Although Crohn's disease is thought to be rare and intestinal tuberculosis common in India, Crohn's disease is being reported more often. However, there is a lack of systematic study on Crohn's disease from India. In this analysis of data from three inflammatory bowel disease clinics (two in northern India and one in eastern India), criteria for Crohn's disease were applied retrospectively: (1) World Health Organization (WHO) criteria; or (2) compatible histology (European Crohn's and Colitis Organization) or failure of response to 4-8 weeks of anti-tuberculosis therapy (Asia-Pacific guidelines); or (3) compatible macroscopic, radiologic, colonoscopic features (European Crohn's and Colitis Organization). Others were classified as probable Crohn's disease. The Montreal classification was used for disease phenotype. Age at onset and duration of symptoms (182 patients, 117 male) were 34.5 (+/-13.6; 7-73) years and 3.0 (+/-5.8; 0.1-36) years, respectively. Diarrhea (68%), abdominal pain (62%), and weight loss (57%) were common. The common intestinal complications were occult (27%) and overt (40%) gastrointestinal bleeding and obstruction (28%). There were 141 (78%) and 41 (22%) with definite and probable Crohn's disease respectively. Of 147 (81%) available histopathology specimens (endoscopic biopsy in 110; 75%), 31 (21%) had granuloma. Seventy-one out of 166 (43%) had received anti-tuberculosis therapy in the past. Results from the Montreal classification were as follows: age at onset, A1:A2:A3 6%:64%:30%; location of disease, L1:L2:L3:L4 32%:41%:23%:4%, and disease behavior, B1:B2:B3 51%:24%:25%. Twenty-six (15%) and 31 (17%) patients had upper gastrointestinal and perianal modifiers. The drugs used were: aminosalicylates (128, 70%), steroids (76, 42%), azathioprine (53, 29%), methotrexate (4, 2%), and salazopyrine (14, 8%). Sixty-six (36%) patients underwent surgical treatment. We concluded that the phenotype of Crohn's disease in India is very similar to that described in other regions of Asia and the West, except for a delay in diagnosis and a more complicated disease at diagnosis.
Summary Background Differentiation between intestinal tuberculosis and Crohn's disease is difficult and may require therapeutic trial with anti‐tubercular therapy in tuberculosis‐endemic regions. Aim To evaluate the role of therapeutic trial with anti‐tubercular therapy in patients with diagnostic confusion between intestinal tuberculosis and Crohn's disease. Methods We performed retrospective‐comparative (n = 288: 131 patients who received anti‐tubercular therapy before being diagnosed as Crohn's disease and 157 intestinal tuberculosis patients) and prospective‐validation study (n = 55 patients with diagnostic confusion of intestinal tuberculosis/Crohn's disease). Outcomes assessed were global symptomatic response and endoscopic mucosal healing. Results In the derivation cohort, among those eventually diagnosed as Crohn's disease, global symptomatic response with anti‐tubercular therapy was seen in 38% at 3 months and in 37% who completed 6 months of anti‐tubercular therapy. Ninety‐four per cent of intestinal tuberculosis patients showed global symptomatic response by 3 months. Endoscopic mucosal healing was seen in only 5% of patients with Crohn's disease compared with 100% of intestinal tuberculosis patients. In the validation cohort, all the patients with intestinal tuberculosis had symptomatic response and endoscopic mucosal healing after 6 months of anti‐tubercular therapy. Among the patients with an eventual diagnosis of Crohn's disease, symptomatic response was seen in 64% at 2 months and in 31% who completed 6 months of anti‐tubercular therapy, none had mucosal healing. Conclusions Disproportionately lower mucosal healing rate despite an overall symptom response with 6 months of anti‐tubercular therapy in patients with Crohn's disease suggests a need for repeat colonoscopy for diagnosing Crohn's disease. Patients with intestinal tuberculosis showing significant symptomatic response after 2–3 months of anti‐tubercular therapy, suggest that symptom persistence after a therapeutic trial of 3 months of anti‐tubercular therapy may indicate the diagnosis of Crohn's disease.
Compensated ALC have increased adiposity and relatively preserved muscularity but decompensation leads to loss of both muscle and fat mass. Prevalence of sarcopenia, based on derived ethnic cut-offs was 12.8%.
INTRODUCTIONIntestinal permeability (IP) is the property of the intestinal epithelium which refers to the facility with which it allows molecules to pass through by non-mediated diffusion [1] . IP has been implicated in the pathogenesis and frequent relapses of Crohn's disease (CD) [2][3][4][5][6] . Seven to 18% higher relapse rate has been reported in patients with increased IP compared to those with normal IP [7][8][9][10][11] . Moreover, RAPID COMMUNICATIONIntestinal permeability and its association with the patient and disease characteristics in Crohn's disease Abstract AIM: To assess the intestinal permeability (IP) in patients with Crohn's disease (CD) and study the association of IP with the patient and disease characteristics.
Background: Liver transplantation (LT) is a game changer in cirrhosis. Poor muscle mass defined as sarcopenia may potentially upset the LT scoreboard. Aim: To assess the prevalence and impact of sarcopenia on the intraoperative and early postoperative outcomes in Indian patients undergoing LT. Methods: Pre LT, single-slice routine computed tomography images at L3 vertebra of 115 LT recipients were analyzed, to obtain crosssectional area of six skeletal muscles normalized for height in m 2skeletal muscle index (SMI; cm 2 /m 2 ). SMI< 52.4 in males and <38.5 in females was called sarcopenia. The intraoperative, postoperative outcome parameters and 90-day mortality were compared between sarcopenics and nonsarcopenics. Results: Sarcopenia was found in 47.8% of patients [M (90.
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