The prevalence of celiac disease (CD) in Indian children is not well documented, with most of the studies focusing on high-risk groups and not the general population. This study was conducted to determine the prevalence of CD in asymptomatic school children of Jaipur, Rajasthan. A cross- sectional study was conducted among healthy school children of Jaipur. Demographic data, symptoms, and signs including dermatological examination were recorded. The screening for CD was done by ELISA-based anti–tissue transglutaminase (tTG) immunoglobulin A (IgA) antibody testing. Children with high IgA anti-tTG underwent upper gastrointestinal endoscopy for small bowel biopsy from the second part of the duodenum. This study involved 575 subjects, out of which, 6 (1.04%) were found to be IgA tissue transglutaminase antibody (IgA-tTG) positive. All 6 subjects were found to be having changes consistent with celiac disease on duodenal biopsy. To conclude, the calculated prevalence of celiac disease was 1 in 96 subjects.

Infected walled-off necrosis (WON) is a well-known complication of acute necrotizing pancreatitis, with higher mortality and morbidity. An infected or symptomatic WON requires drainage. Occasionally, WON may spontaneously fistulize into the gastrointestinal lumen or may rupture into the peritoneum. We describe a case of spontaneous rupture of WON in the transverse colon with uncomplicated spontaneous resolution, which is an extremely rare event.

We read with much interest the study conducted by Bhaskar et al1Bhasker B. Sachdev S. Marwaha N. Grover S. Singh T. Dhiman R.K. Knowledge and attitude regarding hepatitis B and C among blood donors and non-donors in north India.Journal of Clinical and Experimental Hepatology. 2018; 9: 318-323Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar titled “Knowledge and Attitude Regarding Hepatitis B and C Among Blood Donors and Nondonors in North India.” The study showed knowledge of the prospective blood donor with regard to the risk factors for acquiring hepatitis B and C and the mode of spread through blood transfusion. This forms the basis of selection of a low-risk blood donor. Among the 1000 participants, including 2000 blood donors and 2000 nondonors, it was shown that neither the existing level of knowledge nor the attitude of both donors, as well as nondonors toward hepatitis B and C is adequate for being able to select a low-risk blood donor. We appreciate the authors of the present study for their commendable job in assessing the knowledge of voluntary blood donors and selection of low-risk blood donors to decrease the transmission of hepatitis B and C. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important public health problems with broad clinical manifestations, from asymptomatic infection, hepatitis to cirrhosis and hepatocellular carcinoma.2Tan Y.J. Hepatitis B virus infection and the risk of hepatocellular carcinoma.World J Gastroenterol. 2011; 17: 4853-4857Crossref PubMed Scopus (67) Google Scholar,3World Health Organization Hepatitis C.2014http://www.who.int/mediacentre/factsheets/fs164/en/Google Scholar To expand our knowledge regarding population prevalence of hepatitis B and C, we recently conducted a study to determine the prevalence of HBV and HCV among school children of urban and rural Jaipur. A total of 576 children were included. The mean age was 12.23 ± 7.24 years, of which 218 (37.84%) were men and 358 (62.15%) were women. Of these, 5 children were HbsAg positive, making the prevalence of hepatitis B 0.868%. Of these 5 children, two were men and three were women. All these 5 children were from rural Jaipur and none from urban Jaipur. All the children who were positive were >10 years old. Table 1 shows the distribution of hepatitis B and C positive cases by urban or rural background. The proportion of cases was higher in students from rural background compared with urban with a P value of 0.0253. The mean aspartate aminotransferase (AST) of HBsAg-positive subjects was 37 ± 7.16 U/L and mean alanine aminotransferase (ALT) of the subjects was 31.6 ± 8.16 U/L. None of the children were found to be anti HCV positive.Table 1Distribution of Hbsag Seropositivity According to Demographics.TotalHBsAg positiveHBsAg negative% PositiveP valueUrban20102010%O.247Rural37553700.868% Open table in a new tab In a population-based study conducted by Chowdhury et al4Chowdhury A. Santra A. Chakravorty R. et al.Community based epidemiology of Hepatitis B virus infection in West Bengal, India: prevalence of Hepatitis B e antigen-negative infection and associated viral variants.J Gastroenterol Hepatol. 2005; 20: 1712-1720Crossref PubMed Scopus (49) Google Scholar, 7653 subjects were screened and 2.97% tested positive for HBsAg. A study by Lodha et al5Lodha R. Jain Y. Anand K. Kabra S.K. Pandav C.S. Hepatitis B in India: a review of disease epidemiology.Indian Pediatr. 2001; 38: 349-371PubMed Google Scholar from New Delhi depicted the prevalence of HBV infection to be 1–2%. Our study showed a decline in prevalence of Hepatitis B compared with previous studies performed in North India in 2001 and 2005.4Chowdhury A. Santra A. Chakravorty R. et al.Community based epidemiology of Hepatitis B virus infection in West Bengal, India: prevalence of Hepatitis B e antigen-negative infection and associated viral variants.J Gastroenterol Hepatol. 2005; 20: 1712-1720Crossref PubMed Scopus (49) Google Scholar,5Lodha R. Jain Y. Anand K. Kabra S.K. Pandav C.S. Hepatitis B in India: a review of disease epidemiology.Indian Pediatr. 2001; 38: 349-371PubMed Google Scholar Effective vaccination may have contributed to this low prevalence. The low prevalence of HBV infection indicates the positive impact of routine infant hepatitis B vaccination, which was included in the National Immunization Program in 2007–08, in the prevention of transmission in the studied population. In our study, we also found Hepatitis B to be prevalent in rural Jaipur and no case was positive in urban Jaipur. This may be because of more education and awareness about the disease and better immunization in urban areas. The prevalence of hepatitis C in our study was 0%. In a population-based study performed by Chowdhury et al6Chowdhury A. Santra A. Chaudhuri S. et al.Hepatitis C virus infection in the general population: a community-based study in West Bengal, India.Hepatology. 2003; 37: 802-809Crossref PubMed Scopus (159) Google Scholar from West Bengal, seroprevalence of HCV antibody positivity was 0.87%. These results highlight the importance of prevention programs for children and adolescents, both to avoid risk behavior and to maintain the low prevalence of C among these groups of individuals. We hope in future more population based studies be conducted taking more number of study subjects. The authors have none to declare. The authors thank Mrs Meera Saxena and Mrs Mansi Saxena, principals of the rural and urban schools of Jaipur, respectively, for their assistance.

ABSTRACT Background: Capsule endoscopy (CE) has an established role in evaluating obscure gastrointestinal bleeding (OGIB). The aim was to know the diagnostic yield of CE and spectrum of OGIB. Materials and Methods: In this retrospective study, we evaluated all the patients with obscure gastrointestinal bleed using MiroCam capsule endoscope (IntroMedic, Seoul, Korea) between February 2014 and March 2018. Clinical data, ancillary investigations, and response to specific treatment were considered to confirm CE findings. Results: Out of 102 patients included in the study (mean age 54.5 ± 16.1 years, male: female ratio = 1.83:1) OGIB‑overt and OGIB‑occult was present in 46 and 56 patients, respectively. Diagnostic yield of CE was similar in both the groups (overt‑37/46, 80.4% versus occult‑37/56, 66.5%) (P ≥ 0.05), although there was trend to find more lesions in overt group. Overall positive diagnostic yield was 72.5%. Lesions detected were vascular malformations in 21 (20.5%), nonsteroidal anti‑inflammatory drug enteropathy in 13 (12.7%), small bowel ulcerations in 27 (26.4%), which were further divided into three subgroups (a) nonspecific ulcerations 11 (10.7%), (b) tubercular ulcer with/without stricture in 7 (6.8%) and (c) serpiginous ulcers and fissuring with cobble‑stone appearance suggestive of Crohn’s disease in 9 (8.8%), portal hypertensive enteropathy in 5 (4.9%), worm infestation (hookworms in 3, roundworms 1) in 4 (3.9%), and small bowel tumour in 1 (0.98%) patient. Overall, 56.7% patients were having definitive (P2) lesions (Saurin classification). Two patients had retention of capsule, but none developed intestinal obstruction. Capsule was removed with surgical intervention. Conclusion: CE has high diagnostic yield, relative safety and tolerability, and it is an important diagnostic tool for OGIB. Small bowel tuberculosis, Crohn’s disease and Worm infestation continue to be commonly recognized causes of OGIB in developing countries like India.

Background and Aims: Published data regarding correlation between quantitative HBsAg and HBV-DNA and its dependence on HBeAg status, have conflicting results. Thus we aimed to investigate correlation between quantitative HBsAg and HBV-DNA in treatment-naïve chronic hepatitis B patients. Methods: This was a prospective study evaluating treatment-naïve chronic hepatitis B patients conducted in department of Gastroenterology at our tertiary care centre between June 2016–May 2017. Demographic details and laboratory parameters like HBV-DNA, quantitative HBsAg, HBeAg status, SGOT, SGPT, total bilirubin, albumin were noted. HBV-DNA was measured by RT-PCR and serum quantitative HBsAg levels by Abott Architect Assay. Results: Out of total 90 treatment-naïve chronic hepatitis B patients (median age: 23 years, Interquartile range (IQR) 21.75–31.75 years, M:F ratio = 4.2:1), 24 patients were HBeAg positive and 66 were HBeAg negative. In the study group, median HBV-DNA was 1.1 × 103 (IQR 2.9 × 102–5.5 × 103) log10 IU/ml and median quantitative HBsAg 9.7 × 103 (IQR 4.5 × 103–1.4 × 104) IU/ml. There was a strong correlation between serum quantitative HBsAg levels and serum HBV-DNA in HBeAg positive group (r 0.961, p < 0.001) while amongst HBeAg negative patients there was no correlation (r −0.062, p = 0.622). Overall there was no correlation between serum quantitative HBsAg levels and serum HBV-DNA levels (r −0.048, p = 0.65). Conclusions: Quantitative HBsAg is more related with HBV-DNA levels in initial replicative phase than in later non-replicative phases and is less likely to replace serum HBV-DNA test in the low replicative stage of chronic hepatitis B. The authors have none to declare. TableTabled 1OverallHBeAg positiveHBeAg negativeP valueMedian (interquartile range)Median (interquartile range)Median (interquartile range)Age (years)23 (21.75–31.75)26 (21–40)23 (22–30)0.72*Male7357160.07 NSFemale1798Bilirubin (mg/dl)0.9 (0.7–1.1)3 (0.9–14)0.9 (0.8–1.0)0.00*Albumin (gm/dl)4.1 (4.0–4.2)4 (3.9–4.1)4.2 (4.1–4.2)0.58*AST (IU/L)71 (30–98)229.5 (30–476)63 (30.75–76)0.001*ALT (IU/L)40 (27.5–95)261 (28–398)33 (26–55)0.001*HBV DNA (log10 IU/ml)1.1 × 103 (2.9 × 102–5.5 × 103)5.5 × 107 (8.0 × 102–1.1 × 108)4.78 × 102 (6.8 × 101–3.3 × 103)0.00*qHBsAg (IU/ml)9.7 × 103 (4.5 × 103–1.4 × 104)1.2 × 104 (7.5 × 103–1.7 × 104)9.2 × 103 (4.3 × 103–1.3 × 104)0.062* Open table in a new tab

Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.

Background Endoscopic ultrasound (EUS) is a well-established modality in diagnosing and staging of various neoplastic and non-neoplastic lesions. Its accuracy further increases in the presence of an on-site cytopathologist. There is a paucity of data on diagnostic yield of EUS-guided fine needle aspiration cytology (FNAC) without an on-site cytopathologist. Methods Retrospective data were analyzed at SMS Medical College, Jaipur, from January 2014 to October 2015. All patients who underwent EUS-guided FNAC in the Department of Gastroenterology were included. Data related to demography, lesion parameters on EUS, and histology were analyzed. Results Two hundred patients (age 46.2±18.6, 144 male) were studied. EUS-FNAC slides from 162 (82%) were considered adequate by cytopathologist for the diagnosis of benign or malignant lesions. Slide preparation adequacy was 100% for mediastinal and renal and suprarenal masses, 87.06% for pancreatic, 73.46% for lymph nodes, and 88.88% for other lesions. Mean number of passes was 1.92±0.82. Conclusions Diagnostic yield of EUS-guided FNAC is high even in the absence of on-site cytopathologist .

Background Inflammatory bowel disease (IBD) has been associated with increased risk of osteopenia and osteoporosis. Several risk factors contribute to this; however, studies evaluating their association have conflicting results. Methods We conducted a cross-sectional study with prospective enrollment of adult ulcerative colitis patients attending the Gastroenterology Department of Sawai Man Singh Hospital, Jaipur Rajasthan between June 2015 and December 2015. Demographic data including age, gender, body mass index (BMI), disease duration, type of disease, prior steroid use and vitamin D levels were recorded and compared with bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). Results Of the 55 patients enrolled, 41 (74.5%) had abnormal BMD; out of this, 19 (34.5%) had osteopenia and 22 (40.0%) had osteoporosis. In univariate analysis, disease duration and history of steroid use were observed as statistically significant. However, on multivariate analysis, only duration of disease was found to be a significant independent predictor of low BMD. Age, gender, BMI, low levels of vitamin D and steroid usage were not associated with low BMD. Conclusion Prevalence of low BMD is common in Indian ulcerative colitis patients. Prolonged disease duration appears to be the major risk factor.

ABSTRACT Background and Aim: Helicobacter pylori is a major human pathogen. Its role in the pathogenesis of portal hypertensive gastropathy (PHG) is debated. The aim of this study was to evaluate the prevalence of this infection in patients with portal hypertension due to liver cirrhosis and its relation with severity of gastropathy. Patients and Methods: Sixty consecutive patients with liver cirrhosis were enrolled in the study. All patients were subjected to an upper gastrointestinal endoscopy (UGIE), and rapid urease testing for H. pylori was performed. The diagnosis and severity of PHG was evaluated on UGIE. ChildαTurcotteαPugh (CTP) and model for endαstage liver disease (MELD) scores were calculated to assess the severity of liver cirrhosis. Results: H. pylori infection was reported in 33 patients with overall prevalence 55%. The presence of H. pylori was observed in 26 (67%) cirrhotic patients with PHG compared to 7 (33%) cirrhotic patients without PHG. The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P = 0.0133, odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.298–12.325). Out of the 26 patients with PHG and H. pylori infection, 17 had severe PHG (65.3%) and 9 had mild PHG (34.6%) whereas 4 patients had severe PHG (30.8%) and 9 had mild PHG (69.2%%) in the group of H. pyloriαnegative patients. The difference was statistically significant (P = 0.04, OR: 4.25, 95% CI: 1.0188–17.729). Of the 39 patients with PHG, 21 (53.85%) had severe PHG and 18 (46.15%) had mild PHG. No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards CTP score (P = 0.76) and MELD score (P = 0.56). Conclusion: Our results showed a significant association between H. pylori infection and the occurrence and also the severity of gastropathy in patients with liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of gastropathy.

AIM:To determine long-term outcome of endoscopic management of pancreatic pseudocyst/walled-off pancreatic necrosis (WOPN) without necrosectomy.METHODS:One-hundred and sixty-five pancreatic pseudocysts/WOPN managed endoscopically over a period of 22 years were analyzed retrospectively for technical success, complications, and recurrence.RESULTS:Symptomatic 118 males and 47 females with mean age of 35.8 years were included. Alcohol was the most common etiology (41.2%). Transmural endoscopic drainage was done in 144 patients, while 21 patients underwent transpapillary drainage. All the patients were subjected to contrast computed tomography (CT) abdomen or routine/Doppler ultrasound. Endoscopic ultrasound was done in last 11 patients. One or two double pigtail 7 Fr stents were placed when clear watery fluid came out from cyst (130 patients, 78.8%), and nasocystic drainage (NCD) tubes were placed in addition to two 7 Fr stents when there were frank pus, thick dark fluid, or solid components inside the cyst (35 patients). All these patients settled on this treatment. Thirty-three of 35 patients of WOPN could be managed endoscopically without necrosectomy. Complications occurred in 9.2% of pseudocysts and 40% of WOPN. Thirty-five patients were followed up for more than 5 years (3 patients more than 10 years), and 130 patients were followed up for up to 5 years. Recurrence occurred in 8.1% of pseudocysts and 5.7% of WOPN.CONCLUSION:Majority of pancreatic pseudocysts/WOPN can be managed with endoscopic drainage without necrosectomy with high success, low complication, and recurrence rates.

Figure 2: Giant choledochal cyst displacing the stomach (S), duodenum, pancreas and colon (not seen in image) anteromedially with a normal liver.Incidentally detected ectopic ampulla of vater in the antrum in a patient of colonic tuberculosis