Pakistan Journal of Gastroenterology
type: channel
description: The Pakistan Journal of Gastroenterology (PJG) is a prestigious, peer-reviewed, open-access journal dedicated to the field of gastroenterology and related medical disciplines. The journal serves as a vital platform for medical professionals, researchers, and academics to share their findings and contribute to the growing body of knowledge in digestive health. By publishing high-quality research articles, case reports, and reviews, PJG plays a crucial role in the advancement of gastroenterological science, bridging the gap between clinical practice and research innovation.
publisher: Pakistan Society of Gastroenterology and GI Endoscopy
language: en
publication name: Pakistan Journal of Gastroenterology
issn: 3080-1192
copyright: Submission declaration Authors retain the copyright to their work and grant the Pakistan Journal of Gastroenterology (PJG) the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal. By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
items: Aprepitant Use in Pediatric Cyclical Vomiting Syndrome: A Systematic Review
items: Navigating Gastrointestinal Care in Resource-Limited Settings: A Pakistani Perspective
items: Hepatocellular Carcinoma in Viral Hepatitis in Pakistan: Epidemiology, Clinical Challenges, and Transformative Strategies for Control
items: A Comprehensive Single-Center Analysis of Subcutaneous Infliximab in the Management of Inflammatory Bowel Disease, Lahore Pakistan
items: Effectiveness of Sofosbuvir-Based Therapy in Chronic Hepatitis C Patients: A Clinical Study from Abbottabad, KPK Pakistan
items: Pancreatic pseudocyst following enteric fever–associated acute pancreatitis in a child: successful ultrasound-guided percutaneous drainage
items: Fasciola hepatica infestation masquerading as hydatid cysts of the liver
items: Diagnostic accuracy of serum - ascites albumin gradient (SAAG) for detection of esophageal varices in patients with liver cirrhosis
items: Evaluating the Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Diagnosis and Management of Biliary Ascariasis: Clinical Outcomes and its Efficacy
items: Non-Invasive Assessment of Portal Hypertension: An Evolving Landscape
items: Relationship between Upper GI symptoms and Endoscopic findings with Gastric H Pylori density.
items: Exploring Viral and Non-Viral causes of Alanine Aminotransferase Spikes above 1000 in a South Asian Cohort
items: Platelet count to prothrombin (PLT/PT) ratio to predict esophageal varices in patients with hepatitis C related chronic liver disease
items: Stem Cell Therapy for Liver Cirrhosis - Prospects and challenges
items: Peri-Operative FLOT Chemotherapy in Locally-Advanced Gastric and Gastroesophageal Carcinoma: Outcomes In South Asian Population
items: Hepatitis C elimination by 2030. Are we on the road to miss the target?
items: Avoidance behaviour as a coping mechanism in patients with Irritable Bowel Syndrome
items: Serum Alpha Fetoprotein as a Predictor of Tumor Size in Hepatocellular Carcinoma
items: Gastrointestinal and hepatobiliary manifestations of COVID-19 infection: A single center study from Pakistan
items: The Impact of HCV eradication on HBAIC in Genotype 3 Chronic HCV Diabetic Patients
items: The Incidence of Obesity and Overweight amongst Type 2 Diabetic patients, visiting Tertiary Care Hospital of Lahore

Aprepitant Use in Pediatric Cyclical Vomiting Syndrome: A Systematic Review
type: item
description: Background: Cyclical vomiting syndrome (CVS) is a disorder of gut–brain interaction characterized by recurrent, stereotyped episodes of intense nausea and vomiting with return to baseline in between. Pediatric CVS often leads to frequent hospitalizations, comorbidities, and poor quality of life. Standard abortive therapies include 5-HT₃ antagonists (e.g. ondansetron) and triptans, while prophylaxis may involve cyproheptadine or amitriptyline. Aprepitant, an oral neurokinin-1 (NK1) receptor antagonist approved for chemotherapy-induced nausea, is increasingly used off-label in refractory pediatric CVS. Its efficacy and safety in this setting remain unclear. Methods: We conducted a PRISMA-style systematic review of studies reporting on aprepitant in pediatric CVS. We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library from inception to 15 January 2025 for any study (randomized trials, cohorts, case series, reports) of aprepitant in children (<18) with CVS. Two reviewers independently screened records, extracted data, and assessed risk of bias using standard tools. Outcomes were patient-reported response (episode frequency/intensity), healthcare utilization (episodes/year, admissions), and adverse events. Due to heterogeneity, results are summarized narratively. Results: No randomized controlled trials were identified. Evidence consisted of one retrospective controlled cohort study, one retrospective single-center case series, and one case report, with mixed findings and overall low certainty. We included three studies (total n≈1817): one large retrospective controlled cohort (Thavamani et al. 2024; n=1775, 96 received aprepitant), one single-center retrospective series (Cristofori et al. 2014; n=41), and one single-patient case report (Nivatsi et al. 2021). In the Thavamani cohort, aprepitant use as an abortive agent did not reduce 7-day readmission rates (17% vs. 16%, p=0.91), although those receiving aprepitant had more severe initial illness (l…
subject: Articles
  topic: section
subject: Cyclic vomiting syndrome
  topic: keywords
subject: Pediatric gastroenterology
  topic: keywords
subject: Aprepitant
  topic: keywords
subject: Neurokinin-1 receptor antagonist
  topic: keywords
subject: Refractory vomiting
  topic: keywords
subject: Systematic review
  topic: keywords
creator: Dr. Nabeel Ahmad MD
creator: Saad Bin Toufeeq
creator: Dr. Hooria Rehman
creator: Dr. Muhammad Talha
creator: Dr. Muhammad Shahid
creator: Dr. Hassam Suleman
rights: Copyright (c) 2026 Dr. Nabeel Ahmad MD , Dr. Saad Bin Toufeeq, Dr. Hooria Rehman, Dr. Muhammad Talha, Prof. Dr. Muhammad Shahid, Dr. Hassan Suleman (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 883
ending page: 889
doi: 10.63521/pjg.42.1.2026.73

Navigating Gastrointestinal Care in Resource-Limited Settings: A Pakistani Perspective
type: item
subject: Editorials
  topic: section
creator: Saad Khalid Niaz
rights: Copyright (c) 2026 Saad Khalid Niaz (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 851
ending page: 855
doi: 10.63521/pjg.42.1.2026.80

Hepatocellular Carcinoma in Viral Hepatitis in Pakistan: Epidemiology, Clinical Challenges, and Transformative Strategies for Control
type: item
description: Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in Pakistan, driven by chronic viral hepatitis, particularly hepatitis C virus (HCV) and hepatitis B virus (HBV). This article examines the epidemiology, clinical challenges, and transformative strategies to address HCC in Pakistan, with a focus on viral hepatitis. Methods: A systematic review was conducted using PubMed, PMC, PakMediNet, and Google Scholar, covering studies from January 2000 to July 2025. We included studies on HCC etiology, prevalence, clinical presentation, and outcomes in Pakistan. Random-effects meta-analyses estimated pooled prevalence of HCV and HBV in HCC patients. Data on risk factors, diagnostic delays, and treatment access were synthesized. Results: HCV is implicated in 67.9%–70.1% of HCC cases, with HBV contributing 21.8%–32.6%. General population HCV prevalence ranges from 4.8% to 17%, with genotype 3a predominant. Most patients present with advanced HCC (Barcelona Clinic Liver Cancer [BCLC] stage C/D, 62.8%), limiting curative options. Barriers include lack of a national cancer registry, inadequate screening, and restricted access to therapies like transarterial chemoembolization (TACE) and sorafenib. Direct-acting antivirals (DAAs) have reduced HCV-related HCC incidence, but late diagnosis and healthcare disparities persist. Conclusions: Pakistan’s HCC burden demands a paradigm shift toward national screening, decentralized treatment, and innovative technologies like AI-driven diagnostics. A national cancer registry and bold public health reforms are critical to align with global hepatitis elimination goals by 2030.
subject: Articles
  topic: section
subject: hepatocellular carcinoma
  topic: keywords
subject: Hepatitis C, Sofosbuvir, HCV RNA PCR, SVR, Pakistan, DAAs
  topic: keywords
subject: viral
  topic: keywords
subject: hepatitis
  topic: keywords
subject: pakistan
  topic: keywords
creator: Sameed Qureshi
creator: Kamran Khan
creator: Zuhra Khan
creator: Aamir Wisal
rights: Copyright (c) 2026 Sameed Qureshi, Kamran Amir Khan, Zuhra Naheed Khan, Aamir Wisal (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 856
ending page: 863
doi: 10.63521/pjg.42.1.2026.78

A Comprehensive Single-Center Analysis of Subcutaneous Infliximab in the Management of Inflammatory Bowel Disease, Lahore Pakistan
type: item
description: Background: Subcutaneous infliximab (SC-IFX) offers a promising alternative to intravenous infliximab (IV-IFX) for managing moderate-to-severe inflammatory bowel disease (IBD), providing pharmacokinetic stability, patient convenience, and improved adherence. Further evidence is needed to validate its clinical efficacy, safety, and pharmacokinetic profile in real-world settings. Objective: To evaluate the clinical efficacy, safety, and pharmacokinetics of SC-IFX in patients with Crohn’s disease (CD) and ulcerative colitis (UC). Methods: This single-center, open-label, interventional study enrolled 190 patients with IBD (58 CD, 132 UC) aged 18–75 years with moderate-to-severe disease activity (Crohn’s Disease Activity Index [CDAI] 250–450 or Mayo score 6–12). Participants received SC-IFX with a loading dose of 240 mg at weeks 0 and 2, followed by 120 mg every other week from week 4 onward. Assessments at baseline, week 11, and week 22 included disease activity (CDAI and Mayo scores), inflammatory markers (CRP and fecal calprotectin), hematological parameters, and serum infliximab levels. Adverse events were recorded per CTCAE guidelines. Statistical analyses utilized repeated measures ANOVA and chi-square tests, with significance set at P < 0.05. Results: Among 190 patients, clinical remission was achieved in 81.3% of CD (CDAI <150) and 84.8% of UC (Mayo ≤2) patients by week 22. Serum infliximab levels rose from undetectable at baseline to 17.74 ± 0.14 µg/mL at week 11 and stabilized at 11.94 ± 0.11 µg/mL by week 22 (P < 0.001). CRP levels decreased from 35.31 ± 1.24 mg/L to 5.24 ± 0.33 mg/L in CD and from 23.98 ± 0.82 mg/L to 4.18 ± 0.22 mg/L in UC (P < 0.001). Fecal calprotectin levels declined from 470.16 ± 17.32 µg/g to 146.43 ± 2.66 µg/g in CD and from 889.17 ± 11.48 µg/g to 89.42 ± 1.77 µg/g in UC (P < 0.001). Hemoglobin increased significantly in CD and UC patients (P < 0.001), while platelet counts decreased substantially (P < 0.001). Adverse events were mild …
subject: Articles
  topic: section
subject: anti-TNF therapy.
  topic: keywords
subject: therapeutic drug monitoring,
  topic: keywords
subject: clinical remission
  topic: keywords
subject: pharmacokinetics
  topic: keywords
subject: ulcerative colitis
  topic: keywords
subject: Crohn’s disease
  topic: keywords
subject: inflammatory bowel disease
  topic: keywords
subject: Subcutaneous infliximab
  topic: keywords
creator: Junaid Mushtaq
creator: Sehrish Sarwar
creator: Ibtesaam Amjad
creator: Ghias un Nabi Tayyab
creator: Israr ul Haque
creator: Shamail Zafar
rights: Copyright (c) 2026 Junaid Mushtaq, SEHRISH SARWAR, IBTESAAM AMJAD, GHIAS UN NABI TAYYAB, ISRAR UL HAQUE TOOR, SHAMAIL ZAFAR (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 869
ending page: 882
doi: 10.63521/pjg.42.1.2026.77

Effectiveness of Sofosbuvir-Based Therapy in Chronic Hepatitis C Patients: A Clinical Study from Abbottabad, KPK Pakistan
type: item
description: Hepatitis C Virus (HCV) infection is a significant public health issue in Pakistan. Direct acting antivirals (DAAs) particularly sofosbuvir based regimens have demonstrated high efficacy in achieving sustained virologic response (SVR). This observational study included 350 patients diagnosed with chronic hepatitis HCV infection between July 2024 to september 2025. Among 350 patients 190 were male and 160 were female age ranges from 16 to 68 years. After PCR all patients were put on sofosbuvir 400 mg for 12 weeks. Out of 190 male patients 175 (92%) achieved SVR12 while 152 (95 %) female achieved SVR12 after 12 weeks treatment.
subject: Articles
  topic: section
subject: Hepatitis C, Sofosbuvir, HCV RNA PCR, SVR, Pakistan, DAAs
  topic: keywords
creator: Dr saifullah khan
rights: Copyright (c) 2026 Dr saifullah khan (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 864
ending page: 868
doi: 10.63521/pjg.42.1.2026.29

Pancreatic pseudocyst following enteric fever–associated acute pancreatitis in a child: successful ultrasound-guided percutaneous drainage
type: item
description: Pancreatic involvement in enteric fever is uncommon and typically limited to transient enzyme elevation without clinical pancreatitis. We report a previously healthy 4-year-old girl with culture-proven enteric fever who developed acute pancreatitis followed by a large symptomatic pancreatic pseudocyst. Imaging confirmed a 9-cm anterior collection compressing adjacent structures. Given its size and symptoms, ultrasound-guided percutaneous drainage was performed, resulting in rapid clinical improvement and complete radiological resolution without recurrence at six months. This case highlights enteric fever as a rare cause of true pancreatitis and pseudocyst formation in children and demonstrates that minimally invasive image-guided drainage is a safe and effective management option when endoscopic access is limited.
subject: Case Report
  topic: section
creator: Muhammad Shahid
creator: Hassan Suleman
creator: Hooria Rehman
creator: Nabeel Ahmad
creator: Muhammad Talha
rights: Copyright (c) 2026 Muhammad Shahid, Hassan Suleman, Hooria Rehman, Nabeel Ahmad, Muhammad Talha (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 903
ending page: 907
doi: 10.63521/pjg.42.1.2026.74

Fasciola hepatica infestation masquerading as hydatid cysts of the liver
type: item
description: Human hepatic fascioliasis has been reported in 81 countries, some of which are endemic areas. Fascioliasis is a re-emerging food-borne parasitic zoonosis which presents with nonspecific clinical symptoms. Hepatobiliary fascioliasis is one of the rare but important parasitic infections in endemic areas such as Pakistan. Definitive diagnosis requires demonstration of parasitic ova in stool which may often be elusive. Imaging plays a crucial role in raising the possibility of this diagnosis early in the disease course. Contrast enhanced CT scan was performed in an 18 years old female with recent history of hydatid cyst excision and sub-hepatic drain placement, who now presented with increased biliary output. Endoscopic retrograde cholangiopancreatography was performed and this liver parasite was removed.
subject: Case Report
  topic: section
subject: Fasciola Infection, ERCP, Hydatid Cyst
  topic: keywords
creator: Faisal ali
creator: Muslim Atiq Muslim Atiq
creator: Zafar Ali Ali
creator: Muhammad Rehan Javed Muhammad Rehan Javed
creator: Ahmad Faruqui Ahmad Faruqui
rights: Copyright (c) 2026 Faisal ali, Muslim Atiq, Zafar ali, Muhammad Rehan Javed, Ahmad Faruqui (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 899
ending page: 902
doi: 10.63521/pjg.42.1.2026.31

Diagnostic accuracy of serum - ascites albumin gradient (SAAG) for detection of esophageal varices in patients with liver cirrhosis
type: item
description: Introduction: Identifying patients with compensated cirrhosis who are at risk of developing esophageal varices (EVs) is crucial for effective management. The Serum Ascites Albumin Gradient (SAAG) is a non-invasive laboratory tool that can predict the presence of EVs in cirrhotic patients, with a cutoff value of >1.4 g/dL indicating the need for clinical attention. SAAG can potentially reduce the need for repeated upper endoscopies. Objective: To evaluate the diagnostic accuracy of SAAG in diagnosing esophageal varices in patients with cirrhosis, using endoscopy as the gold standard. Materials and Methods: This cross-sectional study was conducted between April 2023 and October 2023 at the North Medical Ward, Department of Medicine, Mayo Hospital, Lahore. A total of 270 patients with cirrhosis and ascites (age 20-60 years) from both the genders were enrolled using non-probability consecutive sampling. 5cc blood and ascitic fluid samples were collected and sent to the hospital's laboratory for SAAG assessment. Patients underwent endoscopy to determine the presence of EVs, with varices considered present if the esophageal veins measured >5 mm in diameter. Results: The diagnostic performance of SAAG in detecting EVs was evaluated, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated. The results showed that SAAG had a sensitivity of 87.5%, specificity of 59.86%, PPV of 66.27%, and NPV of 84.16%. Conclusion: SAAG is a non-invasive, cost-effective tool with high sensitivity but low specificity for diagnosing esophageal varices in cirrhotic patients. Therefore, while SAAG can help reduce the frequency of endoscopy, it should be used in conjunction with other diagnostic methods for more accurate patient management.
subject: Articles
  topic: section
subject: serum ascites albumin gradient
  topic: keywords
subject: esophageal varices
  topic: keywords
subject: liver cirrhosis
  topic: keywords
subject: endoscopy
  topic: keywords
creator: Nauman Dawood
creator: Mian Sajjad Ahmad
creator: Israr ul Haque
creator: Ali Asad Khan
creator: maheen anwaar
creator: shahzad hussain
creator: Muhammad Kamran Yousaf
rights: Copyright (c) 2025 Nauman Dawood, Mian Sajjad Ahmad, Israr ul Haque, Ali Asad Khan, maheen anwaar, shahzad hussain, Muhammad Kamran Yousaf (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 831
ending page: 836
doi: 10.63521/pjg.41.4.2025.9

Evaluating the Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Diagnosis and Management of Biliary Ascariasis: Clinical Outcomes and its Efficacy
type: item
description: Background: Biliary ascariasis, caused by Ascaris lumbricoides invasion of the biliary tree, is a significant health concern in tropical regions like Pakistan. Although imaging plays a diagnostic role, Endoscopic Retrograde Cholangiopancreatography (ERCP) is increasingly employed for both diagnosis and treatment due to its minimally invasive nature. Objective: This study aimed to evaluate the clinical efficacy, technical success, and outcomes of ERCP in managing biliary ascariasis. Methods: A retrospective review of 29 cases of biliary ascariasis managed with ERCP between September 2017 and September 2024 was conducted at a tertiary care center in Karachi. Data on demographics, clinical presentation, imaging findings, procedural details, and outcomes were analyzed using SPSS v26. Results: ERCP achieved a 100% technical success rate with no significant procedure-related complications or mortality. The most common symptoms were abdominal pain (100%) and jaundice (55.17%). Ultrasound identified worms in 41.3% of cases, while ERCP confirmed all. Adjunctive mebendazole therapy was administered post-procedure. Conclusion: ERCP is a highly effective and safe modality for diagnosing and managing biliary ascariasis, reducing the need for invasive surgery. It should be considered the first-line intervention in endemic areas, supported by ant parasitic therapy to minimize recurrence.
subject: Articles
  topic: section
subject: Biliary ascariasis
  topic: keywords
subject: Endoscopic Retrograde Cholangiopancreatography
  topic: keywords
subject: Ascaris lumbricoides
  topic: keywords
subject: parasitic biliary disease
  topic: keywords
subject: worm extraction
  topic: keywords
subject: abdominal ultrasound
  topic: keywords
subject: jaundice
  topic: keywords
subject: tropical infections
  topic: keywords
subject: diagnostic endoscopy
  topic: keywords
creator: Naseer Ahmed
creator: Sania Maqbool
creator: Muhammad Umair Tehseen
creator: Pashmina Roohi
creator: Muhammad Asim Sharif
creator: Noval Zakaria
creator: Abeer Altaf
creator: Mehreen Siyal
creator: Fahad Kakar
creator: Asma Yaseen
creator: Saad Khalid Niaz
rights: Copyright (c) 2026 Naseer Ahmed, Sania Maqbool, Muhammad Umair Tehseen, Pashmina Roohi, Muhammad Asim Sharif, Noval Zakaria, Abeer Altaf, Mehreen Siyal, Fahad Kakar, Asma Yaseen, Saad Khalid Niaz (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-22
publication date: 2026-05-22
starting page: 890
ending page: 898
doi: 10.63521/pjg.42.1.2026.20

Non-Invasive Assessment of Portal Hypertension: An Evolving Landscape
type: item
subject: Editorials
  topic: section
creator: Kashif Malik
rights: Copyright (c) 2025 Kashif Malik (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 808
ending page: 809
doi: 10.63521/pjg.41.4.2025.22

Relationship between Upper GI symptoms and Endoscopic findings with Gastric H Pylori density.
type: item
description: Objective: Helicobacter pylori affects many individuals in developed and developing countries. Inflammation caused by H pylori differs depending on the virulence factors, bacterial density and host response of bacteria. This study is designed to investigate the association between density of H Pylori colonization in gastric mucosa in biopsy specimens and severity of gastric mucosal inflammation. Methods: This study of 75 patients was done at Department of Gastroenterology, Ghurki Trust Teaching Hospital Lahore. These patients presented with GI symptoms and got endoscopy done between June 2023 to June 2024. Their histopathology reports were retrospectively screened and severity of inflammation and H Pylori density were analyzed by Sydney scoring. Data analysis was done using SPSS software version 24. Results: The analysis of H. pylori density and its association with gastrointestinal symptoms and endoscopic findings reveals that most gastrointestinal symptoms, including epigastric pain, nausea, and retrosternal burning, show no significant association with H. pylori density. On endoscopy findings evaluation only esophagitis is associated with higher H. pylori densities (p < 0.001), indicating a potential link between the bacterium and this condition. Other findings, such as moderate gastritis and duodenitis, show trends toward association but are not statistically significant. Conclusion: Our study shows that density of H Pylori infection has no influence over Upper GI symptoms and also endoscopic findings cannot be taken as evidence of H pylori infection.
subject: Articles
  topic: section
subject: Endoscopy
  topic: keywords
subject: H pylori
  topic: keywords
subject: Esophagitis
  topic: keywords
subject: Gastritis
  topic: keywords
subject: Duodenitis
  topic: keywords
creator: Asia Mehmood
rights: Copyright (c) 2025 Asia Mehmood (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 843
ending page: 850
doi: 10.63521/pjg.41.4.2025.21

Exploring Viral and Non-Viral causes of Alanine Aminotransferase Spikes above 1000 in a South Asian Cohort
type: item
description: ABSTRACT Background Elevated ALT levels greater than 1000 U/L indicate severe hepatic injury. In Western studies, ischemic hepatitis and drug-induced liver injury (DILI) are common causes (1, 2). However, in South Asia, hepatitis E (HEV) predominates, contributing to a different clinical pattern. This study explores the causes and outcomes of ALT >1000 U/L in a South Asian cohort. Methods we prospectively analyzed 151 patients with ALT >1000 U/L from AIMS Hospital. Data on demographics, etiology, clinical presentation (acute hepatitis, acute liver failure [ALF], acute-on-chronic liver failure [ACLF]), hospital stay, and 30-day outcomes were collected. Statistical analysis was performed using IBM SPSS Version 22. Results Viral hepatitis was the leading cause (86.1%), with hepatitis E being the most frequent (55.6%). Non-viral causes, including ischemic hepatitis (4.6%) and DILI (3.3%), were rare. Acute hepatitis (63.6%) was the most common presentation, and hepatitis E was responsible for 63.5% of these cases. ALF occurred in 11.9%, primarily due to hepatitis E. The majority of patients (78.1%) had a short hospital stay (<48 hours), with 94% showing improvement. Severe cases (ischemic hepatitis, ACLF) resulted in a 4% mortality rate, and 2% were referred for liver transplantation. Conclusion Our study highlights the dominance of hepatitis E in ALT >1000 U/L in South Asia, contrasting with Western trends where ischemic hepatitis and DILI are more prevalent (1, 2). These findings suggest the need for regional-specific diagnostic strategies, particularly in endemic areas. References: Mohamed MF, Wadhavkar N, Elfanagely Y, Marino D, Beran A, Abdallah M, Promrat K. Etiologies and Outcomes of Transaminase Elevation > 1000 IU/L: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2023 Jul;68(7):2843-2852. doi: 10.1007/s10620-023-07962-w. Epub 2023 May 15. PMID: 37184617. Breu AC, Patwardhan VR, Nayor J, Ringwala JN, Devore ZG, Ganatra RB, Hathorn KE, Horton L, Iriana S, Tap…
subject: Articles
  topic: section
creator: Muhammad Sadik Memon
rights: Copyright (c) 2025 Muhammad Sadik Memon (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 819
ending page: 823
doi: 10.63521/pjg.41.4.2025.18

Platelet count to prothrombin (PLT/PT) ratio to predict esophageal varices in patients with hepatitis C related chronic liver disease
type: item
description: Background Variceal hemorrhage is a serious complication of portal hypertension in patients with chronic liver disease caused by various etiologies. In order to identify varices at earlier stages many noninvasive predictors have been studied to avoid unnecessary EGD and reduce bleeding related mortality. Objective To identify the relationship of PLT/Pt ratio with presence of esophageal varices in patients with HCV-CLD. Methods In this cross sectional study 140 patients with HCV related CLD were included. They distributed into those with and without esophageal varices. Variceal group was further subdivided into those low risk (Grade-I) and high risk Varices (Grade-II/III). All patients were subjected to detailed history and examination. Laboratory tests. Ultrasound abdomen and EGD was performed. Results Median age of patients was 54+/- 10.18 years. 61.4% patients were male (n=86) and 38.6% were female (n=54). 86.4% (n=121) had EVs and 13.5 %( n=19) had no varices. PLT/PT ratio at cut off value of ≤12384 predicted esophageal varices with sensitivity of 85.12%. Specificity of 73.68%, PPV of 95.37%, NPV of 43.74% and diagnostic accuracy of 83.57% with AUC of 0.817. PLT/PT ratio at cut-off value of ≤11145.03, with AUC of 0.707, sensitivity of 88.64%, specificity of 54.55%, PPV of 83.87%, NPV of 64.29% and diagnostic accuracy of 79.34%. Conclusion PLT/PT ratio has significant association with both the presence of esophageal varices and advanced grades of varices. Key words: Platelet count to prothrombin time (PLT/PT) ratio, Esophageal varices, HCV-related chronic liver disease.
subject: Articles
  topic: section
subject: Platelet count to prothrombin time (PLT/PT) ratio
  topic: keywords
subject: Esophageal varices
  topic: keywords
subject: HCV-related chronic liver disease.
  topic: keywords
creator: Munir Ahmed
rights: Copyright (c) 2025 Munir Ahmed (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 824
ending page: 830
doi: 10.63521/pjg.41.4.2025.19

Stem Cell Therapy for Liver Cirrhosis - Prospects and challenges
type: item
description: The burden of liver diseases and their impact on health is a global concern. While liver transplant remains the curative option for end-stage liver diseases, it has many shortcomings restricting its widespread availability and adaptation. The quest for an effective alternative to slow down progression of liver cirrhosis and restoration of function of cirrhotic liver is therefore ongoing, where stem cell therapy is on the table which. However, although in many cases the results are encouraging with stem cells in liver diseases, it still has a long way to go before it can be recommended in regular clinical practice. We have significant experience of treating liver cirrhosis patients with human progenitor stem cells. Here we present a blend of our own experience and review of recent literature to assess where we stand today with stem cells as an option at our disposal for treating liver diseases.
subject: Narrative Review
  topic: section
subject: Stem cell, liver cirrhosis.
  topic: keywords
creator: Mamun Al Mahtab
rights: Copyright (c) 2025 Mamun Al Mahtab (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 810
ending page: 818
doi: 10.63521/pjg.41.4.2025.17

Peri-Operative FLOT Chemotherapy in Locally-Advanced Gastric and Gastroesophageal Carcinoma: Outcomes In South Asian Population
type: item
description: Objective: To compare oncological outcomes of perioperative FLOT chemotherapy in terms of tumor response, tumor margin clearance and average positive number of lymph nodes retrieved in surgical resection specimens of locally advanced gastric and gastroesophageal carcinoma. Materials and Methods: The patients presenting in Department of General Surgery, Shifa International Hospital, Islamabad from July 2020 to March 2023 were included in the study. Out of total 108, we included 37 patients who undertook perioperative FLOT chemotherapy in for resectable, locally advanced gastroesophageal cancer. Response to therapy was assessed based on per operative findings, R0 resection and D2 lymphadenectomy and disease regression on histopathology specimens. Patients were also assessed according to post-operative recovery time, mean ICU and hospital stay, as well as post chemo and post-operative complications. Statistical Analysis Appropriate statistical analysis was performed using SPSS version 26. Results: There were a total 37 patients with mean age 57.21 ± 10.04 years. 4(10.8%) had well-differentiated adenocarcinoma, 19(51.4 %) had moderately-differentiated and 14(37.8%) had poorly-differentiated cancer. Perioperative completion rate of 4 cycles of chemotherapy was 100%. 4 patients had dose reduction due to neutropenia. 100% of the patients had R0 resection. Average positive lymph nodes on histopathology were 2.04 ± 3.01 in 13 patients (35.1%). 24 out of 37 patients (64.9%) had no nodal involvement. Histopathology, evaluated for treatment response according to CAP (College of American Pathologists) -TRG criteria, 7 (18.9%) patients out of 37 showed no tumor regression. 22(59.5%) had partial response and 8(21.6%) patients had complete response. Conclusion: Perioperative FLOT shows highly favorable results in patients with resectable, locally-advanced gastric and gastroesophageal cancer. Considering the burden of this disease in the South Asian population, an optimal therapeuti…
subject: Articles
  topic: section
subject: neo adjuvant
  topic: keywords
subject: locally advanced
  topic: keywords
subject: chemotherapy
  topic: keywords
subject: gastroesophageal cancer
  topic: keywords
subject: peri operative
  topic: keywords
creator: Rabia Arshad
creator: yashfeen malik
creator: Hadi Mohammad Khan
creator: Maaz bin Badshah
rights: Copyright (c) 2025 Yashfeen Malik, Rabia Arshad , Hadi Mohammad Khan , Maaz bin Badshah, MD (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-10-08
publication date: 2025-10-08
starting page: 837
ending page: 843
doi: 10.63521/pjg.41.4.2025.13

Hepatitis C elimination by 2030. Are we on the road to miss the target?
type: item
subject: Editorials
  topic: section
creator: Ghias Un Nabi Tayyab
rights: Copyright (c) 2025 Ghias Un Nabi Tayyab (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-03-27
publication date: 2025-03-27
starting page: 764
ending page: 767
doi: 10.63521/pjg.41.3.2025.15

Avoidance behaviour as a coping mechanism in patients with Irritable Bowel Syndrome
type: item
description: Introduction: Irritable Bowel Syndrome (IBS) and Somatization Symptoms Disorder (SSD) patients experience somatization symptoms that have a significant impact on their quality of life and their primary diagnoses as well. Coping strategies in these patients affect how they seek treatment and how they respond to different interventions. One of these coping strategies is “Avoidance behaviour”. The relationship between avoidance behaviour in relation to demographic and social variables in IBS patients’ needs to be better described. Methods: This study was performed at Shifa International Hospital, Islamabad. Study participants aged 18 years and above who were seeking regular treatment in the respective units of Shifa International Hospital, were surveyed between March 1st , 2023, and January 14th , 2024. Purposeful sampling was done to recruit study participants. Participants were eligible to participate if they had a diagnosis of IBS, or SD. Coping Strategy Indicator (CSI) was used to assess coping strategies in patients with IBS and SD. Results: There was a total of 88 patients; 67 with IBS and 21 with SSD. With increasing age, the avoidance behaviour decreased, with higher education levels avoidance behaviour also increased. Conclusion: Avoidance behaviour was observed as a significant interventional target in IBS patients. This is most evident in the younger age group and those with higher level of education.
subject: Articles
  topic: section
subject: Coping
  topic: keywords
subject: Irriatble Bowel Syndorme
  topic: keywords
subject: Somatization
  topic: keywords
subject: Avoidance Behaviour
  topic: keywords
subject: Coping Strategy Indicator (CSI)
  topic: keywords
subject: Patient Health Questionnaire
  topic: keywords
creator: Saira Akhlaq
creator: Ahmed Bajwa Muhammad
creator: Ahad Abdul
creator: Yaqoob Akhtar Muhammad
creator: Sajawal Hussain
creator: Nosheen Kazmi
creator: Kalsoom Akhlaq
creator: Shahzad Riyaz
creator: Murtaza Kazmi
rights: Copyright (c) 2025 Saira Akhlaq, Muhammad Ahmed Bajwa , Abdul Ahad, Muhammad Yaqoob AKhtar, Sajawal Hussain , Nosheen kazmi , kalsoom Akhlaq, Shahzad Riyaz , Murtaza Kazmi (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-03-27
publication date: 2025-03-27
starting page: 797
ending page: 805
doi: 10.63521/pjg.41.3.2025.1

Serum Alpha Fetoprotein as a Predictor of Tumor Size in Hepatocellular Carcinoma
type: item
description: Objective: To figure out the connection between serum alpha fetoprotein (AFP) amount and tumour load in hepatocellular carcinoma (HCC) patients. Methods: This cross-sectional analytical study was conducted at Interventional Radiology Department of Rehman Medical Department from May 2016 to Nov 2022. Patients with chronic liver diseases and concurrent HCC comprise the study population, while people with liver metastases from other main malignancies were excluded. The variables used in. Demographic characteristics, clinical information, laboratory investigations and imaging modality were considered. Patients were then classified according to AFP and tumor diameter. Frequencies and percentages were generated from descriptive statistics. Inferential statistics correlated with Spearman's rank-order correlation test were used. Compare the degree of association among the variables. Results: There was a direct positive association of AFP levels in patients with tumor size (Pearson Chi-Square = 99.407, p < 0.001). The clinical data revealed that patients with higher AFP levels had significantly larger tumors, more frequent vascular invasion, and extrahepatic metastases. Patients with only AFP >2000 IU/ml had predominantly larger tumor size of >5 cm in diameter. Conclusion: Higher serum AFP levels are positively associated with bigger tumour size and higher tumour progression in patients with HCC. AFP is a useful biomarker for estimating tumor load and therapeutic and diagnostic approaches, yet it has to be combined with other diagnostic methods.
subject: Articles
  topic: section
subject: hepatocellular carcinoma
  topic: keywords
subject: Alfa Fetoprotein
  topic: keywords
subject: AFP
  topic: keywords
subject: HCC
  topic: keywords
subject: Tumor size
  topic: keywords
creator: Muhammad Abdullah
creator: Aman Nawaz khan
creator: Ummara Siddique Umer
creator: Muhammad Kamran Khan
creator: Ghulam Syed Ghaus
rights: Copyright (c) 2025 Muhammad Abdullah, Aman Nawaz, Ummara, Muhammad Kamran, Ghulam Ghaus (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-03-27
publication date: 2025-03-27
starting page: 790
ending page: 796
doi: 10.63521/pjg.41.3.2025.8

Gastrointestinal and hepatobiliary manifestations of COVID-19 infection: A single center study from Pakistan
type: item
description: BACKGROUND: Coronavirus disease was a global challenge affecting around 229 countries with over 700 million confirmed cases with significant morbidity and mortality. OBJECTIVE: To determine the frequency of hepatobiliary manifestations in patients of COVID-19. METHODOLOGY: This was a cross-sectional study conducted at North Medical Ward, Mayo Hospital, Lahore for three months. After ethical approval of the study, 200 COVID-19 RT-PCR positive cases of ages 15 to 80 years were included in the study. Complete history & examination regarding hepatobiliary symptoms were noted. Liver function tests & prothrombin time were sent to pathology laboratory & results were noted. Data was analyzed using SPSS-26. Quantitative variables like age, bilirubin, Aminotransferases & Prothrombin time were taken as mean ± standard deviation. Qualitative variables like gender, hepatobiliary symptoms were taken as frequency and percentages. RESULTS: The most common symptom at presentation was diarrhea 30 (15.0%) followed by fatigue, pruritic and anorexia 17 (8.5%), nausea, vomiting and abdominal pain 15 (7.5%), body petechiae & purpura in 13(6.5%), Right hypochondrial pain 11(5.5%) & Hiccup and dark color urine 1(0.5%). On laboratory findings,17(8.5%) patients had elevated bilirubin levels while AST was raised in 79(39.5%) of cases, ALT in 23(11.5%), Alkaline phosphatase in 6(3.0%), GGT in 95(47.5%) of cases. 8 (4.0%) cases showed decrease albumin level and 12(6.0%) cases had prolonged PT levels. CONCLUSION: Hepatobiliary symptoms and laboratory derangements are not uncommon in patients with COVID-19. So, attention should be given to these extra-pulmonary symptoms to avoid any delay in treatment & disease progression and complications.
subject: Articles
  topic: section
subject: COVID-19
  topic: keywords
subject: Pandemic
  topic: keywords
subject: Liver Function Test
  topic: keywords
subject: Hepatobiliary
  topic: keywords
subject: Manifestations
  topic: keywords
creator: Sami Ullah Mumtaz
creator: Rabiah Haque
creator: Tayyeba Komal
creator: Somia Iqtadar
creator: zafar Niaz
creator: Sajid Abaidullah
rights: Copyright (c) 2025 Rabiah Haque, Sami Ullah Mumtaz, Tayyeba Komal, Somia Iqtadar, zafar Niaz, Sajid Abaidullah (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-03-27
publication date: 2025-03-27
starting page: 768
ending page: 773
doi: 10.63521/pjg.41.3.2025.10

The Impact of HCV eradication on HBAIC in Genotype 3 Chronic HCV Diabetic Patients
type: item
description: ABSTRACT Objective: Hepatitis C Virus (HCV) is a global health concern. WHO estimated that it affects a 170 million people worldwide. In Pakistan, 6.8% of adult population exhibits presence of active disease. With the rise of DAAs especially Sofosbuvir and Velpatasvir the ETR and SVR is remarkable. Patients who secure seroconversion following DAA treatment experience a drop in their HOMA-IR levels, in contrast to those who don't. It means that there are metabolic benefits of HCV eradication. Based on this hypothesis we evaluated the benefit on HBAIC in patients achieving ETR. Methods: The study sample comprised of 100 type 2 diabetics who attended Gastroenterology clinic at GTTH, a tertiary care hospital in Lahore for treatment of HCV infection. All the confirmed type 2 diabetes cases on any therapy were included in the study sample. Data was analyzed using SPSS Statistics version 24. Results: Out of study sample of 100 patients, 100% achieved an end of treatment response (ETR). In our study, mean difference in fasting blood sugar (FBS) from baseline to ETR was found to be a decrease of 48.70 ± 22.20mg/dL (p Value<0.05). Similarly, the mean difference RBS over the same duration showed a reduction of 98.00 ± 39.70 mg/dL (p value <0.05) Quite interestingly, HbA1c levels also showed a decline of mean difference of 1.10 ± 0.82% from baseline to the 3 months mark (p value<0.05) Conclusion: Successful eradication of HCV does lead to improvement in Diabetes control in type 2DM.
subject: Articles
  topic: section
creator: Taha Tariq
creator: Ayesha Waheed
creator: Usman Akram
creator: Umer Hayat
rights: Copyright (c) 2025 Taha Tariq, Ayesha Waheed, Usman Akram, Umer Hayat (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-03-27
publication date: 2025-03-27
starting page: 774
ending page: 782
doi: 10.63521/pjg.41.3.2025.7

The Incidence of Obesity and Overweight amongst Type 2 Diabetic patients, visiting Tertiary Care Hospital of Lahore
type: item
description: Objective: Diabetes continues to be one of the most prevalent global and local health problem as per IDF data. A strong relationship between obesity, overweight and diabetes has been established and thus requires a better understanding of prevalence of obesity and overweight among type 2 diabetics for their better management and prevention of complications. This study is performed to evaluate the incidence of overweight and Obesity amongst Type 2 diabetes patients visiting OPD clinic of Ghurki Trust Teaching Hospital Lahore. Methods: The study sample comprised of 500 type 2 diabetics who attended diabetes clinic at GTTH, a tertiary care hospital in Lahore. All the confirmed type 2 diabetes cases were included in the study sample. The patients who had undergone any gastric surgery for weight loss or taking weight losing medications were excluded. Data was analyzed using SPSS Statistics version 24. Results: The BMI was measured in 500 patients (293 males and 207 females) who attended the clinic. According to the measured BMI, 113 (22.6%) were non-obese i.e. BMI 18.5-24.9 (M=70(23.9%) and F=43(20.7%). Overweight (BMI 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2), were 224(44.8%) and 126 (25.27%) respectively. Females were more overweight than males (40.9% vs 50.2%) and also grade II obesity was more in female than male T2DM patients (6.4% vs 14.9%). Conclusion: The prevalence of obesity in patients with type 2 diabetes mellitus in our population is high, especially in females.
subject: Articles
  topic: section
subject: Obesity
  topic: keywords
subject: Overweight
  topic: keywords
subject: Type 2 Diabetes mellitus
  topic: keywords
subject: HbAIC
  topic: keywords
subject: BMI
  topic: keywords
creator: Taha Tariq
creator: Asia Mehmood
creator: Azan Ali
creator: Usman Akram
creator: Iman Ijaz
creator: Maryam Faseeh
creator: Umer Hayat
rights: Copyright (c) 2025 Taha Tariq, Asia Mehmood, Azan Ali, Usman Akram, Iman Ijaz, Maryam Faseeh, Umer Hayat (Author) https://creativecommons.org/licenses/by/4.0
date: 2025-03-27
publication date: 2025-03-27
starting page: 783
ending page: 789
doi: 10.63521/pjg.41.3.2025.4