Indian Journal of Gastroenterology最新文献

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.

Gut health is gradually emerging as a cornerstone of overall well-being, influencing a wide range of physiological systems including the nervous, immune, metabolic and hepatic pathways. Disruption of the gut ecosystem has been implicated in functional gastrointestinal disorders, metabolic diseases, mental health disturbances and many other entities. The novel concept of 'bowel hygiene' can be developed as a comprehensive, structural framework akin to oral or sleep hygiene, which emphasizes daily, modifiable lifestyle behaviors that can be utilized to improve gastrointestinal function. The conceptual framework of bowel hygiene is based on evidence from dietetics, behavioral science, exercise physiology and traditional practices and identifies five core pillars - dietary regulation and hydration, adhering to routine timing, physical activity, mind-body practices and behavioral toileting habits. These practices, supported by emerging scientific evidence, aim to improve gut motility, stool consistency, microbial diversity and stress resilience and potentially reduce the burden of chronic gastrointestinal and functional bowel disorders. Traditional knowledge systems and community proverbs and sayings, also align with this approach, lending it socio-cultural legitimacy. The potential of bowel hygiene to serve as a low-cost, scalable, culturally adaptable intervention that can be introduced at individual, community and school levels to promote lifelong digestive health needs to be urgently explored from the perspective of public health. While clinical and mechanistic studies continue to evolve, the current understanding suggests that this concept holds significant promise for integration into public health and preventive medicine paradigms.

Background: Phenotyping of gastroesophageal reflux disease (GERD) requires endoscopy, high-resolution esophageal manometry (HREM) and 24-hour pH testing.

Methods: The present study was conducted to determine HREM parameters associated with positive reflux test (acid exposure time > 4% on 24-hour pH test). Further, creation and validation of manometry GERD score (MGS) to predict positive reflux test was done. Consecutive patients > 18 years referred for HREM and 24-hour pH study between May 2019 and December 2024 were included prospectively. Based on the findings in patients enrolled between May 2019 and May 2022, HREM parameters significantly different in patients with and without positive reflux were noted. Based on odds ratio, each parameter was assigned weightage points to formulate MGS. This score was validated prospectively. Data was analyzed for sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and area under the receiver-operating characteristic (AUROC) curve. Optimal cut-off was interpreted based on Index of Union test. A p value < 0.05 was considered statistically significant.

Results: Calibration cohort included 144 patients (90 males)-98 (68%) had positive reflux test. Patients with positive reflux test had higher incidence of abnormal multiple rapid swallows (MRS, p 0.006), esophagogastric junction (EGJ) contractile integral (CI) < 39 (p < 0.0001) and type 2/3 EGJ morphology (p < 0.0001). These parameters were allotted weightage points to formulate MGS (total 5 points). In the validation cohort (n = 151, 95 males), 65 (43%) patients had a positive reflux test. A majority of patients with positive reflux test had MGS > 3.5 (83.1%). MGS score had AUROC equal to 0.85. MGS > 3.5 had sensitivity of 83.1% and specificity 80.2% to detect positive reflux test.

Conclusion: EGJ morphology type 2/3, EGJ-CI < 39 mmHg and abnormal MRS were significantly more common in patients with positive reflux test. MGS is useful in predicting positive reflux test.

Background and objectives: Risk stratification of patients with upper gastrointestinal bleeding (UGIB) is crucial for streamlining healthcare in resource-limited settings, thereby minimizing both morbidity and mortality. Our objective was to validate clinical outcomes of the pre-existing risk assessment scores as full Rockall score (FRS), Glasgow-Blatchford bleeding score (GBS), Progetto Nazionale Emorragia Digestiva (PNED) and AIMS65 (an acronym of albumin, International Normalized Ratio [INR], mental status, systolic blood pressure, age > 65 years) scores and a proposed acronymic A2BC score incorporating four variables as age, serum albumin, mean blood pressure and serum creatinine in our setting.

Methods: Prospective study over a three-year period of patients presenting with UGIB at the Department of Medical Gastroenterology, Medical College, Kolkata.

Results: The mean age of the 535 subject population was 52.84 ± 17.13 years, with male predominance (n = 284, 53.08%) and a majority being non-variceal bleeders (n = 336, 62.8%). The median (IQR) of FRS, GBS, PNED, AIMS65 and A2BC scores with composite risk defined as the presence of one or more of the following: need for blood transfusion during hospitalization, therapeutic intervention in non-malignant NVUGIB, rebleeding and death both within 42 days were 4 (3-6), 14 (12-16), 6 (2-10), 1 (0-2) and 1 (0-2) in comparison to those without the risk 2 (2-3), 10 (8-11), 3 (0-4), 0 (0-0) and 0 (0-0), respectively, all of which were statistically significant (p < 0.001). The discriminant cut-offs of FRS, GBS, PNED, AIMS65 and A2BC scores to predict composite risk of the subjects were ≥ 2, ≥ 7, ≥ 1, ≥ 1 and ≥ 1, respectively, with accuracies of 64.85%, 68.97%, 68.59%, 73.83%, and 77.57% respectively.

Conclusion: Our study validates the commonly used prognostic scores in our context and encourages further studies on the newly formulated A2BC score.

Objectives: Chronic pancreatitis results in pancreatic exocrine insufficiency (PEI), which is treated with pancreatic enzyme replacement therapy (PERT). Despite the clinical benefits, non-compliance to PERT is a frequent problem. Our study aimed at (a) identifying predictors of non-compliance to PERT using machine learning (ML) algorithms and (b) analyzing patient-reported reasons for non-compliance to PERT.

Methods: A prospective observational study was conducted at a high-volume tertiary care center on two independent cohorts of chronic pancreatitis patients on PERT. In Cohort 1 (1057 patients screened), we used ML algorithms to identify predictors of non-compliance to PERT. The best ML model based on performance metrics was chosen for Shapley Additive explanations (SHAP) analysis. In Cohort 2 (465 patients screened), we conducted detailed interviews to understand patient-reported reasons for non-compliance.

Results: In Cohort 1 (751 patients analyzed; median age, 37.5 years; males, 73.1%; idiopathic, 61.9%), 166 (22.1%) patients were non-compliant to PERT. Extreme gradient boosting (XGBoost) exhibited the highest accuracy (area under the curve, AUC = 0.91). The strongest predictors of non-compliance based on SHAP were disease duration, age, fat-restricted diet, rural residence and educational status. A non-compliance (NC) score was developed based on SHAP. In Cohort 2 (129 patients analyzed; mean age, 36 years; males, 72.1%; idiopathic, 52.3%), high treatment costs (34.1%), negligence (19.4%) and adverse effects (10.9%) were the most reported reasons for non-compliance.

Conclusions: This study identifies predictors of non-compliance to PERT (disease duration, age, fat-restricted diet, rural habitat, undergraduate education status) in patients with chronic pancreatitis using machine-learning algorithms. The NC score can be a useful tool to identify patients at risk for non-compliance, who can be subjected to targeted counselling. The NC score needs to be validated in large, independent, multi-centre cohorts of patients.