Numerous environmental factors have been linked with inflammatory bowel disease. These include smoking, diet, hygiene, drugs, geographical and psychosocial factors. These factors may either increase the risk of or pro...Numerous environmental factors have been linked with inflammatory bowel disease. These include smoking, diet, hygiene, drugs, geographical and psychosocial factors. These factors may either increase the risk of or protect against developing this condition and can also affect the course of illness in a positive or negative manner. A number of studies have examined the influence of environmental factors on inflammatory bowel diseases as a whole as well as on ulcerative colitis and Crohn's disease separately. As there are differences in the pathogenesis of ulcerative colitis and Crohn's disease, the effect of environmental factors on their onset and course is not always similar. Some factors have shown a consistent association, while reports on others have been conflicting. In this article we discuss the current evidence on the roles of these factors on inflammatory bowel disease, both as causative/protective agents and as modifiers of disease course.展开更多
AIM: To estimate the prevalence of inherited and acquired thrombophilic risk factors in patients with abdominal venous thrombosis and to compare the risk factor profiles between Budd-Chiari syndromes (BCS) and splanch...AIM: To estimate the prevalence of inherited and acquired thrombophilic risk factors in patients with abdominal venous thrombosis and to compare the risk factor profiles between Budd-Chiari syndromes (BCS) and splanchnic vein thrombosis (SVT). METHODS: In this retrospective study, 36 patients with abdominal venous thrombosis were studied. The patients were divided into Budd-Chiari group (hepatic vein, IVC thrombosis) and splanchnic venous thrombosis group (portal, splenic, superior mesenteric veins) based on the veins involved. Hereditary and acquired thrombophilic risk factors were evaluated in all patients. RESULTS: Twenty patients had SVT, 14 had BCS, and 2 had mixed venous thrombosis. Ten patients (28%) had hereditary and 10 patients (28%) acquired thrombophilic risk factors. The acquired risk factors were significantly more common in the SVT group (SVT vs BCS: 45% vs 7%, χ2 = 5.7, P = 0.02) while hereditary risk factors did not show significant differences between the two groups (SVT vs BCS: 25% vs 36%, χ2 = 0.46, P = 0.7). Multiple risk factors were present in one (7%) patient with BCS and in 3 patients (15%) with SVT. No risk factors were identified in 57% of patients with BCS and in 45% of patients with SVT. CONCLUSION: Hereditary and acquired risk factors play an important role in the etiopathogenesis of abdominal venous thrombosis. Acquired risk factorsare significantly more common in SVT patients while hereditary factors are similar in both groups.展开更多
Therapy of Helicobacter pylori(H.pylori)requires a combination of antibiotics together with an acid suppressing agent;most treatment regimens include Amoxicillin as one of the antibiotics,which is an important constit...Therapy of Helicobacter pylori(H.pylori)requires a combination of antibiotics together with an acid suppressing agent;most treatment regimens include Amoxicillin as one of the antibiotics,which is an important constituent as resistance to it is low.However,allergies to the penicillin group of antibiotics are not uncommon,and treating H.pylori infection in such individuals can be challenging due to the restricted choice of regimens.The aim of this review is to summarise the evidence for therapeutic options in patients with H.pylori infection and penicillin allergy.A literature search was conducted in PubMed for English language publications using the key words‘Helicobacter’and‘treatment’or‘therapy‘and‘penicillin’or‘beta-lactam’and‘allergy’or‘anaphylaxis’.Eighteen studies were identified that specifically evaluated H.pylori treatment success in penicillin allergic patients.The number of subjects in most of them was low and many were retrospective,uncontrolled,single cohort studies.The most effective option for first-line treatment appears to be Bismuth-based quadruple therapy for 10-14 d.The evidence supports second-line treatment with Levoflaxacin-based triple therapy for 10 d.Patients with persistent H.pylori infection after 2 treatment courses should be considered for testing to confirm penicillin allergy.Further treatment should be guided by the results of H.pylori culture and sensitivity testing.展开更多
Endoscopy using magnification narrow band imaging(m NBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role ...Endoscopy using magnification narrow band imaging(m NBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role of this technology in duodenum is still evolving. Studies have shown that m NBI has high accuracy in predicting villous atrophy in the duodenum. Limited data suggests that this technique can provide additional information on duodenal polyps,nodules and ampullary tumour which can help guide their management. In this paper we describe the technique for duodenal assessment using NBI and review the existing literature evaluating its role in diagnosis of various duodenal pathologies.展开更多
BACKGROUND Multiple genetic risk factors for Crohn’s disease(CD)have been identified.However,these observations are not consistent across different populations.The protein tyrosine phosphate non-receptor type 2(PTPN2...BACKGROUND Multiple genetic risk factors for Crohn’s disease(CD)have been identified.However,these observations are not consistent across different populations.The protein tyrosine phosphate non-receptor type 2(PTPN2)gene plays a role in various aspects of host defense including epithelial barrier function,autophagy,and innate and adaptive immune response.Two common polymorphisms in the PTPN2 gene(rs2542151 and rs7234029)have been associated with risk of CD in Western countries.AIM To evaluate the association of PTPN2 gene polymorphisms with risk of CD in Indian population.METHODS We conducted a prospective case-control study.Patients with CD were recruited,and their clinical and investigation details were noted.Controls were patients without organic gastrointestinal disease or other comorbid illnesses.Two common polymorphisms in the PTPN2 gene(rs2542151 and rs7234029)were assessed.DNA was extracted from peripheral blood samples of cases and controls and target DNA was amplified using specific sets of primers.The amplified fragments were digested with restriction enzymes and the presence of polymorphism was detected by restriction fragment length polymorphism.The frequency of alleles was determined.The frequencies of genotypes and alleles were compared between cases and controls to look for significant differences.RESULTS A total of 108 patients with CD(mean age 37.5±12.7 years,females 42.6%)and 100 controls(mean age 39.9±13.5 years,females 37%)were recruited.For the single nucleotide polymorphism(SNP)rs7234029,the overall frequency of G variant genotype(AG or GG)was noted to be significantly lower in the cases compared to controls(35.2%vs 50%,P=0.05).For the SNP rs2542151,the overall frequency of G variant genotype(GT or GG)was noted to be similar in cases compared to controls(43.6%vs 47%,P=0.73).There were no significant differences in minor allele(G)frequency for both polymorphisms between the cases and controls.Both the SNPs had no significant association with age of onset of illness,gender,disease location,disease behaviour,perianal disease,or extraintestinal manifestations of CD.CONCLUSION Unlike observation form the West,polymorphisms in the PTPN2 gene(rs7234029 and rs2542151)are not associated with an increased risk of developing CD in Indian patients.展开更多
BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicti...BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicting therapeutic response is challenging and an area of active research.Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.AIM To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.METHODS We searched the literature database(PubMed,Scopus,and Cochrane database)from inception to August 2025.We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies,with baseline microbiome analyses performed prior to treatment.Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included.The utility of bacterial diversity,microbial community structure,and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed.The results were grouped based on the bacterial parameters studied and presented in separate tables.The quality of the included studies was assessed using the MINORS criteria.The review was registered prospectively in PROSPERO.RESULTS After applying the selection criteria,sixteen studies were included in this systematic review.The majority of the papers were from Europe and the United States.All except two papers assessed gut bacterial population using 16S rRNA gene sequencing.Ten of the sixteen studies were of high quality.Among the sixteen studies included,most identified an association between microbial taxa and treatment response,while the relation with alpha-diversity was inconsistent.The functional characteristics were reported in only four studies and were found to be useful.The best prediction was achieved when microbial characteristics were combined with clinical and other parameters,with area under the curve values up to 0.96.CONCLUSION The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response.However,there are variations across individual studies,probably related to the methodology of assessing microbial communities and the therapeutic agent used.Future multicenter studies integrating microbial,clinical,and metabolomic data are warranted to develop predictive models for personalized therapy in CD.展开更多
文摘Numerous environmental factors have been linked with inflammatory bowel disease. These include smoking, diet, hygiene, drugs, geographical and psychosocial factors. These factors may either increase the risk of or protect against developing this condition and can also affect the course of illness in a positive or negative manner. A number of studies have examined the influence of environmental factors on inflammatory bowel diseases as a whole as well as on ulcerative colitis and Crohn's disease separately. As there are differences in the pathogenesis of ulcerative colitis and Crohn's disease, the effect of environmental factors on their onset and course is not always similar. Some factors have shown a consistent association, while reports on others have been conflicting. In this article we discuss the current evidence on the roles of these factors on inflammatory bowel disease, both as causative/protective agents and as modifiers of disease course.
文摘AIM: To estimate the prevalence of inherited and acquired thrombophilic risk factors in patients with abdominal venous thrombosis and to compare the risk factor profiles between Budd-Chiari syndromes (BCS) and splanchnic vein thrombosis (SVT). METHODS: In this retrospective study, 36 patients with abdominal venous thrombosis were studied. The patients were divided into Budd-Chiari group (hepatic vein, IVC thrombosis) and splanchnic venous thrombosis group (portal, splenic, superior mesenteric veins) based on the veins involved. Hereditary and acquired thrombophilic risk factors were evaluated in all patients. RESULTS: Twenty patients had SVT, 14 had BCS, and 2 had mixed venous thrombosis. Ten patients (28%) had hereditary and 10 patients (28%) acquired thrombophilic risk factors. The acquired risk factors were significantly more common in the SVT group (SVT vs BCS: 45% vs 7%, χ2 = 5.7, P = 0.02) while hereditary risk factors did not show significant differences between the two groups (SVT vs BCS: 25% vs 36%, χ2 = 0.46, P = 0.7). Multiple risk factors were present in one (7%) patient with BCS and in 3 patients (15%) with SVT. No risk factors were identified in 57% of patients with BCS and in 45% of patients with SVT. CONCLUSION: Hereditary and acquired risk factors play an important role in the etiopathogenesis of abdominal venous thrombosis. Acquired risk factorsare significantly more common in SVT patients while hereditary factors are similar in both groups.
文摘Therapy of Helicobacter pylori(H.pylori)requires a combination of antibiotics together with an acid suppressing agent;most treatment regimens include Amoxicillin as one of the antibiotics,which is an important constituent as resistance to it is low.However,allergies to the penicillin group of antibiotics are not uncommon,and treating H.pylori infection in such individuals can be challenging due to the restricted choice of regimens.The aim of this review is to summarise the evidence for therapeutic options in patients with H.pylori infection and penicillin allergy.A literature search was conducted in PubMed for English language publications using the key words‘Helicobacter’and‘treatment’or‘therapy‘and‘penicillin’or‘beta-lactam’and‘allergy’or‘anaphylaxis’.Eighteen studies were identified that specifically evaluated H.pylori treatment success in penicillin allergic patients.The number of subjects in most of them was low and many were retrospective,uncontrolled,single cohort studies.The most effective option for first-line treatment appears to be Bismuth-based quadruple therapy for 10-14 d.The evidence supports second-line treatment with Levoflaxacin-based triple therapy for 10 d.Patients with persistent H.pylori infection after 2 treatment courses should be considered for testing to confirm penicillin allergy.Further treatment should be guided by the results of H.pylori culture and sensitivity testing.
文摘Endoscopy using magnification narrow band imaging(m NBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role of this technology in duodenum is still evolving. Studies have shown that m NBI has high accuracy in predicting villous atrophy in the duodenum. Limited data suggests that this technique can provide additional information on duodenal polyps,nodules and ampullary tumour which can help guide their management. In this paper we describe the technique for duodenal assessment using NBI and review the existing literature evaluating its role in diagnosis of various duodenal pathologies.
基金Supported by the CMC Vellore FLUID grant,No.10360.
文摘BACKGROUND Multiple genetic risk factors for Crohn’s disease(CD)have been identified.However,these observations are not consistent across different populations.The protein tyrosine phosphate non-receptor type 2(PTPN2)gene plays a role in various aspects of host defense including epithelial barrier function,autophagy,and innate and adaptive immune response.Two common polymorphisms in the PTPN2 gene(rs2542151 and rs7234029)have been associated with risk of CD in Western countries.AIM To evaluate the association of PTPN2 gene polymorphisms with risk of CD in Indian population.METHODS We conducted a prospective case-control study.Patients with CD were recruited,and their clinical and investigation details were noted.Controls were patients without organic gastrointestinal disease or other comorbid illnesses.Two common polymorphisms in the PTPN2 gene(rs2542151 and rs7234029)were assessed.DNA was extracted from peripheral blood samples of cases and controls and target DNA was amplified using specific sets of primers.The amplified fragments were digested with restriction enzymes and the presence of polymorphism was detected by restriction fragment length polymorphism.The frequency of alleles was determined.The frequencies of genotypes and alleles were compared between cases and controls to look for significant differences.RESULTS A total of 108 patients with CD(mean age 37.5±12.7 years,females 42.6%)and 100 controls(mean age 39.9±13.5 years,females 37%)were recruited.For the single nucleotide polymorphism(SNP)rs7234029,the overall frequency of G variant genotype(AG or GG)was noted to be significantly lower in the cases compared to controls(35.2%vs 50%,P=0.05).For the SNP rs2542151,the overall frequency of G variant genotype(GT or GG)was noted to be similar in cases compared to controls(43.6%vs 47%,P=0.73).There were no significant differences in minor allele(G)frequency for both polymorphisms between the cases and controls.Both the SNPs had no significant association with age of onset of illness,gender,disease location,disease behaviour,perianal disease,or extraintestinal manifestations of CD.CONCLUSION Unlike observation form the West,polymorphisms in the PTPN2 gene(rs7234029 and rs2542151)are not associated with an increased risk of developing CD in Indian patients.
文摘BACKGROUND Various therapeutic options are available for the treatment of Crohn’s disease(CD).About 30%-40%patients experience primary non-response,and 20%-30%secondary loss of response to biological therapy.Predicting therapeutic response is challenging and an area of active research.Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.AIM To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.METHODS We searched the literature database(PubMed,Scopus,and Cochrane database)from inception to August 2025.We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies,with baseline microbiome analyses performed prior to treatment.Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included.The utility of bacterial diversity,microbial community structure,and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed.The results were grouped based on the bacterial parameters studied and presented in separate tables.The quality of the included studies was assessed using the MINORS criteria.The review was registered prospectively in PROSPERO.RESULTS After applying the selection criteria,sixteen studies were included in this systematic review.The majority of the papers were from Europe and the United States.All except two papers assessed gut bacterial population using 16S rRNA gene sequencing.Ten of the sixteen studies were of high quality.Among the sixteen studies included,most identified an association between microbial taxa and treatment response,while the relation with alpha-diversity was inconsistent.The functional characteristics were reported in only four studies and were found to be useful.The best prediction was achieved when microbial characteristics were combined with clinical and other parameters,with area under the curve values up to 0.96.CONCLUSION The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response.However,there are variations across individual studies,probably related to the methodology of assessing microbial communities and the therapeutic agent used.Future multicenter studies integrating microbial,clinical,and metabolomic data are warranted to develop predictive models for personalized therapy in CD.
