Indian Journal of Gastroenterology最新文献

Gastrointestinal (GI) symptoms occur frequently in pregnant women, resulting in poor quality of life. These patients frequently require co-management with the obstetrician and a physician/GI specialist. The causation is complex and multifactorial. It is a result of a combination of maternal changes in pregnancy and feto-placental hormonal effects on the GI tract (the feto-placental-gut axis). Additional factors such as the gut-brain interaction, genetics, immune response and effects of maternal supplements during pregnancy also contribute to the causation of symptoms. The most common of these symptoms include nausea and vomiting followed by heartburn. The common lower GI symptoms include constipation and hemorrhoids. Irritable bowel syndrome (IBS) is also common in a pregnant patient. But there is a paucity of literature and high-quality studies concerning the management of IBS. This review addresses the pathophysiology and clinical and laboratory evaluation of the common upper GI and lower GI symptoms and their management. A majority of symptoms are mild and lifestyle modifications with non-pharmacological measures should be the first-line management, whereas drugs should be used judiciously in case of non-response or severe symptoms. The nutritional status of the mother and the fetus needs close monitoring. Drugs that are routinely used in pregnancy are discussed with regard to the safety of the mother and the fetus. GI endoscopy may be needed in select patients and the indications for endoscopy and colonoscopy in pregnancy along with special pregnancy-related precautions are discussed. Most symptoms improve to pre-pregnancy state after delivery.

Background: Acute upper gastrointestinal bleeding (UGIB) still has a mortality rate of about 10%. Several pre-endoscopy scoring systems have been developed to predict the outcome, but none accurately predict mortality. The present study was aimed at comparing the new ABC score (age, blood tests and comorbidities) with other pre-existing scoring systems to predict mortality.

Methods: This prospective single-center study was done at a tertiary hospital in India in 2022-2023. Patients > 18 years presenting with UGIB within 48 hours were included in the study. They were divided into variceal and non-variceal UGIB cohorts and were followed for 30 days after receiving standard-of-care treatment.

Results: Out of 296 patients, 168 (56.7%) had variceal (V) bleed, while 128 (43.2%) individuals had a non-variceal (NV) type of GI bleed. The mortality rate was 9.8% (n = 29), which was higher among the V bleed group compared to the NV bleed group (8.7% vs. 1.1%). The area under the receiver operating characteristics (AUROC) for ABC score was the highest (0.75) compared to other scoring systems and was also more significant among deaths related to V bleed (0.76) than NV bleed (0.64). Hypoalbuminemia and > 3 blood transfusions are significant factors in predicting mortality.

Conclusion: Our study demonstrates that the ABC score is superior to other scores in predicting 30-day mortality in patients with UGIB. ABC score may be a better predictor of mortality among V bleed patients than NV bleeds.

Background: The management of Type III sphincter of Oddi dysfunction or functional biliary pain (FBP) is challenging. A strategy of intermittent intrasphincteric botulinum toxin (Botox) injections into the sphincter of Oddi can alleviate pancreaticobiliary pain. In patients who lose response to intermittent Botox injections, endoscopic biliary sphincterotomy (ES) could potentially reset pain facilitating ongoing management of symptoms.

Methods: A retrospective review of case notes over a seven-year period (2014-2021) was performed. All patients underwent blood tests, gastroscopy, trans-abdominal ultrasonography, cross-sectional imaging with magnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) and endoscopic ultrasound (EUS) to rule out alternative causes for their symptoms of pancreaticobiliary pain. A diagnosis of FBP was made in patients with typical post-cholecystectomy pain and normal liver function tests and bile duct size on imaging. Patients with symptomatic FBP underwent intermittent endoscopic Botox injections to the sphincter of Oddi. Patients who lost response to Botox injections underwent ES and were followed up in an outpatient setting to assess response.

Results: One hundred and thirty (128 female, 2 male) patients with FBP underwent a mean of four (2-8) Botox injections over the study period. Of 130 (90%) patients, 117 reported a significant improvement in pain on post procedure review with 81% of patients managing to discontinue opioid medication post procedure. Fifty-one out of 130 (39%) lost response to Botox injections after a median of six (range 5-11) sessions (median eight months between sessions [range 6-18 months]) and continued to have ongoing pancreaticobiliary pain and subsequently underwent biliary ES. Forty-one out of 50 (82%) reported a clinical improvement in their symptoms of pancreaticobiliary pain following ES, with response persisting at follow-up for up to mean of eight (5-15) months and no further hospital attendances due to severe pancreaticobiliary pain.

Conclusion: ES can reset pancreaticobiliary pain in FBP once Botox injection therapy to the sphincter of Oddi becomes ineffective and may provide ongoing relief of symptoms.

Introduction: The use of proton-pump inhibitors (PPI) is linked with infrequent but serious adverse events, including acute kidney injury, chronic kidney disease (CKD) and progression of CKD. Data on renal safety in routine use of PPI are more relevant to clinical practice. We studied whether such use of PPI is associated with renal dysfunction.

Methods: Patients taking PPI for at least six weeks had serum creatinine tested pre (n = 200) and post (n = 180) recruitment. These patients were then advised to follow-up: those taking PPI for at least 90 days in the next six months (n = 77) and at least another 90 days in the following six months (n = 50), had serum creatinine tested at such follow-up. Renal dysfunction was defined as any increase in serum creatinine level above baseline.

Results: The 200 patients recruited had mean age 39.6 (SD 9.2) years. Ninety-eight (49%) patients had a history of previous PPI use (median six months; interquartile range [IQR] 3-24). Only 20 (11.1%) patients at six weeks, 11 (14.3%) at six months and six (12%) at one year had increase in creatinine level; a majority of them had less than 0.3 mg/dL increase. Ten of these 20 (six weeks), five of 11 (six months) and five of six (one year) had other risk factors for renal dysfunction. No patient developed CKD during the study period.

Conclusions: Mild and non-progressive increase in serum creatinine occurred in 10% to 15% of patients on routine PPI use. A majority of them had other risk factors. Small sample size and short follow-up duration are a few limitations of this study.