RESUMEN
Introduction: Barrett’s esophagus (BE) is a complication of gastroesophageal reflux disease (GERD). It is seen among 15% of GERD patients as per a population-based study by Ronkainen et al. Barrett’s has malignant potential and annual progression to carcinoma depends on the presence or absence of dysplasia. There are various risk factors for the development of BE. We compared two symptomatic cohorts of GERD patients from the same geographical area who were evaluated for the presence of Barrett’s and various factors that can contribute to Barrett’s Materials and methods: Cross-sectional study. Two GERD cohorts, one from Kottayam and the other from Trivandrum were taken. The presence of Barrett’s and the factors contributing to the development of Barrett’s were analyzed between the two groups. Since biopsy data of all patients were not available, endoscopically suspected esophageal metaplasia (ESEM) was taken as Barrett’s Results: 415 patients were enrolled for the study (203 from Trivandrum and 212 from Kottayam). 192 females (99 from Trivandrum and 93 from Kottayam), and 223 males (104 from Trivandrum and 119 from Kottayam). Barrett’s esophagus and especially long-segment Barrett’s were significantly more common in Kottayam than Trivandrum (68 vs 22 and 36 vs 9) (p-value <0.001). Among the factors that were traditionally thought to contribute to the development of Barrett’s esophagus, age (>50 years) was not statistically significant among the two cohorts (mean age of Trivandrum was 48 years and Kottayam was 49 years). Duration of GERD symptoms was significantly more in the Trivandrum cohort compared to Kottayam (p-value <0.001). Hiatus hernia and body mass index (BMI) were more common in Kottayam. There were no statistically significant differences in erosive esophagitis and antral gastritis (%age?) between the two cohorts. Conclusion: Both Trivandrum and Kottayam belong to the same geographical area and are separated by a distance of only 150 km. The Kottayam cohort is more prone to develop distal esophageal carcinoma as the BE is more in Kottayam. This data also suggests the need for GERD registries so that high-risk population can be targeted and early intervention can lead to a decrease in the incidence of distal esophageal carcinomas.
RESUMEN
Introduction: Non-Alcoholic fatty liver disease (NAFLD)is increasing worldwide. Among the spectrum of NAFLD,presence of advanced fibrosis is associated with increasedmorbidity and if unchecked can progress to cirrhosis.Advanced fibrosis is also associated with cardiac dysfunction.Hence it is important to predict advanced fibrosis so thatmore intensive lifestyle changes and pharmacotherapy withemerging drugs can be tried. Aims and objectives: To evaluatea novel predictor model for advanced fibrosis in NAFLD.Material and Methods:Present cross sectional study wasperformed on 500 patients with NFALD at GastroenterologyDepartment of Medical College Trivandrum. All the patientsunder went transient elastography(TE) after dividing themin to those having advanced fibrosis (TE>=10Kpa) andwithout advanced fibrosis (TE<10Kpa). Anthropometric andbiochemical variables were assessed on the date of TE.Logisticregression was performed, coefficient of beta of independentvariables was found out and a new score was proposed.Results: Mean age of study cohort was 48.2±11.76 yearswhich ranged from 18 to 74 years. Female preponderance(52.4%) was observed.Weight, body mass index (BMI),platelet count, fasting blood sugar (FBS), serum glutamicoxaloacetictransaminas (SGOT), albumin, alkalinephosphatase and thyroid stimulating hormone (TSH) wereindependent predictors of advanced fibrosis. Logisticregression confirmed TSH, platelet count, albumin and SGOTas the independent predictors. New score has higher AUROCof 0.824(Cut off ≥ - 13.5 has 100% sensitivity in predictingadvanced fibrosis) compared to BARD score (AUROC of0.653) and APRI score (AUROC of 0.802).Specificity of thenew score was less than 50%.Conclusion: New score is a better prognostic model to predictadvanced fibrosis than BARD score and APRI score. It is asimple bedside tool that can be in cooperated into day today practice. Validity of the score needs to be checked in adifferent cohort.