Chhagan Lal Birda

Bile leaks are commonly managed endoscopically with either sphincterotomy and/or biliary stenting. Historically, if these procedures failed, surgery was inevitable, carrying high morbidity. Data are sparse on the management of persistent or refractory bile leaks after failed endoscopic retrograde cholangiopancreatography. We report a young patient, following blunt abdominal trauma, managed with percutaneous catheter drains for bilomas. Ongoing bilious output in the perihepatic drain persisted, despite 3 sessions of biliary stenting and subsequent stent upgradations. Definitive management was achieved by endoscopic injection of glue-lipiodol (1:1) at the leak site under real-time fluoroscopic guidance, highlighting a minimally invasive alternative to surgery.

Our study aims to assess the prevalence of coeliac disease (CD) among patients with irritable bowel syndrome (IBS), a recognised high-risk group for CD, in Rajasthan. We found 9/287 consecutive adult IBS patients seropositive or with biopsy-confirmed CD. Lower haemoglobin levels were independently associated with CD.

Caregiver burden is increasingly acknowledged in chronic illnesses but its impact in the context of Inflammatory Bowel Disease (IBD) remains underexplored.

Visceral muscle dysmotility syndrome (VMDS) is a rare manifestation of systemic lupus erythematosus. VMDS with esophageal aperistalsis (VMDS tetrad) as the initial presentation of systemic lupus erythematosus has not been previously reported. We describe a case of 35-year-old woman with recurrent intestinal pseudo-obstruction associated with pyeloureterectasis, nonobstructive biliary dilatation, and esophageal aperistalsis, constituting a VMDS tetrad. The diagnosis was established based on clinical features, radiologic findings, and serologic evaluation. The patient responded promptly to immunosuppressive therapy, with complete clinical and radiologic resolution, highlighting the importance of early recognition and timely treatment.

Background Limited retrospective data suggest peroral endoscopic cardial constriction with band ligation (PECC-b) as a feasible, safe, and effective treatment for GERD. We performed a prospective study to assess the efficacy and safety of PECC-b for the treatment of GERD. Methods We prospectively recruited proton pump inhibitor (PPI)-dependent GERD patients. Patients with absence of acid reflux on a 24-hour pH study, esophageal motility disorder, and ≥Hill’s grade III hiatus on endoscopy were excluded. The primary endpoint was GERD health-related quality of life (GERD-HRQL) score improvement at 3 months. Secondary end points were decrease in PPI use, esophageal acid exposure time, reflux episodes, and DeMeester score at 3 months. Safety outcomes included serious and overall adverse events. Results Between July 2023 and June 2025, 130 patients were screened. Of these, 40 patients underwent PECC-b therapy (median age 34 years (IQR: 18–60), 75% male) and were followed up for 3 months. At follow-up, significant improvement in GERD-HRQL scores (22.8 ± 3.2 at baseline to 12 ± 4.7; p < 0.001) was observed. In total, 85% (n = 34) of the patients achieved complete or partial PPI independence at 3 months. Median acid exposure time decreased from 28.1% (IQR: 18.2–54.5%) to 14.8% (8.0–18.0%) (p < 0.05), median number of reflux episodes from 81.5 (53.8–126) to 30 (21.8–70.8) (p < 0.005), and the Demeester score decreased from 103 (51–161) to 52.5(33.5–78.3) (p < 0.005). Totally, 15 (37%) patients had chest pain postprocedure and required analgesics. There were no serious procedure-related adverse events. Conclusion PECC-b is a promising, safe, and effective endoscopic treatment for PPI-dependent GERD, offering significant symptomatic relief and improvement in quality of life.

Introduction: Opioid Use Disorder (OUD) affects 2.1% of India’s population. In western Rajasthan, opium use is culturally rooted and socially accepted. Opioid-Induced Bowel Dysfunction (OIBD) and Opioid Enteropathy (OE) are complications often overlooked in community settings, requiring population-level evidence. This study determines the prevalence of OUD in a rural village and assesses OIBD in those who had OUD, identifies individuals at high risk for OE, and characterizes the associated symptom profile in high-risk participants. Methodology: A community-based study was conducted in Khejarli, Jodhpur, using a 2-phase design. In Phase I, a universal sampling strategy was adopted, wherein eligible individuals were screened for OUD using the DSM-5 diagnostic criteria. In Phase II, OUD patients were assessed for OIBD using the Hindi-translated GSRS scale. High-risk OE was defined based on the presence of more than two Alarm symptoms with moderate to severe anaemia. Data were analysed using SPSS v23, applying descriptive and inferential statistics. Results: Out of 882 individuals screened, 136 (15.4%) were diagnosed with OUD (mean age: 49±14.2 years, 98.5% males). OIBD was in 113(83.1%), and 76(55.9%) of these individuals were identified as high-risk for OE, which was significantly associated with older age, lower educational status, longer duration, and greater severity of opioid use, higher morphine-equivalent consumption, financial debt due to opioid use, and presence of other substance use (p < 0.05). Conclusion: This study shows that a considerable burden of gastrointestinal complications exists among opioid users in rural communities. These findings recommend the need for early community-level screening and integrated public health interventions that address both opioid dependence and gastrointestinal health, particularly in resource-limited rural areas. Keywords: Opioid enteropathy, Opioid-induced bowel dysfunction, Opioid use disorder, Rural Population.

Background: Immunogenic response to hepatitis B virus (HBV) vaccine in patients with inflammatory bowel disease (IBD) is variable and often suboptimal. Aim: To compare the immunogenicity of standard‐dose (20 μg) vs. double‐dose (40 μg) HBV vaccination in patients with IBD. Methods: We randomised patients with IBD 1:1 to receive standard‐ or double‐dose HBV vaccine at 0, 1 and 6 months. Anti‐HBs titres were measured 1 month after the third dose. The primary outcome was an adequate immune response (AIR; anti‐HBs titre > 10 IU/L). Secondary outcomes included an effective immune response (EIR; anti‐HBs titre > 100 IU/L) and seroconversion stratified by disease activity. Results: We randomised 45 patients to the standard‐dose and 43 to the double‐dose. Overall, 63 patients (71.6%) achieved AIR, and 51 (57.9%) achieved EIR. Both AIR (88.4% vs. 55.6%, p = 0.001) and EIR (69.8% vs. 46.7%, p = 0.028) rates were significantly higher with the double‐dose. Among patients receiving immunosuppressive therapy, double‐dose vaccination demonstrated significantly higher AIR (87.5% vs. 45.2%, p < 0.001) and EIR (65.6% vs. 35.5%, p = 0.017), while differences were not significant in those without immunosuppression. On multivariable analysis, predictors of AIR included double‐dose vaccination (odds ratio [OR] 11.63; 95% confidence interval [CI] 2.63–51.46) and anti‐TNFs (OR 0.03; 95% CI 0.002–0.6). Double‐dose vaccination was also associated with higher odds of achieving EIR (OR 3.52; 95% CI 1.04–11.92). Conclusions: Double‐dose HBV vaccination significantly improved AIR and EIR over standard‐dose. These findings support a double‐dose strategy to optimize seroconversion in patients with IBD, especially those receiving immunosuppressive therapy.

Hepatomegaly results from diverse inflammatory, infiltrative, and congestive disorders. Massive hepatomegaly may arise from amyloidosis and can rarely be a sole presenting manifestation of this systemic disorder.