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gastroenterologist

Unknown interesting facts, Causes and health tips to deal with “leaky gut”

by Medically Speaking March 27, 2022

written by Medically Speaking

The term “leaky gut” has suddenly captivated everyone’s attention and has become a trendy buzzword, but do you know exactly what this health problem means? Lavleen Kaur, Co-founder and Head Dietitian of Diet Insight, says to HT Lifestyle, “Leaky gut, scientifically known as intestinal permeability, is a disease in which the small intestine lining becomes damaged.” This causes undigested food particles, harmful waste, and pathogens to “leak” into the circulation via the colon. When these foreign particles enter the circulation, they cause an immunological response, which leads to further health problems such as irritable bowel syndrome, chronic weariness, food allergies, inflammatory responses, rheumatoid arthritis, and other ailments. “

In layman’s terms, she explained that the damaged cells in our intestines fail to produce the enzymes needed for efficient digestion, and as a result, our bodies are unable to absorb critical nutrients, leading to hormone imbalances and a weakened immune system. Dr. Anish Desai, MD, Founder and CEO of IntelliMed Healthcare Solutions, added, “The human digestive tract is responsible for food digestion and nutrient absorption.” Small holes in the gut wall enable water and nutrients to flow while preventing hazardous substances from entering. “

He said, “As the tight connections between intestinal walls relax, the gut becomes more permeable, possibly allowing germs and toxins to pass from the gut into the circulation.” This disorder is referred to as “leaky gut.” Leaky gut syndrome is a common digestive disorder that affects the lining of the intestines. The break in the intestinal wall that arises during leaky gut syndrome allows bacteria and other poisons to enter the bloodstream. The main causes of the condition are a decrease in mucus thickness, increased permeability of the intestine, and a change in gut flora. “

The causes of leaky gut:

According to nutritionist Lavleen Kaur, there are several reasons for a leaky stomach, but the actual cause of the leaky gut is unknown. She believes that in many cases, leaky gut is caused by an overabundance of sugar, salt, processed and refined meals.

She did, however, disclose an intriguing and little-known fact: there is a nerve within our brain called the vagus nerve that is directly related to our abdomen. “It uses the same protocol as WhatsApp, meaning it sends messages to the stomach to perform correctly, and the gut responds by absorbing the required nourishment and preventing superfluous particles,” she explained.

Dr. Anish Desai identified many variables that contribute to leaky gut. They are as follows:

1. Excessive sugar consumption: a high fructose diet impairs the intestinal wall’s barrier function.

2. NSAIDs: Long-term use of NSAIDs increases permeability and produces leaky gut.

3. Excessive alcohol consumption: Excessive alcohol consumption increases intestinal permeability.

4. Nutrient insufficiency: Vitamin A, D, and zinc deficiency all have a role in intestinal permeability.

5. Stress: Chronic stress as a result of an unhealthy lifestyle is a factor in intestinal illness.

He also highlighted that some diseases are related to leaky gut and mentioned how numerous research has shown that increased intestinal permeability is becoming a cause of many ailments such as Crohn’s disease, Celiac disease, diabetes, and irritable bowel syndrome.

Suggestions for improving intestinal health:

If you want to cure a leaky gut, you must first address the fundamental causes of the disease, says dietitian Lavleen Kaur. While it is hard to determine whether or not a leaky gut can be repaired, it can certainly be improved. Everyone’s intestines are “leaky” to some extent; our small intestine is meant to allow particular particles into the rest of the body. It only becomes a problem when it starts emitting the incorrect kinds. “

Dr. Anish Desai highlighted a few strategies that help enhance gut health, despite the fact that there is no prescribed treatment for leaky gut. They are as follows:

1. Reduce carbohydrate consumption: Bacteria that are detrimental to the body often feed on sugar, and carbohydrates are a source of sugar.

2. Limit your use of NSAIDs: Long-term use of NSAIDs like ibuprofen contributes to leaky gut syndrome.

3. Eat fermented foods: Fermented foods like yoghurt contain probiotics, which help with intestinal health.

4. Exercise on a regular basis: Exercise on a regular basis helps to promote intestinal health.

5. Consume nutrients: A balanced diet rich in vitamins and minerals should be consumed on a regular basis to maintain the health of the hut.

March 27, 2022 0 comment

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Uncomplicated diagnostic tool for gastrointestinal diseases

by Medically Speaking March 25, 2022

written by Medically Speaking

As food passes through the digestive tract, muscles flex to keep things moving smoothly. Loss of motility can result in acid reflux, inability to transfer food out of the stomach, or constipation.

Dysmotility disorders are often diagnosed with a catheter carrying pressure transducers that detect GI tract contractions. MIT researchers have created a novel gadget inspired by an old Incan technology, the quipu — a collection of knotted ropes used to transfer information — that might offer a cheaper and easier-to-manufacture alternative to existing diagnostics for GI dysmotility.

The MIT researchers and their collaborators at Brigham and Women’s Hospital demonstrated in animal tests that their simple device, a silicone tube filled with liquid metal and knotted many times, produces measurements similar to those produced by the state-of-the-art diagnostic technique known as high-resolution manometry.

“We’re able to make a measurement that would normally require devices that cost thousands of dollars and an instrument that is much more complicated,” says Giovanni Traverso, the Karl van Tassel Career Development Assistant Professor of Mechanical Engineering at MIT, a gastroenterologist at Brigham and Women’s Hospital, and the study’s senior author.

The study’s principal authors are MIT research scientists Kewang Nan and Sahab Babaee, and it was published today in Nature Biomedical Engineering.

Dysmotility Diagnosis

Contractions of the gastrointestinal system are essential for transporting food through the tract, and disruptions of these contractions at any point might result in health concerns. The gold-standard manometry test can be performed to determine if the GI tract muscles are correctly functioning to create those waves.

“High-resolution manometry can detect the pressure and speed of the contractile waves, but those devices are very expensive, in the tens of thousands of dollars, and they require maintenance and sterilising between patients,” Traverso explains.

Traverso (who grew up in Peru) and Nan believed that the Incan technique of quipu may be used to influence the development of a simpler diagnosis. Before writing, the Inca and other ancient Andean cultures employed quipu devices, which are made of colourful threads twisted in various ways, to record information and deliver messages.

“Our objective was to create a device that was equivalent to existing commercially available catheter-based pressure transducers while also lowering the cost and making it easier to build and deploy,” Nan explains.

The researchers started with a basic silicone catheter, which they filled with gallium-indium eutectic, a liquid metal that is harmless in minute amounts, and sealed at both ends. This tube can respond to pressure changes in an unknotted condition, but it is not sensitive enough to detect pressure changes in the gastrointestinal system.

When the researchers added knots at regular intervals throughout the tube, the catheter became considerably more sensitive to pressure fluctuations and could detect pressures up to roughly 200 millimetres of mercury, which is about the greatest pressure encountered in the human digestive system.

The greater sensitivity is due to the knots elongating the cross-section of the tube, making it easier to compress, as demonstrated by the researchers using computer simulations. Furthermore, when the tube is knotted, three or four parts of the tube are stacked on top of one another, increasing its sensitivity to pressure fluctuations.

The researchers also discovered that pressure sensitivity varies depending on the type of knot and how firmly it is tied. The researchers utilised knots spaced approximately 1 centimetre apart to match the spacing of pressure transducers in a manometer for use in the digestive tract, but they might be positioned closer together for other uses, the researchers said.

The researchers utilised the quipu-inspired sensor to monitor pressure in the oesophagus while food was ingested in animal models. They also assessed the rectoanal inhibitory reflex (RAIR). The novel devices produced pressure measures that were comparable to the gold-standard manometry approach in both experiments.

Less complicated option

The researchers also demonstrated that the gadgets can resist high temperatures and can be sterilised using an autoclave, a typical medical equipment used to sterilise things using heat and pressure. This offers them a competitive edge over conventional manometry catheters, which cannot be autoclaved and must be chemically cleaned. Furthermore, because the devices are so cheap to build, they might be thrown after each use if autoclaves aren’t accessible.

“They’re incredibly quick and super cheap to create,” Nan explains. “Another reason for making GI manometers inexpensive and disposable is to encourage decentralised diagnosis. Being inexpensive increases accessibility by lowering costs, and being disposable further aids public acceptability by removing maintenance costs and minimising difficulty during usage.”

The quipu-inspired sensors might be beneficial in locations where current manometry equipment is unavailable, as well as in more industrialised areas as a less-expensive, easier-to-use alternative to manometry.

“I believe that this type of diagnosis might be widely employed in both developing and developed world settings,” Traverso adds. “The next stage is to find possible partners to assist us in manufacturing them, and then test them in patients.”

Walter Chan, director of the Center for Gastrointestinal Motility at Brigham and Women’s Hospital; Johannes Kuosmanen, an MIT technical associate; Vivian Feig, a postdoc at MIT and Brigham and Women’s; Yiyue Luo, an MIT graduate student; Shriya Srinivasan, a postdoc at MIT and Brigham and Women’s; Christina Patterson, an MIT undergraduate; and Ahmad Mujtaba Jebran

The MIT Department of Mechanical Engineering financed the study.

March 25, 2022 0 comment

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Ulcers: Diagnostics, Treatment and More

by Medically Speaking March 22, 2022

written by Medically Speaking

There is no clear evidence that modern life’s stress or a steady diet of fast food causes stomach and small intestine ulcers, but they are still common in our society: one out of every ten Americans will experience the burning, gnawing abdominal pain of a peptic (or gastric) ulcer at some point in their lives.

Peptic ulcers are holes or cracks in the protective lining of the duodenum (the upper section of the small intestine) or the stomach, which are in touch with stomach acids and enzymes. Duodenal ulcers occur more frequently than stomach ulcers.

Esophageal ulcers are very uncommon, forming in the oesophagus (or swallowing tube) as a result of pharmaceutical exposure, such as some antibiotics or anti-inflammatories, or alcohol addiction.

Until the mid-1980s, conventional thinking held that ulcers were caused by stress, a hereditary proclivity for increased stomach acid output, and bad living practises (including overindulging in rich and fatty foods, alcohol, caffeine, and tobacco). It was thought that such impacts lead to the accumulation of stomach acids, which destroy the protective lining of the stomach, duodenum, or oesophagus.

While increased stomach acid output undoubtedly contributes to the formation of ulcers, a relatively new viewpoint contends that bacterial infection is the major cause of peptic ulcers. Indeed, studies undertaken since the mid-1980s have revealed that the bacterium Helicobacter pylori (H. pylori) is present in more than 90% of duodenal ulcers and around 80% of stomach ulcers. However, new data show that such numbers are dropping.

Other variables appear to contribute to ulcer development, particularly in people infected with H. pylori:

Overuse of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen)
Heavy alcohol use
Psychological stress
Smoking

Other research indicates that stomach ulcers are more common in elderly persons. This might be due to:

Arthritic is common among the elderly, and relieving arthritis pain may include taking aspirin or ibuprofen on a regular basis.
The pylorus (the valve between the stomach and the duodenum) relaxes with age, allowing excess bile (a chemical generated in the liver to promote digestion) to leak into the stomach and erode the stomach lining.

People with type A blood are also more prone to develop malignant stomach ulcers for unknown reasons.

Duodenal ulcers are more common in patients with type O blood, presumably because they lack the material on the surface of blood cells that protects the duodenal lining.

DIAGNOSTICS

If your doctor suspects you have a peptic ulcer, they will most likely begin with a physical exam and certain tests:

They’ll feel your stomach and ask whether you’ve had any soreness, pain, or bloating. They may use a stethoscope to listen for any noises coming from your stomach.
The next step will be to conduct tests to search for H. pylori bacteria. For these, your doctor may collect blood, stool, or breath samples from you.
In certain situations, especially if you’re older and your symptoms include weight loss or loss of appetite, they may use a long, flexible tube called an endoscope to examine your neck and stomach for indications of an ulcer. (You will be given sleeping medication.) A tiny sample of tissue from an ulcer can also be taken with an endoscope and examined in a laboratory.
Before taking X-rays of your stomach, they may ask you to consume a milky liquid called barium. This drink covers your digestive tract, making issues like ulcers more visible.

TREATMENT

If you have a peptic ulcer, your doctor will propose a treatment strategy based on the source of the problem:

The most frequent treatment is a combination of antibiotics to kill the H. pylori bacteria and medicines to reduce stomach acid. Proton pump inhibitors (such as Aciphex or Nexium) and antibiotics are common examples. PPIs will be prescribed to you for several weeks.
You must stop taking over-the-counter pain relievers if they are the cause of your ulcer.
They may also provide a protectant, which encapsulates ulcers to protect them from stomach acid.

Lifestyle changes can help, too. You might need to:

Quit smoking.
Drink less alcohol or caffeine.
Stay away from foods that make your symptoms worse.

After treatment, your doctor may want to keep a close eye on you, depending on:

The size of your ulcer and where it was
How well the treatment worked
If you had any other problems

If left untreated, an ulcer can lead to significant complications such as gastrointestinal haemorrhage. Untreated ulcers can potentially cause a hole in your stomach, which may require surgery to repair.

March 22, 2022 0 comment

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Abdominal Lump

by Medically Speaking November 6, 2021

written by Medically Speaking

What exactly is an abdominal lump?

An abdominal lump is a swelling or bulge that appears in any part of the abdomen. It is usually soft, but it can be firm depending on the underlying cause.

A hernia is the most common cause of a lump. An abdominal hernia occurs when the structures of the abdominal cavity push through a weakness in the abdominal wall muscles. Typically, surgery can easily correct this.

In rarer cases, the lump may be an undescended testicle, a harmless hematoma, or a lipoma. In even rarer circumstances, it may be a cancerous tumor.

If you also have a fever, vomiting, or pain around an abdominal lump, you may need emergency care.

Possible causes of an abdominal lump

A hernia causes the majority of lumps in the abdomen. Hernias often appear after you have strained your abdominal muscles by lifting something heavy, coughing for a long period, or being constipated.

There are several types of hernias. Three kinds of hernias can produce a noticeable lump.

Inguinal hernia

An inguinal hernia occurs when there is a weakness in the abdominal wall and a part of the intestine or other soft tissue protrudes through it. You’ll most likely see or feel a lump in your lower abdomen near your groin and feel pain when coughing, bending, or lifting.

In some cases, there are no symptoms until the condition gets worse. A hernia isn’t typically harmful by itself. However, it needs to be repaired surgically because it can cause complications, such as a loss of blood flow to the intestine and/or obstruction of the intestine.

Umbilical hernia

An umbilical hernia is very similar to an inguinal hernia. However, an umbilical hernia occurs around the navel. This type of hernia is most common in babies and often disappears as their abdominal wall heals on its own.

The classic sign of an umbilical hernia in a baby is outward bulging of tissue by the belly button when they cry.

Surgery is required to fix an umbilical hernia if it doesn’t heal on its own by the time a child is four years old. The possible complications are similar to those of an inguinal hernia.

Incisional hernia

An incisional hernia happens when a prior surgical incision that has weakened the abdominal wall, allows intra-abdominal content to push through. It requires corrective surgery to avoid complications.

Less common causes of an abdominal lump

If a hernia isn’t the cause of an abdominal lump, there are several other possibilities.

Hematoma

A hematoma is a collection of blood under the skin that results from broken blood vessels. Hematomas are typically caused by an injury. If a hematoma occurs by your abdomen, a bulge and discolored skin may appear. Hematomas typically resolve without needing treatment.

Lipoma

A lipoma is a lump of fat that collects under the skin. It feels like a semi-firm, rubbery bulge that moves slightly when pushed. Lipomas typically grow very slowly, can occur anywhere on the body, and are almost always benign.

They can be removed surgically, but in most cases, surgery isn’t necessary.

Undescended testicle

During male fetal development, the testicles form in the abdomen and then descend into the scrotum. In some cases, one or both of them may not fully descend. This may cause a small lump near the groin in newborn boys and can be corrected with hormone therapy and/or surgery to bring the testicle into position.

Tumor

Although rare, a benign (noncancerous) or malignant (cancerous) tumor on an organ in the abdomen or in the skin or muscles can cause a noticeable lump. Whether it requires surgery or another type of treatment depends on the type of tumor and its location.

How is it diagnosed?

If you have a hernia, your doctor will likely be able to diagnose it during the physical exam. Your doctor may want you to undergo an imaging study, such as an ultrasound or CT scan of your abdomen. Once your doctor confirms an abdominal hernia is present, you can then discuss arrangements for a surgical correction.

If your doctor doesn’t believe the lump is a hernia, they may require further testing. For a small or asymptomatic hematoma or lipoma, you probably won’t need further tests.

If a tumor is suspected, you may need imaging tests to determine its location and extent. You’ll likely also need a biopsy, which involves tissue removal, to determine if the tumor is benign or malignant.

When to seek medical help

If you feel or see a lump in your abdomen that you can’t identify, make an appointment to see your doctor. If you also have a fever, vomiting, discoloration, or severe pain around the lump, you may need emergency care.

At your doctor’s appointment, you can expect to receive a physical examination of your abdomen. Your doctor may ask you to cough or strain in some way while they’re examining your abdomen.

Other questions they may ask include:

When did you notice the lump?

Has the lump changed in size or location?

What makes it change, if at all?

Do you have any other symptoms?

November 6, 2021 0 comment

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Gut bacteria influence brain development

by Medically Speaking Team September 5, 2021

written by Medically Speaking Team

Complex interplay: the gut-immune-brain axis

The early development of the gut, the brain and the immune system are closely interrelated. Researchers refer to this as the gut-immune-brain axis. Bacteria in the gut cooperate with the immune system, which in turn monitors gut microbes and develops appropriate responses to them. In addition, the gut is in contact with the brain via the vagus nerve as well as via the immune system. “We investigated the role this axis plays in the brain development of extreme preterm infants,” says the first author of the study, David Seki. “The microorganisms of the gut microbiome — which is a vital collection of hundreds of species of bacteria, fungi, viruses and other microbes — are in equilibrium in healthy people. However, especially in premature babies, whose immune system and microbiome have not been able to develop fully, shifts are quite likely to occur. These shifts may result in negative effects on the brain,” explains the microbiologist and immunologist.

Patterns in the microbiome provide clues to brain damage

“In fact, we have been able to identify certain patterns in the microbiome and immune response that are clearly linked to the progression and severity of brain injury,” adds David Berry, microbiologist and head of the research group at the Centre for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna as well as Operational Director of the Joint Microbiome Facility of the Medical University of Vienna and University of Vienna. “Crucially, such patterns often show up prior to changes in the brain. This suggests a critical time window during which brain damage of extremely premature infants may be prevented from worsening or even avoided.”

Comprehensive study of the development of extremely premature infants

Starting points for the development of appropriate therapies are provided by the biomarkers that the interdisciplinary team was able to identify. “Our data show that excessive growth of the bacterium Klebsiella and the associated elevated ??-T-cell levels can apparently exacerbate brain damage,” explains Lukas Wisgrill, Neonatologist from the Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the Medical University of Vienna. “We were able to track down these patterns because, for a very specific group of newborns, for the first time we explored in detail how the gut microbiome, the immune system and the brain develop and how they interact in this process,” he adds. The study monitored a total of 60 premature infants, born before 28 weeks gestation and weighing less than 1 kilogram, for several weeks or even months. Using state-of-the-art methods — the team examined the microbiome using 16S rRNA gene sequencing, among other methods — the researchers analysed blood and stool samples, brain wave recordings (e.g. aEEG) and MRI images of the infants’ brains.

Research continues with two studies

The study, which is an inter-university clusterproject under the joint leadership by Angelika Berger (Medical University of Vienna) and David Berry (University of Vienna), is the starting point for a research project that will investigate the microbiome and its significance for the neurological development of prematurely born children even more thoroughly. In addition, the researchers will continue to follow the children of the initial study. “How the children’s motoric and cognitive skills develop only becomes apparent over several years,” explains Angelika Berger. “We aim to understand how this very early development of the gut-immune-brain axis plays out in the long term. ” The most important cooperation partners for the project are already on board: “The children’s parents have supported us in the study with great interest and openness,” says David Seki. “Ultimately, this is the only reason we were able to gain these important insights. We are very grateful for that.”

Source: University of Vienna

September 5, 2021 0 comment

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Naturopathic Tips to Address Fatty Liver Disease

by Dr. Shanmugam August 19, 2021

written by Dr. Shanmugam

By Shanmugam Asst CMO, Jindal Naturecure Institute

The liver is the largest organ inside the body that helps digestion of food, energy storage, and removal of toxic substances. Fatty liver disease happens to be a condition where excess fat deposits inside the liver. The fatty deposits interfere with the liver’s normal functioning and slow down the process of bile and insulin production necessary for various body functions. Excess amounts of fat in the liver can be worrisome, which can lead to permanent scarring and ultimately leading to liver failure.

Types of Fatty Liver Disease

There are two types of fatty liver disease – Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease. Non-alcoholic fatty liver disease is further categorised into 2 types – Simple Fatty Liver and Non-Alcoholic Steatohepatitis (NASH). In the case of NASH, the inflammation of the liver can lead to cancer or cirrhosis. On the other hand, Alcoholic Steatohepatitis is a condition that results from excessive consumption of alcohol. The liver releases toxic substances while breaking down alcohol which damages the organ’s cells and causes inflammation. Though globally, 25% of the adult population is affected by NAFLD, the prevalence rate is 9% to 32% in India.

Symptoms of Non-Alcoholic Fatty Liver Disease

Individuals of all age groups can be affected by non-alcoholic fatty liver disease. But, it is commonly observed in people within the age group of 40-50 who have certain pre-existing conditions like obesity, type 2 diabetes, high cholesterol, PCOS, sleep apnea, and metabolic syndrome. Usually, NAFLD doesn’t cause any symptoms; however, those with any of the above condition/s can experience enlarged spleen, abdominal swelling, enlarged blood vessels, yellowing of the skin and eyes, and red palms.

Naturopathic Treatment for Fatty Liver Disease

Naturopathic treatment encourages NASH patients to manage their comorbidities through various lifestyle changes, diet and supplements. Naturopathy recognises that every individual is different and requires a different treatment option. Here we look at some of the staples in a naturopathic treatment plan to deal with fatty liver disease.

Diet

Those with fatty liver disease must include plenty of organic fruits and green leafy vegetables in the diet. Proper nutrition can increase antioxidants and lessen the oxidative stress in the body leading to better health. If possible, it is always a good idea to opt for GMO-free (genetically modified organisms free) and organic products. If there is insulin resistance, one should also stay away from sugars.

Exercise

A study published in the ‘Alimentary Pharmacology and Therapeutics’ journal stated that daily exercise effectively reverses NAFLD. One can opt for exercise like yoga, running, cycling, swimming, etc., to maintain a healthy weight and stay fit. Regular exercise reduces fatty acid synthesis, increases fatty acid oxidation and prevents hepatocellular and mitochondrial damage.

Avoid Salted and Fried Foods

High in calories and fats, fried foods can make it a tough job for the liver to deal with them. With increased calorie intake, the chances of putting on weight also increases. Obese people are more at risk of developing fatty liver disease. The Journal of Agriculture and Food Chemistry has published a study stating that too much sodium harms the liver. Excess of sodium in the diet can lower cell division and increase cell deaths in the liver, which can cause liver fibrosis.

Natural Remedies

There are plenty of simple ingredients in everyday use that can bring positive outcomes and enhance the healing process of damaged liver.

Turmeric

Curcumin present in turmeric helps protect the liver cells from non-alcoholic fatty liver disease (NAFLD) when appropriately administered.

Cinnamon

Cinnamon has strong anti-inflammatory properties that are effective in bringing down the inflammation in the liver.

Indian Gooseberry

Amla or Indian Gooseberry is stuffed with antioxidants and Vitamin C that protects the liver from damage and cleans the toxins.

Apple Cider Vinegar

When it comes to home remedies, apple cider vinegar is a preferred choice since it has amazing detoxification properties. Apple Cider Vinegar works by helping the liver flush out the toxins that can interfere with the body’s normal functioning.

Stay Hydrated

When the body is well-hydrated, the toxins are easily removed from the body and blood flow is also improved. Daily 10-12 glasses of water are necessary to keep the body adequately hydrated.

August 19, 2021 0 comment

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Patients with Hepatitis should be vaccinated for Covid on Priority basis, experts suggest

by Medically Speaking Team July 28, 2021

written by Medically Speaking Team

According to the World Health Organization, “Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.”

WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year. World Hepatitis Day takes place every year on 28th July to bring the world together under a single theme to raise awareness of the global burden of hepatitis especially with more focus on viral hepatitis and to influence real change.

To discuss the same we had a panel of experts: Dr Anil Arora, Head of Gastroenterology Dept, Sir Gangaram Hospital; Dr. Sanjeev Sehgal, Principal Director, Liver and Hepatology, from Max Chain of Hospitals; Dr Sudeep Khanna, Senior Consultant, Gastroenterology Dept, Apollo Chain of Hospitals.

Dr. Sehgal, why is hepatitis such a crucial problem? According to WHO reports a person dies of Hepatitis dies every 30 second.

Dr. Sanjeev Sehgal: Hepatitis is a huge burden in our country as it is worldwide. Hepatitis basically means inflammation of the liver ad the prime reason for this are the hepatitis viruses which are of four types primarily: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D. Hepatitis A and E are self-limiting and spread through feco-oral route by contaminated food and water. Hepatitis B and C are huge burden in our country and spread through parenteral route, that is by blood and body fluids. In India, Hepatitis B has a prevalence of 2-7% and Hepatitis C is 0.5-1.5%. They constitute a huge number if patients in the county and are very important cause of liver related deaths in the country. They also cause liver failure, liver cancer and so on. Thus, it should be our topmost priority to treat and cure this disease.

40 million people in India are HBV infected and constitute about 11% of the global rate. What would you say Dr. Arora?

Dr. Anil Arora: This topic is very pertinent as Covid will come and go but the illnesses like Hepatitis have not gone ever since. Certain viruses are spread through contaminated water and infected fluid, which are totally preventable. This is a prevalent issue in developing countries like India and South Asian nations whereas it has been totally eradicated in developed countries. Simple provision of safe drinking water and hygiene can prevent Hepatitis A & E. Virus spread through parental route are problematic. Hepatitis B & C are neglected, and like you said there are 40 million carriers of the infection unaware of the fact that they are infected, hence they are not only potentially disease developers but are also becoming a threat for their families. By increasing awareness, we can prevent this.

Dr. Khanna would you agree with Dr. Arora that there is a problem of awareness that needs to be tackled right away?

Dr. Sudeep Khanna: I would like to add something to it, people know that something like this exists but they are not ready to accept it. A recent study conducted on 1 lakh children from India concluded that only 50% of the children were vaccinated against Hepatitis B.

Isn’t it covered under Universal Health Immunization? Then why aren’t people getting vaccinated?

Dr. Sudeep Khanna: For the same reason as why they wouldn’t get anti-covid vaccine. This becomes a problem for us to help people. The vertical and horizontal transmission from mother to baby and during close contact is the most common cause of Hepatitis B. People need to be tested, treated and educated.

Dr. Arora, we rightly spoke about how people are not even ready to accept it. So what can people do to prevent this stigma?

Dr. Anil Arora: A wonder drug called DAA has been discovered which can cure almost any type of Hepatitis C and hence it is as curable as any other disease but Hepatitis B is problematic. They are not aware of the fact that they may be carrying the virus in their blood for ages before they come down with advanced diseases like Cirrhosis and Carcinoma. My advise will be that anybody with a history of liver transplant, blood transmission, surgery, needle prick trauma or even dental manipulation should get a checkup for Hepatitis B. Now coming to vaccination, Hepatitis B vaccines has been available for over three decade at very low rate and very efficient.

There are about 1.1 million who have died due to Hepatitis, and 3 million are still carrying the disease worldwide. How do we really address this in India especially with the urban rural divide?

Dr. Sudeep Khanna: Multimedia and TV are such a big medium and still unused to their full capacity. A lot of people don’t know about Hepatitis C and lack of initiative from the authorities and doctor bodies are causing this. The disease is significantly asymptomatic and by the time they are symptomatic it is too late. So it is all about awareness.

Dr. Arora, what can one do if one is already infected with Hepatitis B? What about cure?

Dr. Anil Arora: There are two aspects of patient suffering from Hepatitis B, unlike other illnesses, if someone gets an infection today, there are 5% chances that as an adult they will carry the virus in the blood for the next 6 months that is called chronic carrier state and may develop the disease later in life. They remain asymptomatic and thus do not bother about it. This is where screening is needed and if a person is accidentally positive for Hepatitis B, he can be treated with antiviral therapy or else he may spread it to his family. In early diagnosis, regular follow up goes a long way in preventing the chronic illness.

Dr. Sehgal, can a patient of Hepatitis B follow up with their checkup if infected with Covid?

Dr. Sanjeev Sehgal: Patients ask that if I am Covid positive then what happens with the other problems of mine and if you look at Hepatitis, the patients are consulting specialist doctors, and hence can manage with a teleconsultation and it is not required to come to the hospital. If there is an emergency, then they should visit the hospital no doubt. If a Hepatitis patient is Covid positive and taking the concerned medications, I would recommend that they don’t stop taking medicines for Hepatitis as this may provide a flare to the disease.

Dr. Khanna, are the patients with Hepatitis at a greater risk if they get Covid? Are they furthermore immunosuppressed like we have seen in Cirrhosis?

Dr. Sudeep Khanna: If one has Cirrhosis, they are not at higher risk of getting infected. If in case the liver function goes down, the risk of Covid complication increases. Similarly, being infected with Hepatitis B or C does not mean that you are at higher risk of getting Covid. There should be no fear of vaccination.

Dr. Arora, what would you say on the point “ No fear of vaccination”?

Dr. Anil Arora: Liver is a vital organ in many functions including metabolism and immunity. Once you have severe Covid, liver gets involved in the immunity in many patients. Patients who have underlying liver disease should be given vaccine on a priority basis. Because liver handles all the drugs given to the covid patient.

In what conditions in Covid patients does it lead to diseases like Cirrhosis other complications?

Dr. Sanjeev Sehgal: If you develop Jaundice due to contaminated food or water, it is a small chance that they may develop rapid deterioration and altered sensorium thus may have to be admitted to ICU. If someone has chronic disease like Hepatitis B or C and catch infection like Pneumonia, Covid, etc. then they may develop a liver failure. These are the two situation which may cause rapid deterioration and both the type of patients should be diagnosed early and quick treatment can save these patients.

How can the person know that they are carrying the Hepatitis infection?

Dr. Sudeep Khanna: For most of the patients, the disease is asymptomatic. And hence is it not possible for them to diagnose through symptoms. Tiredness, although is a primary symptom so if you have fatigue throughout the day, you may have Hepatitis. One other way is to know if a family member is diagnosed with Hepatitis, one may be a carrier for the disease. Also, screening the high risk population is a way out.

Dr. Arora, we spoke about who all should get tested, what will be your suggestion to all the policy makers?

Dr. Anil Arora: the only way to pick it up early and diagnose is by testing. So my suggestion is that whenever going for any sort of blood test or screening, get tested for Hepatitis B and C. and executive check up is becoming a routine. It should be mandatory and if an asymptomatic patient is not checked up early, the cost of long-term disease treatment is enormous. While it is very cost effective in early stages.

Dr. Sehgal, is there anything that we can do to prevent it other than screening or vaccination?

Dr. Sanjeev Sehgal: As we discussed, we have to identify the high risk population. We need to look for any family member with Hepatitis. If you have a liver problem, you should get it checked. Then you need to avoid contaminated food and liquid. Be careful in interpersonal relationships. Dialysis and following all protocols strictly may help diagnose and treat Hepatitis. We should follow universal practice of screening people. Be aware and screen people which may help people to curb the disease.

What do you suggest policy makers, institutions and common people to eliminate the disease?

Dr. Sudeep Khanna: As an individual I can only think of vaccine being made mandatory which is very difficult in the democracy. Other than that nothing is going to help.

Since we all go to annual checkups, our panelists suggest that do get checked up for Hepatitis on a routine basis, avoid contaminated food and get proper vaccination.

July 28, 2021 0 comment

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World Hepatitis Day: Hepatitis Can’t Wait

by Medically Speaking Team July 28, 2021

written by Medically Speaking Team

Dr Naveen Polavarapu

Sr Consultant Gastroenterologist and Transplant Hepatologist, Apollo Hospitals, Jubilee Hills.

Dr K.S. Soma Sekhar Rao.

Consultant Gastroenterologist and Hepatologist, Apollo Hospitals, Jubilee Hills.

Dr D K Raghu,

Consultant Gastroenterologist and Hepatologist, Apollo Hospitals, Jubilee Hills.

Dr Sarathchandra G

Consultant Gastroenterologist and Hepatologist, Apollo Hospitals, Jubilee Hills.

On world hepatitis day today, here are some facts about liver, causes of hepatitis, symptoms, diagnosis and prevention of the disease complications.

According to WHO, Liver cancer is the fastest growing cancer in the World currently and a person is dying every 30seconds from hepatitis related illness even in the current COVID-19 crisis. World Hepatitis Day takes place every year on 28th July to bring the world together under a single theme to raise awareness of the global burden of hepatitis especially with more focus on viral hepatitis and to influence real change.

What is Liver and what does it do?

Liver is the largest organ in the human body which performs more than 500 vital functions. All the food that we eat including carbohydrates, fats, minerals gets metabolised in the Liver after getting absorbed from the intestines. It produces important proteins which help in clotting of the blood. Liver along with kidneys work like a filter removing all the toxins and acids from the body. It also plays a crucial role in maintaining adequate sugar levels in the body and also acts like a storage organ.

What is hepatitis?

Hepatitis means inflammation of the liver which if unchecked will lead to significant permanent damage to the Liver and life risk. The most common causes of Liver damage are Viral Hepatitis (mainly B,C), fatty Liver and alcohol. Along with these there are more than 100 different causes of Liver damage which will lead to Cirrhosis (end stage Liver disease).

Why is it important to know about Viral Hepatitis?

Hepatitis B directly has been causing 10 lakh deaths every year for the last few decades. It is estimated that around 200 crores population is currently or previously infected with Hepatitis B and around 35 crore population is currently infected and carrying this Hepatitis B virus. Around 75% of these infected people are in Asia and Africa. People with Hepatitis B have 100 times more risk of developing Liver cancer compared to people who do not have Hepatitis.

Similarly Hepatitis C is estimated to be present in 18 crore populations worldwide and most often cause long-term significant damage to the Liver leading to irreversible cirrhosis and Liver cancer. In fact 2 out of 3 Liver cancer deaths are related to Viral Hepatitis.

What are the symptoms and signs of hepatitis?

Liver is such a brilliant organ that it copes until it is at least more than 80% damaged and by the time symptoms appear it is often too late, hence Liver is like a silent killer.

9 out of 10 people don’t even know that they have the virus and often it gets picked up whilst doing routine testing for other reasons.

Common symptoms they present with are Jaundice, tummy swelling, leg swelling, blood vomiting or black stools, confusion and drowsiness. These symptoms appear only when the Liver is significantly damaged.

How can I get checked if I have the virus?

Detection of these viruses is with a simple blood test, which is widely available. Once these viruses are detected then the Liver specialist will evaluate the stage of the virus and also the amount of the damage that has happened to the Liver. Based on these we can offer further treatment.

Are there any treatments available?

If recognised early, Hepatitis is treatable and sometimes curable too. We can arrest the progression to cirrhosis by early recognition of these viruses and early commencement of the medications.

There are excellent medications available now to completely cure the Hepatitis C. You just need to take one tablet a day for generally 3 months with almost 99% chance of completely curing the virus therefore eradicating the risk of future Cirrhosis and Liver cancer.

For Hepatitis B also there are excellent medications to control the virus. Of course there are excellent vaccinations available for Hepatitis B and A.

We at Apollo Hospitals have been running dedicated Liver clinics specifically designed to treat and cure these deadly viruses. We have the state of the art equipment and expertise to identify and treat these viruses with excellent cure rates. In patients who have developed advanced Liver disease, we have been treating them with excellent outcomes and in patients who need Liver transplant as the only mode of survival, we have been doing them at our centre successfully for nearly 10 years.

The theme of World Hepatitis Day 2021 is “Hepatitis can’t wait” to raise the awareness among masses. It is strongly recommended that all of us get checked for these deadly silent killing viruses and if negative then let us get vaccinated.

In fact WHO goal is to make the HEPATITIS FREE WORLD BY 2030 and it is achievable by all of us doing our part in coming forward, getting checked and treated if positive or vaccinated if negative. And we all know that prevention is better than cure.

July 28, 2021 0 comment

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Unusual Large And Multiple Liver Abscesses in Patient Recovered From COVID-19

by Medically Speaking July 22, 2021

written by Medically Speaking

During the second wave of the COVID-19, in April-May 2021, a number of COVID-19 patients presented with some unusual manifestations. We saw for the first time in last two months unusually large and multiple liver abscesses in fourteen patients after recovery from COVID-19 infection. Liver abscess (Pus formation in Liver) is commonly caused by a parasite known as Entamoeba histolytica (Picture attached) which is transmitted by contaminated food and water.

According to Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, “What we found unusual was that after recovery from Covid within 22 days in patients who were otherwise immunocompetent had large areas of both lobes of liver filled with pus at multiple locations requiring drainage and hospitalization.”

Prof. Anil Arora, further added “These patients were of age group between 28-74 yrs, ten were males and four females. All patients had fever and upper abdominal pain and 3 patients also had associated lower GI bleeding with black coloured stools. Eight of these patients received steroids for the management of COVID-19 symptoms. Six patients had multiple large abscesses in both lobes of liver of which 5 patients had unusually large abscess (>8cm) the largest being 19 cm size (Figures attached). Three patients who had blood in stools showed ulcers in large intestine which were detected by colonoscopy (large intestine were seen through a camera). Median duration between COVID-19 symptoms and diagnosis of liver abscess was 22 days. Thirteen out of Fourteen patients were successfully treated with antibiotics, Metronidazole medications and drainage of pus from the liver. While one patient with large multiple abscesses died due to massive bleeding in abdomen after rupture of abscess in the abdominal cavity. Rest are stable and have been discharged.”

Prof. Anil Arora also said that “In our patients we found multiple and large abscesses which is very unusual for an immunocompetent person. We believe that suppression of immunity by COVID-19 infection along with use of steroids to treat Covid infection per se, low index of suspicion for liver abscess and delay in treatment in patients recuperating from Covid in this pandemic probably led to development of multiple and large abscesses in Liver.”

Entamoeba histolytica is a common parasite in countries with poor sanitation services. This parasite causes amoebiasis, an intestinal infection that is also called amoebic dysentery. After an infection has occurred, the parasite may be carried by the bloodstream from the intestines to the liver and causes liver abscess. Normally these abscesses are single and not very large and picked up early on routine ultrasonography of the abdomen as a part of workup for fever and associated symptoms in immunocompetent patients. Poor nutrition, immunocompromised status (like in HIV and cancer patients) and steroid use predisposes patients to these infections by amoeba causing liver abscesses.

In this present pandemic, a high index of suspicion of such infections in the form of fever and pain in right abdomen merits a timely intervention in the form of an early diagnosis and effective medical therapy can effectively save uncalled misery and avoidable hospitalization in these patients, said Dr. Praveen Sharma, Senior Consultant Gastroenterology, Sir Ganga Ram hospital.

July 22, 2021 0 comment

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A new hernia centre is launched by GEM Hospital

by Medically Speaking Team July 12, 2021

written by Medically Speaking Team

CHENNAI: Ma Subramaniam, Health and Family Welfare minister, inaugurated GEM Laparoscopic & Robotic Institute for Hernia and Abdominal Wall Reconstruction at GEM Hospital Chennai, which is a comprehensive speciality centre for hernia care.

Congratulating the doctors on opening a speciality care centre for hernia, he said, “Hernia is a most common surgical problem affecting all age groups and most commonly the labourers and agriculture workers.

Laparoscopic repair reduces recurrence, recovery is faster and helps in early return to routine work which is very important to daily labourers for their day today living. I appeal to GEM Hospital to provide guidance and training on new laparoscopic surgical techniques to surgeons in government service. Government of Tamil Nadu will provide Laparoscopic treatment for the public through Comprehensive CM insurance scheme.”

Dr C Palanivelu. founder and chairman, GM Hospitals, explained the occurrence of hernia and the different treatments. “For the first time in India, a comprehensive approach to hernia will be deployed with a hernia specialist, plastic surgeon, anaesthetist, intensivist, pulmonologist and pain specialist at GEM hospital,” he said.

Dr S Asokan, CEO, GEM Hospital Chennai spoke of the minimally invasive method while Dr P Senthilnathan, director, GEM Hospital Chennai said that as part of the launch, free hernia camps will be organised regularly in the outskirts of the city to create awareness among people.

July 12, 2021 0 comment

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