Kaushal Kishor Prasad

Celiac disease (CD) is a prevalent autoimmune condition that affects a significant portion of the population, resulting in an immune reaction to gluten that damages the small intestine and triggers a range of symptoms. It manifests in various ways, including gastrointestinal issues like chronic diarrhea and abdominal discomfort, as well as extraintestinal symptoms such as dermatitis herpetiformis. The primary treatment for CD is strict adherence to a gluten-free diet (GFD), which has become increasingly popular among those without the disease due to perceived health benefits. This shift has driven growth in the gluten-free product market, improving dietary options for those with CD. Effective management of CD requires addressing nutritional imbalances and preventing associated complications like osteoporosis and cancer. Progress in gluten-free ingredient development and food technology plays a crucial role in enhancing the nutritional quality of these diets and supporting overall well-being. Continued research and innovation are essential to advance care and improve quality of life for individuals with CD.

Bacterial infections, mainly caused by enterobacteria in livestock, poultry, and humans, are the leading cause of illness and mortality worldwide. Bacteriophages are bacterial-infecting viruses that interact dynamically with bacteria and mammalian cells, thereby greatly influencing human health. Despite the vast reservoirs of bacteriophages in the human body, their potential to treat bacterial diseases has been undermined by the widespread use of antibiotics for many years. Despite the rise in antibiotic-resistant bacteria and our growing understanding of the gut microbiota’s significance for health, the exploitation of bacteriophages is making a comeback. Considering the recent trend, the article comprehensively summarizes bacteriophages, their classification, mechanisms of action, comparisons with antibiotics, and some important studies related to phage therapy. Their applications against bacterial infections (e.g., Tuberculosis) and for improving gut health (e.g., Inflammatory Bowel Disease) are also discussed. Also, some novel applications of bacteriophages, such as gene and vaccine delivery, bacterial detection (phage typing), immunomodulation, and use in the food industry, are covered. With the expanding scope of phage therapy, the present review underscores the need to exploit it further and overcome its limitations, thereby improving human health.

Kumari R, et al. Pediatr Gastroenterol Hepatol Nutr. 2026 Mar;29(2):102-119. https://doi.org/10.5223/pghn.2026.29.2.102

Introduction and objectives: The exact role of soluble apoptosis-related mediators in celiac disease is still not fully understood. Serum sFas-sFasL may play a role in the pathogenesis, and the aim of this study was to assess the circulating soluble Fas and Fas ligand levels in celiac disease and compare that with the normal individuals.Methodology: This prospective study included 50 adults with newly diagnosed celiac disease (CD-group/CDG) and 25 non-celiac adults (N-CD group/N-CDG) as controls. The circulating Fas and sFasL levels were assessed by ELISA kits. All duodenal histological parameters were evaluated, classified and histological lesions were graded according to criteria proposed by our group. Results were expressed as the mean±standard error (SE), range and percentage. The serum sFas and sFasL levels and duodenal histological results were analyzed using statistical methods, Mann-Whitney U test, One-way ANOVA and Linear regression using SPSS packed program (version 22 software, SPSS Inc. Chicago, Illinois, USA). The P values<0.05 were considered statistically significant.Results: The mean age of CDG was 31.28±12.83 (15-62 years) years, with a male: female of 1:1. In the CDG, mean serum sFas was significantly lower (p<0.001) than N-CDG. However, the mean serum sFasL was significantly higher (p=0.018) than N-CDG. One-way ANOVA indicated no relationship between the grade of duodenal mucosal damage and concentration of serum sFas (p=0.35). On the other hand, one-way ANOVA indicated a statistically significant relationship between different grades of duodenal mucosal damage and sFasL (p=0.04).Discussion and conclusion: The concentration of serum soluble Fas and FasL are significantly altered in CD. Altered serum sFas does not correlate with histological grades of duodenal mucosal lesions. Further studies are required to see any relation between membrane-bound Fas or FasL and the grading of duodenal mucosal lesions, which may help better understand the pathogenesis of celiac disease.

Gastrointestinal tuberculosis (GITB) and Crohn’s disease (CD) are close mimics. This prospective study aimed to evaluate the diagnostic performance of perfusion computed tomography (CT) in differentiating GITB from CD. Consecutive patients with ileocaecal thickening underwent perfusion CT of the ileocaecal region between January 2019 and July 2020. Two radiologists (blinded to the final diagnosis) independently assessed blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability at perfusion CT. These parameters were compared among the patients with GITB as well as active and inactive CD. Receiver operating characteristic curves were utilized for determining the diagnostic performance of perfusion CT. Interclass correlation coefficient and Bland–Altman analysis were performed to compare the observations of the two radiologists. During the study period, 34 patients underwent perfusion CT. Eight patients had diagnoses other than intestinal tuberculosis or CD. Thus, 26 patients (mean age 36 ± 14 years, 18 males) with GITB (n = 11), active CD (n = 6), and inactive CD (n = 9) were evaluated. BF, MTT, and permeability showed significant differences among the groups, while BV did not differ significantly among the groups. BF and permeability had 100% sensitivity and 100% specificity, while MTT had 61.5–100% sensitivity and 70–100% specificity for differentiating GITB from active CD and active from inactive CD. The interclass correlation coefficient for perfusion CT parameters was 0.88–1. Perfusion CT is a novel imaging technique that can improve the diagnostic performance of differentiating tuberculosis from CD.

Background Procalcitonin may be increased in active ulcerative colitis (UC). We investigated the role of procalcitonin in predicting response in acute severe UC (ASUC). Methods Consecutive patients with ASUC diagnosed on basis of Truelove and Witts criteria were enrolled. Serum procalcitonin levels for consecutive patients were measured at admission and day 3. We assessed role of procalcitonin values at presentation and at day 3 in assessing response on day 3 (Oxford’s criteria) and need for second line therapy (day 28). Results Of fifty patients (23 males, mean age: 35.98±13.8 years), 16 did not respond (day 3). Ten (20%) patients required second-line therapy. Baseline procalcitonin was significantly associated with response on day 3 (P=0.016). There was no association between day 1 or day 3 procalcitonin and need for second-line rescue therapy. Conclusion Serial procalcitonin is not an effective biomarker for predicting outcomes or need for second line therapy in ASUC.

Introduction: Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce. Methods: A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients. Results: Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn’s disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1–5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons. Conclusion: Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.

Background: Polymorphisms in thiopurine methyltransferase (TPMT) and Nudix hydrolase-15 (NUDT15) have been implicated as the predominant cause of thiopurine induced leukopenia in the Western countries and East Asia respectively. Exact role of these polymorphisms in South Asian population with inflammatory bowel disease (IBD) is uncertain.Methods: We included consecutive patients with IBD who were initiated on thiopurines at a center in North India. The dosage of thiopurines was titrated using regular monitoring of hemogram and liver function tests. Three TPMT polymorphisms (c.238 G > C, c.460 G > A, and c.719A > G) and one NUDT15 polymorphism (c.415 C > T) were assessed. Comparison regarding incidence of leukopenia and maximum tolerated thiopurine dosage was performed between those with wild polymorphism and those with TPMT and NUDT15 polymorphisms, respectively.Results: Of the 119 patients (61 males, mean age 36.8 ± 13.5 years), 105 (88.2%) had ulcerative colitis and 14 (11.8%) had Crohn’s disease. Leukopenia was noted in 33 (27.7%), gastrointestinal intolerance in 5 (4.2%) and pancreatitis in 2 (1.6%). TPMT polymorphisms were detected amongst five patients of whom 1 developed leukopenia. NUDT15 polymorphism was noted in 13 patients of whom 7 had leukopenia. The odds of developing leukopenia in TPMT polymorphism were non-significant (0.77, 95% CI:0.0822 to 7.2134,P = 0.819) but were significantly higher in those with NUDT15 polymorphism (3.5933, 1.1041 to 11.6951, P value: = 0.0336).Conclusion: NUDT15 polymorphism was more frequent than TPMT polymorphisms and was associated with thiopurine induced leukopenia. However, the tested polymorphisms account for only 24.2% of the risk of thiopurine induced leukopenia.