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Background Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity. Aim To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT). Methods We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale. Results Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07–0.20, I2 = 89%) and 0.27 (95% CI 0.21–0.33, I2 = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65–0.86, I2 = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40–0.85, I2 = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13–0.32, I2 = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09–0.21, I2 = 0%). Conclusion Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.

An 18-year-old woman presented to the emergency department with dysphagia for 5 days. She had a neurodevelopmental disorder with poor social and motor skills. Her physical examination was unremarkable, except for pallor. Blood investigations revealed microcytic hypochromic anemia (hemoglobin 87 g/L). Chest x-ray showed a heart-shaped opacification in the superior mediastinum (a). A lateral view of the chest x-ray confirmed the lesion in the retrotracheal location (b). Endoscopy showed a large black impacted stone in the upper esophagus (c). Removal of the stone was unsuccessful using a grasping forceps, basket, or retrieval net. A double catheter balloon technique was tried with a double-channel therapeutic endoscope. The first catheter balloon was inserted anteriorly, and the second catheter balloon was placed posterior to the stone. Both the catheters were withdrawn under endoscopic vision, and the stone was retrieved (d). Endoscopic examination at the impacted site showed a circumferential ulcer. A water-solution contrast study of the esophagus revealed no contrast leak. The patient was started orally and discharged. Endoscopic removal is the first-line treatment in foreign body ingestion. The approach to removal should be individualized based on the complexity of the foreign body. Surgical intervention is warranted in complications such as perforation or in cases of failed endoscopic removal. The double-balloon technique came to rescue in this case. (Informed consent was obtained from the patient's next of kin for this case report.

Background: Chronic kidney disease (CKD) a growing epidemic in India with limited studies addressing the problem of ideal equation for estimated glomerular filtration rate (eGFR) among elderly Indian patients. Currently, eGFR is calculated employing the CKD Epidemiology Collaboration (CKD-EPI) equations of which the combination of creatinine and cystatin-c (eGFR cr-cys) is recommended as more accurate. However, preferred equations and filtration markers in elderly individuals are debated. Methods: The present prospective observational study conducted from 2012 to 2014 at our tertiary care centre, aimed at identifying the best filtration marker and eGFR equation for elderly CKD patients. One hundred and seven elderly CKD patients were studied. Comparison of eGFR equations derived from modification of diet in renal disease (MDRD) and CKD-EPI, based on creatinine and cystatin-c was done. Results: Median creatinine was 2.4, and median cystatin-c was 1.9. On comparing the correlation between all four equations by spearman correlation coefficient, difference was noted. eGFR by EPI-creatinine and cystatin-c correlated with all other three equations with correlation coefficient of 0.84 for both MDRD, EPI-creatinine and 0.82 for EPI-cystatin-c equations, respectively. Conclusions: Of the four equations for eGFR, EPI-cystatin-c and creatinine equation showed better correlation with all other equations, hence might be the better equation for confirmation and classification of the elderly CKD patients.