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Sathar SA, Kunnathuparambil SG, Sreesh S, Narayanan P, Vinayakumar KR. Helicobacter pylori infection in patients with liver cirrhosis: prevalence and association with portal hypertensive gastropathy. Ann Gastroenterol 2014; 27:48-52. [PMID: 24714519 PMCID: PMC3959527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/25/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The role of Helicobacter pylori (H. pylori) in the pathogenesis of portal hypertensive gastropathy (PHG) in cirrhotic patients is poorly defined. The aim of this study was toinvestigate the prevalence of H. pylori infection and its association with PHG in patients with liver cirrhosis. METHODS Seroprevalence of H. pylori was tested in 70 cirrhotic patients with PHG (cases) and 70 cirrhotic patients without PHG (controls) using an anti-H. pylori IgG ELISA. All patients underwent upper gastrointestinal endoscopy to assess the severity of PHG and grade of varices. RESULTS The presence of H. pylori was observed in 31 (44.3%) cirrhotic patients with PHG (cases) compared to 19 (27.1%) cirrhotic patients without PHG (controls). The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P=0.034, OR 2.134, 95% CI 1.052-4.327). Out of the 31 patients with PHG and H. pylori infection, 19 had severe PHG and 12 had mild PHG while 5 patients had severe PHG and 34 had mild PHG in the group of H. pylori negative patients. The difference was statistically significant (P<0.001, OR 10.767, 95% CI 3.293-35.205). Of the 70 patients with PHG, 24 had severe PHG and of these 18 (75%) were in Child C compared to 6 (25%) in Child B. CONCLUSION There is significant association between H. pylori infection and PHG in cirrhotic patients which is also related to severity of PHG. Thus, H. pylori needs to be eradicated in cirrhotic patients with PHG.
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Affiliation(s)
- Shanid Abdul Sathar
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India,
Correspondence to: Dr Shanid Abdul Sathar, Senior Resident, Department of Medical Gastroenterology, SSB-3, Super Specialty Block 3rd floor, Government Medical College, Thiruvananthapuram 695 011, India, Tel.: + 91 9447106999, e-mail:
| | | | - Srijaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Premaletha Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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Kunnathuparambil SG, Vinayakumar KR, Varma MR, Thomas R, Narayanan P, Sreesh S. Bilirubin, aspartate aminotransferase and platelet count score: a novel score for differentiating patients with chronic hepatitis B with acute flare from acute hepatitis B. Ann Gastroenterol 2014; 27:60-64. [PMID: 24714407 PMCID: PMC3959525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/30/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Early therapy improves the outcome in patients with chronic hepatitis B with acute flare (CHB-AF). However in mesoendemic countries, it is difficult to differentiate CHBAF from acute hepatitis B (AHB). The aim of this study was to formulate a clinical score to differentiate CHB-AF from AHB in patients presenting with an acute hepatitis-like picture. METHODS Patients with a protracted clinical course of >2 months with elevated liver enzymes and positive hepatitis B virus DNA, who had undergone liver biopsy were included in this study. The clinical and laboratory profiles were compared between patients with biopsy suggestive of CHB-AF and AHB. RESULTS Of the 75 patients included, 32 patients had a liver biopsy suggestive of CHB-AF. At 6 months, HBsAg clearance was lower in the CHB-AF group (9.4 vs. 76.7%). Presence of prodrome, platelet count, aspartate aminotransferase (AST), alanine aminotransferase and bilirubin levels and presence of anti-core antibody (IgM anti HBc) were lower in CHB-AF group (P<0.01). Using the receiver operating characteristic curve, peak bilirubin level, peak AST levels and least platelet count within the first 8 weeks had the highest predictive power. Optimal values of platelet <2.4×105/µL, peak bilirubin <4.5 mg/dL and AST <550 IU/L were given a point each. On internal validation a score of 2 had 86% specificity, 70.1% sensitivity and 82.7% diagnostic accuracy in predicting CHB-AF. CONCLUSION Bilirubin, AST and platelet count (BAP) score may be helpful in differentiating CHB-AF from AHB. A score of >2 could strongly suggest CHB-AF. However the score requires further validation.
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Affiliation(s)
- Sojan George Kunnathuparambil
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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Correspondence to: Dr Sojan George Kunnathuparambil, Senior Resident, Department of Medical Gastroenterology, SSB-3, Super Specialty Block 3rd floor, Govt. Medical College, Thiruvananthapuram 695 011, Kerala, India, Tel.: +91 9400 073067, e-mail:
| | | | - Mahesh R. Varma
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Rony Thomas
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Premaletha Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Srijaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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Kunnathuparambil SG, Sathar SA, Tank DC, Sreesh S, Mukunda M, Narayanan P, Vinayakumar KR. Splenic abscess due to chronic melioidosis in a patient previously misdiagnosed as tuberculosis. Ann Gastroenterol 2013; 26:77-79. [PMID: 24714690 PMCID: PMC3959514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022] Open
Abstract
Melioidosis is endemic in Southeast Asia and Northern Australia. Sporadic cases have been reported from many parts of the world where it has an epidemic potential with high-rate fatality cases. In non-endemic areas, melioidosis may be misdiagnosed with common diseases and this may prove fatal. Sporadic cases of melioidosis are mistaken for tuberculosis in India. We report a case of splenic abscess due to chronic melioidosis who was earlier misdiagnosed as tuberculosis and underwent anti-tuberculosis therapy. Following treatment of melioidosis his symptoms subsided. This case is reported because of the rarity of the disease and to highlight the importance of looking for melioidosis in patients with splenic abscess even in non-endemic areas.
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Affiliation(s)
- Sojan George Kunnathuparambil
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India,
Correspondence to: Dr Sojan George Kunnathuparambil, Senior Resident, Department of Medical Gastroenterology, SSB-3, super specialty block 3rd floor, Government Medical College, Thiruvananthapuram 695 011, India, Tel.: + 91 94 000 73067, e-mail:
| | - Shanid Abdul Sathar
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Devang Chandrakanth Tank
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Srijaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Madhav Mukunda
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Premaletha Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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Kunnathuparambil SG, Payangappadom PK, Yerol PK, Madhavan M, Sreesh S, Narayanan P, Devdas K, Ramakrishanan Kattoor V. Hypercalcemic crisis due to adult T cell leukemia: a rare cause of paralytic ileus. Ann Gastroenterol 2012; 25:170-172. [PMID: 24714244 PMCID: PMC3959384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/11/2012] [Indexed: 11/18/2022] Open
Abstract
Adult T cell leukemia- lymphoma is a rare aggressive malignancy of the peripheral T lymphocytes, caused by human T cell lymphotropic virus -1 (HTLV-1) infection. Hypercalcemia occurs in about 70% of patients with acute adult T cell leukemia. However, there are very few case reports of adult T cell leukemia presenting as a hypercalcemic crisis. We report a case of a 54-year-old male who presented with abdominal pain, constipation and altered sensorium. On examination he had generalized lymphadenopathy, hepatosplenomegaly and paralytic ileus. Investigation revealed hypercalcemic crisis with low parathormone (PTH) levels. Peripheral smear and bone marrow aspirate were consistent with adult T cell leukemia. HTLV-1 serology was positive. Despite the corrective measures for hypercalcemia and chemotherapy, he succumbed to the illness in a week.
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Affiliation(s)
- Sojan George Kunnathuparambil
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India,
Correspondence to: Dr Sojan George Kunnathuparambil, Senior Resident, Department of Medical Gastroenterology, SSB – 3, super specialty block 3rd floor, Govt. Medical College, Thiruvananthapuram 695 011, India, Tel: +01 94000 73067, e-mail:
| | | | - Praveen Kumar Yerol
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Mukunda Madhavan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sreejaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Premaletha Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Krishnadas Devdas
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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