Prevalence of Irritable Bowel Syndrome: A Community Based Study From Northern India

( Govind K Makharia ),( Anil K Verma ),( Ritvik Amarchand ),( Anil Goswami ),( Prashant Singh ),( Abhishek Agnihotri ),( Faizul Suhail ),( Anand Krishnan ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.1

Background/Aims The prevalence of irritable bowel syndrome (IBS) varies from 4% to 20% in different Asian nations. Prevalence of IBS in native North Indian community is not known. Methods Between November 2008 to December 2009, we estimated the prevalence of IBS in a rural community of Ballabgarh block, located in Haryana state. A structured questionnaire based on Rome Ⅲ module was used to collect symptoms related to IBS from all the participants in a door to door survey. A Rome Ⅲ criterion was used for diagnosis of IBS. IBS was further classified based on predominance of symptoms as constipation predominant, diarrhea predominant, mixed and unspecified based on Rome Ⅲ module. Results There were 4,767 participants (mean age 34.6±10.8, males 50%). Overall, 555 (11.6%; 95% CI, 10.7-12.5) had constipation, 542 (11.4%; 95% CI, 10.5-12.3) diarrhea and 823 (17.3%; 95% CI, 16.2-18.4) abdominal pain. The overall prevalence of IBS was 4% (95% CI, 3.5-4.6). The prevalence of constipation predominant IBS was 0.3% (95% CI, 0.16-0.49), diarrhea predominant IBS 1.5% (95% CI, 1.18-1.90), mixed IBS 1.7% (95% CI, 1.35-2.11) and unsubtyped IBS 0.5% (95% CI, 0.32-0.75). The prevalence of IBS was significantly higher in females compared with males (4.8% vs 3.2%, P=0.008). However, there was no significant difference between males and females in the prevalence of different subtypes of IBS. The prevalence increased with age. Conclusions The prevalence of IBS in a North Indian community is 4%. IBS poses a significant burden on the rural adults. (J Neurogastroenterol Motil 2011;17:82-87)

Is There True Gender Difference of Irritable Bowel Syndrome in Asia?: Author`s Reply

( Govind K Makharia ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.2

How to Interpret a Functional or Motility Test : Techniques of Functional and Motility Test: How to Perform and Interpret Intestinal Permeability

( Asha Mishra ),( Govind K Makharia ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.4

Transport of molecules across the intestinal epithelium takes place through 2 major routes, ie, trans-cellular and paracellular. Assessment of intestinal permeability is performed to assess the overall function of transport through the intestinal epithelial paracellular route. Urinary excretion of disaccharides and monosaccharides and ratio of their excretion is a basis for measurement of intestinal permeability. Lactulose and mannitol ratio is the most commonly used test for assessment of small intestinal permeability and the most reliable method for measurement of concentration of lactulose and mannitol in the urine is high performance liquid chromatography. After the measurement of concentration of probes in the urine; the results are expressed as the ratio of percentage excretion of the ingested dose of lactulose and mannitol in the urine. Testing of intestinal permeability is not required for routine patient care, however it is an important tool to understand the function of the paracellular transport in the research setting. Increase in intestinal permeability has been implicated in the pathogenesis of many autoimmune diseases including celiac disease, Crohn’s disease, type I diabetes and food allergy. (J Neurogastroenterol Motil 2012;18:443-447)

Transfer Dysphagia Due To Focal Dystonia

Priyanka Samal,Vinay Goyal,Govind K Makharia,Chandan J. Das,Sankar Prasad Gorthi,Vishnu V Y,Mamta Bhushan Singh,M V Padma Srivastava 대한파킨슨병및이상운동질환학회 2018 Journal Of Movement Disorders Vol.11 No.3

Objective The inability to propel a bolus of food successfully from the posterior part of the oral cavity to the oropharynx is defined as transfer dysphagia. The present case series describes the varied presentation of transfer dysphagia due to focal dystonia and highlights the importance of early detection by following up on strong suspicions. Methods We describe seven cases of transfer dysphagia due to focal dystonia. Transfer dysphagia as a form of focal dystonia may appear as the sole presenting complaint or may present with other forms of focal dystonia. Results Four out of seven patients had pure transfer dysphagia and had previously been treated for functional dysphagia. A high index of suspicion, barium swallow including videofluoroscopy, associated dystonia in other parts of the body and response to drug therapy with trihexyphenidyl/tetrabenazine helped to confirm the diagnosis. Conclusion Awareness of these clinical presentations among neurologists and non-neurologists can facilitate an early diagnosis and prevent unnecessary investigations.

A simple phenotypic classification for celiac disease

( Ajit Sood ),( Vandana Midha ),( Govind Makharia ),( B. K. Thelma ),( Shivalingappa S Halli ),( Varun Mehta ),( Ramit Mahajan ),( Vikram Narang ),( Kriti Sood ),( Kirandeep Kaur ) 대한장연구학회 2018 Intestinal Research Vol.16 No.2

Background/Aims: Celiac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease. Methods: Various variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields. Results: After empirical verification, age at diagnosis was considered appropriate in between A1 (<18) and A2 (≥18). The disease presentation has been classified into 3 types-P1 (classical), P2 (non-classical) and P3 (asymptomatic). Complications were considered as absent (C0) or present (C1). A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification) was derived. Conclusions: APC classification (age at diagnosis, presentation, complications) is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis. (Intest Res 2018;16:288-292)

Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas

Karan Sachdeva,Peeyush Kumar,Bhaskar Kante,Sudheer K. Vuyyuru,Srikant Mohta,Mukesh K. Ranjan,Mukesh K. Singh,Mahak Verma,Govind Makharia,Saurabh Kedia,Vineet Ahuja 대한장연구학회 2023 Intestinal Research Vol.21 No.2

Background/Aims: Intestinal tuberculosis (ITB) and Crohn’s disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same. Methods: Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL. Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy. Results: Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55–0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17. Conclusions: In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.

Efficacy and tolerability of hyperbaric oxygen therapy in small bowel stricturing Crohn’s disease: a pilot study

( Bhaskar Kante ),( Pabitra Sahu ),( Saurabh Kedia ),( Sudheer K. Vuyyuru ),( Kapil Soni ),( Maneesh Singhal ),( Raju Sharma ),( Govind Makharia ),( Vineet Ahuja ) 대한장연구학회 2022 Intestinal Research Vol.20 No.2

Background/Aims: Existing therapeutic options for complicated Crohn’s disease (CD) like biologics and surgery are limited by inadequate long-term efficacy, cost, and adverse effects. Tissue hypoxia is important in CD pathogenesis and may be ameliorated with hyperbaric oxygen therapy (HBOT). We assessed the efficacy and tolerability of HBOT in small bowel stricturing CD. Methods: This pilot study included patients of small bowel stricturing CD (from April 2019 to January 2020) who underwent HBOT. These patients were refractory to conventional medical treatment or had multiple strictures not amenable to resection. Each session of HBOT was given for 60 minutes with a pressure of 1.5-2.5 atm. Clinical, biochemical responses and Short Inflammatory Bowel Disease (SIBD) questionnaire were evaluated at 2 and 6 months, and radiological response was evaluated at 6 months. Results: Fourteen patients (mean age, 42.9±15.7 years; male, 50%) were subjected to 168 HBOT sessions. Thirteen patients (92.7%) had strictures and 1 patient had enterocutaneous fistula in addition. Median number of HBOT sessions was 11 (range, 3-20) which were administered over a median of 4 weeks. Most patients tolerated it well except 1 who had hemotympanum. At 2 and 6 months of follow-up, 64.2% of patients had a clinical response, 50% and 64.2% of patients had clinical remission respectively. Steroid-free clinical remission was seen in 8 (57%) of patients with radiological improvement in 50%. There was a significant improvement in SIBD scores at 2-month follow-up (59.4 vs. 44.5, P=0.03). Conclusions: HBOT can be a safe and effective therapeutic option in patients with stricturing small bowel CD refractory to conventional medical treatment. (Intest Res 2022;20:231-239)

Emergence of Celiac Disease and Gluten-related Disorders in Asia

( Srikant Mohta ),( Mahendra S Rajput ),( Vineet Ahuja ),( Govind K Makharia ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.3

Celiac disease (CeD) is a systemic, immune-mediated enteropathy, which is triggered by gluten protein in genetically susceptible individuals. CeD, once thought to be an uncommon disease, is now recognized to affect approximately 40-60 million people globally. While CeD is now well reported from a few Asian countries such as India, China, Pakistan, and Middle Eastern countries; it is still believed to be uncommon in the rest of Asia. Gluten-related diseases other than CeD, like non-celiac gluten sensitivity (NCGS) are also emerging globally. CeD and NCGS may present with either intestinal or extra-intestinal symptoms, and a proportion of them have overlapping symptoms with irritable bowel syndrome. Hence, many of them are misdiagnosed as having irritable bowel syndrome in clinical practice. In this review, we discuss the emergence of CeD and other gluten-related disorders, both globally and in Asia, the overlapping manifestations between gluten-related disorders and irritable bowel syndrome, and the challenges associated with diagnosis and management of CeD in Asia. (J Neurogastroenterol Motil 2021;27:337-346)

Psychiatric, Somatic and Other Functional Gastrointestinal Disorders in Patients With Irritable Bowel Syndrome at a Tertiary Care Center

( Prashant Singh ),( Abhishek Agnihotri ),( Manish K Pathak ),( Asef Shirazi ),( Rajeew P Tiwari ),( V Sreenivas ),( Rajesh Sagar ),( Govind K Makharia ) 대한소화기기능성질환·운동학회 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.3

Background/Aims To study the prevalence of somatic and psychiatric co-morbidities in the patients of irritable bowel syndrome (IBS) and to assess the quality of life (QOL) of these patients. Methods One hundred and eighty-four IBS patients and 198 controls were included. Diagnosis of IBS, its sub-classification and assessment of other functional gastrointestinal disorders (FGIDs) was made on basis of Rome III criteria. Severity of IBS was assessed using IBS severity scoring system. Psychiatric evaluation was done using Patient Heath Questionnaire. QOL was evaluated using WHO QOL-BREF. Results One hundred and forty-seven (79.9%) and 158 (85.9%) patients with IBS had at least one other FGID or at least one somatic co-morbidity, respectively. Higher number of patients had at least one psychiatric co-morbidity compared to controls (79.9% vs 34.3%; P < 0.001). Major depressive syndrome (47.3% vs 5.1%; P < 0.001), somatoform disorder (50% vs 14.6%; P < 0.001) and panic syndrome (44% vs 11.6%; P < 0.001) were more common in IBS than controls. Only 14 (7.6%) patients were receiving drug treatment for their psychiatric illness. Severe IBS symptoms were present in significantly higher number of patients with constipation predominant IBS than diarrhea predominant IBS. Those with severe disease had higher prevalence of psychiatric (95.1%) and somatic (96.7%) co-morbidities compared with mild disease. QOL of IBS patients was significantly lower in all four domains compared to controls. Presence of at least one other FGID was significantly associated with presence of one or more psychiatric co-morbidity (P < 0.001). Conclusions Majority of IBS patients presenting to a tertiary care center had associated psychiatric, somatic co-morbidities and reduced QOL. Very few of them received specific psychiatric treatment. (J Neurogastroenterol Motil 2012;18:324-331)

Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver

( Ashish Agarwal ),( Alka Singh ),( Wajiha Mehtab ),( Vipin Gupta ),( Ashish Chauhan ),( Mahendra Singh Rajput ),( Namrata Singh ),( Vineet Ahuja ),( Govind K. Makharia ) 대한장연구학회 2021 Intestinal Research Vol.19 No.1

Background/Aims: Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease. Methods: Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan. Results: In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively. Conclusions: Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly. (Intest Res 2021;19:106-114)