Indian Journal of Gastroenterology最新文献

Background and objectives: Some researchers are concerned that the performance of pancreatic resection in cases of low malignancy with distal localization will increase, resulting in the occurrence or worsening of post-operative glucose intolerance. Herein, we retrospectively investigated the relationship between the pancreatic resection ratio and post-operative glucose intolerance in distal pancreatectomy (DP).

Methods: Total 135 patients who underwent DP at our hospital and were followed up for > 12 months between January 2013 and December 2022 were included. Of these, 52 patients were included, excluding those with pre-operative diabetes and those who underwent pancreatectomy using other than a stapling device. The pancreatic resection ratio (%) was measured using pancreatic volumetry by manually tracing the pancreatic area on computed tomography images obtained before and after surgery and the relationship with post-operative glucose intolerance was investigated.

Results: Among the 52 patients, 13 (25.0%) showed post-operative worsening of glucose tolerance (impaired glucose tolerance [IGT] group). The pancreatic resection ratios were 51.1% and 34.8% in the IGT (13 patients) and non-IGT groups (39 patients), respectively (p = 0.0027). The cut-off value for the IGT group was 46.5%. The resection site was divided into two groups as follows. One group was resected near the portal vein (portal group) and the other group was resected more caudally (caudal group). Mean pancreatic resection ratios were 46.5% and 28.5% in cases of resection of the portal group (30 patients) and caudal group (22 patients), respectively (p < 0.0001). The thickness of the pancreas at the resection site was 13.1 mm in the portal group and 17.7 mm in the caudal group (p < 0.0001) and the incidence of pancreatic fistula was 6.7% and 9.1%, respectively (p = 0.7472). The incidence of post-operative glucose intolerance was 40.0% (12/30) in the portal group and 4.5% (1/22) in the caudal group (p = 0.0016).

Conclusion: In cases of low-grade tumors and benign disease, pancreatic resection with preservation of the remaining pancreatic volume should be considered whenever possible.

Background: In inflammatory bowel disease (IBD), a flare can be due to natural history of disease or due to gastrointestinal infection. Infection is conventionally diagnosed by stool microscopy and culture. Stool multiplex polymerase chain reaction (PCR) assay or Biofire® FilmArray^® GI Panel is a sensitive and rapid test for detecting infection, but is expensive; its impact on management and cost-effectiveness has not been studied in IBD.

Aims: To compare stool PCR assay and conventional tests during IBD flare for detection of infection, impact of detection on treatment and cost-effectiveness of the tests.

Methods: Sixty-five patients with IBD flare underwent conventional stool tests (microscopy, culture and Clostridioides difficile toxin assay) and stool PCR assay simultaneously.

Results: We prospectively enrolled 65 consecutive patients presenting with disease flare: ulcerative colitis (58 patients, 28 women, mean age 41.1 years) and Crohn's disease (seven patients; three women; mean age 36.1). Stool PCR detected organisms in 36 (55.4%) patients as compared to six (9.2%) by conventional tests (p < 0.0001). The organisms detected by the PCR assay were enteroaggregative (EAEC) (22 patients), enteropathogenic (EPEC) (12), enterotoxigenic Escherichia coli (ETEC) (5), Plesiomonas shigelloides (4), C. difficile (3), norovirus (3), enteroinvasive E. coli (2), rotavirus (2) and G. lamblia, cryptosporidia, cyclospora, Sapovirus, adenovirus and Entamoeba histolytica (one each). PCR organism detection resulted in management change in 13 (20%) patients as compared to five (7.6%) by conventional tests (p < 0.02). Cost to achieve one positive result on stool PCR that led to management change was INR 60,000 (USD 690, EUR 638) as compared to Indian Rupees (INR) 54,600 (United States Dollar [USD] 627, EUR 580) for conventional tests. The incremental cost-effective ratio (ICER) was INR 63,375 (USD 728, EUR 674).

Conclusion: In an IBD flare, stool PCR or Biofire® FilmArray^® GI Panel detected more organisms and led to more frequent management change as compared to conventional tests. The ICER was INR 63,375 (USD 728, EUR 674). This test should be considered first-line investigation in an IBD flare.

Objectives: Intestinal fatty acid binding protein (IFABP) is a marker of intestinal epithelial injury and has been studied as a surrogate for predicting villous atrophy. The aim of this study was to evaluate the utility of IFABP in the non-invasive diagnosis of celiac disease (CeD) in children.

Methods: Symptomatic children with positive anti-tissue transglutaminase antibody underwent a duodenal biopsy and IFABP measurement. Controls were included who had both tissue transglutaminase antibody (tTG) and IFABP measured. We evaluated the performance of IFABP in the diagnosis of CeD by generating the receiver operating characteristic (ROC) curve.

Results: Total 123 children were screened; 98 had a positive anti-tTG, 74 patients aged 8.5 ± 4.0 years were diagnosed to have CeD and 24 patients had a normal biopsy. Seventy-six children aged 8.4 ± 4.0 years were enrolled as controls. Serum IFABP was significantly higher in children with CeD; median 918 pg/mL (interquartile range [IQR] = 630-1316) as compared to controls; median 386 pg/mL (IQR = 125-581) (p < 0.001). We observed increasing serum IFABP levels with a higher Marsh grade of mucosal injury (p < 0.001). Sensitivity and specificity for diagnosis of CD were 51% and 88% at serum IFABP level > 920 pg/mL and area under the curve (AUC) of 0.79 (0.67-0.90). In children with CD and a tTG 1-10 of normal, this cut-off could make a diagnosis without biopsy in 28/34 cases.

Conclusion: Serum IFABP can improve the non-invasive diagnosis of CeD in children with elevated tTG-IgA titers in a subset of patients and also has good correlation with the degree of villous atrophy.

Background: Swallowing intricately involves sensorimotor systems, pivotal for integrating upper digestive and respiratory functions. Dysphagia, challenging swallowing, often precipitates anxiety and depression, deeply affecting the quality of life (QOL). Understanding patient-centric symptoms is vital for assessing dysphagia's QOL impact.

Aim: This study aimed at developing and validating the Symptom Specific Dysphagia Quality of Life Questionnaire in Tamil (SSDQOL-T).

Method: SSDQOL-T was developed in Tamil and underwent rigorous content validation. This questionnaire was administered to 120 normal individuals and 32 dysphagia patients, assessing various swallowing difficulties and their QOL impact.

Results: Results indicate SSDQOL-T's good internal consistency (Cronbach's α = 0.78). Significant differences in swallowing ability and QOL were noted across age groups, with older adults experiencing heightened symptoms. A high significance in mean score was obtained between healthy adults and dysphagia across all sub-domains with a 'p-value' of 0.0005. Symptoms that were found to have high significance were cough/gag reflex, regurgitation, odynophagia, globus sensation, heartburn and tiredness when compared between mechanical and degenerative dysphagia group. Strong correlations were found between SSDQOL-T scores and the Dysphagia Handicap Index in Tamil (r = 0.89).

Conclusion: The SSDQOL-T questionnaire provides a robust tool for evaluating dysphagia-related QOL in the Tamil-speaking population. Its validation underscores its clinical relevance and utility for understanding the multidimensional impact of dysphagia. This study emphasizes the importance of culturally sensitive assessment tools in comprehensively evaluating dysphagia's QOL implications.

Background: Among cancers, carcinoma gallbladder has one of the most dismal prognosis. Early lesions are difficult to biopsy because of proximity to luminal structures and risk of biliary peritonitis. However, early surgery offers the only chance of a complete cure. Utilizing a risk score would allow characterization of the risk of malignancy and early referral to an oncology centre thereby resulting in better outcomes for patients with carcinoma gallbladder.

Methods: The aim of this study was to develop a risk score for carcinoma in patients with suspicious gallbladder lesions based on clinical presentation and imaging. All patients with suspicious gallbladder lesions on radiological imaging who underwent surgery were analyzed. Patients were considered for scoring if the ultrasound showed the gallbladder wall thickening (more than 4 mm) and computed tomography scan showed operable disease. Statistical analysis was done to derive a score for malignancy.

Results: Total 175 patients underwent an operation for suspicious gallbladder lesions from January 2005 to December 2014. The factors analyzed were clinical biochemical and imaging findings. Of these, 71 were benign on the final histopathology and 104 were malignant. The score was constructed with the following variables: female sex, high total bilirubin (≥ 1 mg/dL), presence of a mass, focal location of the lesion, presence of gallbladder stones and nodal involvement in the hepatoduodenal region on imaging. A model score and modified score were obtained. In this modified score, score of more than 8 out of 20 predicted malignancy with a sensitivity of 78% and specificity of 70.4%. Receiver operating characteristic (ROC) curve constructed with these variables had an area under curve of 0.828. There was no statistically significant difference between the model score and the modified score.

Conclusions: A pre-operative risk score was obtained for carcinoma gallbladder, which needs to be validated prospectively in future.