Venkataraman Jayanthi

Expression profile of mucins (MUC2, MUC5AC and MUC6) in Helicobacter pylori infected pre-neoplastic and neoplastic human gastric epithelium.

BackgroundHelicobacter pylori (H. pylori) causes gastritis and intestinal metaplasia (IM) that may evolve to gastric carcinoma. The objective of this study was to compare the profile of mucins in the progressive stages of H. pylori infected pre-neoplastic and neoplastic human gastric epithelium. We used a panel of monoclonal antibodies with well-defined specificities of MUC2, MUC5AC and MUC6 to characterize the expression pattern of mucins by immunohistochemistry.MethodsRUT and ELISA were down for H. pylori confirmation. Human gastric biopsy sections were stained using immunohistochemistry with MUC2, MUC5AC and MUC6 antibodies.ResultsMUC5AC was expressed in the superficial epithelium and the upper part of the gastric pits. MUC6 expression was detected in the lower part of the gastric glands. MUC2 was expressed in intestinal metaplasia, mostly in goblet cells. The mucin expression profile in the progressive stages of H. pylori infected human gastric epithelium allows the identification of intestinal metaplasia, which is characterized by a decreased expression of the gastric mucins (MUC5AC and MUC6) and de novo expression of MUC2.ConclusionIn conclusion, our results suggest that there is altered expression of MUC5AC and MUC6 together with the aberrant expression of MUC2 in intestinal metaplasia, during the process of gastric carcinogenesis. The present study indicates that the MUC2 mucin expression pattern is a reliable marker of intestinal metaplasia, which appears in the context of H. pylori infected individuals.

Non-invasive predictors of esophageal varices.

Background/Aim: Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices. Patients and Methods: In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classified as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices. Results: Of the 229 patients (141 males; median age 42 years; range 17-73 years) with liver cirrhosis, 97 (42.3%) had small and 81 (35.4%) had large varices. On multivariate analysis, low platelet count (Odd’s Ratio [OR], 4.3; 95% confidence interval [CI], 1.2-14.9), Child Pugh class B/C (OR, 3.3; 95% CI, 1.8-6.3), spleen diameter (OR, 4.3; 95% CI, 1.6-11.9) and portal vein diameter (OR, 2.4; 95% CI, 1.1-5.3) were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count (OR, 2.7; 95% CI, 1.4-5.2), Child Pugh class B/C (OR, 3.8; 95% CI, 2.3-6.5) and spleen diameter (OR, 3.1; 95% CI, 1.6-6.0) were the independent risk factors. Conclusion: The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices.

Prevalence and risk factors for gastroesophageal reflux in pregnancy.

Background and aimPrevalence of gastroesophageal reflux (GER) increases during pregnancy, due to several factors like decreased lower esophageal sphincter pressure, increased intra-abdominal pressure secondary to the enlarged gravid uterus and alteration in gastrointestinal transit. The present study aimed to determine the prevalence of GER in pregnancy in a southern State of the Indian subcontinent and determine the risk factors associated with it.MethodsConsecutive pregnant females (n = 400) at various stages of pregnancy attending the antenatal clinic or admitted in the antenatal wards were enrolled. Patients with heartburn or regurgitation or both (n = 182) for at least a week were defined as cases, and controls were those without these symptoms (n = 218). Data on demographic variables and symptoms were analyzed using Pearson chi-square, Yates corrected chi-square and Fischer exact test and student independent t-test as appropriate; p < 0.05 was considered significant.ResultsDemographic characteristics between cases and controls were similar. The mean age of cases (23.68±3.37 years) was similar to that of controls (23.25±3.31 years). The overall prevalence of GER was 45.5% (182/400), 77 (19.3%) had heartburn (GER-HB), 54 (13.5%) had regurgitation (GER-R) and 51 (12.8%) had both (GER-HB + R). Age and gravida did not influence the frequency of symptoms. Symptoms were more frequent in the second (43.1%) and third trimester (54.1%) as compared to the first trimester (9.5%) in pregnant women with GER (p < 0.001). Atypical symptoms were uncommon. GER was common among non-vegetarians (p = 0.02) and frequent aerated beverage users (p = 0.001).ConclusionsGER prevalence was high in pregnancy, often in second and third trimester. Non-vegetarianism and aerated beverages increased the risk of reflux in pregnancy.

Indian Society of Gastroenterology consensus on ulcerative colitis

In 2010, the Indian Society of Gastroenterology’s Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on ulcerative colitis. This consensus, produced through a modified Delphi process, reflects our current understanding of the definition, diagnostic work up, treatment and complications of ulcerative colitis. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

Indian Society of Gastroenterology consensus statements on Crohn's disease in India.

In 2012, the Indian Society of Gastroenterology’s Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn’s disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

Gram-negative bacteria causing infective endocarditis: Rare cardiac complication after liver transplantation

Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvular abnormalities. Staphylococoocusaureus and Enterococcus species are the most commonly isolated organisms. There are very few reports of gram-negative bacteria causing endocarditis in liver transplant recipients. We report a 51-year-old male, a liver transplant recipient, who developed bacterial endocarditis of the mitral valve due to extended spectrum of betalactamase producing strain of Escherichia coli and was managed successfully with antibiotics.

HBsAg Positive Patient Characteristics in Hospital and Blood Donation Camps

Background. Prevention of the residual risk of transfusion transmitted hepatitis B virus infection (HBV) is mostly dependant on serological screening of blood donors for HBsAg and antibody to hepatitis B core antigen (anti-HBc Ab). This study aimed to study the prevalence of HBsAg and anti-HBc Ab and to compare the profile of blood donors attending a blood donation camp and people attending a hospital based camp. Methods. In the blood donor camp, all the blood units were screened for HBV, (HBsAg and anti-HBc), and in the hospital based camp, screening was done for HBsAg alone. Baseline demographic characteristics were noted. Results. The number of blood bank donors was 363 (47.5%) and hospital camp attendees was 402 (52.5%). Prevalence of HBsAg positivity was similar in both the groups at 1.7% and 1.9%, respectively. Anti-HBc Ab positivity (Total) was 6% among the blood donors; Overall prevalence of HBV infection in this group was 3.2%. Conclusion. Policy for checking the collected blood unit by 3 tests for anti-HBc, anti-HBsAb, and HBsAg should be reconsidered to possibly achieve the zero risk goal of transfusion transmitted HBV infection. Blood obtained from a vaccinated donor may give an added protection to the recipient.

Malignant Hepatic Epithelioid Hemangioendothelioma with Villaret Syndrome

Malignant hepatic epithelioid hemangioendothelioma is a rare, vascular tumor of the liver with peak incidence in the middle age with a female preponderance and of unknown etiology. Majority of the tumors are asymptomatic. The gold standard for diagnosis of the tumor is liver histology showing presence of epithelioid tumor cells on a background of a hyaline stroma. Immunohistochemical positivity for CD31, CD34, Factor VIII, and Podoplanin (D2-40) is confirmatory. The treatment of choice is liver transplantation.

Pancreatitis, Pannicultis, Polyarthritis- A Rare Triad!

A 51 year - old – male, consuming alcohol almost 180 ml/day for 20 years was admitted elsewhere with vomiting for 10 days, reduced urine output for 5 days and severe epigastric pain radiating to back for 3 days.

Is gastroesophageal reflux disease in south Indian population influenced by waist hip ratio and body mass index

Dear Editor: It is widely believed that obesity, especially truncal, increases the risk of gastroesophageal reflux disease (GERD) particularly in the western population [1, 2]. A high body mass index (BMI) [>25.0 kg/m] has been associated with increased risk of erosive esophagitis, Barrett’s esophagus (BE), and adenocarcinoma [3]. Recent studies in the West have shown the waist to hip ratio (WHR), but not BMI, as the key factor associated with GERD complications [3]. We therefore intended to study whether typical and atypical GERD symptoms were associated with BMI and WHR abnormalities. We did a hospital-based case control study, recruiting consecutive cases attending the Department of Gastroenterology at Government Stanley Medical College Hospital, Chennai (tertiary care center catering to lower socioeconomic population) in 2009–2010, with typical GERD symptoms defined as heartburn, regurgitation, or combination of both and atypical GERD symptoms (noncardiac chest pain, chronic cough, unexplained otalgia, dysphonia). Minimum criterion for selectionwas presence of GERD symptoms at least once a week for 6 months. No symptom-based scoring systemwas used during the study. Controls were unmatched patients attending the same outpatient clinic with lower gastrointestinal (GI) symptoms or nonspecific abdominal pain with no upper GI or alarm symptoms like anorexia or weight loss. Patients with gastric outlet obstruction or previous gastric surgery causing secondary esophagitis were excluded. Baseline demographic details, weight, height, and waist and hip circumferences were obtained for all cases and controls. BMI and WHR were calculated from these. A BMI >23, WHR >0.90 (men), and >0.85 (women) were considered abnormal [4]. Analysis was done by gender, comparing cases and controls for demographic characteristics. Before analyzing the individual effect of BMI and WHR on GERD, the presence of any correlation between these two parameters was assessed in both men and women. Ethics committee of the institution (Stanley Medical College Hospital) approved the study. SPSS Version 20 was used for analysis: chi-square test for proportions, Wilcoxon sign rank sum test for comparison of median, and ANOVA for comparison of means. Odds ratio (OR) was computed only for significant risk factors with p<0.05. There were 107 men (+71 controls) and 152 women (+ 93 controls) with GERD symptoms. The median age among men and women in both cases and controls were similar (40 years). There were significantly more smokers (p<0.005), alcoholics (p<0.05), and tobacco chewers (p<0.00001) among men with GERD. As BMI and WHR were not associated with each other in both genders (male r 0.049; female r 0.16), their effect on GERD symptoms was analyzed separately. The prevalence of typical and atypical GERD symptoms was similar in men and women (p not significant). In women, (Table 1) GERD symptoms were not influenced by a raised BMI (OR 1.3; 95 % confidence interval (CI) 1.0–1.6; p<0.05) and in fact, WHR was negatively associated with GERD (OR 0.8; 95 % CI 0.7–1.0; p<0.05). Likewise, individual typical and atypical GERD symptoms were not influenced by raised BMI or WHR. Similarly, in men, GERD symptoms * V. Jayanthi drjayanthi35@yahoo.co.in