Multi-center prospective survey of hepatocellular carcinoma in Kerala: More than 1,200 cases.

BACKGROUND: Hepatocellular carcinoma (HCC) is considered uncommon in India. The aim of this study was to document the demographic characteristics and clinical aspects of HCC in Kerala, India. METHODS: A survey of HCC in Kerala was performed. All gastroenterologists in the region were invited. From May 2018 to April 2020, data was collected in a standardized questionnaire. RESULTS: Forty-three doctors from 15 centers contributed the data. Total 1217 patients were analyzed. This is the largest state-wide survey of HCC in India. HCC was more common in men (90%) than in women (p < 0.01). The etiology of liver disease was hepatitis B virus (7%), hepatitis C virus (4%) and alcohol (40%). Diabetes mellitus was present in 64%, hypercholesterolemia in 17% and hypertension in 38%. Obesity was present in 33% and 15% were overweight. Non-alcoholic fatty liver disease (NAFLD) with or without metabolic syndrome was present in 44%. Serum alpha-fetoprotein was > 400 ng/mL in 24%, total tumor diameter was > 5 cm in 59%, portal vein invasion was seen in 35% and distant metastasis was seen in 15%. Specific therapy was given to 52%. Treatments given included liver transplantation (n = 24), liver resection (n = 39) and transarterial chemoembolization (TACE, n = 184). Although the study was not designed to compare survival, patients who had liver transplantation had longer survival (median 69 months) compared to matched patients given only TACE (median 18 months) (p = 0.03). CONCLUSION: HCC is common in Kerala, India. NAFLD has a predominant association with HCC in Kerala. Most of the patients report late when curative treatment is not possible.

Multi-center prospective survey of inflammatory bowel diseases in Kerala: More than 2000 cases.

BACKGROUND: Inflammatory bowel disease (IBD) is considered uncommon in Asia. The aim of this study was to document the demographic characteristics and clinical aspects of ulcerative colitis (UC) and Crohn's disease (CD) in Kerala, India. METHODS: A survey of IBD in Kerala was performed. All gastroenterologists in the region were invited. From May 2013 to October 2015, data were collected in a standardized pro-forma. RESULTS: Forty-seven doctors in 34 centers contributed data. A total of 2142 patients were analyzed. This is the largest state-wide survey of IBD in India. Ulcerative colitis was diagnosed in 1112 (38 new), Crohn's disease in 980 (53 new), and 50 were unclassified (5 new). The district-wise distribution of IBD cases correlated with the District-wise Gross State Domestic Product (r = 0.69, p < 0.01). Three percent was below the age of 18. Patients with UC had more diarrhea (73% vs. 51%), bleeding PR (79% vs. 34%), and intermittent flares (35% vs. 13%) (all p < 0.01). Patients with CD had more abdominal pain (62% vs. 46%), weight loss (53% vs. 40%), fever (28% vs. 18%), and history of antituberculosis treatment (21% vs. 5%) (all p < 0.01). Compared to adults, children (below 18 years) were more likely to have extensive UC (58% vs. 34%, p < 0.01) and unclassified IBD (15% vs. 2%, p < 0.01). CONCLUSION: Inflammatory bowel disease is common in Kerala, India. The disease characteristics of patients with IBD are almost similar to those from other parts of the country. Both UC and CD were seen in equal proportion in Kerala.

Profile of colonic polyps in a southern Indian population.

BACKGROUND: In Western countries, colonic polyps are usually adenomatous in nature, are evenly distributed along the entire colon in asymptomatic per-sons and show a left-sided predominance in symptomatic patients. There is dearth of such literature from India. METHODS: We retrospectively analyzed reports of colonoscopies done in our institution during the period 2001 to 2005. Clinical features, colonoscopic description and histologic findings of all patients with polyps were noted. Association of the degree of dysplasia with the size, site and type of polyps and the person's age was assessed. RESULTS: Polyps were seen in 124 (5.1%) of 2412 complete colonoscopies. Mean age of patients with polyps was 58.1 (SD 19.9) years; ninety were men. A majority of polyps (92%) were located in the left colon. They were adenomatous in 99 (79.8%), juvenile in 12 (9.8%), hyperplastic in 11 (8.8 %), inflammatory in 1 (0.8%) and Peutz-Jegher's polyp in 1 (0.8%). Dysplasia was severe in large (>2 cm) polyps compared to small (< 1 cm) ones (p< 0.001). Age of patient and location of polyp had no association with degree of dysplasia. CONCLUSIONS: In southern Indian adults, most colonic polyps are adenomatous and are in the left colon. Large polyps are associated with severe dysplasia.

External resection of a giant sigmoid lipoma causing colonic intussusception and prolapse through the anal canal.

We depict the case of an 80-year-old female patient who presented to us with a history of protruding mass per anum. Sigmoidoscopy revealed a large globular pedunculated polyp at 22 cm from the anal verge resulting in a sigmoidorectal intussusception. Endoscopic polypectomy was not technically possible due to the large size of the polyp. At the time of prolapse the polyp was tied at its pedicle with thread and resected surgically. The patient is asymptomatic on follow-up.

Non-familial juvenile polyposis in prolapsed rectum.

Juvenile polyposis located solely on prolapsed rectal mucosa is very unusual. We report the case of a 17-year old boy who presented to us with a history of passage of blood and mucus per rectum of a mass protruding through the anus during defecation. Per rectal and colonoscopic examinations revealed numerous polyps located solely on the prolapsed rectal mucosa. Histopathology was consistent with juvenile polyposis. He was managed with repeated sessions of endoscopic polypectomy. Family screening was negative for colonic polyps.

Prevalence of Hepatitis B and C in the normal population and high risk groups in north Kerala.

BACKGROUND: Our aim is to assess the prevalence of Hepatitis B and Hepatitis C infections among normal healthy persons and high risk groups in the northern part of Kerala state in South India as there is insufficient published literature related to this subject. METHODS: HBsAg and AntiHCV screening were done in normal persons and in high risk groups. Normal persons screened included voluntary blood donors, those attending mandatory medical check up for jobs in middle east Asia and pregnant women. High risk groups were health care workers, intravenous drug abusers, commercial sex workers and male homosexuals. RESULTS: HBsAg and anti HCV antibody test results in the various groups were as follows. Voluntary blood donors--HBsAg was positive in 0.71 % and anti HCV was positive in 0.33%; job seekers to middle east Asia had 0.89% and 0.12% prevalence of HBV and HCV respectively. Among the pregnant women, 0.21% were HBsAg positive. Among the high risk groups, none of the health care workers were HbsAg positive and 0.79% were antiHCV positive. Among the IV drug abusers 2.7% were HBsAg positive and 51.89% were positive for antiHCV. In commercial sex workers, 3.47 % were HBsAg positive and 2.6 % were antiHCV positive. In male homosexuals, 4.49% were HBsAg positive and 3.37% were antiHCV positive. CONCLUSIONS: The prevalence of Hepatitis B and C in the normal population of Calicut in the northern part of Kerela is 0.52% and 0.24%. Compared to other areas of India, the seroprevalence of Hepatitis B and C are low in the normal population of Calicut. Among the high-risk groups, IV drug users have a high prevalence of AntiHCV.

Colitis due to Ancylostoma duodenale.

The larva of hookworm matures into the adult stage in the small intestine, causing chronic intestinal blood loss and iron-deficiency anemia. Hookworm infestation of colon has not been reported previously. We report a 35-year-old man who presented with diarrhea with blood and mucus in stools. Colonoscopy revealed several hookworms in the colon firmly adherent to the mucosa, with oozing of blood and surrounding mucosal erosions. He was treated with mebendazole and symptoms recovered completely.

Carcinoma gall bladder presenting as hemobilia.

A 60-year-old man presented with recurrent bouts of melena, requiring multiple transfusions. Upper GI endoscopic evaluation demonstrated fresh bleeding from the ampulla of Vater. Ultrasonography and CT scan suggested a gall bladder mass without evidence of metastases. Laparotomy confirmed a mass confined to the lumen of the gall bladder. The patient underwent cholecystectomy. Histological examination showed papillary adenocarcinoma of the gall bladder extending up to the muscularis propria.

Randomised double blind placebo controlled clinical trial of sucralfate and ranitidine in chronic duodenal ulcer.

A double blind, randomised, placebo controlled clinical trial was carried out in endoscopically proved chronic duodenal ulcer patients to compare the efficacy of sucralfate and ranitidine. Sucralfate 1 g four times daily and ranitidine 150 mg twice daily were found to be equally effective in inducing ulcer healing (73.1% and 82.1% respectively) during the 6-week treatment period. The rate of recurrence of the ulcer within six months after the initial treatment (84.2% and 82.6%) was also comparable in the sucralfate and ranitidine groups. Sucralfate and ranitidine are equally effective in ulcer healing and prevention of ulcer relapse.