Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in non-obese individuals but remains poorly studied in people with type-2 diabetes (T2D), particularly in India. The study aimed at comparing hepatic steatosis, fibrosis and diabetes-related complications between non-obese (n, 150) and obese (n, 300) individuals with T2D. This was a comparative cross-sectional study in which the participants underwent clinical, biochemical and anthropometric assessments. Hepatic steatosis and fibrosis were evaluated using ultrasonography and transient elastography, with controlled attenuation parameter (CAP) and liver stiffness (kPa) measurements as key indicators. Diabetes-related complications were assessed using standardized protocols. Non-obese individuals had higher retinopathy prevalence (18
Gallstone disease is a common gastrointestinal disorder involving metabolic and inflammatory pathways. Advanced glycation end products, abundant in processed foods and generated during high-temperature cooking, promote oxidative stress and inflammation, mechanisms implicated in gallstone formation. Therefore, this study investigated the association between advanced glycation end products intake and gallstone among Iranian adults. In this case-control study, 189 newly diagnosed patients with gallstone and 342 controls were included. Dietary intake was assessed using a validated 168-item food frequency questionnaire. Dietary advanced glycation end products intake was estimated using established advanced glycation end products databases and expressed as Kilounits (Ku) per day. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95
Evaluating the gut microbial community in Crohn’s disease (CD) is best done before commencing therapy to avoid the effects of therapeutic intervention and provide a better understanding of microbial dysbiosis. We compared the microbial communities in both tissue and stool samples from treatment-naive CD patients with those in remission. Adults with CD were prospectively recruited. Patients with Crohn’s disease activity index (CDAI) > 150 and no prior therapy were included as treatment-naive active cases and those with CDAI ≤ 150 were considered to be in remission. Stool and rectal mucosal biopsy samples were collected, bacterial DNA was extracted, the V3-V4 region of the 16S rRNA gene was amplified and library preparation was done and sequenced on the Illumina MiSeq platform. The microbial community composition, diversity and predicted function were assessed using the QIIME2 pipeline and R packages. Microbial characteristics associated with disease status were determined. Thirty-four active CD cases (age 40.9 ± 11.2 years, males 61.8
Helicobacter pylori (H. pylori) infection is a global health problem that affects more than half of the world population and leads to gastrointestinal disorders such as gastric ulcer, duodenal ulcer and gastric cancer. The available treatment options are inefficient because of patient non-adherence to the regimen due to the polypharmacy approach of treating H. pylori over longer periods. The bio-availability of antibiotics at the gastric mucosa, where the organism resides, is also a major concern. The continuous adaptation of bacteria such as genetic mutation toward beta-lactamase, macrolide and nitroimidazole group of antibiotics and structural barriers such as biofilm or efflux pumps contributes to the decreased efficacy of the antibiotics. These challenges ultimately result in antibiotic resistance. This review discusses the regional disparity in H. pylori infection management and the trend in anti-microbial resistance worldwide. To address these challenges, novel treatment approaches are being explored, ranging from clinically and pre-clinically supported strategies to those still at a conceptual stage, among which gastro-retentive drug delivery, nano-formulation and non-antibiotic therapies are gaining attention worldwide. In conclusion, we suggest effective region-specific management of H. pylori infection with evidence-based emerging treatment strategies to improve eradication outcomes and mitigate anti-microbial resistance.
Upper gastrointestinal bleeding (UGIB) remains one of the common medical emergencies and a serious cause for morbidity and mortality worldwide. There have been significant advances in endoscopic therapy, pharmacological therapy and intensive care, but the outcome still seems to be variable and mainly influenced by the underlying etiology, comorbidities and timing of intervention. Vast regional differences exist in the epidemiological profile of UGIB in the Indian population. Upper GI bleed may manifest as self-limited bleeding to massive GI bleeding causing hemodynamic instability and mortality. The cornerstone of initial management includes early risk assessment, prompt resuscitation and appropriate triage. Endoscopy remains the cornerstone for both diagnosis and therapy since the origin of the bleed can be identified and treated. A wide range of endoscopic options are currently available, including injection therapy, thermal coagulation, mechanical devices, topical hemostatic agents and advanced rescue techniques. Radiologic and surgical interventions play a complementary role in patients with refractory or recurrent bleeding. Management strategies should take into account the clinical setting, available resources and local disease distributions. In the Indian setting, late presentation, poor access to emergency endoscopy and high burden of chronic liver disease present unique challenges. A systematic and step-wise approach with early stabilization, timely endoscopic intervention and proper management post-hemostasis improves outcomes. Ongoing refinement of protocols and wider dissemination of advanced endoscopic and radiological expertise are likely to further reduce re-bleeding and mortality associated with UGIB.
Population-based cancer registries (PBCRs) have reported changes in the patterns of gastrointestinal cancer (GIC) incidence in India over time. This study aimed at observing the differences in GIC incidence between 1988 and 1992 and 2013 and 2017 in selected Indian PBCRs. GIC incidence data was extracted from two volumes of the Cancer Incidence in Five Continents (CI5). The ranking of GIC, crude rates and age-adjusted rates (AAR) were compared between the periods 1988 and 1992 and 2013 and 2017 for Mumbai, Bengaluru, Chennai and Barshi PBCRs. Differences in AAR were expressed through standardized rate ratios (RR) with 95
Supragastric belching (SGB) is a behavioral disorder involving rapid air influx into the esophagus through a transiently relaxed upper esophageal sphincter, followed by immediate expulsion. Unlike gastric belching, it is not related to lower esophageal sphincter (LES) dysfunction or gastroesophageal reflux disease (GERD). Often associated with psychological stress, SGB can significantly impair quality of life and some patients remain refractory to conventional therapies. In this retrospective study, clinical records of patients diagnosed with refractory supragastric belching were systematically analyzed. Extracted data included detailed clinical history and upper gastrointestinal endoscopy findings; high-resolution esophageal manometry (HREM) was performed using Herbert’s 16-channel water perfusion system, with interpretation of esophageal motility patterns based on the Chicago Classification version 3.0 and perceived stress levels assessed using the PSS-10 questionnaire. All patients underwent a standardized intervention protocol consisting of nasogastric tube insertion followed by structured diaphragmatic breathing training (Yellapu Technique), aimed at behavioral modulation of belching. Follow-up evaluations included symptom assessment and perceived stress scores over a three-month period to determine therapeutic response. Total 56 patients were analyzed (40 females and 16 males, mean age of 45.6 ± 10.0 years). Upper gastrointestinal endoscopy and HREM findings were within normal limits in all patients. Endoscopy showed normal mucosal findings. HREM demonstrated normal esophageal motility and sphincter function, with a baseline esophagogastric junction (EGJ) pressure of 33.75 ± 6.45 mmHg and an integrated relaxation pressure (IRP) of 10.90 ± 2.8 mmHg, both within physiological limits. Complete resolution of supragastric belching was observed in 55 patients. The paired mean Perceived Stress Scale (PSS) score showed a statistically significant reduction, decreasing from 33 ± 3.65 at baseline to 22.92 ± 2.34 at one month (p < 0.001). No recurrence of symptoms was reported during the follow-up period. In conclusion, the Yellapu Technique appears to offer a practical and innovative therapeutic approach for the management of refractory supragastric belching. By combining mechanical interruption with behavioral modification, it was associated with immediate symptom relief as well as sustained improvement. These findings suggest that this technique may represent a promising adjunct or alternative to existing therapies, warranting further validation through well-designed prospective controlled studies.
Upper gastrointestinal bleeding is an important gastrointestinal emergency medical condition; however, there is a lack of multi-centre national data on this condition for India. Hence, the Indian Society of Gastroenterology (ISG) constituted a task force on upper gastrointestinal bleeding (UGIB) to collect and create a database representative of every part of India. The aim of this pan-India multi-centre study was to determine the etiology and clinical characteristics of UGIB in India and to identify the risk factors that determine the overall outcome in these patients. In consultation with the members of the task force, a protocol and case record form were developed and members of the ISG were invited to participate in data collection. Overall, 93 centres from different parts of India joined this study. A prospective longitudinal cohort study was designed and data was acquired between October 2014 and September 2018. All 93 participating centres were instructed to recruit patients with UGIB as per the approved protocol. All patients were followed up for 30 days either telephonically or during a hospital visit for re-bleeding rate up to 30 days from the first presentation, requirement for surgery and 30-day mortality. Statistical Package for the Social Sciences (SPSS) software (version 17.0, SPSS, Chicago, IL., USA) was used for all statistical analyses. Of 12,500 patients, 10,564 patients with UGIB were included in this study, 6450 (61.1
