Dr Ayusmati Thakur : Consultant Physician and Endoscopist

Dr Ayusmati Thakur : Consultant Physician and Endoscopist I shall be posting updates and information about common health issues, in a language as lucid as pos

Good evening everyone Many of you, who have attended a gastroenterology clinic or endoscopy, may have heard about a bact...
26/12/2024

Good evening everyone

Many of you, who have attended a gastroenterology clinic or endoscopy, may have heard about a bacteria a Helicobacter pylori. Your doctor may have told you that this bacteria may be responsible for quite a few symptoms or gastric ailments. So what is actually H pylori and what are its clinical implications? I shall make an attempt to give an overview.

Helicobacter pylori (H. pylori) is a gram-negative, spiral-shaped bacteria that colonizes the gastric mucosa (specifically this is the microbiological nature of this organism)

It is one of the most common infections worldwide and has significant clinical implications, ranging from benign to severe gastrointestinal diseases.

Clinical Implications of H. pylori Infection -

1. Asymptomatic Carrier State - Most individuals infected with H. pylori remain asymptomatic, but they may serve as reservoirs for transmission.

2. Gastritis
a . Chronic Gastritis: H. pylori induces chronic inflammation of the gastric mucosa, which can be mild, moderate, or severe.
b. Symptoms: Epigastric pain, nausea, and dyspepsia.

3. Peptic Ulcer Disease (PUD) - H. pylori is a major cause of:
a. Gastric ulcers.
b. Duodenal ulcers (most common).

Mechanism - It disrupts the mucosal barrier by producing urease, which neutralizes stomach acid and leads to increased acid secretion and inflammation.

Symptoms - Epigastric pain, often relieved by food in duodenal ulcers, or worsened after meals in gastric ulcers.

4. Gastric Cancer
a. Adenocarcinoma: H. pylori is classified as a Group 1 carcinogen by WHO.
Mechanism: Chronic inflammation leads to atrophic gastritis, intestinal metaplasia, dysplasia, and eventually cancer.
Risk Factors: Long-standing infection, high salt diet, smoking, and genetic predisposition.

b. MALT Lymphoma: Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma is directly linked to H. pylori. Eradication of H. pylori can induce remission in early stages.

5. Non-Ulcer Dyspepsia - H. pylori is associated with functional dyspepsia (symptoms without an identifiable ulcer or structural cause). Symptoms are epigastric (upper abdominal) discomfort, bloating, nausea.

6. Iron Deficiency Anemia (IDA) - Chronic H. pylori infection may impair iron absorption or cause occult gastrointestinal bleeding, contributing to unexplained IDA.

Diagnosis of H. pylori
1. Non-Invasive Tests:
Urea Breath Test: Measures labeled CO₂ in exhaled breath.
Stool Antigen Test: Detects H. pylori antigens in f***s.
Serology: Detects antibodies but cannot differentiate active from past infection.

2. Invasive Tests (via endoscopy):
Rapid Urease Test (CLO test or RUT): Detects urease activity in biopsy samples.
Histology: Biopsy specimens stained to visualize bacteria.
Culture: For antibiotic susceptibility testing (rarely performed).

Treatment of H. pylori
First-line Therapy: Triple or quadruple therapy.
Triple Therapy (14 days): PPI (e.g., omeprazole) + Clarithromycin + Amoxicillin/Metronidazole. (Most commonly used)
Quadruple Therapy (if resistance or prior treatment failure): PPI + Bismuth subsalicylate + Tetracycline + Metronidazole.
Tailor treatment based on regional antibiotic resistance patterns.

Prevention
• Improved sanitation and hygiene.
• Avoidance of contaminated food and water.
• Screening and treatment in high-risk populations (e.g., family history of gastric cancer).

Early detection and eradication of H. pylori can prevent progression to serious diseases like peptic ulcer and gastric cancer, improving patient outcomes significantly.

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We often see patients in the clinic who come with a history of chronic diarrhoea (> 4 weeks) along with weight loss, blo...
03/11/2024

We often see patients in the clinic who come with a history of chronic diarrhoea (> 4 weeks) along with weight loss, bloating etc. This has often been attributed to gastrointestinal infection and has led to rampant use of over the counter antibiotics. Often these antibiotics can be more harmful than useful - sometimes even aggravating the diarrhoea. Chronic diarrhoea may not always be due to an infection, it may be a symptom of GI malabsorption.

Malabsorption occurs when our body cannot properly absorb nutrients, leading to various symptoms and potential health complications. It can affect the absorption of macronutrients (like fats, proteins, and carbohydrates) or micronutrients (such as vitamins and minerals).

Common Symptoms of Malabsorption:

1. Digestive Symptoms:
• Diarrhoea, often chronic or greasy (steatorrhea - passage of fat in stool)
• Bloating and ‘gas’ (flatulence)
• Abdominal pain or cramping
• Unintentional weight loss

2. Nutritional Deficiency Symptoms:
• Vitamin D, Calcium Deficiency: Bone pain, osteoporosis, increased fracture risk
• Iron Deficiency: Fatigue, weakness, pallor, anemia
• Vitamin B12 Deficiency: Nerve damage, tingling in the hands and feet, difficulty walking, anemia
• Protein Deficiency: Edema, muscle wasting
• Vitamin A, E, K Deficiency: Vision problems, skin issues, easy bruising, bleeding disorders

3. Other Symptoms:
• Fatigue and weakness due to nutrient deficiencies
• Muscle cramps or weakness
• Failure to thrive (this occurs in children) and developmental delays

Common Causes of Malabsorption:

1. Gastrointestinal Disorders:

• Celiac Disease: An autoimmune disorder where gluten damages the small intestine, impairing nutrient absorption.
• Crohn’s Disease: Chronic inflammation of the gastrointestinal tract, often affecting nutrient absorption, especially if the small intestine is involved.
• Irritable Bowel Syndrome (IBS): While not primarily a malabsorption condition, some IBS patients experience malabsorption of certain foods.

2. Pancreatic Insufficiency:

• The pancreas produces enzymes crucial for digesting fats, proteins, and carbs. Conditions like chronic pancreatitis or cystic fibrosis can reduce enzyme production, leading to malabsorption.

3. Liver and Biliary Disease:

• Bile Salt Deficiency due to liver disease, bile duct obstruction, or gallbladder removal affects fat absorption, leading to steatorrhea and fat-soluble vitamin deficiencies.

4. Intestinal Infections or Parasitic Infections:

• Infections like giardiasis can damage the intestinal lining and reduce nutrient absorption. Worm infestation may be an important cause as well.

5. Surgical Causes:

• Short Bowel Syndrome after significant intestinal surgery (such as removal of parts of the small intestine) can limit absorption.

• Gastric Bypass Surgery for weight loss can also cause malabsorption due to reduced surface area and altered gut anatomy.

6. Genetic Disorders:

• Lactose Intolerance: Lactase enzyme deficiency affects lactose absorption, causing bloating, gas, and diarrhea after dairy intake.
• Abetalipoproteinemia: A rare disorder that prevents absorption of certain fats and fat-soluble vitamins.

7. Medications:

• Some drugs, such as certain antibiotics, laxatives, and cholestyramine, can interfere with nutrient absorption.

Diagnosis and Treatment

Diagnosing malabsorption often involves blood tests, stool analysis, imaging, and sometimes endoscopy or biopsy.

Treatment depends on the underlying cause and may involve dietary changes, enzyme supplements, vitamin and mineral supplementation, and addressing any underlying disease.

Proper management can often reduce symptoms and improve nutrient absorption, allowing patients to maintain a healthier nutritional status.

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Of late we have noticed regular monitoring of Vitamin D levels is a part of almost all laboratory profiles. While it may...
03/11/2024

Of late we have noticed regular monitoring of Vitamin D levels is a part of almost all laboratory profiles. While it may be important to replace Vitamin D at times to maintain bone health and immune function, over enthusiastic replacement may be detrimental. Constant over the counter intake of high vitamin D tablets may have its adverse effects.

Overcorrection of vitamin D, or vitamin D toxicity (hypervitaminosis D), occurs when there is an excessive intake of vitamin D supplements, leading to abnormally high levels in the blood.

This can cause a range of health issues due to elevated calcium levels in the blood (hypercalcemia), as vitamin D increases calcium absorption from the intestines.

Symptoms of Vitamin D over correction:

1. Gastrointestinal Symptoms: Nausea, vomiting, constipation, poor appetite, and abdominal pain.
2. Neurological Symptoms: Weakness, fatigue, confusion, and in severe cases, altered mental status.
3. Kidney Issues: Excess calcium can lead to kidney stones, increased thirst, frequent urination, and in severe cases, kidney damage or failure.
4. Bone Pain: Although vitamin D supports bone health, excessively high levels can paradoxically cause bone pain.

Causes of Overcorrection:

• Taking high-dose vitamin D supplements without monitoring blood levels.
• Using high-dose injections or prescription vitamin D and not adjusting the dose after reaching sufficient levels - hence monitoring the levels may be needed after correction.
• Certain health conditions, like sarcoidosis or tuberculosis, where the body produces excess active vitamin D.

Management of Vitamin D Toxicity:

1. Stop Supplementation: Discontinue vitamin D supplements immediately.
2. Reduce Calcium Intake: Avoid high-calcium foods and supplements.
3. Hydration: Increase fluid intake to help flush out excess calcium.
4. Medications: In severe cases, corticosteroids or bisphosphonates may be prescribed to lower calcium levels.
5. Monitoring: Regular monitoring of vitamin D and calcium levels is essential to avoid recurrence.

Prevention:

• Regularly monitor vitamin D and calcium levels, especially if taking high doses.
• Avoid self-prescribing high-dose vitamin D without medical guidance (specially continuous intake of OTC high dose vitamin D supplements)

Moderation or optimisation is the key when supplementing vitamin D, as excessive amounts can have serious health implications.

Image : produced from the internet

What is an upper GI endoscopy or esophagogastroduodenoscopy or in simple terms endoscopy?During this procedure your doct...
25/02/2024

What is an upper GI endoscopy or esophagogastroduodenoscopy or in simple terms endoscopy?

During this procedure your doctor will insert a flexible tube with a camera at its end, down your throat through the food pipe into your stomach till the second part of your duodenum (initial part of the small intestine)

A medicine (local anaesthetic) may be sprayed in your oral cavity to numb the throat and make you more relaxed. Sometimes it may be done under mild intravenous sedation (for too anxious subjects). The subject lies on the left side (left lateral position). Movable dentures should be removed before the procedure. The time taken to complete the procedure may vary from 5-8 min (for diagnostic purposes). If therapeutics are involved it may take more time.

With the help of the camera images from inside the food pipe, stomach and part of the duodenum are produced on the screen which the doctor observes. Any abnormal findings like ulcer, polyp, obstruction, tumor, bleeding from any of the above sites can be easily identified by this procedure. Thereby further management can be done based on the initial findings

The procedure is usually a safe one and done mostly on an outpatient basis. Some complications may be post procedure sore throat or pain, rarely bleeding or injury may occur. There may be some side effects of the sedatives if given, hence it is important to inform your doctor about any prior health condition like cardiac diseases, COPD etc.

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09/02/2024

Some points about Ulcerative Colitis

14/01/2024

Two cases of Endoscopic Sleeve Gastroplasty - Endo Bariatric - the first of its kind in Eastern India, were successfully carried out by our team at Digestive Surgery Clinic, led by Dr Sarfaraz Baig, under the guidance of Dr Rakesh Kalapala (AIG) on 8.1.2024

Both the patients recovered well and were discharged the next day.

A short post on Refined Carbohydrates Carbohydrates can be broadly classified into two categories - 1. Whole, unrefined ...
23/12/2023

A short post on Refined Carbohydrates

Carbohydrates can be broadly classified into two categories -
1. Whole, unrefined carbohydrates that come from nutritious food like whole grains, beans, fruits, and vegetables.
2. Refined carbohydrates, often called processed carbohydrates. They are processed to remove natural fibers, bran, germ, and the nutrients in these parts from the grain. They are often considered as “empty calories”. The refined carbs can again be classified under two categories - sugar (table sugar, high fructose corn syrup) and refined grains (white flour or maida)

Diets high in refined carbs also tend to be low in fiber. They cause sudden spikes of blood sugar level and intake of refined carbohydrates is associated with drastic increase in risk of many diseases, including obesity, cardiac diseases, type 2 diabetes, colon cancer, non alcoholic fatty liver disease and various other gastrointestinal disorders.

The main dietary sources of refined carbohydrates are processed and packaged food. Unfortunately these form a major part of the daily dietary pattern.

Image courtesy - Skinny Chef

22/12/2023

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