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Case Report
Unmasking Alagille Syndrome in Adulthood- A Complete Clinical Portrait of a Rare Syndrome
Issue:
Volume 10, Issue 1, June 2026
Pages:
1-4
Received:
20 December 2025
Accepted:
27 January 2026
Published:
14 February 2026
Abstract: Alagille syndrome (ALGS) is a rare autosomal dominant multisystem disorder characterized by marked phenotypic variability, and the diagnosis is sometimes very challenging. We describe a 26-year-old man who presented with progressive jaundice, pruritus, and weight loss over three months, with a history of similar episodes in early childhood. He had previously been diagnosed with atrial septal defect with severe pulmonary stenosis, myopia, and hypothyroidism. After a thorough Clinical examination which revealed icterus, pedal edema, stigmata of chronic liver disease, and characteristic facial dysmorphism with café-au-lait spots, a possibility of Alagille syndrome was considered. Laboratory evaluation showed cholestatic liver dysfunction and pancytopenia. Whole-exome sequencing identified a likely pathogenic JAG1 variant, and liver biopsy confirmed bile duct paucity. This case highlights the diagnostic challenges of ALGS and underscores the importance of meticulous clinical evaluation and comprehensive longitudinal history-taking, as multiple healthcare encounters preceded the correct diagnosis as far as this patient is concerned.
Abstract: Alagille syndrome (ALGS) is a rare autosomal dominant multisystem disorder characterized by marked phenotypic variability, and the diagnosis is sometimes very challenging. We describe a 26-year-old man who presented with progressive jaundice, pruritus, and weight loss over three months, with a history of similar episodes in early childhood. He had ...
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Case Report
An Unusual Case of Ascites: POEMS Syndrome Presenting as High SAAG Ascites
Issue:
Volume 10, Issue 1, June 2026
Pages:
5-8
Received:
4 February 2026
Accepted:
26 February 2026
Published:
12 March 2026
DOI:
10.11648/j.ijg.20261001.12
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Abstract: Castleman disease is a rare histopathological entity associated with a variety of lymphoproliferative disorders and autoimmune conditions. The disease can occur in a unicentric form (involving single lymph node group) or multicentric form. While sometimes associated with POEMS syndrome, ascites is not an uncommon association with these disorders. However, the ascites described in association with Castleman disease or POEMS is usually a low SAAG ascites. We report a case with high SAAG ascites as the presenting feature in a patient with POEMS syndrome and multicentric Castleman disease which is quite rare as evidenced by scarcity of literature. Our patient who had presented with ascites, was found to have polyneuropathy, organomegaly (liver and spleen), endocrinopathy (thyroid hormone abnormality), monoclonal gammopathy and skin lesions on evaluation. The scenario was complicated due to a misdiagnosis of tuberculosis from elsewhere and an improper course of antituberculosis treatment. Things fell into place when the diagnosis was confirmed with the histopathological examination of the cervical lymph node biopsy showing hyaline vascular variant of Castleman disease. Thalidomide and its congeners along with steroids have been the mainstay of treatment of this along with stem cell transplantation, while anti IL-6 agents like siltuximab are emerging treatment options. In view of its complexity and the multisystem involvement of this syndrome, it may be easily overlooked or missed if one is not aware or actively looking for the various clinical clues.
Abstract: Castleman disease is a rare histopathological entity associated with a variety of lymphoproliferative disorders and autoimmune conditions. The disease can occur in a unicentric form (involving single lymph node group) or multicentric form. While sometimes associated with POEMS syndrome, ascites is not an uncommon association with these disorders. H...
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Research Article
Clinical Profile and Predictors of Hospital Outcomes in Acute-on-chronic Liver Failure
Shreyansh Goyal*
,
Prabhat Sinha,
Sharad Malhotra
Issue:
Volume 10, Issue 1, June 2026
Pages:
9-19
Received:
15 February 2026
Accepted:
9 March 2026
Published:
19 March 2026
Abstract: Acute-on-chronic liver failure (ACLF) is a distinct clinical syndrome characterized by acute hepatic deterioration in patients with underlying chronic liver disease and is associated with multiorgan dysfunction and high short-term mortality. In India, alcohol remains the predominant etiology of chronic liver disease, with infectious causes and alcoholic hepatitis being common acute precipitating events. However, clinical profiles and predictors of in-hospital outcomes show variability across populations. This hospital-based observational study included 50 patients diagnosed with ACLF according to the APASL criteria and admitted to Aakash Healthcare Super Speciality Hospital, New Delhi, between February 2024 and January 2026. Detailed clinical evaluation and laboratory investigations were performed at admission. Disease severity was assessed using Child–Turcotte–Pugh, Model for End-Stage Liver Disease (MELD), and MELD-Na scores. Precipitating factors, complications, organ system involvement, and outcomes during hospitalization were documented. Outcomes were categorized as survival with discharge, in-hospital mortality, or referral for liver transplantation. The mean age of patients was 49.96 ± 11.30 years, with a male predominance (84%). Alcohol-related liver disease was the most common underlying etiology (60%). Alcoholic hepatitis (38%) and sepsis (30%) were the leading precipitating events. Jaundice, abdominal distension, and altered sensorium were the most frequent presenting symptoms. Ascites (96%), portal hypertension (92%), and hepatic encephalopathy (78%) were the predominant complications. In-hospital mortality was observed in 46% of patients, while 22% required referral for liver transplantation. Elevated international normalized ratio, serum creatinine, ammonia, lactate, serum potassium levels, and higher MELD and MELD-Na scores were significantly associated with poor outcomes (p < 0.05). Hepatic encephalopathy was the only clinical complication significantly associated with mortality on univariate analysis (p = 0.021). ACLF predominantly affects middle-aged males with alcohol-related chronic liver disease and is associated with high in-hospital mortality. Early identification of high-risk patients and timely escalation of care, including prompt evaluation for liver transplantation, are crucial to improving outcomes.
Abstract: Acute-on-chronic liver failure (ACLF) is a distinct clinical syndrome characterized by acute hepatic deterioration in patients with underlying chronic liver disease and is associated with multiorgan dysfunction and high short-term mortality. In India, alcohol remains the predominant etiology of chronic liver disease, with infectious causes and alco...
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Research Article
Clinical, Endoscopic, Histological, and Therapeutic Aspects of Gastric Polyps at the Sikasso Regional Hospital, Mali: A Study of 39 Cases
Issue:
Volume 10, Issue 1, June 2026
Pages:
20-24
Received:
21 March 2026
Accepted:
7 April 2026
Published:
16 April 2026
Abstract: Introduction: Gastric polyps are tissue lesions that develop within the gastric lumen. Their clinical, endoscopic, histopathological, and therapeutic features remain variable and poorly described in sub-Saharan Africa. This study aimed to characterize these aspects in patients at Sikasso Regional Hospital, Mali. Methods: We conducted a retrospective study over an eight-year period (2017–2024) including all histologically confirmed gastric polyps. Data were collected from medical records and analyzed using Microsoft Excel. Results: A total of 39 patients were included (24 men, 15 women; sex ratio 1.6), with a mean age of 52 years (range: 15–87). Polyps were sessile in 71% and pedunculated in 29% of cases. Lesions were single in 51% and multiple in 49%, most frequently located in the antrum. The mean polyp size was 6.2 mm (range: 2–29 mm). Histologically, hyperplastic polyps were observed in 30.8%, adenomatous in 23.7%, fibro-inflammatory in 15.4%, juvenile in 12.8%, fundic gland in 12.8%, and papillomatous in 10.3%. Helicobacter pylori infection was present in 35.9% of cases, with 15.4% showing associated gastritis. Mean follow-up duration of patients was 31 months. Conclusion: This study provided valuable insights into gastric polyps in the population of Sikasso, highlighting the diversity of their clinical and endoscopic characteristics. Helicobacter pylori infection remains endemic in this setting and is often chronic, frequently evolving asymptomatically while potentially leading to significant gastric lesions. These findings emphasize the importance of strengthening preventive strategies, including public awareness on screening, early management, and regular surveillance of patients with gastric polyps.
Abstract: Introduction: Gastric polyps are tissue lesions that develop within the gastric lumen. Their clinical, endoscopic, histopathological, and therapeutic features remain variable and poorly described in sub-Saharan Africa. This study aimed to characterize these aspects in patients at Sikasso Regional Hospital, Mali. Methods: We conducted a retrospectiv...
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Review Article
The Beneficial Role of Early-Life Gut Microbiota Development for Improving Intestinal Health Integrity and Gut-Immune Function in Infants of Bangladesh
Issue:
Volume 10, Issue 1, June 2026
Pages:
25-31
Received:
12 March 2026
Accepted:
25 March 2026
Published:
24 April 2026
Abstract: Early life represents a critical window for the establishment of the gut microbiome, a complex microbial ecosystem that plays a central role in intestinal health, immune system development, physical growth, and long-term disease risk. In low- and middle-income countries such as Bangladesh, infants are exposed to a range of nutritional and environmental stressors—including undernutrition, recurrent infections, and inadequate sanitation—that can significantly disrupt normal microbiome development. These challenges make the study of early-life microbiome assembly particularly important in this context. This review synthesizes recent research on gut microbiome development in Bangladeshi infants and explores how deviations from normal patterns—such as microbiome immaturity, dysbiosis, and the overrepresentation of pathogenic organisms—are associated with adverse outcomes. These include impaired intestinal function, chronic inflammation, weakened immune responses, and growth faltering. Studies consistently show that healthy infants typically undergo a predictable succession of microbial colonization, with beneficial taxa such as Bifidobacterium infantis and other members of the Bifidobacterium longum group dominating early life, particularly in breastfed infants. These microbes are crucial for metabolizing human milk oligosaccharides and supporting immune maturation. In contrast, malnourished infants often exhibit delayed or altered microbiome maturation. Their gut microbial communities resemble those of younger infants, indicating immaturity, and are often enriched with harmful or less beneficial bacteria. Importantly, conventional nutritional interventions alone have been shown to only partially restore a healthy microbiome composition, suggesting that more targeted approaches are necessary. Recent advances highlight the potential of microbiota-directed complementary foods (MDCF) and specific probiotic supplementation in addressing these issues. These interventions are designed to promote the growth of beneficial microbes and restore microbial balance. Evidence indicates that MDCF can accelerate microbiome repair, enhance gut barrier integrity, reduce intestinal inflammation, and contribute to improved growth outcomes in undernourished children. In conclusion, targeting gut microbiome development during early infancy offers a promising strategy to improve health outcomes among Bangladeshi children. However, further research is needed to determine the optimal timing, duration, and sustainability of such interventions, as well as to better understand the underlying biological mechanisms driving these benefits.
Abstract: Early life represents a critical window for the establishment of the gut microbiome, a complex microbial ecosystem that plays a central role in intestinal health, immune system development, physical growth, and long-term disease risk. In low- and middle-income countries such as Bangladesh, infants are exposed to a range of nutritional and environme...
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Research Article
The Prevalence of Steatohepatitis Declines with Age in Non-urban Individuals with Obesity
Issue:
Volume 10, Issue 1, June 2026
Pages:
32-38
Received:
5 April 2026
Accepted:
22 April 2026
Published:
29 April 2026
Abstract: Background: Worldwide, the prevalence of the major health disorder, obesity, has risen. Obesity is a risk factor for development of steatohepatitis, a precursor to chronic liver disease. Alanine transaminase (ALT) is a recognized marker for steatohepatitis. The prevalence of steatohepatitis in aging populations with obesity has not been well delineated. Objective: Our hypothesis is that the prevalence of steatohepatitis would be lower in older subjects with obesity due to the increased morbidity and mortality related to chronic liver disease in individuals with obesity. Method: Consecutive individuals with obesity (n=400) have been evaluated in gastrointestinal clinic. Exclusions (n=72) include cirrhosis, hepatitis C, Celiac disease, >28 g/day alcohol, and >2 g/day acetaminophen. Definition of elevation of ALT in men and women is based on the American College of Gastroenterology guidelines. Result: Among 328 eligible subjects, 175 are ≤ 64 years-old and 153 are ≥ 65 years old. Mean body mass index (BMI) of individuals ≤ 64 years is 36.0+/-5.2 kg/m2 and mean BMI of individuals ≥ 65 years is 34.9+/-4.1 kg/m2 (t-test: p=0.036). Subjects with type 2 diabetes mellitus include 53 of 175 subjects ≤ 64 years and 94 of 153 subjects ≥ 65 years (Chi-square 2X2 Statistic: p<.001). The overall prevalence of ALT elevation is 47%. A Chi-square 2X2 statistic (p<.001) supports the hypothesis that ALT elevation is inversely dependent upon age, and a Chi-square 2X2 statistic (p=0.039) supports a higher prevalence of steatotic liver disease in younger subjects. Conclusion: The high prevalence of ALT elevation, consistent with steatohepatitis, in this non-urban population is statistically more common in subjects ≤ 64 years-old, supporting our hypothesis. This difference is not explained by type 2 diabetes, which is statistically more common in subjects ≥ 65 years-old, but is consistent with the higher prevalence of steatotic liver disease in subjects ≤ 64 years-old. The association between a higher prevalence of elevated ALT levels and a higher prevalence of hepatic steatosis supports the importance of weight loss to resolve hepatic steatosis in order to protect younger individuals with steatohepatitis.
Abstract: Background: Worldwide, the prevalence of the major health disorder, obesity, has risen. Obesity is a risk factor for development of steatohepatitis, a precursor to chronic liver disease. Alanine transaminase (ALT) is a recognized marker for steatohepatitis. The prevalence of steatohepatitis in aging populations with obesity has not been well deline...
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Case Report
Duodenal Vascular Ectasia: Rare Cause of Gastrointestinal Bleeding
Issue:
Volume 10, Issue 1, June 2026
Pages:
39-42
Received:
13 January 2026
Accepted:
5 February 2026
Published:
13 May 2026
Abstract: Duodenal vascular ectasia (DVE) is a rare but important cause of upper gastrointestinal bleeding, particularly in patients with chronic liver disease. Gastric antral vascular ectasia (GAVE) is a more commonly recognized vascular lesion associated with cirrhosis; however, vascular ectasia involving the duodenum is infrequently reported and may pose diagnostic and therapeutic challenges. We report a case of a cirrhotic patient presenting with recurrent upper gastrointestinal bleeding manifested as melena and progressive anemia. Initial evaluation suggested variceal bleeding; however, endoscopic examination revealed the presence of GAVE along with vascular ectasia involving the duodenal bulb and extending into the third part of the duodenum. Histopathological examination of duodenal biopsies demonstrated dilated vascular channels within the lamina propria, consistent with duodenal vascular ectasia. Endoscopic management was initially directed toward GAVE using argon plasma coagulation (APC). Due to persistent anemia and recurrent bleeding, APC therapy was subsequently applied to the duodenal vascular lesions with careful technique to minimize the risk of perforation. Hemostasis was successfully achieved without complications, and the patient showed sustained clinical improvement with stabilization of hemoglobin levels and no further transfusion requirement during follow-up. This case highlights duodenal vascular ectasia as a potential source of gastrointestinal bleeding in cirrhotic patients and demonstrates that argon plasma coagulation can be a safe and effective therapeutic modality when applied cautiously.
Abstract: Duodenal vascular ectasia (DVE) is a rare but important cause of upper gastrointestinal bleeding, particularly in patients with chronic liver disease. Gastric antral vascular ectasia (GAVE) is a more commonly recognized vascular lesion associated with cirrhosis; however, vascular ectasia involving the duodenum is infrequently reported and may pose ...
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Research Article
Nigam's Acute Cholecystitis Scoring System (NACSS): Can It Successfully Decide the Ideal Treatment Also in Addition to Assessing Severity
Vinod Kumar Nigam*,
Siddharth Nigam
Issue:
Volume 10, Issue 1, June 2026
Pages:
43-50
Received:
24 April 2026
Accepted:
6 May 2026
Published:
19 May 2026
Abstract: Acute abdomen is a common surgical problem globally and one of the most common emergency condition emergency department receives. Acute cholecystitis is one of the common reasons of acute abdomen for which a patient attends the hospital. Acute cholecystitis is usually caused by gallbladder stones and may lead to serious complications sometimes. Therefore, it should be diagnosed accurately and at earliest. Nigam’s acute cholecystitis scoring system (NACSS) diagnoses the acute cholecystitis at earliest and correctly without needing specialized imaging investigations like CT scan, MRI and HIBA scan. NACSS is a simple procedure with good accuracy. NACSS depends upon simple factors like demographics, history, physical examination, simple laboratory tests and ultrasonography. In this study of 130 cases, NACSS prediction remained high in accuracy in grading (4 grades) the severity of inflammation and preoperative prediction for open surgery. NACSS depends upon points earned by various grades from 5-17. NACSS divides acute cholecystitis cases into 4 grades according to the severity of inflammation, grade I – mild acute cholecystitis, grade II – moderate acute cholecystitis, grade III – severe acute cholecystitis and grade IV – acute cholecystitis with complications like gangrene or perforation of gallbladder. This preoperative scoring system for acute cholecystitis (NACSS) diagnoses quite correctly the degree of inflammation and also advises the surgeon what type of treatment is required, conservative, laparoscopic cholecystectomy and open cholecystectomy.
Abstract: Acute abdomen is a common surgical problem globally and one of the most common emergency condition emergency department receives. Acute cholecystitis is one of the common reasons of acute abdomen for which a patient attends the hospital. Acute cholecystitis is usually caused by gallbladder stones and may lead to serious complications sometimes. The...
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Research Article
Clinical Efficacy of Montelukast on Functional Dyspepsia Patients with Duodenal Eosinophilia: A Double-Blind Placebo Controlled Trial
Issue:
Volume 10, Issue 1, June 2026
Pages:
51-58
Received:
30 April 2026
Accepted:
12 May 2026
Published:
21 May 2026
Abstract: Background: Functional dyspepsia (FD) is the second most common functional gastrointestinal disorder, associated with significant morbidity and impaired quality of life. Duodenal eosinophilia has emerged as a key pathophysiological mechanism underlying FD. Montelukast, a cysteinyl leukotriene receptor antagonist, has shown efficacy in pediatric FD with duodenal eosinophilia, but evidence in adults remains absent. This study aimed to determine the clinical efficacy of montelukast in adult patients with functional dyspepsia and duodenal eosinophilia. Methods: A randomized, double-blind, placebo-controlled parallel group trial was conducted at the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December 2021 to July 2023. Seventy-six adults with Rome IV-diagnosed FD and duodenal eosinophil count greater than 22/5HPF were randomized into two groups of 38 each. Group A received montelukast 10 mg daily and Group B received an identical placebo for four weeks. Symptom severity was assessed using a 5-point Likert scale at baseline and on day 29. Results: The majority of participants (46.1%) were aged 20 to 30 years and most were female. At baseline, both groups were comparable in age, sex, eosinophil count and Likert scores. Following treatment, a positive clinical response was observed in 94.7% of the montelukast group compared with 39.5% in the placebo group (p<0.001). Significant improvements were noted across all four symptom components including postprandial fullness, early satiation, epigastric pain and epigastric burning. Conclusion: Montelukast produced significant symptomatic improvement in adult FD patients with duodenal eosinophilia. It may be prescribed as an adjunct to conventional therapy in this patient population.
Abstract: Background: Functional dyspepsia (FD) is the second most common functional gastrointestinal disorder, associated with significant morbidity and impaired quality of life. Duodenal eosinophilia has emerged as a key pathophysiological mechanism underlying FD. Montelukast, a cysteinyl leukotriene receptor antagonist, has shown efficacy in pediatric FD ...
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Research Article
Expert Perspectives on Acid Peptic Disease Management and the Role of Vonoprazan in Indian Settings
Manjula Suresh*,
Krishna Kumar Manjunath
Issue:
Volume 10, Issue 1, June 2026
Pages:
59-66
Received:
13 May 2026
Accepted:
26 May 2026
Published:
29 June 2026
DOI:
10.11648/j.ijg.20261001.20
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Abstract: Background: Although there are several clinical studies available regarding the management of acid peptic disorders (APD), there is a dearth of studies among clinical experts on their practice. This study aimed to assess clinicians’ perspectives on the management of APD, with particular emphasis on the emerging role of vonoprazan in routine clinical practice in Indian settings. Methodology: This cross-sectional study included 209 clinical experts across India. A validated 22-item questionnaire assessed key aspects of APD management, including epidemiology, diagnostics, treatment practices, challenges related to proton pump inhibitor (PPI) therapy, and perceptions of vonoprazan. Data were analyzed using descriptive statistics. Results: In routine clinical practice, approximately 51% of clinicians reported that about 11–25% of their patients with gastroesophageal reflux disease (GERD) do not respond adequately to PPI therapy, while 49% indicated that nocturnal acid breakthrough is commonly encountered during PPI use. Nearly 63% of respondents emphasized vonoprazan’s unique mechanism of action as its key advantage over PPIs, enabling faster and more prolonged binding to the H⁺/K⁺-ATPase enzyme and providing sustained 24-hour acid suppression. Approximately 42% of clinicians preferred vonoprazan for GERD, while 41.63% favored its use in 11–25% of patients with nonerosive reflux disease, and 38.76% preferred its use across all age groups in PPI-resistant cases. In the setting of NSAID-induced ulcer recurrence, around 55% of respondents reported using vonoprazan in selected cases. Overall, 73% perceived multiple benefits of vonoprazan, including the absence of a requirement for metabolic activation, more rapid intragastric pH elevation, and acid stability with reversible inhibition, allowing meal-independent dosing. Conclusion: This survey highlights important limitations of PPI therapy and strong clinician recognition of vonoprazan’s pharmacological and clinical advantages. The findings suggest strategic use of vonoprazan in patients with an inadequate response to PPIs, particularly in GERD and PPI-resistant cases, positioning it as a valuable therapeutic option for addressing unmet needs in the management of acid-related disorders.
Abstract: Background: Although there are several clinical studies available regarding the management of acid peptic disorders (APD), there is a dearth of studies among clinical experts on their practice. This study aimed to assess clinicians’ perspectives on the management of APD, with particular emphasis on the emerging role of vonoprazan in routine clinica...
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