Analysis of Indications and Results of Anorectal Manometry in Two Tertiary Hospitals in India

The anorectum plays an important role in regulation of defecation and in maintenance of continence [1]. The most widely used test for anorectal function is anorectal manometry. It measures pressures of the anal sphincter muscles, sensation in the rectum, and neural refl exes that are needed for normal bowel movements. This test is mainly used in evaluation of constipation, fecal incontinence, anal sphincter tone, functional anorectal pain, pelvic fl oor dyssynergia and diagnosis of Hirschsprung’s Disease [2].&nbsp; Parameters studied by anorectal manometry are the rectoanal inhibitory refl ex, anal resting pressure, sustained voluntary contraction of anal canal and rectal sensation [3]. Anorectal manometry is now available at multiple centres in India. However, the awareness regarding the procedure and its uses is limited. This study was done with the aim to analyse the indications for referral and results of anorectal manometry in two teaching hospitals in India.</p

Effect of lactase on symptoms and hydrogen breath levels in lactose intolerance: A crossover placebo‐controlled study

Abstract Background and Aim The absence of lactase in the intestinal villi due to mucosal injury or genetic factors causes undigested lactose to reach the colon where it is fermented. Lactose intolerance is diagnosed based on clinical symptoms like bloating, abdominal pain and flatulence, lactose hydrogen breath test (HBT), and lactose tolerance test. No Indian studies are available on the use of lactase supplements. The aim was to study the effect of lactase chewable tablets on clinical symptoms and hydrogen breath excretion in patients with lactose intolerance. Methods This was a randomized, double‐blind, crossover placebo‐controlled trial to study the effect of lactase tablets on symptoms and hydrogen breath levels in adults with lactose intolerance, confirmed by Lactose HBT. Clinical symptom severity was recorded using a visual analog scale, and HBT was performed every 30 min for 180 min. As it was a crossover design, the same patients were tested with both lactase and placebo, acting as their own controls with a washout period of 1 week between visits. Results Forty‐seven patients (mean age 33.6 years; 30 males) with lactose intolerance formed the study group. Clinical symptoms, mean clinical score (P < 0.05), and mean hydrogen breath levels (P < 0.05) were improved when the patients were given lactase. Reduction in cumulative hydrogen breath level over 180 min was 55% when patients received lactase compared to placebo. Conclusions Orally supplemented lactase enzyme significantly reduced the clinical symptoms and hydrogen breath excretion in patients with lactose intolerance

Clinical profile and management of tuberculous bronchoesophageal fistula

Background and Objectives: Tracheoesophageal/bronchoesophageal fistula is a rare clinical condition, and occurs due to a variety of disease processes. This report describes the clinical profile, management, and outcome of bronchoesophageal fistulas due to tuberculosis in five patients. Patients and Methods: Patients diagnosed with esophageal tuberculosis over the last eight years were included. Details regarding the demographics, symptomatology, barium swallow, upper GI endoscopy, with biopsy and high resolution computed tomography of the chest were recorded for patients with tracheoesophageal fistula. The diagnosis was confirmed by acid fast bacilli (AFB) positive fluid aspirate/brush cytology from the fistula, lymph node biopsy showing caseous necrosis or AFB bacillus and tissue tuberculosis culture and polymerase chain reaction (PCR). Results: There were five patients (four males and one female) with a mean age of 43.8 ± 17 years (range, 17 to 59 years). The mean duration of symptoms was 38 ± 7 days. The most common symptom was coughing on swallowing followed by dysphagia. Two patients had concomitant pulmonary tuberculosis; two had human immunodeficiency virus (HIV) infection, and one was a post-renal transplant. The diagnosis of tuberculosis was established in all five patients with esophageal cytology, lymph node biopsy, and tissue tuberculosis PCR. All the patients were successfully treated with a combination of antituberculous drugs (five patients), glue application on fistula (one patient), Percutaneous endoscopic gastrostomy (PEG) tube insertion (three patients), and surgery (one patient). Conclusions: Tuberculous bronchoesophageal fistula is a rare complication and can be successfully managed predominatly with a combination of antituberculous treatment, PEG tube placement, and rarely surgery

Cystic lesion of pancreas - Intraductal papillary mucinous neoplasm

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an intraductal mucin-producing epithelial neoplasm that arises from the main and/or branched pancreatic duct. It usually presents as cystic lesion of pancreas. There are well known differential diagnosis of cystic pancreatic lesion. Pancreatic cystic neoplasms are detected at an increasing frequency due to an increased use of abdominal imaging. The diagnosis and treatment of intraductal papillary mucinous tumors (IPMN) of the pancreas has evolved over the past decade. IPMN represents a spectrum of disease, ranging from benign to malignant lesions, making the early detection and characterization of these lesions important. Definitive management is surgical resection for appropriate candidates, as benign lesions harbor malignant potential. IPMN has a prognosis, which is different from adenocarcinoma of the pancreas. We report a case of a 58-year-old male with intraductal papillary neoplasm involving main duct and side branches presenting to us with clinical symptoms of chronic pancreatitis with obstructive jaundice and cholangitis treated surgically

Prevalence of non-alcoholic fatty liver disease: population based study

Background and aim: Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and liver transplantation in western countries. Increasing incidence of NAFLD has been well documented from Asian countries like Japan and China. Diabetes mellitus (DM), obesity, hyperinsulinemia are predisposing factors for NAFLD. There is increase in incidence of DM, obesity and insulin resistance in India in last two decades. Hence it is logical to expect increase in incidence of NAFLD in India. There is limited data on the prevalence of NAFLD from India. Majority of data comes from hospital based studies including small number of patients. Therefore this study was planned to estimate the prevalence of NAFLD in general population. Material and methods: Residents of two Railway colonies were evaluated on history, clinical examination, anthropometric measurements, biochemical tests and abdominal ultrasound. Results: 1,168 participants were evaluated. Persons with any amount of alcohol consumption, HBs Ag positive, Anti HCV positive, persons with other known liver diseases and taking medications causing liver disease were excluded. Prevalence of NAFLD on ultrasound was 16.6%. Out of 730 subjects above the age of 20 years (341 male 384 female 389) mean age 39.08 ± 12.3 years, 4% had diabetes, 57% had central obesity. Prevalence of NAFLD based on the ultrasound above 20 years of age was 18.9%. NAFLD was more prevalent in male than female (24.6% vs 13.6%, p 25, elevated fasting blood sugar, raised AST and ALT. Conclusion: Prevalence of NAFLD in Indian population is comparable to the west

Association of GST null genotypes with anti-tuberculosis drug induced hepatotoxicity in Western Indian population

Background. The first line anti-tubercular (anti-TB) treatment normally involves isoniazid, rifampicin, pyrazinamide, and ethambutol. Clearance of these drugs depends on the activity of several enzymes such as N-acetyl transferase 2, cytochrome P450 oxidase and glutathione S-transferase (GST). Some of these enzymes are highly polymorphic leading to significant inter-individual variation in their activity thereby increasing the risk of drug induced hepatotoxicity (DIH).Aim. To investigate the possible association of anti-TB DIH with genetic polymorphism of GST genes in Western Indian population.Material and methods. A prospective case-control study was undertaken on patients who received anti-TB treatment. Cases (n = 50) were distinguished from controls (n = 246) based on occurrence of DIH during anti-tubercular treatment. A multiplex polymerase chain reaction was employed to identify homozygous null mutation at GSTM1 and GSTT1 loci.Results. Homozygous null mutation in GSTM1 gene alone or in both GSTM1 and T1 genes was found to be significantly associated with anti-TB DIH at p < 0.02 and p < 0.007, respectively, in our study population.Conclusions. This is the first study to report GSTM1 null and combined GSTM1 and T1 null genotypes to be risk factors of anti-TB DIH in Western Indian population. Screening of patients for these genotypes prior to anti-TB regimen would provide better control of hepatotoxicity