Assessment of Occult Pulmonary Involvement in Ulcerative Colitis.

INTRODUCTION: Nearly 50% of patients with inflammatory bowel disease (IBD) experience at least one extraintestinal manifestation. Bronchopulmonary involvement is rare in IBD. Pulmonary function test (PFT) abnormality in cases of ulcerative colitis (UC) has been reported to be 17-55%. Occult pulmonary disease may be diagnosed using variables of the PFT. Hence, we aim to evaluate the frequency and type of pulmonary dysfunction in patients with UC in remission. METHODS: Eighty-three patients of UC in remission and 48 controls underwent the PFT including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Tiffeneau value (FEV1/FVC), and midexpiratory flow (MEF 25-75%) rate with a spirometer. The patients were divided based on the age of onset of UC into A1 (<16 years), A2 (16-40 years), and A3 (>40 years) and based on the extent of disease into E1 (proctitis), E2 (left-sided colitis), and E3 (extensive colitis). RESULTS: Patients with UC had significantly abnormal PFT compared with controls (51 [61.5%] vss. 8 [16.67%]; p = 0.000). Patients with UC commonly had a restrictive pattern (33 [64.47%]) of PFT followed by small airway disease (11 [21.56%]) and obstructive pattern (7 [13.72%]). Pulmonary involvement in cases of UC was more in E3 followed by E2 and E1. Pulmonary involvement was more in the late age of onset of disease. BMI was positively and significantly correlated with FEV1 and FVC. Hemoglobin had a positive and significant correlation with FEV1 while a negative correlation with FEV1/FVC and MEF 25-75%. All predictors except for age were found to contribute in higher risk (OR > 1) for PFT abnormality. CONCLUSION: Patients with UC have chronic pulmonary inflammation leading to different patterns of lung involvement in the form of restrictive, obstructive airway, and small airway disease. Patients with UC commonly have a restrictive pattern of pulmonary involvement. Impairment of the PFT is related to the disease extent and the age of onset of disease. Assessment of the PFT using a spirometer is a noninvasive, simple, cost-effective, and reliable method for early detection of occult pulmonary involvement in patients of UC.

Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhosis from central India.

BACKGROUND/AIMS: Alcohol is the leading cause of liver cirrhosis, which results in portal hypertension and subsequently, culminates into esophageal varices and esophgeal variceal bleeding. Esophagogastroduodenoscopy is gold standard for diagnosis of varices. Non-invasive markers based on clinical, laboratory - ultrasonographic parameters can be utilised for prediction of risk of esophageal varices - variceal bleed in alcoholic cirrhosis from central India. MATERIALS AND METHODS: This was a cross sectional observational study. Child Turcot Pugh scores, MELD, AST ALT Ratio(AAR), AST Platelet Ratio Index(APRI), FIB-4 index and Platelet count-Spleen diameter(PC/SD) ratio were calculated for all patients and correlated with esophagogastroduodenoscopy findings. Short term follow up was done for variceal bleeding. RESULTS: Total 202 male patients were included with mean age of 43.77±9.95 years. 188(93%) patients had esophageal varices. 61(30.19%) patients had variceal bleeding. On univariate analysis platelet count, APRI, spleen bipolar diameter, and PC/SD ratio were significantly associated with varices. For prediction of esophageal varices, only PC/SD ratio was significant and showed area under the curve of 65.6% at cut-off of <997. CTP score, FIB-4, APRI, and PC/SD ratio were significant for variceal bleeding. At cut-off <985 PC/SD ratio had sensitivity of 82% and specificity of 63% with AUC of 78% for prediction of variceal bleeding. Also, FIB-4 and APRI had diagnostic accuracy of 64% and 61% with AUC of 74% and 72% respectively for bleed. CONCLUSION: FIB-4 and PC/SD may be useful among armamentarium of non-invasive markers for predicting esophageal varices and risk of variceal bleeding in alcoholic liver cirrhosis.

Pneumatic Balloon Dilatation for Achalasia Cardia: Outcome, Complications, Success, and Long-term Follow-up.

BACKGROUND: Achalasia is a chronic disease that can be managed with effective endoscopic modalities. AIM: To evaluate the effectiveness of single setting of pneumatic balloon dilatation for achalasia and assess the long-term success and outcomes. MATERIALS AND METHODS: This is a retrospective study of all achalasia patients who underwent pneumatic balloon dilatation at our institute. Patients who could be contacted were inquired regarding their symptoms and dysphagia-free interval after dilatation. RESULTS: A total of 72 patients were enrolled. Out of this, 14 patients lost to follow-up. Mean age of 58 patients was 45.02 ± 16.51 years. Male:female ratio was 13:16. Mean predilatation Eckardt score was 7.16 ± 0.834. Type I achalasia was present in 10 (17.2%), type II in 44 (75.9%), type III in 4 (6.9%). Predilatation basal integrated relaxation pressure (IRP) was 28.14 ± 14.76 mm Hg. Postdilatation Eckardt score was 2.40 ± 1.67. Postdilatation dysphagia-free interval was 17.28 ± 6.70 months. A total of 9 patients (15.51%) failed to respond to first dilatation and 49 (84.48%) patients benefited from single setting of pneumatic dilatation. Esophageal perforation occurred in 2/58 (3.44%). We did not find any significant difference in gender distribution, age of presentation, duration of symptom, pre- and postdilatation Eckardt score, type of achalasia, and basal IRP on manometry between type of achalasia. Postdilatation dysphagia-free interval in type II achalasia (18.09 ± 5.976 months) was more than types I and III achalasia cardia (p = 0.066), which showed trend toward significance. CONCLUSION: Pneumatic balloon dilatation of achalasia cardia is a highly effective endoscopic procedure with minimal complications and mortality. Even the single setting of dilatation can have long-lasting dysphagia-free interval.How to cite this article: Gupta SJ, Gaikwad NR, Samarth AR, Gattewar SR. Pneumatic Balloon Dilatation for Achalasia Cardia: Outcome, Complications, Success, and Long-term Follow-up. Euroasian J Hepato-Gastroenterol 2017;7(2):138-141.

Efficacy of Pancreatic Endotherapy In Pancreatic Ascites And Pleural Effusion.

Pancreatic ascites and effusion is a challenging complication to manage, hence our aim was to evaluate the efficacy of pancreatic endotherapy in pancreatic ascites and pleural effusion. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) with a pancreatogram and pancreatic stent placement across the leak in patients with pancreatic ascites/effusion. A total of 53 patients were included after successful cannulation. The male:female ratio was 7.8:1. The pancreatogram revealed a leak from the pancreatic duct in 20/53 (37.73%) patients. The most common leak site was the pancreatic body in 10/53 (18.9%) patients followed by the tail in 6/53 (11.32%) patients and the genu in 4/53 (7.5%) patients. In 29/53 (54.7%) patients, stent was placed beyond the leak site. Sphincterotomy was done in 7/53 (13.2%) patients, and in five patients with an obscure leak site, stent was placed empirically. A total of 39/53 (73.6%) patients benefited in terms of achieving the complete resolution of ascites and pleural effusion. The factors which were significant for the success of pancreatic endotherapy in the multivariate analysis were the site of the pancreatic ductal leak (p value = 0.008) and the ability of the stent to cross the leak site (p value = 0.004). To sum up, bridging the pancreatic ductal leak by stent offers a high rate of success. Pancreatic endotherapy is less invasive and highly effective in managing pancreatic ascites/pleural effusion.

Handgrip dynamometry: a surrogate marker of malnutrition to predict the prognosis in alcoholic liver disease.

BACKGROUND: The aim of the study was to determine the utility of handgrip dynamometry (HGD) in predicting short term mortality and complications in alcoholic liver disease. METHODS: Patients with alcoholic liver disease were included and nutritional assessment was done using the Subjective Global Assessment (SGA), HGD and other conventional parameters. Mortality rates and complications were compared to nutritional status. RESULTS: 80 patients were included in the study. Mean age of patients was 43.06±10.03 years. 69 patients survived and 11 patients died within the 3 month study duration. Handgrip strength (HGS) was higher in SGA A (28.76±5.48 kg) than SGA B (22.43±4.95 kg) and SGA C (16.78±3.83 kg) (P=<0.001). Number of complications including spontaneous bacterial Peritonitis, gastrointestinal bleeding and encephalopathy in SGA C group were 66.66%, in SGA B 20.75% and SGA A 10%. Mean HGS was significantly higher in the survivors (24.23±5.86) compared to non-survivors (18.04±4.82) (P=0.0011). There was a strong negative correlation between the HGS and Child-Pugh score (P=<0.0012). Multivariate logistic regression analysis to assess the risk factors for death showed handgrip to be in the suggestive significance range (P=0.072). The sensitivity of HGS was 88.41% in predicting short term mortality. CONCLUSIONS: HGS correlates with Child-Pugh score in predicting short term mortality. HGD is a simple, inexpensive and sensitive tool for assessing the nutritional status in alcoholic liver disease and can reliably predict its complications and survival.

Synchronous Dual Primary Malignancies of Liver and Pancreas with Colonic Metastasis: An Unique Presentation.

Synchronous appearance of the primary gastrointestinal malignancies is rare. Coexistence of primary pancreatic and hepatocellular carcinoma as synchronous malignancy is even rarer. We report a case of such combination in a 50 year old female who presented with bleeding per rectum and while evaluating we found simultaneous appearance of primary malignancies of pancreas, liver and solitary colonic metastasis from the pancreas in the background of chronic calcific pancreatitis. To the best of our knowledge this combination of synchronous pancreatic and hepatocellular carcinoma and colonic metastasis from the pancreas is unique.