Acid Peptic Disease Research Articles

Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature

BackgroudEarly diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis.Case presentationA 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis. Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches.ConclusionClinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.

A clinicopathological study of stomach carcinoma in a tertiary care hospital of central India

Background: The incidence of gastric cancer varies in different part of world. It is a series problem as it involves development of malignancy in stomach and affected by with daily life style of the habituates.Methods: The present study was carried out at tertiary care center of districts of Vidarbha region of Maharashtra and neighborhood districts of Andhra Pradesh and Madhya Pradesh for the tenure of six years. Study and collection of data were assessed by examination of one hundred and seven patients suffering with the gastric carcinoma.Results: Males were found to be more susceptible in a ratio of 1.22/1. Mean age of incidence was assessed as nearly 55 years. Smoking, alcohol, mixed diet, weight gain, positive family history and history acid peptic disease were reported in 23.4%, 24.3%, 63.8%, 2.8% 36.4% and 36.4% cases. Mild to severe anemia was also reported. Most accountable symptom was abdominal pain, followed by vomiting. Lump in abdomen and nausea were some other symptoms. Jaundice in little percentage was also observed. Antrum was most common site of malignancy observed in more than 50% cases. Cardia, pylorus and fundus were involved in 17, 14 and 03 patients. Thickening of stomach wall were observed. Adrenocarcinoma was in 100 patient’s symptoms.Conclusions: Incidence of cases in these areas refers to poor dietary habits. Increasing the literacy and awareness regarding the causative factors in the respective areas contributes to decrease the incidence and risk too.

SUN-325 A Neuroendocrine Tumor with Liver Metastases in a patient with Acid Peptic Disease

Introduction: Gastrinomas are neoplasms that occur in 0.1% of patients with peptic ulcer disease (PUD). We present the case of a neuroendocrine tumor with liver metastasis in a woman with acid peptic disease. Clinical case: 46 yo F with 2 year diagnosis of gastroesophageal reflux disease (GERD) presents with epigastric pain and pyrosis, in addition to colicky right upper quadrant (RUQ) abdominal pain. Upper gastrointestinal endoscopy showed gastritis, multiple antral ulcers and erosive duodenitis. Positive rapid urease test prompted the start of a Helicobacter pylori eradication regimen. Due to continuing RUQ pain, an abdominal ultrasound (US) was ordered. It showed a lesion in the right lobe of the liver measuring 6.4 x 8.3 cm. The patient was referred for admission for further studies. At admission, the patient continued with symptoms of GERD. Laboratory testing showed: glucose: 87 mg/dl (n <100 mg/mL), creatinine: 0.5 mg/dl (n 0.4 - 1.1 mg/mL), total leucocytes: 7.3 x 109/L (n 4.0 -11.0 x 109/L), hemoglobin: 13.2 g/dL (n 12.3-15.3 g/dL), and no alterations on coagulation tests. Gastroscopy showed erythematous mucosa and three duodenal ulcers in scarring stage. A hormone evaluation showed: gastrin: 19,500 pg/ml (n 0-100 pg/mL), ACTH: 17pg/mL (n 5-27 pg/mL), cortisol: 21 µg/dL (n 7-28 µ/dL), GH: 0.3 ng/mL (n <10 ng/mL) , prolactin: 23 ng/mL (n 2-29 ng/mL), PTH: 64 pg/ml (n 10-65 pg/mL), calcium: 8.8 mg/dl (8.9-10.2 mg/dL), and phosphorus: 3.6 mg/dl (n 2.5-4.5 mg/dL). Liver biopsy revealed a neuroendocrine tumor (NET). Octreoscan corroborated the liver lesion, in addition to a lesion in the tail of the pancreas. The patient underwent extended right hepatectomy, distal pancreatectomy and splenectomy. Two lesions were identified in the pancreas, one of 2.4 x 1.6 cm and another one of 1.1 x 0.5 cm. A lesion measuring 13.2 x 8.7 cm and another one of 2.4 x 2 cm was found on the liver surgical sample. Immunohistochemical staining for gastrin and glucagon for the neuroendocrine metastatic tumor was positive. Conclusion: Approximately 25% of gastrinomas are associated with multiple endocrine neoplasia type 1; in this case, the gastrinoma appears to be sporadic. Gastrinomas occur more frequently in men (3:1), and it is diagnosed most frequently between the ages of 20 and 50. Zollinger-Ellison syndrome presents with recurrent PUD in over 90% of cases. The diagnosis is suspected because of clinical presentation, and gastrin levels, which are generally above 1000 pg/ml. Octreoscan is preferred due to its superior sensibility in comparison to other tests for tumor detection. Alternatively, MRI, spiral CT scan, and endoscopic US can be used. Metastases resection, when anatomically possible, is recommended for the treatment of liver metastasis, in addition to somatostatin analogs for symptoms management. Other treatment modalities are chemoembolization and systemic chemotherapy.

A randomized clinical trial on Guduchiyadi gana kwatha in the management of amlapitha (acid peptic disease)

Amlapitha (acid peptic disease) has a population prevalence of 6% and a malefemale ratio of 1.7:1 in a study population of 10,096 urban dwellers. Two third of which constituted cases of duodenal ulcer and there has been a rapid rise in the 20th century globally. Amlapitha is a very common medical condition and the current management available for the same is not comprehensive. The aim of the present study is to assess the efficacy of guduchiyadi gana kwatha in the management of amlapitha. Ayurveda has a rich tradition in the management of gastroenterological disorders, but, due to reasons unknown, the full potential of Ayurvedic wisdom has not been explored so far in its management. Even the existing management is so trifled considering the plethora of management, principles and practice. So, it is highly essential that simple and cheap but effective formulation should be brought to the fore and the benefits of this great science to be extended to the suffering humanity. This would further help to popularize the system of Ayurveda. Existing treatment modalities available in Ayurveda for amlapitha are expensive, timeconsuming and results unsatisfying. So, any initiative that would curtail the high cost and enhance the efficacy would be most welcomed. The existing kalpas used for amlapitha are composed of multiple drugs out of which some drugs are not available today. So, the simple formulation of guduchiyadi gana kwatha mentioned in Ashtanga Hrudaya would be highly practical considering the low cost and high availability of the drugs. Moreover, guduchiyadi gana is the best for the management of amlapitha.

Comorbidity and healthcare utilization in osteoarthritis; a primary care survey from Odisha, India

BackgroundThe study aimed to explore the pattern of comorbidities among Osteoarthritis (OA) patients attending urban primary care settings and its association with healthcare utilization. MethodsAge (±3 years) and sex matched (1:1) case-control study was done among randomly selected 514 people (OA + non-OA) attending primary care settings. Information was collected on 18 comorbidities and healthcare utilization was measured by number of hospital visits in last one year and numbers of medicines taken daily. Multivariate logistic regression was used to examine the association with multimorbidity and linear regression analysis was performed for identifying association between healthcare utilization and comorbidities. ResultThere were 260 radiologically confirmed OA cases and 254 matched controls. The mean age of people with OA was 52.7 years compared to 54.5 years in controls. Mean number of comorbidities among OA was 2.5. Leading comorbidities were acid peptic diseases, chronic back pain, hypertension and diabetes. The adjusted odds of having two or more comorbidities among OA patients was 1.8 [95% CI 1.4–2.2]. The adjusted β coefficient for number of medicines taken was 0.5[95% CI 0.2–0.8] in OA patients with two or more comorbidities compared to non-OA with less than two comorbidities. The hospital visits were 0.7 times less among OA patients with two or more comorbidities compared to non-OA with less than two comorbidities after adjusting for other variables. ConclusionOsteoarthritis has significant association with multimorbidity, which increases medicines intake and health care utilization. Comorbidities in OA should be considered for designing integrated care approach.

Morbidity pattern and healthcare seeking behavior among the elderly in an urban settlement of Bhubaneswar, Odisha

Background:Population aging is inevitable. Old age is marked with health problems because of aging process, long-term chronic illnesses, also associated with social and mental problems.Objectives:To determine the pattern of physical morbidities in geriatric population and to study the utilization of health services among them.Methods:A cross-sectional study was undertaken from April to September 2017, among 270 consenting elderly people, residing in urban slums under field practice area of a medical college, using a structured interview schedule.Results:Among the 270 elderly, 36.30% were males, 80% belonged to nuclear families. A total of 262 reported of some morbidity, 61.85% had hypertension, 45.19% had diabetes, 37.78% had acid peptic disease, and 51.08% reported to have 1--3 morbidities. Majority (41.85%) of them had visited a physician on an average of 4--6 times in the preceding year. A total of 84.81% went to the urban health center, whereas 24.81% to a government hospital for treatment. Reasons cited for preference of health facility were “free consultation” and “nearby location” (85.19%). A total of 90.74% received allopathic medicines.Conclusion:Prevalence of morbidity was found to be high, which can be attributed to their compromised living conditions. Health-seeking behavior was found to be good.

Cholecystogatric Fistula as a Rare Complication of Gall Bladder Empyema Secondary to Cholelithiasis

Introduction: Cholecysto-enteric(CF) fistula is one of the complication of biliary lithiasis with incidence reported 3-5% of patients wuth cholelithiasis and in 0.15-4.8% of all patients undergoing operations on biliary tract. CF defined as a spontaneous track with bile flow between inflammed gallblader and one or more adjacent structures. Among all the internal fistulas, cholecysto-gastric fistula are not very common. They are mostly due to gallstones, gastric ulceration or in certain cases malignant infiltration of carcinoma of the gall bladder or stomach. Most of the time the clinical presentation will be similar to those with chronic cholecystitis and acid peptic disease, however with current advancement in radiological and endoscopic modalitites , early diagnosis can be obtained and surgical inervention can be planned ahead as elective case. Dilemma comes when patient presents with acute abdomen which warrants immediate surgery and on table decision making, increasing the morbidity and mortality also sometimes may lead to multiple surgeries. Method: Case report on a 63 years old gentleman, presented with vague symptoms of epigastric discomfort and fever over one week duration, who eventually underwent emergency laparotomy and was found to have a cholecysto-gastric fistula as a complication of calculus disease. Result: Prompt on table diagnosis and a successful 'one-stage' surgery which includes cholecystectomy, excision of cholecysto-gastric fistula and on table cholangiogram with a speedy recovery of patient post operatively eventually discharged well. Conclusion: Cholecystogastric fistula though rare, carries significant morbidity and mortality , thus requires prompt diagnosis and early treatment. With the advancement in radiological and endoscopic modalities, early accurate diagnosis can be made and proper surgical treatment can be outlined. However use of such modalities becomes restricted when patient presents acutely and unstable hemodnamically. Thus cholecysto-gastric fistula have to be kept as one of the differentials in case patients vague presentations

A Clinical Study of Management of Perforative Peritonitis and Its Surgical Outcome

Background Secondary peritonitis presents common life-threatening conditions associated with high mortality and morbidity. Management of perforative peritonitis poses significant challenges to the treating surgeons with respect to surgical outcome thereby demanding thorough evaluation and appropriate management in such cases. Objectives To study the clinical profile, management of perforative peritonitis and its surgical outcomes. Methodology A case series study of 513 patients with Perforative Peritonitis was studied in setting of tertiary care hospital in the department of general surgery at Vijayanagara Institute of Medical Sciences, Ballari, Karnataka during the period of June 2015 to January 2018. Among the selected patients the clinical profile, etiological profile and the surgical interventions were undertaken and the outcome were noted. Appropriate descriptive statistics were used to analyse the findings and to draw the inferences. Results There were 390 males and 123 females. The mean age of patients was 35.95 ± 24.87 years. Common cause of perforative peritonitis were acid peptic disease (35.7%), infectious disease (23%), trauma (13%) and malignancy (2.3%). Complication rate and mortality among the patients was 47.2% and 9.6% respectively. Elderly age, comorbid condition, infectious disease etiology and malignancy and site of perforation were the important determinants of mortality among the patients. Conclusion GI perforations are one of the most common surgical emergencies. Mortality depends on the age and general condition of the patient, associated pre-operative co-morbidities, site of perforation and etiology.

Zollinger-Ellison syndrome. Case report

Introduction: The Zollinger-Ellison syndrome (ZES) is a pathology caused by a neuroendocrine tumor, usually located in the pancreas or the duodenum, which is characterized by elevated levels of gastrin, resulting in an excessive production of gastric acid.Case presentation: A 42-year-old female patient with a history of longstanding peptic ulcer disease, who consulted due to persistent epigastric pain, melena and signs of peritoneal irritation. Perforated peptic ulcer was suspected, requiring emergency surgical intervention. Subsequently, a tumor lesion in the head of the pancreas was documented and managed with Whipple procedure. The pathology results reported a tumor suggestive of neuroendocrine neoplasm.Discussion: The Zollinger-Ellison syndrome occurs in 0.1 to 3 people per 1 000 000 inhabitants worldwide and is predominant in women between 20 and 50 years of age. It usually appears as a refractory acid-peptic disease or as a complication of gastric acid hypersecretion. Medical therapy is the standard management, being proton pump inhibitors (PPI) the most effective option. Surgery is recommended for sporadic ZES.Conclusions: ZES has a low incidence rate. It is rarely considered in the differential diagnosis of chronic epigastric pain and high clinical suspicion is required to achieve adequate management. This article is highly relevant as it presents a confirmed clinical case of ZES in Colombia, highlighting the importance of producing local scientific literature to improve the diagnosis and treatment of this pathology.

SPECTRUM OF PERFORATION PERITONITIS IN WESTERN NEPAL

Introduction: Despite advances in surgical technique, antimicrobial therapy and perioperative care morbidity and mortality in perforated peritonitis is still high. Aim of this study was to highlight the clinical presentation, intra operative findings and postoperative complications and mortality among patient who has undergone emergency surgery for perforated peritonitis in tertiary care center in western Nepal.Materials and Methods: This was a retrospective descriptive study carried out in Universal College of Medical Sciences, Bhairawha, Nepal. All patients who underwent emergency exploratory laparotomy for perforated peritonitis in one year period (from April 2014 to March 2015) were included in the study.Results: Total 90 cases met inclusion criteria and were analyzed. Most common presenting symptom was pain abdomen. Pneumoperitoneum was seen in 86 (95.6%) patients. Most common site of perforation was prepyloric perforation followed by duodenum. Most common cause of perforation was Acid peptic disease. Most common surgical procedure performed was Omentopexy. There were total of 11 (12.2%)mortality.Conclusion: The spectrum of perforation peritonitis in our study differs from western countries whereas it is similar to that of other research from Indian subcontinent. Majority of perforations are noticed in the duodenum and stomach due to acid-peptic disease and small bowel typhoid followed by trauma. Overall mortality was seen in 12.2%.Journal of Universal College of Medical ScienceVol. 6, No. 1, 2018, Page: 11-13

Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease.

1. Desiree Sierra, MD* 2. Mary Wood, MD* 3. Sneha Kolli, MD* 4. Lina Maria Felipez, MD† 1. *Department of Medical Education and 2. †Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL * Abbreviations: H2RA: : histamine 2 receptor antagonist IBD: : inflammatory bowel disease NSAID: : nonsteroidal anti-inflammatory drug PPI: : proton pump inhibitor PUD: : peptic ulcer disease Providers should be able to identify the signs and symptoms of peptic ulcer disease in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment regimens to start once the diagnosis is confirmed. After completing this article, readers should be able to: 1. Understand the mechanism and pathogenesis of gastritis, gastropathy, and peptic ulcer formation. 2. Recognize the symptoms of and risk factors for gastritis, gastropathy, and peptic ulcer disease. 3. Understand which patients warrant referral to a gastroenterologist for possible endoscopy. 4. Review the role of Helicobacter pylori in peptic ulcer disease. 5. Review the treatment of peptic ulcer disease with and without the presence of H pylori. Gastritis, gastropathy, and peptic ulcer disease (PUD), collectively known as acid peptic disease, are often described as a spectrum of the same disease. Although these conditions are more common in adults, their incidence in the pediatric population is clinically significant. Left untreated, gastritis can progress to PUD, which can result in serious complications such as perforation, bleeding, bowel strictures, and obstruction. Studies describing the role of Helicobacter pylori , nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other causes have helped to further expand our understanding of gastritis and PUD in children. Direct visualization and the ability to biopsy with endoscopy have revolutionized the diagnosis and treatment of these diseases. The incidence of PUD in children is lower than that in adults. Based on several international studies, the incidence in children varies from 2% to 8%. (1)(2) The incidence of bleeding ulcers is lower and is estimated to be between 0.5 and 4.4 of 100,000 individuals. (3) These rates …

H. Pylori Infection Status in Cases of Acid Peptic Disease Patients in Rural Population of Malwa Region of Madhya Pradesh

H. Pylori Infection Status in Cases of Acid Peptic Disease Patients in Rural Population of Malwa Region of Madhya Pradesh

Prevalence and risk factors of Helicobacter pylori infections in the patients suffering from acid-peptic disease at tertiary care center, Gujarat, India

Background: Helicobacter pylori (H. pylori) infection is a medical encumber especially in the developing countries, ranging from acute inflammation to malignancy. The study is intended to explore the prevalence of H. pylori infection and also to compute its associated risk factors.Methods: Sixty two (n=62) symptomatic patients attending the tertiary care hospital, were included in the study. Two antral biopsies collected from each patient were subjected to rapid urease test and Gram staining. IgG antibodies were detected by rapid test based on the principle of Immunochromatography. To evaluate the risk factors, various determinants were asked to each patient in the form of questionnaire. Statistical analysis was done using Fisher exact test. P value &lt; 0.05 was considered significant.Results: Prevalence rate of H. pylori infection was 24.19 % (15/62). More than half (53%) of the infected patients had complained of persistent burning abdominal pain. Prevalence rate was found highest in the patients suffering from peptic ulcer disease (66.6%, P=0.0237). Consumption of unfiltered water (P=0.007, Odd Ratio (OR)-1.06), eating spicy food, meat, fish and chili pepper (P=0.052, OR-1.01) was found the major risk factors. Addictive habits of either smoking/alcohol/tobacco (P=0.904) were not associated with infection.Conclusions: Prevalence of H. pylori infection was found low comparatively and was mainly associated with symptom of persistent burning abdominal pain and peptic ulcer. Use of unfiltered water, spicy food, chili pepper and meat undoubtedly increase the risk of acquiring H. pylori infection. Addictive habits were not significantly associated with infection.

Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia.

BackgroundHospitalisation for atherothrombotic disease (ATD) is expected to rise in coming decades. However, increasingly, associated comorbidities impose challenges in managing patients and deciding appropriate secondary prevention. We investigated the prevalence and pattern of multimorbidity (presence of two or more chronic conditions) in Aboriginal and non-Aboriginal Western Australian residents with ATDs.Methods and findingsWe used population-based de-identified linked administrative health data from 1 January 2000 to 30 June 2014 to identify a cohort of patients aged 25–59 years admitted to Western Australian hospitals with a discharge diagnosis of ATD. The prevalence of common chronic diseases in these patients was estimated and the patterns of comorbidities and multimorbidities empirically explored using two different approaches: identification of the most commonly occurring pairs and triplets of comorbid diseases, and through latent class analysis (LCA). Half of the cohort had multimorbidity, although this was much higher in Aboriginal people (Aboriginal: 79.2% vs. non-Aboriginal: 39.3%). Only a quarter were without any documented comorbidities. Hypertension, diabetes, alcohol abuse disorders and acid peptic diseases were the leading comorbidities in the major comorbid combinations across both Aboriginal and non-Aboriginal cohorts. The LCA identified four and six distinct clinically meaningful classes of multimorbidity for Aboriginal and non-Aboriginal patients, respectively. Out of the six groups in non-Aboriginal patients, four were similar to the groups identified in Aboriginal patients. The largest proportion of patients (33% in Aboriginal and 66% in non-Aboriginal) was assigned to the “minimally diseased” (or relatively healthy) group, with most patients having less than two conditions. Other groups showed variability in degree and pattern of multimorbidity.ConclusionMultimorbidity is common in ATD patients and the comorbidities tend to interact and cluster together. Physicians need to consider these in their clinical practice. Different treatment and secondary prevention strategies are likely to be useful for management in these cluster groups.

Prevalence and risk factors of acid peptic ulcer disease at a tertiary care hospital

Background: In day to day practice, at outpatient department of General Medicine, at Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India authors are coming across a significant number of patients with acid peptic disease (APD). This prompted us to carry out the present study. The objective is to study the prevalence, risk factors of acid peptic disease and to give suitable recommendationsMethods: Present study was hospital based cross sectional study carried out at outpatient department of General Medicine for a period of ten months from June 2017 to March 2018 among 307 outpatients.Results: The prevalence of acid peptic disease was found to be very high in the present study i.e. 38.1%. This was very high compared to the available literature. The prevalence of acid peptic disease was significantly associated with increasing age, lower social class, alcohol use, tea use and NSAID use. Acid peptic disease was not found to be associated with sex, residence, literacy, smoking, coffee intake, and obesity.Conclusions: Prevalence of acid peptic disease was found to be very high in the present study. Hence there is a need to institute the preventive and control measures to bring down the prevalence. At the same time the people in the surroundings should be made aware of this health problems and its risk factors.

Clinical Profile and Upper Gastrointestinal Endoscopy Findings in Patients with Acid Peptic Disease

Clinical Profile and Upper Gastrointestinal Endoscopy Findings in Patients with Acid Peptic Disease

Terapie peptického vředu

The modern therapy for peptic ulcer disease and other acid peptic diseases is based on administration of proton pump inhibitors (PPI) which have fully replaced anacids, parasympatholytics and histamine H2 receptor antagonists. The most effective way is to administer proton pump inhibitors in the morning on an empty stomach in a single daily dose. It is a very safe therapy, despite the fact that a potential adverse effect of long-term PPI treatment on the efficacy of other medications (clopidogrel), on bone metabolism and development of respiratory infections have been discussed recently. PPI also play an essential role in the eradication treatment of Helicobacter pylori infection, the prevention and treatment of gastropathy induced by nonsteroidal anti-inflammatory drugs and in relation to some rare hypersecretory conditions. The role of proton pump inhibitors in the therapy for functional dyspepsia is contradictory. Massive bleeding from the peptic ulcer is a relatively frequent complication of NSAID gastropathy. Endoscopic hemostasis and parenteral administration of PPI for at least 72 hours are used in therapy. Key words: acid peptic diseases - gastric secretion - peptic ulcer - proton pump inhibitors.

Prevalence of Helicobacter pylori infection among dyspepsia patients with mucosal lesion in tertiary care hospital

Background: Helicobacter pylori (H. pylori), a curved rod shaped bacteria, is found to be associated with acid peptic disease patients, more in ulcer than non-ulcer, leading to a belief that H. pylori plays a role in its etiopathogenesis. In this study we examine the prevalence of H. pylori infection among dyspepsia patients with mucosal lesion.Methods: 300 patients of dyspepsia were enrolled in the study as per inclusion/exclusion criteria for a period of eight months. Enrolled patients were subjected to upper gastro-intestinal endoscopy and findings were recorded. Biopsy specimen taken from mucosal lesions were immediately inoculated on ‘RUT dry kit’ to test for H. pylori infection.Results: 234 out of 300 patients (78%) were found to be positive for H. pylori infection. The incidence of H. pylori infection was higher in patients with ulcer dyspepsia (88.46%) when compared to the patients with non-ulcer dyspepsia (72.44%).Conclusions: Prevalence of H. pylori infection was high and was found to have an association with ulcer dyspepsia allowing us to conclude that H. pylori may have a role in its etiopathogenesis.

A Cross-Sectional Study on the Prevalence of Diseases among the Geriatric Population in the Rural Field Practice Areas of a Tertiary Care Hospital in Mangaluru, India

Background: Population ageing is a universal and inevitable phenomenon. Hence, it is necessary to understand the disease burden among the elderly in our rural field practice areas and a demographic survey was conducted to know the common diseases prevailing among them. Objectives: To know the common diseases among the elderly population 60 years and above and to assess the Prevalence of these diseases and to improve the quality of life of the elderly and also to treat them. Methodology: A community based study was conducted in the rural areas of Bollary, Jarandagudde, Mundaje and Ammunje which comes under the field practice areas of Father Muller MedicalCollege, Mangaluru, Karnataka, India between June 2014 to May 2015. All the elderly people who visited these Centers during that period were included in the study. The data was allocated from the records kept in the out-patient departments of these health centers. Results: A total of 1452 elderly people were examined in the study. Among them 530(36.50%) were males and 922(63.50%) were females participated in the study. Most of the elderly were suffering from hypertension (37.67%), diabetes (5.99%) both hypertension and diabetes (9.02%), while acid peptic disease (5.51%) and other complaints (45.52%), were also seen. Conclusion: Non-Communicable diseases like hypertension and diabetes were more compared to acid peptic disease, other complaints like fever, cough and cold, breathlessness were effecting the elderly population. Thus it is necessary to do an early diagnosis and treatment. Key words: Elderly population, Hypertension, Diabetes, Acid peptic disease, Other Complaints.

Pattern and severity of multimorbidity among patients attending primary care settings in Odisha, India.

Multimorbidity is increasingly the primary concern of healthcare systems globally with substantial implications for patient outcomes and resource cost. A critical knowledge gap exists as to the magnitude of multimorbidity in primary care practice in low and middle income countries with available information limited to prevalence. In India, primary care forms the bulk of the health care delivery being provided through both public (community health center) and private general practice setting. We undertook a study to identify multimorbidity patterns and relate these patterns to severity among primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire. Multimorbidity patterns (dyad and triad) were identified for 21 chronic conditions, functional limitation was assessed as a proxy measure of severity and the mean severity score for each pattern, was determined after adjusting for age. The leading dyads in younger age group i.e. 18–29 years were acid peptic disease with arthritis/ chronic back ache/tuberculosis /chronic lung disease, while older age groups had more frequent combinations of hypertension + arthritis/ chronic lung disease/vision difficulty, and arthritis + chronic back ache. The triad of acid peptic disease + arthritis + chronic backache was common in men in all age groups. Tuberculosis and lung diseases were associated with significantly higher age-adjusted mean severity score (poorer functional ability). Among men, arthritis, chronic backache, chronic lung disease and vision impairment were observed to have highest severity) whereas women reported higher severity for combinations of hypertension, chronic back ache and arthritis. Given the paucity of studies on multimorbidity patterns in low and middle income countries, future studies should seek to assess the reproducibility of our findings in other populations and settings. Another task is the potential implications of different multimorbidity clusters for designing care protocols, as currently the protocols are disease specific, hardly taking comorbidity into account.