Gastro Flash Vol-4, No-2, 2018

Glycogenic hepatopathy (GH) is a rare and under-recognized complication in patients with long-standing poorly controlled diabetes mellitus (DM). It was first described by Mauriac, in 1930, in diabetic children.1 The key feature is glycogen accumulation in the liver causing hepatomegaly and raised serum transaminases with wide fluctuations in both glucose and insulin levels. It is important to distinguish this entity from other causes of hepatomegaly and elevated liver enzymes in diabetics, such as nonalcoholic fatty liver disease. Persistent and relatively mild disturbance in liver function favours nonalcoholic fatty liver disease whereas transaminase flares are more compatible with GH. The hallmark of this condition is its reversibility with improved glycemic control, unlike other conditions such as hepatic steatosis. Furthermore, glycogen overload is not known to progress to fibrosis, thus it is distinguishes from fatty liver disease. However, a final distinction can be made with a liver biopsy.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder; it is also one of the most commonly diagnosed gastrointestinal diseases. The worldwide prevalence of IBS ranges from 10% to 20% with an estimated incidence of 1.4–1.5%, according to longitudinal population-based study lasting 10-12 years.1,2 IBS is more common in women and in young adults. The clinical manifestation of IBS is not unique; however, it can be classified into three subtypes. IBS subtypes include constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), and IBS with predominant irregular (mixed diarrhea/ constipation) bowel habits (IBS-M). IBS subtyping is more accurate when patients have at least 4 days of abnormal bowel habits monthly in the absence of any specific treatment such as laxatives or antidiarrheal agents using a diary report of at least 14 days. An alteration in stool consistency (i.e. hard/lumpy stools or loose/watery stools) for more than 25% of bowel movements is the threshold for classification in the various IBS subtypes.