Celiac disease (CD) is an immune-mediated disorder that may be associated with various diseases that share a similar pathogenic immune mechanism. This study reports on the prevalence of various diseases in a cohort of CD patients in northern India. Patients diagnosed with CD based on modified ESPGHAN criteria were prospectively evaluated for associated concomitant diseases. Of the 363 patients evaluated, 207 (57.0 %) were male. The mean age was 19 years. Seventy-one percent of patients presented with typical diarrheal disease, while 29 % presented with atypical nondiarrheal disease. One or more associated diseases were noted in 70 (19.2 %) patients. Liver diseases were the most common association. Portal hypertension was present in 33 (9 %) patients; chronic liver disease was the underlying cause in 17 patients, while noncirrhotic causes were noted in 16 patients. Type 1 diabetes was seen in 13 and hypothyroidism in 11 patients. Other unreported or rarely reported associated diseases were also found in some of the patients. Associated comorbid diseases are common, and may need to be actively screened, in Indian CD patients.
Increasingly frequent dilation may become a self-defeating cycle in refractory stricture as recurrent trauma enhance, scar formation, and ultimately recurrence and potential worsening of the stricture. In 12 patients of caustic induced esophageal stricture, who failed to respond despite rigorous dilatation regimen for more than one year, a trial of topical mitomycin-C application to improve dilatation results was undertaken, considering the recently reported efficacy and safety of this agent. Mitomycin-C was applied for 2-3 minutes at the strictured esophageal segment after dilation with wire-guided Savary-Gilliard dilator. Patient was kept nil by mouth for 2-3 hours. After 4-6 sessions of mitomycin-C treatment, resolution of symptoms and significant improvement in dysphagia score and periodic dilatation index was seen in all 12 patients. Mitomycin-C topical application may be a useful strategy in refractory corrosive esophageal strictures and salvage patients from surgery.
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