Evaluations of measurement techniques in functional dyspepsia : electrogastrography, satiety drinking test and 14C-urea breath test

The overall aim of this thesis was to evaluate the clinical usefulness of certain measurement techniques that may be helpful in the understanding of functional dyspepsia (FD). Electrogastrography (EGG) parameters were evaluated and found unable to discriminate one specific motility disorder from other motility disorders of the gut. Moreover the relationship between the electrical activity of the stomach determined by EGG and contractile activity of the gastric antrum assessed by antro-duodenal manometry (ADM) were analyzed and no spatial correlation between EGG and ADM was observed. These results suggest that the clinical usefulness of EGG in the diagnosis of a motility disorder is generally poor and that EGG and ADM measure two different aspects of gastric physiology. The validity of 14C urea breath test (UBT) was compared with histology and rapid urease test (RUT) for the diagnosis of H. pylori infection. Both sensitivity and specificity of 14C UBT for the diagnosis of H. pylori infection were high. This study also indicated a very good concordance between UBT, histology, and RUT for the diagnosis of H. pylori infection. These observations suggest that 14C UBT is a reliable test for diagnosis of H. pylori infection. Satiety drinking tests were done in healthy volunteers by using drinking water at 100 ml/minute or nutrient drinks at 20 and 100 ml/minute. It was found that the maximum tolerated volume (MTV) determined by slow nutrient drinking (SND) was not influenced by body mass index, age and gender compared to rapid water and rapid nutrient drinking. Moreover there was more symptom generation after drinking nutrient liquid at a slow rate. These results suggest that SND is more meaningful in the assessment of MTV. This study also determined the normal values of MTV for satiety drinking tests in a Pakistani population. The relationship between MTV and dyspepsia symptoms in patients with FD before and after the treatment was assessed. We found a significant correlation between dyspepsia symptom severity scores and MTV. Some of the individual symptom severity scores also correlated with MTV before and after treatment. The findings of this study indicate that determination of MTV by SND can be a surrogate marker for symptoms severity in patients with FD. This thesis concluded that the diagnostic usefulness of EGG is limited, that 14C UBT is a reliable test for the diagnosis of H. pylori infection, that SND is a better test for the assessment of MTV compared to rapid water and nutrient drinking, and that MTV determined by SND may be useful for the assessment of response to treatment in patients with FD

Helicobacter pylori infection and micronutrient deficiencies.

It is known that deficiencies of micronutrients due to infections increase morbidity and mortality. This phenomenon depicts itself conspicuously in developing countries. Deficiencies of iron, vitamins A, E, C, B12, etc are widely prevalent among populations living in the third world countries. Helicobacter pylori (H pylori) infection has a high prevalence throughout the world. Deficiencies of several micronutrients due to H pylori infection may be concomitantly present and vary from subtle sub-clinical states to severe clinical disorders. These essential trace elements/micronutrients are involved in host defense mechanisms, maintaining epithelial cell integrity, glycoprotein synthesis, transport mechanisms, myocardial contractility, brain development, cholesterol and glucose metabolism. In this paper H pylori infection in associated with various micronutrients deficiencies is briefly reviewed

Functional gastrointestinal disorders and gut-brain axis: What does the future hold?

Despite their high prevalence, lack of understanding of the exact pathophysiology of the functional gastrointestinal disorders has restricted us to symptomatic diagnostic tools and therapies. Complex mechanisms underlying the disturbances in the bidirectional communication between the gastrointestinal tract and the brain have a vital role in the pathogenesis and are key to our understanding of the disease phenomenon. Although we have come a long way in our understanding of these complex disorders with the help of studies on animals especially rodents, there need to be more studies in humans, especially to identify the therapeutic targets. This review study looks at the anatomical features of the gut-brain axis in order to discuss the different factors and underlying molecular mechanisms that may have a role in the pathogenesis of functional gastrointestinal disorders. These molecules and their receptors can be targeted in future for further studies and possible therapeutic interventions. The article also discusses the potential role of artificial intelligence and machine learning and its possible role in our understanding of these scientifically challenging disorders

Refeeding syndrome in a young girl with anorexia nervosa.

We report the case of a 20-year-old anorexic girl (BMI=12.9), who was misdiagnosed the first time and developed severe electrolyte imbalances due to lack of awareness about refeeding syndrome. Few cases of RS have been reported in literature and protocols have been suggested for prevention and management of this syndrome, including the awareness of circumstances in which it is most likely to develop, refeeding slowly and building-up micronutrient content over several days. Improved awareness and understanding of refeeding syndrome along with a well-coordinated plan are vital in delivering safe and effective nutritional rehabilitation. We suggest a slow and gradual increase in nutrition along with nutritional counselling and psychotherapy

Drug induced liver injury is associated with high mortality- A study from a tertiary care hospital in Pakistan

Background and aim: In light of few established drug induced liver injury (DILI) registries, this study aims to evaluate the clinical spectrum and predictors of mortality and morbidity of hospitalized patients with suspected DILI.Patients and methods: DILI cases were identified and categorized on basis of COIMS/RUCAM score and the exclusion of other liver diseases. Clinical and laboratory parameters were analyzed to identify the predictors of morbidity (prolonged hospital stay \u3e 5 days) and mortality.Results: Out of 462 patients, there were 264 (57.6%) males and the mean age of the cohort was 50.83 years (range: 20-94 years). DILI was classified as definite or highly probable in 31.1%, probable in 62.5%, and possible in 7.4% of cases. Pattern of liver injury was hepatocellular in 25.1%, cholestatic in 56.17%, and mixed in 18.72% of patients. Anti-tuberculosis drugs (ATDs) were found to be the most common category of drugs causing DILI, in 295 (63.9%) patients. Clinically, encephalopathy was present in 21.6% patients; other presenting symptoms included abdominal pain (57.1%), vomiting (57.1%), jaundice (54.1%) and pruritus (42.3%). In-hospital mortality was 26.5% and prolonged hospital stay (\u3e 5 days) was observed in 35.93% of patients. Mortality was significantly greater in patients with encephalopathy, male gender, hepatocellular pattern of DILI, increased INR and use of ventilator support.Conclusion: In our study, the most frequent cause of DILI in hospitalized patients was ATDs. More than a quarter of patients died during hospital stay. A close control of clinical and biochemical parameters are required to prevent and monitor DILI, especially in patients taking ATDs in our region

Impact of coronavirus disease 2019 on prevention and elimination strategies for hepatitis B and hepatitis C

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality since its first case was discovered in December 2019. Since then, multiple countries have witnessed a healthcare system collapse due to the overwhelming demand for COVID-19 care. Drastic measures have been taken globally in order to curb the spread of the virus. However, those measures have led to the disruption of other aspects of healthcare, increasing the burden due to other medical conditions. We have also stepped back in achieving the ambitious goal set in place by World Health Organization to eliminate viral hepatitis as a public threat by 2030. Hepatitis B and C are chronic conditions with a significant worldwide burden, and COVID-19 has resulted in many hepatitis elimination programs slowing or stopping altogether. In this review, we elucidate the impact of the ongoing COVID-19 pandemic on the interventions targeted towards the elimination of hepatitis B virus and hepatitis C virus. Some of the salient features that we have covered in this review include hindrance to screening and diagnostic tests, neonatal vaccinations, the transmission dynamics affecting hepatitis B virus and hepatitis C virus, role of limited awareness, restrictions to treatment accessibility, and disparity in healthcare services. We have highlighted the major issues and provided recommendations in order to tackle those challenges

Impact of direct acting antivirals on occurrence and recurrence of hepatocellular carcinoma: Biologically plausible or an epiphenomenon?

Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. Chronic hepatitis C virus infection (HCV) is the most common cause of HCC in many European countries, Japan and Pakistan. Introduction of the new direct acting antivirals (DAAs) has revolutionized the management of HCV worldwide, with high rates of sustained virologic response in patients who could not have tolerated the previous interferon based treatments. However, recently there have been reports raising caution about the long term effects of DAAs, particularly a possible increased risk of HCC. Therefore this review explores the current molecular studies as well as clinical data that investigate the impact of DAAs on occurrence and recurrence of HCC