Quality of life in dyspepsia and its subgroups using EQ-5D (EuroQol) questionnaire

Background/Aim: Dyspepsia has a significant impact on the quality of life. Health-related quality of life (HRQoL) can be assessed by disease-specific and generic HRQoL instruments. The present study evaluated HRQoL and compared it among dyspepsia subgroups by using EQ (Euro QoL)-5D questionnaire. Patients and Methods: Patients with abnormal findings on upper gastrointestinal endoscopy were classified to have organic dyspepsia, whereas those with normal endoscopy were classified as functional dyspepsia if they met the ROME III criteria or as endoscopy negative recent dyspepsia if symptom duration was <6 months. HRQoL was assessed using the EQ-5D questionnaire, and the overall health status on a visual analogue scale (VAS); and the frequency of impairment in each dimension were compared between the dyspepsia subgroups. Results: The overall health status was affected equally in all three dyspepsia subgroups. Impairment in HRQoL was commonly seen in the dimensions of pain (98.4%), usual activities (66.20%), and anxiety/depression (70.60%), however, much less so in mobility (22.70%) and self-care (10.9%). Any impairment in HRQoL was not significantly different between the three subgroups in the dimensions of mobility and usual activities. Self-care was more commonly affected in organic dyspepsia, anxiety/depression was more common with functional dyspepsia, while pain, though significantly different among various subgroups, was very common in all three subgroups. Conclusion: HRQoL was equally affected in all three subgroups of dyspepsia but variably so in the different domains of EQ-5D. These differences need to be studied further to improve the management of different etiological subgroups of dyspepsia

Subclinical Anal Sphincter Injuries Following Instrumental Delivery–A Physiological Analysis: A Pilot Study

Introduction: Obstetric Anal Sphincter Injuries (OASIS) has been reported in up to 25% patients and occult OASIS has been reported in up to 1.2%. Instrumental delivery has been considered a risk factor for OASIS. Aim: To compare the anal sphincter functions as assessed by Anorectal Manometry (ARM) in asymptomatic patients following instrument delivery with those of patients who underwent Lower Segment Caesarian Section (LSCS) after six months of delivery. Materials and Methods: Seventeen women who had instrumental delivery and thirteen who underwent elective cesarean section were recruited. Evaluation included a detailed history and physical examination, administration of the Cleveland Clinic Questionnaire and ARM to record the basal pressure, squeeze pressure, anorectal sensation and balloon expulsion time. Categorical variables were compared using the Chi-square test. All calculations were done using the software SPSS 21.0. Results: We found statistically significant lower basal (34 ± 3.4 vs 60±2.3 mm hg, p<0.05) and squeeze pressures (56±4.1 vs 76±5.2 mm hg, p<0.05), and higher balloon expulsion time (58±2.9 s vs 19±1.8 seconds, p<0.05) in women with instrument delivery compared to LSCS. The rectal sensation was comparable in both the groups. Conclusion: Persistent subtle anal sphincter dysfunctions are common following instrument delivery compared to LSCS. The role of identifying these and preventing future incontinence in such women needs to be assessed in future studies

Helicobacter pylori in dyspepsia: Phenotypic and genotypic methods of diagnosis

Background: Helicobacter pylori affects almost half of the world's population and therefore is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with chronic gastritis, ulcer disease (gastric and duodenal), mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Several diagnostic methods exist to detect infection and the option of one method or another depends on various genes, such as availability, advantages and disadvantages of each method, monetary value, and the age of patients. Materials and Methods: Patients with complaints of abdominal pain, discomfort, acidity, and loss of appetite were chosen for endoscopy, detailed history was contained, and a physical examination was conducted before endoscopy. Biopsies (antrum + body) were received from each patient and subjected to rapid urease test (RUT), histopathological examination (HPE), polymerase chain reaction (PCR), and culture. Results: Of the total 223 biopsy specimens obtained from dyspeptic patients, 122 (54.7%) were positive for H. pylori for HPE, 109 (48.9%) by RUT, 65 (29.1%) by culture, and 117 (52.5%) by PCR. The specificity and sensitivity were as follows: RUT (99% and 88.5%), phosphoglucosamine mutase PCR assay (100% and 95.9%), and culture (100% and 53.3%), respectively. Conclusion: In this study, we compared the various diagnostic methods used to identify H. pylori infection indicating that, in comparison with histology as gold standard for detection of H. pylori infection, culture and PCR showed 100% specificity whereas RUT and PCR showed 99% and 100% sensitivity, respectively