. Women's unique vulnerability and resilience to GI cancers are influenced by differences in immune response, genetic profiles and exposure to risk factors. Site-specific evaluations show that hormonal factors can either protect or predispose women to certain cancers, often depending on life stage and hormonal status. Gender-directed approaches to prevention, screening and treatment, along with tackling psycho-social burdens and detection challenges, will significantly impact the outcomes of GI cancer in women. Further research in this area is vital to enhance outcomes and address gaps in GI cancer care for women.

Background: There are limited studies on the impact of gender on training and career advancement in gastroenterology.

Aim: The aim was to study this impact and understand the perceptions of work-life balance and beliefs regarding gender dynamics among gastroenterologists in India and other South Asian countries.

Methods: A web-based survey was conducted among trainees and attending physicians in South Asia from November 15, 2021, to March 30, 2022. The survey instrument had four components: demographic features, training, career advancement and work-life balance.

Results: As many as 622 gastroenterologists completed the survey, of which 467 responses were from India (mean age: 41.1 years; females: 11.5%). A higher proportion of female respondents from India believed that gender bias in recruiting and training had negatively impacted their careers (40.7% females vs. 1.5% males). Radiation hazard for fertility (11.1% females vs. 1.9% males, p < 0.001) and as a health concern (14.8% females vs. 5.1% males, p = 0.005) were significant career deterrents for females. A higher proportion of female participants from India faced a career interruption (59.3% females vs. 30.3% males, p ≤ 0.001). Common reasons were pregnancy (37%) and childcare provision (25.9%). More females believed that women were more productive than men (40.8% females vs. 16.9% males, p < 0.001) and that a salary gap existed (44.7% females vs. 29.1% males, p < 0.001). The incidence of self-perceived burnout was 63% among females and 51.6% among males (p = 0.115).

Conclusion: Gender-related factors impact the training and career of female gastroenterologists.

Background and aim: The study aimed at assessing the course of portal hypertension and safety of non-selective beta blockers (NSBB) in pregnant patients with portal hypertension.

Methods: Pregnant women with portal hypertension (PHT), diagnosed preconceptionally or during pregnancy, were included in this retrospective study. Medical records were assessed for NSBB prescription, liver decompensation (ascites, variceal bleed, hepatic encephalopathy), overall and pregnancy-related outcomes. All outcomes were documented at discharge from the hospital.

Results: One-hundred thirty-four pregnancies in 93 patients (median age: 26, range [17-39 years]). The study included 54 primigravidas. Among the 93 patients, the etiology of portal hypertension was vascular in 48 and cirrhosis in 45. Of the 134 pregnancies, 90 were diagnosed with portal hypertension prior to pregnancy. Of these, 46/90 (51.1%) had a history of prior GI bleed. In the remaining 44/134, PHT was diagnosed during the index pregnancy. Of the 134 pregnancies, NSBB was prescribed during 51 pregnancies (38%; primary prophylaxis: 18, secondary prophylaxis: 33). Of these, 36 (26.9%) were started on NSBB preconceptionally, while 15 (11.2%) were initiated during pregnancy-one in first, 10 in second and four in third trimester. Sixteen (12%) patients presented with acute decompensation (ascites:13; GI bleed: 5; both 2). Of the remaining 118 pregnancies, not presenting initially with decompensation, 12 pregnancies were associated with hepatic decompensation either during antenatal or immediate post-partum period. Decompensation during pregnancy was similar in patients on NSBB (6/51, 11.8%, ascites: 3, GI bleed: 3) and not on NSBB (6/67, 8.9%; ascites: 6, GI bleed:0). Although maternal (100% survival) outcome was good, adverse fetal outcomes were noted (live: 116; abortion: 10, stillbirth: 7, neonatal death: 1). Hepatic decompensation was associated with poor fetal outcomes (live births: 69% vs. 91%, p = .03). NSBB was well tolerated with no effect on fetal outcome (p = .82), birth weight (2.5, 1.2-3.4 kg vs. 2.7, 1.1-3.7 kg; p = .12) or intra-uterine growth retardation (34% vs. 28%; p = .40).

Conclusions: Pregnancy is well tolerated in patients with portal hypertension, with favorable maternal outcomes. De novo decompensation was associated with adverse fetal outcomes. NSBB use appears safe and well tolerated in this subset of expectant mothers with portal hypertension.

Introduction: Colorectal cancer (CRC) incidence is rising in India, yet formal screening programs are lacking, in part due to the perceived low adenoma prevalence. This study aimed at evaluating the impact of quality improvement measures on adenoma detection rate (ADR) in a real world Indian setting and identifying factors associated with adenoma detection.

Methods: In this single-center study, consecutive patients aged ≥ 18 years undergoing colonoscopy between September 2022 and August 2024 were included. Colonoscopy data from September 2022 to August 2023 served as a retrospective control arm, while those from September 2023 to August 2024 formed the prospective intervention arm, following implementation of standardized quality-focused withdrawal techniques.

Results: Of 2260 patients (mean age 47.3 ± 13.8 years, 69% male), 1265 were in the intervention arm. The intervention arm showed significantly higher polyp detection rates (32.7% vs. 11.0%) and ADR (20.5% vs. 6.3%) compared to controls (p < 0.0001), with no difference in CRC detection (1.8% vs. 2.3%, p = 0.48). ADR increased with age: 11.1% in < 45 years, 27.9% in ≥ 45 years and 36.2% in > 60 years. Independent predictors of adenoma detection included implementation of quality improvement measures (OR 3.3), age ≥ 45 years (OR 3.0), male sex (OR 1.6) and withdrawal time ≥ 6 min (OR 1.8) (all p < 0.0001).

Conclusion: Implementation of quality improvement measures and standardized withdrawal techniques significantly improved ADR in an Indian clinical practice setting. These findings support the adoption of quality-focused practices and provide epidemiological insights relevant to CRC screening strategies in developing countries like India.

Background: Bile acid malabsorption (BAM) is often missed in patients with chronic diarrhea as diagnostic tests are technically challenging and not available widely. Quantitative estimation of fecal bile acids (FBA) in a single stool sample has been reported recently for the diagnosis of BAM and may be easily applied.

Methods: We performed a pilot observational cross-sectional study to estimate the optimal FBA cut-point for the diagnosis of BAM, using the IDK^® Bile Acid test, an enzymatic spectrophotometry-based assay for measuring total stool bile acids. We estimated FBA concentrations in healthy adults (n = 100; negative controls) and patients with known ileal Crohn's disease (n = 67; positive controls), generating a receiver-operator characteristics (ROC) curve for assessing its diagnostic accuracy. FBA levels were then assessed in three groups of patients, namely diarrhea-predominant irritable bowel syndrome (IBS-D) and functional diarrhea (FD) (n = 100), post-cholecystectomy (n = 100) and ileal tuberculosis (n = 33).

Results: Optimal cut-off point for FBA was identified at 2.8 µg/g (sensitivity = 89.5%; specificity = 92.0%; area under ROC = 0.959 [95%CI = 0.929-0.989]), with median FBA in healthy controls (1.5 [IQR = 0.7-2.2]) being significantly lower than that in patients with ileal Crohn's disease (6.0 [IQR = 4.7-8.0]; p < 0.001). Median FBA in patients with IBS-D/FD, post-cholecystectomy and those with ileal tuberculosis were 2.0 (IQR = 1-2.8), 3.4 (IQR = 1.7-5.3) and 3.0 (IQR = 2.2-4.6), respectively. Overall, 21%, 57% and 54.5% of patients with IBS-D/FD, post-cholecystectomy and ileal tuberculosis had BAM.

Conclusions: We demonstrate the feasibility of quantitative estimation of fecal bile acids in a single stool sample to diagnose BAM.

Background and objectives: Helicobacter pylori infection is highly prevalent globally. Standard bismuth quadruple therapy is commonly used in India, but there are growing concerns regarding the emergence of anti-microbial resistance and treatment failure, necessitating the search for newer modalities. This study evaluated the efficacy and safety of adding mastic gum to standard bismuth quadruple therapy (BQTs) for H. pylori eradication.

Methods: In this single-blind, randomized pilot trial, adults with Helicobacter pylori infection were assigned to receive two weeks' course of either standard bismuth quadruple therapy combined with mastic gum (Group A, n = 32) or bismuth quadruple therapy alone (Group B, n = 32). The primary endpoint was the eradication rate of Helicobacter pylori assessed by urea breath test at six weeks after therapy. Secondary endpoints included symptom improvement, measured by Dyspepsia Symptom Severity Index (DSSI), adverse events and compliance.

Results: Urea breath test demonstrated higher eradication rates in Group A vs. Group B (85% vs. 67%, absolute risk reduction = 0.18, number needed to treat ≈ six). However, it failed to reach statistical significance (p = 0.19). Both groups showed significant reductions in DSSI scores, with greater mean improvement in Group A (0.941 vs. 0.766, p = 0.001). Both treatment regimens were well-tolerated and treatment compliance was notably high in both groups, with 84.4% in each group reporting 100% compliance.

Conclusions: In this pilot study, the addition of mastic gum to standard bismuth quadruple therapy resulted in an observed increase in the proportion of eradicated cases; however, it did not meet the primary endpoint due to a lack of statistical significance. Nevertheless, the adjunct therapy was associated with significantly greater dyspepsia symptom relief and was well-tolerated without increasing adverse effects.