Clinicomicrobiological analysis of patients with cholangitis.

Acute cholangitis is inflammation of biliary ductal system from infection with an associated biliary obstruction. This retrospective study was done to determine the factors responsible for cholangitis and the microbiological profile of the bile in patients with cholangitis. In the study involving 348 patients, 36.4% had associated malignancy. A total of 54% of the bile samples were positive for aerobic culture. Nearly 66-73% of the Escherichia coli and Klebsiella isolates were Extended spectrum beta lactamases (ESBL) producers. Two isolates of Candida spps were also obtained. Polymicrobial infection was seen in 31.5% of the culture positive cases. Ideal antibiotics in case of cholangitis would be those which are excreted in the bile such as third‑generation cephalosporins, ureidopenicillins, carbapenems and fluoroquinolones to combat resistance and polymicrobial aetiology. Anti‑fungal drugs may also be necessary if the patient is not responding to biliary decompression and antibacterial agents to prevent fungaemia.

Solitary rectal ulcer syndrome in childhood.

Solitary rectal ulcer syndrome is a rare disorder of childhood and usually goes unrecognised or misdiagnosed because it can mimic various other rectal entities. Here a 9-year old boy presented with bleeding per rectum and altered bowel habits. Colonoscopy revealed multiple ulcers which on histopathological examination showed features of SRUS with severe reactive changes of regeneration mimicking malignancy.

Role of anxiety and personality in non-ulcer dyspepsia: a comparative study with duodenal ulcer.

BACKGROUND: Though emotional factors are known to influence gut functions, studies evaluating the role of anxiety and personality in non-ulcer dyspepsia (NUD) are few and have not yielded consistent results. AIMS: To find out whether anxiety and abnormal personality pattern are specifically associated with NUD. METHODS: 33 patients with NUD and 30 patients with duodenal ulcer, who were randomly selected from among those attending a gastroenterology out-patient clinic, were administered a) the Eyesenck Personality Inventory, to measure neuroticism and extroversion; and b) a short self-rating scale for anxiety, to measure state and trait anxiety. RESULTS: There were no significant differences between the two groups in state anxiety, neuroticism and extroversion. Trait anxiety, however, was significantly higher in the NUD group (p = 0.05). CONCLUSIONS: Though the difference in trait anxiety score between the two groups attained significance, this finding needs further support to indicate a causal role for anxiety in NUD. There is need for further studies about the role of anxiety in various subgroups of NUD.

Medical myotomy for achalasia cardia. Long term results.

Pneumatic dilatation was effective in relieving dysphagia in 16/17 subjects with achalasia cardia. It was also effective and safe in those with sigmoid oesophagus, although dilatation persisted in them. Recurrences were noted in one quarter of cases which were managed satisfactorily with subsequent dilatations. There were no complications. Pneumatic dilatation appears very useful in the management of achalasia cardia.

Post sclerotherapy esophageal ulcers: a prospective analysis of their behaviour.

The reported incidence of post sclerotherapy esophageal ulcers has shown marked variation, possibly due to lack of uniform criteria for their diagnosis. Using fixed criteria (size greater than or equal to 5 mm, duration greater than or equal to 2 weeks), we prospectively studied 82 patients with portal hypertension, who underwent four or more sessions of endoscopic sclerotherapy (EST), for the occurrence and behaviour of these ulcers. Post sclerotherapy ulcers occurred after 43 (9.2%) of 465 EST sessions in 30 (36.6%) of 82 patients. Ulcers were significantly associated with two complications: rebleed during the course of sclerotherapy (33% of ulcers bled compared to 3% from variceal rupture; p less than 0.001) and esophageal stricture formation (66.7% of strictures occurred in patients who had ulcers; p less than 0.05). Ulcers occurred more frequently in patients with poor liver function (61.5% in Child's C grade compared with 31.9% in Child's A or B grades; p less than 0.05) and after injection into larger varices (83.7% in varices grades 3 and 4, 16.3% in lower grades; p less than 0.005). Severe persistent chest pain (p less than 0.001) and pyrexia (p less than 0.01) after sclerotherapy were clinical pointers of ulcerogenesis.