Mahesh Prakash Sharma

Impact of 24-h esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: Defining the gold standard

Background and Aims:  The tests that are currently available for the diagnosis of gastroesophageal reflux disease (GERD) lack the desired diagnostic accuracy. To date, only pH monitoring has been shown to have a good sensitivity and specificity, but recent studies have failed to confirm this. Thus there is a need to find a test with acceptable sensitivity and specificity for diagnosing GERD. The present study aimed to find a single test or a combination of tests that could serve as a gold standard for the diagnosis of GERD and to identify an evidence‐based diagnostic work‐up for GERD in clinical and research settings.

Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in Northern India

Background and aimsGastroesophageal reflux disease (GERD) is considered to be a common and chronic gastrointestinal disorder. The prevalence of GERD is believed to be less in Asia than in Western countries. Population-based data on GERD are lacking from India. The present study aimed at determining the prevalence of GERD symptoms in an adult Indian community and the potential risk factors associated with GERD.MethodsThe study population consisted of all the employees of All India Institute of Medical Sciences, New Delhi. An interview-based observational study was done on the basis of an earlier validated questionnaire. The subjects were asked about the frequency and severity of heartburn and/or regurgitation experienced by them in the previous year. These symptoms were then scored from 0 to 18. Subjects with a score of at least 4 were considered to have symptomatic GERD. Association of GERD with factors like age, sex, BMI, Kuppuswamy social class index, smoking, alcohol, NSAID use, and comorbid illness was analyzed.ResultsA total of 4079 employees were interviewed in person on a 29-item questionnaire from June 2003 to January 2005. Of the 4039 eligible subjects, 653 (16.2%) had GERD; 3.6% had heartburn on daily basis and 5.9% on a weekly basis. The corresponding prevalences for regurgitation were 3.3% and 5.0%, respectively. One hundred and eight of 4039 (2.7%) had severe GERD symptoms. Higher BMI (OR = 1.90, 95% CI: 1.4–2.6 for BMI ≥ 25), current smoking (OR = 1.48, 95% CI: 1.19–1.83), asthma (OR = 3.13, CI: 2.06–4.76) and hypertension (OR = 1.71, 95% CI: 1.16–2.50) were associated with the presence of GERD symptoms.ConclusionsPrevalence of GERD in an urban adult population from northern India is 16.2% which is similar to other industrialized countries. Higher body mass index, current smoking, and presence of asthma or hypertension predisposes to GERD in our population.

Multilineage hempoietic stem cell defects in Budd Chiari syndrome

Abstract Background/Aims: Erythropoietin-independent endogenous growth of erythroid colony from bone marrow cells has been shown in many patients with Budd Chiari syndrome in earlier studies. In another report, increased megakaryocyte colony growth has also been documented in this disease. However, defects in granulocyte-macrophage cell lines in Budd Chiari syndrome have yet to be reported in the literature. Methods: Both in vitro erythroid and granulocyte-macrophage colony cultures from peripheral blood mononuclear cells with and without erythropoietin or granulocyte-macrophage colony stimulating factor, respectively, were studied in 32 patients with Budd Chiari syndrome, along with 20 normal healthy controls and ten patient controls with portal hypertension (five patients each with noncirrhotic portal fibrosis and liver cirrhosis). In 18 patients the occlusion was only in the inferior vena cava, in five patients only in hepatic veins, and in nine patients both inferior vena cava and hepatic veins were blocked. Result: Endogenous erythroid or granulocyte-macrophage colony growth was not observed in any of the normal healthy controls or in patient controls with portal hypertension. However, 22 of the 32 (68.8%) patients showed endogenous erythroid colony growth. Moreover, four of them also showed endogenous growth of granulocyte-macrophage colony, not previously reported in Budd Chiari syndrome. Conclusion: It may be inferred that stem cell defects affecting all three hemopoietic cell lines (erythroid, megakaryocyte and granulocyte-macrophage) occur in Budd Chiari syndrome, which may be the primary defect responsible for the pro-thrombotic state causing venous thrombosis in them.

Role of anti‐Helicobacter pylori treatment in H. pylori‐positive and cytoprotective drugs in H. pylori‐negative, non‐ulcer dyspepsia: Results of a randomized, double‐blind, controlled trial in Asian Indians

Background : The efficacy of anti‐Helicobacter pylori treatment and cytoprotective drugs in H. pylori‐positive and ‐negative non‐ulcer dyspepsia (NUD), respectively, is debatable.

Use of imidazole‐based eradication regimens for Helicobacter pylori should be abandoned in North India regardless of in vitro antibiotic sensitivity

Background and Aim:  The purpose of this study was to compare the efficacy of tinidazole‐ versus clarithromycin‐based triple regimens for eradication of Helicobacter pylori in North Indian patients of peptic ulcer disease, and to correlate the outcome with in vitro antibiotic susceptibility.

Diagnostic utility of ultrasonography in hepatic venous outflow tract obstruction in a tropical country.

The present study was undertaken to define the role of ultrasonography (US) in screening and diagnosis of hepatic venous outflow tract obstruction. Forty‐five consecutive patients clinically suspected to have hepatic venous outflow tract obstruction were included in the study for screening by US and for assessment of patency or block in the hepatic vein (HV) and/or inferior vena cava (IVC). Four patients were excluded from the study. Eleven patients had a diagnosis other than hepatic venous outflow tract obstruction and all these patients were found to have patent HV and IVC. Thirty patients were finally diagnosed to have hepatic venous outflow tract obstruction. Using US, as a screening test 27 (90%) out of 30 such cases were correctly identified as cases of hepatic venous outflow tract obstruction and in these cases the site of block in hepatic venous outflow tract (major HV and/or IVC) was correctly diagnosed in 90% of the cases.

Rank Order of Success Favors Longer Duration of Imidazole‐Based Therapy for Helicobacter pylori in Duodenal Ulcer Disease: A Randomized Pilot Study

Background.  Studies on eradication therapy in developing countries have shown a success rate of 70–85%, which is suboptimal. Duration of therapy may be an important factor dictating eradication success in such regions.

Can the C-14 urea breath test replace follow-up endoscopic biopsies in patients treated for Helicobacter pylori infection?

BACKGROUND The C-14 urea breath test (UBT) is the most specific noninvasive test to detect Helicobacter pylori, with reported sensitivity and specificity rates of 90% and 95%, respectively. This test has not been evaluated for eradication after a therapeutic trial. The goal of this study was to assess the accuracy of C-14 UBT in the diagnosis and eradication of H. pylori infection in patients with duodenal ulcer who were treated with a triple drug regimen. METHODS Sixty patients with active duodenal ulcers who tested positive for the rapid urease test had a C-14 UBT at 0 weeks (at enrollment) and at 6 and 12 weeks using 5 microCi (185 KBq) of C-14 urea. A single breath sample was collected at 15 minutes for UBT. H. pylori was eradicated using lansoprazole and two antibiotics. RESULTS Receiver operator characteristic curves showed that, using a value of 400 counts per minute (cpm), UBT had a sensitivity rate of 91%, specificity rate of 93%, positive predictive value of 77%, and a negative predictive value of 97% in the prediction of H. pylori eradication. The mean + 3 SD of H. pylori-negative patients was 380.1 cpm; at this cutoff value, the sensitivity and specificity rates were 91.3% and 92.8%, respectively. CONCLUSION The C-14 UBT was an accurate, rapid, and easily administered test to diagnose initial H. pylori infection and to monitor its eradication, thereby obviating the need for repeated endoscopic biopsies.

A prospective randomized double blind trial comparing prednisolone and 4‐aminosalicylic acid enemas in acute distal ulcerative colitis

A prospective double blind and randomized study was conducted to compare 4‐aminosalicylic acid (4‐ASA) and prednisolone‐21‐phosphate enemas in inducing remission in patients with acute distal ulcerative colitis. Patients with ulcerative colitis distal to the splenic flexure as assessed by flexible colonoscopy, barium enema and histology were included in the study. Of 40 consecutive patients, 20 were randomized to each of the two treatment groups. Clinical evaluation was done weekly; sigmoidoscopy and histology were performed at entry and at the end of 4 weeks. Therapy was discontinued in four patients treated with prednisolone enemas due to worsening of symptoms. The clinical improvement was significant in the remaining patients (P<0.001) and was similar in the two groups P > 0.1). Sigmoidoscopic and histological improvement were better with 4‐ASA than with prednisolone enemas. No adverse effects were observed in any of the patients treated. The present study suggests that 4‐ASA is a safe and effective treatment for inducing remission in acute distal ulcerative colitis.

Poor Response to Long-term Albendazole Therapy of Hydatid Liver Cysts

Seven patients with uncomplicated hepatic hydatid cysts (Echinococcus granulosus) were treated with albendazole 10 mg/kg/day for 2-6 months (mean 4 months). Serial sonographic evaluation showed reduction in cyst size in only 1 patient (the anteroposterior diameter decreased from 16.5 cm to 4.9 cm). Therapy in this patient was discontinued after 4 months due to development of jaundice. Albendazole appears to have a limited role in the treatment of hydatid disease of the liver.