Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

Symptomatic overlap in patients with diarrhea predominant irritable bowel syndrome and microscopic colitis in a sub group of Bangladeshi population.

Microscopic Colitis (MC) and diarrhea predominant irritable bowel syndrome (IBS-D) has almost similar clinical feature but MC is diagnosed by histologic criteria and IBS is diagnosed by symptom-based criteria. There is ongoing debate about the importance of biopsies from endoscopically normal colonic mucosa in the investigation of patients with IBS-D. Aim of this study was to assess the prevalence of MC in patient with IBS-D and to determine the distribution of MC in the colon. This observational study was conducted in department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2008 to December 2009. Patients were evaluated thoroughly & who meet Rome-II criteria with normal routine laboratory tests, were included in the study. Colonoscopy was done and biopsies were taken from the caecum, transverse colon, descending colon, and rectum. Out of total 60 patients, 22 had Lymphocytic Colitis (LC), 28 had nonspecific microscopic colitis (NSMC) and 10 had irritable bowel syndrome noninflamed (IBSNI). The distribution of LC was restricted to proximal colon in 15 patients, in the left colon in 2 patients and diffuses throughout the colon in 5 patients. There is considerable symptom overlap between the patients of IBS-D and patients with microscopic colitis. Without colonoscopic biopsy from multiple sites, possibility of MC cannot be excluded in patients with IBS-D and it can be said that clinical symptom based criteria for irritable bowel syndrome are not sufficient enough to rule out the diagnosis of microscopic colitis.

To compare the efficacy of triple therapy with furazolidone, amoxicillin and omeprazole for two weeks and three weeks in the eradication of Helicobacter pylori in Bangladeshi duodenal ulcer patients.

Helicobacter pylori eradication is the mainstay in the treatment of Helicobacter pylori associated peptic ulcer disease. Furazolidone was tried in several developing countries and showed good results in some trials. Increasing the duration of treatment has been shown to improve the eradication rate. This study was done to compare the efficacy of triple therapy for two weeks (Group-A) and three weeks (Group-B) consisting of omeprazole 20 mg b.d. amoxicillin 1 gm b.d. and furazolidone 200 mg b.d. in the eradication of Helicobacter pylori in duodenal ulcer patient. A total of 70 duodenal ulcer patients with Helicobacter pylori infection were included in the study. Healing of duodenal ulcer was assessed three months after the end of treatment and at the same time Helicobacter pylori eradication assessed by Campylobacter Like Organism (CLO) test and histology. In group-A, duodenal ulcer was healed in 17 (58.62%) patients and Helicobacter pylori was eradicated in 15 (52%) patients. In group-B, duodenal ulcer was healed in 19 (61.30%) patients and Helicobacter pylori was eradicated in 18 (58%) patients. Healing of duodenal ulcer was not significantly different between two groups. Eradication of Helicobacter pylori was also not significantly different between two groups.

Sero-epidemiology of sporadic acute hepatitis in Bangladesh: high prevalences of infection with type-B, type-E and multiple types of hepatitis virus.

In a recent investigation of hepatitis in Bangladesh, the sera from 74 adult patients (aged 15-67 years) who had been clinically diagnosed as cases of sporadic acute hepatitis were collected at various hospitals in and around Dhaka. Five cases were positive for IgM antibody against the hepatitis A virus and 30 were positive both for the surface antigen of the hepatitis B virus (HBV) and for IgM antibody against the HBV core (HBc). The six cases found positive for antibodies against the hepatitis D virus were all also positive for the HBV surface antigen but negative for anti-HBc IgM. Thirteen patients harboured hepatitis C virus RNA and 29 were positive for IgM antibody against the hepatitis E virus (HEV). There were 14 non-A-to-E subjects, whose illness was of unknown aetiology. Of the 83 infections with hepatitis viruses detected in the other 60 patients, 6%, 36%, 16%, 7% and 35% were of types A, B, C, D and E, respectively. Each of 28 of the patients (47% of those confirmed to have viral hepatitis) had concomitant infection with more than one type of hepatitis virus. The predominance of HBV and HEV infections and the high prevalence of multiple infection seen among these Bangladeshi cases have not been observed among hepatitis cases in developed countries.

Detection of hepatitis E virus RNA and genotype in Bangladesh.

BACKGROUND/AIMS: Hepatitis E virus (HEV) in Bangladesh has not been adequately documented. We report HEV RNA and genotype detection in Bangladesh. METHODS: In total, 82 samples were used; 36 sporadic acute hepatitis (AH), 12 fulminant hepatitis (FH), 14 chronic liver disease (CLD) and 20 from an apparently healthy population (HP) positive for both immunoglobulin (Ig) M and IgG specific anti-HEV antibodies (anti-HEV). The male/female ratio was 61/21, ages 12-67 (mean 30.4) years. RNA was extracted, transcribed to cDNA and amplified in nt 6345-6490 (ORF2) of HEV. Nucleic and amino acid sequences were determined. Homology comparison between Bangladesh clones and other representative HEV clones and phylogenetic tree analyses were done. Relations between HEV RNA-positivity and clinical factors were analyzed. RESULTS: HEV RNA was positive in 9/36 (25.0%) of AH cases, 4/12 (33.3%) FH, 3/14 (21.4%) CLD and 0/20 (0%) HP samples; total 16/82 (19.5%). Four factors correlated significantly with HEV RNA-positivity (Mann-Whitney U test); alanine aminotransferase (ALT) (P = 0.0229), aspartate aminotransferase (AST) (P = 0.0448), and titers of IgG (P = 0.0208) and IgM (P = 0.0095) specific anti-HEV. The 16 HEV clones were divided mainly into two groups, A and B, including six different cDNA sub-groups. CONCLUSION: HEV RNA was found in sporadic AH and FH and sub-clinical CLD cases, but not in HP. HEV RNA-positivity was significantly related to values of ALT and AST and titers of IgG and IgM specific anti-HEV, with IgM specific anti-HEV showing the most significant relationship. All clones were genotype I, which is prevalent in South Asia.

Duodenal ulcer dyspepsia in the first degree relatives of subjects with duodenal ulcer disease.

In a population survey, the point prevalence of duodenal ulcer disease (DUD) was found to be 11.98 percent which is the highest prevalence rate so far reported in the literature. The prevalence of duodenal ulcer dyspepsia in the first degree relatives of groups of subjects with proven duodenal ulcer, non ulcer dyspepsia (NUD) (duodenal ulcer dyspepsia but without evidence of ulcer at endoscopy) and normal healthy control (HC), all matched by age and sex and all from the population with the high prevalence of duodenal ulcer disease, were studied. Both DUD and NUD subjects had a significantly higher family history of duodenal ulcer dyspepsia than the control subjects.