86 results on '"Bhatia, S. J."'
Search Results
2. Effectiveness of voice therapy in reflux-related voice disorders
- Author
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Vashani, K., Murugesh, M., Hattiangadi, G., Gore, G., Keer, V., Ramesh, V. S., Sandur, V., and Bhatia, S. J
- Published
- 2010
- Full Text
- View/download PDF
3. Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force
- Author
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Ghoshal, U. C., Abraham, P., Bhatt, C., Choudhuri, G., Bhatia, S. J., Shenoy, K. T., Banka, N. H., Bose, K., Bohidar, N. P., Chakravartty, K., Shekhar, N. C., Desai, N., Dutta, U., Das, G., Dutta, S., Dixit, V. K., Goswami, B. D., Jain, R. K., Jain, S., Jayanthi, V., Kochhar, R., Kumar, A., Makharia, G., Mukewar, S. V., Mohan Prasad, V. G., Mohanty, A., Mohan, A. T., Sathyaprakash, B. S., Prabhakar, B., Philip, M., Veerraju, E. P., Gautam Ray, Rai, R. R., Seth, A. K., Sachdeva, A., Singh, S. P., Sood, A., Thomas, V., Tiwari, S., Tandan, M., Upadhyay, R., and Vij, J. C.
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Adult ,Irritable Bowel Syndrome ,Male ,Gastroenterology ,Humans ,India ,Female ,Prospective Studies ,Societies, Medical - Abstract
To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India.In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires.Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3or= stools/week), 50 (4%) had diarrhea-predominant IBS (3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects.Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.
- Published
- 2008
4. Prevalence of gastro-esophageal reflux disease in patients with difficult to control asthma and effect of proton pump inhibitor therapy on asthma symptoms, reflux symptoms, pulmonary function and requirement for asthma medications.
- Author
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Sandur, V., Murugesh, M., Banait, V., Rathi, P. M., Bhatia, S. J., Joshi, J. M., and Kate, Al
- Subjects
ALBUTEROL ,ASTHMA ,GASTROESOPHAGEAL reflux ,LONGITUDINAL method ,OMEPRAZOLE ,PULMONARY function tests ,SCALE analysis (Psychology) ,STATISTICS ,T-test (Statistics) ,DATA analysis ,PRE-tests & post-tests ,FLUTICASONE ,SYMPTOMS ,THERAPEUTICS - Abstract
Background: The hypothesis that GER can trigger or exacerbate asthma is supported by several clinical trials that have shown amelioration in asthma symptoms and/or an improvement in pulmonary function after antireflux therapy. Aims: To investigate the prevalence of GER in patients with difficult to control asthma and to determine the effect of omeprazole on asthma symptoms, reflux symptoms, pulmonary function and on the requirement of asthma medications. Materials and Methods: Patients with difficult to control asthma were recruited into the study. All patients underwent esophageal manometry and 24 hour esophageal pH monitoring. Pulmonary function tests were done before and after treatment. The severity of asthma and reflux was assessed by a 1 week pulmonary symptom score(PSS) and reflux symptom score(RSS) respectively before and after treatment. Those who had an abnormal pH study (pH <4 in the distal esophagus for >5% of the time) underwent anti-GER treatment with lifestyle changes, and a proton pump inhibitor (omeprazole 40 mg, bid) for 3 months. Asthma medications were added or deleted based on severity of asthma. Results: Out of 250 asthmatic patients screened, forty patients fulfilled the inclusion criteria. Twenty eight of 40 patients(70%) were diagnosed to have GERD. Of the patients 28 with GER, 8 patients(28.5%) had no reflux symptoms. On 24 hr pH metry, the percentage time pH <4.0 was 10.81 ± 4.72 and 1.11 ± 1.21; Deemester score was 37.65 ± 14.54 and 4.89 ± 6.39 (p-value is 0.0001) in GERD and non-GERD patients respectively.In GERD group, post treatment reflux symptom score(RSS) improved from 22.39 ± 14.99 to 1.04 ± 1.07, pulmonary symptom score(PSS) improved from27.14 ± 7.49 to 13.82 ± 4.21and night time asthma symptom score(NASS) improved from 6.71 ± 1.80 to 3.04 ± 1.23 (p-value <0.0001). After treatment, FEV1 and PEFR increased from 1.38 ± 0.57 and 4.14 ± 1.97 to 1.47 ± 0.54 and 5.56 ± 1.72, respectively (p-value 0.00114). Conclusions: PPI therapy improves nocturnal asthma symptoms, daytime asthma symptoms, pulmonary function and decreases requirement of asthma medications in these patients. [ABSTRACT FROM AUTHOR]
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- 2014
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5. Detection of rectal and pararectal varices in patients with portal hypertension: efficacy of transvaginal sonography.
- Author
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Malde, H, primary, Nagral, A, additional, Shah, P, additional, Joshi, M S, additional, Bhatia, S J, additional, and Abraham, P, additional
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- 1993
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6. Congestive jejunopathy in portal hypertension.
- Author
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Nagral, A S, primary, Joshi, A S, additional, Bhatia, S J, additional, Abraham, P, additional, Mistry, F P, additional, and Vora, I M, additional
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- 1993
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7. Assessment of valvular heart disease with Doppler echocardiography.
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Lee, R T, Bhatia, S J, and St John Sutton, M G
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BLOOD flow measurement , *COMPARATIVE studies , *DOPPLER echocardiography , *PROSTHETIC heart valves , *HEART valve diseases , *HEMODYNAMICS , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *EVALUATION research , *DIAGNOSIS - Abstract
The addition of Doppler principles to two-dimensional echocardiography has revolutionized the noninvasive evaluation of valvular heart disease. Doppler techniques allow precise measurements of blood flow velocity at different locations in the heart and great vessels, so that many aspects of hemodynamics can now be measured noninvasively. These techniques are particularly useful for the quantitative assessment of valvular stenosis; both valve areas and transvalvular gradients may be determined. Doppler echocardiography (particularly with color flow mapping) is also useful for the qualitative assessment of valvular regurgitation. By understanding the uses and limitations of Doppler echocardiography, physicians may now confidently follow up patients with mild or moderate valvular disease with serial noninvasive studies, avoiding the risks of cardiac catheterization in many patients. [ABSTRACT FROM AUTHOR]
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- 1989
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8. Digitalis toxicity: mechanisms, diagnosis, and management.
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BHATIA, SATINDER J.S., SMITH, THOMAS W., Bhatia, S J, and Smith, T W
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- 1987
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9. Left ventricular tamponade: Echocardiographic and hemodynamic manifestations.
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Lee, R. T., Bhatia, S. J. S., Kirshenbaum, J. M., and Friedman, P. L.
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- 1989
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10. Change of guard at the Indian Journal of Gastroenterology
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Bhatia, S. J., Ramakrishna, B. S., and Rakesh Aggarwal
11. Adult Hirschsprung's disease
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Hemant M Kocher, Pandya, S. V., Rohandia, O. S., Pwadhwa, R., Bhatia, S. J., Joshi, A. S., and Bapat, R. D.
12. Time course of resolution of pulmonary hypertension and right ventricular remodeling after orthotopic cardiac transplantation.
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Bhatia, S J, primary, Kirshenbaum, J M, additional, Shemin, R J, additional, Cohn, L H, additional, Collins, J J, additional, Di Sesa, V J, additional, Young, P J, additional, Mudge, G H, additional, and Sutton, M G, additional
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- 1987
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13. Lactobacillus acidophilus inhibits growth of Campylobacter pylori in vitro
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Bhatia, S J, primary, Kochar, N, additional, Abraham, P, additional, Nair, N G, additional, and Mehta, A P, additional
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- 1989
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14. Sigmoidoscopy in the Indian bowel
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Abraham, P, primary, Bhatia, S J, additional, and Pipalia, D H, additional
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- 1988
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15. A method of screening for growth hormone deficiency using anthropometrics
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Bhatia, S J, primary, Moffitt, S D, additional, Goldsmith, M A, additional, Bain, R P, additional, Kutner, M H, additional, and Rudman, D, additional
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- 1981
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16. Suppression of silent ischemia by metoprolol without alteration of morning increase of platelet aggregability in patients with stable coronary artery disease.
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Willich, S N, primary, Pohjola-Sintonen, S, additional, Bhatia, S J, additional, Shook, T L, additional, Tofler, G H, additional, Muller, J E, additional, Curtis, D G, additional, Williams, G H, additional, and Stone, P H, additional
- Published
- 1989
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17. A method of screening for growth hormone deficiency using anthropometrics
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Rudman, D., Kutner, M. H., Moffitt, S. D., Bhatia, S. J. S., Goldsmith, M. A., and Bain, R. P.
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SOMATOTROPIN ,CHILDREN ,HORMONES ,NUTRITION - Published
- 1981
18. Prevalence of short segments of specialized columnar epithelium in distal esophagus: association with gastroesophageal reflux.
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Dhawan PS, Alvares JF, Vora IM, Joseph TK, Bhatia SJ, Amarapurkar AD, Parikh SS, Kulkarni SG, and Kalro RH
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- Adult, Aged, Alcian Blue, Barrett Esophagus etiology, Confidence Intervals, Endoscopy, Female, Gastroesophageal Reflux complications, Humans, Male, Middle Aged, Periodic Acid-Schiff Reaction methods, Prevalence, Esophagus chemistry, Esophagus pathology, Laryngeal Mucosa pathology
- Abstract
Background and Aims: Recent studies have reported high prevalence rates of short segments of specialized columnar epithelium (SCE) in the distal esophagus. The association of SCE with gastroesophageal reflux disease is not well established. We studied the prevalence and associations of short segments of SCE in the distal esophagus amongst Indians., Methods: 271 patients (mean age 36 [14] y; 160 men) undergoing diagnostic upper gastrointestinal endoscopy were interviewed regarding symptoms of gastroesophageal reflux, and history of medications, smoking or chewing tobacco and alcohol ingestion. At endoscopy, presence and grade of esophagitis and hiatus hernia were recorded. One biopsy each was taken from the squamocolumnar junction and 2 cm proximal to it. Biopsies were stained with hematoxylin/eosin and alcian blue/periodic acid-Schiff. The pathologist was blinded to the clinical and endoscopic data., Results: Short segments of SCE in the distal esophagus were present in 16/271 (6%; CI 5.03-6.97) patients. Increasing age (p<0.01), and endoscopic (p<0.01) and histologic (p<0.001) esophagitis were associated with its presence, whereas symptoms of gastroesophageal reflux, smoking, tobacco chewing, use of alcohol or non-steroidal anti-inflammatory drugs, and hiatus hernia were not. One patient with SCE had dysplasia., Conclusion: Prevalence of short segments of SCE in the distal esophagus amongst Indians is low and is usually associated with inflammation in the esophagus.
- Published
- 2001
19. Epidemiology of dyspepsia in the general population in Mumbai.
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Shah SS, Bhatia SJ, and Mistry FP
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- Adolescent, Adult, Aged, Analysis of Variance, Chi-Square Distribution, Dyspepsia etiology, Female, Health Expenditures, Humans, India epidemiology, Male, Middle Aged, Prevalence, Risk Factors, Surveys and Questionnaires, Dyspepsia epidemiology
- Abstract
Background and Aims: Dyspepsia is a common complaint in the general population. The prevalence, demography and economic implications of dyspepsia in India are not known; we studied these using a detailed symptom questionnaire., Methods: 2549 presumably healthy adults (mean age 37.2 [14.1] years; 1441 men) were interviewed. Gastrointestinal symptoms, their investigation and treatment, dietary history and history of addictions were noted. Dyspepsia was defined as abdominal fullness or upper abdominal pain present for at least one month; irritable bowel syndrome (IBS) was defined by Manning's criteria. Based on the symptom profile, subjects were divided into three broad groups: no dyspepsia (n=1695; 945 men), dyspepsia with (110; 63 men) or without (664; 382 men) IBS, and IBS alone (80; 51 men)., Results: 774 subjects (30.4%) had dyspepsia; the median (range) duration of symptoms was 24 (1-360) months. Abdominal fullness (n=614), abdominal pain (374), heartburn (272) and belching (271) were the most common symptoms; significant symptoms (present at least once a week) occurred in 306 subjects (12.0% of the population). More than half the subjects had symptoms suggestive of mixed type of dyspepsia; dysmotility-like dyspepsia was the next most common (n=257; 33.2%). The frequency of dyspepsia was not related to type of diet or consumption of spices. Dyspepsia was more prevalent in subjects who abused tobacco or alcohol. Three hundred and twenty-one subjects with dyspepsia (41.4%) had visited a physician for their complaints and had received treatment with antacids, acid suppressors or prokinetic drugs; 4.5% and 7.2% had undergone previous endoscopy and ultrasonography, respectively; dyspeptic subjects underwent more investigations (p<0.001) than those with IBS., Conclusions: Dyspepsia is reported by almost one-third of the population in Mumbai; significant symptoms occur in 12%. Forty percent of these subjects receive treatment and only a small number undergo endoscopy or ultrasonography.
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- 2001
20. Red hot chilli pepper: irritating the irritable colon.
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Bhatia SJ
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- Animals, Clinical Trials as Topic, Disease Models, Animal, Humans, Risk Assessment, Sensitivity and Specificity, Spices adverse effects, Capsaicin adverse effects, Colonic Diseases, Functional physiopathology, Gastrointestinal Motility drug effects
- Published
- 2000
21. Effect of acute and long-term oral tobacco use on oesophageal motility.
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Bhandarkar PV, Shah SK, Meshram M, Abraham P, Narayanan TS, and Bhatia SJ
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- Adolescent, Adult, Aged, Esophagogastric Junction drug effects, Esophagogastric Junction physiology, Esophagus physiology, Female, Humans, Male, Manometry methods, Middle Aged, Pressure, Time Factors, Esophagus drug effects, Gastrointestinal Motility drug effects, Nicotine pharmacology, Plants, Toxic, Nicotiana adverse effects
- Abstract
Background and Aims: Nicotine administration is known to decrease lower oesophageal sphincter (LOS) pressure. Although a few studies have assessed the effect of tobacco on the LOS, the effect of acute and long-term oral tobacco use on oesophageal motility is not known. The study was designed to investigate the effect of acute and long-term oral tobacco use on LOS and distal oesophageal motility., Methods: Thirty-six healthy men (aged 18-65 years, median 34 years; 18 oral tobacco users, 18 non-tobacco users) underwent oesophageal manometry using a water-perfusion system. After baseline manometry, tobacco users were asked to keep 0.5 g tobacco in their mouth for 10 min; non-users of tobacco were kept in quiet surroundings for a similar period. Manometry was then repeated., Results: The LOS basal pressures were similar in tobacco users and non-tobacco users (mean +/- SD 15.4 +/- 6.3 vs 13.4 +/- 5.3 mmHg). In the distal oesophageal body, the velocity (4.4 +/- 3.1 vs 4.9 +/- 2.6 cm/s), amplitude (92.7 +/- 38.3 vs 84.8 +/- 33.2 mmHg) and duration of contraction (2.1 +/- 0.7 vs 1.7 +/- 0.9 s) were similar in tobacco users and non-users. Acute tobacco use did not affect these parameters. The numbers of abnormal waves (triple peaks and non-transmitted contractions) were also similar in the two groups., Conclusion: Oral tobacco use does not appear to affect LOS pressures and distal oesophageal motility acutely or in the long term.
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- 2000
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22. Eradication of Helicobacter pylori in nonulcer dyspepsia.
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Bhatia SJ, Bhandarkar PV, Aggarwal R, and Sawant PD
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- Humans, Dyspepsia microbiology, Dyspepsia therapy, Helicobacter Infections therapy, Helicobacter pylori isolation & purification
- Published
- 2000
23. Seroprevalence of IgG antibodies to Helicobacter pylori among gastrointestinal endoscopists, radiologists and paramedical personnel.
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Kamat AH, Mehta PR, Bhatia SJ, and Koppikar GV
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- Adult, Allied Health Personnel, Endoscopy, Gastrointestinal, Female, Gastritis immunology, Helicobacter Infections immunology, Helicobacter Infections transmission, Humans, India epidemiology, Infectious Disease Transmission, Patient-to-Professional statistics & numerical data, Male, Occupational Diseases etiology, Occupational Diseases immunology, Radiology, Risk Factors, Seroepidemiologic Studies, Antibodies, Bacterial blood, Gastritis epidemiology, Helicobacter Infections epidemiology, Helicobacter pylori immunology, Immunoglobulin G blood, Occupational Diseases epidemiology, Patient Care Team statistics & numerical data
- Abstract
Background: The route of transmission of Helicobacter pylori is unknown. Since the organism has been isolated from saliva, gastric juice and stool, medical personnel could be at high risk for acquiring the infection during procedures like gastrointestinal endoscopy., Aims: To study whether endoscopy is a professional hazard for acquisition of H. pylori., Methods: We studied the prevalence of IgG antibodies to H. pylori in endoscopists (n = 17), radiologists (n = 17) and personnel from paraclinical branches (n = 35); microbiology (n = 21), pathology (n = 7) and forensic medicine (n = 7); among the paraclinical personnel five were at high risk because they worked with cultures of H. pylori. Subjects answered a questionnaire regarding upper gastrointestinal symptoms, and precautions taken at the work place against infection. The serum was tested for IgG antibodies to H. pylori using a microwell ELISA and a rapid card test., Results: H. pylori antibodies were present in five (29.4%) endoscopists, three (17.6%) radiologists and seven (20%) paraclinical personnel; only one of the 5 high risk para medical personnel was positive. There was no correlation between the duration of performing endoscopies and the H. pylori IgG status., Conclusion: Endoscopy is not a risk factor for acquiring H. pylori infection.
- Published
- 1999
24. Profile of extrahepatic portal venous obstruction in Mumbai.
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Bhandarkar PV, Sreenivasa D, Mistry FP, Abraham P, and Bhatia SJ
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- Adolescent, Adult, Causality, Child, Child, Preschool, Female, Follow-Up Studies, Gastrointestinal Hemorrhage etiology, Home Childbirth, Humans, India, Infant, Infant, Newborn, Male, Pregnancy, Risk Factors, Developing Countries, Hemangioma, Cavernous etiology, Hypertension, Portal etiology, Portal Vein, Thrombosis etiology, Vascular Neoplasms etiology
- Abstract
Aim of the Study: To study the clinical profile of extrahepatic portal venous obstruction (EHPVO) in a tertiary referral centre in Mumbai., Methodology: Retrospective analysis of records of 113 patients with EHPVO, treated between January 1984 and May 1996., Results: Thirty eight of 54 (70.4%) patients in whom information was available were delivered at home. Eleven of the 50 (22%) had umbilical sepsis after birth. Median disease duration was 5 years (range 4 months-31 years), with age at initial presentation 13 (range 0.5-45) years; 24 (20%) patients presented after age 20 years. Eleven presenting initially with splenomegaly bled after 3 (1-14) years. Number of bleeding episodes per patient was 2.5 (1-12). 13 of 44 (29.6%) patients bled (first bleed or recurrence) after age 20 years. Twenty five (22.3%) had ascites at some time, 17/102 (16.7%) had hypersplenism, and hypoalbuminaemia was present in 20/103 (19.2%). Endoscopic sclerotherapy obliterated varices in 47/52 (90.4%) in 10.5 (3-40) sessions over 7 (1-100) months. Twenty three patients underwent surgery: devascularisation in 20 (with splenectomy in seven), distal lieno-renal shunt in two, and meso-caval shunt in one patient. Follow-up was available in 68 (60.2%) patients. Rebleeding after sclerotherapy occurred in 27/64 (42.2%), with median one (1-5) per patient; recurrence of varices was noted in 15/35 (42.9%) patients over 12 (3-39) months. Varices were present in 12 patients 163 (33-305) months after surgery., Conclusions: Home delivery and umbilical sepsis may be risk factors in the development of EHPVO. A significant number of patients present or continue to bleed from varices after age 20. Variceal sclerotherapy is effective for eradication of oesophageal varices.
- Published
- 1999
25. Prospective evaluation of medication-induced esophageal injury and its relation to esophageal function.
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Alvares JF, Kulkarni SG, Bhatia SJ, Desai SA, and Dhawan PS
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- Adolescent, Adult, Aged, Endoscopy, Gastrointestinal, Esophageal Diseases physiopathology, Esophagus physiopathology, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Anti-Bacterial Agents adverse effects, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Doxycycline adverse effects, Esophageal Diseases chemically induced, Esophagus drug effects, Indomethacin adverse effects
- Abstract
Background: Few prospective studies are available on the incidence of medication-induced esophageal injury (MIEI)., Aims: To prospectively study the occurrence of MIEI with indomethacin and doxycycline and the predictive factors for its development., Methods: In an operator-blinded study, 51 patients (age 16-65 y) requiring indomethacin (n = 24) or doxycycline (27) underwent symptom evaluation, endoscopy and scintigraphy before and after 7 days of therapy. MIEI was defined as de novo occurrence or worsening of pre-existing esophagitis or development of esophageal ulcer., Results: Pre-therapy endoscopy was normal in 32 patients and revealed esophagitis in 19 (grade I--11, grade II--8). Post-therapy, 16 patients developed esophageal symptoms, which appeared earlier with doxycycline (2.0 [0.8] vs 4.1 [1.7] days, p = 0.016). MIEI developed in 23 patients--de novo esophagitis in 16, worsening of esophagitis in 6; 5 patients developed ulcer. Seven of 12 patients with hiatus hernia developed MIEI. Presence of pre-therapy gastroesophageal reflux disease did not predict MIEI. There was no difference in pre- or post-therapy transit values between patients with and without MIEI; patients who developed ulcers had significantly slower esophageal transit (p < 0.05). There was no difference in esophageal transit or occurrence of MIEI between patients who received indomethacin or doxycycline; however, 5 of 8 patients with hiatus hernia who received doxycycline developed MIEI (p = 0.02; relative risk 3.96 [CI 1.2-12.7])., Conclusions: 40% of patients receiving doxycycline or indomethacin developed MIEI; 10% developed ulcers. Hiatus hernia increased the risk for MIEI.
- Published
- 1999
26. Effect of tense ascites on esophageal body motility and lower esophageal sphincter pressure.
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Bhatia SJ, Narawane NM, Shalia KK, Mistry FP, Sheth MD, Abraham P, and Dherai AJ
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- Ascites surgery, Case-Control Studies, Female, Humans, Male, Manometry, Middle Aged, Paracentesis, Peristalsis, Pressure, Prospective Studies, Ascites physiopathology, Esophagogastric Junction physiopathology, Esophagus physiopathology, Liver Cirrhosis physiopathology
- Abstract
Background: Esophageal motility and lower esophageal sphincter (LES) pressure change with rapid changes in intraabdominal pressure (IAP); the response of these to slow change in IAP is not known., Aims: To study esophageal body motility and LES pressures in patients with cirrhosis with tense ascites in the basal state and after paracentesis., Methods: Twenty four patients with cirrhosis of liver and tense ascites and 13 with cirrhosis without ascites (controls) were studied. Basal intragastric (IGP) and LES pressures, and esophageal body response to water swallows, were recorded using a water perfusion system; IAP was measured in patients with ascites. In patients with ascites, the study was repeated twice: after paracentesis of two liters of fluid and after adequate control of ascites., Results: Basal IGP (p = 0.002) and duration of esophageal contraction (p = 0.01) were lower in controls, but basal LES pressures were similar in the two groups. After control of ascites, IAP (p = 0.02) and IGP (p = 0.005) decreased; amplitude and duration of distal esophageal contraction decreased (p < 0.05). The frequency of high-amplitude waves also decreased (p = 0.04). LES pressure remained unaltered., Conclusions: Esophageal contraction duration is increased in the presence of ascites, and decreases after control of ascites; LES pressure is not affected by ascites.
- Published
- 1999
27. Cholangiopathy associated with portal hypertension: diagnostic evaluation and clinical implications.
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Malkan GH, Bhatia SJ, Bashir K, Khemani R, Abraham P, Gandhi MS, and Radhakrishnan R
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- Adult, Alkaline Phosphatase blood, Bile Duct Diseases diagnostic imaging, Bile Duct Diseases etiology, Bilirubin blood, Cholangiography, Common Bile Duct diagnostic imaging, Dilatation, Pathologic, Female, Hepatic Duct, Common diagnostic imaging, Humans, Male, Radionuclide Imaging, Ultrasonography, Bile Duct Diseases diagnosis, Hypertension, Portal complications
- Abstract
Background: There are few studies of biliary changes due to portal hypertension. We ascertained the incidence of such changes on endoscopic retrograde cholangiography and determined the reliability of biochemistry, ultrasonography (US) and hepatobiliary radionuclide scan in detecting this type of cholangiopathy., Methods: Forty-two patients with portal hypertension were studied., Results: Cholangiopathy was detected by cholangiography in 17 of 20 patients with extrahepatic portal venous obstruction. Abnormalities (mainly strictures and caliber irregularity) were seen in the common bile duct (5) and common hepatic duct (7) and in the right (8) and left (11) hepatic ducts (mainly dilatation). One of 11 patients with noncirrhotic portal fibrosis had a dilated right hepatic duct. Three of 11 patients with cirrhosis had pruned intrahepatic ducts. Eight patients with portal venous obstruction had elevated alkaline phosphatase levels; two had elevated bilirubin levels. US detected gallbladder varices (11) and choledochal varices (9) in patients with extrahepatic portal venous obstruction. Biliary abnormalities were detected on hepatobiliary scintigraphy in 16 of 17 patients., Conclusions: Cholangiopathy associated with portal hypertension occurs exclusively in patients with extrahepatic portal venous obstruction. It rarely leads to functional obstruction; jaundice does not occur in the absence of functional blockage. Elevated alkaline phosphatase level (after excluding bile duct calculi), presence of gallbladder varices on US, and abnormal radionuclide scans are reliable in detecting these lesions.
- Published
- 1999
- Full Text
- View/download PDF
28. "Cobblestone" appearance of esophagus: an unusual endoscopic presentation of Barrett's esophagus.
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Alvares JF, Dhawan PS, Kulkarni SG, Vora IM, Pereira N, Rananavare R, and Bhatia SJ
- Subjects
- Adult, Humans, Male, Barrett Esophagus diagnosis, Esophagoscopy
- Published
- 1999
29. Early changes in esophageal motility after endoscopic variceal sclerotherapy or ligation.
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Narawane NM, Bhatia SJ, Sheth MD, Dherai A, Abraham P, Paranjape AY, and Mistry FP
- Subjects
- Adult, Esophageal Motility Disorders physiopathology, Esophageal and Gastric Varices surgery, Female, Humans, Hypertension, Portal complications, Ligation, Male, Manometry, Pressure, Endoscopy, Esophageal Motility Disorders etiology, Esophageal and Gastric Varices therapy, Esophagus physiopathology, Sclerotherapy
- Abstract
Introduction: Endoscopic variceal sclerotherapy (EVS) and ligation (EVL) are reported to be associated with altered esophageal motility. Most studies have been in patients with alcoholic cirrhosis and ascites., Aims: To study the early effect of EVS and EVL in patients with portal hypertension without ascites., Methods: Forty six portal hypertensive patients without ascites underwent esophageal manometry 24 h prior to EVS or EVL and within 24 h of two subsequent sessions. Nineteen such patients but without prior gastrointestinal bleed were studied once as controls., Results: The protocol was completed in 35 patients (cirrhosis--16, noncirrhotic portal hypertension--19; 27 men; mean age 36 years). Basal midexpiratory lower esophageal sphincter pressure was similar in the study group (mean [SD] 20.1 [9.1] mmHg) and controls (17.6 [6.0] mmHg); the pressure did not change following EVS or EVL. Amplitude of contractions in the lower 5 cm of the esophageal body was similar in the two groups (84.8 [43.1] mmHg and 95.9 [59.6] mmHg), and decreased (63.6 [34.0] mmHg; p = 0.03) after two sessions of variceal therapy. The duration of contraction did not change following intervention. Nonperistaltic waves > 2 of 10 swallows were present during the baseline study in 9 patients in each group; 13 and 21 patients (p < 0.02 compared to baseline) developed them after the first and second sessions of therapy, respectively. Percentage of abnormal waves also increased following therapy. Thirteen patients developed esophageal ulcers; there was no correlation between the presence of ulcers and dysmotility. There was no difference in the changes between the EVS and EVL groups, and between patients with cirrhosis and noncirrhotic portal hypertension., Conclusion: Both EVS and EVL affect esophageal motility; these changes do not cause significant esophageal symptoms.
- Published
- 1999
30. Manometric mapping of normal esophagus and definition of the transition zone.
- Author
-
Narawane NM, Bhatia SJ, Mistry FP, Abraham P, and Dherai AJ
- Subjects
- Adult, Aged, Esophagus anatomy & histology, Female, Humans, Male, Manometry methods, Middle Aged, Muscle, Skeletal physiology, Muscle, Smooth physiology, Reference Values, Esophagus physiology, Muscle Contraction physiology
- Abstract
Background: The normal esophagus has not been manometrically mapped. The transition zone between esophageal smooth and skeletal muscles has also not been defined manometrically., Aims: To manometrically map the normal esophagus and to define the transition zone., Methods: Thirty normal adults [23 men; mean age 34.8 (10.4) years] underwent manometry using a water-perfused system. The lower esophageal sphincter (LES) was studied by station pull-through, and esophageal body musculature was evaluated at 1-cm intervals with five wet swallows at each level. The transition zone was identified as an area where the wave-forms did not resemble typical skeletal or smooth muscle wave-forms., Results: The basal mid-expiratory LES pressure was 18.7 (7.2) mmHg, and its length was 3.6 (1.2) cm. Based on our findings, we defined the transition zone as an area where either the amplitude of contraction was < 40 mmHg or, if the amplitude was 40-50 mmHg, the rate of change of pressure from baseline to peak of the wave was < 50 mmHg/s. The lengths of the skeletal, transition and smooth muscle zones were 2.8 (1.2), 4.0 (1.7) and 12.5 (2.7) cm, respectively. The amplitude and dp/dt of contraction and transmission velocity were lowest in the transition zone (p < 0.05)., Conclusions: We have manometrically mapped the normal esophageal muscle zones; the parameters obtained may be used as reference values. The manometric criteria for the transition zone have also been defined.
- Published
- 1998
31. Vagal dysfunction following endoscopic variceal sclerotherapy.
- Author
-
Mistry FP, Sreenivasa D, Narawane NM, Abraham P, and Bhatia SJ
- Subjects
- Adult, Esophagoscopy, Female, Humans, Hypertension, Portal complications, Male, Peripheral Nervous System Diseases etiology, Esophageal and Gastric Varices therapy, Gastric Acid metabolism, Sclerotherapy adverse effects, Vagus Nerve physiopathology
- Abstract
Background: Sclerotherapy is associated with complications which involve adjacent structures like the pleura. The effect of sclerotherapy on function of the vagus nerve, which lies in close proximity to the thoracic esophagus, is not clear., Aim: To study gastric acid secretion as a marker of vagal function in portal hypertensive patients who have undergone sclerotherapy., Methods: Portal hypertensive patients who had undergone at least three sessions of sclerotherapy were evaluated by mapping gastric acid-secreting mucosa by the Congo red test and by estimating gastric acid secretion using the modified sham feeding test. Patients with portal hypertension who had never been subjected to endoscopic sclerotherapy were recruited as controls., Results: On Congo red test, complete or substantial reduction in acid-secreting mucosa was observed in eight patients in comparison to none of the controls. Significantly lower acid secretion on modified sham feeding test was observed in these eight patients., Conclusion: A lower gastric acid secretion, probably secondary to vagal dysfunction, is seen in patients who have undergone multiple sessions of sclerotherapy; vagus nerve involvement may be secondary to periesophageal inflammation.
- Published
- 1998
32. Position paper on Helicobacter pylori in India. Indian Society of Gastroenterology.
- Author
-
Abraham P and Bhatia SJ
- Subjects
- Humans, India epidemiology, Prevalence, Helicobacter Infections diagnosis, Helicobacter Infections drug therapy, Helicobacter Infections epidemiology, Helicobacter Infections transmission, Helicobacter pylori
- Published
- 1997
33. Cost-effectiveness of Helicobacter pylori eradication in India: to live and let live ... expensively?
- Author
-
Bhatia SJ and Kulkarni SG
- Subjects
- Cost-Benefit Analysis, Costs and Cost Analysis, Drug Therapy, Combination, Duodenal Ulcer drug therapy, Duodenal Ulcer epidemiology, Helicobacter Infections epidemiology, Histamine H2 Antagonists economics, Histamine H2 Antagonists therapeutic use, Humans, Duodenal Ulcer economics, Duodenal Ulcer microbiology, Helicobacter Infections drug therapy, Helicobacter Infections economics, Helicobacter pylori
- Published
- 1997
34. Existence of a high pressure zone at the rectosigmoid junction in normal Indian men.
- Author
-
Wadhwa RP, Mistry FP, Bhatia SJ, and Abraham P
- Subjects
- Adult, Aged, Body Height, Constipation physiopathology, Dietary Fiber, Humans, India, Male, Manometry, Middle Aged, Posture, Pressure, Reference Values, Colon, Sigmoid physiology, Defecation physiology, Rectum physiology
- Abstract
Purpose: A hypertonic, electrically hyperactive segment has been described in the rectosigmoid region mainly in constipated persons. Anatomic or manometric evidence to satisfy the criteria for a sphincter here is, however, inconclusive. We evaluated the pressure profile of the rectosigmoid region in normal Indian men., Methods: Fifteen male volunteers with regular bowel habits were studied. Rectosigmoid manometry (1 cm station pull-through) was done in the fasting state using a water-perfused system and three-lumen catheter with radially oriented recording ports 5 cm apart., Results: Eight volunteers had a zone of high pressure. Proximal extent of this zone was identified as the station with a rise in basal pressure of at least 10 mmHg over the previous station. A further rise of at least 10 mmHg in subsequent distal stations was considered essential for defining the existence of the zone. This zone had a median length of 3 cm, with midpoint at median 18 cm from the anal verge and median highest pressure of 36 mmHg. There was no antegrade pressure gradient across the zone; rectal pressures were higher than those in the sigmoid in 12 of 15 volunteers., Conclusions: Approximately one-half of normal Indian men with regular bowel habits have a high pressure zone in the rectosigmoid region. The role of diet or defecation posture in its etiology and its effect on bowel habit need to be studied.
- Published
- 1996
- Full Text
- View/download PDF
35. Knife, balloon, drugs, and now the needle for treatment of achalasia cardia.
- Author
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Bhatia SJ and Aggarwal R
- Subjects
- Botulinum Toxins, Type A therapeutic use, Catheterization, Deglutition Disorders prevention & control, Esophageal Achalasia physiopathology, Esophagogastric Junction drug effects, Esophagogastric Junction surgery, Humans, Laparoscopy, Neuromuscular Agents therapeutic use, Esophageal Achalasia therapy
- Published
- 1996
36. Total and segmental colonic transit time in non ulcer dyspepsia.
- Author
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Nabar AA, Bhatia SJ, Abraham P, Ravi P, and Mistry FP
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Colon physiopathology, Dyspepsia physiopathology, Gastrointestinal Transit
- Abstract
Background: Patients with non ulcer dyspepsia (NUD) often have associated lower alimentary tract symptoms which are labelled as due to the irritable bowel syndrome., Aims: To asymptomatic colonic dysmotility is present in patients with NUD., Methods: We studied total and segmental colonic transit times in 25 patients with NUD (14 men age range 20-70 yr), and 25 matched normal controls (13 men; 18-50 yr), using the multiple-marker, single-film technique. Twenty markers each were administered at 0, 9 and 18 h and an abdominal film taken at 27 h., Results: Total colonic transit time was shorter (median 9 h) in patients with NUD as compared to controls (median 15.8 h) p = 0.0018, with similar segmental motility pattern as in controls. There was no significant difference between the symptom subgroups of NUD., Conclusions: Patients with NUD often have altered colonic transit even in the absence of symptoms. NUD may therefore be only a subset of diffuse gastrointestinal dysmotility with predominant proximal alimentary tract symptoms, whereas the term irritable bowel syndrome is used when lower tract symptoms predominate.
- Published
- 1995
37. Helicobacter pylori in the Indian environment.
- Author
-
Bhatia SJ and Abraham P
- Subjects
- Chronic Disease, Dyspepsia microbiology, Gastritis microbiology, Helicobacter Infections microbiology, Humans, India epidemiology, Peptic Ulcer microbiology, Helicobacter Infections epidemiology, Helicobacter pylori isolation & purification
- Published
- 1995
38. Correlation of manometric and radiographic diagnosis in esophageal motility disorders.
- Author
-
Bhatia SJ, Malkan GH, Ravi P, and Abraham P
- Subjects
- Adult, Esophageal Motility Disorders diagnostic imaging, Female, Fluoroscopy, Humans, Male, Manometry, Middle Aged, Predictive Value of Tests, Retrospective Studies, Sensitivity and Specificity, Esophageal Motility Disorders diagnosis
- Abstract
Background: Radiography and manometry are complementary investigations in the diagnosis of esophageal motility disorders. In most centers, however, manometry is not available and diagnosis is based on radiography alone., Aims: To correlate the findings on radiography in patients with esophageal motility disorders in whom a manometric diagnosis was available., Methods: Retrospective analysis of esophageal manometry and barium contrast studies of 138 patients, done for suspected motility disorders, over a period of two years., Results: Manometry was abnormal in 111 (80.4%) cases [achalasia 87, scleroderma 6, non specific esophageal motility disorders (NEMD) 13, diffuse esophageal spasm (DES) 5]. Radiology was abnormal in 106 cases; the overall radiographic sensitivity was 73.9% (achalasia 87.4%, scleroderma 83.3%, NEMD 38.5%) and the positive predictive value was 75.5% (achalasia 95%, scleroderma 100%, NEMD 29.4%)., Conclusion: Radiography has a high sensitivity and positive predictive value in esophageal motility disorders like achalasia and scleroderma but in DES and NEMD the two investigative modalities (radiography and manometry) do not correlate well.
- Published
- 1995
39. Gastric bacterial overgrowth accompanies profound acid suppression.
- Author
-
Patel TA, Abraham P, Ashar VJ, Bhatia SJ, and Anklesaria PS
- Subjects
- Adult, Bacteria isolation & purification, Enterobacteriaceae growth & development, Female, Gastric Mucosa drug effects, Gastric Mucosa metabolism, Humans, Male, Middle Aged, Staphylococcus growth & development, Anti-Ulcer Agents therapeutic use, Bacteria growth & development, Gastric Acid metabolism, Omeprazole therapeutic use, Stomach microbiology
- Abstract
Background: Suppression of gastric acid may lead to gastric colonization by aerobic and anaerobic bacteria, and consequent clinical manifestations. The risk is likely to be higher with poor environmental hygiene., Aims: To study the effect of short-term acid suppression with omeprazole on gastric bacterial flora., Methods: Twenty-five ambulatory patients with acid-peptic diseases underwent clinical assessment and gastric juice collection (for pH and culture) prior to start of therapy with 20 mg omeprazole daily, on days 7 and 14 of therapy, and 7 days after omission of therapy (day 21)., Results: Eighteen patients completed the study. The median gastric pH was 1.8, 7.5, 7.5 and 3.4 on days 0, 7, 14 and 21 respectively. Positive gastric cultures were obtained in 13 of 25, 17 of 21, 18 of 18 and 14 of 18 patients on respective study days, with median colony counts of 1.5 x 10(4), 7.5 x 10(5), 8.7 x 10(7) and 7.3 x 10(4) cfu/mL respectively. Three patients developed self-limiting diarrhea during therapy and two more immediately after discontinuing therapy., Conclusions: Gastric colonization is common with short-term profound acid-suppression, and may cause diarrhea. Acid suppressive therapy should be used with caution especially in patients with poor environmental hygiene.
- Published
- 1995
40. Adult Hirschsprung's disease.
- Author
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Kocher HM, Pandya SV, Rohandia OS, Pwadhwa R, Bhatia SJ, Joshi AS, and Bapat RD
- Subjects
- Adult, Constipation etiology, Female, Humans, Hirschsprung Disease complications, Hirschsprung Disease diagnosis, Hirschsprung Disease surgery
- Abstract
Hirschsprung's disease in adulthood is a rare entity. We report Hirschsprung's disease in a 35-year-old woman who had absence of anorectal inhibitory reflex on manometric studies.
- Published
- 1995
41. Intrapulmonary vascular dilatations with hypoxemia in extrahepatic portal vein obstruction.
- Author
-
Nagral AS, Dalvi BV, Khanna MU, Abraham P, Bhatia SJ, Mistry FP, and Lokare A
- Subjects
- Dilatation, Pathologic, Hemangioma, Cavernous complications, Humans, Lung blood supply, Male, Middle Aged, Portal System, Hypertension, Portal complications, Hypoxia etiology
- Abstract
Several mechanisms have been suggested for the development of hypoxemia in cirrhosis. A few patients of portal hypertension due to non cirrhotic liver disease with cyanosis have also been reported earlier. We report probably the first documented case of portal hypertension with portal cavernoma and a normal liver, who had intrapulmonary vascular dilatations leading to hypoxemia and cyanosis. Our case suggests that changes leading to hypoxemia can occur due to portal hypertension alone, in the presence of a normal liver.
- Published
- 1993
42. Detection of rectal and pararectal varices in patients with portal hypertension: efficacy of transvaginal sonography.
- Author
-
Malde H, Nagral A, Shah P, Joshi MS, Bhatia SJ, and Abraham P
- Subjects
- Adult, Aged, Female, Hemorrhoids diagnosis, Hemorrhoids etiology, Humans, Incidence, Middle Aged, Sigmoidoscopy, Ultrasonography, Varicose Veins diagnosis, Varicose Veins epidemiology, Varicose Veins etiology, Hypertension, Portal complications, Rectum blood supply, Varicose Veins diagnostic imaging
- Abstract
Objective: The appearance and frequency of pararectal varices in patients with portal hypertension have not been studied. Accordingly, we used transvaginal sonography to detect pararectal varices and to compare their appearance and frequency with those of rectal varices in patients with portal hypertension., Subjects and Methods: Transvaginal sonography was performed in 21 women with portal hypertension of different causes. The frequency and appearance of pararectal varices were determined and compared with those of rectal varices detected either in the same sonographic study or by sigmoidoscopy., Results: Pararectal varices were detected in 17 (81%) of 21 patients. The varices varied in diameter from 2.1 to 5.5 mm (median, 3.5 mm). Seven of the patients with pararectal varices did not have rectal varices. Rectal varices were detected in 10 of 21 patients by transvaginal sonography and in nine patients by sigmoidoscopy; the two methods together showed rectal varices in 13 patients., Conclusion: Transvaginal sonography is useful for detecting pararectal and rectal varices in patients with portal hypertension. Pararectal varices are more common than rectal varices in these patients.
- Published
- 1993
- Full Text
- View/download PDF
43. Pulmonary function tests in cirrhotic and non-cirrhotic portal hypertension.
- Author
-
Nagral A, Kolhatkar VP, Bhatia SJ, Taskar VS, and Abraham P
- Subjects
- Adult, Ascites etiology, Ascites therapy, Drainage, Female, Humans, Hypertension, Portal complications, Liver Cirrhosis complications, Male, Hypertension, Portal physiopathology, Liver Cirrhosis physiopathology, Lung physiopathology, Respiratory Function Tests
- Abstract
Objective: To determine pulmonary functions in portal hypertension of different etiologies and with various grades of ascites., Setting: Gastrointestinal clinic in a large community based and secondary referral hospital., Patients and Methods: Forty five patients with portal hypertension, including 19 cirrhotics with tense ascites, 8 with moderate ascites, 6 with no ascites and 12 patients with non-cirrhotic portal hypertension. All patients underwent basal pulmonary function testing by spirometry and helium dilution technique, and arterial blood gas estimation and measurement of ascitic fluid pressure. Patients with tense ascites underwent paracentesis of up to 2 liters following which ascitic fluid pressure and pulmonary functions were estimated again., Main Results: In cirrhotic patients without ascites, FVC (forced vital capacity), RV (residual volume), TLC (total lung capacity) and FRC (functional residual capacity) were lower than predicted values. In patients with ascites, FVC, FEV1 (forced expired volume in one second) and FEF25-75 (forced expired volume in one second) and FEF25-75 (forced expiratory flow rate between 25% and 75% of forced vital capacity) were significantly lower as compared to predicted values. FVC, FEV1, FEF25-75, pO2, pCO2 and SaO2% decreased significantly with increasing ascites. Paracentesis in patients with tense ascites led to clinical improvement and significantly improved lung volumes., Conclusions: Pulmonary functions are impaired in patients with cirrhosis, and ascites causes further deterioration. Patients with non-cirrhotic portal hypertension have normal pulmonary functions.
- Published
- 1993
44. The medical management of upper gastrointestinal bleeding.
- Author
-
Bhatia SJ and Abraham P
- Subjects
- Esophageal and Gastric Varices diagnosis, Esophageal and Gastric Varices therapy, Hemostatic Techniques, Humans, Intubation, Gastrointestinal, Monitoring, Physiologic, Peptic Ulcer Hemorrhage diagnosis, Peptic Ulcer Hemorrhage therapy, Resuscitation, Sclerotherapy, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy
- Published
- 1993
45. Oesophageal manometry: an overview.
- Author
-
Bhatia SJ
- Subjects
- Humans, Esophagus physiology, Manometry
- Published
- 1993
46. Oxygen desaturation and tachycardia during upper gastrointestinal endoscopy are transient and benign.
- Author
-
Mistry FP, Abraham P, and Bhatia SJ
- Subjects
- Adolescent, Adult, Aged, Child, Female, Humans, Hypoxia etiology, Male, Middle Aged, Sclerotherapy, Time Factors, Endoscopy, Gastrointestinal adverse effects, Oxygen blood, Tachycardia etiology
- Abstract
We continuously monitored the arterial oxygen saturation (SaO2) and pulse rate by pulse oximetry in 46 patients undergoing upper gastrointestinal endoscopy for diagnosis (21 cases) or variceal sclerotherapy (25). No premedication or prior topical anaesthesia was used. Significant hypoxaemia (percent drop in SaO2 > 2) occurred in 24 (52%) patients during the procedure; in 16 of these it occurred during introduction of the endoscope. Twenty seven (59%) patients had hypoxaemia during recovery, 25 of these immediately after withdrawal of the endoscope. All these episodes were short-lived and were probably due to gagging; basal levels were reached within 1 to 5 min. Tachycardia (> 100 beats/min) occurred in 41 (89%) patients. Sclerotherapy and history of smoking did not affect the incidence and magnitude of hypoxaemia and tachycardia. Transient cardio-respiratory changes occur during and immediately after endoscopy, but these appear to be clinically benign.
- Published
- 1992
47. NSAIDs: a pain in the gut.
- Author
-
Abraham P and Bhatia SJ
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Arthritis, Rheumatoid drug therapy, Duodenal Ulcer prevention & control, Humans, Misoprostol therapeutic use, Stomach Ulcer prevention & control, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Duodenal Ulcer chemically induced, Gastric Mucosa drug effects, Intestinal Mucosa drug effects, Stomach Ulcer chemically induced
- Published
- 1991
48. A scoring system to differentiate cirrhotic from non-cirrhotic portal hypertension.
- Author
-
Mistry FP, Karnad DR, Abraham P, and Bhatia SJ
- Subjects
- Adult, Age Factors, Diagnosis, Differential, Female, Humans, Hypertension, Portal complications, Liver Cirrhosis complications, Male, Middle Aged, Pilot Projects, Prospective Studies, Regression Analysis, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Hypertension, Portal diagnosis, Liver Cirrhosis diagnosis
- Abstract
When it is not possible to perform a liver biopsy in cirrhosis, one has to rely on suggestive clinical and biochemical parameters and imaging procedures to arrive at a presumptive diagnosis. Based on the statistical method described by Spiegelhalter and Knill-Jones, we have devised a scoring system to reliably differentiate cirrhotic from non-cirrhotic portal hypertension without a liver biopsy. Age, presence of ascites, liver scan result and serum albumin, taken together, could confirm or rule out the diagnosis of cirrhosis in two-thirds of patients with portal hypertension. A score of 5 or more suggested cirrhosis (sensitivity 78%), and of 5 or more suggested cirrhosis (sensitivity 78%), and a score of -6 or less suggested a non-cirrhotic cause (sensitivity 64%) for portal hypertension, both with 100% specificity. Eliminating liver scan result reduced both sensitivity and specificity, suggesting that liver scan is an important component of the score. This score may be useful not only in the management of individual patients but also to classify them in clinical trials.
- Published
- 1991
49. Changes in placental blood flow in the normal human fetus with gestational age.
- Author
-
Sutton MS, Theard MA, Bhatia SJ, Plappert T, Saltzman DH, and Doubilet P
- Subjects
- Female, Humans, Pregnancy, Ultrasonography, Prenatal methods, Umbilical Arteries anatomy & histology, Umbilical Veins anatomy & histology, Gestational Age, Placenta blood supply, Umbilical Arteries diagnostic imaging, Umbilical Veins diagnostic imaging
- Abstract
We assessed fetoplacental blood volume flow and placental resistance prospectively with Doppler sonography in 74 normal human fetuses of 19 to 42 wk gestation to determine the changes in placental perfusion with gestational age. Placental blood volume flow was assessed from the umbilical vein as the product of the mean flow velocity integral and the cross-sectional area of the umbilical vein. Placental resistance was assessed as the ratio of maximum systolic and minimum diastolic blood flow velocities from an umbilical artery. Umbilical vein blood volume flow increased exponentially (r = 0.86) with gestational age from 19 wk to term, and did not decrease in postdate fetuses. Umbilical vein blood volume flow increased linearly with fetal weight (r = 0.77), although volume flow per unit body weight changed little with gestational age. Umbilical artery velocity ratio decreased progressively, indicating diminishing placental resistance with gestational age, but did not correlate closely with umbilical vein blood volume flow. We submit that fetoplacental blood volume flow can be readily calculated directly from the umbilical vein with Doppler ultrasound and may provide a better index of placental perfusion than the umbilical artery velocity ratio.
- Published
- 1990
- Full Text
- View/download PDF
50. Helicobacter pylori in its lair: a role in ulcer recurrence?
- Author
-
Abraham P and Bhatia SJ
- Subjects
- Dental Plaque microbiology, Gastric Mucosa microbiology, Humans, Recurrence, Helicobacter pylori pathogenicity, Peptic Ulcer microbiology
- Published
- 1990
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