The effect of antidepressants on serum melatonin levels in endogenous depression

OBJECTIVES

1. To assess the serum melatonin levels in patients suffering from endogenous depression and the effect of pharmacological therapy. 2. To establish possible correlation between the height from the mean sea levels and the patients suffering from endogenous depression.

METHODS

Forty patients, 18 males and 22 females, suffering from endogenous depression (according to DSM IV criteria), aged 48.3 +/- 12.32 years were evaluated and serum melatonin level was assayed between 9-10 am. They were not on any drugs/medication, which was likely to alter serum melatonin level for one month prior to study. The serum melatonin levels were assessed at 0, 3, 6 and 12 months while they were continued to be treated. It also included 30 controls of the matched age and sex and satisfying the inclusion criteria. The possible correlation was also studied between the serum levels and the height from the mean sea level at which the patients reside.

RESULTS

The two groups were comparable at the beginning of the study. The serum melatonin levels started falling from three months onwards (from 9.99 +/- 3.59 pg/nl to 8.49 +/- 3.16 pg/nl; p < 0.05). However, the decline was maximum between 3-6 months (from 8.49 +/- 3.16 to 5.589 +/- 1.96; p<0.05). The serum levels became stationary beyond six months. Highest melatonin levels were observed in patients residing at an altitude of 6001-8000 metres (14.32 +/- 2.68 pg/ml; p < 0.05) followed by 4,001-6,000 meters (11.137 +/- 2.62 pg/ml; p < 0.05). However, the levels were almost stationary below 4,000 metres (p = 0.05).

CONCLUSION

1. Higher serum melafonin values were observed in patients suffering from endogenous depression. 2. Morning serum melatonin values decreased with pharmacological therapies. 3. Patients living at higher altitudes had higher serum values for the hormone.

Benign signet ring cell change with multilayering in the gallbladder mucosa--a case report

We describe a case of benign signet ring cell change in the gallbladder mucosa. On histopathological examination of H&E-stained sections, the gallbladder epithelium showed multilayering. The epithelial cells were large, columnar to polygonal with a small round basal or eccentric nucleus and vacuolated cytoplasm, giving them a signet ring appearance. There was no nuclear atypia, hyperchromatism or mitotic activity. The cells showed uniform positivity with mucicarmine, PAS and Alcian blue stains. The cytoplasmic vacuolations were negative for fat stains (Oil red O and Sudan IV). On immunohistochemistry, the cells showed positivity with antibodies for pancytokeratin (PCK) and epithelial membrane antigen (EMA). A diagnosis of benign signet ring cell change with multilayering in the gall bladder mucosa was made. Thoroughly reviewing the literature, we found only one case of benign signet ring cell aggregates in the gallbladder mucosa documented earlier. The lesion is hereby reported because of the unique histomorphology and the diagnostic dilemma which can occur as a malignant change in situ has to be excluded.

Dysembryoplastic neuroepithelial tumors: report of 10 cases from a center where epilepsy surgery is not done

Dysembryoplastic neuroepithelial tumor (DNT) is a recently recognized tumor entity with distinctive clinicopathological features and an excellent long-term prognosis. We report 10 cases of DNT out of neurosurgical specimens sent for histopathological examination since 1994. Epilepsy surgery is not done at our center, and all the cases were sent with a clinical diagnosis of glioma. On histopathological examination, all the 10 cases contained the specific glioneuronal element. In 6 cases, glial nodules were noted in addition. This study therefore reports 4 cases of simple DNT and 6 cases of complex DNT. There was no nuclear atypia or mitosis in any of the cases. Proliferative index by PCNA varied from negative to <1%. It is very important to recognize this entity, as surgery cures the patient, and radiotherapy or chemotherapy is not required.

Clinical implications of viral activity in dual infection with hepatitis B and C in chronic liver disease

BACKGROUND

There is limited information on the clinical and biochemical profile of chronic liver disease due to dual infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. There are variable reports on the severity of liver disease in dual infections. This is important, from clinical and therapeutic point of view. The present study analyzes liver disease in dual infections as compared to HBV and HCV infection present alone.

MATERIAL AND METHODS

Out of 186 histologically proven non-alcoholic chronic liver disease patients, 30 (16.1%) were serologically diagnosed to be HBV and HCV dual infection (Group A, n=30). The clinical profile of these patients was compared with consecutively seen HBV related (Group B, n=30) and HCV related chronic liver disease (Group C, n=30) patients. Patients with dual infection were further grouped based on predominant HBV or HCV viral activity.

RESULTS

Patients with dual infection were younger than those with chronic HCV infection (38.4 +/- 14.4 vs. 45.9 +/- 14.7 years, p < 0.05); with male predominance (p=0.06). Patients with chronic HCV infection more often presented with low-grade fever than dual infection group (60% vs. 30%, p < 0.05). Ascites and variceal bleeding were common presentations of HBV related cirrhosis. Patients with dual infection had significantly more deranged liver functions. The duration of illness was shorter in these patients compared with chronic HCV (2.9 +/- 1.6 vs. 7.3 +/- 1.4 year, p < 0.05). When patients with dual infection were subgrouped on HBV DNA and HCV RNA positivity, there was a tendency for increased biochemical derangement with active HBV infectionity.

CONCLUSIONS

Our results highlight the fact that patients with HBV and HCV dual infection related chronic liver disease have a more aggressive course. There is a tendency for a more severe liver disease when HBV is active in the dual infection group.

Histoplasmosis of the liver: a rare case

A 39 year old male presented with history of fever and jaundice for 3 months. A liver biopsy showed numerous ovoid fungal bodies around 5 mm in size in the macrophages and Kupffer cells. A diagnosis of hepatic histoplasmosis was made which is an uncommon entity in our country.

Combined low-dose intravesical immunotherapy (BCG + interferon alpha-2b) in the management of superficial transitional cell carcinoma of the urinary bladder: a five-year follow-up

Between July 1994 and July 2001, all patients with superficial transitional cell carcinoma (TCC) of urinary bladder (pT1 and pTa), 7 days after undergoing transurethral resection of tumor were subjected to intravesical instillation of 60 mg BCG (Danish 1331) combined with 5 million IU interferon alpha-2b (Intron-A) mixed with 50 ml of physiological saline weekly for 8 weeks, then fortnightly for 8 weeks, then monthly for 8 weeks, followed by maintenance dose at the end of the 9th, 12th, 18th, 24th months. Each instillation was for 2 h duration with an average follow-up period of 60 months. At the end of the 1st year of follow-up 84% of patients had no tumor recurrence which dropped to 36% at the end of 5-year follow-up, while no incidence of disease progression at the end of the first year was recorded but was 20% at the end of 5 years, thereby resulting in a disease progression-free 5-year interval in 80% of our patients. Drug tolerance was excellent with a very low incidence of toxicity.

Intramedullary cavernous haemangioma

A 35 years old male presented with episodic weakness of left upper limb followed by gradually progressive neurological deterioration. MRI revealed an intra medullary cervical cord angiomatous lesion. Histopathology revealed it to be cavernous haemangioma. A complete surgical removal of the haemangioma was carried out.

Autoimmune hepatitis in the Indian subcontinent: 7 years experience

BACKGROUND

Autoimmune hepatitis (AIH) is presumed to be rare in India. The present prospective study was carried out to determine the prevalence, clinical, biochemical and histological profile of patients with AIH in India.

METHODS

Consecutive patients with chronic liver disease suspected to be AIH, were screened for antinuclear antibodies (ANA), antismooth muscle antibodies (ASMA), antimitochondrial antibody (AMA), and anti-liver kidney microsomal antibodies (anti-LKM-1). Serum protein electrophoresis and liver biopsy were done. Autoimmune hepatitis was diagnosed according to the International Autoimmune Hepatitis Group criteria.

RESULTS

Fifty of 1358 (3.43%) patients with chronic liver disease were diagnosed as autoimmune liver disease; 39 with AIH, two with overlap syndrome, five with primary sclerosing cholangitis, and four with primary biliary cirrhosis. Twenty-nine patients were categorized as definite AIH and 10 as probable AIH. Autoimmune hepatitis was common in females (males : females 1:3), with a mean age of 31 +/- 17 years. Patients often presented with fatigue, jaundice and anorexia. Skin lesions (58%), joint symptoms (30%), and menstrual abnormalities (26%) were not uncommon. Mildly elevated alkaline phosphatase and hyper gamma globulinemia were seen in 78 and 91% patients, respectively. Eighty percent of patients were type I AIH, while 20% of cases remained unclassified. Histopathological changes included piecemeal necrosis (100%), plasma cell infiltration (91%), rosette formation (82%), and cirrhosis (76%). Overall mortality was 25% during a mean follow up of 15.7 +/- 17.0 months.

CONCLUSIONS

Our results clearly demonstrate that: (i) AIH is not uncommon in India; and (ii) while the profile and spectrum of AIH resembles that seen in the West, Indian patients present late, often in a cirrhotic state.

Clinical, biochemical and histological profile of nonalcoholic steatohepatitis

BACKGROUND

Nonalcoholic steatohepatitis (NASH) has often been described in obese women with diabetes and/or hyperlipidemia. We evaluated the clinical, biochemical and histological profile of NASH.

METHODS

52 patients with persistently elevated ALT (>40 IU/L) for >6 months with no history of significant alcohol consumption and negative serological work-up for hepatitis B and C and HIV were enrolled. Twenty-five patients were diagnosed as having NASH and their clinical, biochemical, and histological profile was evaluated.

RESULTS

Of the 25 patients with NASH (mean age 33 years), 24 were men. Three were obese, seven had hyperlipidemia and two had impaired glucose tolerance. Thirteen patients presented with pain in the right hypochondrium, three with fatigue and weakness, and nine were asymptomatic. No patient had evidence of portal hypertension or liver cell failure. Mild elevation of ALT was the most common biochemical abnormality. Twenty-three of the 25 patients had ALT/AST ratio >1.0. Liver histology revealed macrovesicular steatosis in all, with mild inflammatory activity in the majority (70%). Fibrosis was seen in 12 patients-portal fibrosis in six, periportal fibrosis in three and bridging fibrosis in another three patients. None of the patients had features of cirrhosis. None of the factors was found to be associated with fibrosis except serum AST level, which was significantly higher in patients with fibrosis as compared to those without (89 [52] vs. 54 [18] IU/L; p<0.05).

CONCLUSIONS

NASH is often seen in men, in the absence of obesity, diabetes and hyperlipidemia, and its severity is better assessed by liver histology than clinical assessment.

Periampullary gangliocytic paraganglioma

A33-year-old man presented with features of obstructive jaundice. Enterohepatic retrograde cholangiopancreatography examination revealed a periampullary growth. After pancreatoduodenectomy, histologic examination of the growth revealed three elements: a spindle cell element, large ganglion cells, and smaller paraganglioma-like cells arranged in small nests and groups. A diagnosis of gangliocytic paraganglioma was given. Gangliocytic paraganglioma is a rare benign duodenal tumor, with uncertain histogenesis. It is possible to identify the three components that are essential for its diagnosis on routine hematoxylin and eosin sections without the use of immunohistochemical markers. Because this lesion may present clinically as a periampullary carcinoma, it is important to recognize and diagnose this rare, but benign, entity.

Polo-like kinase is required for the fragmentation of pericentriolar Golgi stacks during mitosis

The pericentriolar stacks of Golgi cisternae undergo extensive reorganization during mitosis in mammalian cells. GM130 and GRASP65 (Golgi reassembly stacking protein of 65 kDa) are Golgi-associated proteins that are targets of mitotic kinases, and they have also been implicated in the reorganization of the Golgi structure during cell division. Previous studies have reported that mitogen-activated protein kinase kinase-1 (MEK1) and Cdc2 protein kinases are involved in these dynamic changes in the Golgi structure. More recently, the mitotic polo-like kinase (Plk) has been shown to interact with and phosphorylate GRASP65. Here, we provide evidence that Plk is involved in the mitosis-specific fragmentation of the Golgi apparatus. The addition of kinase-defective Plk or immunodepletion of Plk disrupts the fragmentation process. Furthermore, Golgi fragmentation is inhibited by the addition of either full-length or truncated GRASP65. These findings suggest that phosphorylation of GRASP65 by Plk may be a critical event in the reorganization of the Golgi structure during mitosis.

A preliminary report on the role of yoga asanas on oxidative stress in non-insulin dependent diabetes mellitus

Nineteen subjects of non-insulin dependent diabetes mellitus (NIDDM) between the age group of 30-60 yrs were studied to see the effect of specific yoga asanas on fasting and postprandial blood glucose (FBG, PPG), serum malondialdehyde (MDA) and glycosylated hemoglobin (HbA(1)) in addition to drug treatment and diet control. The duration of diabetes ranged from 1-10 years. Patients with renal, cardiac and proliferative retinal diseases were excluded from the study. The same patients served as their own control. Subjects were called in the morning to the cardio-respiratory laboratory and were given training by a yoga expert. Yoga asanas included Suryanamskar, Tadasan, TriKonasan, Padmasan, Pranayam, Paschimottanasan, Ardhmatsyendrasan, Pavanmukthasan, Sarpasan and Shavasan. The asanas were done every day for 40 days for 30-40 min. FBG, PPG, serum MDA and HbA(1) were estimated before and after 40 days of yoga asanas regimen. Significant reduction was seen in FBG from 220 mg/dl to 162 mg/dl, PPG from 311 mg/dl to 255 mg/dl, MDA from 6 nmol/l to 3 nmol/l and HbA(1), from 8.8% to 6.4%. Subjects felt better and were relieved of their stresses and had an improvement in their day to day performance. The decrease was statistically significant (p<0.0001 for FBG and PPG, p<0.001 for MDA and for HbA(1)).

Angio-access for haemodialysis--current perspective

Vascular access for haemodialysis has seen many developments in recent times. Double lumen catheters introduced into wide bore veins have replaced the traditional Scribner shunt as temporary access thus reducing the complications and morbidity associated with it. Cuffed tunnelled internal jugular catheters and synthetic arteriovenous (AV) grafts usually made of polytetrafluoroethylene are the new additions to the vascular access armamentarium, but the AV fistula introduced in 1966 still remains the life-line for chronic haemodialysis patient. However, in elderly and diabetic patients, synthetic AV grafts are beneficial. The added advantage of synthetic grafts is short maturation time and multiple potential access sites. Access failure in 80% cases is due to venous stenosis and thrombotic episodes while infections or other complications are there in 20% cases. The complications of vascular access are not only a major cause of morbidity in haemodialysis patients but a major cost for the end stage renal disease programme. In western countries, access related morbidity accounts for almost 25% of all hospital stays for end stage renal disease patients and may contribute to as much as 50% of all hospitalisation cost. Access salvage includes prospective monitoring and treatment of outflow stenosis. The direct intra-access measure of blood flow by ultrasound dilution and duplex colour flow Doppler technique is the ideal method detecting venous outflow stenosis; however, conventional and digital subtraction angiography has an advantage, that total vasculature and blood flow may be visualised. The various treatment modalities for outflow stenosis include use of percutaneous transluminal angioplasty, stents and surgical correction. The lyses of secondary thrombosis can be done by surgical, medical and mechanical thrombolysis. The various methods being used to prevent graft stenosis include use of dipyridamole and radiation. The gene therapy holds promises for the future.

Radiation-induced and chemotherapy-induced pulmonary injury

The management of cancer has continued to advance with the development of new chemotherapeutic agents and improved techniques of radiation therapy. Although new therapeutic approaches have improved survival in cancer patients, each form of intervention has the potential to produce adverse effects on normal host tissues. Some of these toxicities may be accentuated with combined modality therapy. The use of chemotherapy and radiation therapy, alone or combined, can be associated with clinically significant pulmonary toxicity. The pulmonary toxic effects of chemotherapy can be divided into (1) early onset, resulting in interstitial lung injury, and (2) late onset, with pulmonary fibrosis as a sequela. These toxic effects are frequently dose related but may be enhanced by radiation therapy. Similar to chemotherapy, radiation can produce acute or chronic lung injury depending on dose rate, duration, preexisting lung disease, and concomitant steroid use. Acute radiation injury typically occurs 2 weeks to 3 months after treatment and is usually limited to the irradiated field. Mild injury often resolves without treatment, whereas more serious injury results in fibrosis 6 to 12 months after treatment. Histopathologic evaluation of acute lung injury is no different from drug-induced injury, and damage to vascular endothelial cells and alveolar lining cells is seen. This article reviews and provides an update on the clinically important chemotherapy and radiation-induced pulmonary injuries, the pathologic mechanisms, where known, and the treatment advances that have occurred in this field.

The ablation of atrial fibrillation with the loop catheter design: what we have learned from the animal model

Ablation of chronic atrial fibrillation (AF) with the use of transcutaneous catheter ablation is yet to become a clinical tool. This article summarizes the development of the technology and the technique for the ablation of AF that was tested on the rapidly paced AF dog model. The current ablation technology using the standard ablation technique used in humans is not suitable for the creation of transmural contiguous linear lesions, and such technology is subjecting the patient to the prolonged procedures with considerable risk of complication. The use of the loop catheter design or other designs of ablation technology, which is specifically targeted for the creation of linear lesions, should be developed if the catheter approach for the ablation of AF is to succeed. This article describes the data available for the loop catheter design that is currently undergoing human feasibility studies.

Geldanamycin inhibits NF-kappaB activation and interleukin-8 gene expression in cultured human respiratory epithelium

Geldanamycin is a benzoquinone ansamycin with multiple pharmacologic properties. Recent data demonstrated that geldanamycin conferred protection in an animal model of inflammation-associated acute lung injury. In the current study, we investigated the effects of geldanamycin on interleukin (IL)-8 gene expression and nuclear factor (NF)-kappaB activation. Geldanamycin inhibited tumor necrosis factor (TNF)-alpha-mediated IL-8 gene expression in A549 human respiratory epithelial cells as measured by enzyme-linked immunosorbent assay and Northern blot analyses. In cells transiently transfected with an IL-8 promoter-luciferase reporter plasmid, geldanamycin inhibited TNF-alpha-mediated luciferase activity. Geldanamycin inhibited TNF-alpha-mediated NF-kappaB activation as measured by electromobility shift assays and transient transfections with a NF-kappaB-dependent luciferase reporter plasmid. In contrast, geldanamycin did not affect TNF-alpha-mediated degradation of the NF-kappaB inhibitory protein IkappaBalpha and did not block nuclear translocation of the NF-kappaB p65 subunit as measured by Western blot analyses. Geldanamycin added directly to nuclear extracts of TNF-alpha-treated cells reduced the formation of the NF-kappaB/DNA complex. These results demonstrate that geldanamycin inhibits TNF-alpha-mediated IL-8 gene expression in A549 cells by inhibiting activation of the IL-8 promoter. The mechanism of inhibition involves inhibition of NF-kappaB activation, which is independent of IkappaBalpha degradation or p65 nuclear translocation. Geldanamycin appears to directly inhibit the ability of NF-kappaB to bind DNA. The observed in vitro effects could account, in part, for the anti-inflammatory properties of geldanamycin observed in vivo.

Brush cytology: an adjunct to diagnostic upper GI endoscopy

Endoscopic brush cytology (EBC) was performed in antral and duodenal brushings of children subjected to upper GI endoscopy for the detection of H. pylori (Hp) and trophozoites of Giardia lamblia (Glt) in addition to routine endoscopic grasp biopsy (EGB). It was hospital based prospective study. EBC was performed in children subjected to upper GI endoscopy with a sheathed cytology brush. Mucosal brushings were collected from antrum, body of the stomach and second or third part of duodenum by gently rubbing the surface of the brush with the mucosal wall in all the directions, brush withdrawn and brushings performed on a glass slide. The smears were placed in 95% ethyl alcohol and later examined for Glt and Hp using Giemsa and Hematoxylin & Eosin stain. EGB was taken from antrum, body of the stomach and duodenum from sites other than those used for brushings. One hundred and seventy children between 1-13 years (median age = 5 years) were subjected to upper GI endoscopy for malabsorption (n = 94), recurrent abdominal pain (n = 49), failure to thrive (n = 16) and recurrent vomiting/regurgitation (n = 11) and EBC was performed in addition to routine EGB. Thirty five children (20.4%) were colonized by Hp, 14 (8.2%) were detected to have Glt and in 6 cases (3.5%) both Hp as well as Glt were detected. Out of 41 cases colonized by Hp, 24 cases (58.5%) were detected by EGB and 27 cases (65.8%) were detected by EBC. Out of 20 children in whom Glt were detected from their duodenum, the detection was by EBG in 12 cases (60%) and by EBC in as many as 19 cases (95%). Comparison of EGB and EBC suggested that detection rates with EBC were higher than EGB. Detection by EBC was significantly higher for Glt than Hp. There were no complications attributed to EBC and procedure time for endoscopy was not significantly prolonged. On the contrary, detection of Hp and particularly Glt in higher proportion of cases with the help of EBC was helpful in their appropriate management. Our results suggest that EBC is a safe and useful tool to enhance the value of diagnostic endoscopic procedure when used in combination with routine EGB.

Investigation of the biological mode of action of clerocidin using whole cell assays

Clerocidin, a diterpenoid natural product, has been shown in vitro to inhibit DNA religation following cleavage by topoisomerase II. Herein, we characterize the efficacy and specificity of clerocidin in HeLa cells. Our results suggest that clerocidin recognizes topoisomerase II as its main intracellular target and binds to this enzyme prior to formation of the 'cleavable complex' with DNA. These pharmacological features attest to the promising chemotherapeutic potential of this natural product.

Profile of hepatocellular carcinoma in India: an insight into the possible etiologic associations

BACKGROUND

Several etiologic factors including hepatitis viruses, alcohol and aflatoxin have been implicated in the pathogenesis of hepatocellular carcinoma (HCC). There is, however, limited information from the Indian subcontinent.

METHODS

Seventy-four consecutive cases of HCC were studied. A detailed history, tests for hepatitis B virus (HBV; HBsAg, HBeAg, anti-HBe, IgG anti-HBc, anti-HBs and HBV-DNA), hepatitis C virus (HCV; anti-HCV and HCV-RNA) infection, liver histopathology and HBV-DNA integration by using Southern blot hybridization were studied. A p53 gene mutation was also studied by using PCR and single-strand conformation polymorphism.

RESULTS

Hepatocellular carcinoma patients were predominantly males (mean age 49.5 +/- 14.0 years). Portal hypertension and cirrhosis were seen in 56 (76%) patients, more often (P < 0.05) in viral marker positive cases. Forty-five percent of patients had features of hepatic decompensation at presentation. Evidence of HBV infection was present in 53 (71%) patients. Twenty-six (49%) of these patients had either HBeAg + ve, HBV-DNA + ve (n = 12), or HBsAg - ve, HBV-DNA + ve (n = 14) forms of HBV infection. Hepatitis B virus DNA integration in the liver tissue was seen in 10 of 17 (59%) patients. Infection with HCV alone was detected in three (4%) and dual HBV and HCV infection in six (8%) patients. A majority (78.5%) of the chronic alcoholics had associated viral infection. The etiology of HCC remained undetermined in 15 (20%) patients. The p53 gene mutations were detected only in three of 21 (14%) liver tissues. Aflatoxin toxicity, oral contraceptive use or metabolic disorder were not seen.

CONCLUSIONS

In India: (i) HBV infection is the predominant factor for the development of HCC, often related to mutant forms of HBV; (ii) a majority of the HCC patients have overt cirrhosis of the liver; and (iii) HCV and alcohol per se are uncommonly associated.

Proboscis lateralis of nose

A rare case of congenital malformation of the nose that was successfully corrected surgically is reported.

Gastrooesophageal reflux in infants and children in north India

OBJECTIVES

To assess the prevalence of gastrooesophageal reflux disease (GERD) as suggested by the symptom profile in babies ranging in age from 1 month to 2 years.

METHODS

Six hundred and two babies were recruited from the well baby clinic for hospital delivered babies and from the childrens OPD of a tertiary care hospital. Children with acute severe illness needing hospitalization were excluded from the study. The primary care taker of each baby was interviewed using a questionnaire (IGERQ) designed by Orenstein et al and the I-GERD score obtained was used to assess for likelyhood of GERD. Upper gastrointestinal (GI) endoscopy was carried out and an oesophageal biopsy was taken in clinically suspected cases of GERD (IGERD > 5).

RESULTS

Sixty one (10%) of the 602 subjects had an I-GERD score of > 5 suggestive of GERD. Regurgitation was present in 56 of these 61 subjects and also in 106 of the 541 normal subjects. 112 of 205 infants aged 1-6 months had regurgitation and 25 (22.2%) of these regurgitant infants had a score suggestive of GERD. Only 30 of the 202 infants aged 6-12 months and 20 of the 195 babies aged 12-24 months had regurgitation, however 14 of the 30 (46.5%) and 17 of the 20 (85%) regurgitant babies had an I-GERD score suggestive of GERD. Upper GI endoscopy was carried out in 31 babies with a score > 5 and endoscopic oesophagitis was detected in 16 (51.6%). Oesophageal biopsies were taken in 25 of these cases and showed histological evidence of reflux oesophagitis in 23 (92%).

CONCLUSION

GERD is fairly common under 2 years of age as observed by symptom evaluation using the I-GERD score. Regurgitation when present beyond 6 months of age with no other identifiable cause needs evaluation. Upper GI endoscopy and oesophageal biopsy is a useful means of demonstrating reflux oesophagitis in babies with a symptom profile suggestive of GERD.