High Dose Pantoprazole for Gastroesophageal Reflux Disease: Need, Evidence, Guidelines and Our Experience.

Gastroesophageal reflux disease (GERD) has a pooled prevalence of 15.2% in India with varying presentation in different subset of patients. The approach towards the management of GERD includes use of monotherapy or a combination of OTCs like antacids and/or prescription drugs like H2 receptor antagonists and proton pump inhibitors (PPI). Better efficacy and safety profile of PPIs have contributed to its wide spread use as compared with other drugs for the same indication. Among PPIs, most of the healthcare professionals prefer to prescribe pantoprazole in India. Standard dose of Pantoprazole (40 mg) is unable to meet the needs in case of extraesophageal symptoms, partial responders, patients with concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs), or severe presentation in cases of overweight/obese patients. Multiple guidelines recommend doubling the dose of PPI in such cases. Twice daily dosing of PPI may reduce compliance. Thus, there is a need for a higher dose of Pantoprazole (80 mg) to be prescribed once daily in these cases so that improved compliance leads to better outcomes. The use of dual release Pantoprazole 80 mg may help to improve compliance and also enhance the time for which acid suppression takes place. In this review, we discuss the use of higher dose PPI based on scientific evidence and experience of clinicians for the same. How to cite this article: Upadhyay R, Soni NK, Kotamkar AA, et al. High Dose Pantoprazole for Gastroesophageal Reflux Disease: Need, Evidence, Guidelines and Our Experience. Euroasian J Hepato-Gastroenterol 2024;14(1):86-91.

Edema India: Executive Summary of Screening, Diagnosis, and Management of Edema.

The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema.

An Empirical Investigation of Critical Factors Affecting Acceptance of E-Learning Platforms: A Learner's Perspective.

E-learning is evolving as the paradigm of modern-day education. Globally, e-learning has seen a rise; however, failures happen. There is a dearth of studies that discuss why a lot of learners quit e-learning after a preliminary experience. Preceding research studies carried out under diverse task settings have proposed an assortment of factors impacting learners' satisfaction with e-Learning. This study developed an integrated conceptual model with the instructor, course, and learners' dimensions and then empirically validates it. The technology acceptance model (TAM) has been employed for testing the acceptance of various technologies and software within an e-learning context. This study intends to examine the salient factors of effective e-learning acceptance by learners. A survey investigates the critical factors using a self-administered questionnaire influencing the satisfaction of learners in the e-Learning system/platform. The study uses quantitative methodology and data were collected from 348 learners. On performing the structured equation modeling for testing the hypothesized model, outcomes reveal the significant factors influencing learners' perceived satisfaction studied in three dimensions of the instructor, course, and learner. It will facilitate educational institutes and provide directions on improving learners' satisfaction and additionally improve e-Learning implementation.

Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology.

The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.

PPIs and Safety Concerns - A Pending Verdict?

Proton pump inhibitors (PPIs) with a high therapeutic index have strong evidence to support their efficacy in the management of common gastrointestinal (GI) conditions such as gastroesophageal reflux (GERD), peptic ulcer diseases, H. pyloriinfection etc. Despite this, the list of adverse effects being cited across literature with chronic use of these drugs is on an upward trend. Studies and published literature have associated PPI use with risk of bone fractures, various micronutrient deficiencies, gastro-intestinal infection, pneumonia, cardiac complications, dementia, kidney disease, intestinal bacterial overgrowth and drug interactions. It is however of clinical interest to note that in most of the studies published, the risk association reported with PPIs is weak. Unfortunately, widespread media publicity around these studies has prompted discontinuation of the drug in patients in whom it is indicated and created generalized anxiety among its users 20 years later since their introduction. The primary objective is to review the literature for an unbiased translation of the knowledge to appropriately guide decision in clinical practice.

Acute Pancreatitis in Severe COVID Pneumonia.

Covid-19 has emerged as a global pandemic with significant morbidity and mortality. Although it is predominantly a respiratory disorder, the gastrointestinal involvement in Covid 19 infection has been extensively documented. We report two cases of acute pancreatitis in severe Covid pneumonia. Detailed history taking, physical examination, laboratory and radiological investigations were used to rule out common causes of acute pancreatitis in these cases. This case report aims to highlight SARS CoV-2 virus as an important etiological factor of acute pancreatitis, in line with few reports from around the world. There is a scarcity of data regarding acute pancreatitis in Covid infection from India.

Methods of preparation of microparticles for radioactive particle tracking experiments.

Radioactive particle tracking (RPT) technique is a relatively newer technique for the characterization of flow of process materials (liquids, solids) in laboratory- and pilot-scale industrial systems. The technique uses a single particle labelled with a suitable radioisotope having similar physical properties to that of the bulk of the process material. The preparation of a representative radioactive microparticle is a challenging task in the implementation of the technique. There are no standard methods available for the preparation of radioactive microparticles. This paper discusses some of the methods of preparation of radioactive microparticles for RPT studies. A few examples of RPT applications using the prepared microparticles are also discussed.

API-ISG Consensus Guidelines for Management of Gastrooesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a common problem in the community. The Indian Society of Gastroenterology and Association of Physicians of India have developed this evidence-based practice guideline for management of GERD in adults. A modified Delphi process was used to develop this consensus containing 43 statements, which were generated by electronic voting iteration as well as face-to-face meeting, and review of the supporting literature primarily from India. These statements include 4 on epidemiology, 9 on clinical presentation, 11 on investigations, 18 on treatment (including medical, endoscopic, and surgical modalities), and one on complications of GERD. The statement was regarded as accepted when the proportion of those who voted either to accept completely or with minor reservation was 80% or higher. The prevalence of GERD in large population-based studies in India is approximately 10% and is probably increasing due to lifestyle changes and increase in obesity. The diagnosis of GERD in the community should be mainly based on presence of classical symptoms like heartburn and sour regurgitation, and empiric treatment with a proton pump inhibitor (PPI) or H2 receptor antagonist should be given. All PPIs in equipotent doses are similar in their efficacy in the management of symptoms. Patients in whom symptoms do not respond adequately to PPI are regarded as having PPIrefractory GERD. Invasive investigations should be limited to patients with alarm symptoms and those with refractory GERD.

Experimental validation of design and performance parameters of radioactive particle tracking (RPT) experimentation.

In recent years, radioactive particle tracking (RPT) has emerged as a powerful noninvasive technique for characterization and visualization of flow in opaque multiphase flow reactors. This technique has been applied to a variety of multiphase flow reactors largely based on the theoretical framework for optimal design and performance parameters. No systematic evaluation and validation of the design and performance parameters of the RPT technique has been reported in the literature thus far. Consequently, the theoretical framework for the design of RPT experiments has had limited scalability and application to a wide variety of flow systems. Thus far, design of a "good" RPT experiment continues to be an art, no matter how much the richness of flow of information that the experimental method brings. The present work reports systematic experimental evaluation of design parameters for an optimal RPT experiment and validation of the theoretical results reported in literature. The experiments were performed in a carefully designed setup in which precise positioning of the tracer particle was made possible. The experiments assess the effect of various parameters on the performance of the RPT experiment, such as the choice of radioactive isotope, activity, gamma-ray energy, size of the detector, and relative positioning of detectors. Finally, a set of recommendations based on experimental work are provided to "optimally" perform the RPT experiment in any single or multiphase reactor.

Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology.

The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.

Effect of dynamic bias on accuracy of radioactive particle tracking (RPT) technique at different data acquisition frequencies.

The accuracy of radioactive particle tracking technique depends on the ability to locate the exact position of a tracer particle. In the current work, experiments are performed to find the accuracy of an RPT measurement in terms of locating the position of the tracer particle and its velocity measurement. Results are presented for different tracer velocities at different data acquisition frequencies to minimize the error generated due to dynamic bias. Finally an optimal frequency is recommended for different velocities of a tracer particle to achieve the best possible accuracy.

Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology.

Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. Prevalence of metabolic risk factors including diabetes mellitus, obesity, etc. is rapidly increasing in India putting this population at risk for NAFLD. Patients with NAFLD are at increased risk for liver-related morbidity and mortality and also cardiovascular disease risk and increased incidence of diabetes mellitus on long-term follow-up. Management of patients with NAFLD may require a multi-disciplinary approach involving not only the hepatologists but also the internists, cardiologists, and endocrinologists. This position paper which is a combined effort of the Indian National Association for Study of the Liver (INASL), Endocrine Society of India (ESI), Indian College of Cardiology (ICC) and the Indian Society of Gastroenterology (ISG) defines the spectrum of NAFLD and the association of NAFLD with insulin resistance and metabolic syndrome besides suggesting preferred approaches for the diagnosis and management of patients with NAFLD in the Indian context.