Background/Aim:The study was carried out to compare the efficacy of Vitamin E versus Ursodeoxycholic acid (UDCA) in nondiabetic nonalcoholic fatty liver disease (NAFLD) patients.Patients and Methods:We randomized 250 non cirrhotic and non diabetic NAFLD patients diagnosed on ultrasound, with raised alanine aminotransferase (ALT) level. (>40 IU/L), to receive Vitamin E 400 mg twice a day (Group A) or UDCA 300 mg twice a day (Group B) for 52 weeks. Lifestyle modification to achieve at least 5% weight reduction and subsequent weight control and regular exercise was advised to both groups. The primary study endpoint was normalization of ALT. Secondary endpoints were the proportion of patients with reduction in ALT, relative reduction in the NAFLD Fibrosis score (NFS), symptomatic improvement and tolerability.Results:One hundred and fifty patients received UDCA as compared to 100 patients receiving Vitamin E. The treatment groups were comparable at entry with regard to age (44.1 vs 42.4 years), gender (67% vs 63% female), risk factors for nonalcoholic steatohepatitis, hypochondriac pain, serum liver biochemistries, and NAFLD Fibrosis score. The primary endpoint was achieved in 21 (14%) and 19 (19%) of patients in Group A and Group B, respectively (P = 0.2). The proportion of patients with reduction in ALT (56% vs 63%, P = 0.2), symptomatic improvement (78% vs 67%, P= 0.058), reduction in the NFS (44% vs 47%, P= 0.69), and tolerability (98% vs 95%, P= 0.2) were similar between Group A and Group B, respectively.Conclusion:UDCA is an effective and safe alternative to Vitamin E in nondiabetic–noncirrhotic Indian NAFLD patients.

Serum ferritin was low in Indian individuals, and levels even within apparently normal range indicated fibrosis and cirrhosis. A cutoff level of 48.0 IU/mL distinguished fibrosis in NAFLD. Fibroscan correlated well with serum ferritin levels.

BackgroundConstipation is a common problem worldwide. Constipation can be primary or secondary. Primary constipation is subdivided in slow transit constipation, normal transit constipation, and dyssynergic defecation. Colon transit time (CTT) is the most basic and primary tool in evaluating disorders of colonic motility. CTT helps to differentiate between types of constipation and plan the treatment.MethodsFifty functional constipation patients and 25 healthy controls were asked to ingest four gelatin capsules (each containing five radio-opaque markers) at 0, 12 and 24 hours. An abdominal X-ray was taken at 36 hours. Total or segmental CTT was measured after calculating the number of markers remaining in each segment at 36 hours on abdominal X-ray.ResultsMean CTT in healthy controls in our study was 15.4 hours which is shorter than western population. Total CTT is significantly higher in constipation group (23 hours) compared to healthy subjects (15.4 hours). Transit time in right segment was significantly high in constipation group than healthy population (14.2 vs. 8.3 hours). Total as well as segmental transit times are slightly higher in females as compared to males in both the groups, however not statistically significant. To the best of our knowledge, there are no studies from India that compared the CTTs in functional constipation and healthy controls.ConclusionRadio-opaque marker study for CTT is a simple and reliable technique for evaluation of constipation. Patients with functional constipation have significantly longer CTT than healthy population. Total CTT is much less in this study population compared to west. There is need to establish standards for slow colon transit.

Isolated pancreatic tuberculosis (TB) is considered an extremely rare condition, even in the developing countries. Most reported cases of pancreatic TB are diagnosed after exploratory laparotomy or autopsy. Pancreatic TB is a potential mimic of invasive pancreatic malignancy and the presence of vascular invasion does not distinguish one condition from the other. Every effort should be made for the earliest diagnosis of this condition as TB is a treatable condition and it avoids unnecessary management of pancreatic carcinoma. Here we report a rare case of primary pancreatic head TB in a 58-year-old male who presented with hypodense lesion in head of pancreas with double duct sign and portal vein invasion mimicking non-resectable pancreatic carcinoma.

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