Eosinophilic pancreatitis with pseudocyst.

Eosinophilic pancreatitis is a rare entity in patients having underlying systemic manifestations such as peripheral eosinophilia, elevated serum IgE levels and/ or eosinophilic infiltrates in other organs, including the gastrointestinal tract. We report a 38-year-old woman with peripheral eosinophilia in association with acute pancreatitis, pancreatic ascites and pseudocyst.

Role of magnification endoscopy in the diagnosis and evaluation of suspected celiac disease: correlation with histology.

BACKGROUND: Magnification endoscopy (ME), with 115-fold magnification, allows visualization of duodenal villi. We assessed the efficacy of ME for evaluation of villous atrophy. METHODS: ME and duodenal biopsy were done in 16 patients with suspected celiac disease and 16 control subjects undergoing endoscopy for reflux symptoms. The pathologist was unaware of the ME findings. RESULTS: Sensitivity, specificity and positive and negative predictive values for villous atrophy (partial or total) were 100%, 91%, 83% and 100%, respectively. Corresponding values for normal villous structure were 91%, 100%, 100% and 83%, respectively. There was significant concordance between the ME and histology findings. CONCLUSION: ME is a reliable technique to diagnose villous atrophy.

Capsule endoscopy in obscure gastrointestinal bleeding--an Indian experience.

BACKGROUND: Obscure gastrointestinal bleeding (OGIB) is a common indication for capsule endoscopy (CE). Reports on diagnostic yield of CE in this situation show a wide variation. We evaluated the diagnostic yield and clinical impact of CE in patients with OGIB. METHODS: We reviewed the medical records of patients with OGIB who underwent CE at our institution between June 2002 and October 2005. RESULTS: 154 patients (mean age 47 [SD 17] years; 117 men), including 74 with overt OGIB and 80 with occult OGIB, underwent CE. CE yielded positive findings in 57 of 74 patients (77%) with overt OGIB and 22 of 80 (27%) of those with occult OGIB (p < 0.0001); the overall positive diagnostic yield was 52%. NSAID-induced lesions (15%), angiodysplasias (14%) and aphthous ulcers (12%) were the most frequent findings. CE helped in planning further management in 79% of patients with overt OGIB and 26% of those with occult OGIB. CONCLUSION: CE is a useful diagnostic technique in patients with OGIB, especially those with overt OGIB.

Malarial hepatitis: a heterogeneous syndrome?

BACKGROUND. The incidence of malarial hepatitis in patients with Plasmodium falciparum infection and jaundice is not known and it is not clear whether the condition is a single entity or a heterogeneous syndrome. METHODS. We prospectively studied the natural history of all patients with falciparum malaria and jaundice admitted to military hospitals in Northeast India from 1988 to 1991. A possible drug or viral cause for the hepatitis was excluded by the history, serological tests and liver histology. RESULTS. Of the 732 patients admitted with falciparum malaria, 39 had jaundice but only 18 had malarial hepatitis indicated by a rise in their serum glutamate pyruvate transaminase levels to more than three times the upper limit of normal and an absence of clinical or serological evidence to suggest drug or viral hepatitis. The liver in these patients was always enlarged. Their mean age was 27.6 years and 85% were males. The mean serum bilirubin was 12.7 +/- 10.3 mg/dl, serum glutamate oxaloacetate transaminase was 212.8 +/- 144.9 IU, serum glutamate pyruvate transaminase was 287.1 +/- 206.2 IU and the serum alkaline phosphatase was 20.4 +/- 10.1 KA. Clinically, 2 groups of patients were seen. Thirteen patients who presented with a severe form of disease had coma, deep jaundice and renal failure. The other 5 patients had a relatively mild illness with only fever, headache and vomiting for 2 days. Four patients with severe disease died. Liver histology (studied in 5 patients) showed Kupffer cell hyperplasia and deposition of malarial pigment. Plasmodium falciparum was demonstrated in sinusoidal red blood cells in only 2 cases. CONCLUSIONS. Malarial hepatitis occurred in 18 out of 39 patients with jaundice and falciparum malaria. It is a heterogeneous syndrome with at least two clinical subsets and the severe disease should not be mistaken for fulminant hepatic failure as there is a better response to therapy.