Pawan Rawal

Endoscopic retrograde pancreatography in pancreatic trauma: Need to break the mental barrier

Pancreatic injury has a high morbidity and mortality. The integrity of the main pancreatic duct is the most important determinant of prognosis. Serum amylase, peritoneal lavage and computed tomography of the abdomen can assist with diagnosis but endoscopic retrograde pancreatography (ERP) is the most accurate investigation for diagnosing the site and extent of ductal disruption. However, it is invasive and can be associated with significant complications. Magnetic resonance cholangiopancreatography (MRCP) and secretin‐enhanced MRCP probably parallel ERP in delineating pancreatic ductal injuries. They can also delineate the duct upstream to complete disruption, an area not visualized on ERP. In relation to therapy, endoscopic transpapillary drainage has been successfully used to heal duct disruptions in the early phase of pancreatic trauma and, in the delayed phase, to treat the complications of pancreatic duct injuries such as pseudocysts and pancreatic fistulae. Transpapillary drainage is especially effective in patients who have partial pancreatic duct disruption that can be bridged. Endoscopic transmural drainage has also been successfully used to treat post‐traumatic pancreatic pseudocysts. Further large, prospective and randomized studies are required to adjudge the efficacy and long‐term safety of pancreatic duct drainage in the treatment of post‐traumatic pancreatic duct injuries.

Role of Colostrum in Gastrointestinal Infections

Colostrum is breast milk produced after the birth of the newborn and lasts for 2–4 days. Colostrum is very important part of breast milk and lays down the immune system and confers growth factors and other protective factors for the young ones in mammals. This is the source of passive immunity transferred to the baby from the mother. The biological value of bovine colostrum in present day medical practice is documented in clinical trials and large databases containing case reports and anecdotal findings. The main actions include an antibacterial effect and modulation of immune response with the ability to neutralize lipopolysaccharides arising from gram negative bacterial pathogens. It has been found to be effective in infantile hemorrhagic diarrheas, other diarrheas and reduces the likelihood of disease progressing to hemolytic uremic syndrome. It has also been tested in H pylori infection and diarrhea in immunodeficiency. Side effects of clinical relevance are limited to possible intolerance due to lactose and sensitivity to milk proteins.

Zinc supplementation to patients with celiac disease--is it required?

BACKGROUND AND OBJECTIVES This study was conducted to evaluate plasma levels of zinc in children with celiac disease, to correlate plasma zinc levels among the celiacs with short stature and diarrhea and to compare plasma zinc levels in deficient patients on gluten-free diet (GFD) with or without 4 weeks of zinc supplementation. METHODS A total of 134 patients underwent plasma zinc estimation at baseline and after a four week period. Zinc-deficient patients were randomly assigned to two groups. Group G (n = 48) received GFD without zinc supplementation, Group G + Z (n = 48) received GFD with zinc supplementation for 4 weeks. RESULTS The rise in plasma Zinc levels was significant in each group regardless of zinc supplementation but similar when compared in the two groups after 4 weeks. Mean zinc levels at baseline and increase in zinc levels were statistically similar at 4 weeks in patients with diarrhea and short stature. CONCLUSIONS Zinc levels rise with GFD irrespective of zinc supplementation.

Association of Celiac Disease with Cardiomyopathy and Pulmonary Hemosiderosis

Celiac disease is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing gluten, such as wheat, barley and rye. Although previously believed to be uncommon, celiac disease may be present in up to 1% of the general population. Celiac disease is frequently associated with many extraintestinal disorders, but rarely with cardiomyopathy. We describe a patient with celiac disease associated with cardiomyopathy and pulmonary hemosiderosis.

Familial Prevalence of Celiac Disease

BACKGROUND AND OBJECTIVE Serological screening enables us to detect patients of celiac disease (CD) before they develop serious complications. This study was planned to assess the prevalence of CD in the family members of index cases by serological screening. PATIENTS AND METHODS A prospective study was conducted on 50 children diagnosed to be having CD. Serological screening of the family members of index cases was done and those showing positivity for the screening tests were further subjected to endoscopic duodenal biopsy for histopathological examination. RESULTS A total of 164 members of 50 celiac families were initially screened for antibodies. Antibody picked up 32.9% by IgG anti-gliadin (AGA), 20.7% by endomysial antibody, 19.5% by tissue transglutaminase and 14.6% IgA AGA as seropositive for CD. Endoscopic findings characteristics for CD were present in only eight family members. CONCLUSION Family members of CD cases represent potential cases of CD.