The infection of Helicobacter pylori (H. pylori) is affected by the host immune system and the genetic makeup. It is postulated that deficiency of vitamin D may interfere in normal immunological response to infectious agents, including H. pylori, and increase the risk of infection. This study aims to find the relationship between vitamin D status in the body and patient's response to H. pylori eradication treatment. MethodsOne hundred and fifty patients (n = 150) between the ages of 18 and 60 years of either gender, diagnosed with H. pylori, were included in the study. After enrollment, patients were started on first-line eradication therapy, which included omeprazole, amoxicillin, and clarithromycin for 14 days. Patient's vitamin D levels were tested via laboratory. After 14 days, patients' stools were tested for presence of H. pylori antigen. ResultsA total of 128 participants completed the study, out of which 92 (71.8%) participants showed no H. pylori antigen in stool after 14 days and 36 (28.1%) participants still showed H. pylori in their stool. The mean serum vitamin D level was significantly higher in participants who had successful treatment compared to those who had unsuccessful treatment (31.01 ± 7.8 ng/mL vs. 18.9 ± 5.6 ng/mL; p-value < 0.0001). ConclusionVitamin D levels may affect the response of H. pylori eradication therapy. Further large-scale studies are needed in which vitamin D is given as an intervention to further study the association between vitamin D levels and H. pylori treatment response.

Background and Aim: Gastroesophageal reflux disease (GERD) is a physiological passage of stomach contents into the esophagus. It is basically the pathological complications and symptoms. Endoscopy is a gold standard investigation tool that eliminates the gastroesophageal reflux disease co-morbidities such as malignancy and Barret’s esophagus. The present study was carried out to evaluate the correlation between endoscopic findings and symptoms of gastroesophageal reflux disease. Materials and Methods: This intervention cross-sectional study was carried out on 109 gastro esophageal reflux disease patients in Gastroenterology department of Isra University Hospital, Hyderabad for six months duration from January 2021 to June 2021. Suspected gastroesophageal reflux disease patients were assessed thoroughly by physical examination, history, and endoscopy for gastrointestinal symptoms. Severity, symptom type, duration, and frequency were assessed as clinical symptoms. The upper gastrointestinal endoscopy findings were evaluated in terms of esophageal erosions, and their grades such as Grade A, Grade B, Grade C, and Grade D. The endoscopy abnormal findings such as hernia, esophagus, malignancy, and Barret’s esophagus were correlated with gastroesophageal reflux disease. Result: Out of 109 patients, 78 (71.5%) were females while 31 (28.5%) were male. The mean age of the patients was 43.54 ± 7.3 years with an age range between 25 and 67 years and the mean BMI was 43.34 ± 5.76 kg/m2. Gastro esophageal reflux disease symptoms such as malignancy and Barrett’s esophagus shown no evidence on pre-operative endoscopy. About 29 (26.6%) patients had normal endoscopy. The symptomatic patients were 80 (73.4%) which were categorized based on LA classifications into Grade A 62 (77.5%), Grade B 13 (16.3%), Grade C 3 (3.8%) and Grade D 2 (2.5%). Based on the reflux score system, patients were distributed as mild 43 (53.8%), moderate 11 (13.8%), severe 5 (6.3%), and very severe 21 (26.3%). Conclusion: Our study found a significant correlation between gastro esophageal reflux disease and endoscopy esophagitis findings. Pre-operative endoscopy should be carried for abnormal endoscopy in both symptomatic and asymptomatic patients. Keywords: Gastro-oesophageal reflux disease, Endoscopy, Esophagitis

Objective: To determine the diagnostic accuracy of serum albumin for the detection of esophageal varices (EV) in cases presented with chronic liver disease taking Esophagogastroduodenoscopy (EGDs) as the gold standard. Methodology: This cross-sectional study was conducted at the Department of Medicine, Sir Ganga Ram Hospital, Lahore in collaboration of Department of Gastroenterology, Services Hospital, Lahore, during a period of six months. After receiving informed consent, each patient's blood was drawn using a 5cc disposable syringe and sent to the hospital's laboratory for analysis of serum albumin levels. Esophageal varices were suspected as positive on albumin level <3.5mg. Then, patients were referred to and underwent EGD. All EGDs were done on every patient by a consultant gastroenterologist having a minimum experience of 5 years. Self-made study proforma was used for the data collection and SPSS version 26 was used for the data analysis. Results: The patient’s average age was 55.44+12.51 years. Males were found in majority 70.53%. Esophageal varices were noted positive among 41.1% of the cases out of a total 95 study subjects. The sensitivity and specificity of the serum albumin in the diagnosis of esophageal varices were found to be 80.55 percent and 83.05 percent, respectively, followed by a positive predictive value 74.35 percent, negative predictive value 87.5 percent, and the diagnostic accuracy was 82.10 percent by taking EGD as the gold standard. Conclusion: Decreased serum albumin level was observed to be the non-invasive, useful predictor and as a good first-line diagnostic tool of esophageal varices among cases having chronic liver disease in clinical practice. Keywords: Serum Albumin, Esophageal Varices, CLD, EGD

Background and aim: The association of gastro esophageal reflux disease with oral health manifestations faced major challenges in terms of invasive investigative approaches to be performed on patients for necessary treatment. The current study aimed to evaluate the risk factors and impact of gastro-esophageal reflux disease on oral health. Materials and Methods: The cross-sectional study was carried out on 194 gastro-oesophageal reflux disease in Gastroenterology department of Isra University Hospital, Hyderabad for duration of six from July 2020 to December 2020. The individuals underwent duodenoscopy for oesophago–gastro–reflux disease and met the inclusive criteria were enrolled. The gastro-oesophageal reflux disease patients were categorized into two group’s namely chronic gastro-oesophageal reflux disease as a group I (97 patients), while mild GORD was group II (97). The exclusion criteria for this study was individuals with limited mouth opening and unconscious patients. Mucosa oral lesion and abnormal conditions were measured as primary and secondary outcomes. Oral Health Impact Profile-14 was utilized for assessment of life quality changes with hard and soft tissue. Results: Of the total 194 patients, 113 (58.2%) were male while 81 (41.8%) were females. The mean age was 48.32±7.56 years with an age range of 20-80 years. The socioeconomic status of the participants was as follows; urban residents 127 (65.5%) and rural 67 (34.5%). The gastro-oesophageal reflux disease prevalence was found 35.6% (n=69) out of which 34.8% (24) were dental erosion (DE). Group I and II had 97 patients each. The group I was comprised of significantly common diseases such as ulceration 52 (53.6%), Oral submucous fibrosis 59 (60.8%), and xerostomia 42 (43.3%). Chronic gastro-oesophageal reflux and dental erosion diseases were statistically significant with an unhealthy pattern of diets such as ulceration, nausea/vomiting, gingivitis, angular cheilitis, and oesophagitis. The prevalence of overall oral tobacco and smoking addiction was 59 (30.4%) and 52 (26.8%). Tea was the most prevalent consumed beverage 141(72.7%). Gastro-oesophageal reflux and dental erosion diseases were positively correlated with oral health assessment scale-14 (p-value <0.05). The psychological discomfort, psychological disability, physical disability, and functional limitation were the notable impacts with their respective ranks correlation coefficient (rs) 0.29, 0.26, 0.28, and 0.19. Conclusion: Gastro-oesophageal reflux and dental erosion disease had higher severity among patients of oral manifestation compared to those with no gastro-oesophageal reflux and dental erosion disease. The systemic and oral disease severity needs to be assessed routinely with dental checkup. Keywords: Oral manifestations, Gastro-oesophageal reflux disease

Background; The COVID-19 pandemic has steered the exceptional disorder among the health care system. Gastrointestinal disorder and mortality are considerably associated with the utilization of health care which is disrupted by coronavirus pandemic. Aim: The aim of the present study was to assess the prevalence, mechanism and implications of Gastrointestinal Symptoms in COVID-19. Materials and Methods: This retrospective study was carried out on consecutive patients of laboratory tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received inpatients/ emergency care at Isra University Hospital, Hyderabad for duration of six months between November 2020 to April 2021. The SARS-CoV-2 tested patients of either symptomatic or asymptomatic were enrolled in this study. The prevalence, mechanism, and implications of gastrointestinal symptoms were evaluated with COVID-19 among patients. The basic parameters such as GI symptoms, health care utilization, clinical predictor, and medication used were assessed with three Functional gastrointestinal and motility disorders (familial dysautonomia (FD), gastroparesis, and Irritable bowel syndrome (IBS)). The nasopharyngeal swab was used for SARS-CoV-2 testing. The COVID-19 sensitivity and specificity were 95% and 98% respectively. STATA version 15.1 was used for data analysis. Results: Of the total SARS-CoV-2 tested patients in our hospital, 1540 FGIMD patients underwent testing for SARS-CoV-2 were enrolled. COVID-19 RNA positive test rate was found 15.3% (235/1540) during the same period. Of all the tested patients, SARS-CoV-2 positive rate was higher (p<0.05) in COVID-19 patients with risk factors such as obesity, hypertension, autoimmune disease, diabetes, and cardiovascular disease) at 57.5% (885/1540) compared to 42.5% (655/1540) without risk factors. The COVID-19 prevalence in FGIMD patients was 3.3% (51/1540), 4.8% in IBS (56/1174), gastroparesis3.12% (24/770), and FD 2.4% (30/1250) in our hospital. Increased diarrhea, vomiting/nausea, weight loss, abdominal pain, and constipation were observed in FGIMD patients along with increases in H2 blocker, proton pump inhibitor and opioid use. The outpatient’s visits, diagnostic tests such as lower and upper endoscopies and hospitalization were higher during COVID-19 pandemic compared to the pandemic prior period. Conclusion: The prevalence of gastrointestinal symptoms was found higher in functional gastrointestinal and motility disorders patients during COVID-19 pandemic with increase healthcare utilization and medication usage. Key words: Gastrointestinal Symptoms, COVID-19 pandemic, Respiratory syndrome