Antiviral treatment for cirrhosis due to hepatitis C: a review

Chronic hepatitis C infection is an important cause of cirrhosis and hepatocellular carcinoma (HCC). Antiviral therapy (AVT) for patients with cirrhosis due to hepatitis C may retard the progression of cirrhosis and prevent both the development of HCC as well as the recurrence of hepatitis C following liver transplantation. This review highlights the issues associated with AVT for patients with compensated and decompensated cirrhosis due to hepatitis C virus.

Symptomatic gastroesophageal reflux amongst hospital personnel in South India.

Introduction: Prevalence of gastro-esophageal reflux (GER) disease is on the rise in South Asian countries. Though there are reports of GER prevalence amongst various ethnic populations there are fewer reports on its prevalence in different occupational groups. Materials and Methods: To study the prevalence of GER amongst hospital personnel at the tertiary referral hospital in south India. Results: Of the 1468 hospital personnel, the overall prevalence of GER was 28.5%. It was highest amongst the clerical staff (31.3%) and least among nursing students (3%). Eighty five percent of the symptomatic GER personnel were young; those below the age of 35 years had symptoms for less than 6 months while those above 55 years had symptoms for more than 6 months. Combination of reflux symptoms with ulcer or dysmotility type dyspepsia was the dominant type amongst all cadres. The nursing staff (62.5%) preferred antacids whereas the doctors (63%) preferred PPI. Conclusion: GER prevalence is not uncommon amongst the hospital personnel. It is significantly more common amongst doctors, clerical staff and housekeepers.

Prevalence and risk factors for gastroesophageal reflux in pregnancy.

Background and aim Prevalence 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. Methods Consecutive 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. Results Demographic 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). Conclusions GER prevalence was high in pregnancy, often in second and third trimester. Non-vegetarianism and aerated beverages increased the risk of reflux in pregnancy.

Recurrent abdominal pain in a 16-year-old girl

A 16-year-old girl was admitted with acute onset of abdominal pain associated with vomiting. There was no abdominal distension, fever, jaundice or gastrointestinal bleeding. She had two similar episodes in the preceding 6 months. On examination, there was mild tenderness in the epigastrium. Her blood sugar, renal parameters, results of liver function tests and serum amylase were normal. The blood samples collected for analysis are shown in Figure 1, Upper gastrointestinal endoscopy was unremarkable

Peptic ulcer disease in India - A 16 year trend analysis.

Background and Aim: The incidence of peptic ulcer disease has steadily declined throughout the world. The influence of seasonal changes on the incidence of peptic ulcer disease is not well established. The aim of the study was to identify the changing trends in the occurrence of peptic ulcer disease from a tertiary referral center in south India and to study the seasonal variation in the occurrence of peptic ulcer. Methods: Retrospective analysis of the endoscopic records between the years 1989 to 2004. Results: There was a significant decrease in the endoscopic diagnosis of duodenal and gastric ulcers (DU and GU) over the years. Both duodenal and gastric ulcers were more common in men than women. Over the years, there was a steady increase in the proportion of women affected with both DU and GU. A steady increase in the mean age of endoscopic diagnosis of GU and DU was seen over the years. The adjusted seasonal index revealed an increase in the endoscopic diagnosis of GU and DU in the months October – March. Conclusion: The endoscopic diagnosis of DU and GU has shown a decreasing trend over the past 16 years. The adjusted seasonal index has shown an increasing trend between the months of October- March.

Distinguishing tuberculosis and crohn's disease in developing countries: How certain can you be of the diagnosis?

Distinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohn's disease are initially misclassified as having Intestinal tuberculosis in places where tuberculosis is endemic before they are treated for Crohn's disease. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. Future prospective studies are required in patients with granulomatous colitis to prevent unnecessary inappropriate anti tuberculous therapy for patients with Crohn's disease and appropriate early treatment for a patient with tuberculosis