151
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Sehgal R, Bhatti HPS, Bhasin DK, Sood AK, Nada R, Malla N, Singh K. Intestinal myiasis due to Musca domestica: a report of two cases. Jpn J Infect Dis 2002; 55:191-3. [PMID: 12606827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Myiasis is the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host's dead or living tissue, liquid body substances, or ingested food. Intestinal myiasis is usually an accidental phenomenon, which occurs due to the ingestion of eggs or larvae present in food. Usually the patient is asymptomatic and the larvae are excreted harmlessly in the feces. In some cases, however, the passage of larvae may be associated with symptoms. The present paper describes two such cases.
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Affiliation(s)
- Rakesh Sehgal
- Department of Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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152
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Nagi B, Lal A, Kochhar R, Bhasin DK, Thapa BR, Singh K. Perforations and fistulae in gastrointestinal tuberculosis. Acta Radiol 2002; 43:501-6. [PMID: 12423461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Perforation and fistulae, though uncommon, are serious complications of gastrointestinal tuberculosis. Patients with acute tuberculous perforation are subjected to surgery, whereas localized perforation and fistulae with subtle clinical signs are detected by barium contrast examination. There has been no report on radiological series regarding the incidence of perforation and fistulae, detected by barium contrast studies. MATERIAL AND METHODS A retrospective analysis of barium contrast studies of 684 proven cases of gastrointestinal tuberculosis seen over a period of 15 years was done to detect the incidence of perforation and fistulae. RESULTS Fifty-two patients (7.6%) with localized perforation and fistulae were seen. Twenty-eight patients had evidence of perforation, and 24 patients showed fistulae formation. The most common site of perforation and fistulae was the small bowel followed by the colon. Associated abnormalities noted were ulcerations, strictures, nodular filling defects and extrinsic compression. CONCLUSION Perforation and fistulae along with other associated abnormalities of the gastrointestinal tract are suggestive of tuberculosis, particularly in a population predisposed to tuberculous infection.
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Affiliation(s)
- B Nagi
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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153
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Sud A, Ray P, Bhasin DK, Wanchu A, Bambery P, Singh S. Helicobacter pylori in Indian HIV infected patients. Trop Gastroenterol 2002; 23:79-81. [PMID: 12632975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Helicobacter pylori is a causative organism for chronic gastritis and associated with peptic ulcer disease. Infection may be asymptomatic as well. Human immuno-deficiency virus infection predisposes to a multitude of opportunistic infections, many of them resulting in gastrointestinal symptoms. We studied the prevalence of H pylori co-infection with HIV and its correlation with gastrointestinal symptoms in HIV infected patients. Seventy-three consecutive HIV infected patients presenting to the medical out patient department of Postgraduate Institute of Medical Education & Research, Chandigarh, India, were included in the study. Antibodies (IgG) to H pylori were tested by ELISA. There were 43 males, 30 females; mean age 26.1 +/- 4.7 years. Risk factors for acquiring HIV infection was predominantly heterosexual exposure. Eleven patients presented with gastrointestinal symptoms. Thirty-five of the 73 (47.9%) patients had serological evidence of H pylori infection. Six of them had gastrointestinal symptoms. These were odynophagia in 5, dyspepsia in 4 and recent diarrhoea in 2. Twenty-four patients with H pylori infection had AIDS. There was no difference in the prevalence of H pylori infection between patients with and without AIDS.
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Affiliation(s)
- A Sud
- Sexually Transmitted Diseases Research Center, Marian Villa, Westmead Hospital, Westmead, NSW 2145, Australia.
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154
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Malhi NS, Bhasin DK, Gupta NM, Vaiphei K, Singh K. Exacerbation of ulcerative colitis by cytomegalovirus infection in an immunocompetent Indian patient. Trop Gastroenterol 2002; 23:88-90. [PMID: 12632977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A patient with typical features of idiopathic ulcerative colitis, in remission, developed an attack of severe colitis. Sigmoidoscopy showed submucosal black nodules in the sigmoid colon. Mucosal biopsies from the involved areas showed evidence of acute on chronic colitis with cytomegalic cells and intra-nuclear inclusions suggestive of cytomegalovirus (CMV) disease. The patient attained remission following subtotal colectomy and intravenous ganciclovir therapy for 3 weeks. The patient had another relapse five months later. The colonic biopsies during this relapse showed evidence only of idiopathic ulcerative colitis, with no CMV infection. The patient responded well to steroid therapy.
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Affiliation(s)
- N S Malhi
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012, India
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155
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Abstract
The newer diagnostic and therapeutic options continue to evolve and important developments have been made in the field of variceal bleeding and portal hypertension. A meeting was held at Baveno to update consensus on different terminologies in relation to portal hypertension. beta-blockers continue to be the mainstay for primary prophylaxis of variceal bleeding, and endoscopic variceal ligation (EVL) is fast emerging as a strong contender. The role of vasoactive drugs in the management of variceal bleeding was assessed. Octreotide and terlipressin were shown to be as effective as sclerotherapy in achieving initial hemostasis, and octreotide was shown to be safe and efficacious in the prevention of rebleeding. EVL was superior to endoscopic sclerotherapy (EST) for obliteration of esophageal varices. Sequential and simultaneous ligation and sclerotherapy were more effective than ligation alone, in reducing the recurrence rate after variceal obliteration. For gastric varices, cyanoacrylate glue continues to be the first line of treatment, and band ligation is being assessed further. Bleeding ectopic varices were dealt by appropriate endoscopic means. Endosonography has developed strongly in the assessment of variceal eradication and prediction of variceal recurrence. Transjugular intrahepatic portosystemic shunting (TIPS) significantly reduces rebleeding rates compared to EVL.
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Affiliation(s)
- D K Bhasin
- Dept. of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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156
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Nada R, Bhasin DK, Joshi K, Sharma BC, Ray P, Pathak CM, Singh K. Effect of eradication of Helicobacter pylori on gastric antrum histology. Trop Gastroenterol 2002; 23:20-4. [PMID: 12170915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Helicobacter pylori is a leading cause of gastritis. Some of the histological changes revert after eradication of H. pylori. There is paucity of reports from India. AIM To study the effect of H. pylori eradication on the histopathological changes. METHODS Endoscopically obtained antral biopsies from 164 consecutive H. pylori positive cases of dyspepsia were analysed before and 4 weeks after completion of treatment. RESULTS Treatment for H. pylori resulted in eradication of the organism as confirmed histologically in 123 out of 164 (76.22%) cases. Analysis of histopathological changes in pre and post treatment biopsies from the same patient revealed a significant reduction in neutrophils, eosinophils, chronic inflammatory cells, acute epithelial changes and regenerative foveolar hyperplasia (p < 0.001) There was no difference in these findings in cases where H. pylori eradication failed when compared with their pre-treatment biopsies (p > 0.05). Similarly the pre and post treatment biopsies revealed, no difference in frequency of intestinal metaplasia and gastric atrophy in cases where H. pylori was eradicated or persisted after treatment. CONCLUSION There was significant reduction in neutrophils, eosinophils, chronic inflammatory cells, acute epithelial changes and regenerative foveolar hyperplasia, following eradication of H. pylori.
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Affiliation(s)
- R Nada
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India
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157
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Poddar U, Thapa BR, Sinha SK, Bhasin DK. Massive steatorrhea in a child due to isolated pancreatic hypoplasia. Indian Pediatr 2001; 38:1298-300. [PMID: 11721073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- U Poddar
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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158
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Gupta NM, Jindal R, Prakash O, Gupta R, Bhasin DK. Comparison of the clinical profile and outcome for squamous cell carcinoma and adenocarcinoma of the distal esophagus and cardia in India. Surg Today 2001; 31:400-4. [PMID: 11381502 DOI: 10.1007/s005950170129] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This retrospective review aimed to assess the clinical profile and outcome of squamous cell carcinoma as compared with adenocarcinoma of the lower third of esophagus and cardia following a transhiatal esophagectomy. A total of 169 patients were analyzed retrospectively in this series from 1989 to 1994. There were 100 patients with squamous cell carcinoma (SCC) and 69 patients with adenocarcinoma (ADC). All tumors were assessed by an esophagogram, upper gastrointestinal endoscopy, and abdominal ultrasonography. The surgical procedure performed in all cases was a transhiatal esophagectomy (THE). The mean age of the patients with SCC and ADC was comparable (48 +/- 14 vs 54 +/- 12 years). Male/female ratio was 1.0:1.4 in the SCC group while in the ADC group it was 8.8:1.0. The main symptom in both the groups was grade II dysphagia (62% in SCC and 60% in ADC). The mean length of the tumor was 6.6 +/- 4.5 cm in the SCC group and 4.2 +/- 3.3 cm in the ADC group. The resectability rate of the SCC group was significantly higher (76%) than in the ADC group (55%). The 6-month and 1-year survival for the SCC patients was not significantly different from the ADC patients (83.7% and 49.3% vs 85.0% and 54.0%). The 5-year survival achieved in SCC was higher than in the ADC group (11.6% vs 7.2%) but the difference was not statistically significant. Adenocarcinoma arising from the distal esophagus and cardia was more common in males, and also occurred in a higher age group and had a lower resectability rate than squamous cell carcinoma. No case of Barrett's esophagus was encountered. The short- and long-term survival in both tumors were similar.
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Affiliation(s)
- N M Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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159
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Jindal B, Vashishta RK, Bhasin DK. Vascular transformation of sinuses in lymph nodes associated with myelodysplastic syndrome--a case report. INDIAN J PATHOL MICR 2001; 44:453-5. [PMID: 12035363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
We describe a case of plexiform variant of vascular transformation of lymph nodes sinuses in association with myelodysplastic syndrome. The patient had repeated bacterial infections and terminal fungal infection and dies after a protracted illness of seven years.
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Affiliation(s)
- B Jindal
- Department of Pathology, Post Graduate Institute of Medical Education Research, Chandigarh
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160
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Poddar U, Thapa BR, Bhasin DK, Prasad A, Nagi B, Singh K. Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children. J Gastroenterol Hepatol 2001; 16:927-31. [PMID: 11555109 DOI: 10.1046/j.1440-1746.2001.02545.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The role of endoscopic retrograde cholangiopancreatography (ERCP) is not yet fully established in children. The purpose of this study was to assess the use of ERCP in the diagnosis and management of various pancreaticobiliary disorders in children. METHODS Eighty-four ERCPs were performed over 5.5 years in 72 children with suspected pancreaticobiliary tract disorders with an adult-type duodenoscope. In all cases, indications, procedure time, ERCP findings, complications, patients course and therapeutic intervention (if any) were recorded. RESULTS The mean (+/- SD) age of these children was 8.8 +/- 3.3 years. Successful cannulation was possible in 70 (97%) cases. Of the 44 cases with suspected biliary tract disease, 14 had a choledochal cyst, 13 had portal biliopathy, two each had CBD stones, primary sclerosing cholangitis and a bile leak, one had biliary ascariasis, eight had a normal cholangiogram, and CBD cannulation failed in two. Eight of the 28 children with suspected pancreatic disorders had chronic pancreatitis, five had pancreatic duct disruption, three had pancreas divisum and the rest had a normal pancreatogram (including all eight children with unexplained abdominal pain). Therapeutic ERCP was performed in 22 children, endoscopic nasobiliary or a nasocystic drain was placed in 16, biliary stenting was conducted in two, pancreatic duct stenting was conducted in three, and minor papilla dilation was conducted in one child. Six children had mild procedure-related complications. CONCLUSION Endoscopic retrograde cholangiopancreatography is very useful in the treatment of cholangitis, bile leak, pseudocyst and pancreatic fistulae in children. However, its role in unexplained abdominal pain is doubtful.
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Affiliation(s)
- U Poddar
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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161
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Rana SV, Bhasin DK, Katyal R, Singh K. Comparison of duodenal and jejunal disaccharidase levels in patients with non ulcer dyspepsia. Trop Gastroenterol 2001; 22:135-6. [PMID: 11681105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
AIMS This study was conducted to compare the duodenal and jejunal disaccharidase levels in the same individual with duodenal ulcer or non ulcer dyspepsia. METHODS Thirty seven patients (duodenal ulcer--11, non-ulcer dyspepsia--26) were included in the study. Endoscopic biopsy samples were obtained from jejunum and duodenum using pediatric colonofibroscope. RESULTS Levels of jejunal disaccharidases were significantly higher than the duodenal disaccharidases. CONCLUSIONS An estimate of jejunal disaccharidases can be had by multiplication of duodenal disaccharidased by a factor 1.48 for lactase, 1.50 for sucrase and 1.56 for maltase.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh-160 012, India.
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162
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Kaura D, Bhasin DK, Rana SV, Katyal R, Vaiphei K, Singh K. Alterations in duodenal disaccharidases in chronic smokers. Indian J Gastroenterol 2001; 20:62-3. [PMID: 11305493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the effect of smoking on activity of intestinal disaccharidases. METHODS The study was conducted on patients with non-ulcer dyspepsia who were smokers (n=20) or non-smokers (n=20). Smokers were classified according to smoking index into mild, moderate and heavy smokers. Biopsy specimens were taken from the second part of the duodenum at endoscopy and examined histologically, and for disaccharidase (lactase, sucrase, maltase and trehalase) activities. RESULTS Mean duration of symptoms was more in smokers than in non-smokers. None of the smokers had endoscopic evidence of duodenal inflammation. Lactase and trehalase levels were significantly decreased in smokers. There was no difference in enzyme levels between mild smokers and non-smokers. Decreased lactase, maltase and trehalase activities were observed in moderate smokers compared to mild smokers. Duration of symptoms had no relation to enzyme activities. CONCLUSIONS Intestinal disaccharidase levels are diminished by smoking.
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Affiliation(s)
- D Kaura
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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163
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Bhasin DK, Poddar U. Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy. Gastrointest Endosc 2000; 52:586-7. [PMID: 11184143 DOI: 10.1067/mge.2000.108720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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164
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165
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Lhatoo SD, Bhasin DK, Rana SV, Katyal R, Singh K. Effect of alcohol dependence on the levels of duodenal disaccharidases in human subjects. Indian J Physiol Pharmacol 2000; 44:495-9. [PMID: 11214508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The aim of the study was to detect the duodenal enzyme activity in patients of alcohol dependence and to compare with non-alcoholic patients of non-ulcer dyspepsia. METHODS Disaccharidases (lactase, sucrase, maltase) were estimated in 20 non alcoholic patients of non-ulcer dyspepsia and 20 alcoholics admitted to the drug de-addiction and treatment centre of PGIMER, Chandigarh, India. RESULTS No significant influence of alcohol on enzyme levels in patients of alcohol dependence when compared to patients of non-ulcer dyspepsia was observed. However, a significant decrease in lactase level was noted in patients consuming more than 125 gm/day of alcohol. CONCLUSION Amount of consumption of alcohol showed decrease in lactase enzyme, but not in maltase and sucrase. There was no effect of duration of alcohol consumption on dissacharidases in the two groups.
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Affiliation(s)
- S D Lhatoo
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
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166
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Singh KD, Bhasin DK, Rana SV, Vaiphei K, Katyal R, Vinayak VK, Singh K. Effect of Giardia lamblia on duodenal disaccharidase levels in humans. Trop Gastroenterol 2000; 21:174-6. [PMID: 11194577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The study was conducted to detect the effect of giardiasis on human disaccharidase levels. Forty patients attending the medical outpatient department of PGIMER, Chandigarh were enrolled. Twenty patients, positive for Giardia lamblia comprised the study group while 20 patients negative for Giardia lamblia were taken as controls. Upper gastrointestinal endoscopy was performed in all patients. Estimation of lactase, sucrase, maltase and trehalase was done in biopsies. Histopathological investigation was carried out in all biopsy specimens after Haematoxylin and Eosin staining. Complaints of pain abdomen and bloating occurred commonly in giardiasis. Four biopsy samples in study group showed mild increase in lymphomononuclear infiltrate. Giardia lamblia was detected in 7 biopsies. Lactase levels were decreased significantly (p < 0.05) in giardiasis. Rest of the enzymes were comparable to the controls. No differences in the enzyme activities were observed between males and females in either group and with the duration of symptoms.
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Affiliation(s)
- K D Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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167
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Abstract
Our aim was to present a report about the usefulness of ileoscopy as an adjunct to colonoscopy, as studied in India, in the face of a dearth of such reports from the developing countries and to study the role of ileoscopy in increasing the yield of diagnosis reached and modified. In a prospective study in 66 consecutive patients undergoing colonoscopy for various indications, colonoscopy/ileoscopy was performed with a forward viewing fiberoptic colonoscope. Details of ileal mucosa, time taken to reach ileum, and length of ileum intubated were noted. Of the 66 patients undergoing colonoscopy, cecum could be reached in 62, whereas ileum was successfully intubated in 57 (86.4%). In 13 (22.5%) cases, additional information was obtained. In eight (14.4%) cases, diagnosis was established on ileoscopy. Of these, two were of lower gastrointestinal (GI) bleed (typhoid ulcer and nonsteroidal antiinflammatory drug ulcer), one had lymphoma, two had tuberculosis, and three were cases of reactive arthritis with ulcers in terminal ileum. After ileoscopy, the diagnosis was altered in five (8.7%) cases. Time taken to reach ileum from cecum was 3.3 +/- 2.5 minutes and the length of examined ileum was 17.3 +/- 7.5 cm. Ileoscopy is a useful adjunct to colonoscopy that not only helps to modify the diagnosis but also established them.
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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168
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Bhasin DK, Sharma BC, Ray P. Drug resistance in Helicobacter pylori infection. Indian J Gastroenterol 2000; 19 Suppl 1:S29-32. [PMID: 11060974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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169
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Bhasin DK, Sharma BC, Ray P, Pathak CM, Singh K. Comparison of seven and fourteen days of lansoprazole, clarithromycin, and amoxicillin therapy for eradication of Helicobacter pylori: a report from India. Helicobacter 2000; 5:84-7. [PMID: 10849056 DOI: 10.1046/j.1523-5378.2000.00012.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In developed countries, a 1-week regimen of combined proton pump inhibitors and two antibiotics is considered adequate for Helicobacter pylori eradication. However, there is a paucity of reports from developing countries on treatment duration of less than 14 days. We compared efficacy of 7 and 14 days of lansoprazole (L), clarithromycin (C), and amoxicillin (A) combinations for eradication of H. pylori. PATIENTS AND METHODS Forty-six consecutive patients who presented with upper gastrointestinal symptoms and tested positive for H. pylori infection were included in the study. In every patient, after performance of upper gastrointestinal endoscopy, antral biopsies were obtained. H. pylori infection was diagnosed by positive rapid urease test and identification of organisms on antral histology. Patients were randomly selected to receive lansoprazole, 30 mg once daily, plus clarithromycin, 250 mg twice daily, plus amoxicillin, 500 mg three times daily for 2 weeks (group 1; n = 24; age, 36 +/- 12 years; 18 men) or 1 week (group 2; n = 22; age, 45 +/- 15 years; 12 men). One month after completion of treatment, repeat upper gastrointestinal endoscopy was performed. H. pylori eradication was defined as absence of organism on histopathological examination of both antrum and body of stomach and negative rapid urease test. RESULTS Eradication rate was higher in group 1 (23 of 24; 96%) as compared to group 2 (12 of 22; 54%; p <.05). One patient in group 1 had diarrhea, and one patient in group two had skin rash and itching. CONCLUSIONS Fourteen-day therapy with lansoprazole, clarithromycin, and amoxicillin is highly effective in eradication of H. pylori. Reducing duration of therapy to 7 days significantly lowers eradication rates.
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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170
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Abstract
BACKGROUND AND STUDY AIMS Anastomotic leak is a known complication after transhiatal esophagectomy (THE) and cervical esophagogastric anastomosis. Conservative management takes a long time to heal such leaks. We assessed the role of endoscopic dilation in patients with anastomotic leak following THE. PATIENTS AND METHODS Eight consecutive patients (seven men, one woman; mean age 51) with anastomotic leak following THE were subjected to endoscopic dilation using Savary Gilliard dilators of 7-15 mm diameter. The mean interval between surgery and detection of leak was 9 days (range 5-22 days) and dilation was performed at a mean interval of 11.4 days (range 1-20 days) after detection of the leak. RESULTS Drainage from fistulas stopped completely after 1-8 days (mean 3 days). X-ray with water soluble contrast showed closure of the fistula in all cases. Duration of follow-up ranged from 2 to 12 months. Anastomotic strictures developed in three patients. These patients required three sessions each of repeat dilation, and were alive at follow-up periods of 2, 4, and 12 months, respectively. One patient developed recurrence of growth at an anastomotic site. Four patients died because of distant metastasis. CONCLUSIONS Bougie dilation of anastomotic sites is a safe and effective technique for the healing of anastomotic leaks following THE. However there is a need for a prospective randomized trial comparing endoscopic dilation with no dilation in patients with anastomotic leaks following THE.
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Affiliation(s)
- D K Bhasin
- Dept. of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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171
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172
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Bhasin DK, Poddar U, Wig JD. Knot formation in a floppy-tipped guidewire in the common bile duct: an unusual complication of ERCP. Endoscopy 2000; 32:S17. [PMID: 10774982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D K Bhasin
- Dept. of Gastroenterology and Surgery, PGIMER, Chandigarh, India.
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173
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Affiliation(s)
- H Prasad
- Division of Paediatric Gastroenterology, Departments of Gastroenterology and Paediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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174
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Rajashekhar V, Bhasin DK, Ray P, Vaiphei K, Sharma BC, Singh K. Helicobacter pylori infection in chronic smokers with non ulcer dyspepsia. Trop Gastroenterol 2000; 21:71-2. [PMID: 10881628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND/AIMS Both H. pylori infection and smoking are risk factors for acid peptic disorders. There is paucity of data on relationship between smoking and H. pylori infection. Therefore, we studied prevalence of H. pylori infection in smokers with non-ulcer dyspepsia (NUD). PATIENTS AND METHODS 30 smokers with NUD (age 29.5 +/- 1.2 years; all men) and 30 non-smokers with NUD (age 29.2 +/- 1.6 years; all men) were included. None was on antiulcer drugs or antibiotics for more than 2 weeks. Upper gastrointestinal endoscopy was performed and antral biopsies obtained were subjected to rapid urease test, Gram's staining, culture and histopathology. Patient was considered H. pylori positive, if culture was positive or combination of histopathology plus rapid urease test or Gram's staining plus rapid urease test was positive. RESULTS 24 of 30 (80%) smokers and 13 of 30 (43%) non smokers were positive for H. pylori infection (p < 0.001). There was no significant difference in the positivity of H. pylori in light (78%), moderate (81%) and heavy smokers (80%). All the 37 patients who were positive for H. pylori had histological gastritis compared to 65% in H. pylori negative patients. However there was no difference in presence of histological gastritis among H. pylori negative smokers (33%) and non smokers (70%; p = NS). CONCLUSIONS H. pylori infection is more common in smokers with NUD than in non-smokers. However duration and amount of smoking has no relationship with H. pylori positivity.
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Affiliation(s)
- V Rajashekhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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176
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Sharma BC, Bhasin DK, Bhatti HS, Das G, Singh K. Gastrointestinal bleeding due to worm infestation, with negative upper gastrointestinal endoscopy findings: impact of enteroscopy. Endoscopy 2000; 32:314-6. [PMID: 10774972 DOI: 10.1055/s-2000-7393] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS In cases of hookworm and roundworm infestation, chronic occult bleeding is well known, but acute gastrointestinal bleeding is rarely described. We report five patients with worm infestation who presented with acute massive gastrointestinal bleeding. PATIENTS AND METHODS Over 1 year, we have encountered 15 patients with obscure gastrointestinal bleeding. All the patients had normal findings on upper gastrointestinal endoscopy. Push enteroscopy was performed in each patient and evaluation of the proximal 40-50 cm of the jejunum was done. RESULTS Five patients (four men, one woman; average age 50 yr, range 40-60) had worm infestation (two hookworm, three roundworm). All the patients had gastrointestinal bleeding (five had melena, one hematemesis, and two hematochezia) for a duration of 7-14 days. Hemoglobin ranged from 2.8 to 9 g/dl. Push enteroscopy revealed fresh blood in the jejunum, multiple erosions, and hookworms in two patients and roundworms in three patients. Hookworms were retrieved endoscopically in two patients whereas roundworms could be retrieved in only one patient. All the patients were treated with mebendazole (100 mg twice a day for 3 days), iron, and folic acid. Gastrointestinal bleeding subsided in all the patients. CONCLUSIONS In developing countries, worm infestation should be considered an important cause of obscure acute gastrointestinal bleeding. Evaluation of the jejunum using an enteroscope will result in more frequent diagnosis of worms as a cause of acute gastrointestinal bleeding which might have been classified as obscure gastrointestinal bleeding.
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Affiliation(s)
- B C Sharma
- Dept. of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
OBJECTIVE We sought to assess the diagnostic value of push-type enteroscopy in relation to indications. METHODS Ninety-nine consecutive patients (mean age, 42+/-15 yr; 65 men) with suspected small bowel disorders underwent push enteroscopy. The indications were chronic diarrhea (n = 54), obscure gastrointestinal (GI) bleeding (n = 21), abdominal pain (n = 10), abnormal radiological studies of small bowel (n = 5), iron deficiency anemia (n = 5), and others (n = 4). Push enteroscopy was performed using the Olympus SIF-10 (160-cm) enteroscope. RESULTS Endoscopic examination of the jejunum was successful in all the patients, except one with a distal duodenal stricture. The length of the jejunum examined ranged from 10 to 70 cm. The time taken to complete the procedure varied from 2 to 30 min. Lesions were found in nine (42.8%) patients with obscure GI bleeding; six (28.5%) had worms (Ascaris lumbricoides [n = 3], Ankylostoma duodenale [n = 3]) in the jejunum, producing multiple erosions and bleeding points. In the chronic diarrhea group, a diagnosis was made in 13 (24%) patients on enteroscopic visualization and jejunal histology: celiac disease (n = 6), tropical sprue (n = 3), Crohn's disease (n = 1), secondary lymphangiectasia (n = 1), strongyloidiasis (n = 1), and nodular lymphoid hyperplasia with giardiasis (n = 1). In patients with abdominal pain, enteroscopy provided a diagnosis in one (10%) patient. No positive diagnosis could be made on enteroscopy in patients with iron deficiency anemia and abnormal radiological studies of small bowel. CONCLUSION Push-type enteroscopy is a useful test in the evaluation of patients with obscure GI bleeding and chronic diarrhea. In developing countries, in patients with obscure GI bleeding, the presence of worms in the jejunum is an important finding on enteroscopy. Tropical sprue, giardiasis, and strongyloidiasis are distinct findings in patients with chronic diarrhea in the present series.
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Affiliation(s)
- B C Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma BC, Bhasin DK, Makharia G, Chhabra M, Vaiphei K, Bhatti HS, Singh K. Diagnostic value of push-type enteroscopy: a report from India. Am J Gastroenterol 2000; 95:137-140. [PMID: 10638572 DOI: 10.1016/s0002-9270(99)00733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
OBJECTIVE We sought to assess the diagnostic value of push-type enteroscopy in relation to indications. METHODS Ninety-nine consecutive patients (mean age, 42+/-15 yr; 65 men) with suspected small bowel disorders underwent push enteroscopy. The indications were chronic diarrhea (n = 54), obscure gastrointestinal (GI) bleeding (n = 21), abdominal pain (n = 10), abnormal radiological studies of small bowel (n = 5), iron deficiency anemia (n = 5), and others (n = 4). Push enteroscopy was performed using the Olympus SIF-10 (160-cm) enteroscope. RESULTS Endoscopic examination of the jejunum was successful in all the patients, except one with a distal duodenal stricture. The length of the jejunum examined ranged from 10 to 70 cm. The time taken to complete the procedure varied from 2 to 30 min. Lesions were found in nine (42.8%) patients with obscure GI bleeding; six (28.5%) had worms (Ascaris lumbricoides [n = 3], Ankylostoma duodenale [n = 3]) in the jejunum, producing multiple erosions and bleeding points. In the chronic diarrhea group, a diagnosis was made in 13 (24%) patients on enteroscopic visualization and jejunal histology: celiac disease (n = 6), tropical sprue (n = 3), Crohn's disease (n = 1), secondary lymphangiectasia (n = 1), strongyloidiasis (n = 1), and nodular lymphoid hyperplasia with giardiasis (n = 1). In patients with abdominal pain, enteroscopy provided a diagnosis in one (10%) patient. No positive diagnosis could be made on enteroscopy in patients with iron deficiency anemia and abnormal radiological studies of small bowel. CONCLUSION Push-type enteroscopy is a useful test in the evaluation of patients with obscure GI bleeding and chronic diarrhea. In developing countries, in patients with obscure GI bleeding, the presence of worms in the jejunum is an important finding on enteroscopy. Tropical sprue, giardiasis, and strongyloidiasis are distinct findings in patients with chronic diarrhea in the present series.
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Affiliation(s)
- B C Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bhasin DK, Sinha SK. Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones. Gastrointest Endosc 1999; 50:886-8. [PMID: 10644185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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180
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Yerra LN, Bhasin DK, Panigrahi D, Vaiphei K, Sharma BC, Ray P. Prevalence of Helicobacter pylori infection in patients with reflux oesophagitis. Trop Gastroenterol 1999; 20:175-7. [PMID: 10769606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In this prospective study 30 patients of reflux esophagitis were studied to detect if there was any association between presence of esophagitis and H. pylori infection. 30 patients of non-ulcer dyspepsia acted as controls. In both the groups esophageal and antral biopsies were studied for the presence of H. pylori infection. None of the esophageal biopsies showed H. pylori infection in either group. H. pylori positivity was similar in the antrum of the patients with esophagitis (20 out of 30) and non ulcer dyspepsia (19 out of 30) (p > 0.05). There was no significant association between presence of H. pylori infection in antrum and severity of esophagitis (p > 0.05). In conclusion, this study has shown that H. pylori did not colonise esophagus in patients of esophagitis or patients of non-ulcer dyspepsia. There was no significant association between H. pylori colonization in the antrum and esophagitis and the grade of esophagitis with H. pylori infection.
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Affiliation(s)
- L N Yerra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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181
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Singh K, Vinayak VK, Bhasin DK, Ganguly NK. A monoclonal antibody-based test system for detection of Entamoeba histolytica-specific coproantigen. Indian J Gastroenterol 1999; 18:104-8. [PMID: 10407562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diagnosis of amebiasis based on stool microscopy or demonstration of anti-amebic antibodies has limitations. A diagnostic system based on demonstration of the parasite product in clinical specimens holds promise. METHODS Murine monoclonal antibodies were developed against an Entamoeba histolytica-specific coproantigen. A monoclonal antibody (MoAb) 3D10 was employed in a double-antibody sandwich microELISA system for the detection of amebic coproantigen in fecal specimens. The system was evaluated in three groups of subjects: 63 patients with intestinal amebae, 27 with non-amebic parasitosis, and 57 apparently healthy controls. RESULTS The MoAb 3D10 belonged to IgG1 isotype and recognized three antigens, with mol. wt. 36, 25 and 17 kDa in the crude extract of E. histolytica (HM1-IMSS), and an amebic coproantigen with MW 36 kDa in the stool supernatant from patients with intestinal amebae. The coproantigen was detected in the stool eluates of 56 (89%) patients with intestinal amebae and in none of the stool eluates from other subjects, thereby giving this system a sensitivity of 89% and specificity of 100% for the detection of intestinal amebae. CONCLUSIONS This monoclonal antibody recognizes as intact epitope on the E. histolytica-specific coproantigen. The validity of the MoAb-based microELISA system needs to be established.
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Affiliation(s)
- K Singh
- Department of Experimental Medicine and Biotechnology, Government of India, New Delhi
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Sharma BC, Bhasin DK, Sethi A, Vashishta RK, Gupta NM, Singh K. Extended survival of carcinoma head of pancreas following palliative treatment. Trop Gastroenterol 1999; 20:140-1. [PMID: 10695425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
A 48 year old woman presented with obstructive jaundice 10 years back. Upper gastrointestinal endoscopy revealed a growth infiltrating the ampulla of Vater, which was confirmed to be adenocarcinoma on cytology. At laparotomy, a large nodular growth was seen in the head of pancreas. Surgical resection could not be done because of encasement of superior mesenteric vessels, hence a cholecystojejunostomy was performed. The patient remained asymptomatic for 9 years, when she developed cholangitis. Duodenoscopy at this stage revealed an ulcerated growth at the ampulla and biopsy from the growth confirmed a well differentiated adenocarcinoma. A straight flap 10 F stent was placed in the common bile duct. Thereafter the patient has remained asymptomatic for more than a year.
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Affiliation(s)
- B C Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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183
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Abstract
Conventional bismuth-based triple therapy has multiple problems, such as inadequate drug compliance, side effects, and drug resistance. Combination of omeprazole and clarithromycin with or without combination with antibiotics like amoxycillin has been shown to be effective in eradication of Helicobacter pylori. Reports from India are few on the efficacy of clarithromycin-based drug combinations. Therefore, we evaluated efficacy of omeprazole and clarithromycin with or without amoxycillin for treating H. pylori infection. Sixty-four consecutive patients with upper gastrointestinal symptoms and having H. pylori infection were included. In every patient, complete upper gastrointestinal endoscopy was done. H. pylori infection was diagnosed by identification of organism on antral biopsies and positive rapid urease test. Patients were treated with omeprazole 40 mg/day + clarithromycin 250 mg twice daily (group I, n = 22), or omeprazole 40 mg/day + clarithromycin 250 mg twice daily + amoxycillin 500 mg three times daily (group II, n = 20), or bismuth subcitrate 120 mg four times daily + amoxycillin 500 mg three times daily + metronidazole 400 mg three times daily (group III, n = 22) for 2 weeks. H. pylori status was reevaluated 1 month after completion of treatment. One patient in each group stopped drugs due to side effects. Eradication rate was not significantly different in group I (15/22, 68%), group II (14/20, 70%), and group III (13/22, 59%). Of those completing therapy, side effects were observed in three patients in group III (nausea, skin rash, metallic taste), whereas none of the patients in group I and group II had any side effects. Addition of amoxycillin did not appear to improve efficacy of dual omeprazole and clarithromycin therapy and appeared to be no different than bismuth, metronidazole, and amoxycillin triple therapy. Overall, none of regimens was particularly good.
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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184
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Abstract
BACKGROUND Treatment for Helicobacter pylori reduces ulcer recurrence. Eradication rates of the organism vary with different drug regimens from 30% to 90%. There is a need to identify patients who have failed treatment. [14C]-Urea breath test (UBT) is non-invasive, sensitive, safe and highly reliable test for diagnosis of H. pylori infection. As there is a paucity of reports on the utility of [14C]-UBT in confirming H. pylori eradication, this study was undertaken. METHODS Thirty-eight patients (age 34 +/- 17 years, range 16-84 years, 27 men) with upper gastrointestinal symptoms underwent upper gastrointestinal endoscopy. Baseline H. pylori infection was diagnosed by identification of the organism on antral biopsies and positive rapid urease test (RUT). After 1 month of completion of treatment, repeat RUT and histological examination of antral endoscopic biopsies were performed. Eradication of H. pylori was defined as absence of the organism on histology, and negative RUT. The [14C]-UBT was performed using 185 kBq [14C]-urea dissolved in 300 mL water. Breath samples were collected once before ingestion of [14C]-urea, and subsequently at 5 and 15 min. Results were expressed as 14CO2/mmol CO2 exhaled as per cent of administered urea. RESULTS Endoscopy revealed antral gastritis (n = 14), duodenal ulcer (n = 8), duodenitis (n = 2), oesophagitis (n = 1), antral gastritis and duodenal ulcer (n = 3), antral gastritis and duodenitis (n = 7) and normal upper gastrointestinal endoscopy (n = 3). All the 20 patients who were negative for H. pylori on RUT and histology, tested negative for H. pylori on [14C]-UBT. However, of 18 patients shown to have H. pylori infection on RUT and histology, 16 were positive for H. pylori on [14C]-UBT. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [14C]-UBT were 100, 89, 91, 100 and 95% respectively. CONCLUSIONS The [14C]-UBT is a reliable indicator of H. pylori eradication after treatment. It can obviate the need for antral biopsies to confirm eradication of H. pylori after completion of treatment.
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Affiliation(s)
- B C Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Bleeding from antral and duodenal varices is an uncommon feature in patients with portal hypertension. We report a patient with cirrhosis and portal vein thrombosis, who had a massive bleed from antral and duodenal varices. Bleeding was controlled with endoscopic injection of varices using histoacryl. Endoscopic treatment and the relatively uncommon occurrence of antral and duodenal varices are highlighted.
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Pathak CM, Khanduja KL, Bhasin DK, Sharma BC. The Helicobacter pylori breath test: a surrogate marker for peptic ulcer disease in dyspeptic patients. Gut 1999; 44:582-3. [PMID: 10366298 PMCID: PMC1727464 DOI: 10.1136/gut.44.4.579g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Bhasin DK, Kakkar N, Sharma BC, Joshi K, Sachdev A, Vaiphei K, Singh K. Helicobacter pylori in gastric cancer in India. Trop Gastroenterol 1999; 20:70-2. [PMID: 10484891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/AIMS Helicobacter pylori infection has been implicated in pathogenesis of gastric cancer. Since there is paucity of reports from developing countries on association of H. pylori with gastric cancer, we performed case control study to find out the relationship between H. pylori and gastric cancer and also compared characteristics of gastric cancer and H. pylori positivity in younger and older patients. PATIENTS AND METHODS Gastrectomy (n = 37) or endoscopic biopsy (n = 43) samples from area adjoining the cancer were collected from 80 patients of gastric cancer. Tissue specimens were stained with hematoxylin-eosin and Giemsa stains and histological type of cancer was determined according to Lauren, as intestinal or diffuse type. The presence of H. pylori was assessed by Giemsa staining. Eighty age and sex matched patients with non-ulcer dyspepsia (NUD) served as controls. RESULTS Of 80 patients, 48 had intestinal type, 28 diffuse type and 4 had mixed type of gastric cancer. Tumour was located in antrum in 37, in body in 31, and at other sites in 12 cases. H. pyolri infection was present in 29 of patients compared to 36 patients with non-ulcer dyspepsia (p > 0.05, odd ratio 0.69, confidence interval 0.37-1.32). The positivity for H. pylori was higher in intestinal type than in diffuse type (p < 0.05) of gastric cancer but similar in patients with growth in antrum and body (p = NS) of stomach. There was no significant difference in tumor type, tumor site, frequency of intestinal metaplasia and H. pylori positivity (39% vs 35%, P > 0.05, odd ratio 1.19, confidence interval 0.44-3.23) in younger (< 45 yrs) and older (> 45 yrs) patients. CONCLUSIONS Approximately one-third of patients with gastric cancer show presence of H. pylori infection on histological examination. No difference in H. pylori positivity were observed in young and old patients of gastric cancer.
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Affiliation(s)
- D K Bhasin
- Postgraduate Institute of Medical Education and Research, Chandigrah
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Vaishnavi C, Kochhar R, Bhasin DK, Thapa BR, Singh K. Detection of Clostridium difficile toxin by an indigenously developed latex agglutination assay. Trop Gastroenterol 1999; 20:33-5. [PMID: 10464446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
An indigenously developed latex agglutination assay using C. sordelli antitoxin was used to screen 211 stool samples received from hospitalized patients. Of 126 samples from patients receiving single to multiple antibiotics for various ailments, 38 (30%) were positive by the toxin assay, whereas only 6/85 (7%) of samples of patients not receiving antibiotics were also positive. Thus, of 211 samples a total of 44 (20.8%) were positive by our toxin assay, giving titers ranging from 1 in 5 to 1 in 320. The test developed by us is simple, rapid, easy and reliable and can be easily adapted to all microbiology laboratories.
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Affiliation(s)
- C Vaishnavi
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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189
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Kakkar N, Vasishta RK, Banerjee AK, Bhasin DK, Singhi S. Phlegmonous inflammation of gastrointestinal tract autopsy study of three cases. INDIAN J PATHOL MICR 1999; 42:101-5. [PMID: 10420693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Three cases of Phlegmonous inflammation of gastrointestinal tract detected at necropsy are described. Predisposing factors were seen in all three cases. These were chronic alcoholism with submissive hepatic necrosis (HbsAg and HbcAg positive) in Case 1, Indian Childhood cirrhosis in Case 2 and acute on chronic Budd Chiari syndrome in Case 3. In case 1 and 3 the inflammation was limited to the large intestine where as in Case 2 it was seen both in the stomach and large intestine. In two of the three cases blood culture grew Staphylococcus aureus (Case 1) and gram negative organisms (Case 2).
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Affiliation(s)
- N Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bhasin DK, Sharma BC, Gupta S, Singh K. Double guidewire placement in common bile duct: a technique for teaching biliary endoprosthesis placement. Gastrointest Endosc 1998; 48:453-4. [PMID: 9786134 DOI: 10.1016/s0016-5107(98)70031-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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191
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Abstract
Spontaneous bacterial peritonitis (SBP) is classically described in patients with cirrhosis and nephrotic syndrome. However, SBP rarely occurs in patients with malignant ascites. We report a patient with gastric cancer with ascites, who developed SBP. Clinicians need to be aware of this complication in patients with malignant ascites.
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Affiliation(s)
- G K Makharia
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Agnihotri N, Bhasin DK, Vohra H, Ray P, Singh K, Ganguly NK. Characterization of lymphocytic subsets and cytokine production in gastric biopsy samples from Helicobacter pylori patients. Scand J Gastroenterol 1998; 33:704-9. [PMID: 9712233 DOI: 10.1080/00365529850171639] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study characterized the phenotypic subsets of isolated gastric lymphocytes and the cellular immune response in cultured gastric biopsy specimens. METHODS Endoscopy specimens from 40 Helicobacter pylori-positive and 40 H. pylori-negative patients were studied. a) Isolated gastric lymphocytes were analysed for CD4+, CD8+ T-lymphocyte subsets, activated T cells, and natural killer cells on a fluorescence-activated cell sorter, using monoclonal antibodies. b) The supernatant of cultured gastric biopsy specimens were assayed for interleukin (IL)-2, IL-4, and IL-6 levels. RESULTS In H. pylori-positive patients there was (a) a decrease in CD4+/CD8+ T cells, no change in activated T cells, and an increase in natural killer cells, and (b) no change in IL-2 levels and a significant increase in IL-4 and IL-6 levels. CONCLUSIONS There is an increase in CD8+ lymphocytes and natural killer cells, and the observed increase in IL-4 and IL-6 might be important in H. pylori-associated gastritis.
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Affiliation(s)
- N Agnihotri
- Dept. of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kaul A, Bhasin DK, Pathak CM, Ray P, Vaiphei K, Sharma BC, Singh K. Normal limits of 14C-urea breath test. Trop Gastroenterol 1998; 19:110-3. [PMID: 9828710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND/AIMS 14C-urea breath test has been widely used for diagnosis of Helicobacter pylori (H. pylori) infection. There is no general agreement on the cutoff values for determination of H. pylori negative subjects. We studied baseline values in subjects who were proved to be H. pylori negative and calculated the cutoff value of normalcy. A comparison of this test with other tests for diagnosis of H. pylori infection was also done. PATIENTS AND METHODS 12 patients (mean age 34 +/- 14, range 22-65 years; 8 men) of non-ulcer dyspepsia were studied, who were proved to be H. pylori negative by rapid urease test, Gram's staining, histopathology and culture of gastric mucosal biopsies obtained four each from the antrum, body and fundus of the stomach. The controls included 12 patients (mean age 40 +/- 13, range 22-65 years, 9 men), who were positive for H. pylori on culture or combination of rapid urease test and histopathology or rapid urease test and Gram's stain. 14C-urea breath test was performed using 5 uCi of 14C-urea dissolved in 300 ml of water. Breath samples were collected once before ingestion of 14C urea and subsequently at 5, 15 and 30 minutes after ingestion and 14C-contents in the breath samples measured. Results were expressed as 14 CO2/mmol CO2 exhaled as percent of administered urea. RESULTS The mean +/- SD 14-C value in H. pylori negative vs H. pylori positive patients at 5 minutes, 15 minutes and 30 minutes were found to be 0.003 +/- 0.003 vs 0.064 +/- 0.042 (p < 0.001), 0.002 +/- 0.001 vs 0.056 +/- 0.039 (p < 0.001) and 0.001 +/- 0.002 vs 0.041 +/- 0.026 (p < 0.001) respectively. The mean values of 14C-urea breath test were significantly lower in H. pylori negative patients as compared to H. pylori positive patients. Using receiver operating characteristic (ROC) analysis of the data, the cutoff values obtained were 0.01, 0.007 and 0.009 at 5 minutes, 15 minutes and 30 minutes respectively. CONCLUSIONS 14C-urea breath test levels at 5, 15 and 30 minutes intervals are significantly lower in H. pylori negative patients as compared to H. pylori positive patients. This test has high sensitivity and specificity in detecting H. pylori infection.
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Affiliation(s)
- A Kaul
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- D K Bhasin
- Dept. of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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196
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Chowdhary SK, Bhasin DK, Panigrahi D, Malik AK, Kataria RN, Behra A, Roy P, Singh K. Helicobacter pylori infection in patients with perforated duodenal ulcer. Trop Gastroenterol 1998; 19:19-21. [PMID: 9641028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia. PATIENTS AND METHODS The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori. RESULTS While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis. CONCLUSION Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.
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Affiliation(s)
- S K Chowdhary
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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197
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Bhasin DK, Dhavan S, Sriram PV, Nagi B, Varma V, Singh G, Behra A, Singh K. Endoscopic management of pancreatic diseases. Indian J Gastroenterol 1997; 16:151-2. [PMID: 9357189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopic management has recently been used for a variety of chronic pancreatic diseases. We used this approach in five patients with pancreatic diseases (calcific pancreatitis 2, pancreatic pseudocyst 3). Nasocystic drain was placed in a patient with pancreatic pseudocyst at the tail end of the pancreas; a 5 Fr stent was placed over 0.021"/0.035" guide wire in the main pancreatic duct in the others. All patients had relief of pain. Nasocystic drain led to resolution of pseudocyst, perisplenic collection and pleural effusion. Endoscopic treatment is safe and effective in various pancreatic disorders.
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Affiliation(s)
- D K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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198
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Abstract
Endoscopic sclerotherapy has emerged as an effective and safe mode of treatment for long-term management of esophageal varices due to cirrhosis of liver and extrahepatic portal venous obstruction. There are few studies that have evaluated the role of sclerotherapy in the management of esophageal varices in patients with noncirrhotic portal fibrosis (NCPF). We report our results of long-term sclerotherapy in patients with NCPF. Seventy-two consecutive patients (men 29, women 43; age 32.9 +/- 11.8 years) with recurrent variceal bleeding due to NCPF were entered into the sclerotherapy program. Forty-eight patients received intravariceal absolute alcohol and 24 patients received intravariceal sodium tetradecyl sulfate (STD). Variceal obliteration was achieved in 65 (90.3%) patients with a mean of 5.7 +/- 3.0 (range 1-14) sessions. These patients were followed-up for a mean of 21.4 +/- 20.4 (range 1-96) months. Thirteen (17.3%) patients had episodes of upper gastrointestinal bleeding during sclerotherapy. Rebleed after obliteration was seen in 6 (9.2%) patients. Sclerotherapy was associated with a significant reduction in bleeding rate (bleeds per month per patient) during sclerotherapy and after obliteration of varices as compared to presclerotherapy period (P < 0.000001 for both). Recurrence of esophageal varices after obliteration was seen in 9 (13.9%) patients with reobliteration of varices in five patients in whom sclerotherapy was attempted. Complications including esophageal ulcer and stricture formation were seen in 18 (25%) and 4 (5.6%) patients respectively; strictures were restricted to patients who received absolute alcohol. Two (2.77%) patients died of massive upper gastrointestinal bleed during follow-up. We conclude that sclerotherapy is an effective and safe modality in the prevention of variceal bleeds in patients with NCPF.
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Affiliation(s)
- Y K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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199
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Rana S, Bhasin DK, Sachdev A, Singh K. Number of breath samples required for detection of lactose intolerance by lactose hydrogen breath test. Indian J Gastroenterol 1997; 16:118. [PMID: 9248196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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200
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Chatha L, Ray P, Bhasin DK, Panigrahi D, Khanna T, Vaiphei K, Singh K, Singh H. Western blot analysis of serological response in Helicobacter pylori in acid peptic diseases. Indian J Med Res 1997; 105:170-5. [PMID: 9145600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A prospective study was undertaken in 70 patients presenting with acid peptic disease with the objective of characterising the serological response to Helicobacter pylori and finding antigens specific for the serodiagnosis of H. pylori infection. H. pylori status was assessed by smear microscopy, rapid urease activity, culture and histopathology of endoscopic gastric antral biopsy specimens. Serological characterisation was carried out by using western blotting of various antigenic components of H. pylori and subsequent enzymatic detection of antibodies against them. Four reactive bands in the molecular weight range of 45-65 kDa were present in all subjects irrespective of H. pylori status. Four to six immunoreactive bands in the molecular weight range of 21-45 kDa were found only in patients with positive H. pylori status and histopathologically proven gastritis. These immunoreactive components may be valuable in specific immunodiagnosis of H. pylori infection.
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Affiliation(s)
- L Chatha
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh
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