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Biomedical subjects

M Dwivedi

Publications and source records attributed to M Dwivedi.

At least 73 records · Page 4Linked to original sources
PubMed1997

Point prevalence of peptic ulcer and gastric histology in healthy Indians with Helicobacter pylori infection.

OBJECTIVES: To study the prevalence of peptic ulcer and the histological appearance of the gastric mucosa in healthy, asymptomatic Indians infected with Helicobacter pylori. METHODS: Asymptomatic, healthy individuals without any GI symptoms were invited to undergo endoscopy of the upper GI tract. A careful search was made for any erosion or ulcer. Four biopsy specimens were obtained from the gastric corpus and antrum. Histological sections were stained with hematoxylin and eosin for histological details and with Loffler's methylene blue for the presence of H. pylori. Alcian blue periodic acid-Schiff stain (pH 2.5) was used to classify and grade areas of intestinal metaplasia. RESULTS: Histological examination showed chronic gastritis in 72 (80%) persons. Pangastritis was seen in 22% of subjects; pangastritis with antral predominance, in 28%; and antrum-only gastritis, in 50%. Activity was noted in biopsy specimens from only 33% of the subjects. H. pylori infection was present in 70 (78%) subjects. All of these subjects had evidence of chronic gastritis. Endoscopic examination revealed a normal appearance in 88 individuals. In two individuals a duodenal ulcer was seen. Both subjects had severe H. pylori infection in the antral mucosa. Of the 70 persons having H. pylori infection, only two (2.8%) had a duodenal ulcer. CONCLUSIONS: This study showed that despite a high prevalence of H. pylori infection in asymptomatic, healthy Indians, the point prevalence of peptic ulcer is low, and chronic active gastritis is uncommon.

Adolescent↗
PubMed1996

Prevalence and factors influencing hemorrhoids, anorectal varices, and colopathy in patients with portal hypertension.

BACKGROUND AND STUDY AIMS: Little is known about the colon in patients with portal hypertension. The present study was carried out in order to assess the prevalence of, and factors influencing, hemorrhoids, anorectal varices, and colopathy in these patients. PATIENTS AND METHODS: Seventy patients with cirrhosis and portal hypertension, and seventy controls, were prospectively studied. Full-length colonoscopy was carried out in all cases, and the presence of hemorrhoids, anorectal varices, and colopathy was noted. RESULTS: Hemorrhoids and anorectal varices were seen in 36% and 40% of patients, compared to 40% and 0% in the controls. The difference was statistically significant only for anorectal varices (p < 0.001). Neither hemorrhoids nor anorectal varices were associated with the Child's grade of cirrhosis, the grade of esophageal varices, the presence of gastric varices, portal hypertensive gastropathy, or whether or not patients received sclerotherapy. Nor were they associated with each other. Colopathy was seen in 48.5% of the patients and 3% of the controls (p < 0.001). It was seen more frequently in patients with large esophageal varices compared to those with small varices (87% vs. 28.5%; p < 0.001), and more often in those with gastric varices than those without (71% vs. 28.5%; p < 0.001). It had no association with the severity of liver disease, the presence of hemorrhoids, portal hypertensive gastropathy, or whether or not patients received sclerotherapy. CONCLUSIONS: It is concluded that the prevalence of hemorrhoids is not increased in patients with portal hypertension. However, the prevalence of anorectal varices and colopathy is higher in these patients. Portal colopathy occurs more commonly in patients with large esophageal varices, those with gastric varices, and those who do not have anorectal varices.

Adolescent↗
PubMed1996

Long-term follow-up of patients undergoing ballon dilation for benign pyloric stenoses.

BACKGROUND AND STUDY AIMS: Balloon dilation is a useful alternative to surgery in patients with benign pyloric stenoses. However, little data are available on the long-term outcome of the procedure. PATIENTS AND METHODS: Fourteen patients with benign pyloric stenoses were treated by through-the-scope balloon dilation. Short-term and long-term follow-up was conducted (median 27 months). RESULTS: Balloon dilation was successfully performed in 12 patients (86%), and all 12 had immediate relief of symptoms after a single session. During a median follow-up of 27 months, 50% of the patients had recurrences of their symptoms, requiring redilation. Following this, two patients became symptomatic once again; one underwent surgery, and the other received a further session of balloon dilation, and was well at a further follow-up after one year. CONCLUSIONS: Balloon dilation of benign pyloric stenoses results in short-term symptomatic relief in the majority of patients. However, in the long-run, about half of the patients can be expected to experience a recurrence of symptoms, requiring further endoscopic or surgical treatment.

Adult↗
PubMed1996

Endoscopy-assisted emergency treatment of gastroduodenal and pancreatobiliary ascariasis.

Five patients with gastrointestinal tract and pancreatobiliary ascariasis presenting as emergency cases are reported here. Two patients presented with hematemesis due to gastric ascariasis, one with abdominal pain due to duodenal ascariasis, and one each with biliary and pancreatic ascariasis manifesting as acute cholangitis and acute pancreatitis, respectively. Endoscopy-assisted management consisted of roundworm removal using a Dormia basket, insertion of a biliary endoprosthesis, and carrying out endoscopic sphincterotomy alone or in combination, and was successful in all cases, with administration of albendazole. The condition of all the patients improved, and they have been asymptomatic on follow-up (2-12 months).

Acute Disease↗
PubMed1996

Biliary endoprosthesis as an alternative to endoscopic nasobiliary drainage in patients with acute cholangitis.

BACKGROUND AND STUDY AIMS: Conventionally, acute cholangitis is managed by placing a nasobiliary drainage catheter. We have attempted to place a biliary endoprosthesis in such patients as an alternative to using nasobiliary catheter drainage. PATIENTS AND METHODS: Twenty-seven patients with acute cholangitis were managed by placement of 7-Fr straight biliary endoprostheses instead of using nasobiliary drainage catheters to decompress the biliary system. The procedure was carried out without sphincterotomy and without image intensification. RESULTS: Biliary endoprosthesis placement was successfully carried out in all the patients. Definitive treatment was then provided to all but four patients, who either had inoperable cancer or were at high risk for surgery. Early stent occlusion occurred in one patient, and in another patient the Dormia basket became entrapped while stones were being removed from the common bile duct. There were no mortalities. CONCLUSIONS: Biliary endoprosthesis placement is safe, easy to perform, and is a cheaper alternative to endoscopic nasobiliary drainage.

Acute Disease↗
PubMed1995

Role of AgNORs in diagnosis of early malignant lesions of gall bladder.

Sections from eighty nine specimens of gall bladder including 40 cases of chronic cholecystitis, 9 dysplasia 15 well differentiated adenocarcinoma, 14 moderately differentiated adenocarcinoma and 11 poorly differentiated adenocarcinomas were studied for argyrophilic nucleolar organizer regions (AgNOR's). The difference between mean +/- SD NOR counts of chronic cholecystitis (1.97 +/- 0.28), dysplasia (5.6 +/- 0.88) well differentiated adenocarcinoma (7.2 +/- 0.30) and moderately differentiated adenocarcinoma (8.0 +/- 0.63) was statistically significant (p < 0.001). NOR counts of poorly differentiated adenocarcinoma (8.5 +/- 0.78) were higher than moderately differentiated carcinoma but the difference was not statistically significant. Despite the significant difference in the mean values, a considerable overlap in the NOR counts of individual cases of different groups was observed suggesting that though NOR counts can not act as a specific diagnostic parameter for diagnosis of early carcinoma and dysplasia in isolated cases, they may prove to be a good adjunct to already existing parameters like imaging techniques or cytology.

Adenocarcinoma↗
PubMed1993

Imprint cytology--a cheap, rapid and effective method for diagnosing Helicobacter pylori.

To compare the efficacy of imprint cytology, histology and CLO-test (for biopsy urease) in detecting Helicobacter pylori infection, antral biopsies were taken from 239 patients undergoing upper gastrointestinal endoscopy. Both imprint cytology and histology showed the presence of H. pylori in 215 (90%) patients. The sensitivity and specificity of imprint cytology vis-à-vis histology was noted to be 100%. The CLO-test was performed in 165 patients and was positive in 130 (79%) patients. The sensitivity and specificity of the CLO-test were 89% and 95%, respectively. The median time required for the CLO-test to become positive and for imprint was 60 minutes for each. The sensitivity of the CLO-test was reduced further in patients receiving colloidal bismuth subcitrate. Of the 27 patients receiving the drug the sensitivity of the CLO-test was only 9% after 4 weeks of therapy. However, the specificity was 100%. The sensitivity and specificity of imprint cytology were unaffected by the antimicrobial therapy and after 4 weeks of treatment were still 100%. It is concluded that the CLO-test has a lower sensitivity and specificity for diagnosing H. pylori infection compared to imprint cytology, which had a sensitivity and specificity equal to that of histology. Imprint cytology may be prepared as an adjunct to histology in patients in whom antral biopsies are taken as it offers a relatively quick diagnosis of H. pylori infection, is considerably cheaper than the CLO-test and does not require additional biopsy material.

Anti-Ulcer Agents↗
PubMed1992

A prospective randomized trial comparing repeated endoscopic sclerotherapy and propranolol in decompensated (Child class B and C) cirrhotic patients.

A prospective randomized study was conducted to compare the efficacy of long-term endoscopic sclerotherapy vs. propranolol in Child class B and C patients with variceal bleeds within the 30 days before the study. Forty-five and 46 patients were randomized to receive sclerotherapy and propranolol, respectively, after preentry stratification for Child scores. Sclerotherapy was administered with 1% polidocanol at 10-day intervals until obliteration of varices was achieved. Propranolol was administered to achieve a reduction in resting pulse rate of 25%. Rebleeding occurred in 19 patients undergoing sclerotherapy and in 31 receiving propranolol (p less than 0.05). The number of episodes of rebleeding was higher (p less than 0.05) in the propranolol group (n = 64) than in the sclerotherapy group (n = 35). The mean bleeding risk factor, number of hospitalizations for rebleeding and blood transfusion requirement were also significantly higher in the propranolol-treated patients. The median bleed-free period was more than 36 mo in the sclerotherapy group and 2.5 mo in the propranolol group (p less than 0.01). The median survival time was significantly longer in the sclerotherapy group (greater than 36 mo) than in the propranolol group (greater than 24 mo). We conclude that in decompensated cirrhotic patients, long-term endoscopic sclerotherapy is superior to propranolol in preventing rebleeding and improving survival.

Adult↗
PubMed1992

Endoscopic sclerotherapy versus propranolol in prevention of recurrent variceal bleeding in patients with child's B and C cirrhosis: a preliminary report.

Thirty two patients with cirrhosis of the liver of Child's B and C class and an episode of endoscopically proven variceal bleed were randomly assigned to receive endoscopic sclerotherapy (EST) or oral propranolol for the prevention of recurrent upper gastrointestinal bleeding. EST was performed at 3 week intervals using 1% polidocanol intravariceally, till eradication of varices. Propranolol dose was adjusted to reduce the resting heart rate by 25% of the basal value (mean +/- SD, 194.3 +/- 63.9 mg/day) Two patients in the propranolol group were excluded within 48 hours due to side effects of the drug. Thirty patients (EST-16, propranolol-14) completed the trial. Patients were followed up for a maximum of 480 days. Mean follow-up in the EST and propranolol groups was 217 and 243 days respectively. The median bleeding free intervals were 480 and 194 days and number of rebleeding episodes was eight and 16 respectively in the EST and propranolol groups (both p = ns). Our study suggests a trend in favor of EST in preventing variceal rebleeding in patients with hepatic cirrhosis who belong to Child's B and C classes.

Adult↗
PubMed1992

Sucralfate versus ranitidine in non-ulcer dyspepsia: results of a prospective, randomized, open, controlled trial.

In an open trial, 100 patients with non-ulcer dyspepsia were randomized to receive either ranitidine 150 mg twice daily (n = 47) or sucralfate 1 g four times a day (n = 53) for four weeks. An 'intention to treat' analysis revealed that global relief in symptoms was significantly more frequent in the sucralfate group than in the ranitidine group after two weeks (77.4% vs 59.6%; p less than 0.05) and four weeks (86.8% vs 63.8%; p less than 0.001) of treatment. It is concluded that sucralfate is superior to ranitidine in providing symptomatic relief in patients with non-ulcer dyspepsia.

Adult↗
PubMed1991

Do gallstones cause chronic pancreatitis?

Gallstones are well known to cause acute pancreatitis. However, the role of gallstone disease in the causation of chronic pancreatitis is still controversial. Abnormalities of the pancreatic duct have been noted in about one-half of patients with calculous biliary disease undergoing endoscopic retrograde cholangiopancreatography (ERCP), but despite this, it is generally believed that gallstones rarely, if ever, cause chronic pancreatitis. The clinical significance and the natural history of the pancreatographic changes seen in patients with gallstone disease is not known. Studies of the pancreatic functions and long-term follow-up of patients with calculous biliary disease, especially those who have abnormal pancreatograms, and the effect of removal of the gallstone on the pancreatographic abnormalities and pancreatic functions are needed to clarify the issue.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1991

Gallbladder dynamics in patients with irritable bowel syndrome and essential dyspepsia.

To assess whether gallbladder motility is altered in patients with irritable bowel syndrome (IBS) or essential dyspepsia (ED), we studied gallbladder function in 25 healthy volunteers, 20 patients with IBS, and 22 with ED. By real time ultrasonography, we studied the following parameters: (a) fasting gallbladder volume, (b) maximum percent of gallbladder emptied, (c) time required for maximal contraction, (d) residual volume after maximal contraction, and (e) percent fasting volume at 2 h. All parameters, except fasting gallbladder volume, were measured after a high-fat meal. The fasting gallbladder volume, maximum percent of gallbladder emptied, time required for maximal contraction, residual volume after maximal contraction, and percent fasting volume at 2 h in controls and patients with IBS was 19.3 +/- 8.8 ml and 24.4 +/- 9.7 ml, 67.1 +/- 10.7% and 67.6 +/- 13.5%, 41 +/- 20.6 min and 49.7 +/- 25.3 min, 6.2 +/- 3.3 ml and 7.6 +/- 5.3 ml, and 38.1 +/- 12.2% and 40.7 +/- 14.5%, respectively. The differences between the two groups were statistically not significant. The corresponding values in patients with ED were 15.5 +/- 6.3 ml, 57.6 +/- 16.5%, 51.8 +/- 29.3 min, 6.1 +/- 3.2 ml, 44.1 +/- 17%, respectively. Compared with controls there was no statistically significant difference in these parameters, except the maximum percent of gallbladder emptied, which was significantly less than that in controls (57.6 +/- 16.5% vs. 67.1 +/- 10.7%; p less than 0.05). Therefore, we could not find that patients with IBS have any abnormality of gallbladder function; postprandially, patients with ED have submaximal contraction of the gallbladder.

Adolescent↗