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( Saransh Jain ),( Divya Namdeo ),( Pabitra Sahu ),( Saurabh Kedia ),( Peush Sahni ),( Prasenjit Das ),( Raju Sharma ),( Vipin Gupta ),( Govind Makharia ),( Lalit Dar ),( Simon Pl Travis ),( Vineet Ah 대한장연구학회 2021 Intestinal Research Vol.19 No.4
Background/Aims: Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC. Methods: Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ in-dex (ulcerative colitis index of severity >6 at day 1+fecal calprotectin >1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome. Results: Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0-2,700,000] vs. 116 copies/mg [0-27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load >2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6-39.7; P<0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4-364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC. Conclusions: High mucosal CMV DNA ( >2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC. (Intest Res 2021;19:438-447)
Saransh Jain,Saurabh Kedia,Sawan Bopanna,Dawesh P Yadav,Sandeep Goyal,Peush Sahni,Sujoy Pal,Nihar Ranjan Dash,Govind Makharia,Simon P. L. Travis,Vineet Ahuja 대한장연구학회 2018 Intestinal Research Vol.16 No.1
Background/Aims: Truelove and Witts criteria have been used to define acute severe colitis since the 1950s. However, hemoglobin(an additional criterion of the definition) levels in the general population in developing countries are lower than in the population of developed countries. We aimed to determine the relevance of Truelove and Witts criteria in the Indianpopulation. Methods: Consecutive patients with acute severe colitis satisfying the Truelove and Witts criteria, hospitalized ata single center between April 2015 and December 2016 were included. All patients received intravenous corticosteroids and 16 required colectomy. The hemoglobin levels at admission were subsequently excluded from the classification criteria, and the effect this had on the criteria for diagnosis was determined. Results: Out of 61 patients of acute severe colitis diagnosed according to the original Truelove and Witts criteria, 12 patients (20%) had 1 additional criterion, 33 (54%) had 2 additionalcriteria and 16 (26%) had 3 or more additional criteria in addition to 6 or more blood stained stools on admission. On excludinghemoglobin as an additional criterion from the Truelove and Witts definition, all patients still met the criteria for acute severecolitis. Conclusions: Truelove and Witts criteria can be used to define acute severe colitis in India, despite lower mean hemoglobinin the native population.
Predictive factors for malignancy in undiagnosed isolated small bowel strictures
( Ujjwal Sonika ),( Sujeet Saha ),( Saurabh Kedia ),( Nihar Ranjan Dash ),( Sujoy Pal ),( Prasenjit Das ),( Vineet Ahuja ),( Peush Sahni ) 대한장연구학회 2017 Intestinal Research Vol.15 No.4
Background/Aims: Patients with small bowel strictures have varied etiologies, including malignancy. Little data are available on the demographic profiles and etiologies of small bowel strictures in patients who undergo surgery because of intestinal obstruction but do not have a definitive pre-operative diagnosis. Methods: Retrospective data were analyzed for all patients operated between January 2000 and October 2014 for small bowel strictures without mass lesions and a definite diagnosis after imaging and endoscopic examinations. Demographic parameters, imaging, endoscopic, and histological data were extracted from the medical records. Univariate and multivariate analyses were conducted to identify factors that could differentiate between intestinal tuberculosis (ITB) and Crohn’s disease (CD) and between malignant and benign strictures. Results: Of the 7,425 reviewed medical records, 89 met the inclusion criteria. The most common site of strictures was the proximal small intestine (41.5%). The most common histological diagnoses in patients with small bowel strictures were ITB (26.9%), CD (23.5%), non-specific strictures (20.2%), malignancy (15.5%), ischemia (10.1%), and other complications (3.4%). Patients with malignant strictures were older than patients with benign etiologies (47.6±15.9 years vs. 37.4±16.4 years, P=0.03) and age >50 years had a specificity for malignant etiology of 80%. Only 7.1% of the patients with malignant strictures had more than 1 stricture and 64% had proximally located strictures. Diarrhea was the only factor that predicted the diagnosis of CD 6.5 (95% confidence interval, 1.10-38.25; P=0.038) compared with the diagnosis of ITB. Conclusions: Malignancy was the cause of small bowel strictures in approximately 16% patients, especially among older patients with a single stricture in the proximal location. Empirical therapy should be avoided and the threshold for surgical resection is low in these patients. (Intest Res 2017;15:518-523)