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Background Inflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu. Methods TNISG members from 32 institutions completed an online cross‐sectional questionnaire on IBD patients from March 2020 to January 2021. Results Of 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD‐unclassified (IBD‐U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left‐sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruction were noted in 4.3, 14.0, and 23.5%, respectively, of CD. The most widely used drugs were mesalamine, azathioprine, and corticosteroids. Surgery was undertaken in 141 patients with CD and 23 patients with UC. Of the 138 patients with pediatric IBD (≤16 years), 23 were characterized as very early onset IBD (VEO‐IBD), 27 as early‐onset, and 88 as adolescent IBD. VEO‐IBD were more likely to have a positive family history of IBD and were more likely to have perineal disease and to have the IBD‐U phenotype. Among pediatric IBD patients, corticosteroids, mesalamine, and azathioprine were the most commonly used medications, while 25 pediatric patients received biologics. Conclusion This study provides important information on demography, clinical profile, and treatment practices of IBD in India., Regional differences in inflammatory bowel disease (IBD) profile inform our understanding of the disease as well as prevention, and health planning. This study provides a snapshot of IBD presentation and practices in India at a time when the country is in the second of four phases of IBD transition. The apparently mild nature of IBD, the consequent widespread use of mesalamine, and the association of Crohn's disease with higher levels of education, compared to ulcerative colitis, are of notable interest.

Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.

Purpose To report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease. Case report An elderly woman with decompensated chronic liver disease presented with features of periorbital, facial, and mediastinal emphysema, characterized with crepitant swelling over the right periorbital area, face, neck, and mediastinum after undergoing upper gastrointestinal endoscopy. There was no history of trauma or Valsalva maneuver. Ocular findings were stable with no evidence of orbital compartmental syndrome. Urgent computed tomography scans of the orbit and chest were performed, and emergency systemic treatment with nasogastric decompression and antibiotics was initiated. However, she suddenly collapsed and succumbed despite all resuscitative efforts. Conclusion Our case demonstrates that periorbital emphysema can occur following procedures such as upper gastrointestinal endoscopy, in the eyes without history of local trauma. This complication should be suspected especially if there is associated cervicofacial and mediastinal emphysema. Subcutaneous emphysema is usually self-resolving; however, extension of air into deeper planes can cause dangerous complications such as blindness due to orbital emphysema or mortality due to mediastinal emphysema. Hence, prompt diagnosis and urgent intervention are crucial to avoid vision and life threatening complications.

Pancreatic Tuberculosis is an uncommon form of extra pulmonary tuberculosis that resembles malignancy of pancreas and serve as a diagnostic challenge for physicians. Conservative management with Anti Tuberculosis Therapy (ATT) will suffice for pancreatic tuberculosis whereas a malignancy may require major surgeries which may lead to significant morbidity. Here, we discuss the case of a female patient who presented with abdominal pain and vomiting and is a known case of chronic calcific pancreatitis. Radiological findings were that of malignancy of the pancreas. Enteroscopy showed pus flowing out from the duodenum. Endoscopic Ultrasound (EUS) guided Fine Needle Aspiration Cytology (FNAC) of the pancreas revealed acid fast bacilli. The patient was treated successfully with ATT. Timely diagnosis of this rare form of extra pulmonary tuberculosis can thus help avoid unwanted resections done for presumed malignancy, for which a high index of suspicion is needed.

Background: Abnormal esophageal motility and low Lower Esophageal Pressure (LES) play an integral role among various etiologies implicated in pathogenesis and severity of Gastro Esophageal Reflux Disease (GERD). Delayed clearance of refluxate leads to prolonged mucosal exposure to gastro duodenal contents which promotes esophagitis and its complications. To find out the association of ineffective esophageal motility (IEM) and low Lower Esophageal Sphincter (LES) pressure with endoscopic esophagitis in patients presenting with symptoms of GERD. Settings and designs: Prospective cross sectional study done in a tertiary medical care center in south India from October 2016 to March 2017. Methods: This cross sectional study was carried out among patients presenting with symptoms of GERD (heart burn and regurgitation,) at least twice per week for past three months. Based on their endoscopy findings patients with GERD are grouped into two having erosive and nonerosive reflux disease. After general and systemic clinical examination, High resolution Manometry was performed, and data was analyzed using Trace 1.2.3a V software. Statistical methods: Data was analysed using SPSS version 19. Chi square test was used to analyze categorical variables and independent ’t’ test was used for continuous variables. Results: A total of 66 patients with GERD symptoms were subjected to esophageal manometry. Out of these 66 patients 42 were males and 22 were females with their mean age 40.82±12.86 years. Among 66 patients presented with GERD symptoms 26.7% were found to have ineffective esophageal motility and only 11.7% had low LES pressure. Ineffective esophageal motility was also found to be more common among older age group individuals with their mean age being 44.64 ±14.154. Among the patients with erosive reflux disease (70.21%), 66.7% had low LES pressure and 75 % had IEM; the association was not statistically significant. Conclusions: The incidence of Ineffective esophageal motility in patients with GERD is found to be higher than that of low LES pressure. There was no significant association observed between IEM and low LES pressure with endoscopic esophagitis in patients with GERD.

Infected pancreatic necrosis (IPN) is associated with high morbidity and mortality. It is increasingly being recognized that noninvasive management, radiological guided drainage, and minimally invasive procedures rather than the traditionally advocated open necrosectomy are associated with a better outcome in IPN. We present a patient with IPN who was managed with the now popular “step up” approach and describe the procedure of Minimal access retroperitoneal pancreatic necrosectomy.