This issue of the Indian Journal of Gastroenterology has some interesting articles from different parts of the world. These include Original Articles, Systematic Reviews and Meta-Analyses, Short Reports, Letters to the Editor and Images in Gastroenterology. Here’s a glimpse of the issue contents.

Prothrombotic states in portal vein thrombosis and Budd-Chiari syndrome in India: A systematic review and meta-analysis

Prothrombotic states play a potential role in the pathogenesis of portal vein thrombosis (PVT) and Budd-Chiari syndrome (BCS). The spectrum and causes for PVT and BCS are different across the globe. Giri et al., in their systematic review and meta-analysis, explore the prothrombotic profile in patients with PVT and BCS in India [1]. The results suggest the presence of at least one prothrombotic condition in 46.2% and 44.9% of patients with PVT and BCS, respectively. Overall, the prothrombotic profile differs in Indian patients from that reported in the west.

Prevalence of hepatic encephalopathy in patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis

Giri et al. [2] provide a systematic review and meta-analysis of hepatic encephalopathy in patients with non-cirrhotic portal hypertension (NCPH). The authors report that one in three patients (adults or children) with NCPH have minimal hepatic encephalopathy (MHE), whereas overt hepatic encephalopathy (HE) is uncommon and present in 1.2% of patients only. Future studies are needed to explore the effect of MHE and HE on clinical outcomes. At present, HE management is on the lines of patients with cirrhosis. Future studies are needed to explore the management options in such patients.

Comparison of the mechanical properties of retrieval basket catheters for bile duct stones: An experimental study

The choice of baskets is usually based on the endoscopist’s preferences. In an experimental study, Inoue et al. [3] from Nagakute, Aichi, Japan, evaluated the mechanical properties—the axial and radial force—of baskets used for bile duct stones. This study helps in understanding the properties and criteria that can be utilized to select a better basket for different endoscopic procedures.

Combination of antimicrobials for non-specific isolated terminal ileal abnormalities—A randomized clinical trial

Antibiotics are one of the most commonly used medicines and it is unclear if their use is of benefit for non-specific isolated ileal abnormalities. Kumar et al. [4] from Bhubaneswar, India, compared the use of antibiotics vs. symptomatic therapy for the management of patients with non-specific isolated ileal abnormalities. Ileal abnormalities are not uncommon and in the absence of florid signs of other etiologies, the clinical relevance and treatment of these abnormalities is unclear. Although a small sample size, the study results do not show the benefit of antibiotics in patients with non-specific ileal abnormalities.

Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn’s disease: A cohort study from northern India

Singh et al., [5] from Ludhiana, India, in a series of Crohn’s disease (CD) patients, provide the details of the clinical presentations and magnetic resonance imaging findings in cases with complex perianal fistulizing disease. A majority of the fistulae were active and trans-sphincteric. Females accounted for 63% of all cases. The authors report that the cumulative rates of development of perianal fistula in the population studied were similar to that reported from the west.

To evaluate the prevalence of spontaneous portosystemic shunts in decompensated cirrhosis patients and its prognostic significance

Kothari et al. [6] from Vaishali, Ghaziabad, India, report the prevalence and clinical decompensating events in a prospective study of 92 patients with cirrhosis. Almost 60% of patients had a spontaneous portosystemic shunt (SPSS), with no differences across etiologies. As expected, patients with large SPSS had higher rates of hepatic encephalopathy on follow-up. It would be interesting to see how such patients behave with the embolization of shunts in terms of liver function tests and clinical outcomes in well-designed studies.

Transcriptional analysis of Helicobacter pylori cytotoxic associated gene-pathogenicity island (cag-PAI) in response to different pH levels and proton pump inhibitor exposure

Helicobacter pylori is common and associated with gastritis, ulcers and carcinoma in the stomach. The pathogenesis of complications is still unclear. Rezaei et al. [7], from Tehran, Iran, in an in-vitro study, report that omeprazole is associated with an increase in the expression of H. pylori cag A and cag L at acidic pH. Although a small sample size study, the results are important, as they provide insights into the interaction of omeprazole with H. pylori in vitro. How this effect is translated in vivo needs to be explored.

Survival outcomes of anal adenocarcinoma versus rectal adenocarcinoma: A retrospective cohort study

Mankarious et al. [8], Hershey, PA, USA, in a small sample size study, compared the clinical outcomes of patients with anal (n = 16) and rectal (n = 30) adenocarcinoma. The survival in patients with anal adenocarcinoma was significantly less than those with rectal adenocarcinoma with similar treatment. The Kaplan-Meier curves were separate even with a small sample size with variable treatment. The major limitation of the study was the small sample size and the results need to be validated in larger sample sizes across populations.

Differences in Coronavirus disease-19 vaccination-related side effects in patients with ulcerative colitis and Crohn’s disease in Japan

Coronavirus disease-19 (Covid-19) is associated with increased mortality, especially among patients with comorbidities. The Covid-19 vaccines were developed over a short period of time and have been shown to reduce mortality. Miyazaki et al. [9], from Chuo Ku, Kobe, Japan, in a cross-sectional survey of 195 patients with inflammatory bowel disease, 134 with ulcerative colitis (UC) and 61 with Crohn’s disease (CD), report the side effects and factors related to adverse events in patients who received Covid-19 vaccination. There were no differences in the side effects between patients with UC and CD. The use of corticosteroids was associated with muscle pain after Covid-19 vaccination. Young age, female sex and history of smoking were associated with increased occurrence of adverse events after vaccination. The study adds to the existing evidence towards the safety of Covid-19 vaccines.

Gastrointestinal involvement in gallbladder cancer: Computed tomography findings and proposal of a classification system

Soundararajan et al. [10], from Chandigarh, India, report a computed tomography (CT)-based classification for gastrointestinal (GI) involvement in patients with carcinoma gallbladder. The authors have described GI involvement as probable, definite and fistulization. A major drawback is the inter-individual variability in reading the CT images. This classification system needs validation across centers. It would be important to see how this CT-based classification performs in patient management decisions. In addition, the clinical outcomes over time in patients need to be seen, based on the proposed classification.

Falsely elevated anti-tissue transglutaminase antibodies in patients with immunoproliferative small intestinal diseases: A case series

Celiac disease (ceD) is an important cause for diarrhea and is being recognized more frequently these days with the availability of easy-to-do tissue transglutaminase IgA (tTg-IgA) test. The specificity of the test for CeD is 90%; therefore, it is important to know about conditions with similar presentations as CeD in which the tests may be falsely positive. Mohta et al. [11], from New Delhi, India, in their case series of 11 patients with immunoproliferative small intestinal disease (IPSID), found IgA-tTG to be false positive (defined as a titre above the upper limit of normal) in 8/11 (72.7%). Their data reiterates that duodenal biopsy is essential in diagnosing CeD and differentiating it from other diseases with similar clinical presentations.

Real-world effectiveness and safety of ustekinumab and vedolizumab in elderly patients with Crohn’s disease

Garg et al. [12], from Cleveland, OH, USA, report the effectiveness and safety of ustekinumab and vedolizumab in a series of 78 elderly patients with CD in a real-life scenario. The authors observed similar clinical responses and steroid-free responses. Infusion reactions and infections in the two groups were low. The data reiterates that these drugs are safe for older people and associated with good clinical and endoscopic responses.

Significant gut microbiota related to patterns of drinking and alcohol relapse in patients with alcoholic hepatitis undergoing stool transplant or corticosteroid therapy

Gut microbiota has been linked to many diseases. It is unclear whether the change in the gut microbiome is the reason for the disease or it is secondary to the disease itself. Philips et al. [13], from Aluva, India, explore the role of gut microbiota and its association with alcohol use patterns and alcohol relapse in patients with alcoholic hepatitis, who underwent fecal microbial transplantation or were treated with corticosteroids. The results are exciting from this one-of-a-kind study from India. Although a small sample size study, the results suggest possible distinct gut microbiome patterns in these patients. Future studies are needed in larger sample sizes to explore the role of gut microbiota in alcoholic hepatitis further.