Department Of Gastroenterology Research Articles

Comparison of Clinicopathological Characteristics of Patients with Early and Late-onset Colorectal Adenocarcinoma: A Cross-sectional Study

Introduction: Colorectal Cancer (CRC) has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has also been suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. Aim: To assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed at ages over and below 45 years. Materials and Method: This prospective cross-sectional study was conducted between January 2020 and August 2022 in the Departments of Surgical, Medical, Radiation Oncology, Surgical Gastroenterology, and General Surgery at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakand, India. All patients underwent a biopsy from the representative site for histological documentation of the disease. They then underwent treatment (surgery/chemotherapy/radiotherapy) as required. All the data were categorised into two groups: an early-onset group (age <45 years) and a late-onset group (≥45 years). A comparison of the clinicopathological characteristics (age, gender, comorbidities, tumour subsite, clinical presentation, clinical stage, etc.), pathological data (grade and differentiation of tumour, as per World Health Organisation (WHO) grading system), and serum Carcinoembryonic Antigen (CEA) levels between the two groups was performed. The association between categorical variables was investigated using the Chi-square test. The mean difference was assessed using an independent t-test. A p-value of 0.05 or below was considered statistically significant. Results: A total of 51 patients with rectal cancer, 35 males and 16 females, were included in the study. The mean age was 44.73±16.47 years. Out of the total of 51 (100%) patients, lower rectum involvement was seen in 22 (43.1%) patients, followed by 7 (13.7%) patients each with ascending colon and sigmoid involvement resepectively. However, the Chi-square test showed no statistically significant association of location involved with age groups (χ2 =9.09; p=0.16). Out of 51 (100%) adenocarcinoma patients in total, three patients each under 45 years of age had signet cell adenocarcinoma and mucinous adenocarcinoma (χ2 =7.07; p=0.029). Among the total of 51 (100%) patients, moderately differentiated lesions were seen in 17 (33.3%) patients, poorly differentiated lesions were seen in 15 (29.4%) patients, and well-differentiated lesions were seen in 10 (19.6%) patients (χ2 =13.01; p=0.005). Conclusion: Younger patients tended to have larger tumours that were of a higher grade and had signet ring or mucinous histopathology. The social and clinical implications of these findings are to be explored.

Diagnostic Accuracy of Transabdominal Ultrasonography in Evaluation of Gastric Malignancies: A Cross-sectional Study

Introduction: Gastric cancer (GC) is the fifth most common malignancy worldwide. Transabdominal Ultrasonography (TA- USG) is a non invasive and inexpensive imaging modality that is widely available. However, there is a lack of knowledge regarding the utility of USG among radiologists in the diagnosis of GC. Aim: To evaluate the accuracy of TA-USG in the detection of gastric malignancy. Materials and Methods: This was a cross-sectional study conducted in the Department of Radiodiagnosis at Father Muller Hospital, Mangaluru, Karnataka, India from October 2021 to February 2023. Patients with Upper Gastrointestinal (UGI) symptoms and suspected Gastric Carcinoma, who underwent UGI scopy (n=107) referred from the Departments of Gastrosurgery, Medical Gastroenterology, and Oncosurgery, were included. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of TA-USG in the diagnosis of GC were determined. Results: The TA-USG could diagnose 94 out of 107 cases of malignancy, with the best results in detecting antropyloric malignancy. TA-USG performed worst in early GC. The authors had four cases of early GC, all of which were not diagnosed with TA-USG. The sensitivity, specificity, PPV, NPV, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), and accuracy were calculated to be 87.85%, 93.83%, 86.24%, 94.61%, 14.23, 0.13, and 92%, respectively, with a p-value of <0.001. Conclusion: The TA-USG is a valuable tool for detecting gastric malignancy, especially in patients with gastric outlet obstruction, a non distensible stomach, or other risk factors that preclude endoscopy. It can also play a role in regions where UGI endoscopy is not available.

Assessment of the severity of ulcerative colitis: An effective pathway from invasive to non-invasive diagnosis

The purpose of the study is to study the Diagnostic and prognostic importance of TGF-β2 in patients with ulcerative colitis with different severity. The study received 82 patients with stasionar and outpatient treated ulcerative colitis in the Gastroenterology Department of Bukhara regional Multidisciplinary Medical Center during 2021-2023 and 20 health professionals as a control group. Patients were diagnosed with serum immunoferment analysis using IL-6 and TGF-β2, and its importance was studied. The results of the study showed an increase in IL-6 and a decrease in TGF-β2 in severe types of ulcerative colitis, and found that it could be used in diagnosis as a poor prognostic marker.

Right-side diverticulitis.

Colonic diverticula develop at specific weak spots, where the vasa recta enter the colonic circular smooth muscle layer.1 They are usually seen in the left colon. Their most common complication is diverticulitis, with mild cases resolving even without antibiotic therapy.2 Right-side diverticulitis develops in only 1.5% of cases, primarily on the anterior aspect of the cecum, proximal to the ileocecal valve (80%).4 Given its low incidence, location, and the fact that it involves younger patients, a differential diagnosis is needed to rule out abdominal inflammatory conditions such as appendicitis or ileitis, as well as gynecological disorders. Diverticulitis is diagnosed using imaging modalities. Computed tomography (CT) is the modality of choice,5 and confirmation is required after clinical remission, primarily using colonoscopy. We studied a series of 3 cases of patients initially diagnosed with acute, uncomplicated right-side diverticulitis who were admitted to the Gastroenterology Department, Hospital de León, from January to December 2023. Our goal was to confirm a presumptive diagnosis of right-side diverticulitis using delayed endoscopy or barium enema to ascertain the presence of right-side diverticulosis and rule out other conditions manifesting with abdominal pain in the right iliac fossa. Cases 1 and 3 were admitted with an accurate diagnosis of right-side diverticulitis. Case 1 was confirmed by ambulatory colonoscopy, and case 3 was confirmed by barium enema because of a history of previous colonoscopy without findings. All three patients required surgical assessment to rule out appendicular involvement. The imaging technique of choice was CT, using the WSES scale for severity grading. Case 2 was diagnosed with right-side diverticulitis by means of ultrasonography, and its origin was later confirmed to be in the sigmoid colon. The remaining clinical, laboratory, and diagnostic characteristics are listed in Table 1.

Assessment of the severity of ulcerative colitis: An effective pathway from invasive to non-invasive diagnosis

The purpose of the study is to study the Diagnostic and prognostic importance of TGF-β2 in patients with ulcerative colitis with different severity. The study received 82 patients with stasionar and outpatient treated ulcerative colitis in the Gastroenterology Department of Bukhara regional Multidisciplinary Medical Center during 2021-2023 and 20 health professionals as a control group. Patients were diagnosed with serum immunoferment analysis using IL-6 and TGF-β2, and its importance was studied. The results of the study showed an increase in IL-6 and a decrease in TGF-β2 in severe types of ulcerative colitis, and found that it could be used in diagnosis as a poor prognostic marker.

Nutritional status analysis in patients with ulcerative colitis

The study included 128 patients treated ulcerative colitis in the Gastroenterology Department of Bukhara regional Multidisciplinary Medical Center during 2021-2023 and 20 health professionals as a control group. Nutritional status has been studied in patients with ulcerative colitis on the basis of anthropometry. When nutritional indicators were analyzed in patients with ulcerative colitis, depending on the activity levels of the disease, it was noted that the incidence of the disease is obvious, that is, in the type of high activity, all indicators are relatively low.

INDEX ASSESSMENT OF THE CONDITION OF PERIODONTAL TISSUES IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Introduction. Significant prevalence of periodontal diseases, tendency to progress with the subsequent loss of teeth, onset at a young age, decrease in the quality of life of patients and significant financial costs determine the relevance of this medical and social problem. The problem of gastroesophageal reflux disease (GERD) is being increasingly paid attention by researchers and doctors due to the high prevalence and variety of its clinical manifestations. One of the atypical (extraordinary) syndromes of gastroesophageal reflux disease is dental. The purpose of the research was to assess the condition of periodontal tissues in patients with gastroesophageal reflux disease. Materials and methods. For the study, 65 patients with GERD were selected who had been hospitalized to the gastroenterology department of Ternopil City Hospital No. 2. In total, the sample included 34 (52.31 %) men and 31 (47.69 %) women. To identify inflammatory changes in the gum mucosa, the papillary-marginal-alveolar index (PMA) and the complex periodontal index (CPI) according to P.O. Leus (1989) were used. Statistical processing of the data obtained during the study was carried out using the licensed Microsoft Excel 2016 and Statsoft Statistica 12 statistical analysis packages. Results. As a result of our study, we found that only 18.5 % of patients suffering from GERD had clinically healthy gums. 9.2 % of patients showed signs of mild gingivitis (PMA index values were within 20 %). According to the RMA index, 33.8 % of patients in the main group were diagnosed with moderate gingivitis (values ranged from 25–50 %). In 38.5 %, manifestations of severe gingivitis were visualized (the PMA index value was more than 51 %). We have found that in patients with GERD, the manifestations of inflammatory phenomena in periodontal tissues increase with age and their severity increases. According to the data obtained when determining the CPI index, 11.2 % of patients with erosive lesions of the esophagus were diagnosed with moderate periodontal tissue damage (CPI value was (2.9 ± 0.1)). In 44.4 % of patients with the erosive form of GERD, mild periodontal tissue damage was visualized (CPI = (1.6 ± 0.1)). All patients with periodontitis secondary to erosive GERD were elderly (45–59 years, according to WHO). Only 44.4 % of patients with the erosive form of GERD and 100.0 % of patients with non-erosive GERD had no inflammation of periodontal tissue (the average CPI value did not exceed 1.0). Conclusions. Based on the studies described above, we can come to the conclusion that inflammatory processes in the tissues of the periodontal complex and oral mucosa in patients suffering from gastroesophageal reflux disease are interconnected processes that aggravate each other.

Comparison of severity of pancreatitis with and without diclofenac sodium in post ERCP patients.

Objective: To compare the diclofenac sodium intramuscular prophylaxis given with standard treatment in patients having ERCP was compared with standard treatment alone with respect to frequency and severity of pancreatitis within 48 hours after the procedure. Study Design: Randomized Controlled Trial. Setting: Department of Gastroenterology, Hepatology, and GI Endoscopy, SZABMU, Pakistan Institute of Medical Sciences, Islamabad. Period: August 2021 and April 2022. Material & Methods: The study enrolled 160 patients with obstructive jaundice with or without pruritus (20-70 years). Each group consisted of 80 patients. A prophylactic dose of 75 mg of diclofenac sodium was administered intramuscularly to Group A in addition to standard treatment, while standard treatment was given to Group B alone. The standard treatment for PEP was antibiotics (Cefoperazone/Sulbactam 2g IV) for both groups. IV dormicum (midazolam) was given to both groups as sedation. All patients were tested for lipase and amylase after the procedure to detect any complications. They were also monitored for abdominal pain at 4 and 24 hours after the procedure. Results: In patients of Group A (n=80), the mean age was 47.1 years ± 8.4 SD, whereas in patients in Group B (n=80), the mean age was 47.5 years ± 7.4 SD. In Group A, 3.8% of patients (n=3/80) developed PEP, while 11% (n=11/80) developed PEP (p=0.025). Intramuscular diclofenac sodium was more efficient at preventing PEP when compared to the control group on standard treatment alone, on all of the following parameters: (1) the proportion of patients that did not develop PEP, (2) the rate of patients that developed PEP, and (3) the average quantity of days that patients were sick. In both groups A and B, the PEP diagnosis was mild and the patients were discharged within 2-3 days of diagnosis. PEP efficacy was not significantly different across age groups or genders in both treatment groups (p>0.05). Conclusion: Diclofenac sodium is significantly more effective than standard treatment alone for intramuscular pancreatitis prophylaxis after ERCP.

Pre-operative rehabilitation in reducing post operative pain

Background: Prehabilitation is the process of improving the functional reserve of the patient. It is being a new paradigm increasingly being applied in recent days for all types of surgeries. The postoperative outcome of the patient is being affected if their functional reserve is low. It induces major complications, reduced ambulation and higher respiratory and wound related complications. One of the major factors in reducing the mobility of the patient is postoperative pain following surgery. Many studies are being done in assessing the effectiveness of prehabilitation in improving the postoperative outcome of the patients. We have done a study to evaluate the efficacy of the prehabilitation in relation to the postoperative pain score in pancreatic surgery and its outcome. Methods: To study the effect of prehabilitation over the postoperative pain score. All patients related to benign and malignant disorders of pancreas who were subjected to surgery were taken in to study. The nutritional regimen, additional protein intake and their physical activity along with their preoperative Metabolic equivalents were taken in to study. All patients were studied for their postoperative pain score and data generated comparing their preoperative workup with postoperative pain scale. Results: The higher metabolic equivalents had a higher significant value relating to their pain scale. The distance covered in a day also influenced the postoperative pain. About the protein intake it was shown that additional protein intake in the preoperative period has shown a significant impact on the postoperative pain scale. Conclusions: From this little cohort group it cannot be generalised but In relation to the prehabilitory measures for pancreas related surgery in our surgical gastroenterology department. It is shown that preoperataive additional protein intake and their physical activity especially their metabolic equivalents prior to surgery had a good relation to their pain scale showing a positive correlation between them.

Analysis of the structure of comorbidity in children with gastrointestinal tract pathologies

Diseases of the gastrointestinal tract take the second place in the structure of somatic pathology in children and adolescents. The number of cases of comorbid pathology also tends to increase. The combination of the most common diseases can be both random and causal relationship, the determination of which is important for improving the health care of the child population.
 Objective — to analyse of comorbidities in children with gastrointestinal diseases based on the results of the city specialized children’s gastroenterological department work.
 Materials and methods. The performance indicators of Kharkiv City Children’s Clinical Hospital No19 for the period from 01.01.2019 to 31.12.2019 were studied. During 2019, 2633 children aged 5 to 18 years (average age: 10.6±2.9 years) with diseases of the digestive system were hospitalized.
 Results. The presence of comorbidity was established in 73.6% of children. The most common among children with diseases of the gastrointestinal tract were manifestations of diseases of the nervous system — 31.8%. Diseases of the endocrine system — 15.4% and cardiovascular system — 15.7% were equally represented. A fairly common pathological condition in patients with gastrointestinal diseases was anemia, which was established in 8.1%. Visual impairment was found in 2.7% children, which coincides with the prevalence of this pathology among the general children’s population.
 Conclusions. The leading place is held by the gastroduodenal pathology, notably chronic gastroduodenitis. The presence of comorbidity from other organs and systems was established in 73.6% of children with gastrointestinal diseases. The most common comorbidity in diseases of the gastroduodenal zone are diseases of the nervous system. The greatest chances of combining pathological conditions with the development of comorbid pathology are diseases of the gastroduodenal zone and nervous system, intestines and autoimmune thyroiditis, gastroesophageal reflux diseases and obesity. The results suggest the necessity of additional examination of children with gastrointestinal pathology in order to early diagnosis of comorbidity and provide the required comprehensive assistance.

A clinical case of diverticular disease in a patient with COVID-19: features of the course against the background of comorbid pathology

As a consequence of the global pandemic of the coronavirus disease (COVID‑19), cases of combination of gastroenterological pathology with endocrinopathies, associated with this pandemic, occur sporadically. Therefore, reporting about a unique clinical case of post‑covid comorbidity of these diseases seems to be advisable.
 Patient K., 68 years old, who had been suffering from diabetes insipidus for five years and received appropriate treatment (desmopressin) daily, was hospitalized for 28 days at the lung disease center of the Regional Phthisiopulmonological Center due to a severe course of COVID‑19. Two months after discharge, due to prevailed gastrointestinal complaints (pain in the bowel areas, stool frequency up to 7 times a day, dryness mouth, urination up to 3 times at night (nocturia), general weakness), which required another thorough differential diagnosis, she was hospitalized in the Gastroenterology Department of Regional Clinical Hospital. The diagnosis of severe post‑covid complications has been established, including intestinal diverticular disease and type 2 diabetes mellitus, and patient was transferred to the surgical department.
 The problems of searching and improving methods for early diagnosis of post‑covid conditions that potentiate the development of polymorbidity are urgent. A pathogenetically based approach to the administration of therapy will promote reducing morbidity and mortality in patients with comorbid diseases. The coronavirus pandemic forces the medical and scientific community to join efforts for investigation of new comorbid condition. The timely diagnosis of relatively new and understudied post‑covid diseases should become the main task of multidisciplinary teams of doctors. Investigation of the diversity of the clinical courses, the development and improvement of algorithms for the treatment and prevention of severe complications of diverticular intestinal disease in combination with diabetes insipidus and diabetes mellitus are the important prospects of scientific research.

Instant duodenal decompression after endoscopic retrograde cholangiopancreatography can effectively reduce the incidence of post-ERCP pancreatitis and hyperamylasemia.

Post-ERCP pancreatitis (PEP) is significantly influenced by the reflux of duodenal fluid. While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management, the effectiveness of immediate duodenal decompression following ERCP to prevent PEP remains uncertain. This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP. This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithiasis at the Department of Gastroenterology, Chun'an Branch of Zhejiang Provincial People's Hospital (Zhejiang, China) between January 2020 and June 2023. Based on the immediate placement of a duodenal decompression tube post-ERCP, patients were categorized into two groups: the duodenal decompression group and the conventional procedure group. Primary outcomes included the incidence of PEP and hyperamylasemia. A total of 195 patients were enrolled (94 in the duodenal decompression group and 101 in the conventional procedure group). Baseline clinical and procedural characteristics exhibited no significant differences between the two groups. PEP occurred in 2 patients (2.1%) in the duodenal decompression group, in contrast to 11 patients (10.9%) in the conventional procedure group (Risk difference [RD] 8.8%; 95% confidence interval [CI] 1.7%-16.5%, P = 0.014). Hyperamylasemia was observed in 8 patients (8.5%) in the duodenal decompression group, compared to 20 patients (19.8%) in the conventional procedure group (RD 11.3%; 95% CI 1.4%-21.0%; P = 0.025). Patients with PEP in both groups showed improvement after receiving active treatment. No severe cases of PEP occurred in either group, and no serious adverse events related to duodenal catheter decompression were reported. Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamylasemia and PEP.

DNA Content of Various Fluids and Tissues of the Human Body.

Due to the scarcity of literature data on the DNA content of different human tissues, this study aimed to isolate DNA from different tissues and fluids of the human body together with the determination of its content in the samples studied. Material was collected and tests were performed between 1990 and 2010, during autopsies performed for prosecutor's offices in the Department of Forensic Medicine. Goiter and thyroid cancer tissues were obtained from the Department of General Surgery, Gastroenterology and Endocrinology of Wroclaw Medical University. Isolated samples were measured spectrophotometrically, yielding an R 260/280 nm between 1.5 and 1.6. In some cases (when a sufficiently pure preparation could not be obtained), isolation was continued using the silica-based commercial QIAquick PCR Purification Kit (Qiagen). If the sampling tissues showed signs of decomposition such as bad odour or colour, the results were calibrated by Real-Time PCR, using the Quantifiler DNA assay (Thermo Fisher Scientific, Applied Biosystems). The results have shown that the maximum amount of genetic material was obtained from hair roots, adrenal glands, gonads and lymph nodes. The lowest DNA content per gram or milliliter of tissue or body fluid was found in adipose tissue, blood, saliva, bile, sweat, tears and the vitreous body of the eye. The presented findings indicate the best sources of high-quality DNA from the human body: gonads, kidneys, muscle (including heart), blood and bones (after decalcification).

Stress of the COVID-19 and its Consequences on Irritable Bowel Syndrome Patients in A Selected Tertiary Level Hospital in Bangladesh

Background: The COVID-19 pandemic represents a multiple stress. Stress can worsen the symptoms of (IBS) patients.
 Aims & Objective: The aim of the study was to assess the stress of COVID -19 and its impact on IBS patients during the pandemic situation among the Bangladeshi population.
 Methods: This cross-sectional study was conducted among the self-reported previously diagnosed IBS patients aged 18 years and above, irrespective of sex, in the Gastroenterology department of ShaheedSuhrawardy Medical College Hospital. Data was collected by a structured questionnaire which included the patient’s socio-demographic, clinical symptoms of IBS, personal habits, comorbidities, self-reported stress due to COVID-19, and its effect on the symptoms of IBS.
 Results: The study respondents consisted of 210 IBS patients, among them 71.90% were male and 28.10% were female. The majority of the study population (43.0%) belonged to age group of 31-40 years and mean age 35.12 ± 11.55 years. Most of the respondents (91.9%) reported stress due to the COVID-19 pandemic. The most commonly reported causes of stress were fear of a family member being infected with the virus (94.8%), followed by fear of self-infection (90.5%), and death due to COVID-19 infection (68.1%). Most of the stressed respondents (72.9%) reported that stress usually exaggerates IBS symptoms. Almost 25.7% of the subjects consulted a physician for stress aggravation of the symptoms, 21.0% used sedatives due to stress, and 21.0% modified IBS medications due to stress. Moreover, 36.2% of the participants reported hampered daily activities due to IBS symptoms exacerbation.
 Conclusion: The study revealed that most of the IBS patients had been suffering from stress during the COVID-19 pandemic situation. IBS patients should be advised to participate in mental health education programs to adjust to the current pandemic COVID-19 situation.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 50-56

Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan.

To determine the etiologies and outcomes of liver disease in pregnancy in a developing country. A total of 336 consecutive pregnant women with liver disease were included in this prospective cohort study conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Center, Karachi from August 2019 to August 2021. Patients' baseline demographic, clinical, and laboratory data and outcomes were collected on a pre-designed questionnaire. Among all the pregnant females, the most common liver disease was acute hepatitis E virus (HEV) infection (37.2%), followed by preeclampsia (PEC)/eclampsia (EC), hemolysis, elevated liver enzymes & low platelets (HELLP) syndrome, and hyperemesis gravidarum (HG). The most common maternal complications were fulminant hepatic failure (FHF) in 14.9% and placental abruption in 11.0%. Fetal complications included intrauterine death (IUD) in 20.8% and preterm birth in 8.6%. The maternal and neonatal mortality rates were 11.6% and 39.6%, respectively. Among the predictors, low maternal weight, low body mass index (BMI), and low hemoglobin (Hb) were associated with increased maternal mortality. Low fetal weight, height, maternal systolic blood pressure (SBP), and low maternal Hb were independent predictors of fetal mortality. In our cohort of pregnant females in a tertiary care medical center, acute HEV was the most common liver disease, followed by PEC/EC, HELLP, and HG. Maternal and fetal deaths were alarming in this group of patients and demanded careful management.

Frequency and risk factors of malabsorption in patients presenting at tertiary care hospital, Karachi.

The objective of this study was to find out frequency and risk factors of malabsorption in patients presenting at tertiary care hospital, Karachi. This was a prospective-observational study conducted through a non-probability consecutive sampling technique. Ninety two adult patients presenting with a history of chronic diarrhea (diarrhea having duration of more than four weeks), age ≥14 years, both males & females, and diagnosed as malabsorption syndrome visiting out-patient or admitted in the department of Gastroenterology of the Jinnah Postgraduate Medical Center, Karachi between June 2018 and July 2020 were enrolled. Baseline and clinical data were recorded in a pre-designed questionnaire and analyzed using statistical package for the social sciences (SPSS) version 21.0. The overall mean age and standard deviation of patient was 35.42±10.83 years. Diarrhea n=71 (77.17%), fever n=35 (38.04%), abdominal pain n=32 (34.78%), and weight loss n=13 (14.13%) were the most common symptoms observed in our study subjects. Most of the patients had normal upper GI endoscopy (26.56%) while multiple fundal erosions with pre-pyloric ulcer and severe pangastric erythema & classical scalloping of duodenal folds were most common findings observed, 21.87% and 17.18%, respectively. Our study provides evidence that malabsorption syndrome is most commonly present in males with younger age group and the most common causes were celiac disease and intestinal tuberculosis and most common presentation was diarrhea, fever, and abdominal pain.

Association of ITPA 94C>A genetic polymorphisms with azathioprine induced adverse effects in the South Indian population.

Azathioprine (AZA) is an effective immunosuppressant commonly used for malignancy and immune-mediated disorders. The association between genetic polymorphisms and AZA-induced adverse effects has not been elucidated. Hence this study aimed to evaluate the relationship between single nucleotide polymorphisms of ITPA (C94A) with azathioprine-induced adverse effects. A cross-sectional study was performed on 120 patients who were on AZA therapy for immunobullous disorders and inflammatory bowel disease (IBD). Eligible patients were enrolled from outpatient Departments of dermatology and medical gastroenterology and five mL ofblood was collected after obtaining written informed consent. DNA extraction and genotyping were done by phenol-chloroform method and real-time polymerase chain reaction (RT-PCR), respectively. The minor allele frequency of ITPA (A allele) was 30.8 %. The mutant genotypes of ITPA (C94A) were found to have no significant association with overall adverse effects in the South Indian patients on AZA therapy. We report no significant association between ITPA rs1127354 genetic polymorphism and adverse effects in the South Indian patients on AZA therapy.

Эффективность трансабдоминальной ультразвуковой диагностики состояния толстой кишки для оценки эндоскопической активности язвенного колита у детей

Transabdominal ultrasound examination of the colon is an informative research method that does not require special training, which is vital in pediatric practice. The purpose of the study was to compare the informativeness of transabdominal ultrasound of the colon vs the colonoscopy using the clinical and laboratory data of pediatric patients with ulcerative colitis (UC). Materials and methods used: a single-center retrospective cohort study was conducted at the Gastroenterology Department of the National Medical Research Center for Children’s Health (Moscow, Russia) in 2021-2023, which included 119 children 7 to 17 years and 11 months old with an established UC diagnosis. All children have undergone clinical and laboratory tests, ultrasound and ileocolonoscopy. The UCEIS scale and the PMI index of clinical activity were used to assess the endoscopic activity. The study of fecal calprotectin was carried out with immunochromatographic method. During transabdominal ultrasound, the thickness of the intestinal wall and blood flow were assessed using the Color Doppler imaging mode. Results: statistically significant increase in the thickness of the intestinal wall against the background of the growth of UCEIS (Rs=0.654; p<0.001), PUCAI (Rs=0.642; p<0.001) and the level of fecal calprotectin (Rs=0.463; p<0.001) was detected. Statistically significant differences in increased blood flow in the intestinal wall of the sigmoid colon were found with the UCEIS, PUCAI index (p<0.001, for both indices) and the level of fecal calprotectin (p=0.014). The area under the ROC curve corresponding to the relationship between the prognosis of the development of ulcerative colitis and the thickness of the sigmoid colon was 0.850±0.054 with 95% CI: 0.745-0.955. The resulting model was statistically significant (p<0.001). The threshold value of the sigmoid colon thickness was 2.05 mm, in case of an increase in this value, a high risk of exacerbation of ulcerative colitis was predicted. The sensitivity and specificity of the method were 84.3% and 72.7%, respectively. When comparing the PUCAI index, the UCEIS index and the level of fecal calprotectin based on the blood flow in the sigmoid colon wall, the statistically significant differences were found (p<0.001, for both indices, and p=0.014 for fecal calprotectin, respectively). Conclusion: transabdominal ultrasound diagnostics showed good correlation with colonoscopy, clinical activity of the disease and the level of fecal calprotectin, as a result of which ultrasound of the colon should be considered as a useful imaging method for assessing inflammatory activity in the colon and follow-up of patients with UC.

Оценка эффективности применения модифицирующей терапии (комплекса VERIS (пектин + инулин) с солевым энтеральным раствором) у пациентов с язвенным колитом

Purpose: to evaluate the effect of the use of modifying therapy (VERIS complex (Pectin + Inulin) in combination with saline enteral solution) on the effectiveness of treatment of patients with moderate ulcerative colitis (UC). Material and methods. A comparative clinical study was conducted with active effects on the observed group. This study included men and women with a moderate attack of ulcerative colitis without severe concomitant pathology and signs of reactivation of an opportunistic infection. Using a continuous sampling method, 45 patients (n = 45) aged 32 ± 7.5 years were selected who were undergoing inpatient treatment in the gastroenterological department of the State Budgetary Healthcare Institution “Research Institute-KKB No. 1” named after Professor S.V. Ochapovsky regarding inflammatory bowel diseases (IBD). Depending on the chosen treatment strategy, all patients were divided into 3 groups: group 1 included patients who, in addition to basic therapy for IBD, received VERIS (pectin + inulin) (n = 15), group 2 included patients receiving only basic therapy (n = 15), the third group included patients who, in addition to the main therapy, received the combination of VERIS (pectin + inulin) + SER (n = 15). In the groups, a comparative assessment of the volume of the lesion, symptoms of the disease, such as pain, fever, tenesmus, stool frequency and the presence of blood in it, as well as the results of laboratory tests, including data from the blood flow rate, ESR, CRP, blood electrolyte composition, nitrogenous wastes, were carried out and liver transaminases, albumin and indicators of electrolyte metabolism (K, Na, Cl). The dynamics of the above-described indicators in each of the groups was also assessed at 3 stages of observation: initially, on the 5th and 10th day of treatment. In addition to the listed parameters, in both groups the duration of hospitalization in bed days, the level of quality of life (IBDQ questionnaire), and the degree of psycho-emotional disorders according to the HADS hospital anxiety and depression scale were assessed. Results. It was found that when the combination VERIS (Pectin + Inulin) was included in the basic therapy in combination with saline enteral solution, a decrease in the activity of the systemic inflammatory process was revealed, which was manifested by positive dynamics of leukocytosis, a decrease in the average erythrocyte sedimentation rate, and an increase in hemoglobin levels. A statistically significant decrease in cytolysis markers (decrease in liver transaminases) and catabolism indicators was also noted, which was reflected in the form of a decrease in the level of nitrogenous wastes. It should be noted that no undesirable side effects or allergic reactions were registered during the study period. The revealed reduction in the length of hospitalization of patients in the group receiving VERIS (pectin + inulin) + SER, an increase in adherence to therapy due to an increase in the quality of life due to the rapid regression of symptoms can be regarded as significant indicators of the effectiveness of the therapy. The above results obtained by us indicate the modifying effect of the complex of enteroprotective drugs on the standard basic therapy of ulcerative colitis. Conclusion. The addition of the enteroprotective combination VERIS (pectin + inulin) in combination with saline enteral solution to the standard therapy of patients with moderate ulcerative colitis increases the effectiveness of treatment results by reducing the inflammatory process, the phenomena of cytolysis, catabolism and, as a consequence, leads to a decrease in hospitalization time, an increase in quality of life. All of the above allows us to consider this combination of drugs with the function of enteroprotection VERIS (pectin + inulin) + SER as a promising way to modify the basic therapy of inflammatory bowel diseases by compensating for intestinal failure during the treatment period.

Smart Endoscopy Is Greener Endoscopy: Leveraging Artificial Intelligence and Blockchain Technologies to Drive Sustainability in Digestive Health Care.

The surge in the implementation of artificial intelligence (AI) in recent years has permeated many aspects of our life, and health care is no exception. Whereas this technology can offer clear benefits, some of the problems associated with its use have also been recognised and brought into question, for example, its environmental impact. In a similar fashion, health care also has a significant environmental impact, and it requires a considerable source of greenhouse gases. Whereas efforts are being made to reduce the footprint of AI tools, here, we were specifically interested in how employing AI tools in gastroenterology departments, and in particular in conjunction with capsule endoscopy, can reduce the carbon footprint associated with digestive health care while offering improvements, particularly in terms of diagnostic accuracy. We address the different ways that leveraging AI applications can reduce the carbon footprint associated with all types of capsule endoscopy examinations. Moreover, we contemplate how the incorporation of other technologies, such as blockchain technology, into digestive health care can help ensure the sustainability of this clinical speciality and by extension, health care in general.