ABSTRACT
BACKGROUND: Progression of potential celiac disease (PCD) to overt celiac disease (CD) has been described in some studies from the Western Hemisphere. There are no Asian data on this aspect of CD. OBJECTIVE: We aimed to study the short-term histological course of PCD in Indian patients. METHODS: Patients with PCD were prospectively identified by screening relatives of patients with CD, the diarrheal subtype of irritable bowel syndrome (IBS-D) and patients with iron deficiency anemia (IDA). Patients with serology that was positive for immunoglobulin A antibodies against tissue transglutaminase (IgA anti-tTG) were subjected to endoscopy with duodenal biopsy. PCD was defined as a Marsh-0 to Marsh-II lesion on duodenal biopsy, along with positive IgA tTG serology. Retesting for serology and histology was done at 6-month intervals, for 12 months. RESULTS: We diagnosed 57 patients (23 male) of mean age 28.7 years (range: 4-73 yrs) as having PCD. Of these 57 patients, 28 were identified by screening 192 first-degree relatives of 55 index cases of CD, while the remaining 29 had either IBS-D or IDA. Duodenal biopsy showed Marsh-0, Marsh-I and Marsh-II changes in 28, 27 and 2 patients, respectively. At 6 months, 12 patients became seronegative. The remaining 45 patients continued to be seropositive at the 12-month time point. Histological progression to Marsh-III occurred in only four patients, while progression from Marsh-0 to either Marsh-I or Marsh-II occurred in six patients and one patient, respectively; but 14 patients with Marsh-I did show regression to Marsh-0. Of the two patients who were initially Marsh-II, one remained so upon follow up and one showed regression to Marsh-0. CONCLUSIONS: Our data suggested that despite the fact that nearly 80% of the patients diagnosed to have PCD continue to remain seropositive for tTG 12 months later, histological progression to Marsh-III occurred in only 7% of patients over the same time period. These observations do not justify starting a gluten-free diet in all patients with PCD, in India.
ABSTRACT
BACKGROUND: Gastric varices are found in patients with portal hypertension. Incidence of bleeding from gastric varices is relatively low, but tends to be more severe, and is associated with higher mortality than esophageal variceal bleeding. AIMS AND OBJECTIVES: To compare the prevalence and types of gastric varices in cirrhosis versus extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. METHODS: Eighty six patients presenting with bleeding from gastric varices between August 2010 and August 2011 were retrospectively analyzed. RESULTS: Of 86 patients, 65% (n = 56) were cirrhotics and 35% (n = 30) had EHPVO. Distribution of types of gastric varices showed GOV1 in 14% (n = 8) of cirrhotics vs. 7% (n = 2) of EHPVO, GOV2 in 80% (n = 45) of cirrhotics vs. 53% (n = 16) of EHPVO, IGV1 in 40% (n = 12) of patients with EHPVO vs. 4% (n = 2) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 3.7 ± 2.58 ml over a median of 1 session (range: 1-8). The total volume of glue required was lower in cirrhotics (3.2 ± 2 ml vs. 4.7 ± 3.1 ml, p < 0.05) than in EHPVO patients. Twenty (36%) of cirrhotics required >1 sessions of glue injection as compared to 17 (57%) of EHPVO patients. Over mean follow up of 12 months, rebleeding (9% vs. 10%) and mortality (11% vs. 3%) were similar in patients with cirrhosis and EHPVO. CONCLUSIONS: In patients with bleeding from gastric varices, GOV2 is more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for gastric varix obturation.
