Indian Journal of Gastroenterology最新文献

Background and objectives: Functional dyspepsia (FD) is a common disorder with multi-factorial pathophysiology. It has two sub-types, post-prandial distress syndrome (PDS) and epigastric pain syndrome (EPS), which frequently overlap. Emerging evidence suggests that low-grade inflammation, particularly duodenal eosinophilia (DE), may play a pathogenic role in FD. However, Indian data on this subject remains scarce. This study aimed at evaluating the prevalence and clinical correlates of DE in patients with refractory FD.

Methods: In this prospective, cross-sectional study, Rome- IV defined FD patients with refractory symptoms and normal esophagogastroduodenoscopy (EGD) were enrolled. Age and sex-matched non-dyspeptic controls with normal EGD were also recruited. Standardized duodenal biopsies from cases and controls were independently assessed by two blinded histopathologists for eosinophil counts and degranulation. Symptom profiles and health-related quality of life (HRQoL) were evaluated using validated questionnaires.

Results: Of 274 patients with refractory dyspepsia screened, 189 patients with normal EGD (mean age 41.4 ± 15.2 years; 54.5% males) were enrolled, along with 96 controls. The mean duodenal eosinophil count in controls was 8.2 ± 1.5 per high-power field (HPF). Applying the mean + 3 standard deviation criteria, DE was defined as ≥ 13 eosinophils/HPF. DE was identified in 65.3% (123/189) of refractory FD patients (65.7% in EPS, 52.5% in PDS and 69.1% in the overlap group, p > 0.05). Duodenal eosinophil counts correlated positively with PDS symptom severity (r = 0.376; p < 0.0001), overlap symptom severity (r = 0.3; p = 0.031) and worse HRQoL (r = 0.21; p = 0.010). Furthermore, patients with eosinophilic degranulation (24.3%) had significantly higher PDS scores and worse HRQoL scores, compared to those without degranulation.

Conclusions: Up to two-thirds of the refractory FD patients exhibited duodenal eosinophilia, which was associated with increased symptom severity in PDS and overlap sub-types and poorer HRQoL. These findings support the incorporation of duodenal mucosal assessment in the diagnostic algorithm for refractory FD.

Aim: Hepatic encephalopathy (HE) is a serious complication in patients with liver cirrhosis and is strongly associated with morbidity and mortality. Melatonin, a neuroprotective hormone secreted by the pineal gland and enterochromaffin cells of the gastrointestinal tract is involved in the sleep cycle in normal people. This may be disrupted in cirrhotic patients. We aimed at evaluating the role of serum melatonin in cirrhotic patients with HE.

Methods: A prospective observational study was conducted in hospitalized patients with liver cirrhosis after meeting the inclusion and exclusion criteria. Morning melatonin levels were measured in patients categorized into three groups based on their progression of HE according to West Haven criteria (WHC) as group 1 (no HE), group 2 (WHC grades I and II) and group 3 (WHC grades III and IV). Biochemical measurements were done using standardized procedures.

Results: Fifty-two patients underwent morning melatonin levels, with a mean age of 55.46 ± 12.26 years old, and nine (17.3%) patients were women. The morning melatonin levels (pg/mL) of healthy volunteers and liver cirrhosis patients were 23.88 (range, 12.54-31.32) and 190 (range, 30.53-300) pg/mL. Among cirrhotic patients, group 1 (n = 11), group 2 (n = 27) and group 3 (n = 14), the morning melatonin levels were (pg/mL) 45.62 ± 15.09, 214.01 ± 107.78 and 280.98 ± 52.74 (p < 0.001), respectively. The correlation coefficient (r) between morning melatonin levels and the grades of HE was 0.797 (p < 0.001). A serum melatonin level of ≥ 85 pg/mL predicted HE with a sensitivity of 86.96%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.43% and accuracy of 90.16%. The area under the receiver operating characteristic curve (AUROC) for melatonin in predicting HE was 0.94 (p < 0.001).

Conclusion: Serum melatonin levels are significantly higher in HE patients with liver cirrhosis, with the highest levels measured in patients with the most severe grade of HE. A melatonin level of ≥ 85 pg/mL was associated with HE and level ≥ 248.95 pg/mL was associated with severe HE. Prospective large studies are required to validate the role of melatonin as a prognostic marker.

Chronic liver disease (CLD) poses a growing public health burden in India, with hepatitis B virus (HBV) remaining a preventable contributor despite the nation's expanding immunization and screening frameworks. This narrative review critically appraises programme-level preventive strategies for HBV-related CLD in India, structured across three tiers of prevention: public awareness, vaccination and screening. Evidence was synthesized from 26 eligible studies, incorporating national surveys, cohort studies, policy reports and qualitative analyses. Findings reveal substantial deficits in HBV-related knowledge, particularly among socio-economically disadvantaged and rural populations, where stigma, mis-information and poor health literacy impede timely diagnosis and care-seeking. Although hepatitis B vaccination is part of India's Universal Immunization Programme, birth-dose coverage remains sub-optimal due to labor-room workflow challenges, cold chain fragility and provider hesitancy, especially in high-fertility states. Uptake among healthcare workers and medical students is also inconsistent, highlighting gaps between theoretical knowledge and preventive behavior. Screening efforts, primarily through the National Viral Hepatitis Control Programme, remain fragmented, with significant inter-state disparities in antenatal HBsAg testing and limited penetration in tribal and remote regions. While decentralized, community-led models have shown promise; broader scale-up is hampered by logistical and infrastructural constraints. The review underscores the urgent need for culturally tailored awareness campaigns, cold chain automation, subsidized adult vaccination and robust digital linkage-to-care models. Generating rural-specific cost-of-illness and willingness-to-pay data will be vital for evidence-informed policymaking. A life-course approach anchored in equity, digital health and decentralization is essential to achieving HBV elimination goals and reducing the burden of chronic liver disease in India.

Background: Sarcopenia, characterized by progressive skeletal muscle loss, is associated with poor outcomes in various diseases. Traditional methods for assessing muscle cross-sectional area using computed tomography (CT) scans are manual, time-consuming and prone to variability.

Aim: This study comprehensively validates a deep-learning (DL) pipeline for accurate and reproducible sarcopenia detection on computed tomography across diverse disease abdominal conditions and imaging protocols.

Methods: We utilized the publicly available Sparsely Annotated Region and Organ Segmentation (SAROS) CT dataset (n = 550 CT scans, 6516 slices) for model training. Testing was conducted on 601 CT scans from public (SAROS, Cancer Imaging Archive [TCIA] , WAW-TACE) and in-house multi-center datasets representing varied clinical conditions (acute pancreatitis, inflammatory bowel disease, gallbladder cancer and distal bile duct obstruction). The implemented pipeline integrated TotalSegmentator for L3 vertebral segmentation, automated L3 slice extraction and skeletal muscle segmentation using nnU-Net. Performance evaluation included expert qualitative scoring, Dice scores, intersection over union (IoU) and diagnostic accuracy metrics for sarcopenia detection.

Results: The DL pipeline demonstrated consistent segmentation accuracy across diverse datasets, with mean Dice scores ranging from 0.9287 to 0.9701 and mean IoU values up to 0.9423. Expert evaluation confirmed reliable L3 vertebral segmentation (78%-85% rated as complete) and skeletal muscle segmentation (90%-92.6% rated as excellent). Sarcopenia detection was consistent across varied patient populations, with sensitivity (0.94-0.97), specificity (0.84-0.97) and AUC values up to 0.92. Importantly, sub-group analysis confirmed comparable performance across varying disease conditions, CT protocols, contrast usage and radiation doses.

Conclusion: This study demonstrates that a deep-learning pipeline can achieve consistent and reliable performance for skeletal muscle segmentation and sarcopenia detection across heterogeneous abdominal CT protocols and diverse clinical conditions.

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.