Rectal tuberculosis after infliximab therapy despite negative screening for latent tuberculosis in a patient with ulcerative colitis

( Jatinderpal Singh ),( Amarender S Puri ),( Sanjeev Sachdeva ),( Puja Sakhuja ),( Kulandaivelu Arivarasan ) 대한장연구학회 2016 Intestinal Research Vol.14 No.2

Tumor necrosis factor-α inhibitors are now considered as standard therapy for patients with severe inflammatory bowel disease who do not respond to corticosteroids, but they carry a definite risk of reactivation of tuberculosis. We present a case in which a patient with inflammatory bowel disease developed a de novo tuberculosis infection after the start of anti-tumor necrosis factor-α treatment despite showing negative results in tuberculosis screening. Although there are many case reports of pleural, lymph nodal and disseminated tuberculosis following infliximab therapy, we present the first case report of rectal tuberculosis following infliximab therapy. (Intest Res 2016;14:183-186)

Biologics for the treatment of pyoderma gangrenosum in ulcerative colitis

K Arivarasan,Vaishali Bhardwaj,Sukrit Sud,Sanjeev Sachdeva,Amarender Singh Puri 대한장연구학회 2016 Intestinal Research Vol.14 No.4

Pyoderma gangrenosum (PG) is an uncommon extra-intestinal manifestation of inflammatory bowel disease (IBD). Despitelimited published literature, biologics have caused a paradigm shift in the management of this difficult-to-treat skin condition. The clinical data and outcomes of three patients with active ulcerative colitis and concurrent PG treated with biologics (infliximabtwo and adalimumab one) are reviewed in this report. Biologics were added because of the sub-optimal response of thecolonic symptoms and skin lesions to parenteral hydrocortisone therapy. All three patients showed a dramatic response to theaddition of the biologics. In view of the rapid healing of the skin lesions, superior response rate, and the additional benefit of improvementin the underlying colonic disease following treatment, anti-tumor necrosis factor blockers should be considered asa first line therapy in the management of PG with underlying IBD.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis

( Amol Sonyabapu Dahale ),( Amarender Singh Puri ),( Sanjeev Sachdeva ),( Anil K Agarwal ),( Ajay Kumar ),( Ashok Dalal ),( Pritul D Saxena ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.3

Background/Aims: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions: The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value. (Korean J Gastroenterol 2021;78:168-176)

Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study

Anurag Mishra,Amarender Singh Puri,Sanjeev Sachdeva,Ashok Dalal 대한장연구학회 2022 Intestinal Research Vol.20 No.4

Background/Aims: Response to vaccine in patients with inflammatory bowel disease is lower than in the general population. We aimed to evaluate the efficacy of hepatitis B virus (HBV) vaccination in patients with ulcerative colitis (UC) versus controls.Methods: We prospectively compared antibody response to HBV vaccination in 100 patients with UC versus controls. HBV vaccination was given to all the cases and controls at 0, 1 and 6 months. Anti-hepatitis B surface (anti-HBs) titers were then measured 4 weeks after the first and the third dose. Adequate immune response (AIR) was considered if the anti-HBs titer was >10 IU/L and effective immune response (EIR) if the anti-HBs titer was >100 IU/L.Results: Median anti-HBs titer was lower in patients with UC than controls (67 IU/L vs. 105 IU/L, P<0.01). AIR and EIR were significantly lower in patients than in controls (82% vs. 96%, P=0.001; 41% vs. 66%, P<0.001, respectively). Univariate analysis showed that age <30 years, mild to moderate severity of disease, disease duration <5 years, male sex, post first dose anti-HBs titer >2 IU/L and non-exposure to corticosteroids, azathioprine and biologicals were predictors of AIR in patients with UC (P<0.05). Multivariate analysis revealed that only non-exposure to corticosteroids, azathioprine and biologicals, male sex, and disease duration <5 years were independent predictors of AIR.Conclusions: Response rate to the HBV vaccination in patients with UC was significantly lower as compared to the controls. Male sex, shorter disease duration, and non-exposure to immunomodulators were independent predictors of AIR.

COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy

Ashok Dalal,Ujjwal Sonika,Manish Kumar,Roshan George,Ajay Kumar,Siddharth Srivastava,Sanjeev Sachdeva,Barjesh Chander Sharma 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4

Background/Aims: The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopyunits globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool priorto endoscopy to prevent the transmission of coronavirus disease (COVID-19). Methods: This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopywas performed only when the RAT was negative. The data are presented as numbers and percentages. Results: A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure wasperformed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during thisperiod. Conclusions: The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.

The Practice of Gastrointestinal Motility Laboratory During COVID-19 Pandemic: Position Statements of the Asian Neurogastroenterology and Motility Association (ANMA-GML-COVID-19 Position Statements)

( Siah Kewin T H ),( Rahman M Masudur ),( Ong Andrew M L ),( Soh Alex Y S ),( Lee Yeong Yeh ),( Xiao Yinglian ),( Sachdeva Sanjeev ),( Jung Kee Wook ),( Wang Yen-Po ),( Oshima Tadayuki ),( Patcharatra 대한소화기기능성질환·운동학회 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.3

During the Coronavirus Disease 2019 (COVID-19) pandemic, practices of gastrointestinal procedures within the digestive tract require special precautions due to the risk of contraction of severe acute respiratoy syndrome coronavirus-2 (SARS-CoV-2) infection. Many procedures in the gastrointestinal motility laboratory may be considered moderate to high-risk for viral transmission. Healthcare staff working in gastrointestinal motility laboratories are frequently exposed to splashes, air droplets, mucus, or saliva during the procedures. Moreover, some are aerosol-generating and thus have a high risk of viral transmission. There are multiple guidelines on the practices of gastrointestinal endoscopy during this pandemic. However, such guidelines are still lacking and urgently needed for the practice of gastrointestinal motility laboratories. Hence, the Asian Neurogastroenterology and Motility Association had organized a group of gastrointestinal motility experts and infectious disease specialists to produce a position statement paper based-on current available evidence and consensus opinion with aims to provide a clear guidance on the practices of gastrointestinal motility laboratories during the COVID-19 pandemic. This guideline covers a wide range of topics on gastrointestinal motility activities from scheduling a motility test, the precautions at different steps of the procedure to disinfection for the safety and well-being of the patients and the healthcare workers. These practices may vary in different countries depending on the stages of the pandemic, local or institutional policy, and the availability of healthcare resources. This guideline is useful when the transmission rate of SARS-CoV-2 is high. It may change rapidly depending on the situation of the epidemic and when new evidence becomes available. (J Neurogastroenterol Motil 2020;26:299-310)