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Abstract Background and Aim Azathioprine (AZA) forms the cornerstone for maintenance of sustained remission in inflammatory bowel disease (IBD). There is apprehension regarding the long‐term effectiveness and safety of AZA in IBD. We present our experience with AZA use and outcomes in a cohort of IBD patients followed up over a long period of time. Methods Records of 507 IBD patients under treatment at a single, tertiary care center in south India between 2013 and 2022 were evaluated retrospectively. Long‐term compliance, tolerance, clinical outcome at the point of last follow‐up, type and duration to the onset of adverse events, and subsequent amendment to treatment with regard to AZA were analyzed. Results Of 507 patients with IBD, 320 patients (207 Crohn's disease [CD], 113 ulcerative colitis [UC]) who received AZA were included. The median follow‐up was 41 months (interquartile range 15.5–77.5). Total duration of exposure was 1359 patient‐years with median usage of 33 months. Of the patients, 26.9% received AZA for >5 years. Mean initiation and maximum doses of AZA were 0.97 and 1.72 mg/kg/day. Among the participants, 20.6% experienced side effects, including myelotoxicity (7.2%) and gastrointestinal intolerance (5.6%). Six patients developed malignancy. Among the side effects, 39.4% of side effects were dose‐dependent. Among the patients, 38.1% had relapses requiring pulse corticosteroid therapy, and 16.2% had more than one relapse after commencement of AZA. AZA was continued till the last follow‐up in 76.5%. Among the patients, 49.7% (UC 51.3, CD 48.8) attained durable remission without biologics, and 5.3% continued to have active disease. Conclusion AZA is safe and effective in the long‐term in IBD. Effectiveness, tolerance, and compliance with AZA are well sustained beyond 5 years of usage and comparable between UC and CD.

Many gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.

Aim: Metabolic syndrome (MeS) refers to metabolic risk factors with different phenotype combinations. The study aim was to determine the clusters of MeS components by age and gender as predictors for the presence of fatty liver (FL). Materials and Methods: The cohort consisted of 990 subjects, undergoing executive health check between January 2019 and February 2020. Baseline data, anthropometric parameters, and ultrasound findings were noted. Patients with normal ultrasound were categorized as group 1 and those with FL as group 2. MeS is defined and clustered and risk of predicting FL was analyzed in age and gender. Results: Of the 990 subjects, 689 (69.6%) had FL (group 2); 554 patients (56%) were >45 years. Females had significant grade 1 (P < 0.05) and grade 2 (P < 0.01) FL, ≥45 years, and MeS of three or more components in FL, both above (P < 0.01) and below (P < 0.03) 45 years of age. Waist circumference (WC), diabetes mellitus (DM) with hypertension, triglyceride, and high-density lipoprotein (cluster 3) were statistically significant in males, both 45 years of age (P < 0.001); in females, the same cluster was statistically significant only for >45 years (P

Abstract Background Achalasia cardia is a rare esophageal motor disorder that is frequently diagnosed late. Aim The aim of this study was to study the symptoms, treatment given, and response to treatment in patients with achalasia cardia in an Indian setting. Materials and methods This retrospective study included all patients diagnosed with achalasia cardia on high‐resolution esophageal manometry, using Chicago Classification v 3.0. On follow up, patients were contacted by telephone, and details of the treatment given and response were recorded in a predesigned pro forma. We excluded overseas patients, postoperative cases of achalasia, and those in whom the manometry catheter could not be passed across the gastroesophageal junction. Results A total of 452 patients (260 males, median age 44.5 years) were included in the study cohort. The major symptoms included dysphagia for solids and liquids (428, 94.7%), regurgitation (360, 79.6%), naso‐oral regurgitation (182, 40.3%), weight loss (322, 71.3%), and chest pain (158, 35%). Type 2 achalasia (229, 50.6%) was the most common subtype, followed by type 3 (154, 34.1%). Chest pain was more common in type 3, and weight loss and naso‐oral regurgitation were more common in type 2 achalasia. A majority of patients underwent Heller's myotomy and pneumatic dilatation. Of 280 patients for whom treatment details were available, 98% reported good response to endoscopic/surgical management. Conclusion The predominant symptoms of achalasia cardia vary per the manometric subtype. Heller's myotomy and pneumatic dilatation are the most commonly used treatment options. Response to treatment is good. The choice of treatment modality was likely influenced by financial reasons and availability of local expertise.

The major drawback of conventional white light endoscopy (WLE) is that it lacks accuracy in diagnosis and differentiation of various benign and premalignant mucosal gastrointestinal lesions. To overcome this, image-enhanced endoscopy techniques, which provide high-definition images with good resolution and contrast enhancement, have been developed. One such technique is narrow-band imaging (NBI). NBI functions by filtering the illumination light. The red component of the standard red, green, and blue filters is rejected and the selected bandwidth of the blue and green light is transmitted. The present review highlights the role of NBI in diagnosis of benign gastric lesions like atrophic gastritis, Helicobacter pylori–related gastritis, intestinal metaplasia, and other rarer conditions. NBI is a simple procedure which does not require any additional equipment and does not have a long learning curve. Use of NBI in daily practice is likely to improve detection of mucosal abnormalities.

Background and Aim To determine the concordance of liver explants with the pretransplant diagnosis. Methods This was a retrospective analysis of 251 liver explants. Patient information included demography, comorbidity, and etiological diagnosis. Final diagnosis was based on morphological and histological findings. For non‐alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis, we investigated comorbid states such as obesity, hypertension, and diabetes. Chi square test and Cohen's Kappa value were used. A P value of

Background and Aim Regional differences in gallstone (GS) composition are well documented in the Indian subcontinent. The reasons for the same are unknown. Etiopathogenesis of GS remains elusive despite advances in instrumentation. This was an in‐depth analysis of the chemical, structural, and elemental composition of GS with special reference to synchroton studies. Methods We used high‐end sensitive analytical complementary microscopic and spectroscopic methods techniques, such as X‐ray diffraction, scanning electron microscopy, Fourier transform infrared, synchrotron X‐ray fluorescence spectroscopy (SR‐XRF), and 2D and 3D synchrotron microtomography (SR‐μCT), to study the ultra structure and trace element composition of three major types of GS (cholesterol, mixed, and pigment). SR‐XRF quantified the trace elements in GS. Results The cholesterol GS (monohydrate and anhydrate) were crystalline, with high calcium content. The pigment GS were amorphous, featureless, black, and fragile, with high calcium bilirubinate and carbonate salts. They had the highest concentration of iron (average 31.50 ppm) and copper (average 92.73 ppm), with bacterial inclusion. The mixed stones had features of both cholesterol and pigment GS with intermediate levels of copper (average 20.8 ppm) and iron (average 17.78 ppm). Conclusion SR‐μCT has, for the first time, provided cross‐sectional computed imaging delineating the framework of GS and mineral distribution. It provided excellent mapping of cholesterol GS. SR‐XRF confirmed that pigment GS had high concentrations of copper and iron with bacterial inclusions, the latter possibly serving as a nidus to the formation of these stones.

Background: A good bowel preparation for colonoscopy is the most important factor that has an impact on visualization and outcome of the procedure. Aim: The primary aim of the study was to assess the quality of bowel preparation as reported by the Boston Bowel Preparation Score (BBPS). The secondary aim of the study was to analyze the patient feedback on ease of administration, palatability, and side effects with the bowel preparation. Materials and Methods: Patients undergoing colonoscopy between March 2018 and September 2018 were enrolled in the study. Patients

Aim: This study aimed to determine the mortality in Indian patients awaiting liver transplantation and to assess the impact of cirrhosis-related complications (CRCs) on mortality. Materials and Methods: This was a prospective study on patients of Indian origin, aged >18 years, with cirrhosis liver (confirmed by imaging and/or liver biopsy), and registered for liver transplant (LTx) between November 2015 and May 2016. Patients were followed up for at least a year. Any admission or day-care procedure for complications after registration was recorded as an event, and outcome was noted as recovered, deterioration, or death. The primary end point of the study was LTx, survival, or death. Patients undergoing transplantation were grouped with survivors for analysis of factors predicting waitlist mortality. Statistics: t-test, Chi-square test, Mann–Whitney U-test, and univariate and logistic regression analyses were used for statistical analysis. P < 0.05 was considered statistically significant. Results: A total of 227 (72.3%) registered patients survived. Waitlist mortality at 1 year was 27.7%, and the waitlist mortality rate was 33.8 deaths/100 patient-years. A significant proportion of nonsurvivors belonged to the Child–Turcotte–Pugh C score (P = 0.031), with higher Model for End Stage Liver Disease (P = 0.002) and greater frequency of CRC (P < 0.001). Hepatic encephalopathy (HE), renal dysfunction (RD), infection, and variceal bleeding were significantly associated with death. A higher proportion of nonsurvivors had combination of more than two CRCs. Conclusion: The waitlist mortality was 27.7%. Complications such as variceal bleed, spontaneous bacterial peritonitis, HE, and RD were significantly high in nonsurvivors.

Background: Cirrhotic cardiomyopathy (CCM) occurs in 39.4%–48.3% of patients with chronic liver disease with or without decompensation. A significant number of patients are likely to be listed for liver transplantation (LT). The early outcome of LT in these patients is not known. Aims and Objectives: The aim is to study the prognostic implication of CCM on survival at 3 months post-LT. Materials and Methods: This prospective study was conducted from July 2016 to July 2017. Patients, who were diagnosed as cirrhosis of the liver based on clinical, biochemical, imaging, and endoscopic findings, were included in the study. After informed consent, details of demography, comorbidity, and cirrhosis-related complication were noted. Cardiac evaluation included electrocardiography, two-dimensional echocardiography, dobutamine stress test, and coronary angiography whenever indicated. CCM was diagnosed based on the standard criteria. Patients who underwent LT were followed up in the posttransplant period up to 3 months. Statistics: Mann–Whitney U-test, Chi-square test, and Kaplan–Meier survival plot were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Five hundred and eighty-six adult patients with cirrhosis of the liver underwent cardiac evaluation. One hundred and ninety-eight (33.8%) patients were diagnosed with CCM. Forty-one patients underwent LT. Following LT, there was an improvement in diastolic dysfunction in a third of patients (12 patients; 29.3%) but with no survival benefit at 3 months (P = 0.23). Higher baseline model for end-stage liver disease and left ventricular diastolic dysfunction were more common among nonsurvivors. Conclusion: CCM does not influence the short-term survival in patients undergoing LT.

Aim: Retrospective analysis of medical records to determine whether diabetes mellitus (DM) was a risk factor for hepatocellular carcinoma (HCC) and whether it enhances the neoplastic potential of hepatotropic virus-related chronic liver disease (CLD). Materials and Methods: Patients registered between April 2017 and March 2018 with a clinical diagnosis of HCC in a pre-existing CLD were included. Controls were patients with CLD registered during the same period but with no HCC. Prevalence of DM, hypertension and coronary artery disease (CAD) alone or in combinations was noted in the two groups. The odds ratio (OR) of developing HCC was calculated independently for DM, hepatitis B and hepatitis C infection alone and in combinations. Chi-square test, Mann–Whitney test and OR calculation were done. A P < 0.05 was considered statistically significant. Results: The study population consisted of 150 cases of CLD with HCC and 812 controls (CLD with no HCC). CLD patients with HCC were significantly older (P < 0.0001) with a male preponderance, but no gender predisposition (P = NS). The overall prevalence of DM in patients with CLD was 31.9%, more significant amongst cases than in controls (50.7% vs. 28.7%) (P < 0.0001) and also for a significant duration (10.6 vs. 3.8 years; P < 0.03). Amongst the cases, comorbid conditions such as hypertension and CAD and diabetes in combination with hypertension and CAD was also more frequent among cases (P = 0.0001).The odds of developing HCC in CLD was higher for DM. The OR for HCC was highest for DM with hypertension and/or CAD at 4.69 (3.19–6.88, P < 0.0001). Conclusion: DM and other constituents of metabolic syndrome such as hypertension and CAD are significantly more common in CLD patients with HCC. DM is of prolonged duration and is a risk factor increasing the neoplastic potential of CLD.

Aim: This study aims to determine the clinical presentation, and ileal mucosal changes during colonoscopy for which terminal ileal (TI) biopsies were taken at our center and to determine the specific histopathology which had the best yield for specific colonoscopy findings. Materials and Methods: Retrospective audit of all patients who underwent colonoscopy with ileoscopy between 2012 and 2016. All patients with TI mucosal changes and normal colonic mucosa, who underwent ileal biopsy, were included in this study. Patient data regarding age, gender, indication for ileocolonoscopy (screening for colorectal cancers, inflammatory bowel disease [IBD], or irritable bowel syndrome [IBS]) and histopathology changes were collected. Appropriate statistical tests were used and P < 0.05 was considered statistically significant. Results: One hundred and nine patients had isolated ileal lesions. The median age was 44.1 years (range 8–80 years). Men outnumbered women in a ratio of 82:27. The major clinical indications for ileocolonoscopy were IBS (64.2%), followed by IBD (22%). Ulcers (aphthoid) were the most frequent finding followed by mucosal nodularity and nonspecific findings. Ulcers in ileum were most often reported as chronic ileitis (46.2%), followed by nonspecific changes (35.2%) Biopsy from nodular ileal lesions, were predominantly nonspecific (74.4%), followed by acute (15.4%) and chronic ileitis (10.2%). About 50% of specimens with nonspecific ileal changes had nonspecific histological changes. Ileal ulcers had the highest sensitivity, PPV, and NPV for significant histological findings. Conclusion: Ileal ulcers are the significant colonoscopy findings where tissue biopsy is likely to yield a definitive diagnosis and justify specific management. Biopsies from nonspecific ileal changes and nodularity should be discouraged as it is unlikely to pick up any major abnormality.

Background: The histological nature of polyps by site prevalence and size is unclear. Aim: To determine the prevalence of polyps in patients undergoing routine lower gastrointestinal (LGI) endoscopy and identify the histological types and their characteristics by age, location and size. Materials and Methods: For this retrospective study, patients undergoing ileocolonoscopy or sigmoidoscopy between 2014 and 2016 were included. Data on age, gender, test indication, site and size of polyps and histology type were collected. Results: Two hundred and ninety (12.7%) of 2303 patients who underwent LGI endoscopy had colonic polyps (n= 317; single in 272 patients). The median age was 61.1 years (range 5-99 years) and 223 (76.4%) were men. Polyps were rare 60 years age. High grade dysplasia and carcinoma were rare (10.3%). While two-thirds of polyps

Background: The interface between tuberculosis (TB) and Crohn’s disease (CD) is relevant as TB complicates both the diagnosis and management of CD. Aim: This study aimed to identify the distinctive characteristics of ileocaecal and colonic TB (C‑TB) and colonic CD (C‑CD) at colonoscopy and to correlate the colonoscopy findings with histology. Materials and Methods: This prospective study included consecutive patients presenting with classical symptoms of TB or CD. The colonoscopic findings were compared with histology, which was taken as gold standard. Appropriate statistical tests were applied. Results: Fifty‑eight individuals fulfilled the inclusion criteria. Nine and 16 patients with C‑TB and C‑CD, respectively, had histological confirmation of respective diagnosis. In 33 specimens, the histological diagnosis was inconclusive. The sensitivity of colonoscopy for diagnosing C‑TB was high at 88.9% (95% confidence interval [CI]: 51.8–99.7). It was 50% (95% CI: 24.7–75.4) for CD. The reverse was true for CD whose specificity was high at 71.4% (95% CI: 55.3–84.3) and low for TB at 46.9% (95% CI: 32.5–61.7). All the patients diagnosed as confirmed CD or TB responded well to respective treatment. Six of the thirty patients with failed response to anti‑TB treatment required surgery or change in treatment after 2 months. Conclusion: Colonoscopic findings of isolated ileal involvement, aphthous ulcer, cobble stoning, long‑segment strictures, skip lesions and perianal involvement favored a diagnosis of CD. Correlation of colonoscopy with histology is poor for both CD and TB. The accuracy, sensitivity and specificity of colonoscopy were better and superior for the diagnosis of CD, than in the diagnosis of TB.

Background & Aim. Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of combination of TACE and sorafenib in BCLC stages B/C.Material and methods. We undertook an observational study on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival.Results. Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLC-C. Baseline characteristics were comparable. The predominant etiology was cryptogenic (37.2% and 38.5%, p = NS). 49.1% in BCLC-B and 56.9% in BCLC-C had received TACE+sorafenib. In BCLC-B, the overall survival improved from 9 months (95% CI 6.3-11.7) using TACE only to 16 months (95% CI 12.9-19.1) using TACE+sorafenib (p < 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4 months (95%CI 3-5) to 9 months (95%CI 6.8-11.2) (p < 0.0001). As per mRECIST criteria, patients on TACE+sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (p < 0.0001) in BCLC-C but not in BCLC-B group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted.Conclusion. TACE+sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients.

Background: Liver cirrhosis is a unique clinical entity wherein long-standing diabetes mellitus (DM) can predispose an individual to cirrhosis, and on the other hand, a long-standing cirrhosis liver can predispose a cirrhotic to DM, secondary to deranged glucose and insulin metabolism. Aim of the Study: The aim of this study is to determine the prevalence of impaired glucose tolerance (IGT) in patients with liver cirrhosis and risk factors predicting these patients to progression to DM. Materials and Methods: Adult patients above 18 years of age, with a diagnosis of cirrhosis of liver, irrespective of the diabetic status, the aetiology and severity of liver disease, were enrolled for the prospective cross-sectional study. The American Diabetes Association guidelines were followed for classification of DM. Fasting serum insulin assay was done for calculation of homeostatic model assessment insulin resistance (HOMA-IR) with a cut-off of >2.5. Patients with normal baseline glucose tolerance test (GTT) or IGT were followed up prospectively for 6 months at 3 monthly interval. Appropriate statistical tests were applied. Results: Of the 505 cirrhotic patients screened, 158 patients fulfilled the selection criteria. The overall mean age of these 158 patients was 53.3 ± 11.5 years; majority were men (93.7%). As a significant proportion of patients belonged to Child-Turcotte-Pugh (CTP)-C (51.3%) followed by CTP-B and CTP-A. Seventy-four patients had self-reported diabetes (46.8%) at registration. Post-GTT, the prevalence of impaired IGT was 27.4%, and new-onset diabetes mellitus (NODM) was 11.9%. Patients with CTP-C were at greatest risk for either IGT or NODM (P < 0.05). IGT+NODM patients had high median values of 2-h GTT, fasting serum insulin and HOMA-IR compared to non-diabetic participants at admission with a significant trend increase at 3 and 6 months. Conclusion: The prevalence of glucose intolerance is significantly high in individuals with cirrhosis. A 2-h GGT unmasks a significant number of cirrhosis with normal fasting blood sugar and glycated haemoglobin. A trend towards an increase in glucose intolerance and insulin resistance is noted with increasing duration of illness.

Introduction: Space occupying lesions (SOLs) of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT)/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%). The median age of presentation was 48 years (range: 11–82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1%) and nonneoplastic lesions (78.3% vs. 73.9%) and was similar to CT/MRI for benign lesions (76.9% for both). EUS-FNA had a higher specificity (87.8% vs. 80.5%) with a good PPV for benign lesions (66.7% vs. 55.6%). CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2%) and nonneoplastic lesions (79.6% vs. 81.5%) compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to both –. Conclusions: Endoscopic ultrasound-guided fine-needle aspiration had a higher specificity, but low sensitivity for the both neoplastic and nonneoplastic lesion of the pancreas compared to the world literature. The overall EUS-FNA yield was low when compared to the follow-up definitive diagnosis.

Peroral Endoscopic Myotomy has become the preferred therapy for achalasia cardia.An important predictor of the success and safety of this technique remains the correct identification of the Esophago gastric junction and the extent of myotomy. However, this key step may be difficult in a subset of patients. The present case highlights the use of double scope technique to manage such technical issues.

Hepatitis B virus (HBV)-related liver disease is a common indication for liver transplantation (LT) in Asian countries.1 When left untreated, the overall five-year survival rate in HBV-related cirrhosis is 71%, which in cases of decompensated cirrhosis decreases to 14%.2 In the 1980s, hepatitis B-related acute liver failure and chronic liver disease (CLD) were considered contraindications for LT because of almost universal graft reinfection and high rates of graft and recipient failure (>50%).3-4 These patients had severe and rapidly progressive liver disease with a two-year graft and patient survival of 50% compared to 80% in those transplanted for non-HBV-related CLD.5 As a result, there were fewer LT for HBV liver disease for several years.6 However, with the introduction of nucleoside and nucleotide analogues and the use of intra and post- operative hepatitis B immunoglobulin (HBIG), there was renewed interest in the application of LT in these patients. There was a significant decrease in post-operative HBV recurrence rates.7-9 The current overall survival of patients transplanted for HBV-related cirrhosis has improved to 85% at one year, and 75% at five years.7,10-12 The present review highlights issues pertaining to HBV reinfection and de novo infection in LT recipients with recommendations for its management.

Hepatopulmonary syndrome (HPS) is the one of the complication of liver cirrhosis with portal hypertension, irrespective of etiology, age and sex. It has also been observed in non cirrhotic portal hypertension and in acute hepatic conditions. Presence of hypoxemia or abnormal alveolar arterial oxygen tension with intra-pulmonary vasodilation in liver cirrhosis is termed as HPS. Contrast echocardiogram is the better screening tool to demonstrate intrapulmonary shunt. Clinicians should be aware of other common chronic pulmonary and cardiac comorbid conditions, in particular COPD, tuberculosis, bronchial asthma and idiopathic pulmonary fibrosis, etc. which may coexist with HPS. There is no specific clinical finding to diagnose but digital clubbing, cyanosis, dyspnoea, platypnoea, and spider naevi are more common among cirrhosis with HPS. The presence of HPS independently worsens prognosis of cirrhosis. Even though number of mechanisms have been proposed to explain arterial hypoxemia in HPS, role of nitric oxide is the major one along with cytokines. Liver transplantation is the choice of treatment though mortality is comparatively high. There is no still effective recommended medical therapy to reverse this condition and anti cytokine/ nitric oxide inhibitors, etc are under preliminary stage.

Abstract Background Helicobacter pylori (H. pylori) causes gastritis and intestinal metaplasia (IM) that may evolve to gastric carcinoma. The objective of this study was to compare the profile of mucins in the progressive stages of H. pylori infected pre-neoplastic and neoplastic human gastric epithelium. We used a panel of monoclonal antibodies with well-defined specificities of MUC2, MUC5AC and MUC6 to characterize the expression pattern of mucins by immunohistochemistry. Methods RUT and ELISA were down for H. pylori confirmation. Human gastric biopsy sections were stained using immunohistochemistry with MUC2, MUC5AC and MUC6 antibodies. Results MUC5AC was expressed in the superficial epithelium and the upper part of the gastric pits. MUC6 expression was detected in the lower part of the gastric glands. MUC2 was expressed in intestinal metaplasia, mostly in goblet cells. The mucin expression profile in the progressive stages of H. pylori infected human gastric epithelium allows the identification of intestinal metaplasia, which is characterized by a decreased expression of the gastric mucins (MUC5AC and MUC6) and de novo expression of MUC2. Conclusion In conclusion, our results suggest that there is altered expression of MUC5AC and MUC6 together with the aberrant expression of MUC2 in intestinal metaplasia, during the process of gastric carcinogenesis. The present study indicates that the MUC2 mucin expression pattern is a reliable marker of intestinal metaplasia, which appears in the context of H. pylori infected individuals.