Nakechand Pooran

Cytokines (IL-6, IL-8, TNF): early and reliable predictors of severe acute pancreatitis.

Background Severe acute pancreatitis is associated with a high mortality, especially when compared with mild acute pancreatitis. Early intervention in patients with severe acute pancreatitis has been shown to improve mortality. The value of cytokines (interleukin [IL]-6, IL-8 and tumor necrosis factor [TNF]-alpha) in diagnosing severe acute pancreatitis at an early stage was studied. Study Thirty-six patients with acute pancreatitis were prospectively evaluated. Age-matched controls were obtained from healthy volunteers. Levels of IL-6, IL-8, and TNF-alpha were obtained within 24 hours of admission. Ransons prognostic signs and Banks clinical criteria were used to differentiate patients into mild and severe pancreatitis. Results There was significant difference in IL-6 levels between controls and mild pancreatitis, controls and severe pancreatitis, and mild and severe pancreatitis. IL-8 levels were significantly different between controls and severe pancreatitis and mild and severe pancreatitis. There was no significant difference between controls and mild pancreatitis. The results for TNF-alpha were similar to the findings for IL-8. Conclusion IL-6, IL-8, and TNF can be used independently in differentiating mild acute pancreatitis from early severe acute pancreatitis.

A meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett's esophagus in patients with gastroesophageal reflux disease

OBJECTIVES:To evaluate the diagnostic accuracy of esophageal capsule endoscopy (ECE) for Barretts esophagus (BE) in patients with gastroesophageal reflux disease (GERD).METHODS:Literature was searched for blinded studies evaluating the diagnostic accuracy of ECE for BE in patients with GERD. Meta-analysis was carried out to calculate pooled sensitivity and specificity of ECE for diagnosis of BE. Subgroup analysis was also carried out based on the reference standard used.RESULTS:Nine studies comprising a total of 618 patients met the inclusion criteria. The pooled sensitivity and specificity of ECE for the diagnosis of BE for all studies were 77 and 86% respectively. The pooled sensitivity and specificity of ECE for the diagnosis of BE using esophagogastroduodenoscopy (EGD) as the reference standard were 78 and 90%, respectively; using histologically confirmed intestinal metaplasia (IM) as the reference standard pooled sensitivity and specificity were 78 and 73%, respectively. Statistical heterogeneity was not evident among studies for sensitivity results (P=0.270, I2=19), but heterogeneity was present for specificity results (P<0.001, I2=74). There was no evidence of publication bias. The ECE was found to be safe and had a high rate of patient preference.CONCLUSIONS:Capsule endoscopy of esophagus has a moderate sensitivity and specificity for the diagnosis of BE in patients with GERD. The EGD remains the modality of choice for evaluation of suspected BE.

Protracted hiccups due to severe erosive esophagitis : A case series

Background Hiccups although a common annoyance of life, have been linked with significant morbidity and even death. There are numerous causes of prolonged hiccups, including diseases of the gastrointestinal tract. Hiccups are reported to represent an atypical manifestation of gastroesophageal reflux disease. Cases We report 4 cases of prolonged hiccups in patients who failed to respond to initial treatment with abortive neurologic medications and who subsequently improved on proton-pump inhibitors. Endoscopic examination revealed severe reflux esophagitis. Conclusion Hiccups are an atypical manifestation and may represent a more severe course of gastroesophageal reflux disease.

Osteopetrosis: A New Cause of Upper Gastrointestinal Bleeding

Osteopetrosis is a genetic disorder of bone remodeling caused by osteoclast dysfunction. Clinical features include short stature, frequent fractures, and recurrent infections. Abnormal bone obliterates the marrow cavity, resulting pancytopenia and extramedullary hematopoiesis in the liver and spleen. The splenomegaly can lead to left-sided portal hypertension. We report the second case of osteopetrosis-induced portal hypertension and the first case of upper gastrointestinal bleeding in a 52-year-old woman with osteopetrosis.