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 objectives: This study evaluated the feasibility and effectiveness of near-infrared fluorescence using indocyanine green (ICG) for intra-operative identification of cystic duct and artery anatomy, including aberrations, during laparoscopic cholecystectomy.

Methods: A prospective observational non-blinding study was conducted from November 2019 to February 2023, enrolling 67 adult patients scheduled for laparoscopic cholecystectomy. Indocyanine green (0.2 mg/kg) was administered six to 10 hours before surgery. Visualization of the cystic duct, common bile duct (CBD) and cystic artery was assessed using near-infrared fluorescence imaging. Univariate and multivariate analysis was done to identify the correlation between demographic and clinical factors with the identification of the cystic duct, CBD and cystic artery. Univariate and multivariate analysis was done to identify the correlation between gender and body mass index (BMI) with the identification of the cystic duct, CBD and cystic artery.

Results: The vasculo-biliary structures were visualized with ICG administration. The cystic duct was identified in 88%, the CBD in 92.6% and the cystic artery in 85% (Group-II variant was the commonest). Visualization of the cystic duct was significantly more difficult in male patients, while the visualization of the cystic artery was significantly reduced in patients with a > 25 kg/m².

Conclusions: Indocyanine green-based near-infrared fluorescence is a safe, feasible and effective tool for enhancing the visualization of vasculo-biliary anatomy during laparoscopic cholecystectomy. It aids in preventing bile duct injury and supports safe dissection, particularly in patients with normal BMI. While not a replacement for intra-operative cholangiography, ICG fluorescence is a promising adjunct.

Obesity is a highly prevalent, chronic disease driven by food addiction and associated with increased premature mortality. Obesogenic environments promote unhealthy behavior, making weight management challenging. Until recently, effective pharmacological treatments were lacking. The introduction of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represents a major breakthrough in obesity care, with the potential to transform treatment strategies. Despite their efficacy, high costs (as of 2025) limit accessibility, particularly in low and middle-income regions, where parallel, unregulated use is emerging. Obesity remains under-recognized as a primary medical condition, especially in populations prone to metabolic complications, including metabolic dysfunction-associated steatotic liver disease (MASLD). Gastroenterology has historically underestimated the role of GLP-1 RAs in the past. Moving forward, the choice between GLP-1 therapy and bariatric endoscopy/surgery will become a central research focus, with treatment failures in one modality already leading to crossover. GLP-1 RAs are expected to significantly impact obesity-related comorbidities, including hypertension, dyslipidaemia, type-2 diabetes, sleep apnea, MASLD and inflammatory bowel disease (IBD). An "Obesity First" approach may reshape healthcare by addressing obesity as the primary topic cause for chronic disease. By 2035, the role of GLP-1 RAs as potential lifelong treatment will become clearer, with generic market expansion anticipated following patent expirations (China 2026; Europe 2031).