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Kumar, Ramesh; Kumar, Abhishek; Patel, Rishabh; Prakash, Sabbu Surya; Kumar, Sudhir; Surya, Himanshu; Marrapu, Sudheer
2024 Indian Journal of Gastroenterology
doi: 10.1007/s12664-024-01643-wpmid: 39225936
BackgroundAntituberculosis drug-induced liver injury (ATDILI) is a significant problem of tuberculosis treatment. This systematic review and meta‑analysis aimed at evaluating the incidence and risk factors of ATDILI in adult patients with tuberculosis in India.MethodsFive electronic databases were searched comprehensively for studies on Indian adult patients with tuberculosis investigating the incidence and/or risk factors of ATDILI. The relevant data was pooled in a random or fixed-effect model to calculate the pooled incidence with a 95% confidence interval (CI), standardized mean difference (MD) or odds ratio (OR).ResultsFollowing the screening of 3221 records, 43 studies with 12,041 tuberculosis patients were finally included. Based on the random effect model, the pooled incidence of ATDILI was 12.6% (95% CI, 9.9–15.3%, p < 0.001, I2 = 95.1%). The pooled incidence was higher in patients with daily treatment regimen compared to the thrice weekly regimen (16.5% vs. 3.5%). The concurrent hepatitis B or C infection, alcohol consumption and underlying chronic liver disease were associated with high incidence of ATDILI. The pooled incidence of acute liver failure (ALF) among ATDILI patients was 6.78% (95% CI 3.9–9.5%). Female gender (OR 1.24), older age (MD 0.26), lean body mass index (OR 3.8), hypoalbuminemia (OR 3.09), N-acetyltransferase slow acetylator genotypes (OR 2.3) and glutathione S-transferases M null mutation (OR 1.6) were found to be associated with an increased risk of ATDILI. The pooled mortality rate of ATDILI patients was 1.72% (95% CI 0.4–3.0%) overall and 71.8% (95% CI 49.3–94.2%) in case of ALF.ConclusionOverall, 12.6% patients of tuberculosis in India developed ATDILI when combination of first-line antituberculosis drugs was used. An average of 7% of ATDILI patients progressed to ALF which had a high mortality rate. Older age, female, poor nutritional status and some genetic polymorphisms were identified as significant risk factors.Graphical Abstract[graphic not available: see fulltext]
Kumar, Pawan; Singh, Anuradha; Triveni, G. S; Chandrashekhara, S. H; Gamanagatti, Shivanand; Nichat, Vaibhav
2024 Indian Journal of Gastroenterology
doi: 10.1007/s12664-024-01656-5pmid: 39243342
The awareness of anatomical variations of hepatic arteries and celiac trunk is very important in interventional radiology, liver transplant and intra-abdominal oncologic surgeries. Radiology plays an important role in the identification of these variants non-invasively. Digital subtraction angiography was the gold standard for their identification. Computed tomography (CT) angiography non-invasively provides detailed knowledge of various anatomical vascular variations. This pictorial review highlights the role of multidetector computed tomography (MDCT) in the identification of celiac trunk–hepatic arterial system variations and clinical consequences.
2024 Indian Journal of Gastroenterology
doi: 10.1007/s12664-024-01680-5pmid: 39259450
Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) includes EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided choledochoduodenostomy (EUS-CDS), EUS-guided gallbladder drainage (EUS-GBD), EUS-guided antegrade stenting (EUS-AG) and EUS-guided rendezvous (EUS-RV). While EUS-HGS, EUS-CDS and EUS-GBD are transluminal drainage procedures, EUS-AG is a traspapillary drainage procedure and EUS-RV is a procedure intended to facilitate endoscopic retrograde cholangio pancreatography (ERCP) in instances of failed cannulation. These procedures were initially developed as options for endoscopic salvage of failed ERCP, but have evolved to become first-line interventions also for select indications over time as the technique and expertise improved. Several randomised controlled trials have demonstrated EUS-BD, especially EUS-CDS has similar or even better outcomes as compared to ERCP in malignant biliary obstruction. However, widespread adoption of these modalities is limited by the availability of expertise, steep learning curve, lack of standardization of techniques and cost. In this review, we aim to provide an overview of various EUS-BD procedures including the indications, accessories, technique, outcomes and follow-up of each of these procedures.
Jagtap, Nitin; Kumar, C. Sai; Lakhtakia, Sundeep; Ramchandani, Mohan; Memon, Sana Fathima; Asif, Shujaath; Kalapala, Rakesh; Nabi, Zaheer; Basha, Jahangeer; Gupta, Rajesh; Tandan, Manu; Reddy, D. Nageshwar
2024 Indian Journal of Gastroenterology
doi: 10.1007/s12664-024-01668-1pmid: 39240508
IntroductionThe role of endo-biliary radio-frequency ablation (EB-RFA) in treating malignant biliary strictures remains a subject of controversy. This study aims to assess the efficacy and safety of EB-RFA in conjunction with self-expandable metal stents (SEMS) compared to SEMS alone.MethodsThis single-center prospective pragmatic comparative study, conducted between June 2021 and November 2022, involved 23 patients undergoing EB-RFA plus SEMS and 48 patients undergoing SEMS for unresectable malignant hilar obstruction. The study evaluated overall survival, stent patency and adverse events.ResultsSeventy-one patients (mean age [SD], 57.8 [11.2] years; 73.2% men) were enrolled. The clinical success rates did not significantly differ between the two groups (78.3% in EB-RFA and 66.6% in SEMS; p 0.316). The median (95% CI) overall survival was 155 (79.87–230.13) days in the EB-RFA group, contrasting with 86.0 (78.06–123.94) days in the SEMS group (p 0.020). The presence of carcinoma gallbladder (p 0.035; HR 0.55; 95% CI 0.32–0.96) and EB-RFA (p 0.047; HR 1.88; 95% CI 1.01–3.49) independently predicted overall survival. Median (95% CI) stent patency was 143.0 (95% CI, 61.61–224.39) days in the EB-RFA group compared to 78.0 (95% CI, 32.74–123.26) days in the SEMS group (p 0.019). The presence of carcinoma gallbladder (p 0.046, HR 0.60; 95% CI, 0.36–0.99), EB-RFA (p 0.023; HR 1.92; 95% CI, 1.10–3.36) and chemotherapy (p 0.017, HR 1.91; 95% CI, 1.12–3.26) independently predicted longer stent patency. There was no difference in procedure-related adverse events in both groups.ConclusionEB-RFA with SEMS placement proves to be a safe and effective technique for palliative biliary decompression in patients with malignant biliary strictures, demonstrating superior overall survival and stent patency compared to SEMS alone. Further confirmation through multi-center trials is warranted.Clinical trial registrationClinicalTrials.gov (ID: NCT05320328).Graphical Abstract[graphic not available: see fulltext]
2024 Indian Journal of Gastroenterology
doi: 10.1007/s12664-024-01662-7pmid: 39259451
BackgroundSwallowing intricately involves sensorimotor systems, pivotal for integrating upper digestive and respiratory functions. Dysphagia, challenging swallowing, often precipitates anxiety and depression, deeply affecting the quality of life (QOL). Understanding patient-centric symptoms is vital for assessing dysphagia’s QOL impact.AimThis study aimed at developing and validating the Symptom Specific Dysphagia Quality of Life Questionnaire in Tamil (SSDQOL-T).MethodSSDQOL-T was developed in Tamil and underwent rigorous content validation. This questionnaire was administered to 120 normal individuals and 32 dysphagia patients, assessing various swallowing difficulties and their QOL impact.ResultsResults indicate SSDQOL-T’s good internal consistency (Cronbach’s α = 0.78). Significant differences in swallowing ability and QOL were noted across age groups, with older adults experiencing heightened symptoms. A high significance in mean score was obtained between healthy adults and dysphagia across all sub-domains with a ‘p-value’ of 0.0005. Symptoms that were found to have high significance were cough/gag reflex, regurgitation, odynophagia, globus sensation, heartburn and tiredness when compared between mechanical and degenerative dysphagia group. Strong correlations were found between SSDQOL-T scores and the Dysphagia Handicap Index in Tamil (r = 0.89).ConclusionThe SSDQOL-T questionnaire provides a robust tool for evaluating dysphagia-related QOL in the Tamil-speaking population. Its validation underscores its clinical relevance and utility for understanding the multidimensional impact of dysphagia. This study emphasizes the importance of culturally sensitive assessment tools in comprehensively evaluating dysphagia’s QOL implications.Graphical Abstract[graphic not available: see fulltext]
Tunney, Ruth; Liu, Eleanor; Limdi, Jimmy K.
2024 Indian Journal of Gastroenterology
doi: 10.1007/s12664-024-01657-4pmid: 39222194
BackgroundOptimal management of inflammatory bowel disease (IBD) in pregnancy is associated with better pregnancy outcomes. We describe management of IBD during pregnancy and maternal and fetal outcomes of patients from a tertiary UK IBD centre.MethodsThis is a retrospective observational cohort study of all pregnancies occurring between 2015 and 2021 in a large tertiary IBD centre in the UK. IBD activity and management prior to, during and after pregnancy were recorded along with pregnancy and neonatal outcomes. Associations between IBD-focused interventions and any adverse pregnancy outcomes, as well as the association between IBD severity and treatments and adverse maternofetal outcomes were assessed.ResultsPregnancies in 130 women with IBD were included for analysis. The mean maternal age at delivery was 30.5 (± 4.7) years. At conception, 73 women (56.2%) were in clinical remission and 24 (18.4%) were treated with a biologic agent. Active disease during pregnancy, measured by physician global assessment, was less frequent in women who were in clinical remission at conception, compared to those not in remission at conception (16/73 21.9% vs. 39/49 79.6%; data insufficient for eight women). Active IBD at conception was associated with pre-term birth (p = 0.04). Maternal corticosteroid use in any trimester was associated with low birth weight (T1 p = 0.02; T2 p = 0.005; T3 p = 0.007). Active disease (p = 0.008) and steroid use in the third trimester (p = 0.05) were both associated with neonatal infections up to six months after birth.ConclusionWomen in clinical remission at the time of conception have favorable outcomes, consistent with prospective observational studies. Our observations emphasize the importance of high quality IBD care for women pre and post-partum in line with international recommendations.Graphical Abstract[graphic not available: see fulltext]
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