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Papers by Narendra Bhargava

Research paper thumbnail of S1426 Simplified Prognostic Model for Predicting First 15 Days Mortality in Alcoholic Acute on Chronic Liver Failure Patients

American Journal of Gastroenterology

Research paper thumbnail of Simplified Prognostic Model for Predicting the First 15 Days Mortality in Alcoholic Acute On Chronic Liver Failure (ACLF) Patients

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Prediction of Significant Liver Fibrosis in Diabetic Nafld Patients

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of NASH Cirrhosis: How Is It Different from Alcohol Related Liver Cirrhosis?

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Comparing Clinical Presentation & Spectrum Of Acute Kidney Injury In Patients With Alcohol Related And Non-Alcoholic Steatohepatitis Related CLD

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Bottle Gourd Juice: Poison or Panacea

Cureus

Ingestion of toxic bottle gourd juice, particularly the bitter one, may pose a significant risk t... more Ingestion of toxic bottle gourd juice, particularly the bitter one, may pose a significant risk to life if not treated in time. Notwithstanding its usefulness, people drink it routinely without concern for fruit quality, extraction hygiene, and mixture with other fruits. We report two cases of bottle gourd juice poisoning with severe abdominal pain and hematemesis. On evaluation, patients were hypotensive with associated esophagitis, pangastritis, and duodenitis. After conservative management, both were discharged after five days of hospitalisation. We conclude that the chances of bottle gourd juice poisoning are higher in waterstressed arid regions; hence, care should be taken on quality and quantity while consuming it.

Research paper thumbnail of Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Cureus

Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia ... more Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. Methodology This prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and highresolution manometry (HRM) at the one-year follow-up. Results There was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). Conclusions The study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.

Research paper thumbnail of Retrograde Transvenous Obliteration of Gastric Varices using Sodium Tetradecyl Sulphate: Technical Considerations and Results from a Single Institution Retrospective Study

Journal of Clinical Interventional Radiology ISVIR, 2021

Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or... more Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or a vascular plug (PARTO) is an established method for treating gastric varices (GVs) secondary to portal hypertension. Most of the available studies on RTO have used lipiodol along with sclerosing agents like ethanolamine oleate or sodium tetradecyl sulfate (STS). We evaluated the safety and efficacy of RTO for treating GVs using STS as a sclerosant without lipiodol. Materials and Methods Sixteen patients (nine men, age range 16–74 years) were included in this retrospective study. Twelve patients presented with acute bleeding, two with chronic bleeding, one with large varices without bleeding, and one with refractory hepatic encephalopathy (HE). BRTO was attempted in 14 patients and PARTO in 2 patients. The technical and clinical success and complications of RTO were studied. Results The RTO procedure was technically successful in 14 (14/16, 87.5%) patients, with 13 (13/14, 93%) obtainin...

Research paper thumbnail of Duodenal Gastrointestinal Stromal Tumour Imitating as Pancreatic Head Tumour: A Typical Case of Whodunit

Duodenal gastrointestinal stromal tumours (D-GISTs) are rare disease. It may arise commonly from ... more Duodenal gastrointestinal stromal tumours (D-GISTs) are rare disease. It may arise commonly from second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a sixty-year-old woman who presented with abdominal pain and was diagnosed as a case of pancreatic neuroendocrine tumour on radiologic imaging and granulomatous lesion on aspiration cytology. On laparotomy, a ~5x3 cm mass was noted in the pancreatic head and pancreatoduodenectomy was performed. Histopathology reported an exophytic GIST arising from the second part of the duodenum.Hence, D-GIST can invade into the pancreas and mimic pancreatic head tumour; therefore, these tumours should be kept in the differential diagnosis of an atypical pancreatic head mass.

Research paper thumbnail of Inspecting Management Strategies of Hepatocellular Carcinoma in a Tertiary Centre in Western Rajasthan

Journal of Evolution of Medical and Dental Sciences, 2021

BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patient... more BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patients with cirrhosis. It is usually diagnosed late in the course of the illness and the median survival following diagnosis ranges between 6 - 20 months. India lacks data on management strategies and their efficacy. In the absence of data on treatment protocols and its adequacy; we evaluated our own centre data for a period of 1 year to get the estimate of incidence, aetiology, treatment adequacy and response to treatment. Barcelona Clinic Liver Cancer (BCLC) prognostic staging classification comprising five stages is used for prognostication, which is based on the extent of the primary lesion, performance status, vascular invasion and extrahepatic spread. Surgical therapies including resection and transplantation are feasible in early stages (BCLC stage 0 and stage A). Trans arterial chemoembolisation is recommended in intermediate stage (BCLC stage B) while systemic therapies are recommend...

Research paper thumbnail of 57. Impact of sarcopenia on clinical outcome of cirrhotic patients—A prospective study from tertiary care centre

Journal of Clinical and Experimental Hepatology, 2018

Background and Aims: Liver fibrosis or scaring is abnormal continuation of fibrogenesis due to ex... more Background and Aims: Liver fibrosis or scaring is abnormal continuation of fibrogenesis due to excessive deposition of extra cellular matrix (Glycogprotein, collagen and Proceoglacans) in the process of repeated cycle of hepatocyte injury and repair. Liver fibrosisi was considered as irreversible process by which patient leads to cirrhosis of liver. Cirrhosis is one of the leading causes of death worldwide. Oxidative stress has been documentated as major cause of CLD and fibrosis. Trasient elastography or fibroscan can measure liver stiffness or elasticity and can acess liver fibrosis. Ayurveda herbs and products having defined biochemical active component can protect liver from oxidative stress, block fibrogenesis, anti inflammatory, immune-modulating, liver regenerating and inhibit tumour growth in vitro and in vivo studies. The aim of this study was to assess the impact of Ayurveda treatment on the fibrosis in patients with cirrhosis. Methods: We measured the liver fibrosis before and after ayurveda medication of three pre-diagnosed cirrhosis patients. Trasient elastography or fibroscan is used to assess the liver fibrosis. The treatment protocol was initial digestive, hepato protective, anti oxidant then potala katu rohinyadi kasaya and Lokanath Rasa for one year. Results: Out of three patients, one female patient's cirrhosis is due to auto immune and another two male patient's cirrhosis is due to heavy alcohol intake. The friboscan (median stiffness) was reduced from 69.1 to 30 kPa in one female patient where other two cases reduces 48 to 28 kPa and 56 to 28.1 Kpa respectively. Conclusions: Ayurveda medications may reverse the fibrosis in patients with cirrhosis.

Research paper thumbnail of 28. Nonalcoholic fatty liver disease in asymptomatic T2DM patients – prevalence, risk factors and role of fibroscan

Journal of Clinical and Experimental Hepatology, 2018

Weight reduction ≥5 kg achieved (n = 49) Weight reduction ≥5 kg not achieved (n = 42) Baseline 3 ... more Weight reduction ≥5 kg achieved (n = 49) Weight reduction ≥5 kg not achieved (n = 42) Baseline 3 months P value Baseline 3 months P value AST, IU/dL 43 (23-144) 36 (23-88) <0.01 36 (22-110) 35 (21-102) 0.016 ALT, IU/dL 57 (17-164) 45 (20-102) <0.01 34 (13-125) 32 (17-102) 0.001 GGT, IU/dL 46 (4-169) 43 (17-86) 0.073 40 (15-171) 35 (11-80) 0.076 LSM, kPa 6.7 (3.6-13.1) 5.9 (3.1-11.2) <0.01 6.4 (3.6-13.1) 6.1 (4.1-14.1) 0.141 CAP, dB/m 315 (251-400) 264 (210-354) <0.01 285 (249-367) 288 (206-396) 0.031

Research paper thumbnail of Role of Narrow Band Imaging in Suspected Malabsorption

Research paper thumbnail of Even Hepatologist Need to Follow Surveillance Strategy for HCC Religiously!

Journal of Clinical and Experimental Hepatology, 2015

Conclusion: Point mutation detected in the HCC cases can be used as diagnostic marker once the fi... more Conclusion: Point mutation detected in the HCC cases can be used as diagnostic marker once the findings of the current study are established by further study at the proteomic levels.

Research paper thumbnail of Ampullary tumor presenting as acute cholangitis

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Research paper thumbnail of Cardiac dysfunction in cirrhotic portal hypertension with or without ascites

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it... more Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it correlates with severity of hepatic failure. But cardiac functions by conventional 2-dimensional (2-D) echocardiography has limitations. The aim of the study was to evaluate cardiac systolic and diastolic functions in liver cirrhosis patients with or without ascites by tissue Doppler imaging and conventional 2-D- echocardiography. A cross sectional case control study of sixty patients. Twenty subjects grouped as healthy controls, pre-ascitic cirrhosis and cirrhosis with ascites were enrolled. Cardiac evaluation was done by both conventional Doppler and tissue Doppler echocardiography. Cirrhosis with portal hypertension is associated with increased heart rate, ejection fraction and mean peak systolic velocity, while mean arterial pressure is decreased. All cardiac chamber dilation occurs and is mostly seen in the left atrium. Ratio of early diastolic annular velocity to peak early diasto...

Research paper thumbnail of Insulin resistance in euglycemic cirrhosis

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Insulin resistance (IR) is associated with hepatic fibrosis and cirrhosis, regardless of its etio... more Insulin resistance (IR) is associated with hepatic fibrosis and cirrhosis, regardless of its etiology but the mechanism of hyperinsulinemia in cirrhosis is still unclear. The current study was designed to assess hyperinsulinemia and pancreatic β-cell function in euglycemic cirrhosis of varied etiology. A cross sectional case control study of 100 subjects. IR was assessed by the Homeostasis Model Assessment (HOMA) and quantitative insulin sensitivity check index in euglycemic cirrhosis of varied etiology and in different stages of cirrhosis. HOMA-β was calculated for insulin secretion ability of pancreatic β-cells in different stages of cirrhosis. Overall IR in euglycemic cirrhosis was seen in 68.5%. IR was seen in the order hepatitis C (100%), non-alcoholic fatty liver disease (100%), autoimmune hepatitis (100%), hepatocellular carcinoma (80%), alcoholic liver disease (72%) and hepatitis B (45%). HOMA-IR value was raised in Child Turcotte Pugh (CTP) score >9 (P value 0.0004) and ...

Research paper thumbnail of Colonic involvement in amebic liver abscess: does site matter?

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Colonic involvement in amebic liver abscess (ALA) occurs in more than half of the patients. Howev... more Colonic involvement in amebic liver abscess (ALA) occurs in more than half of the patients. However no studies have found any association between the site of the colonic lesions and location of abscesses in the liver. Thus, the present study was designed to find the correlation between colonic involvement in solitary and multiple ALAs. This is a case control study of 80 patients allocated in two groups, the first with solitary (controls) and the second with multiple ALAs (cases). Colonoscopy was performed in all patients enrolled in the study. Solitary ALA was seen in 70% of patients whereas multiple ALAs in 30%. Colonic involvement in the form of erythema, inflammation and ulceration was seen in 77.5% of cases of ALA. 71.4 % cases of solitary ALA had colonic lesions compared to 91.6% cases of multiple ALAs (P=0.02). Most of the patients with multiple ALAs had involvement of the transverse and right colon (75%). Involvement of right colon was present in all patients with colonic inv...

Research paper thumbnail of A young lady with post-partum jaundice and right upper quadrant lump abdomen: an unusual etiology

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Intraductal papillary mucinious neoplasm-biliary type is the biliary counterpart of intraductal p... more Intraductal papillary mucinious neoplasm-biliary type is the biliary counterpart of intraductal papillary mucinious neoplasm-pancreatic type. We report a rare case of intraductal papillary mucinous tumor arising from extrahepatic biliary system. The diagnosis was established on histopathological analysis following endoscopic retrograde cholangiopancreatography-guided biopsy. Isolated papillary adenoma of the bile duct is extremely rare, and in this unusual case the patient was a 22-year-old young lady who had delivered a healthy infant 6 weeks previously.

Research paper thumbnail of Use of narrow band imaging in assessing duodenal villous atrophy

Indian Journal of Gastroenterology, 2014

METHODS All patients who underwent gastroscopy were included. The duodenum was further examined w... more METHODS All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach. RESULTS 124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy-eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients. CONCLUSIONS NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.

Research paper thumbnail of S1426 Simplified Prognostic Model for Predicting First 15 Days Mortality in Alcoholic Acute on Chronic Liver Failure Patients

American Journal of Gastroenterology

Research paper thumbnail of Simplified Prognostic Model for Predicting the First 15 Days Mortality in Alcoholic Acute On Chronic Liver Failure (ACLF) Patients

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Prediction of Significant Liver Fibrosis in Diabetic Nafld Patients

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of NASH Cirrhosis: How Is It Different from Alcohol Related Liver Cirrhosis?

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Comparing Clinical Presentation & Spectrum Of Acute Kidney Injury In Patients With Alcohol Related And Non-Alcoholic Steatohepatitis Related CLD

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Bottle Gourd Juice: Poison or Panacea

Cureus

Ingestion of toxic bottle gourd juice, particularly the bitter one, may pose a significant risk t... more Ingestion of toxic bottle gourd juice, particularly the bitter one, may pose a significant risk to life if not treated in time. Notwithstanding its usefulness, people drink it routinely without concern for fruit quality, extraction hygiene, and mixture with other fruits. We report two cases of bottle gourd juice poisoning with severe abdominal pain and hematemesis. On evaluation, patients were hypotensive with associated esophagitis, pangastritis, and duodenitis. After conservative management, both were discharged after five days of hospitalisation. We conclude that the chances of bottle gourd juice poisoning are higher in waterstressed arid regions; hence, care should be taken on quality and quantity while consuming it.

Research paper thumbnail of Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Cureus

Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia ... more Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. Methodology This prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and highresolution manometry (HRM) at the one-year follow-up. Results There was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). Conclusions The study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.

Research paper thumbnail of Retrograde Transvenous Obliteration of Gastric Varices using Sodium Tetradecyl Sulphate: Technical Considerations and Results from a Single Institution Retrospective Study

Journal of Clinical Interventional Radiology ISVIR, 2021

Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or... more Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or a vascular plug (PARTO) is an established method for treating gastric varices (GVs) secondary to portal hypertension. Most of the available studies on RTO have used lipiodol along with sclerosing agents like ethanolamine oleate or sodium tetradecyl sulfate (STS). We evaluated the safety and efficacy of RTO for treating GVs using STS as a sclerosant without lipiodol. Materials and Methods Sixteen patients (nine men, age range 16–74 years) were included in this retrospective study. Twelve patients presented with acute bleeding, two with chronic bleeding, one with large varices without bleeding, and one with refractory hepatic encephalopathy (HE). BRTO was attempted in 14 patients and PARTO in 2 patients. The technical and clinical success and complications of RTO were studied. Results The RTO procedure was technically successful in 14 (14/16, 87.5%) patients, with 13 (13/14, 93%) obtainin...

Research paper thumbnail of Duodenal Gastrointestinal Stromal Tumour Imitating as Pancreatic Head Tumour: A Typical Case of Whodunit

Duodenal gastrointestinal stromal tumours (D-GISTs) are rare disease. It may arise commonly from ... more Duodenal gastrointestinal stromal tumours (D-GISTs) are rare disease. It may arise commonly from second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a sixty-year-old woman who presented with abdominal pain and was diagnosed as a case of pancreatic neuroendocrine tumour on radiologic imaging and granulomatous lesion on aspiration cytology. On laparotomy, a ~5x3 cm mass was noted in the pancreatic head and pancreatoduodenectomy was performed. Histopathology reported an exophytic GIST arising from the second part of the duodenum.Hence, D-GIST can invade into the pancreas and mimic pancreatic head tumour; therefore, these tumours should be kept in the differential diagnosis of an atypical pancreatic head mass.

Research paper thumbnail of Inspecting Management Strategies of Hepatocellular Carcinoma in a Tertiary Centre in Western Rajasthan

Journal of Evolution of Medical and Dental Sciences, 2021

BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patient... more BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patients with cirrhosis. It is usually diagnosed late in the course of the illness and the median survival following diagnosis ranges between 6 - 20 months. India lacks data on management strategies and their efficacy. In the absence of data on treatment protocols and its adequacy; we evaluated our own centre data for a period of 1 year to get the estimate of incidence, aetiology, treatment adequacy and response to treatment. Barcelona Clinic Liver Cancer (BCLC) prognostic staging classification comprising five stages is used for prognostication, which is based on the extent of the primary lesion, performance status, vascular invasion and extrahepatic spread. Surgical therapies including resection and transplantation are feasible in early stages (BCLC stage 0 and stage A). Trans arterial chemoembolisation is recommended in intermediate stage (BCLC stage B) while systemic therapies are recommend...

Research paper thumbnail of 57. Impact of sarcopenia on clinical outcome of cirrhotic patients—A prospective study from tertiary care centre

Journal of Clinical and Experimental Hepatology, 2018

Background and Aims: Liver fibrosis or scaring is abnormal continuation of fibrogenesis due to ex... more Background and Aims: Liver fibrosis or scaring is abnormal continuation of fibrogenesis due to excessive deposition of extra cellular matrix (Glycogprotein, collagen and Proceoglacans) in the process of repeated cycle of hepatocyte injury and repair. Liver fibrosisi was considered as irreversible process by which patient leads to cirrhosis of liver. Cirrhosis is one of the leading causes of death worldwide. Oxidative stress has been documentated as major cause of CLD and fibrosis. Trasient elastography or fibroscan can measure liver stiffness or elasticity and can acess liver fibrosis. Ayurveda herbs and products having defined biochemical active component can protect liver from oxidative stress, block fibrogenesis, anti inflammatory, immune-modulating, liver regenerating and inhibit tumour growth in vitro and in vivo studies. The aim of this study was to assess the impact of Ayurveda treatment on the fibrosis in patients with cirrhosis. Methods: We measured the liver fibrosis before and after ayurveda medication of three pre-diagnosed cirrhosis patients. Trasient elastography or fibroscan is used to assess the liver fibrosis. The treatment protocol was initial digestive, hepato protective, anti oxidant then potala katu rohinyadi kasaya and Lokanath Rasa for one year. Results: Out of three patients, one female patient's cirrhosis is due to auto immune and another two male patient's cirrhosis is due to heavy alcohol intake. The friboscan (median stiffness) was reduced from 69.1 to 30 kPa in one female patient where other two cases reduces 48 to 28 kPa and 56 to 28.1 Kpa respectively. Conclusions: Ayurveda medications may reverse the fibrosis in patients with cirrhosis.

Research paper thumbnail of 28. Nonalcoholic fatty liver disease in asymptomatic T2DM patients – prevalence, risk factors and role of fibroscan

Journal of Clinical and Experimental Hepatology, 2018

Weight reduction ≥5 kg achieved (n = 49) Weight reduction ≥5 kg not achieved (n = 42) Baseline 3 ... more Weight reduction ≥5 kg achieved (n = 49) Weight reduction ≥5 kg not achieved (n = 42) Baseline 3 months P value Baseline 3 months P value AST, IU/dL 43 (23-144) 36 (23-88) <0.01 36 (22-110) 35 (21-102) 0.016 ALT, IU/dL 57 (17-164) 45 (20-102) <0.01 34 (13-125) 32 (17-102) 0.001 GGT, IU/dL 46 (4-169) 43 (17-86) 0.073 40 (15-171) 35 (11-80) 0.076 LSM, kPa 6.7 (3.6-13.1) 5.9 (3.1-11.2) <0.01 6.4 (3.6-13.1) 6.1 (4.1-14.1) 0.141 CAP, dB/m 315 (251-400) 264 (210-354) <0.01 285 (249-367) 288 (206-396) 0.031

Research paper thumbnail of Role of Narrow Band Imaging in Suspected Malabsorption

Research paper thumbnail of Even Hepatologist Need to Follow Surveillance Strategy for HCC Religiously!

Journal of Clinical and Experimental Hepatology, 2015

Conclusion: Point mutation detected in the HCC cases can be used as diagnostic marker once the fi... more Conclusion: Point mutation detected in the HCC cases can be used as diagnostic marker once the findings of the current study are established by further study at the proteomic levels.

Research paper thumbnail of Ampullary tumor presenting as acute cholangitis

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Research paper thumbnail of Cardiac dysfunction in cirrhotic portal hypertension with or without ascites

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it... more Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it correlates with severity of hepatic failure. But cardiac functions by conventional 2-dimensional (2-D) echocardiography has limitations. The aim of the study was to evaluate cardiac systolic and diastolic functions in liver cirrhosis patients with or without ascites by tissue Doppler imaging and conventional 2-D- echocardiography. A cross sectional case control study of sixty patients. Twenty subjects grouped as healthy controls, pre-ascitic cirrhosis and cirrhosis with ascites were enrolled. Cardiac evaluation was done by both conventional Doppler and tissue Doppler echocardiography. Cirrhosis with portal hypertension is associated with increased heart rate, ejection fraction and mean peak systolic velocity, while mean arterial pressure is decreased. All cardiac chamber dilation occurs and is mostly seen in the left atrium. Ratio of early diastolic annular velocity to peak early diasto...

Research paper thumbnail of Insulin resistance in euglycemic cirrhosis

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Insulin resistance (IR) is associated with hepatic fibrosis and cirrhosis, regardless of its etio... more Insulin resistance (IR) is associated with hepatic fibrosis and cirrhosis, regardless of its etiology but the mechanism of hyperinsulinemia in cirrhosis is still unclear. The current study was designed to assess hyperinsulinemia and pancreatic β-cell function in euglycemic cirrhosis of varied etiology. A cross sectional case control study of 100 subjects. IR was assessed by the Homeostasis Model Assessment (HOMA) and quantitative insulin sensitivity check index in euglycemic cirrhosis of varied etiology and in different stages of cirrhosis. HOMA-β was calculated for insulin secretion ability of pancreatic β-cells in different stages of cirrhosis. Overall IR in euglycemic cirrhosis was seen in 68.5%. IR was seen in the order hepatitis C (100%), non-alcoholic fatty liver disease (100%), autoimmune hepatitis (100%), hepatocellular carcinoma (80%), alcoholic liver disease (72%) and hepatitis B (45%). HOMA-IR value was raised in Child Turcotte Pugh (CTP) score >9 (P value 0.0004) and ...

Research paper thumbnail of Colonic involvement in amebic liver abscess: does site matter?

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Colonic involvement in amebic liver abscess (ALA) occurs in more than half of the patients. Howev... more Colonic involvement in amebic liver abscess (ALA) occurs in more than half of the patients. However no studies have found any association between the site of the colonic lesions and location of abscesses in the liver. Thus, the present study was designed to find the correlation between colonic involvement in solitary and multiple ALAs. This is a case control study of 80 patients allocated in two groups, the first with solitary (controls) and the second with multiple ALAs (cases). Colonoscopy was performed in all patients enrolled in the study. Solitary ALA was seen in 70% of patients whereas multiple ALAs in 30%. Colonic involvement in the form of erythema, inflammation and ulceration was seen in 77.5% of cases of ALA. 71.4 % cases of solitary ALA had colonic lesions compared to 91.6% cases of multiple ALAs (P=0.02). Most of the patients with multiple ALAs had involvement of the transverse and right colon (75%). Involvement of right colon was present in all patients with colonic inv...

Research paper thumbnail of A young lady with post-partum jaundice and right upper quadrant lump abdomen: an unusual etiology

Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology, 2014

Intraductal papillary mucinious neoplasm-biliary type is the biliary counterpart of intraductal p... more Intraductal papillary mucinious neoplasm-biliary type is the biliary counterpart of intraductal papillary mucinious neoplasm-pancreatic type. We report a rare case of intraductal papillary mucinous tumor arising from extrahepatic biliary system. The diagnosis was established on histopathological analysis following endoscopic retrograde cholangiopancreatography-guided biopsy. Isolated papillary adenoma of the bile duct is extremely rare, and in this unusual case the patient was a 22-year-old young lady who had delivered a healthy infant 6 weeks previously.

Research paper thumbnail of Use of narrow band imaging in assessing duodenal villous atrophy

Indian Journal of Gastroenterology, 2014

METHODS All patients who underwent gastroscopy were included. The duodenum was further examined w... more METHODS All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach. RESULTS 124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy-eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients. CONCLUSIONS NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.