Open Access Case Report

A Case Report on Gastric Xanthelasma

Shruti Verma, Arshdeep Singh, Aminder Singh, Yogesh Kumar Gupta, Ajit Sood

Asian Journal of Research and Reports in Gastroenterology, Page 22-28

Xanthelasmas of the gastrointestinal tract are rare. Gastric xanthelasmas (GX) are benign clusters of lipid-laden-macrophages present in lamina propria of the gastric mucosa. We present a case of a 44-year-old female who presented with complaints of upper abdominal discomfort, bloating and fatigue. On evaluation she had anemia. Esophagogastroduodenoscopy revealed GX, without pathological evidence of concomitant Helicobacter pylori infection. Though the exact pathogenesis of GX is not known, it is commonly associated with dyslipidemia, Helicobacter pylori infection-related chronic gastritis, hyperplastic gastric polyps, intestinal metaplasia, diabetes mellitus and synchronous or metachronous gastric cancer. A review of literature describing common clinicopathologic differentials of GX is presented after the case discussion.

Open Access Case Study

Remnant Causing Obstruction! - A Case of Patent Omphalomesenteric Duct in Adult

Dhiraj Kachare, Waqar Ansari, Gayatri Muley, Harekrishna G. Venkariya, Urvashi Jain, Atish Parikh

Asian Journal of Research and Reports in Gastroenterology, Page 9-14

Omphalomesenteric duct remnant is a congenital anomaly associated with the primitive yolk stalk commonest remnant being Meckel's diverticulum. Persistence of omphalomesenteric duct in infants is a rare congenital anomaly present in 2% of the population with being completely patent is observed in about 0.1 % population. In adults, the incidence is not reported though there are a few case reports (approximately 23) out of which 13 cases presented as small bowel obstruction, 6 as mesenteric cyst, and 4 as discharge from the umbilicus. An exceptional case of persistent omphalomesenteric duct in adolescents leading to small bowel obstruction is hereby presented. After relevant investigations on exploratory laparotomy, a patent band identified as an omphalomesenteric duct causing acute small bowel obstruction was seen and resection and anastomosis were done. The patient was discharged on postoperative day 10 and is currently asymptomatic. In conclusion, the persistent omphalomesenteric duct is an extremely rare cause of obstruction of the small bowel in adults, while it can be taken into consideration in patients without a history of previous abdominal surgery.

Open Access Original Research Article

Assessment of Histological Activity in Patients with Ulcerative Colitis using Nancy Index and its Correlation with Endoscopic Score (UCEIS) – A Prospective Study

Vivek Kumar Singh, Ubal Dhus, K. S. Sunil Kumar, Bhavin Davra, P. Piramanayagam

Asian Journal of Research and Reports in Gastroenterology, Page 1-8

Aims: Assessment of histological activity in patients with Ulcerative Colitis (UC) using Nancy Index (NI) and determining its correlation with endoscopic grading using Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score.

Study Design: Cross sectional prospective observational study.

Place and Duration of Study: Department of Medical Gastroenterology and Department of Pathology, Apollo Hospital Chennai, between March 2020 to October 2021.

Methodology: Consecutive patients with UC between the age 18-80 years undergoing endoscopic examination and biopsy were enrolled. Patients with infective colitis, toxic megacolon, perforation, hemodynamic instability and patients with previous colorectal surgery were excluded. Clinical disease severity was assessed using Truelove Witts score (TLW). Whereas, endoscopic and histologic activity was graded using UCEIS and Nancy Index into remission (UCEIS-0-1, NI-0-1), mild (UCEIS- 2-4,NI -2), moderate (UCEIS - 5-6,NI - 3) and severe (UCEIS - 7-8,NI - 4). Statistical analysis was performed using Spearman’s correlation coefficient using SPSS v.25.0.

Results: Our study included 85 (M:F-1.5:1) patients. Mean age at presentation was 44.25(±13.44) years and age at onset of disease 39.68 (±1.32) with a median duration of disease 2(IQR – 2.5) years. Most common symptoms at the time of presentation were blood in stool followed by mucus in stool in 64.7% and 45.9%, respectively. Most of the patients were on oral ASA preparation, 43% were on AZA and 7% on steroids. Endoscopically – E1:E2:E3 disease was seen in 29%, 47% and 24%, respectively. Correlation between UCEIS and NI was found to be very strong with r =0.85(p<0.001). 95.7% of patients in endoscopic remission also had histologic remission. No statistically significant difference was found when a UCEIS score of 0 or ≤1 was used to predict histological remission.

Conclusion: Significant correlation was observed between validated endoscopic and histologic indices of severity. A UCEIS score of 0 or ≤1 both predicted histological remission. Endoscopic remission can be used as surrogate marker for histological remission.

Open Access Original Research Article

Prevalence of Functional Defecation Disorder among Patients with Functional Constipation: Experience from a Tertiary Care Hospital in India

Bhavin Khimjibhai Davra, Usha Srinivas, Vivek Kumar Singh

Asian Journal of Research and Reports in Gastroenterology, Page 15-21

Aims: To study the manometry findings and its association with clinical symptoms in patients with functional constipation (FC) and prevalence of Functional defecation disorder (FDD) among them.

Study Design:  Prospective observational study.

Place and Duration of Study: Patients from the department of Gastroenterology, Apollo Main Hospital Chennai between March 2020 to October 2021.

Methodology: Consecutive patients with FC between age 18-70 years presenting to our institute and undergoing anorectal manometry (ARM) and balloon expulsion test (BET) were enrolled. Patients with mechanical obstruction or severe cardiopulmonary co-morbidities were excluded. Patients with abnormal ARM and absent BET were diagnosed as FDD and were classified into dyssynergic defecation (DD) I-IV according to Rao’s classification.

Results: 75 patients (M:F-39:36) were enrolled. Mean age and mean duration of constipation was 44.59 (±13.89) years and 3.32(±2.87) years, respectively. Common symptoms were sensation of incomplete evacuation (67%), use of manual manoeuvres (55%) and excessive straining (53%). 69.2% males (27/39) had a FDD compared to 44.4% females (16/36) which was statistically significant (P = .037). 83% (20/24) of the patients presenting with sensation of blockage/obstruction had a FDD while 17% (4/24) had a normal manometry study which was statistically significant (P = .002). No other symptoms could predict an abnormal finding in manometry.

Conclusion: This study is aimed to describe the clinical and anorectal manometry profile of patients with FC. A large number of patients with FC had FDD. Male patients and those presenting with symptom of sensation of obstruction/blockage were more likely to have FDD.

Open Access Original Research Article

Evaluation of the Relationship between Fecal/ Serum Levels of Infliximab and Clinical Response to Treatment of IBD patients: A Cross-sectional Study

Foroogh Alborzi, Hesam Aldin Varpaei, Nasser Ebrahimi Daryani, Keyvan Rezvan, Sara Rafiee Sevyeri

Asian Journal of Research and Reports in Gastroenterology, Page 29-38

Background: Inflammatory bowel disease (IBD) includes two major disorders: ulcerative colitis (UC) and Crohn's disease (CD). Infliximab is a monoclonal antibody that targets tumor                   necrosis factor (TNF) and is used to treat UC and CD. The aim of this study was to evaluate the fecal and blood levels of infliximab and the response to treatment of IBD patients after induction period.

Methods: This was a cross-sectional study conducted at the Imam Khomeini Hospital Complex (January to May 2021). All patients who were candidate for anti-TNF therapy received 5 mg/kg given as an IV induction regimen at 0, 2, and; 6 weeks, followed by a maintenance regimen of 5 mg/kg IV every 8 weeks. At the end of second week (day 14), Patient’s response to treatment with either CDAI or MAYO score, fecal levels of infliximab, serum CRP and albumin level were measured. At the end of 14th week, fecal levels of Infliximab, serum levels of Infliximab serum albumin and CRP level were assessed again.

Results: A total of 28 patients (75% male and 25% female) were included into the study (14 patients with Ulcerative colitis and 14 patients with Crohn's disease). The mean age of the population was 34 ± 10. The distribution of Serum Infliximab after 14 weeks was not the same across clinical response (P < 0.05). Specifically, after adjusting for the Fecal Infliximab concentration day 14, UC patients had higher level of Serum Infliximab level at week 14 (3.853 ± 1.803) compared to the Crohn's disease patients.

Conclusion: Measurement of serum infliximab is widely recommended now and can be used for therapeutic monitoring of patients. The presence of higher serum infliximab is associated with a higher clinical response. In spite of early fecal loss of infliximab, which is an indicator of low serum infliximab level, late fecal infliximab is not a good marker for response since the inflammation is reduced.