Journal of Pediatric Gastroenterology and Nutrition, 2006
To find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensi... more To find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy (PHG) and risk of rebleeding following esophageal variceal eradication. Between 1992 and 2002, children with extrahepatic portal venous obstruction (EHPVO) and bleeding from esophageal varices received endoscopic injection sclerotherapy until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal (GOV) or isolated gastric varices (IGV). Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy. 163 of 183 children who achieved esophageal variceal eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices (before sclerotherapy) were seen in 61% cases [GOV 98% (83% GOV1, 15% GOV2) and IGV 2%] and secondary (after sclerotherapy) in 28% [GOV 71% (47% GOV1, 24% GOV2) and IGV 29%]. Secondary gastric varices were distributed as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy and at the last follow up showed decrease in GOV1 from 82 to 56 (P = 0.02), increase in GOV2 from 15 to 23 and increase in IGV from 2 to 15 (P < 0.001). PHG increased in frequency from 12% to 41% (P < 0.001) and severity from one patient to 12 (P < 0.001). Eleven cases had rebleeding from gastric varices (5 GOV1, 4 GOV2 and 2 IGV). Following esophageal variceal eradication in children with EHPVO a significant decrease in GOV1, increase in IGV and increased frequency and severity of PHG takes place. Small rebleeding risk persists from gastric varices irrespective of the type.
Dapsone can rarely cause a hypersensitivity reaction called dapsone syndrome, consisting of fever... more Dapsone can rarely cause a hypersensitivity reaction called dapsone syndrome, consisting of fever, hepatitis, exfoliative dermatitis, lymphadenopathy and hemolytic anemia. Dapsone syndrome is a manifestation of the DRESS (drug rash with eosinophilia and systemic symptoms) syndrome which is a serious condition that has been reported in association with various drugs. Cholangitis in dapsone syndrome has not been reported so far in the world literature. We report a patient who presented with fever, exfoliative dermatitis, jaundice and anemia within three weeks of starting of dapsone therapy. These features are typical of dapsone syndrome, which is due to dapsone hypersensitivity and is potentially fatal. Unlike previous reports of hepatitic or cholestatic injury in dapsone syndrome we report here a case that had cholangitic liver injury. It responded to corticosteroids. We conclude that cholangitis, though unusual, can also form a part of dapsone syndrome. Physicians should be aware of...
BACKGROUND Data are scarce on liver involvement in adult patients with dengue virus infection. ME... more BACKGROUND Data are scarce on liver involvement in adult patients with dengue virus infection. METHODS During a recent outbreak of dengue fever in Uttar Pradesh, India, we looked for evidence of liver dysfunction among patients with dengue fever. RESULTS A total of 45 patients with dengue fever (age 7-65 [median 33] years; 29 men; 39 adults) were studied, including 23 with uncomplicated dengue fever, 15 with dengue haemorrhagic fever and 7 with dengue shock syndrome. The median platelet count was 34 x 10(9)/L (9-99 x 10(9)). Seven patients (15%) had jaundice, 11 (24%) hepatomegaly and 9 clinically detectable ascites; none had splenomegaly. Twelve patients (30%) had hyperbilirubinaemia. Serum alanine and aspartate aminotransferase activities were elevated in 43 patients (96%) each; 5-fold elevated levels were more frequent in severe disease. Hypoalbuminaemia was found in 31/41 patients (76%). Seven patients died, including 2 with acute liver failure. CONCLUSION Our data show that liv...
The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompany... more The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompanying editorial,2 but also from an earlier Indian study3 by the absence of intestinal tuberculosis as a cause of obscure GI bleed. The authors may wish to comment on this. We also want to ...
Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is ... more Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We report a patient with PNH complicated by intracranial venous thrombosis and Budd-Chiari syndrome, who was managed with transjugular intrahepatic portosystemic shunt. A 26-year-old man presented with thrombosis of the superior sagittal and right sigmoid sinuses. Initial investigations did not reveal any underlying cause. Nine months later, he developed hepatic venous thrombosis. At this time, Ham test was positive. Flow cytometry confirmed the diagnosis of PNH. The patient was treated with transjugular intrahepatic portosystemic shunt; one episode of stent blockage one month later was managed successfully with balloon dilatation and restenting. PNH should be considered in patients with unexplained venous thrombosis. Thrombosis in these patients needs to be managed with prolonged anticoagulation. For Budd-Chiari syndrome in patients with underlying PNH, transjugular intrahepatic portosystemic shunt may be a good option but caution is needed to prevent stent occlusion.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We prospectively evaluated the usefulness of IgA tissue transglutaminase antibodies (IgA tTG) in ... more We prospectively evaluated the usefulness of IgA tissue transglutaminase antibodies (IgA tTG) in the initial diagnosis of celiac disease (CD) and compared its diagnostic potential with that of IgA anti-endomysial antibodies (IgA EMA) and anti-IgA and IgG gliadin antibodies (AGA and AGG, respectively). Sera of 23 untreated children fulfilling the revised ESPGHAN criteria for diagnosis of CD (Group I; mean age 10.8 y); 19 disease controls (Group II; mean age 8.5 y) presenting with chronic diarrhea, short stature or both; and 22 healthy children (Group III; mean age 8.8 y) were studied. These were tested in a blinded manner for AGA, AGG, IgA tTG (guinea pig as antigen) and IgA EMA. In Group I, IgA EMA was positive in 19, IgA tTG in 17, AGA in 14 and AGG in 17 patients. In Group II, these tests were positive in 1, 0, 2 and 14 patients, respectively and in Group III, in 0, 0, 0 and 1 child, respectively. Analyzing data from Group I and II, IgA EMA, IgA tTG, AGA and AGG had sensitivity ra...
OBJECTIVE: Achalasia is a well-defined esophageal motor disorder for which pneumatic dilation is ... more OBJECTIVE: Achalasia is a well-defined esophageal motor disorder for which pneumatic dilation is an established therapeutic method. Even though it has been used for several years, there are limited data on the long-term outcomes of patients treated with this ...
Background. Data are scarce on liver involvement in adult patients with dengue virus infection. M... more Background. Data are scarce on liver involvement in adult patients with dengue virus infection. Methods. During a recent outbreak of dengue fever in Uttar Pradesh, India, we looked for evidence of liver dysfunction among patients with dengue fever. Results. A total of 45 patients with dengue fever (age 765 [median 33] years; 29 men; 39 adults) were studied, including 23 with uncomplicated dengue fever, 15 with dengue haemorrhagic fever and 7 with dengue shock syndrome. The median platelet count was 34x10 9 /L (999x10 9). Seven patients (15%) had jaundice, 11 (24%) hepatomegaly and 9 clinically detectable ascites; none had splenomegaly. Twelve patients (30%) had hyperbilirubinaemia. Serum alanine and aspartate aminotransferase activities were elevated in 43 patients (96%) each; 5-fold elevated levels were more frequent in severe disease. Hypoalbuminaemia was found in 31/41 patients (76%). Seven patients died, including 2 with acute liver failure. Conclusion. Our data show that liver injury is common in adult patients with dengue infection. Further studies are needed to determine the mechanism of liver injury in this disease.
The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompany... more The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompanying editorial,2 but also from an earlier Indian study3 by the absence of intestinal tuberculosis as a cause of obscure GI bleed. The authors may wish to comment on this. We also want to ...
Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, havi... more Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, having high recurrence despite antibiotic prophylaxis. Small bowel dysmotility and bacterial overgrowth have been documented to be related to SBP. The purpose of the present paper was (i) to study whether addition of a prokinetic agent to norfloxacin ameliorates the development of SBP in high-risk patients; and (ii) to identify risk factors for SBP development. A prospective, single blinded, randomized controlled trial was conducted in high-risk cirrhotic patients with ascites who had either recovered from an episode of SBP or who had low ascitic fluid protein. Norfloxacin 400 mg once daily (group I) or norfloxacin 400 mg once daily with cisapride 20 mg twice a day (group II) was given and occurrence of side-effects of therapy and mortality were recorded. Of the 94 patients, 48 (51%) were in group I, and 46 (49%) in group II. The actuarial probability of developing SBP at 12 month in group I was 56.8% and in group II, 21.7% (P = 0.026). Treatment failure was observed in five patients (10%) in group I and none in group II (P = 0.003). The actuarial probability of death at 18 months was 20.6% in group I and 6.2% in group II (P = 0.1). Low serum albumin, low ascitic fluid protein and alcoholic cirrhosis were related to development of SBP (P < 0.05). Additionally, low serum albumin (2.8 g/dL), gastrointestinal bleeding, alcoholic cirrhosis and low ascitic fluid protein were significantly associated with multiple occurrences of SBP. Prophylaxis with norfloxacin and cisapride significantly reduces the incidence of SBP in high-risk cirrhosis patients; low serum albumin, low ascitic fluid protein and alcoholic cirrhosis predispose to the development of SBP in high-risk cirrhosis patients; and low ascitic fluid protein should also be considered as a risk factor for the development of SBP requiring prophylaxis.
BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoieti... more BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We ...
We read with interest the study by Del Piano et al 1 about treatment of malignant gastroduodenal ... more We read with interest the study by Del Piano et al 1 about treatment of malignant gastroduodenal outflow obstruction (GOO). They compared endoscopic placement of self-expanding metallic stent (SEMS) with open surgical gastrojejunostomy (GJ) and found the former procedure superior to the latter. We appreciate their effort; however, we want to point out certain flaws in the study and seek the investigators' clarifications for the same. The investigators report a technical success rate of 96%, which is comparable with the literature. However, it is not clear from the study on what basis the patients were chosen for endoscopic or surgical treatment. Were there any patients with difficult anatomy that precluded endoscopic treatment (also amounting to technical failure)? Were these patients directly offered surgical GJ? If this is the case, then these patients should either be excluded from the study or they should be included in the SEMS group, and the technical success rate should be lower than projected. From the study by Dormann et al, 2 in the pooled data of 606 patients, it was found that after the procedure, 48% resumed a full diet, 39% remained on soft diet, and 13% were still taking liquid diet only. It takes a mean of 4 days (range 1 to 7 days) for resolution of GOO symptoms. A ''gastric outlet score'' usually is helpful in monitoring the progress of the patient (no oral intake, 0; liquids only, 1; soft solids, 2; full diet, 3). 3 The score improved from a baseline of 0.4 to 2.4 after intervention. However, in the study by Del Piano et al, 1 resolution of full normal diet in all patients in the endoscopy group within 24 hours is hard to believe. Was any gastric outlet score used in the study? The delayed gastric emptying reported in 10 patients in the surgical group requires further elaboration. How many days did this delayed gastric emptying last? The literature mentions that usually it is transient and improves in up to 67% of patients by 8 days and 89% in 15 days. 4 The high 30-day mortality in the surgical group by itself shows a poor selection of cases. Because nutritional status was comparable in the two groups, were there any other comorbid illness that contributed to the high 30-day mortality? In summary, we do not believe this study is of a robust enough design to provide support for the conclusions drawn.
Journal of Pediatric Gastroenterology and Nutrition, 2006
To find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensi... more To find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy (PHG) and risk of rebleeding following esophageal variceal eradication. Between 1992 and 2002, children with extrahepatic portal venous obstruction (EHPVO) and bleeding from esophageal varices received endoscopic injection sclerotherapy until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal (GOV) or isolated gastric varices (IGV). Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy. 163 of 183 children who achieved esophageal variceal eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices (before sclerotherapy) were seen in 61% cases [GOV 98% (83% GOV1, 15% GOV2) and IGV 2%] and secondary (after sclerotherapy) in 28% [GOV 71% (47% GOV1, 24% GOV2) and IGV 29%]. Secondary gastric varices were distributed as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy and at the last follow up showed decrease in GOV1 from 82 to 56 (P = 0.02), increase in GOV2 from 15 to 23 and increase in IGV from 2 to 15 (P < 0.001). PHG increased in frequency from 12% to 41% (P < 0.001) and severity from one patient to 12 (P < 0.001). Eleven cases had rebleeding from gastric varices (5 GOV1, 4 GOV2 and 2 IGV). Following esophageal variceal eradication in children with EHPVO a significant decrease in GOV1, increase in IGV and increased frequency and severity of PHG takes place. Small rebleeding risk persists from gastric varices irrespective of the type.
Dapsone can rarely cause a hypersensitivity reaction called dapsone syndrome, consisting of fever... more Dapsone can rarely cause a hypersensitivity reaction called dapsone syndrome, consisting of fever, hepatitis, exfoliative dermatitis, lymphadenopathy and hemolytic anemia. Dapsone syndrome is a manifestation of the DRESS (drug rash with eosinophilia and systemic symptoms) syndrome which is a serious condition that has been reported in association with various drugs. Cholangitis in dapsone syndrome has not been reported so far in the world literature. We report a patient who presented with fever, exfoliative dermatitis, jaundice and anemia within three weeks of starting of dapsone therapy. These features are typical of dapsone syndrome, which is due to dapsone hypersensitivity and is potentially fatal. Unlike previous reports of hepatitic or cholestatic injury in dapsone syndrome we report here a case that had cholangitic liver injury. It responded to corticosteroids. We conclude that cholangitis, though unusual, can also form a part of dapsone syndrome. Physicians should be aware of...
BACKGROUND Data are scarce on liver involvement in adult patients with dengue virus infection. ME... more BACKGROUND Data are scarce on liver involvement in adult patients with dengue virus infection. METHODS During a recent outbreak of dengue fever in Uttar Pradesh, India, we looked for evidence of liver dysfunction among patients with dengue fever. RESULTS A total of 45 patients with dengue fever (age 7-65 [median 33] years; 29 men; 39 adults) were studied, including 23 with uncomplicated dengue fever, 15 with dengue haemorrhagic fever and 7 with dengue shock syndrome. The median platelet count was 34 x 10(9)/L (9-99 x 10(9)). Seven patients (15%) had jaundice, 11 (24%) hepatomegaly and 9 clinically detectable ascites; none had splenomegaly. Twelve patients (30%) had hyperbilirubinaemia. Serum alanine and aspartate aminotransferase activities were elevated in 43 patients (96%) each; 5-fold elevated levels were more frequent in severe disease. Hypoalbuminaemia was found in 31/41 patients (76%). Seven patients died, including 2 with acute liver failure. CONCLUSION Our data show that liv...
The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompany... more The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompanying editorial,2 but also from an earlier Indian study3 by the absence of intestinal tuberculosis as a cause of obscure GI bleed. The authors may wish to comment on this. We also want to ...
Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is ... more Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We report a patient with PNH complicated by intracranial venous thrombosis and Budd-Chiari syndrome, who was managed with transjugular intrahepatic portosystemic shunt. A 26-year-old man presented with thrombosis of the superior sagittal and right sigmoid sinuses. Initial investigations did not reveal any underlying cause. Nine months later, he developed hepatic venous thrombosis. At this time, Ham test was positive. Flow cytometry confirmed the diagnosis of PNH. The patient was treated with transjugular intrahepatic portosystemic shunt; one episode of stent blockage one month later was managed successfully with balloon dilatation and restenting. PNH should be considered in patients with unexplained venous thrombosis. Thrombosis in these patients needs to be managed with prolonged anticoagulation. For Budd-Chiari syndrome in patients with underlying PNH, transjugular intrahepatic portosystemic shunt may be a good option but caution is needed to prevent stent occlusion.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We prospectively evaluated the usefulness of IgA tissue transglutaminase antibodies (IgA tTG) in ... more We prospectively evaluated the usefulness of IgA tissue transglutaminase antibodies (IgA tTG) in the initial diagnosis of celiac disease (CD) and compared its diagnostic potential with that of IgA anti-endomysial antibodies (IgA EMA) and anti-IgA and IgG gliadin antibodies (AGA and AGG, respectively). Sera of 23 untreated children fulfilling the revised ESPGHAN criteria for diagnosis of CD (Group I; mean age 10.8 y); 19 disease controls (Group II; mean age 8.5 y) presenting with chronic diarrhea, short stature or both; and 22 healthy children (Group III; mean age 8.8 y) were studied. These were tested in a blinded manner for AGA, AGG, IgA tTG (guinea pig as antigen) and IgA EMA. In Group I, IgA EMA was positive in 19, IgA tTG in 17, AGA in 14 and AGG in 17 patients. In Group II, these tests were positive in 1, 0, 2 and 14 patients, respectively and in Group III, in 0, 0, 0 and 1 child, respectively. Analyzing data from Group I and II, IgA EMA, IgA tTG, AGA and AGG had sensitivity ra...
OBJECTIVE: Achalasia is a well-defined esophageal motor disorder for which pneumatic dilation is ... more OBJECTIVE: Achalasia is a well-defined esophageal motor disorder for which pneumatic dilation is an established therapeutic method. Even though it has been used for several years, there are limited data on the long-term outcomes of patients treated with this ...
Background. Data are scarce on liver involvement in adult patients with dengue virus infection. M... more Background. Data are scarce on liver involvement in adult patients with dengue virus infection. Methods. During a recent outbreak of dengue fever in Uttar Pradesh, India, we looked for evidence of liver dysfunction among patients with dengue fever. Results. A total of 45 patients with dengue fever (age 765 [median 33] years; 29 men; 39 adults) were studied, including 23 with uncomplicated dengue fever, 15 with dengue haemorrhagic fever and 7 with dengue shock syndrome. The median platelet count was 34x10 9 /L (999x10 9). Seven patients (15%) had jaundice, 11 (24%) hepatomegaly and 9 clinically detectable ascites; none had splenomegaly. Twelve patients (30%) had hyperbilirubinaemia. Serum alanine and aspartate aminotransferase activities were elevated in 43 patients (96%) each; 5-fold elevated levels were more frequent in severe disease. Hypoalbuminaemia was found in 31/41 patients (76%). Seven patients died, including 2 with acute liver failure. Conclusion. Our data show that liver injury is common in adult patients with dengue infection. Further studies are needed to determine the mechanism of liver injury in this disease.
The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompany... more The study by Gupta et al1 differed not only from Western studies, as highlighted in the accompanying editorial,2 but also from an earlier Indian study3 by the absence of intestinal tuberculosis as a cause of obscure GI bleed. The authors may wish to comment on this. We also want to ...
Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, havi... more Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, having high recurrence despite antibiotic prophylaxis. Small bowel dysmotility and bacterial overgrowth have been documented to be related to SBP. The purpose of the present paper was (i) to study whether addition of a prokinetic agent to norfloxacin ameliorates the development of SBP in high-risk patients; and (ii) to identify risk factors for SBP development. A prospective, single blinded, randomized controlled trial was conducted in high-risk cirrhotic patients with ascites who had either recovered from an episode of SBP or who had low ascitic fluid protein. Norfloxacin 400 mg once daily (group I) or norfloxacin 400 mg once daily with cisapride 20 mg twice a day (group II) was given and occurrence of side-effects of therapy and mortality were recorded. Of the 94 patients, 48 (51%) were in group I, and 46 (49%) in group II. The actuarial probability of developing SBP at 12 month in group I was 56.8% and in group II, 21.7% (P = 0.026). Treatment failure was observed in five patients (10%) in group I and none in group II (P = 0.003). The actuarial probability of death at 18 months was 20.6% in group I and 6.2% in group II (P = 0.1). Low serum albumin, low ascitic fluid protein and alcoholic cirrhosis were related to development of SBP (P < 0.05). Additionally, low serum albumin (2.8 g/dL), gastrointestinal bleeding, alcoholic cirrhosis and low ascitic fluid protein were significantly associated with multiple occurrences of SBP. Prophylaxis with norfloxacin and cisapride significantly reduces the incidence of SBP in high-risk cirrhosis patients; low serum albumin, low ascitic fluid protein and alcoholic cirrhosis predispose to the development of SBP in high-risk cirrhosis patients; and low ascitic fluid protein should also be considered as a risk factor for the development of SBP requiring prophylaxis.
BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoieti... more BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH), caused by somatic mutation of hematopoietic cells, is associated with complement-mediated hemolysis and a hypercoagulable state. Thrombotic complications in this disease are associated with reduced survival. We ...
We read with interest the study by Del Piano et al 1 about treatment of malignant gastroduodenal ... more We read with interest the study by Del Piano et al 1 about treatment of malignant gastroduodenal outflow obstruction (GOO). They compared endoscopic placement of self-expanding metallic stent (SEMS) with open surgical gastrojejunostomy (GJ) and found the former procedure superior to the latter. We appreciate their effort; however, we want to point out certain flaws in the study and seek the investigators' clarifications for the same. The investigators report a technical success rate of 96%, which is comparable with the literature. However, it is not clear from the study on what basis the patients were chosen for endoscopic or surgical treatment. Were there any patients with difficult anatomy that precluded endoscopic treatment (also amounting to technical failure)? Were these patients directly offered surgical GJ? If this is the case, then these patients should either be excluded from the study or they should be included in the SEMS group, and the technical success rate should be lower than projected. From the study by Dormann et al, 2 in the pooled data of 606 patients, it was found that after the procedure, 48% resumed a full diet, 39% remained on soft diet, and 13% were still taking liquid diet only. It takes a mean of 4 days (range 1 to 7 days) for resolution of GOO symptoms. A ''gastric outlet score'' usually is helpful in monitoring the progress of the patient (no oral intake, 0; liquids only, 1; soft solids, 2; full diet, 3). 3 The score improved from a baseline of 0.4 to 2.4 after intervention. However, in the study by Del Piano et al, 1 resolution of full normal diet in all patients in the endoscopy group within 24 hours is hard to believe. Was any gastric outlet score used in the study? The delayed gastric emptying reported in 10 patients in the surgical group requires further elaboration. How many days did this delayed gastric emptying last? The literature mentions that usually it is transient and improves in up to 67% of patients by 8 days and 89% in 15 days. 4 The high 30-day mortality in the surgical group by itself shows a poor selection of cases. Because nutritional status was comparable in the two groups, were there any other comorbid illness that contributed to the high 30-day mortality? In summary, we do not believe this study is of a robust enough design to provide support for the conclusions drawn.
Uploads
Papers by Srivenu Itha