Background Opioids and non steroidal anti inflammatory drugs (NSAIDs) are commonly used for pain relief in acute pancreatitis (AP). Opioids carry risk of sphincter of oddi constriction. Although diclofenac prevents post endoscopic retrograde cholangio‐pancreatography (ERCP) pancreatitis, few reports of diclofenac associated AP are also present. Although, both tramadol and diclofenac are commonly used for pain relief in AP, no study has evaluated their comparative efficacy and safety. Materials and Methods Forty‐six eligible participants were randomized to either diclofenac or tramadol. Primary objectives of our study were improvement in pain intensity on visual analogue scale (VAS pain score after 1 hr of drug administration) and number of patients requiring supplementary analgesia. The secondary objectives were total number of times of supplementary analgesia requirement, time to significant decrease (33%) in VAS pain score from baseline, number of painful days (VAS pain score >5), VAS pain score on 7th day, side effects, all cause death and complications of pancreatitis between the two groups. Results Although 46 patients were randomized, the final analysis included 41 participants. Five patients were withdrawn from the study (intubation = 3, altered sensorium = 2). No significant difference was seen in terms of VAS score after 1 hr of drug administration, number of patients requiring supplementary analgesic and number of painful days. However, time taken to significant reduction of pain was lower in the diclofenac group (p = .028). Both the agents were comparable in terms of safety. Although complications were less in the diclofenac group, the difference was not statistically significant. Conclusion Both diclofenac and tramadol are equally effective in controlling pain in AP with similar safety profile. Significance There are no studies that have compared the safety and efficacy of two commonly used analgesics for pain relief in patients with AP. We found that both diclofenac and tramadol are equally effective in decreasing the pain associated with AP. There is also no significant difference in the incidence of side effects between both the groups. Hence both diclofenac and tramadol can be used safely and effectively for pain control in AP. Trial registration: The trial was registered with clinical trials registry India (Number‐ CTRI/2018/05/014309).

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Background Quality of life (QOL) in children with celiac disease (CD) has been sparsely studied. Aims We aimed to study QOL in pediatric CD and the effect of a gluten‐free diet (GFD) in a North Indian population. Methods QOL was assessed at baseline and 6 months after GFD using a pediatric symptom checklist (PSC) score. The effect of GFD was assessed using a CD‐specific questionnaire on domains such as dietary compliance, parental behavior and perceptions, children's feeling, and difficulty identifying gluten‐free foods. Results A total of 60 CD children (age 6.03 ± 0. 42 years, range: 2–12 years, M:F 2:1) were prospectively enrolled. The median PSC score at baseline was 11.5 (2–35), which showed a statistically significant improvement after GFD to 2.5 (0–34) (P < 0.001). Significant concerns regarding specific domains emerged: difficulty in maintaining GFD 26.2%, at school 14.3%, at parties 43.2%, poor taste 11.4%, special diet a burden 28.5%, felt left out at school or friend's home 40.9%, felt different from other kids 40.9%, felt embarrassed to bring GFD to parties 54.6%, felt angry about following a special diet 56.8%, felt not invited out for meals because of CD 13.6%, and difficulty determining if food available was gluten free in 75%. Conclusion GFD has a significant impact on emotional, behavioral, and psychosocial domains in children with CD. Proper labeling of commercially available food items, counseling, and patient support groups are the need of the hour.

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Review Article IntRoductIonVariceal bleeding and hepatorenal syndrome (HRS) often complicate advanced liver disease. Earlier vasopressin was used for the treatment of HRS and variceal bleeding, but it had moderate efficacy and was associated with high rate of ischemic adverse effects. [1] Terlipressin, introduced in the early 1990s, is a synthetic analog of vasopressin with fewer side effects and longer duration of action. [2] Terlipressin is recommended for the management of both the conditions. [2][3][4] Ischemia leading to gangrene is a relatively rare adverse effect of terlipressin. In this context, we reviewed all the published case reports of terlipressin-induced ischemic complications. This is the first review of this kind for evaluation of different terlipressin associated ischemic complications, management strategies, and their outcome. Search strategyWe used different permutations and combinations of keywords "terlipressin," "ischemia," "gangrene," "necrosis," "infarction," "case report," and "report" for searching different databases such as PubMed, Embase, Google Scholar, and Cochrane database (till July 22, 2016). In addition, we also searched references of the studies of screened articles to extract information about relevant articles. Study selectionIn the first step, titles and abstracts of the articles were reviewed and irrelevant articles were excluded. In the next step, full texts of the selected articles were screened as per inclusion and exclusion criteria.Inclusion criteria -(a) patients: any age group and both genders, (b) intervention: terlipression, and (c) type of study: case report. Exclusion criteria: articles with an outcome other than ischemic event were excluded from the study. Data extractionThe first two authors independently extracted the data. In case of any discrepancy, the last and the penultimate authors were consulted Terlipressin is used in the management of variceal bleeding and hepatorenal syndrome. Ischemic complications are rare, but serious adverse effects of terlipressin therapy can be fatal. In this context, we reviewed all the published case reports of terlipressin-induced ischemic complications, and data were collected regarding the part of body affected by ischemic complication, latency, geographical variation, different treatment strategies and their outcome, and other relevant information. After an exhaustive search in different databases, 33 published cases were found. The ischemic complications affected virtually every part of the body. Peripheral gangrene was the most common ischemic complication followed by ischemic complications of more proximal parts such as thigh and abdominal wall. Other parts affected were heart, colon, small intestine, scrotum, etc. Most cases were managed conservatively. Although in few cases, other treatment options were also explored, knowledge of this dreaded complication and different management strategies is necessary for early identification of this adverse effect and early management so as to prevent fatality.