Ajay Choksey

Gastric lipoma: an unusual cause of dyspeptic symptoms

Gastric lipomas are rare tumours accounting for 2–3% of all benign gastric tumours. These are usually submucosal in origin but in rare cases may be subserosal in origin. Although a majority of gastric lipomas are asymptomatic and usually detected incidentally, occasionally these can cause abdominal pain, dyspeptic disorders, obstruction, invagination and haemorrhages. In the literature, only 200 cases of gastric lipomas have been reported so far. We report a case of a 56-year-old female with a submucosal symptomatic gastric lipoma presenting with disabling dyspeptic symptoms.

Unusual complication of amebic liver abscess: Hepatogastric fistula

Amebic liver abscess is a parasitic disease which is often encountered in tropical countries. A hepatogastric fistula secondary to an amebic liver abscess is a rare complication of this disease and there are only a handful of reported cases in literature. Here we present a case of an amebic liver abscess which was complicated with the development of a hepatogastric fistula. The patient presented with the Jaundice, pain and distension of abdomen. The Jaundice and pain improved partially after he had an episode of brownish black colored increase in frequency of stools for 5 to 6 d. Patient also had ascites and anemia. He was a chronic alcohol drinker. Esophagogastroduodenoscopy performed in view of the above findings. It showed a fistulous opening with bilious secretions along the lesser curvature of the stomach. On imaging multiple liver abscesses seen including one in sub capsular location. The patient was managed conservatively with antiamebic medications along with proton pump inhibitors. The pigtail drainage of the sub capsular abscess was done. The patient improved significantly. The repeat endoscopy performed after about two months showed reduction in fistula size. A review of the literature shows that hepatogastric fistulas can be managed conservatively with medications and drainage, endoscopically with biliary stenting or with surgical excision.

A Randomized Comparative Study of Efficacy of Lamivudine and Adefovir Combination versus Tenofovir versus Entecavir in Decompensated Cirrhotic Patients of Hepatitis B

Decompensation is a frequent presentation of Hepatitis B related liver disease. In India transplantation is not easily available. Hence antiviral drugs form the backbone of management. Lamivudine and Adefovir, either as alone or as combination has been useful, Entecavir and tenofovir have good efficacy. These drugs have different side effect, resistance and cost profile which is important considering long term treatment

CVID enteropathy- a rare cause of chronic diarrhea in a child.

Common variable immunodeficiency (CVID) is a rare primary immunodeficiency disease characterized by hypogammaglobulinemia and recurrent bacterial infections especially in respiratory and gastrointestinal systems. The authors present here a case of CVID with uncommon gastrointestinal manifestation in the form of CVID enteropathy. Based upon the clinical presentation and histopatholic findings the patient was diagnosed as CVID enteropathy and treated with intravenous antibiotics and 3–4 wkly intravenous immunoglobulin infusion and he had responded poorly to gastrointestinal symptoms but the frequency of respiratory and skin infection reduced. CVID has heterogenous gastrointestinal manifestations; among them the CVID enteropathy is an uncommon presentation which responds poorly to the mainstay therapy of intravenous immunoglobulin infusion and represents a diagnostic as well as therapeutic challenge for treating physician.

Prevalence of Overweight and Obesity in 4 Schools of South Mumbai

INTRODUCTION The paediatric obesity is on the rise so as the complications of obesity like cardiovascular diseases, liver diseases, dyslipidaemia are increasing. The changing dietary habits and less of outdoor activities are risk factors for obesity. AIM The study was conducted to find out prevalence of overweight and obesity among students in four schools of the Mumbai and compare with studies from rest of the country. MATERIALS AND METHODS It is school based, cross-sectional study conducted in four Schools from class of 5(th) to 10(th). The anthropometric measurements of height, weight were taken of each student. The body mass index was calculated based on the age based Cole et al., criteria (International) as well as Khadilkar et al., criteria which are specially develop for Indian children. The data was analysed with chi-square test. RESULTS Total 1828 students were screened from 4 schools. Out of which 590 were girls and 1238 were boys. The prevalence of overweight and obesity by Cole et al., criteria were 11.3% and 3.3% and by Khadilkar et al., criteria were 17.5% and 7.8 % respectively. CONCLUSION It shows significant difference in obesity between boys and girls and also between government and private schools. There is overall decrease in prevalence of overweight and obesity as age increases. The overweight and obesity among these schools in Mumbai is comparable with the rest of the studies from India.

Evanescent eosinophilic gastritis in recurrent Helicobacter pylori infection

Eosinophilic gastroenteritis is characterized histologically by eosinophilic infiltration of the gut wall and clinically manifests by gastrointestinal (GI) symptoms. A high index of suspicion is required for the early diagnosis of this uncommon disease in patients who have concomitant GI symptoms and peripheral eosinophilia. This unusual case who initially had duodenal ulcer with duodenal stenosis, responded to Helicobacter pylori treatment and dilatation. He was symptom free for 2 years. Subsequently, developed evanescent eosinophilic gastritis and recurrent H. pylori infection with refractory prepyloric ulceration, but no duodenal stenosis. Eosinophilic gastritis and H. pylori infection initially responded to treatment, but subsequently the patient developed nonhealing prepyloric ulcer and refractory H. pylori infection and had persistent symptoms; all these necessitated surgical intervention consisting of antrectomy with gastrojejunostomy.