Epidemiology, diagnosis and management of patients with biliary dyskinesia and sphincter of Oddi dysfunction: a survey of Indian gastroenterologists

Background: A cross-sectional, physician-based survey was conducted to address the relative lack of data on the awareness about and management of biliary dyskinesia and sphincter of Oddi dysfunction among Indian gastroenterologists. Methods: A structured questionnaire containing questions on epidemiology, etiology, clinical presentation, diagnostic investigations, prognosis and management was used. Physician responses were analyzed as descriptive statistics and reported as frequency and percentages. Results: A total 146 gastroenterologists across 137 cities participated in the survey. Majority (76.0%) of physicians stated that <10% of their patients with cholecystitis get diagnosed with BD, while 84.7% stated that <25% of patients with BD have SOD. SOD and BD were reported to be common in females <50 years. Patients recovering from major surgeries/stroke/heart attack/sepsis/extensive trauma were identified by 53.0% of physicians to be at risk for BD. Majority of physicians (69.4%) reported that irritable bowel syndrome (IBS) was a major risk factor for SOD. Cholescintigraphy and hepatobiliary scintigraphy were investigations of choice for BD and SOD according to 55.5% and 33.6% of physicians, respectively. Sepsis was identified as a frequent complication of BD (45.2%). Laparoscopic cholecystectomy was identified by 64.4% participants to result in partial resolution of symptoms in many patients. Calcium channel blockers and antispasmodics were preferred by 55.9% and 30.8% physicians for functional gall bladder disorder, respectively. IBS was the most common indication for prescribing the antispasmodic pinaverium, with the primary objective of pain relief. Conclusions: Findings from this survey provide insights for further research on BD and SOD in India

Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system

Model for End-Stage Liver Disease (MELD) score-based allocation systems have been adopted by most countries in Europe and North America. Indeed, the MELD score is a robust marker of early mortality for patients with cirrhosis. Except for extreme values, high pretransplant MELD scores do not significantly affect posttransplant survival. The MELD score can be used to optimize the allocation of allografts according to a sickest first policy. Most often, patients with small hepatocellular carcinomas (HCCs) and low MELD scores receive extra points, which allow them appropriate access to transplantation comparable to the access of patients with advanced cirrhosis and high MELD scores. In addition to patients with advanced cirrhosis and HCC, patients with a number of relatively uncommon conditions have low MELD scores and a poor prognosis in the short term without transplantation but derive excellent benefits from transplantation. These conditions, which correspond to the so-called MELD score exceptions, justify the allocation of a specific score for appropriate access to transplantation. Here we report the conclusions of the French consensus meeting. The goals of this meeting were (1) to identify which conditions merit MELD score exceptions, (2) to list the criteria needed for defining each of these conditions, and (3) to define a reasonable time interval for organ allocation for each MELD exception in the general context of organ shortages. MELD exceptions were discussed in an attempt to reconcile the concepts of transparency, equity, justice, and utility