A 6-year-old girl was brought with complaints of poor weight gain and poor appetite for the past 2 years. Her weight and height lay below the 5th percentile for age as per the World Health Organization (WHO) growth chart. The mid-parental height lay between the 75th and 95th percentile, and thus, the child was evaluated for pathological short stature. She was found to have microcytic hypochromic anemia and positive celiac serology [anti-tissue transglutaminase (tTG) antibody >70 AU/mL]. Celiac disease was suspected, and an endoscopic duodenal biopsy was done, which showed a large number of Giardia organisms with lymphoid nodules formation. Antimicrobials were started for giardiasis, and no dietary restrictions were done. On the 3-month follow-up, weight and height increased, appetite improved, and celiac serology was negative (anti-tTG antibody <3 AU/mL).
Various diagnostic methods have been designed and developed over the years to discriminate between physiologic and pathologic gastroesophageal reflux. Though pH-metry has been used for years, its benefits and limitations became clearer with time and newer diagnostic techniques like wireless methods (Bravo pH capsule), pharyngeal probes, and multichannel intraluminal impedance with pH (MII-pH) to measure both acid and nonacid reflux (NAR) were introduced. Evidence indicates that MII-pH seems to be the new gold standard for the evaluation of patients with extraesophageal symptoms of suspected gastroesophageal reflux disease (GERD) or in patients with persistent symptoms despite acid suppression therapy however the lack of true pediatric normal reference values and limited therapeutic options for NAR is a major issue. The technique to perform MII-pH-metry has been described in this article.
The liver is an important organ of the body or the liver as a metaphor. From literature to Bollywood, the liver has an important place in everybody's life. A humorous take on an organ of vital importance.