An Unusual Spectrum of Upper Gastrointestinal Tract Foreign Bodies: A 4-Year Prospective Endoscopic Study

Introduction: Ingestion of a foreign body (FB) is a commonoccurrence in day to day clinical practice; however, fewstudies have been reported from Northern India. The aimof this study was to study the spectrum and managementoutcome of patients with FBs in their gastro intestinal tracts(GIT) presenting to gastroenterology unit in a tertiary carereferral hospital.Material and methods: Data were collected from allconsecutive patients with history of FB ingestion admitted toour endoscopy centre from January 2015 to December 2018.The demographic data, clinical presentations, and endoscopicmanagement was reviewed and analyzed.Results: A total of 204patients with suspectedFBingestionunderwent endoscopic management. 211 FBs were found in204 patients with suspected FB.Scarf pin was most common(57.3%) followed by knitting needle in twenty-six (12.3%)cases. Most of theFBs were located in the stomach (72.6%). Themajorityof patients (95.2%) were successfully removed withflexibleendoscopy with the addition of suitable accessorieswithout any serious procedure-related complications.Conclusion: In this part of the world the pattern and types ofUpper gastrointestinal tract foreign bodies is unique not seenelsewhere across the globe. Endoscopic management wasfound to be highly safe and efficacious.

Changing Prevalence of Gastric Fundic Gland Polyps: Current Scenario in North India.

Introduction: The prevalence and histopathological type ofgastric polyp vary between populations. In the recent pastaggressive treatment of Helicobacter pylori (H. pylori) and theexcessive use of proton pump inhibitors (PPIs) have alteredthe prevalence of specific types of gastric polyp. This studywas designed to evaluate the prevalence and histopathologybackground of gastric mucosa in cases with fundic glandpolyps (FGP).Material and Methods: The medical record of patients whounderwent esophagogastroduodenoscopy in 2 centers inNorthern India from 2011-2018 were reviewed.Results: The prevalence of gastric polyps was 5%, of which900 (50%) were fundic gland polyps (FGP). Mean age ofpresentation was 51.42 years, 70% were located in fundus/corpus, 62% had dyspepsia, chronic inactive gastritis (CIG)was present in 60%, 95% were multiple and 27% were morethan 1cm in size.Conclusions: As a result of anti - H. pylori treatment and theexcessive use of PPIs, FGP are most common in Northern India.CIG, H. pylori gastritis and Intestinal metaplasia were seen ingastric histology of the cases. These results are interesting andprovide new perspective to look for pathogenesis of gastricpolyps.

Helicobacter Pylori Sequential Eradication Therapy: Clarithromycin based Therapy Versus Levofloxacin based Therapy. Study from Kashmir Valley

Introduction: Various regimens have been used for H-pylorieradication. Sequential therapy is an alternative to classicaltriple therapy. This study was designed for evaluatingthe efficacy of levofloxacin based sequential therapyvs clarithromycin based sequential therapy in H-pylorieradication.Material and methods: It is a randomized clinical trial. Twohundred H. Pylori infected patients diagnosed by rapid ureasetest (RUT) on UGI endoscopy were randomly divided intotwo groups A and B. Group B Levofloxacin based sequentialregimen and group A clarithromycin based sequential regimen.H-pylori eradication status was evaluated with rapid ureasetest on UGI endoscopy 6 weeks after completion of sequentialtherapy.Results: As per protocol, eradication rates for group B and Awere 86% and 81% respectively. Eradication rate for H-pyloriis greater with levofloxacin based sequential therapy ascompared to that of clarithromycin based sequential therapybut it is not statistically significant p >0.05.Conclusion: Levofloxacin based sequential therapy has highereradication rate than clarithromycin based sequential therapy.Although not statistically significant in our study, levofloxacinbased sequential therapy could be better alternative forthe treatment of H-pylori in areas with high clarithromycinresistance.

A Haemodynamic Analysis to Assess the Safe Dose of Carvedilol across Different Child Class of Liver Disease.

Background: Literature regarding safe dose of carvedilol is limited and also safe dose across different child classes of chronic liver disease is not very clear. Aim: We aimed primarily to study, the effect of reasonably safe dose (12.5 mg) of carvedilol in acute reduction of portal pressure and compared it with chronic reduction of portal pressure, after proper optimization of dose of carvedilol. Second aim of our study was to define predictors of response for acute and chronic reduction of portal pressure and to assess difference in dose tolerated and response across different child class on chronic basis. Methods: One hundred two consecutive patients of cirrhosis of liver with significant portal hypertension were included and hepatic venous pressure gradient was measured at the base line and after 90 minutes of administration of 12.5 mg carvedilol. After proper dose optimization of carvedilol, hepatic venous pressure gradient was again measured after 3 months to assess the chronic response. Results: The mean age of study population was 58.3±6.6 years. A total of 42.2%, 31.9% and 26.6% patients had child class A, child class B and Child class C cirrhosis, respectively. Mean pre-drug hepatic venous pressure gradient was 16.75±2.12 mmHg which dropped to 13.07±2.32 mmHg after 90 minutes of administration of 12.5 mg of carvedilol. The mean drop of hepatic venous pressure gradient was 4.5±2.2 mmHg and 2.4±1.9 mmHg among responders and non-responders, respectively. Overall, 51% showed acute response while 49% were nonresponders. Low cardiac output and high mean arterial pressure were significantly predicting the acute response, while, low baseline cardiac output was found as an independent predictor. After dose optimization, number of responders increased from 52 to 62. Mean dose of carvedilol was higher in non–responders as compared to responders, though statistically insignificant (p>0.05). Mean reduction of hepatic venous pressure gradient from baseline and after 3 months was 5.5±1.7 mmHg and 2.8±1.6 mmHg among responders and non responders on chronic basis, respectively (p<0.001). Absence of any adverse events (OR 11.3, 95% CI; 1.9-67.8), and more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response (OR 8.7, 95% CI; 3.1-25.3) were found as independent predictors of chronic response (p<0.05). Univariate analysis found that no adverse events, no ascites, low baseline cardiac output, more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response, as predictors of chronic response. However, etiology, child class, variceal size (large vs small) and gender were not significantly associated with chronic response Conclusion: At safe dose and with proper optimization of dose, carvedilol may achieve greater response with minimum side effects among different child classes of liver disease.

Ahlstrom's Syndrome with Type IV Choledochal Cyst.

Ahlstrom's syndrome is an autosomal recessive, single gene disorder with multisystem involvement with cone-rod retinal dystrophy leading to juvenile blindness, sensorineural hearing loss, obesity, insulin resistance and type 2 Diabetes mellitus. The other less common involvements may severely affect the prognosis and survival and include endocrine abnormalities, dilated cardiomyopathy(DCM) , pulmonary fibrosis and restrictive lung disease, progressive hepatic and renal failure.Apart from its typical, well known clinical features, hepatic & biliary involvement should be kept in mind. Though not known in literature, the biliary tract abnormalities might not be so uncommon. A routine MRCP in a child of AS with typical or atypical biliary tract involvement is thus advisable.