Recurrent acute pancreatitis and chronic pancreatitis are disorders associated with significant morbidity. Despite increased awareness of quality-of-life impairment in these conditions, data comparing quality of life between chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP) remains limited, particularly in Indian populations. This study aimed at assessing and comparing the quality of life in patients with CP and RAP compared to healthy controls. This prospective cross-sectional bicentric study enrolled patients from two tertiary care centers in India between 2019 and 2024. Quality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Demographic characteristics, risk factors, complications and treatments were recorded for all participants. Statistical analysis included a comparison of quality-of-life domains across groups and a reliability assessment of the questionnaire. The study comprised 216 participants: 54 CP patients (mean age 26.8 ± 9.4 years, 59.3

Background and Aims Acute upper gastrointestinal (UGI) bleeding is a potential life-threatening medical emergency among the elderly. There are limited data on the presentation, management, and outcomes of nonvariceal UGI bleeding (NVUGIB) in the elderly from India. We aimed to study clinical presentation, endoscopic findings, and outcomes in elderly patients with acute nonvariceal UGI bleeding. Methods In this retrospective study, we analyzed data from elderly patients (>= 60 years) who presented with acute nonvariceal UGI bleeding at our tertiary care center between 2020 and 2023. Patient demographics, clinical presentation, comorbidities, medication history, laboratory parameters, endoscopic findings, and therapeutic interventions were recorded. Risk stratification was performed using AIMS65 and Complete Rockall scores. Primary outcomes studied were rebleeding and in-hospital mortality rates. Results Of the 623 patients who had acute nonvariceal UGI bleed, 445 patients aged < 60 years were excluded. Among 178 elderly patients (mean age: 69.83 +/- 7.36 years, 83.1% males), hematemesis was the predominant presentation (34.8%). Antiplatelet use was noted in 40.4% of patients. Gastric ulcer was the most common endoscopic finding (42.7%), followed by duodenal ulcer (21.3%). Early endoscopy (within 24 hours) was performed in 82.5% of patients, and endoscopic therapy was required in 34.8% of patients. The Complete Rockall score indicated moderate risk (3-7) in 79.2% of patients. The rebleeding and in-hospital mortality rates were 5% and 1.1%, respectively. Conclusion Our study showed that gastric ulcer was the most common cause of acute NVUGIB in the elderly, and hematemesis being the most common presentation. The predominance of low-risk peptic ulcers and the administration of early endoscopic intervention could have contributed to favorable outcomes, despite the majority of patients falling into moderate-risk categories. Future prospective studies with longer follow-up periods and multiple centers would be valuable to validate these findings.

Exocrine pancreatic insufficiency (EPI) can affect individuals with a wide range of diseases. Despite the publication of multiple international guidelines, the prescribing practices vary across the globe. The present study was done with an aim to assess how doctors in India evaluate and manage EPI, focusing on usage of pancreatic exocrine replacement therapy (PERT) and barriers to its use. This was a cross-sectional questionnaire-based survey using Google forms. Doctors practicing gastroenterology were invited using email, social media networks to participate voluntarily. Trainees were excluded to ensure that the responses reflected independent clinical practice. The questionnaire was designed to assess the following domains: evaluation of EPI, use of PERT, response to therapy, strategies for non-response and perceived barriers to therapy. Total 586 doctors were approached for the questionnaire survey between May 2023 and January 2024. Responses were received from 520 doctors, eight were excluded as they were still in training. Among the doctors most were gastroenterologists, in private practice with a mean age of 42.2 (SD 9.4) years. Fecal elastase-1 appeared to be the most popular test for testing EPI. The most common indication for starting PERT was symptomatic EPI. Approximately 50

Background and Purpose: COVID-19 infection has been associated with arterial and venous thrombosis, including acute mesenteric ischemia (AMI). Information on AMI during the COVID-19 pandemic is very limited; coagulopathy related to the gastrointestinal system manifests as AMI, a severe complication due to its high morbidity and poorer outcomes. This project aimed to study the clinical profile and outcomes of patients with AMI during the COVID-19 pandemic and compare them with a similar group of patients with AMI prepandemic. Methodology: All patients admitted with AMI between March and December 2020 and March and December 2019 were included. Data were collected from electronic hospital records. Results: Twenty-six patients during the pandemic and 15 in the prepandemic era were admitted with AMI, indicating a 73.3% increase in admissions during the pandemic. Baseline characteristics, coagulation parameters, and overall mortality were similar between both the groups. Venous ischemia rates were 53.8% when compared to 40% in the prepandemic era. Prothrombotic rates were 11.5% when compared to 26.6% during the prepandemic era. During the pandemic, bowel resection rates were 93% (14/15), and backout rates were 7% (1/15) when compared to 60% (6/10) and 40% (4/10), respectively, during the prepandemic era. Conclusions: More AMI was seen during the COVID-19 pandemic, with lower rates of preexisting hypercoagulable states. However, rates of nonoperative management and small bowel resection were higher, with fewer backouts. Deranged coagulation was associated with a higher mortality.

Inflammatory bowel disease (IBD) has an increased risk of venous thromboembolism (VTE), with factors such as hospitalization and surgery enhancing this risk. This study was aimed at evaluating rotational thrombo-elastometry (ROTEM) for assessing blood coagulation status in ulcerative colitis (UC) and determining its relationship with disease severity and response to treatment. This was a prospective age and sex-matched study with 60 patients each in UC and irritable bowel syndrome groups, the latter being controls. Clinical details and blood investigations, including ROTEM (clotting time [CT], clot formation time [CFT], alpha angle [AA], maximum clot firmness [MCF], maximum lysis [ML]) and D-dimer, were collected, analyzed and compared between the two groups. A hypercoagulable state was defined by Kaufmann et al. as having two or more of the following: short CT and/or CFT time, increased AA and increased MA. There were 60 patients with UC (age, 38.6 ± 11.64 years; 44 males). The UC group significantly had more patients with hypercoagulable ROTEM than the control group (66.7

Groove pancreatitis (GP) is a form of pancreatitis that affects the pancreaticoduodenal groove area, which lies between the head of the pancreas, the second part of the duodenum and the distal bile duct, presenting as abdominal pain and gastric outlet obstruction. In this study, we present the clinical and radiological characteristics of individuals diagnosed with groove pancreatitis at our center and discuss the use of a conservative treatment approach in managing GP. The data of patients with groove pancreatitis treated at our center between January 2012 and December 2021 was analyzed. The clinical, laboratory and radiological features were recorded and patients were followed up for at least six months in the pancreatic clinic by a specialist doctor. Fifty patients were included in the study. Most patients were males (98

Background and Objectives: Eosinophilic esophagitis (EoE) is increasingly recognized worldwide, but data from India remain limited. This study aimed to assess the hospital-based prevalence of EoE in patients with chronic reflux symptoms at our institution, a tertiary care center in South India, and identify potential predictors for the same. Materials and Methods: We enrolled adult patients with reflux symptoms persisting for 3 or more months from January 2022 to June 2022. Patients underwent symptom assessment using validated questionnaires, upper gastrointestinal endoscopy with systematic documentation using the EoE Endoscopic Reference Score (EREFS), and standardized esophageal biopsies. EoE was diagnosed based on ≥15 eosinophils per high-power field alongside esophageal dysfunction symptoms. Results: Among 197 included patients (62.4% male, mean age 41 ± 12 years), EoE was diagnosed in five patients, yielding a prevalence of 2.54% (95% confidence interval: 1.09–5.8). Atopic conditions were present in 28% of all patients. In EoE patients, endoscopic abnormalities were found in 40%. On multivariate analysis, elevated EREFS score (odds ratio [OR]: 2.65, P = 0.04) and presence of microabscesses (OR: 21.07, P = 0.02) independently predicted EoE. An EREFS score >0 showed high specificity (90%) but moderate sensitivity (40%) for diagnosing EoE. Conclusions: In our hospital-based patient population with chronic reflux complaints, EoE prevalence was 2.5%. Given this relatively low prevalence, routine esophageal biopsies may not be cost-effective. Instead, a targeted biopsy approach is recommended for patients with typical endoscopic findings or specific symptoms like dysphagia.

BACKGROUND:Splanchnic venous thrombosis (SVT) involving veins in the vicinity of the pancreas is a significant complication of acute pancreatitis (AP). The natural history of SVT, especially the rates of recanalization, is poorly understood. AIM:This study aimed to evaluate the natural history of SVT in AP, with a focus on recanalization rates and identifying predictors of nonrecanalization. MATERIALS AND METHODS:This was an observational study in which patients with SVT in the setting of AP were included. Patients were followed for at least 6 months. Recanalization was assessed using Doppler ultrasound or CT imaging, and outcomes were classified as complete recanalization, partial recanalization, or nonrecanalization. Statistical analysis was done to identify predictors of nonrecanalization. RESULTS:Among 814 patients with AP, 92 (11.3%) developed SVT. Of these, 70 met the inclusion criteria. The mean age was 38.1 years, with 92.8% male predominance. Alcohol was the most common etiology (62.8%). The retropancreatic splenic vein was the most commonly affected vessel. At follow-up, complete recanalization was observed in 54.3% of cases, partial recanalization in 2.9%, while 42.8% showed no evidence of recanalization. Therapeutic anticoagulation was administered to 20% of patients without significantly influencing recanalization rates. A BISAP score ≥2 was a significant predictor of nonrecanalization ( P =0.007). CONCLUSION:Most patients with SVT following AP demonstrate spontaneous recanalization. A key predictor for nonrecanalization is the severity of pancreatitis.

Background: The pathophysiology of Acute Pancreatitis (AP) may be complicated by endothelial activation. von Willebrand Factor (vWF)- ADAMTS13 axis is a marker of endothelial activation. The study aimed to investigate the axis in AP, comparing it in patients with and without persistent organ failure (OF), with and without pancreatic necrosis, and correlating it with the standard severity scores (CRP, APACHE II, BISAP, SOFA, and qSOFA) Methods: vWF-Antigen (vWF:Ag), vWF-Collagen-Binding-Assay (vWF:CBA), and ADAMTS13 activity (ADAMTS13:act) levels were measured within 5 days of symptom onset in consecutive patients (n = 98), who were admitted with a first episode of AP (Dec 2021-May 2023). Results: Of the 98 patients admitted with AP, 78(79.6 %) had no or transient OF; 20(20.4 %) had persistent OF. Age was comparable (43.73 +/- 15.36 vs 38.65 +/- 13.69) [mean +/- SD](years), and males were predominant in both groups (70.5 % vs 80 %). Patientswith persistent OF had higher vWF:CBA(%)[323(279-486.5) vs 199.5(159.1-295.75)] and lower ADAMTS13:act(%)[35.4(23.8-56.85) vs 56.35(44.1-71.9)] [median (25th- 75th percentile)](P = 0.001) than those with no or transient OF. Patients with pancreatic necrosis (n = 19) had lower ADAMTS13:act(%)[42.79 +/- 18.69] than those without pancreatic necrosis (n = 18) [62.49 +/- 22.64] (P < 0.01). ADAMTS13:act had a negative correlation(r =-0.2), whereas vWF:Ag and vWF:CBA had a positive correlation (r = 0.2) with the standard severity scores (P < 0.05). ADAMTS13:act could predict pancreatic necrosis [AUROC-0.737, P < 0.05] and persistent OF [AUROC-0.746, P < 0.001], while vWF:CBA could predict persistent OF [AUROC- 0.73, P < 0.001]. Conclusion: vWF-ADAMTS13 axis helps to predict severe disease and is associated with poor outcomes in acute pancreatitis. (c) 2024 IAP and EPC. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Bile cultures are often sent with blood cultures in patients with acute bacterial cholangitis. To assess the yield of blood and bile cultures in patients with cholangitis and the clinical utility of bile cultures in guiding therapy. All patients diagnosed with cholangitis, based on the Tokyo 2013/2018 guidelines were recruited retrospectively over ten years. The clinical and investigation details were recorded. The results of bile and blood cultures including antibiotic sensitivity patterns were noted. The concordance of microorganisms grown in blood and bile cultures and their sensitivity pattern were assessed. A total of 1063 patients with cholangitis were included. Their mean age was 52.7 ± 14 years and 65.4

Background:The role of rapid on-site evaluation (ROSE) for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is debatable. In this study, we aimed to compare the diagnostic yield of ROSE vs. non-ROSE in solid pancreatic lesions.Methods:This retrospective single-center study included patients undergoing EUS-FNA of solid pancreatic lesions from 2019-2021. Patients with cystic lesions, those undergoing fine-needle core biopsy, those undergoing repeat procedures, and patients with non-diagnostic smears with less than 6-month follow up were excluded. The diagnostic yield, need for repeat procedures and number of passes required with and without ROSE were analyzed in these patients.Results:Of the 111 patients included, 56 underwent ROSE. The majority of lesions were malignant in both groups (79.6% ROSE vs. 75% non-ROSE). The diagnostic yield was 96.4% in the ROSE group and 94.5% in the non-ROSE group. Repeat samples were needed in 1 ROSE and 2 non-ROSE patients. The median number of passes made was significantly fewer in the ROSE group (3.5, interquartile range - 3,4) compared with the non-ROSE group (4, interquartile range - 3,5) P=0.01. However, the frequency of procedure-related complications was similar in both groups.Conclusion:The utilization of ROSE during EUS-FNA of solid pancreatic lesions does not affect the diagnostic yield or the need for repeat samples, but reduces the number of passes needed for acquiring samples.

Background Ultrasound-guided (USG) erector-spinae plane block (ESPB) may be better than intravenous opioids in treating acute hepatopancreaticobiliary (HPB) pain in the ED. Methods This open-label randomised controlled trial was conducted in the ED of a tertiary-care hospital between March and August 2023. All adult patients with severe HPB pain were recruited during times that a primary investigator was present. Unconsenting patients, numeric rating scale (NRS) ≤6, age ≤18 and ≥80 years, pregnant, unstable or with allergies to local anaesthetics or opioids were excluded. Patients in the intervention arm received bilateral USG ESPB with 0.2% ropivacaine at T7 level, by a trained ED consultant, and those in the control arm received 0.1 mg/kg intravenous morphine. Pain on a 10-point NRS was assessed by the investigators at presentation and at 1, 3, 5 and 10 hours after intervention by the treatment team, along with rescue analgesia requirements and patient satisfaction. Difference in NRS was analysed using analysis of co-variance (ANCOVA) and t-tests. Results 70 participants were enrolled, 35 in each arm. Mean age was 40.4±13.2 years, mean NRS at presentation in the intervention arm was 8.0±0.9 and 7.6±0.6 in the control arm. NRS at 1 hour was significantly lower in the ESPB group (ANCOVA p<0.001). At 1, 3, 5 and 10 hours, reduction of NRS in the intervention arm (7±1.6, 6.7±1.9, 6.6±1.8, 6.1±1.9) was significantly greater than the control arm (4.4±2, 4.6±1.8, 3.7±2.2, 3.8±1.8) (t-test, p<0.001). Fewer patients receiving ESPB required rescue analgesia at 5 (t-test, p=0.031) and 10 hours (t-test, p=0.04). More patients were ‘very satisfied’ with ESPB compared with receiving only morphine at each time period (p<0.001). Conclusion ESPB is a promising alternative to morphine in those with HPB pain. Trial registration number CTRI/2023/03/050595.

Introduction: Acute upper gastrointestinal bleeding (AUGIB) is a frequent life-threatening scenario in everyday clinical practice. We undertook a study to understand the role of bedside endoscopy for significant AUGIB in sick patients unstable to be shifted, their etiologies, and major outcomes at our institution.

BackgroundEarly-onset idiopathic chronic pancreatitis (EOICP) is a disease that affects young individuals. Data on pregnancy outcomes in EOICP are limited.AimTo assess the pregnancy outcomes in patients with EOICP and the effect of pregnancy on the course of EOICP.MethodsPatients with EOICP with disease onset before their pregnancy were recruited. Data regarding demographic variables, disease duration, pregnancy outcomes, and course of illness were noted.Results50 patients were included in the study contributing to a total of 86 pregnancies. The mean age of onset of symptoms and at the time of delivery was 17.95 (5.71) and 23.44 (4.28) years, respectively. Gestational diabetes (GD) and gestational hypertension (GH) noted in one (1.5%) each. 3 (4.5%) pregnancies were preterm. 19 (22.1%) pregnancies did not have successful outcomes (7 (8.1%) were induced abortions). 12 (15.2%) pregnancies had spontaneous pregnancy losses. 8 (10.1%) were spontaneous abortions and 4 (5.1%) were stillbirths. Of 67 successful pregnancies, 33 (49.3%) pregnancies were delivered by LSCS. Compared to average rates of LSCS in India, this was significantly higher (21.5% vs 49.3%-p <= 0.001). The average birth weight was 2.87 (0.48) kg. There was one (1.5%) neonatal death. Compared to the published Indian data, there was no significant difference in the incidence of spontaneous pregnancy losses, GD, GH, preterm labor, and birth weight.Pancreatic pain was reported by 21 (42%) women in total 27 (31.4%) pregnancies. There was no difference in maternal or fetal outcomes between pregnancies with or without pancreatic pain. There were no pancreatitis-related complications reported during the pregnancies.Results50 patients were included in the study contributing to a total of 86 pregnancies. The mean age of onset of symptoms and at the time of delivery was 17.95 (5.71) and 23.44 (4.28) years, respectively. Gestational diabetes (GD) and gestational hypertension (GH) noted in one (1.5%) each. 3 (4.5%) pregnancies were preterm. 19 (22.1%) pregnancies did not have successful outcomes (7 (8.1%) were induced abortions). 12 (15.2%) pregnancies had spontaneous pregnancy losses. 8 (10.1%) were spontaneous abortions and 4 (5.1%) were stillbirths. Of 67 successful pregnancies, 33 (49.3%) pregnancies were delivered by LSCS. Compared to average rates of LSCS in India, this was significantly higher (21.5% vs 49.3%-p <= 0.001). The average birth weight was 2.87 (0.48) kg. There was one (1.5%) neonatal death. Compared to the published Indian data, there was no significant difference in the incidence of spontaneous pregnancy losses, GD, GH, preterm labor, and birth weight.Pancreatic pain was reported by 21 (42%) women in total 27 (31.4%) pregnancies. There was no difference in maternal or fetal outcomes between pregnancies with or without pancreatic pain. There were no pancreatitis-related complications reported during the pregnancies.ConclusionThe present study shows that mothers affected with EOICP have pregnancy outcomes similar to healthy women in India.