Acid Peptic Disease Research Articles

A197 INVESTIGATING THE PROTON-PUMP INHIBITOR USE PRECEDING AND POST AN INFLAMMATORY BOWEL DISEASE DIAGNOSIS

Abstract Background Proton-pump inhibitors (PPI) have an impact on gut microbiome. The use of PPI has increased since the late 1980s and between 2007-2017, there were nearly 59 million PPIs dispensed annually in France.1 Considering that inflammatory bowel disease (IBD) affects persons of all races, a disease trigger for IBD may be a factor that can directly alter the intestinal immune response, or indirectly through changes in the gut microbiome. This raises the possibility that the advent use of PPI may be associated with the worldwide rise in IBD. Purpose We investigated whether increased use of PPI was associated with a diagnosis of IBD. Method The University of Manitoba IBD Epidemiology Database includes all Manitobans diagnosed with IBD between 1984 to 2018 with age, sex and geography-matched controls and comprehensive prescription drug data from April 1995. Subjects were considered to be users if they received 2 prescriptions of PPI. We assessed PPI prescriptions pre-diagnosis and for 3-years post-diagnosis of IBD. The absolute and relative rates were calculated and compared for PPI use pre- and post-IBD diagnosis. Result(s) A retrospective analysis was completed by analyzing 5920 subjects that were diagnosed with IBD after April 1996. Rates of PPI use in controls increased gradually from 1.5 to 6.5% over 15-years. Persons with IBD have a higher rate of PPI use peaking up to 17% within 1-year of IBD diagnosis with a rate ratio (RR) of 3.1 [95% CI 2.9 – 3.3]. Furthermore, persons with Crohn’s disease (CD) [RR= 4.2; 95% CI 3.7 – 4.6] were more likely to have been PPI users pre-diagnosis than persons with ulcerative colitis [RR= 2.4; 95% CI 2.2 – 2.7]. Important predictors of increased PPI use were older age, year of data collection and CD diagnosis. Conclusion(s) This retrospective analysis showed an increase in PPI use over the past 20-years among all Manitobans. Persons with IBD have higher PPI use within 1-year of their IBD diagnosis. It is possible that persons with IBD have an increase in acid peptic diseases or alternatively, the use of a PPI alters the gut microbiome increasing the risk for IBD diagnosis, or that some IBD symptoms are treated with PPI whether warranted or not. Future studies are needed to delineate whether the indication for ongoing PPI use is appropriate.

A real-world retrospective study of omeprazole-domperidone combination in managing acid peptic disease with PRoton-pump Inhibitors in patients with type 2 DiabEtes mellitus (PRIDE-2).

Proton-pump inhibitors, along with a prokinetic agent, are widely used to provide symptomatic relief amongst patients with acid peptic disease (APD). This article evaluates the effectiveness and safety of the omeprazole-domperidone combination amongst patients with type 2 diabetes mellitus for the management of APD. PRIDE-2 (PRoton-pump Inhibitor in patients with type 2 DiabEtes mellitus) is a retrospective study reviewing electronic medical records of patients with type 2 diabetes mellitus and APD who were receiving the omeprazole-domperidone combination and visiting multiple Indian healthcare settings between March 2018 and April 2021. The effectiveness outcome of the therapy was evaluated in terms of resolution of APD symptoms at visit 5 (120 days after baseline visit) compared with visit 1 (baseline visit). Safety was determined in terms of reported adverse events (AEs) during the treatment period (120 days). A total of 174 patients were included in the study. The mean age of the patients was 51.5±9.6 years, with the majority (59.8%) being men. A significant proportion of patients reported relief from APD symptoms, including abdominal pain (91.6%), epigastric burning (68.7%), nausea (89.5%), flatulence (100.0%), loss of appetite (93.6%), and altered bowel movements (94.7%) (p<0.001 for each) at visit 5 compared with visit 1. No serious AEs were reported. Omeprazole-domperidone combination was beneficial in providing symptomatic relief to patients with diabetes and APD. The combination therapy was well tolerated, with few reports of minor AEs.

Patterns of multimorbidity among a community-based cohort in rural India.

Multimorbidity estimates are expected to increase in India primarily due to the population aging. However, there is a lack of research estimating the burden of multimorbidity in the Indian context using a validated tool. We estimated the prevalence and determinants of multimorbidity amongst the adult population of the rural Uddanam region, Andhra Pradesh. This community-based cross-sectional study was conducted as a part of an ongoing research program. Multistage cluster sampling technique was used to select 2419 adult participants from 40 clusters. Multimorbidity was assessed using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool, collecting information on 13 chronic diseases. Patient Health Questionnaire (PHQ-12) was used to screen for depression. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. Of the 2419 participants, 2289 completed the MAQ-PC tool. Mean age (standard deviation) of participants was 48.1 (13.1) years. The overall prevalence of multimorbidity was 58.5% (95% CI 56.5-60.6); with 30.7%, 15.6%, and 12.2% reporting two, three, and four chronic conditions, respectively. Acid peptic disease-musculoskeletal disease (44%) and acid peptic disease-musculoskeletal disease-hypertension (14.9%) were the most common dyad and triad. Among metabolic diseases, diabetes-hypertension (28.3%) and diabetes-hypertension-chronic kidney disease (7.6%) were the most common dyad and triad, respectively. Advancing age, female gender, and being obese were the strongest determinates of the presence of multimorbidity. Depression was highly prevalent among the study population, and participants with higher PHQ-12 score had 3.7 (2.5-5.4) greater odds of having multimorbidity. Our findings suggest that six of 10 adults in rural India are affected with multimorbidity. We report a higher prevalence of multimorbidity as compared with other studies conducted in India. We also identified vulnerable groups which would guide policy makers in developing holistic care packages for individuals with multimorbidity.

A Socio-demographic and Clinical Study on Surgical Cases in a Tertiary Care Teaching Hospital, Suraram, Hyderabad

A descriptive study on surgical case profile related to socio demographic and clinical aspects was conductedin a tertiary care teaching hospital Hyderabad, Telangana. This was a retrospective and record based study. Atotal of 885 case sheets were collected from Medical record department among which 488 were males and 397were females. In-patient surgical case sheets were collected from 1st July 2021 to 30th June 2022 for a period ofone year after obtaining permission from the Institutional Ethics Committee. Absolute professional secrecy wasmaintained. All inpatient case sheets from department of Surgery were collected from the medical records andconsidered for this study. The study results were evaluated and analyzed by SPSS software.We found that highest number of patients admitted was in the age group of 31 to 50 years. Co- morbid conditionslike hypertension and diabetes (23.9%) was associated with surgical conditions. Majority of patients were fromurban locality (62.7%). Pain abdomen (36.3%) followed by swelling both inflammatory and tumor (35.5%) werethe common clinical presentations at the time of admission. Highest cases of surgical conditions in our study wereinflammatory swellings (17.9%), followed by benign tumors (17%), hernias(12.4%), appendicitis 9.2%, cholecystitisand cholelithiasis (9%), acid peptic diseases (7.2%) and renal calculi contributing 6.3%. Of the malignant conditions(3.16%) noticed, carcinoma of breast was common in females and oral cancers were commonest in males. Inguinalhernias were common in males and incisional hernias were common in females. Highest number of cholecystitisand cholelithiasis were observed in female population. Mean hospital stay was 6 days in our study. Most of thecases were reported in rainy season and treated conservatively (50.7%), very least genetic predisposition (0.4%)was observed in the study population. Study results were similar when compared with other studies conductedin India and abroad.

Spectrum of Gastrointestinal Perforations in a Tertiary Care Hospital of Central Nepal: An Analytical cross-sectional study.

Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and mortality. This study was conducted to evaluate different spectrum of gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality.&#x0D; &#x0D; Methods: This was an analytical cross-sectional study conducted in the Surgical Gastroenterology Department at College of Medical Sciences, Bharatpur, Chitwan, Nepal from October 1st 2021 to October 31st 2022. Patients undergoing emergency laparotomy for GI tract perforations were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded.&#x0D; &#x0D; Results: A total 100 patients with gastrointestinal perforations were analyzed. The mean age was 46.55 years. Male predominance with M:F=1.56:1 was seen. Almost 54% patients presented after 24 hrs of onset of pain. Peptic ulcer disease as a cause of perforation was seen in 26%, trauma in 23% cases, appendicular perforation in 20%, malignant perforation in 8%, tubercular perforation in 7% and foreign body perforation in 3% cases. Duodenal, appendicular and colorectal perforations were seen in 28%, 20% and 17% cases respectively. Total morbidity was 54% and mortality was 13%. Increasing age, delayed presentation, presence of comorbidities, systolic blood pressure less than 100 mm Hg, oliguria, presence of malignancy were significantly associated with high mortality.&#x0D; &#x0D; Conclusion: Perforations of duodenum, appendix and colorectum are commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.

Effect of Kunjal (Vamana Dhauti ) and Amalaki Mudaga As A Pathya In Urdhwaga Amlapitta WSR Acid-Peptic Disease

Effect of Kunjal (Vamana Dhauti ) and Amalaki Mudaga As A Pathya In Urdhwaga Amlapitta WSR Acid-Peptic Disease

An Evidence-Based Retrospective Study for the Management of Acid Peptic Disease With Omeprazole, a Proton Pump Inhibitor, in Indian Patients With Type 2 Diabetes Mellitus (PRIDE-1).

Background In this study, we aimed to assess the effectiveness of omeprazole therapy in the management of acid peptic disease (APD) among type 2 diabetes mellitus (T2DM) patients. Methodology In this multicenter retrospective study, electronic medical records (EMRs) of T2DM patients with APD who were prescribed omeprazole between March 2018 and April 2021 at multiple Indian healthcare settings were reviewed. The resolution of APD symptoms was assessed at visit five (120 days after the index visit) and compared to visit one (index visit). Safety was established in terms of reported adverse events during the study period. Results Overall, 174 patients were included. The majority of patients (63.8%) were males with a mean age of 48.6 ± 11.03 years. After receiving omeprazole therapy, a significant number of patients reported improvement in symptoms such as abdominal pain (98.2%), epigastric burning (74.2%), altered bowel movements (62.1%), and nausea (80.5%) (p < 0.001 for each). Complete resolution was observed in all patients who complained about flatulence (100.0%) and loss of appetite (100.0%) (p < 0.001 for each). The drug was found to be well tolerated. Conclusions Omeprazole therapy was well tolerated and highly effective in resolving APD symptoms among T2DM patients receiving fixed oral hypoglycemic agents.

New CagL Amino Acid Polymorphism Patterns of Helicobacter pylori in Peptic Ulcer and Non-Ulcer Dyspepsia

Background and Objectives: Helicobacter pylori infection is associated with chronic gastritis, ulcers, and gastric cancer. The H. pylori Type 4 secretion system (T4SS) translocates the CagA protein into host cells and plays an essential role in initiating gastric carcinogenesis. The CagL protein is a component of the T4SS. CagL amino acid polymorphisms are correlated with clinical outcomes. We aimed to study the association between CagL amino acid polymorphisms and peptic ulcer disease (PUD) and non-ulcer dyspepsia (NUD). Materials and Methods: A total of 99 patients (PUD, 46; NUD, 53) were enrolled and screened for H. pylori by qPCR from antrum biopsy samples. The amino acid polymorphisms of CagL were analyzed using DNA sequencing, followed by the MAFFT sequence alignment program to match the amino acid sequences. Results: Antrum biopsy samples from 70 out of 99 (70.7%) patients were found to be H. pylori DNA-positive. A positive band for cagL was detected in 42 out of 70 samples (PUD, 23; NUD, 19), and following this, these 42 samples were sequenced. In total, 27 different polymorphisms were determined. We determined three CagL amino acid polymorphism combinations, which were determined to be associated with PUD and NUD. Pattern 1 (K35/N122/V134/T175/R194/E210) was only detected in PUD patient samples and was related to a 1.35-fold risk (p = 0.02). Patterns 2 (V41/I134) and 3 (V41/K122/A171/I174) were found only in NUD patient samples and were linked to a 1.26-fold increased risk (p = 0.03). Conclusions: We observed three new patterns associated with PUD and NUD. Pattern 1 is related to PUD, and the other two patterns (Patterns 2 and 3) are related to NUD. The patterns that we identified include the remote polymorphisms of the CagL protein, which is a new approach. These patterns may help to understand the course of H. pylori infection.

ODP084 Denosumab as a therapuetic modality in management of primary hyperparathyroidism induced severe hypercalcemia

Abstract Background Primary Hyperparathyroidism(due to parathyroid adenoma) is usually associated with smoldering clinical course due to effects of chronic hypercalcemia whereas malignancy related hypercalcemia is often associated with life threatening severe hypercalcemia. However in rare instances, hypercalcemic crisis may be sole presenting feature of primary hyperparathyroidism. The role and utility of denosumab therapy in such clinical settings is less well studied. Case Report: A 53 year old male patient was referred for evaluation of severe hypercalcemia. He presented with symptoms of nausea, vomiting and constipation for last two weeks. He did not give any history of abdominal pain, polyuria, polydipsia, nephrolithiasis, bony fractures, acid peptic disease or cognitive impairment in past. He was a known case of type 2 diabetes mellitus for last 2 years and was on oral anti diabetic drugs with fairly good glycemic control. On evaluation, the patient was conscious, oriented and lethargic. His vitals were stable and systemic examination was grossly normal. Abdominal imaging including upper gastrointestinal endoscopy for his above complaints revealed no gross abnormality. Significant positive findings from biochemical evaluation included: severe hypercalcemia(serum calcium level-20.45 mg/dl, normal: 8.6-10.3mg/dl), serum phosphorous-2. 09mg/dl(normal: 2.7-4.5mg/dl), serum albumin-4.26g/dl(normal: 3.4-4.4g/dl) and serum creatinine-3.1mg/dl(normal: 0.8-1.5mg/dl). A kidney function test done during periodic health screening two months ago was absolutely normal(serum creatinine: 0.9 mg/dl). PTH levels were found to be significantly elevated (1383.6pg/ml, normal: 15-65pg/ml). A presumptive diagnosis of primary hyperparathyroidism induced severe hypercalcemia with acute kidney injury was made. He was initially managed with saline rehydration followed by diuretic therapy and subcutaneous calcitonin administration. However, no significant response was seen. In view of his deteriorating renal function and severe hypercalcemia, immediate hemodialysis was planned in consultation with nephrologist. Despite three sessions of hemodialysis, his serum calcium and creatinine levels were lowered to 17.69mg/dl and 2.1mg/dl respectively. Owing to refractory and persistent hypercalcemia, injection denosumab(60 mg sc) was subsequently administered. Following denoumab therapy, serum calcium continued to show a declining trend and it came down to 10.8mg/dl by end of fourth day. In the meantime, localization studies including neck ultrasonography and Technetium 99m sestamibi scan confirmed presence of right inferior parathyroid adenoma. The patient subsequently underwent successful focused parathyroidectomy with rapid improvement in his health status. Following surgery, he was managed with calcium and calcitriol supplementation to maintain normocalcemia. Histopathological examination of excised tumor confirmed presence of parathyroid adenoma. Conclusion Hypercalcemic crisis can be a rare presenting feature of primary hyperparathyroidism. Denosumab therapy can play a pivotal role in managing such patients(especially when other therapeutic modalities fail to control underlying severe hypercalcemic state) and act as beneficial bridging therapy till definitive surgery can be undertaken. Presentation: No date and time listed

OBSERVATIONAL STUDY OF ETIOLOGY AND OUTCOME IN HOLLOW VISCUS PERFORATION

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Missed diagnosis and late intervention are frequent causes of increased morbidity and mortality especially in patients who survive the initial phase of insult. Diagnosis and treatment of gastrointestinal perforation remains a formidable problem in our country. Aim &amp; Objevtives: To compare certain common etiologies and their outcomes in the following diseases and sites respectively Acid Peptic Disease–Duodenal/Gastric Typhoid- Ileal Diverticulitis-Colon Trauma-Any Part Retrospec Methods: tive observational study of 50 Operated Patients done in Government Medical College Surat during period of September 2019 to December 2020 According to Inclusion and Exclusion Criteria. Data is analysed using descriptive statistics (Percentage, Proportions). Among 50 cases of hollow viscus Results &amp; Conclusion: perforation, Peptic perforation was common (33 out of 50 cases). Next being Ileal perforation. Jejunum was common site of perforation in blunt abdominal trauma. Peptic Perforations are more commonly seen in 40-60yrs of age group with alcohol and smoking as their addiction, with worker as occupation. Typhoid Perforations are more commonly seen in 20-40yrs of age group. In this study except for wound dehiscence in 4 cases which needed secondary suturing, no major morbidity noted. 4% mortality noted in the present study.

Endoscopic findings of acid peptic disease at low and high altitude: Kathmandu versus Rasuwa districts of Nepal

Introduction: Features of Acid Peptic Disease (APD) have specific presentations from low to high altitudes. This study aims to compare the endoscopy findings of APD at low altitudes (Kathmandu Valley) and High Altitudes (Rasuwa District) of Nepal.&#x0D; Method: Endoscopy findings of APD patients from Nov 2017 to Dec 2021 at Manmohan Medical College and Teaching Hospital (MMTH) were reviewed from the data kept in the endoscopy unit to compare the findings in patients from low altitudes (Kathmandu valley) and high altitudes (Rasuwa district). Variables included were age, sex, and endoscopy findings of APD. Microsoft Excel was used for data analysis. Chi-square analysis was used for the association between APD findings and altitude. A p-value ≤0.05 was considered statistically significant.&#x0D; Result: Out of 2937 APD patients, 1560 (53.1%) were male and 1377(46.9%) female, age 48.5 years (range 16-81) with 2701(91.6%) having endoscopic findings of APD. Among 2701 APDs, 1448 (88.6%) were from the low altitude of Kathmandu valley, and 1253 (96.2%) from high altitude (Rasuwa district), p-value &lt;0.0002. There were 736(50.8%) patients with gastritis from Kathmandu vs. 695 (55.46%) from Rasuwa, followed by gastro-duodenitis 219(15.1%) vs. 32 (2.5%), duodenitis 171 (11.8%) vs. 169(13.5%) respectively.&#x0D; Conclusion: The incidence of endoscopic findings of overall APD was high among patients from the high altitude of Rasuwa district compared to the low altitude Kathmandu valley of Nepal.

Profile of comorbidity and multimorbidity among women attending antenatal clinics: An exploratory cross-sectional study from Odisha, India.

ABSTRACTBackground:Multimorbidity is being recognized as a crucial maternal health challenge in India. However, pregnancy remains an exclusion criterion in most multimorbidity estimation studies resulting in a deficient understanding of the problem in this population. The present study aims to estimate the prevalence of multimorbidity, identify its correlates, and assess healthcare utilization and expenditure outcomes among women availing of antenatal care clinicsMethods:An exploratory cross-sectional study was conducted among 127 pregnant women attending three antenatal clinics of Bhubaneswar, Odisha, from February to July 2016. Data were collected using a “multimorbidity assessment questionnaire for primary care,” contextualized for antenatal settings. The prevalence and correlates were determined using descriptive analysis, and the outcomes were measured by the number of healthcare visits, medications, and healthcare expenditure. About 15% of antenatal women were multimorbidResult:Anemia (52.6%), hypertension (31.6%), acid-peptic diseases (26.3%), and thyroid (26.3%) were the leading chronic conditions. Statistically, significant association was found between multimorbidity and medical consultation, the medicines consumed, and functional limitation. The healthcare expenditure was significantly higher among the multimorbidity groupsConclusion:Our findings suggest the inclusion of comprehensive multimorbidity assessment in routine antenatal screening. Preconception care should establish linkages between maternal and reproductive health with chronic disease prevention, and identify ways to reduce healthcare utilization and expenditure. Longitudinal studies to assess the trajectory and impact of multimorbidity on maternal and infant health are warranted.

Comparative study of endoscopic rapid urease test with serology of helicobacter pylori infection in acid peptic disease

Acid Peptic Disease (APD) is worldwide health issue for the surgeons, mainly due to risk and associated complications like Gastric Ulcer (GU), Duodenal Ulcer (DU), Gastro intestinal tract (GIT) perforation. This aims at early detection of disease which is caused by Helicobacter Pylori (HP) and intervention prevents the further complications. This study is Cohort study was conducted in the endoscopic unit of Department of General Surgery Tertiary care teaching Hospital over a period of 1 year with a sample size of 121. All the patients suitable for the study in regards to the inclusion and exclusion criteria are subjected to both the study until the sample size is achieved, with the prior agreement of the institutional ethical committee. All the participants are tested with RUT and ELISA and 87.60% had RUT positive and 86.78% had ELISA positive infection. RUT had sensitivity of 87.62% in predicting ELISA, specificity was 12.50%, with a total diagnostic accuracy of 77.69%. We treated 51.24% with the CMO kit and 48.76% with HP kit. O

Prevalence of Helicobacter pylori infection by rapid urease test among patients with dyspeptic symptoms who underwent upper gastrointestinal endoscopy in a secondary care hospital

Background: Functional dyspepsia is referred to wide spectrum of upper gastrointestinal symptoms which are nonspecific and without organic pathology of upper gastrointestinal tract, and accounts for &gt;60% of patients undergoing upper gastrointestinal endoscopy. The aim of our study was to determine the prevalence of active Helicobacter pylori (H. pylori) infection by retrospective review of patient records using only rapid urease test reports which gives us the magnitude of the H. pylori prevalence.Methods: 200 patients who presented with dyspepsia were studied clinically according to the proforma over a period of 18 months from April 2020 to October 2021, Patients underwent upper gastro-intestinal endoscopy under topical anesthesia, and biopsies were taken from the antrum. Biopsy specimens were immediately placed onto rapid urease test kit containing urea and an indicator. Positive test for H. pylori was confirmed by the change in color of the medium from yellow to pink or red and when the rapid urease test was positive, patient was considered as H. pylori positive.Results: Out of 200 patients, most commonly affected age group are patients between 18-35years and is more in males than females (48:36), 86 patients were found to be H. pylori positive (43%) associated with acid peptic disease and duodenal ulcers, gastric antral ulcers.Conclusions: H. pylori is a potential risk factor of gastric malignancy. After being aware of the prevalence of H. pylori by early detection of active H. pylori infections, rapid urease test serves only as a rapid screening tool in dyspeptic symptoms of patients with acid peptic disease than all other tests.

The importance of association of comorbidities on COVID-19 outcomes: a machine learning approach

Background The individual influence of a variety of comorbidities on COVID-19 patient outcomes has already been analyzed in previous works in an isolated way. We aim to determine if different associations of diseases influence the outcomes of inpatients with COVID-19. Methods Retrospective cohort multicenter study based on clinical practice. Data were taken from the SEMI-COVID-19 Registry, which includes most consecutive patients with confirmed COVID-19 hospitalized and discharged in Spain. Two machine learning algorithms were applied in order to classify comorbidities and patients (Random Forest -RF algorithm, and Gaussian mixed model by clustering -GMM-). The primary endpoint was a composite of either, all-cause death or intensive care unit admission during the period of hospitalization. The sample was randomly divided into training and test sets to determine the most important comorbidities related to the primary endpoint, grow several clusters with these comorbidities based on discriminant analysis and GMM, and compare these clusters. Results A total of 16,455 inpatients (57.4% women and 42.6% men) were analyzed. According to the RF algorithm, the most important comorbidities were heart failure/atrial fibrillation (HF/AF), vascular diseases, and neurodegenerative diseases. There were six clusters: three included patients who met the primary endpoint (clusters 4, 5, and 6) and three included patients who did not (clusters 1, 2, and 3). Patients with HF/AF, vascular diseases, and neurodegenerative diseases were distributed among clusters 3, 4 and 5. Patients in cluster 5 also had kidney, liver, and acid peptic diseases as well as a chronic obstructive pulmonary disease; it was the cluster with the worst prognosis. Conclusion The interplay of several comorbidities may affect the outcome and complications of inpatients with COVID-19.

Health care utilization and out-of-pocket expenditure of type 2 diabetic patients: A study in primary care in Bhubaneswar, India.

Globally, noncommunicable diseases (NCD) demand a higher healthcare expenditure. Among NCDs, diabetes mellitus is often associated with multiple, co-existing chronic conditions. In low- and middle-income countries where most of the healthcare expenditure is borne out of pocket, diabetes management may pose a significant financial stress. A cross-sectional study was conducted in 17 urban primary healthcare facilities of Bhubaneswar to assess the healthcare utilization and out-of-pocket expenditure among type 2 diabetes patients attending these facilities. Healthcare utilization was determined by the number of visits to healthcare facilities in the last 6 months, and out-of-pocket expenditure was assessed by outpatient consultation fees, medicines, travels to health care facilities, and diagnostic tests. Total out-of-pocket expenditure was defined as the sum of these costs. The median number of visits in 6 months for diabetes patients with any comorbidity was 4 and 5 for diabetes patients with more than 4 comorbidities. Among the comorbid conditions, depression, stroke, auditory impairment, and acid peptic disease were associated with higher healthcare utilization. The total out-of-pocket expense was 2.3 times higher among diabetes patients with any comorbid condition compared to patients with diabetes only. The total median expenditure was higher for diabetes patients having stroke, heart diseases, kidney diseases, and cancer compared with other comorbid conditions. The association of comorbidity in diabetes patients with health care utilization and out-of-pocket expenditure is statistically significant after adjustment for sociodemographic characteristics and diabetes duration. Considerable expenditure is incurred by diabetes patients attending primary healthcare facilities for the management of diabetes and other chronic conditions. This is a significant burden for diabetes patients below the poverty line and with limited or no insurance cover. There is a need to increase the coverage of insurance schemes to address the chronic conditions management expenditure of outpatients.

Incidence and management of acid peptic disorders in sickle cell disease patients in Western Odisha

Background: Sickle cell disease (SCD) is a chronic hemolytic disorder characterized by the presence of crescent-shaped red blood cells. Abdominal pain is the common presenting symptom in adults with SCD. Among the patients who are not in crisis, it is estimated that one third of patients with homozygous SCD with chronic recurrent epigastric pain has endoscopic evidence of peptic ulcer disease. Aims and Objectives: This study was undertaken with an aim to analyze the incidence and management of acid peptic disorders among SCD patients in Western Odisha. Materials and Methods: A prospective study was done considering 88 homozygous SCD patients. All the patients underwent upper gastrointestinal endoscopy (UGIE) with gastric antral biopsy and rapid urease test (RUT). Cases with Helicobacter pylori were administered a 14 days course of three drug regimen of anti H. pylori drugs and followed-up to 6 weeks of beginning the treatment with repeat UGIE and RUT. Results: Out of 88 cases, 19 cases had duodenal ulcer (21.6%) which was significantly high than patients with gastric ulcer (13.6%). Other findings were gastroesophageal reflux disease and gastritis. About 93.5% of patients became RUT negative after taking anti H. pylori medication. Conclusion: SCD patients with acid peptic disorder constitute a sizeable proportion of patients attending surgical outpatient department and indoor department of surgery. Conservative treatment with life style modification can effectively improve the symptoms of acid peptic disease.

Treatment regimens used in the management of Helicobacter pylori in Colombia

BackgroundHelicobacter pylori infection can cause gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. Its treatment involves different medications, but resistance to these treatments is increasing. It is currently considered a public health problem. Aimsto identify regimens used for H. pylori eradication by age group, year of treatment and geographical region of Colombia. MethodsA cross-sectional study that identified regimens used H. pylori eradication in outpatient consultations over a 6-year period based on a medication dispensing database of 8.5 million people affiliated to the Colombian Health System. The appropriate regimens were those that included a proton pump inhibitor, associated with two antibiotics recommended by clinical practice guidelines (amoxicillin, clarithromycin, levofloxacin, moxifloxacin, tetracycline, doxycycline, metronidazole, tinidazole, and furazolidone). ResultsA total of 12,011 patients with a diagnosis of acid-peptic disease and H. pylori infection were identified, who had undergone 12,426 eradication treatment courses. Of these, 98.0% used a proton pump inhibitor (PPI), and 91.1% used amoxicillin. A total of 56.1% of the regimens were considered adequate; of these, 42.0% were a combination of PPI, amoxicillin/clarithromycin. This regimen predominated between 2015 and 2017 for all age groups. ConclusionsThe management of H. pylori infection in the majority of patients is heterogeneous and inconsistent with current recommendations based on evidence of antimicrobial resistance.

An assessment of functional limitations and its relation to morbidity pattern among the elderly residing in urban area, Kerala, India

Background: Ageing is an inevitable process and a person aged 60 years or above is often referred to as ‘elderly’. Older age is characterized by emergence of several complex health states that tend to occur only later in life and that do not fall into discrete disease categories. These are commonly called as geriatric syndromes. The aim of the study was to estimate the prevalence of functional limitations among the elderly and to determine the association between functional limitations and morbidity pattern among the elderly residing in urban area in Ernakulam district, Kerala.Methods: A community-based cross-sectional study was carried out among 302 elderly participants by using cluster sampling technique in two urban areas of Ernakulam. The structured questionnaire included socio-demographic details, diagnosed morbidities and modified Barthel index to assess functional limitations.Results: The overall prevalence of functional limitations was 22.4% among the elderly. Functional limitations were significantly associated with acid peptic diseases, constipation, kidney disorder, urinary tract infection, arthritis/joint pain, visual impairment, senile deafness and edentulous mouth.Conclusions: In our study 22.4% of the elderly had some form of functional limitations in terms of difficulties in performing basic ADL. Association of functional limitations and different type of morbidities were found in acid peptic diseases, constipation, kidney disorder, urinary tract infection, arthritis/joint pain, visual impairment, senile deafness showed statistically significant. Individuals who had edentulous mouth was also found to be statistically significant.

Involvement of Doshas in Acid Peptic Disease - A Literary Review

Doshas represent physiological activities going on continuously in our body. They form the elementary basis of living body along with Dhatus and Malas. A healthy state of body is maintained by the normal physiological equilibrium between Tridoshas. Any vitiation occurring to one among them can result in disequilibrium between Doshas and hence result in diseases. In the process of disease manifestation, not a single Dosha but all the three Doshas can get involved in varying degrees based on the Nidanas. The Doshas get aggravated due to various causes and produce different diseases by locating itself in various body parts. Therefore, one should understand a disease after examining the characteristics of a disease, its regional alterations and involvement of Doshadi nidanas. The literary review reveals that Acid Peptic Disease has more similarity to Amlapittta and all the three Doshas are involved in the manifestation of the disease. Vitiation of Pachaka pitta, Prana vayu, Samana vayu, Apana vayu and Kledaka kapha are evident and these are responsible for the manifestation of all the four diseases considered here viz. GERD, Gastritis, Gastric ulcer and Duodenal ulcer.