Place: Bellary
Date:
From,
DR. MILIND H. IDDALAGI
Post Graduate Student in M.S GENRAL SURGERY.
Dept. of Surgery,
VIMS, Bellary.
To,
The Principal,
Vijayanagar Institute of Medical Sciences,
Bellary.
THROUGH PROPER CHANNEL
Respected sir,
Subject: Acceptance of registration and forwarding of dissertation topic,
In accordance with the above cited subject, I the undersigned studying Post Graduate Course in M.S. General surgery have been allotted the dissertation topic “EVALUATION OF PERSISTENT UPPER ABDOMINAL PAIN BY UPPER GASTROINTESTINAL ENDOSCOPY AND ITS MANAGEMENT”, under the guidance of Dr. C. CHENNANNA, Professor, Department of surgery, VIMS, Bellary.
I request you to kindly forward the dissertation topic in the prescribed form to the university for approval.
Thanking you,
Yours faithfully,
DR. MILIND H. IDDALAGI.
Signature of the guide
Dr. CHENNANNA,
Professor,
Department of surgery,
VIMS, Bellary.
Place: Bellary
Date:
From,
The Professor & Head of the Department,
Department of surgery,
VIMS, Bellary.
To,
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore.
THROUGH PROPER CHANNEL
Respected sir,
As per the regulations of the University for registration of Dissertation topic, the following Post Graduate in M.S. in General Surgery has been allotted the dissertation topic as follows, by the Official Registration Committee of all qualified and eligible guides of the Department of surgery.
NAME / TOPIC / GUIDEDR. MILIND H. IDDALAGI
Post Graduate Student in M.S in GENERAL SURGERY.
Dept. of Surgery,
VIMS, Bellary. / “EVALUATION OF PERSISTENT UPPER ABDOMINAL PAIN BY UPPER GASTROINTESTINAL ENDOSCOPY AND ITS MANAGEMENT”. / Dr. CHENNANNA,
Professor,
Department of surgery,
VIMS, Bellary.
Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking you,
Yours faithfully,
Signature of the guide DR. VIDYADHAR.KINHAL.
Dr. CHENNANNA Professor & Head of the Department,
Professor, Department of Surgery, VIMS, Bellary
Department of surgery,
VIMS, Bellary .
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE—II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS (in block letters) / DR. MILIND H. IDDALAGI.POST GRADUATE STUDENT IN M.S GENRAL SURGERY.
DEPT. OF SURGERY, VIMS, BELLARY
2. / NAME OF THE INSTITUTION / VIJAYANAGAR INTITUTE OF MEDICAL SCIENCES, BELLARY
3. / COURSE OF STUDY AND SUBJECT / MS in GENERAL SURGERY
4. / DATE OF ADMISSION TO THE COURSE / 26-05-2007
5. / TITLE OF THE TOPIC:“ EVALUATION OF PERSISTENT UPPER ABDOMINAL PAIN BY UPPER GASTROINTESTINAL ENDOSCOPY AND ITS MANAGEMENT ”.
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Persistent abdominal pain is the main symptom of majority of chronic abdominal conditions. Even though the duration, site, radiation, its character and the relieving factors may point towards the underlying pathology, the evaluation of persistent abdominal pain and its management has been challenging to physicians and surgeons.
Majority of the conditions causing persistent abdominal pain arise from oesophagus(cardiac sphincter), stomach and small intestine. Non ulcer dyspepsia being one of the leading causes of persistent abdominal pain.
Upper GI endoscopy is usually perform to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting and difficulty in swallowing. Upper GI endoscopy is more accurate than X-ray films for detecting inflammation, ulcers or tumours of oesphagus stomach and duodenum2.
Endoscopy is the procedure of choice for the diagnostic evaluation of UGI tract because of its ease, reliability, diagnostic superiority and the ability it gives the endoscopist to perform biopsies and therapeutic interventions.
Hence the need for study of evaluation of persistent upper abdominal pain by upper GI endoscopy and its management.
6.2 REVIEW OF LITERATURE:
Flexible endoscopy is more sensitive than conventional radiology in the assessment of majority of gastroduodenal conditions. This is particularly the case with peptic ulceration, gastritis & duodenitis1.
The American society of gastroinstenal endoscopy (ASGE) have guidelines regarding the upper GI endoscopy. UGI endoscopy is more accurate than radiology in detecting inflammations, ulcers or tumours of the UGI tract. A variety of instruments can also be passed through the endoscope that allows many abnormalities to be treated directly with little or no discomfort2.
Tom Richard Okello at Lacor Hospital, Uganda, in his study of upper GI endoscopy in adolescents analyzed 135 children who were referred for UGI endoscopy held that upper GI endoscopy is a diagnostic procedure in children with GI disorder3.
N. Ukarapol, N lertprasertsuk, L Wongsawasdi in a three months study of upper abdominal pain in children enrolled 38 children. The study concluded that one of the most common causes of recurrent abdominal pain was H.pylori infection. Upper GI endoscopy was very helpful in identifying the underlying pathology4.
One of the series of statement by American society for GI endoscopy defines the role of upper GI endoscopy in the diagnostic evaluation and management of patients with dyspepsia. It states that endoscopic examination of the upper GI remains the gold standard for establishing/excluding peptic ulcer disease & other causes of non ulcer dyspepsia5.
6.3 OBJECTIVES OF THE STUDY:
1.To study various causes of persistent abdominal pain in different age groups
2. To study role of upper GI endoscopy in evaluation of persistant upper abdominal pain.
3. To study the management of the persistent abdominal pain and the role of UGI endoscopy in management.
7. / MATERIALS AND METHODS
7.1 SOURCE OF DATA:
Patients under going upper GI endoscopy both on IPD and OPD basis in VIMS Bellary are included in our study by applying the following inclusion and exclusion criteria. The study will be conducted during the period from Jan 2008 to June 2009.
INCLUSION CRITERIA FOR THE STUDY:
1.Patients of all age groups complaints of persistent upper abdominal pain.
2.Patients with history of pain abdomen more than 4 weeks.
3. Patients of both sexes.
EXCLUSION CRITERIA :
1. Patients pain abdomen confirmed by other investigations (e.g. USG) to have pathologies in other organic systems e.g. renal/ureteric calculi.
2. Patients with acute on chronic abdominal pain.
7.2 METHOD OF COLLECTION OF DATA (including sampling procedure, if any):
. Data will be collected from a specially designed proforma case recording proforma (CRF) pertaining to patients particulars, proper history, clinical examinations, investigations, diagnosis. It is then subjected to statistical analysis with the help of biostatistician of our institute. All the procedures and investigations will be conducted under direct guidance and supervision of our guide. Before start of our study a written/informed consent will be obtained in local vernacular in each patient .
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO DESCRIBE BRIEFLY.
YES. Our study requires the following investigations.
· Routine Investigations:
o Haemoglobin
o Urine
o Fasting blood sugar
o Blood urea
o Serum creatinine
o Total leucocyte count
o Differential count
o Erythrocyte sedimentation rate
· Upper GI endoscopy & biopsies wherever required.
· Erect X-ray abdomen, USG abdomen, CT scan abdomen if required.
Among the above mentioned investigation UGI endoscopy will be the principal procedure.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM ETHICAL COMMITTEE OF YOUR INSTITUTION IN CASE OF 7.3
Yes. Clearance has been obtained for Ethical Clearances Committee, VIMS, Bellary.
8. / LIST OF REFERENCES:
1. John N. Primrose; stomach and duodenum – Bailey and Love, Short practice of Surgery 24th edition: pp.1030-1031, editors-R.C.G.Russell, N.S.Williams and Christoper J.K. Bulstrode
2. http://medpolicy.unicare.com/policies/guidelines - ASGE guidelines.
3. Tom Richard Okello at Lacor Hospital, Uganda – Upper GI endoscopy in adolescents, 2006 – www.ajol.info/sitemap.
4. N. Ukarapol, N lertprasertsuk, L Wongsawasdi, Singapore Med. J. 2004, vol 45(3).
5. The role of endoscopy in dyspesia – American Society for Gastriointestinal Endoscopy, Vol 54 no.6,2001.
9. / SIGNATURE OF THE CANDIDATE: / (DR. MILIND H. IDDALAGI )
10. / REMARKS OF THE GUIDE: / Recommended and forwarded for the needful
11. / NAME AND DESIGNATION OF
(in block letters)
11.1 GUIDE / Dr. CHENNANNA,
Professor,
Department of surgery,
VIMS, Bellary.
11.2 SIGNATURE
11.3 CO.GUIDE (if any)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT:
/ DR.VIDYADHAR KINHAL
PROF. & HEAD OF THE DEPARTMENT,
DEPARTMENT OF SURGERY,
VIMS, BELLARY.
11.6 SIGNATURE
12. / 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2 SIGNATURE