Akash Shukla

Risk factors for Barrett's esophagus in Indian patients with gastroesophageal reflux disease

Background and Aims:  Barretts esophagus (BE) is reported to be infrequent in Asians, with no data from India regarding its prevalence and risk factors. We investigated the frequency and risk factors of columnar mucosa with or without specialized intestinal metaplasia (SIM) in Indian patients with gastroesophageal reflux disease (GERD).

Acute‐on‐chronic liver failure in India: The Indian National Association for Study of the Liver consortium experience

The aim of this study was to analyze etiologies and frequency of hepatic and extrahepatic organ failures (OFs) and outcome of acute‐on‐chronic liver failure (ACLF) at 10 tertiary centers in India.

Acute on chronic liver failure in India: the INASL Consortium experience.

The aim of this study was to analyze etiologies and frequency of hepatic and extrahepatic organ failures (OFs) and outcome of acute‐on‐chronic liver failure (ACLF) at 10 tertiary centers in India.

Sofosbuvir plus ribavirin in treatment-naïve patients with chronic hepatitis C virus genotype 1 or 3 infection in India

Until 2014, pegylated interferon plus ribavirin was the recommended standard of care for the treatment of chronic hepatitis C virus (HCV) infection in India. This open‐label phase 3b study, conducted across 14 sites in India between 31 March 2014 and 30 November 2015, evaluated the efficacy and safety of sofosbuvir plus ribavirin therapy among treatment‐naïve patients with chronic genotype 1 or 3 HCV infection. A total of 117 patients with genotype 1 or 3 HCV infection were randomized 1:1 to receive sofosbuvir 400 mg and weight‐based ribavirin (1000 or 1200 mg) daily for 16 or 24 weeks. Among those with genotype 1 infection, the primary efficacy endpoint of sustained virologic response at 12 weeks post‐treatment (SVR12) was reported in 90% (95% confidence intervals [CI], 73‐98) and 96% (95% CI, 82‐100) of patients following 16 and 24 weeks of treatment, respectively. For patients with genotype 3 infection, SVR12 rates were 100% (95% CI, 88‐100) and 93% (95% CI, 78‐99) after 16 and 24 weeks of therapy, respectively. Adverse events, most of which were mild or moderate in severity, occurred in 69% and 57% of patients receiving 16 and 24 weeks of treatment, respectively. The most common treatment‐emergent adverse events were asthenia, headache and cough. Only one patient in the 24‐week group discontinued treatment with sofosbuvir during this study. Overall, sofosbuvir plus ribavirin therapy achieved SVR12 rates ≥90% and was well tolerated among treatment‐naïve patients with chronic genotype 1 or 3 HCV infection in India.

Endovascular treatment of Budd–Chiari syndrome: Single center experience

Percutaneous radiologic interventions are increasingly being used in management of Budd–Chiari syndrome (BCS). Minimal invasive approach has resulted in excellent long‐term outcomes. We evaluated the treatment efficacy and safety of radiological intervention in patients with BCS.

Esomeprazole-induced photoallergic dermatitis

There are no published case reports of esomeprazole-induced photoallergic dermatitis. We report here a 58-year-old lady with prior history of propylthiouracil and carbimazole-induced photoallergy, who presented with heartburn and dysphagia. She was diagnosed to have erosive esophagitis and was treated with esomeprazole, following which she developed photoallergic dermatitis. It improved on cessation of the drug and did not recur on subsequent treatment with ranitidine. Naranjo score for this adverse drug event was 8, thereby making it a probable adverse drug reaction. This reaction may be due to sulphur moiety, which is common to all these drugs. Physicians must be aware of this possible side-effect, especially in patients with prior history of photoallergy to other drugs.

Multiple Extrasplanchnic Venous Thromboses: A Rare Complication of Pancreatitis. A Case Report

CONTEXT Venous thrombosis has been described in patients with acute and chronic pancreatitis. This is especially common in portal vein, splenic vein and superior mesenteric vein. To the best of our knowledge, involvement of superior vena cava and subclavian vessel due to pancreatitis has not been reported. CASE REPORT We present here a case of an adult male with alcoholic chronic pancreatitis who presented with multiple vessel thromboses involving superior vena cava, inferior vena cava, bilateral subclavian, internal jugular vein, axillary, iliac and renal vein without involvement of portal, splenic and superior mesenteric vein that was effectively treated with i.v. anticoagulation therapy. CONCLUSION Venous thromboses can occur outside the splanchnic circulation in pancreatitis.

Chronic HBV-infected subjects older than 35 years with persistently normal ALT and ultrasound, despite high viral load do not have significant fibrosis

Dear Sir, Liver biopsy is recommended in patients who do not meet clear-cut guidelines for antiviral treatment, especially in patients >40 years of age [1]. At our centre, we perform liver biopsy in all patients with chronic hepatitis B virus (HBV) infection who are >35 years of age and who have normal ALT and ultrasonography (USG), and a significant viral load. Here, we present our data on the stage of fibrosis and grade of inflammation on liver biopsy in these patients, and its comparison with a group of patients with chronic HBV infection who had mild liver enzyme elevation (1–2× ULN) and/or coarse echotexture of the liver on USG. Institutional review board clearance was obtained. We retrieved records of all the patients with chronic hepatitis B infection (CHB) who underwent liver biopsy between January 2010 and June 2012. ALT levels up to 40 U/L were considered as normal. Normal hepatoportal USGwas defined as the presence of normal liver span and contour, and absence of coarse echotexture. Patients with features of portal hypertension on USG (splenomegaly, venous collaterals and ascites) were not included. A team of three dedicated liver pathologists reviewed histopathology at our institute and arrived at a consensus. Stage of fibrosis (using HE 9 patients did not give consent. Fifty-four patients underwent liver biopsy. Twenty-nine patients (44.3±6.5 years, 23 men) with normal ALT, normal USG, age >35 years and HBV DNA ≥2000 IU/mL comprised group A and had a median HBV DNA of 4020 IU/mL [2030–1.7×10]. Twenty-five patients (35.8±11.9 years, 22 men) had either ALT 1–2× ULN or coarse echotexture on USG or both, and comprised group B and had a median HBV DNA of 9000 IU/mL (2000–1.7× 10). Twelve patients of group A had ALT less than or equal to 20 U/L (subgroup A1), and 17 had an ALT level between 20 and 40 U/L (subgroup A2). The biopsy findings have been shown in Table 1. More patients in group B had fibrosis and inflammation as compared to group A (p=0.001, stage; p=0.001, grade). Within group B, six patients had coarse echotexture on USG and normal ALT; two of them had a significant fibrosis and one had a significant inflammation. In a previous study in patients with chronic hepatitis B infection, 71 % of the subjects with elevated ALT had an HAI >3, and 36 % with normal ALT showed significant histological changes [3]. In another study, patients with chronic hepatitis B virus infection with persistently normal ALT (≤40 U/L) had fibrosis stage ≥2 in 39.7 % in hepatitis B e* Akash Shukla drakashshukla@yahoo.com

Gastrodiscoides hominis infestation of colon: endoscopic appearance

A 15-year-old girl from rural North India was seen with a 7-month history of dull aching, periumbilical abdominal pain. Barium examination revealed a contracted cecum with an irregular outline (Fig. 1). Colonoscopy showed multiple parasites with sucking discs in the cecum and ascending colon. The parasites were adherent to the mucosa, which bled on removal of the parasites. The parasites were from 8 to 10 mm in length, with an expanded circular end having a large sucker adherent to the mucosa and a motile end, which was narrowed and conical. A diagnosis of Gastrodiscoides hominis was made at histology of the parasite. The organism is a trematode, infesting

Differentially expressed serum host proteins in hepatitis B and C viral infections

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection often lead to hepatocellular carcinoma (HCC), which is mostly detected in advanced stage. Hence, its early detection is of paramount importance using a biomarker having sensitivity and specificity both. The present study highlights differentially expressed host proteins in response to HBV/HCV infection at different stages. Comparative proteomic study was done by two-dimensional gel electrophoresis followed by mass spectrometry. Sera from each of chronically infected, liver cirrhosis and HCC in HBV or HCV infection along with controls were selected. Analysis of functional association between differentially expressed proteins with viral hepatitis was extensively carried out. Forty-three differentially expressed spots (≥ 1.5 fold; P < 0.05) on two-dimensional gel electrophoresis were corresponded to 28 proteins by mass spectrometry in variable liver diseases. Haptoglobin protein levels were decreased upon disease progression to HCC due to HBV infection. The other proteins expressed differentially are ceruloplasmin, serum paraoxonase 1, retinol binding protein and leucine rich alpha 2 proteins in plasma maybe associated to HBV HCC. Whereas, upregulation of C4a/C4b showed it as a reliable marker in patients with end stage liver disease related to HCV infection. ApolipoproteinA1 levels in liver diseases in both HBV and HCV infection corresponding to healthy controls may be a common marker for early diagnosis and disease monitoring. Protein interaction studies by extensive pathway analysis using bioinformatics tools such as EnrichNet application and STRING revealed significant associations with specific infections.