Balakrishnan Ramakrishna | SRMSIMS - Academia.edu (original) (raw)

Papers by Balakrishnan Ramakrishna

Research paper thumbnail of Urine neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury and prognosis in decompensated chronic liver disease: A prospective study

Indian Journal of Gastroenterology, Feb 1, 2023

Research paper thumbnail of Inflammatory bowel diseases in Tamil Nadu: A survey of demographics, clinical profile, and practices

JGH Open, 2021

BackgroundInflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey b... more BackgroundInflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu.MethodsTNISG members from 32 institutions completed an online cross‐sectional questionnaire on IBD patients from March 2020 to January 2021.ResultsOf 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD‐unclassified (IBD‐U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left‐sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruct...

Research paper thumbnail of Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor

Journal of Pathology and Translational Medicine, 2020

Research paper thumbnail of Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: An initiative of the Indian Neurogastroenterology and Motility Association

Indian Journal of Gastroenterology

In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-di... more In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiop...

Research paper thumbnail of Risk factors of tuberculosis (TB) among homeless population in Chennai city

International Journal of Health Sciences (IJHS), Mar 23, 2022

Research paper thumbnail of Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test

Scandinavian Journal of Gastroenterology, Mar 17, 2021

Abstract Background A subset of chronic pancreatitis patients respond poorly to pancreatic enzyme... more Abstract Background A subset of chronic pancreatitis patients respond poorly to pancreatic enzyme replacement therapy. Small intestinal bacterial overgrowth (SIBO) is considered to be one of the major reasons for this poor response. Previous studies have reported a wide range of prevalence of SIBO in patients with chronic pancreatitis. We aimed to assess the prevalence of SIBO in chronic pancreatitis using quantitative jejunal aspirate culture and glucose hydrogen breath test (GHBT). The sensitivity and specificity of GHBT for the diagnosis of SIBO in chronic pancreatitis were also estimated. Methods Newly diagnosed chronic pancreatitis patients were recruited into the study. A detailed history and relevant laboratory tests were done. All patients underwent an endoscopy and jejunal fluid aspiration for bacterial cultures and GHBT to detect SIBO. The results of GHBT were compared with jejunal fluid aspirate culture. Results The jejunal aspirate culture was positive in 18/48 (37.5%) patients while the GHBT showed that 14/48 (29%) patients had SIBO. The sensitivity, specificity, positive and negative predictive value of GHBT in our study was 44.4, 80, 57.14 and 70.59%, respectively. Conclusions SIBO is not uncommon in chronic pancreatitis patients. One-third of our study population had SIBO. GHBT has low sensitivity but had high specificity in the diagnosis of SIBO in chronic pancreatitis.

Research paper thumbnail of Distribution of celiac disease predisposing genes HLA-DQ2 and HLA-DQ8 in the native population of southern India

Indian Journal of Gastroenterology

Research paper thumbnail of Risk factors of tuberculosis (TB) among homeless population in Chennai city

International journal of health sciences, 2022

Background: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless... more Background: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. Tuberculosis (TB) is a major public health problem. The Chennai City has a large population of homeless persons and caregivers and is estimated to be the largest TB-endemic area in the intermediate-prevalence country, India. However, there have been few studies of homeless persons and caregivers. The objective of this study to assess the prevalence and risk factors for pulmonary TB among homeless population around Chennai. Methods: We conducted a cross-sectional study for screening TB symptoms using questionnaire. The study participants were recruited from 15 zones, which included 47-night shelters around Chennai under the control of the Chennai City in Tamil Nadu. Data was collected from homeless people who were living in night shelters in the northern, central, and southern regions of Chennai City. Results: Complete responses were available from 484 individuals (263 homeless persons ...

Research paper thumbnail of FaecalbifidobacteriainIndianneonates&theeffectofasymptomatic rotavirusinfectionduringthefirstmonthoflife

. Bifidobacteria arebelieved to be beneficialto health. Interventions to increase their populatio... more . Bifidobacteria arebelieved to be beneficialto health. Interventions to increase their population by administering them as probiotics, or administering prebiotics to stimulate their growth and colonization, are often suggested. It is also suggested that bifidobacteriaprotect against or attenuate rotaviral illness in infants. Studies in experimental animals indicate that was followed for a minimum of 30 days. The study administration of bifidobacteriaresulted in the development of increased titres of IgA antibody in both faeces and serum of infected animals, indicating that the bacteria potentiated immune responses

Research paper thumbnail of Percutaneous endoscopic gastrostomy: A prospective study

Gastroenterology, Hepatology and Endoscopy Practice, 2021

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure for est... more Introduction: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure for establishing enteral access for nutrition. There is a paucity of literature on PEG from the Indian subcontinent. With the rate of complications in the literature showing a downward trend, we aimed to analyze the same in our institute following a standard procedure of PEG tube placement. Methods: The prospective study was conducted including patients referred for PEG placement from August 2017 to December 2019. Data were recorded on a proforma. The primary aim of the study was to determine the rate of complications in patients undergoing PEG, whereas the secondary aim was to determine whether early feeding was associated with increased rate of infection or other complications. Patients were reviewed after 3 days, 1 month, and every 3 months thereafter later with clinical examination. Results: Sixty-seven (83.75%) males and 13 (16.25%) females with a median age of 51 years (range 1–85) were included in the study. Forty-one (51.25%) patients had comorbidities with hypertension being the most common (n = 28). Postoperative placement of the PEG tube was done in 47 (58.75%) patients. Seventy-four patients had underlying neurological or neurosurgical conditions. At the time of PEG placement, 59 (73.75%) had tracheostomy. All procedures were performed in the endoscopic suite, of which two were performed as day care procedures. There were no intraprocedural complications. Feed was started within 2 h in 45 (56.25%) patients and all tolerated feed well. There were no major postprocedural complications. Thirteen patients had clinically suspected PEG site infection, of which 11 patients had a culture-positive organism. All responded to conservative management. Thirty-two patients were on follow-up at a median follow-up period of 2 years. Conclusion: The incidence of complications following PEG tube placement is low. With the standardization of the PEG technique, no major complications were seen in our study. Early PEG feeding was not associated with an increase in the rate of complications.

Research paper thumbnail of A phase 2 randomized controlled trial of oral resistant starch supplements in the prevention of acute radiation proctitis in patients treated for cervical cancer

Journal of Cancer Research and Therapeutics, 2019

Background: Radiation induced proctitis is frequently encountered during the radiation therapy of... more Background: Radiation induced proctitis is frequently encountered during the radiation therapy of cervical and prostate cancers that causes pain and occasionally with bleeding and may affect the continuity of radiation therapy. Aims and Objectives: The purpose of the study is to look at the benefit of administration of an oral prebiotic amylase resistant starch in reducing the incidence of acute radiation proctitis, a distressing symptom in patients receiving radiation therapy for cancer of the cervix. Material and Methods: The study was conducted between 2011 and 2014 in 104 patients receiving radical chemo-radiotherapy for carcinoma cervix. Patients were randomized in to two arms, one receiving 30 gm of resistant starch and the other digestible starch on a daily basis throughout the course of the external radiotherapy. All patients received standard 4-field box radiation portals, 50 Gy in 25 fractions with 4 cycles of weekly concurrent Cisplatin. At completion of external beam radiotherapy, all patients underwent LDR/HDR brachytherapy. The study was double blinded and allocation was concealed from the investigators. The investigator recorded the radiotherapy related toxicity of the patients according to CTC V 3.0. The incidence and severity of grade 2-4 diarrhoea and proctitis were documented on a weekly basis and compared across the two groups and analyzed. Stool short chain fatty acid concentrations were measured at baseline at 2nd and 4th week and after 6 weeks of completion of radiotherapy in both study placebo arms and reported. The pattern of microbiota in the stool were also estimated in all patients at 4 time points. Two patients who progressed during therapy were not included in the analyses and two patients discontinued the intervention. A per protocol analyses was done. Results: At analysis there were 50 patients in each arm. The severity of clinical proctitis was found to be similar in both groups of patients with 12.2 % of patients experiencing toxicity of grade 2 and above in digestible starch group versus 14.6% in the resistant starch group. Functional proctitis was similarly graded and it was found that 16.3 % patients in digestible starch group experienced toxicity against 10.2 % patients in the resistant starch group. This difference was seen at 4th week and continued in the subsequent weeks till the end of radiation. Both groups had similar reported toxicity at 6 weeks post intervention and similar incidence of grade 2 and above diarrhea. The resistant starch group was found to have 8% incidence as compared to 2% in the other group at the 5th and 6th week. The short chain fatty acid concentrations were not significantly different in the groups at any point. Conclusion: The study did not demonstrate a significant benefit in administering resistant starch over and above normal diet to patients receiving pelvic radiotherapy. The reasons may be attributed to concurrent use of chemotherapy and decrease in intestinal probiotics. The use of digestible starch in the control arm may have contributed to lower incidence of the toxicity endpoints as well.

Research paper thumbnail of Effect of Native and Acetylated Dietary Resistant Starches on Intestinal Fermentative Capacity of Normal and Stunted Children in Southern India

International Journal of Environmental Research and Public Health, 2019

The health benefits of dietary amylase resistant starch (RS) arise from intestinal microbial ferm... more The health benefits of dietary amylase resistant starch (RS) arise from intestinal microbial fermentation and generation of short chain fatty acids (SCFA). We compared the intestinal fermentative capability of stunted and nonstunted (‘healthy’) children in southern India using two types of RS: high amylose maize starch (HAMS) and acetylated HAMS (HAMSA). Twenty children (10 stunted and 10 healthy) aged 2 to 5 years were fed biscuits containing HAMS (10 g/day) for two weeks followed by a 2-week washout and then HAMSA biscuits (10 g/day) for 2 weeks. Fecal samples were collected at 3-4 day intervals and pH and SCFA analyzed. At entry, stunted children had lower SCFA concentrations compared to healthy children. Both types of RS led to a significant decrease in fecal pH and increase in fecal acetate and propionate in both healthy and stunted children. However, while HAMS increased fecal butyrate in both groups of children, HAMSA increased butyrate in healthy but not stunted children. Fu...

Research paper thumbnail of Prevalence of Adult Celiac Disease in India: Regional Variations and Associations

American Journal of Gastroenterology, 2016

Research paper thumbnail of Novel biomarkers of acute kidney injury in chronic liver disease: Where do we stand after a decade of research?

Hepatology Research

Acute kidney injury (AKI) is a frequently encountered complication in decompensated chronic liver... more Acute kidney injury (AKI) is a frequently encountered complication in decompensated chronic liver disease (CLD) with an estimated prevalence of 20%–50% among hospitalized patients. AKI often heralds the onset of a downhill course in the natural history of CLD. Serum creatinine has several limitations as a stand‐alone marker of AKI in patients with decompensated CLD. The concept of hepatorenal syndrome, the prototype of AKI in decompensated CLD, has evolved tremendously over recent years. There is emerging evidence of an additional “structural” component in the pathophysiology of hepatorenal syndrome‐AKI, which was previously identified as a purely “functional” form of renal impairment. Lacunae in the existent biochemical arsenal for diagnosis and prognosis of AKI have fueled enthusiastic research in the field of novel biomarkers of kidney injury in patients with cirrhosis. The advent of these biomarkers provides a crucial window of opportunity to improve the diagnosis and clinical o...

Research paper thumbnail of Report of a Meeting Zinc deficiency in children with environmental enteropathy— development of new strategies: report from an expert workshop1–4

Zinc deficiency is a major cause of childhood morbidity and mortal-ity. The WHO/UNICEF strategy f... more Zinc deficiency is a major cause of childhood morbidity and mortal-ity. The WHO/UNICEF strategy for zinc supplementation as adjunc-tive therapy for diarrhea is poorly implemented. A conference of experts in zinc nutrition and gastrointestinal disorders was convened to consider approaches that might complement the current recom-mendation and what research was needed to develop these ap-proaches. Several key points were identified. The design of novel zinc interventions would be facilitated by a better understanding of how disturbed gut function, such as environmental (or tropical) enteropathy, affects zinc absorption, losses, and homeostasis. Be-cause only 10 % of zinc stores are able to be rapidly turned over, and appear to be rapidly depleted by acute intestinal illness, they are probably best maintained by complementary regular supplemen-tation in a primary prevention strategy rather than secondary preven-

Research paper thumbnail of Gastrointestinal Nutritional Problems in the Aged

Vegetables, Fruits, and Herbs in Health Promotion, 2000

Research paper thumbnail of Alterations in fecal microbiota in patients with inflammatory bowel disease and enteropathic arthropathy

Gastroenterology, Hepatology and Endoscopy Practice, 2021

Objectives: Inflammatory arthritis or enteropathic arthropathy (EA) is a common extra-intestinal ... more Objectives: Inflammatory arthritis or enteropathic arthropathy (EA) is a common extra-intestinal manifestation in patients with inflammatory bowel disease (IBD). We aimed to determine whether EA in patients with IBD was associated with changes in the gut microbiome. Methods: Consecutive patients with ulcerative colitis (UC) or Crohn's disease (CD) were prospectively recruited and characterized. Stool samples were collected and real-time polymerase chain reaction targeting 16S ribosomal RNA genes was used to quantitate specific communities of “beneficial”; (Clostridium coccoides, bifidobacteria, and lactobacilli) or “aggressive” (Bacteroides and Enterobacteriaceae) bacterial flora. In 12 patients with UC and 12 with CD, fecal 16S ribosomal RNA gene was subjected to next-generation sequencing (NGS) and bacterial taxa were enumerated and compared between IBD patients with and without EA. Results: Sixty-eight patients with UC and 60 with CD were included in the study. Arthropathy was noted in 13 (21.6%) patients with CD and 11 (16.1%) patients with UC. Arthritis was peripheral in 12, axial in 7, and mixed in the rest. The most prevalent commensal bacteria in IBD patients were Bacteroides and Bifidobacterium. Enterobacteriaceae count was significantly higher in patients with UC than in CD. UC patients with EA had relatively higher Enterobacteriaceae and lesser C. coccoides than UC patients without EA. The NGS analyses showed a significant reduction in alpha diversity in patients with EA compared to IBD without EA. Patients with EA had significantly greater abundance of enterococci compared to IBD without EA. Conclusions: EA in IBD patients is characterized by gut microbiome changes including dysbiosis, reduction in alpha diversity, and increased abundance of enterococci.

Research paper thumbnail of Human Leukocyte Antigen DQ (HLA‐DQ) genotypes and haplotypes and their association with phenotype in patients with celiac disease in India

JGH Open, 2021

Human Leukocyte Antigen DQ (HLA‐DQ) genotypes play a permissive role in the genesis of celiac dis... more Human Leukocyte Antigen DQ (HLA‐DQ) genotypes play a permissive role in the genesis of celiac disease (CeD). In this case–control study, we used next‐generation sequencing to determine HLA‐DQA1 and ~DQB1 genotypes and haplotypes associated with CeD in Indian patients.

Research paper thumbnail of Pancreatic Adenocarcinoma With Synchronous Colonic Metastases

ACG Case Reports Journal, 2020

Research paper thumbnail of Indian guidelines on imaging of the small intestine in Crohn’s disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement

Indian Journal of Radiology and Imaging, 2019

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Ind... more The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn’s disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

Research paper thumbnail of Urine neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury and prognosis in decompensated chronic liver disease: A prospective study

Indian Journal of Gastroenterology, Feb 1, 2023

Research paper thumbnail of Inflammatory bowel diseases in Tamil Nadu: A survey of demographics, clinical profile, and practices

JGH Open, 2021

BackgroundInflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey b... more BackgroundInflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu.MethodsTNISG members from 32 institutions completed an online cross‐sectional questionnaire on IBD patients from March 2020 to January 2021.ResultsOf 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD‐unclassified (IBD‐U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left‐sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruct...

Research paper thumbnail of Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor

Journal of Pathology and Translational Medicine, 2020

Research paper thumbnail of Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: An initiative of the Indian Neurogastroenterology and Motility Association

Indian Journal of Gastroenterology

In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-di... more In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiop...

Research paper thumbnail of Risk factors of tuberculosis (TB) among homeless population in Chennai city

International Journal of Health Sciences (IJHS), Mar 23, 2022

Research paper thumbnail of Assessment of small intestinal bacterial overgrowth in chronic pancreatitis patients using jejunal aspirate culture and glucose hydrogen breath test

Scandinavian Journal of Gastroenterology, Mar 17, 2021

Abstract Background A subset of chronic pancreatitis patients respond poorly to pancreatic enzyme... more Abstract Background A subset of chronic pancreatitis patients respond poorly to pancreatic enzyme replacement therapy. Small intestinal bacterial overgrowth (SIBO) is considered to be one of the major reasons for this poor response. Previous studies have reported a wide range of prevalence of SIBO in patients with chronic pancreatitis. We aimed to assess the prevalence of SIBO in chronic pancreatitis using quantitative jejunal aspirate culture and glucose hydrogen breath test (GHBT). The sensitivity and specificity of GHBT for the diagnosis of SIBO in chronic pancreatitis were also estimated. Methods Newly diagnosed chronic pancreatitis patients were recruited into the study. A detailed history and relevant laboratory tests were done. All patients underwent an endoscopy and jejunal fluid aspiration for bacterial cultures and GHBT to detect SIBO. The results of GHBT were compared with jejunal fluid aspirate culture. Results The jejunal aspirate culture was positive in 18/48 (37.5%) patients while the GHBT showed that 14/48 (29%) patients had SIBO. The sensitivity, specificity, positive and negative predictive value of GHBT in our study was 44.4, 80, 57.14 and 70.59%, respectively. Conclusions SIBO is not uncommon in chronic pancreatitis patients. One-third of our study population had SIBO. GHBT has low sensitivity but had high specificity in the diagnosis of SIBO in chronic pancreatitis.

Research paper thumbnail of Distribution of celiac disease predisposing genes HLA-DQ2 and HLA-DQ8 in the native population of southern India

Indian Journal of Gastroenterology

Research paper thumbnail of Risk factors of tuberculosis (TB) among homeless population in Chennai city

International journal of health sciences, 2022

Background: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless... more Background: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. Tuberculosis (TB) is a major public health problem. The Chennai City has a large population of homeless persons and caregivers and is estimated to be the largest TB-endemic area in the intermediate-prevalence country, India. However, there have been few studies of homeless persons and caregivers. The objective of this study to assess the prevalence and risk factors for pulmonary TB among homeless population around Chennai. Methods: We conducted a cross-sectional study for screening TB symptoms using questionnaire. The study participants were recruited from 15 zones, which included 47-night shelters around Chennai under the control of the Chennai City in Tamil Nadu. Data was collected from homeless people who were living in night shelters in the northern, central, and southern regions of Chennai City. Results: Complete responses were available from 484 individuals (263 homeless persons ...

Research paper thumbnail of FaecalbifidobacteriainIndianneonates&theeffectofasymptomatic rotavirusinfectionduringthefirstmonthoflife

. Bifidobacteria arebelieved to be beneficialto health. Interventions to increase their populatio... more . Bifidobacteria arebelieved to be beneficialto health. Interventions to increase their population by administering them as probiotics, or administering prebiotics to stimulate their growth and colonization, are often suggested. It is also suggested that bifidobacteriaprotect against or attenuate rotaviral illness in infants. Studies in experimental animals indicate that was followed for a minimum of 30 days. The study administration of bifidobacteriaresulted in the development of increased titres of IgA antibody in both faeces and serum of infected animals, indicating that the bacteria potentiated immune responses

Research paper thumbnail of Percutaneous endoscopic gastrostomy: A prospective study

Gastroenterology, Hepatology and Endoscopy Practice, 2021

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure for est... more Introduction: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure for establishing enteral access for nutrition. There is a paucity of literature on PEG from the Indian subcontinent. With the rate of complications in the literature showing a downward trend, we aimed to analyze the same in our institute following a standard procedure of PEG tube placement. Methods: The prospective study was conducted including patients referred for PEG placement from August 2017 to December 2019. Data were recorded on a proforma. The primary aim of the study was to determine the rate of complications in patients undergoing PEG, whereas the secondary aim was to determine whether early feeding was associated with increased rate of infection or other complications. Patients were reviewed after 3 days, 1 month, and every 3 months thereafter later with clinical examination. Results: Sixty-seven (83.75%) males and 13 (16.25%) females with a median age of 51 years (range 1–85) were included in the study. Forty-one (51.25%) patients had comorbidities with hypertension being the most common (n = 28). Postoperative placement of the PEG tube was done in 47 (58.75%) patients. Seventy-four patients had underlying neurological or neurosurgical conditions. At the time of PEG placement, 59 (73.75%) had tracheostomy. All procedures were performed in the endoscopic suite, of which two were performed as day care procedures. There were no intraprocedural complications. Feed was started within 2 h in 45 (56.25%) patients and all tolerated feed well. There were no major postprocedural complications. Thirteen patients had clinically suspected PEG site infection, of which 11 patients had a culture-positive organism. All responded to conservative management. Thirty-two patients were on follow-up at a median follow-up period of 2 years. Conclusion: The incidence of complications following PEG tube placement is low. With the standardization of the PEG technique, no major complications were seen in our study. Early PEG feeding was not associated with an increase in the rate of complications.

Research paper thumbnail of A phase 2 randomized controlled trial of oral resistant starch supplements in the prevention of acute radiation proctitis in patients treated for cervical cancer

Journal of Cancer Research and Therapeutics, 2019

Background: Radiation induced proctitis is frequently encountered during the radiation therapy of... more Background: Radiation induced proctitis is frequently encountered during the radiation therapy of cervical and prostate cancers that causes pain and occasionally with bleeding and may affect the continuity of radiation therapy. Aims and Objectives: The purpose of the study is to look at the benefit of administration of an oral prebiotic amylase resistant starch in reducing the incidence of acute radiation proctitis, a distressing symptom in patients receiving radiation therapy for cancer of the cervix. Material and Methods: The study was conducted between 2011 and 2014 in 104 patients receiving radical chemo-radiotherapy for carcinoma cervix. Patients were randomized in to two arms, one receiving 30 gm of resistant starch and the other digestible starch on a daily basis throughout the course of the external radiotherapy. All patients received standard 4-field box radiation portals, 50 Gy in 25 fractions with 4 cycles of weekly concurrent Cisplatin. At completion of external beam radiotherapy, all patients underwent LDR/HDR brachytherapy. The study was double blinded and allocation was concealed from the investigators. The investigator recorded the radiotherapy related toxicity of the patients according to CTC V 3.0. The incidence and severity of grade 2-4 diarrhoea and proctitis were documented on a weekly basis and compared across the two groups and analyzed. Stool short chain fatty acid concentrations were measured at baseline at 2nd and 4th week and after 6 weeks of completion of radiotherapy in both study placebo arms and reported. The pattern of microbiota in the stool were also estimated in all patients at 4 time points. Two patients who progressed during therapy were not included in the analyses and two patients discontinued the intervention. A per protocol analyses was done. Results: At analysis there were 50 patients in each arm. The severity of clinical proctitis was found to be similar in both groups of patients with 12.2 % of patients experiencing toxicity of grade 2 and above in digestible starch group versus 14.6% in the resistant starch group. Functional proctitis was similarly graded and it was found that 16.3 % patients in digestible starch group experienced toxicity against 10.2 % patients in the resistant starch group. This difference was seen at 4th week and continued in the subsequent weeks till the end of radiation. Both groups had similar reported toxicity at 6 weeks post intervention and similar incidence of grade 2 and above diarrhea. The resistant starch group was found to have 8% incidence as compared to 2% in the other group at the 5th and 6th week. The short chain fatty acid concentrations were not significantly different in the groups at any point. Conclusion: The study did not demonstrate a significant benefit in administering resistant starch over and above normal diet to patients receiving pelvic radiotherapy. The reasons may be attributed to concurrent use of chemotherapy and decrease in intestinal probiotics. The use of digestible starch in the control arm may have contributed to lower incidence of the toxicity endpoints as well.

Research paper thumbnail of Effect of Native and Acetylated Dietary Resistant Starches on Intestinal Fermentative Capacity of Normal and Stunted Children in Southern India

International Journal of Environmental Research and Public Health, 2019

The health benefits of dietary amylase resistant starch (RS) arise from intestinal microbial ferm... more The health benefits of dietary amylase resistant starch (RS) arise from intestinal microbial fermentation and generation of short chain fatty acids (SCFA). We compared the intestinal fermentative capability of stunted and nonstunted (‘healthy’) children in southern India using two types of RS: high amylose maize starch (HAMS) and acetylated HAMS (HAMSA). Twenty children (10 stunted and 10 healthy) aged 2 to 5 years were fed biscuits containing HAMS (10 g/day) for two weeks followed by a 2-week washout and then HAMSA biscuits (10 g/day) for 2 weeks. Fecal samples were collected at 3-4 day intervals and pH and SCFA analyzed. At entry, stunted children had lower SCFA concentrations compared to healthy children. Both types of RS led to a significant decrease in fecal pH and increase in fecal acetate and propionate in both healthy and stunted children. However, while HAMS increased fecal butyrate in both groups of children, HAMSA increased butyrate in healthy but not stunted children. Fu...

Research paper thumbnail of Prevalence of Adult Celiac Disease in India: Regional Variations and Associations

American Journal of Gastroenterology, 2016

Research paper thumbnail of Novel biomarkers of acute kidney injury in chronic liver disease: Where do we stand after a decade of research?

Hepatology Research

Acute kidney injury (AKI) is a frequently encountered complication in decompensated chronic liver... more Acute kidney injury (AKI) is a frequently encountered complication in decompensated chronic liver disease (CLD) with an estimated prevalence of 20%–50% among hospitalized patients. AKI often heralds the onset of a downhill course in the natural history of CLD. Serum creatinine has several limitations as a stand‐alone marker of AKI in patients with decompensated CLD. The concept of hepatorenal syndrome, the prototype of AKI in decompensated CLD, has evolved tremendously over recent years. There is emerging evidence of an additional “structural” component in the pathophysiology of hepatorenal syndrome‐AKI, which was previously identified as a purely “functional” form of renal impairment. Lacunae in the existent biochemical arsenal for diagnosis and prognosis of AKI have fueled enthusiastic research in the field of novel biomarkers of kidney injury in patients with cirrhosis. The advent of these biomarkers provides a crucial window of opportunity to improve the diagnosis and clinical o...

Research paper thumbnail of Report of a Meeting Zinc deficiency in children with environmental enteropathy— development of new strategies: report from an expert workshop1–4

Zinc deficiency is a major cause of childhood morbidity and mortal-ity. The WHO/UNICEF strategy f... more Zinc deficiency is a major cause of childhood morbidity and mortal-ity. The WHO/UNICEF strategy for zinc supplementation as adjunc-tive therapy for diarrhea is poorly implemented. A conference of experts in zinc nutrition and gastrointestinal disorders was convened to consider approaches that might complement the current recom-mendation and what research was needed to develop these ap-proaches. Several key points were identified. The design of novel zinc interventions would be facilitated by a better understanding of how disturbed gut function, such as environmental (or tropical) enteropathy, affects zinc absorption, losses, and homeostasis. Be-cause only 10 % of zinc stores are able to be rapidly turned over, and appear to be rapidly depleted by acute intestinal illness, they are probably best maintained by complementary regular supplemen-tation in a primary prevention strategy rather than secondary preven-

Research paper thumbnail of Gastrointestinal Nutritional Problems in the Aged

Vegetables, Fruits, and Herbs in Health Promotion, 2000

Research paper thumbnail of Alterations in fecal microbiota in patients with inflammatory bowel disease and enteropathic arthropathy

Gastroenterology, Hepatology and Endoscopy Practice, 2021

Objectives: Inflammatory arthritis or enteropathic arthropathy (EA) is a common extra-intestinal ... more Objectives: Inflammatory arthritis or enteropathic arthropathy (EA) is a common extra-intestinal manifestation in patients with inflammatory bowel disease (IBD). We aimed to determine whether EA in patients with IBD was associated with changes in the gut microbiome. Methods: Consecutive patients with ulcerative colitis (UC) or Crohn's disease (CD) were prospectively recruited and characterized. Stool samples were collected and real-time polymerase chain reaction targeting 16S ribosomal RNA genes was used to quantitate specific communities of “beneficial”; (Clostridium coccoides, bifidobacteria, and lactobacilli) or “aggressive” (Bacteroides and Enterobacteriaceae) bacterial flora. In 12 patients with UC and 12 with CD, fecal 16S ribosomal RNA gene was subjected to next-generation sequencing (NGS) and bacterial taxa were enumerated and compared between IBD patients with and without EA. Results: Sixty-eight patients with UC and 60 with CD were included in the study. Arthropathy was noted in 13 (21.6%) patients with CD and 11 (16.1%) patients with UC. Arthritis was peripheral in 12, axial in 7, and mixed in the rest. The most prevalent commensal bacteria in IBD patients were Bacteroides and Bifidobacterium. Enterobacteriaceae count was significantly higher in patients with UC than in CD. UC patients with EA had relatively higher Enterobacteriaceae and lesser C. coccoides than UC patients without EA. The NGS analyses showed a significant reduction in alpha diversity in patients with EA compared to IBD without EA. Patients with EA had significantly greater abundance of enterococci compared to IBD without EA. Conclusions: EA in IBD patients is characterized by gut microbiome changes including dysbiosis, reduction in alpha diversity, and increased abundance of enterococci.

Research paper thumbnail of Human Leukocyte Antigen DQ (HLA‐DQ) genotypes and haplotypes and their association with phenotype in patients with celiac disease in India

JGH Open, 2021

Human Leukocyte Antigen DQ (HLA‐DQ) genotypes play a permissive role in the genesis of celiac dis... more Human Leukocyte Antigen DQ (HLA‐DQ) genotypes play a permissive role in the genesis of celiac disease (CeD). In this case–control study, we used next‐generation sequencing to determine HLA‐DQA1 and ~DQB1 genotypes and haplotypes associated with CeD in Indian patients.

Research paper thumbnail of Pancreatic Adenocarcinoma With Synchronous Colonic Metastases

ACG Case Reports Journal, 2020

Research paper thumbnail of Indian guidelines on imaging of the small intestine in Crohn’s disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement

Indian Journal of Radiology and Imaging, 2019

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Ind... more The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn’s disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.