Gastric Health

Alcoholic Hepatitis     Alcoholic hepatitis is a severe syndrome and a stage of alcoholic liver disease.   It is mostly caused by long term heavy alcohol consumption. However, it is important to note that it is not quantity dependent. Risk factors High BMI Pre-existing liver disease Genetics   It is characterized by Rapid onset of jaundice, Malaise Right upper quadrant pain Elevated liver enzymes Features of systemic inflammatory response . Signs of severe disease a)      Ascites b)      Hepatic encephalopathy c)      Coagulation disorders (bleeding disorder) d)      Variceal bleeding e)      Thrombocytopenia     Evaluation The diagnosis of alcoholic hepatitis is done clinically with supporting laboratory investigation.   Liver function tests Complete blood counts Ultrasound   Treatment Complete alcohol ...

Current COVID wave (BF.7 and XBB)   The recombinant variant, XBB, is the dominant strain in India right now.   The variant causing a surge in cases in China is the BF.7 variant. Few cases have been reported in India amongst travellers.   The symptoms of this strain are mild with most patients recovering at home. Symptoms of the current wave   Sore throat Fever Body ache Runny nose Dry cough   Some patients have reported having mild nausea and self-limiting diarrhea. What we need to know?   Please do not panic. If you're vaccinated, you just need to take preventive measures.   If you have any symptoms, please self-isolate and take rest. Consume plenty of fluids and consult your physician.   Please get all your vaccine doses (if not vaccinated, including the precautionary dose). It is our best shield against COVID.     Preventive measures   Do Not Panic ...

Acute Gastritis   Acute gastritis refers to inflammation of the mucosal lining of the stomach. Common causes 1.       H. Pylori infection 2.       Overuse of NSAID’s 3.       Food poisoning 4.       Excessive alcohol consumption 5.       Autoimmune diseases 6.       Stress or injury/trauma Cancer Clinical features 1.       Burning sensation in the chest or abdomen 2.       Nausea 3.       Vomiting Complications 1.       Gastric ulcers 2.       Upper gastrointestinal bleeding 3.       Untreated cases may progress to chronic gastritis Evaluation 1.       Upper gastrointestinal endoscopy 2.       H.Pylori testing (stool antigen...

        Tropical sprue Tropical sprue is a rare chronic  malabsorptive disorder due to an unknown cause. It is seen prevalent among people traveling to the tropical regions or in the native population. It is characterized by : 1. Persistent diarrhea, 2. Weight loss 3. Chronic fatigue 4. Abdominal discomfort or pain Consequently, nutritional deficiencies and abnormalities in the mucous lining of the small intestine may be present. The exact cause of this disorder is yet to found out however, it may be related to a complex medley of environmental and nutritional factors of the region. Due to the inflammation of the small bowel, it leads to poor absorption of many vitamins and minerals like: – Folate and Vit B12 deficiency Vit D and calcium Vit C If the condition is left undiagnosed or untreated, the ensuing malnutrition leads to infections, anorexia, osteoporosis etc Management Tropical sprue is a diagnosis made after excluding infective and other inflammator...

Eosinophilic esophagitis   Eosinophilic esophagitis is a chronic immune-mediated disorder of the esophagus. The cause of the disease is not understood yet but is though to be allergic reaction to food antigens. This condition is predominantly seen in young and middle-aged group population. Associated risk factors There are many risk factors associated with this disease which include 1.       Atopy (asthma, eczema, dermatitis) 2.       Premature delivery 3.       Genetic predisposition 4.       Gastroesophageal reflux disease (GERD) Clinical features The presentation varies among different age-groups. In adults, it presents as: - a)       Difficulty in swallowing solids and/or liquids b)       Food impaction c)       Heartburn (refractory to antacids) d)       Ches...

24-hour pH impedance testing Gastroesophageal reflux disease (GERD) is a disease in which the contents of the stomach including gastric acid travel back into the esophagus. 24-hour pH impedance test which best diagnoses this condition and its severity. In this test, the gastroenterologist can identify whether the reflux (stomach contents) is acidic or non-acidic.  What is done in the procedure? a)     1)    A thin long catheter is inserted is inserted through the nose and is guided through into the opening of the stomach.   b)     2)   The catheter is kept for 24 hours where it records real-time pH values along its entire length and other activities   c)     3)   The information obtained from the catheter is relayed into a computer which is worn on a belt.   d)       4) After 24 hours, the information is checked and a diagnosis is made. Things you should know 1.       1) ...

Gastric Polyps  Gastric polyps are masses or a small aggregation of cells seen in the stomach. They represent areas of higher-than-normal proliferative growth and may potentially turn neoplastic.    They can be further sub-divided into  1) Gastric hyperplastic polyps  2) Fundic gastric polyp  3) Adenomatous polyp s Most polyps are diagnosed incidentally on upper GI endoscopy. Gastric hyperplastic polyps are associated with chronic H.pylori infection and atrophic gastritis.  Risks associated with gastric polyps    1. Age     2. Chronic H.pylori infection    3. Chronic gastritis due to any cause    4. Genetically inherited polyposis syndromes like Familial adenomatous polyposis (FAP) Clinical features  Majority of the polyps are asymptomatic and are incidentally found. However, a     fraction of cases may present with    1. Heartburn and chest discomfort    2. Indigestio...

 Esophageal webs and rings Esophageal webs and rings are outpouchings or growths which may partially occlude the lumen. The clinical presentation varies from being asymptomatic to having intermittent dysphagia to solids. Webs are predominantly seen in the proximal esophagus (near throat) and rings in the distal esophagus (near stomach) Risk factors The etiology of esophageal webs and rings is poorly understood. However, it commonly seen with the following disorders: - a)       Plummer-Vinson syndrome b)       Zenker’s diverticulum c)       Epidermolysis bullosa d)        Hiatus hernia e)       Eosinophilic esophagitis (rings) Clinical features Most esophageal webs and rings are seen incidentally on upper gastrointestinal endoscopy. However, a small percentage may present with 1.       Intermittent dysphagia to solids ...

Endoscopic Submucosal Dissection  Endoscopic submucosal dissection (ESD) is a procedure to remove tumors from the gastrointestinal (GI) tract. It is done under general anesthesia and is done mostly on outpatient basis.  It is done using a high-definition upper GI endoscope either through the mouth or anus (depending on location of the tumor). An electrosurgical knife used to cut the tumor from the adjacent tissue with the use of high-frequency electrical current.  The knife also aids in cauterizing any bleed during the procedure. The tissue which is excised is then sent for histopathological examination. It is indicated in: -  1. Early-stage cancer of the GI tract (especially esophagus)  2. Polyps  3. Non-invasive tumors of the stomach or large intestine  4. Pre-malignant diseases like Barrett’s Special note: -  a) Because it is special minimally invasive procedure, the organ of involvement is preserved. This helps maintain quality of life fo...

     What causes GI abdominal pain ?  Abdominal pain can occur anywhere between your chest and your groin . The pain could be generalized, localized, or even resemble stomachaches.  If you experience gas, bloating, or constipation, your stomach may be painful or cramping.  Colonoscopy and endoscopy can be used in the assessment of abdominal pain  Doctors will often recommend endoscopy to evaluate:  ● Stomach pain  ● Ulcers, gastritis, or difficulty swallowing  ● Digestive tract bleeding  ● alterations to bowel habits  ● Polyps or growths in the colon  In addition, your doctor might perform a biopsy (tissue removal) using an endoscope to check for the presence of disease.  A digestive system issue may also be treated using endoscopy. For instance, the endoscope may be able to stop bleeding by passing devices through it in addition to detecting any active bleeding from an ulcer. Polyps in the colon can be removed with a...

           Endoscopic submucosal dissection (ESD) Endoscopic submucosal dissection is a minimally invasive advanced endoscopic procedure which is used to remove or resect pre-cancerous or early cancerous lesions of the gastrointestinal tract (GI).  The upper-most lining of the GI tract is the mucosa and layer below it is the submucosa. Lesions or masses originating from this layer can be managed only with this procedure. The procedure uses an electrical current based ’surgical knife’ to remove the mass. Any minor bleeding is also cauterized and the entire mass is resected under real-time visualization.  Indications: - 1. Early cancers or micro invasive cancers of the upper gastrointestinal tract like            esophagus, stomach or duodenum  2. Masses or polyps in the lower gastrointestinal tract, especially neoplastic polyps  3. Pre-cancerous lesions like Barrett’s esophagus Advantages of ESD over surgery...

 Chronic Constipation Constipation is a term used to describe infrequent or fewer hard bowel movements (<3 week). In many cases the problem may become persistent and affect the quality of life of the patient. The clinical features associated with constipation include: -  1. Reduced frequency (<3 times per week)  2. Hardened consistency  3. Excessive straining required to evacuate bowel  4. Manual removal of stool needed 5. Feeling of passing or having ‘incomplete bowel movement’ Causes  1. Sedentary lifestyle or inadequate physical activity 2. Functional constipation  3. Lack of fiber in diet 4. Inadequate consumption of water  5. Medication side effect  6. Irritable bowel syndrome (IBS-C)  7. Endocrinal disorders like hypothyroidism, diabetes mellitus 8. Electrolyte disturbances Evaluation  A number of tests need to be done to find the cause; however, in some cases the cause may not be established. Some of the tests are ...

Hiatus Hernia A hernia is a term used to describe when an organ or part protrudes through the tissue that contains it. The esophagus and stomach are connected through a small opening in the diaphragm (hiatus). A hiatus hernia is when part of the stomach pushes up through the opening into the chest cavity causing problems. Causes Age-related changes Surgical trauma Sudden or persistent intra-abdominal pressure (excessive coughing, vomiting, straining during urination or defecation) Clinical features Small Hiatal hernias are usually asymptomatic and may be discovered incidentally. However, in some cases, the following features may be seen Burning sensation or discomfort in the chest Reflux or regurgitation of food contents or stomach acid Discomfort while swallowing Early feeling of fullness Evaluation Upper GI endoscopy to rule out gastritis or esophagitis Barium swallow Esophageal manometry Treatment 1. Conservative - Most Hiatal Hernias are...

  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) What is Endoscopic ultrasound ? Endoscopic ultrasound (EUS) is a minimally invasive procedure to assess the digestive (gastrointestinal) tract, especially the mucosal lining. The procedure employs a  modified endoscope that uses high-frequency sound waves . This enables a more detailed view of the lining of the digestive tract. Structures near the lining of the tract which include the  pancreas, gallbladder, and liver can also be studied  using this procedure. What is Fine-needle aspiration (FNA )? Fine-needle aspiration(FNA) is a procedure in which tissue/cells are  extracted from suspected masses or lymph nodes  for  evaluation under a microscope . Under EUS, real-time visualized aspiration of tissue is achieved from different parts of the upper gastrointestinal tract Common Indications of EUS-FNA 1. Masses or tumors 2. Deep-seated lymphadenopathy Steps in EUS-FNA  – 1. Real-time l...