Acquisition of Helicobacter pylori infection and reinfection after its eradication are uncommon in Indian adults.

BACKGROUND: Eradication of Helicobacter pylori infection is known to decrease the recurrence rate of peptic ulcer disease. Data from India on the acquisition rate of H. pylori infection and reinfection after eradication are scant. AIM: To study the rates of acquisition of H. pylori infection and of reinfection after eradication in Indian adult patients. METHODS: We evaluated 116 consecutive patients with dyspepsia undergoing endoscopy. Sixty-four of them were H. pylori-positive on gastric antral biopsy (rapid urease test and histology). Patients diagnosed to have H. pylori infection were treated with a four-drug regimen (omeprazole, bismuth subcitrate, tetracycline, furazolidine) for 2 weeks; those failing H. pylori eradication were treated with a second regimen (lansoprazole, amoxycillin, secnidazole) for one week. Patients who were H. pylori-negative to begin with and those who had successful H. pylori eradication were followed up clinically and endoscopically every 3 months for a median of one year. RESULTS: Ninety-six patients (50 H. pylori-positive) were available for study; the other 20 were lost to follow up after the first endoscopy. Fifty of the 96 (52%) were H. pylori-positive; four of these 50 patients did not follow up after first treatment. The eradication rate with the four-drug regimen was 89.1% (41/46). Four of the 5 non-responders eradicated H. pylori with the second regimen. At the end of median one year follow-up (range 9-15 months), one of the 45 patients (2.4%) who eradicated the organism developed reinfection; none of the 46 patients who were initially H. pylori-negative acquired new infection. CONCLUSIONS: The risk of reinfection after eradication is low in Indian subjects at the end of one year. The rate of acquisition of new infection is also low in the adult population.

Predictors of response to pneumatic dilatation in achalasia cardia.

BACKGROUND: The role of esophageal laboratory testing in predicting response to balloon dilatation in patients with achalasia cardia has been evaluated in the West; data in Indian patients are scant. AIM: To study the predictors of response to pneumatic balloon dilatation in Indian patients with achalasia cardia. METHODS: Twenty-five patients with achalasia cardia who had earlier undergone esophageal manometry before balloon dilatation (Group A) were recalled for clinical evaluation. Another consecutive 25 patients with newly diagnosed achalasia (Group B) underwent esophageal manometry and isotope transit studies before and after dilatation. RESULTS: The overall symptom response to dilatation in the 50 patients at median (range) follow up of 26 (1-60) months was 64%. Pre-dilatation clinical and laboratory parameters did not predict outcome. All patients with 1-week post-dilatation lower esophageal sphincter (LES) basal pressure less than or equal to 10 mmHg and residual pressure less than 6 mmHg were asymptomatic at follow up. CONCLUSION: Post-dilatation LES basal pressure less than or equal to 10 mmHg and residual pressure less than 6 mmHg are predictors of symptom response to balloon dilatation in patients with achalasia cardia.

Jejunal stricture complicating acute mesenteric venous thrombosis secondary to protein C deficiency and factor V Leiden gene mutation.

We report a patient with high small intestinal obstruction due to ischemic stricture, secondary to acute mesenteric venous thrombosis. Tests done for hypercoagulability revealed dual etiology (protein C deficiency and factor V Leiden gene mutation). The patient underwent surgical resection and has been on anticoagulation treatment. At 2 years' follow up, she remains asymptomatic.

Acute lymphoblastic leukemia presenting with severe jaundice in an adult.

We report an adult patient of acute lymphoblastic leukemia presenting with liver dysfunction.

Dental plaque: an unlikely reservoir of Helicobacter pylori.

BACKGROUND AND AIM: Dental plaque has been suggested as a reservoir for Helicobacter pylori, though data in this regard are conflicting. We evaluated the prevalence of H. pylori DNA in dental plaque using polymerase chain reaction (PCR). METHODS: Antral H. pylori status of 156 patients with acid-peptic disease (APD) was studied by rapid urease test (RUT), histology and culture. Dental plaque obtained from these 156 patients and 92 healthy volunteers was evaluated for the presence of H. pylori using RUT, culture and PCR. RESULTS: H. pylori was present in 133 antral biopsy samples by RUT and/or histology. The dental plaque of 37 patients with APD and 21 healthy volunteers tested positive by RUT. H. pylori was not isolated by culture from any of the dental plaques. PCR gave a significant amplification product in 11 of 248 (4.4%) dental plaque samples, 7 from patients with APD and 4 from normal healthy volunteers. CONCLUSION: The frequency of H. pylori in the dental plaque is low, and this is unlikely to be a prominent site of infection with H. pylori.

Multiple abdominal venous thrombosis in HIV-seropositive patient.

HIV infection is known to be associated with endothelial dysfunction leading to thrombosis. We report a patient with multiple abdominal venous thrombosis and splenic hematoma who was seropositive for HIV-1. No cause for the hypercoagulable state was detected; prothrombin time, activated partial thromboplastin time, and levels of protein S, protein C and antithrombin III were normal. He tested negative for VDRL and anticardiolipin antibodies.

Hepatitis E virus and Salmonella paratyphi A coinfection.

We report a patient with simultaneous Salmonella paratyphi A and hepatitis E virus infection. The possibility of coinfection with water borne diseases in India is emphasized.

Long-term anti-inflammatory drug use and Helicobacter pylori infection: a clinical, endoscopic and histological study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori are independent risk factors for gastroduodenal damage and peptic ulcer. OBJECTIVE: To study the frequency and effect of H pylori infection on gastroduodenal mucosa in patients on long-term NSAID use. METHODS: A total of 125 subjects were studied: 65 patients (Group 1) on NSAID therapy (> 6 months), 30 patients (Group 2) with arthritic disorders prior to starting NSAID therapy, and 30 healthy volunteers (Group 3). Dyspeptic symptoms were evaluated using a questionnaire. All patients underwent endoscopy and antral and duodenal biopsies were obtained to assess the extent of gastroduodenal damage and H pylori status. RESULTS: H pylori infection was less frequent in Group 1 (37%) compared to Group 2 (57%, p = ns) and 3 (60%, p < 0.05). Among Group 1 patients, H pylori infection did not increase the risk of gastroduodenal damage (52% vs 45%) or ulceration (32% vs 27%). Group 1 patients with H pylori infection were more likely to be symptomatic (48% vs 27%) and have chronic active gastritis (76% vs 12%) and chronic active duodenitis (68% vs 5%). Gastric metaplasia was seen only in patients with H pylori infection, chronic active gastritis and duodenitis. Chemical gastritis was observed more commonly in Group 1 (34% vs 3%) compared to Group 2; its was not seen in Group 3. H pylori infection was less commonly observed in patients with chemical gastritis (8% vs 50%). CONCLUSION: Patients on long-term NSAIDs are not at increased risk of H pylori infection. Presence H pylori infection is not associated with increased risk of gastroduodenal damage in these patients. H pylori infection correlated with presence of chronic active gastritis, and NSAID with presence of chemical gastritis.

Spontaneous drastic reduction of alpha-fetoprotein in hepatocellular carcinoma.

Alpha-fetoprotein levels in patients with hepatocellular carcinoma usually increase with tumor progression. We report a patient in whom levels decreased spontaneously despite tumor growth.

Tuberculous abscess of the liver associated with HIV infection.

Tuberculosis is an AIDS-defining illness in HIV-seropositive patients. Though disseminated tuberculosis is common in HIV-seropositive patients, hepatic involvement in the form of abscess formation is rare. We report such a patient.

Multiple system organ failure: a study of outcome.

One hundred patients with Multiple System Organ Failure (MSOF) were studied. The precipitating factors were infections, poisoning, metabolic disorders, surgical disorders and cardiac arrest resulting in an overall mortality of 65%. Mean inpatient stay was 3.86 days, being significantly longer in patients who survived (6.25 days). Age, sex, addictions and premorbid health did not affect outcome. GIT (89%), CNS (81%) and Liver failure (62%) were seen most commonly. Highest mortalities were observed with RS (81.2%), CVS (80.37%) and CNS (76.5%). The mortality with 2,3,4,5,6 and 7 OSF was 8.3%, 18.7%, 70%, 92%, 100% and 100% respectively. The mortality was highest (50.76%) on the first day of MSOF and during the initial 48 hours of the total duration of disease. The method proposes an easily reproducible way to evaluate severity of illness and predicting outcome in acute MSOF.