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आयतन 5, मुद्दा 1 (2020)

छोटी समीक्षा

Dietary Interventions for GI Disorders: Stepping Beyond FODMAPs

David A Johnson

The burden of a suboptimal diet is a preventable risk for non-communicable diseases, including most gastrointestinal (GI) illnesses. Clinicians providing gastrointestinal directed care are well aware of the values of specific diets e.g., gluten free for celiac, fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) for irritable bowel disease, and six food exclusion diet for eosinophilic esophagitis. There is increasing evidence that dietary intervention for maintenance of GI health and/or treatment directed intervention for disease, warrants priotization by clinicians.

राय लेख

Statin Use and Risk of Acute Diverticulitis: A Population-Based Case-control Study

Michael O��?Grady, Louise Clarke, Gregory Turner, Matt Doogue, Frank Frizelle and Rachel Purcell

Objective: To examine the association between statin use and the development of acute diverticulitis requiring hospital admission.

Methods: A retrospective, population-based, case–control study was carried out on a cohort of adults, resident in Canterbury, New Zealand between 1-1-2003 and 31-1-2008, identified from the National Census; all identified cases were admitted to hospital and had CT confirmed diverticulitis. The positive control group comprised patients on nonaspirin non-steroidal anti-inflammatory drugs (NSAIDs), and the negative control group were patients on selective serotonin reuptake inhibitors (SSRIs). Medicine exposure was obtained from the Pharmaceutical Management Agency of New Zealand. Subgroup analysis was done by age and for complicated diverticulitis and recurrent diverticulitis.

Results: During the study period, there were 381,792 adult’s residents in Canterbury. The annual incidence of diverticulitis requiring hospital presentation was 18.6 (<65 years, 13.1;>64 years, 41.3) per 100,000 per year. Complicated disease was seen in 37.4% (158) of patients, and 14.7 % (62) had recurrent disease. Statins were not found to affect the risk of developing acute diverticulitis, nor the risk of complicated or recurrent diverticulitis. Subgroup analysis suggested statin use was associated with a decreased risk of acute diverticulitis in the elderly (age>64 years). NSAIDs were associated with a decreased risk of acute diverticulitis (RR=0.65, CI: 0.26–0.46, p<0.001), as were SSRIs (RR=0.37, CI: 0.26 – 0.54, p<0.001).

Conclusion: This population-based study does not support the hypothesis that statins have a preventative effect on the development of diverticulitis, including complicated disease. We also found a decreased risk of diverticulitis associated with NSAID and SSRI use.

Keywords: Diverticulitis; Statins; Non-steroid anti-inflammatory drugs (NSAID); Selective serotonin re-uptake inhibitors (SSRI); Complicated diverticulitis; Recurrent diverticulitis

मामला का बिबरानी

Sickle Cell Disease with Ulcerative Colitis as a Presenting Feature

Siddharth Bhattacharjee and Ganesh N Ramesh

Sickle cell disease (SCD) is an inherited blood condition which is most common among people of African, Arabian and Indian origin. The sickle gene is widespread among many tribal population groups in India with prevalence of heterozygotes varying from 1-40 percent. It seems to be a North-South divide with more ulcerative colitis (UC) in North and Crohn’s disease (CD) in South India.

शोध आलेख

Can Multiparity Predict a Difficult Colonoscopy? Prospective, Single-Centre Study in an Orthodox Jewish Hospital in Israel

Melamud B, Derjak O, Odes S, Stark M and Fireman Z

Background and aim: The effects of multiparity on performing colonoscopies have not been evaluated. This study compared the levels of difficulties encountered in performing colonoscopies among unipara and multipara orthodox Jewish women.

Patients and methods: This single-centre, prospective observational study included all consecutive women who underwent colonoscopies between November, 2017 and July, 2018 by four gastroenterologists trained in endoscopy. Patient characteristics included age, body mass index, and history of constipation, number and type of past deliveries, past abdominal or pelvic surgeries, and date and indications for colonoscopy.

Colonoscopy-associated data included abdominal compression, position changes, scope insertion time, type and dosage of sedation, cleansing status of the bowel, the presence of diverticulosis or other pathologies, and the reasons for an incomplete procedure. The patients were divided into those undergoing therapeutic colonoscopy (e.g., for polypectomy) and those undergoing diagnostic colonoscopy. The parameters that defined a difficult procedure were position changes, weight-related abdominal compression, and scope insertion time.

Results: A total of 227 women participated in the current study, of whom 181 underwent diagnostic colonoscopy and 46 underwent therapeutic colonoscopy. Multipara women had significantly more position changes (89.5% vs. 10.5% for unipara women, p=0.05), and unipara women weighed more than multipara women (75.04 ± 19.60 vs. 70.11 ± 15.16 kg, respectively, p=0.05). Being multipara and a longer scope insertion time were associated with encountering difficulties (OR=2.29; %CI: 0.95-8.81 and OR=4.49; %CI: 2.11-9.97, respectively).

Conclusion: Practicing endoscopists should be alert to the likelihood of colonoscopy being more difficult to perform on multipara women compared to unipara women.

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