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What is terminal ileitis and symptoms? Terminal Ileitis is inflammation (-itis) of the last part of the small intestine (terminal ileum). This is not a disease by itself but is rather a finding. It is often equated with Crohn’s disease, an autoimmune condition, but there are other common causes such as: Bacterial infections (e.g., Salmonella, Yersinia, Campylobacter) or intestinal tuberculosis or viral infections. Even some drugs such as pain reliever or NSAID can trigger this. It is necessary to identify the cause as this affects treatment, which differs widely, since treatment is based on the cause. Dr Chetan Kalal, Hepatologist and Liver Transplant Physician, Saifee Hospital, Mumbai shares that “It is important to note that the word ‘terminal ileitis’ does not necessarily indicate a dangerous disorder or a high risk (depending on the cause. Inflammatory disease of the terminal ileum can be mild and self-limited or severe. With the correct treatment, most people recover. In some cases, which are more severely inflamed, there may be dehydration, intense pain, the failure to eat, bleeding or, rarely, complications like intestinal blockage or perforation.” The doctor also elaborated on the symptoms, sharing: If, however, the inflammation is caused by conditions such as Crohn’s disease or TB of the intestines, then there is a possibility that treatment will be required on an ongoing basis to avoid complications. Anyone who has a persistent abdominal pain, prolonged diarrhoea, blood in stools, fever or unexplained weight loss should be evaluated by a medical professional before attempting any self-medicines.Symptoms depend on the cause but tend to have pain in the lower right side of the abdomen, diarrhoea (sometimes with blood in the stool), fever, loss of appetite, nausea or vomiting. The symptoms that last for weeks should be followed by additional tests, including colonoscopy or imaging and stool tests, for some infectious reasons. What are Lifestyle and Dietary changes? Dr Pramod Kadam, Consultant, General Surgery, Ruby Hall Clinic added, “Since there are a variety of causes of terminal ileitis, there is no single prevention method.All people can do to limit their risk from infectious causes is to: – Practising good hand hygiene. – Eating well cooked food and drinking safe water, particularly when travelling. – Rejection of raw or undercooked meats, poultry, egg and unpasteurized dairy. – Thoroughly washing fruits and vegetables. – Not using unnecessary antibiotics or painkillers (like ibuprofen or diclofenac) unless a doctor recommends them. – Don’t smoke, as smoking worsens and increases the risk of Crohn’s disease. While no food can cure terminal ileitis, a balanced diet can be beneficial in boosting overall gastrointestinal health, particularly when recovering from the disease. It is preferable to use oats, brown rice, green leafy vegetables, and fruits. Nuts and lentils aid also. Curd or Yogurt contains beneficial bacteria. And good hydration is crucial. Some patients may find it easier to tolerate a low fibre diet during an acute attack when there is a lot of pain or diarrhoea. Eating recommendations, then, should be personalised according to the diagnosis and severity of symptoms. However, anyone who has a persistent abdominal pain, prolonged diarrhoea, blood in stools, fever or unexplained weight loss should be evaluated by a medical professional before attempting any self-medicines.

The monsoons each year are a welcome respite from the summer heat. As a gastroenterologist, however, I know it also coincides with a typical increase in stomach infections. My clinic begins to see patients with cases of hepatitis A, hepatitis E, acute gastroenteritis, typhoid and severe food poisoning within a few weeks of the first rains. Unfortunately, many of these diseases are 100% preventable. Bacteria, viruses and parasites flourish with the monsoon. Gut infections can happen if the pipelines are flooded, if water is contaminated, if food is not stored properly, and if poor hygiene is practiced. Fortunately, there are a number of simple habits that can go a long way toward keeping your digestive system healthy. Water, food and hygiene issues The first and foremost rule is awareness of drinking water. Contamination can be caused by damaged or flooded pipelines, even if the city supply is treated. Use boiled water or water treated by a good RO-UV purifier. Whenever purchasing packaged water, inspect it for seal and a valid water quality certification. The foods that are eaten also have an impact. Though street food can be very attractive during the rainy season, all that exposed food, cut fruit, fresh juice and food made under unhygienic conditions can carry bad bacteria like Salmonella and E. coli. Medical intervention Lastly, be familiar with when to seek medical attention. If the child vomits often, has a high temperature, is severely ill with diarrhoea, eyes become yellow or dark coloured urine or if the child has a high fever, this is not something to be ignored. Prompt diagnosis and treatment is key to avoiding complications, especially if it involves the presence of hepatitis and/or highly dehydration. The monsoon should be fun not avoided because you catch an illness that is preventable. There are a few conscious alterations in how you eat, drink and take care of your personal hygiene that can make a huge difference. The gut is your body’s first line of defence and you need to protect it, and it will protect you this rainy season. Dr. Chetan Kalal, DM Hepatology & Liver Transplant Specialist, Saifee Hospital, Mumbai

🌐 Language / ਭਾਸ਼ਾ / اللغة / Langue / ભાષા:   English العربية Français ગુજરાતી ਪੰਜਾਬੀ Résultats de la Transplantation Hépatique à 1 An : Guide Complet pour les Patients Le Dr Chetan Kalal, hépatologiste DM et médecin spécialiste de la transplantation hépatique à l’Hôpital Gleneagles de Mumbai, est reconnu comme le premier hépatologiste DM du Maharashtra. Avec 26 publications indexées sur PubMed dans les domaines de la transplantation hépatique, de l’insuffisance hépatique aiguë-sur-chronique (ACLF) et de la nutrition en soins intensifs, il accompagne les patients atteints d’une maladie hépatique avancée — y compris ceux venant du Maroc, d’Algérie, de Tunisie et d’Afrique de l’Ouest — tout au long du parcours de greffe et du suivi post-transplantation. Ses consultations sont disponibles en présentiel à Mumbai ou en téléconsultation internationale. La transplantation hépatique représente aujourd’hui l’une des interventions chirurgicales les plus complexes et les plus porteuses d’espoir en médecine moderne. Lorsqu’un patient reçoit un nouveau foie, la première année qui suit est déterminante : c’est durant cette période que le corps s’adapte, que le système immunitaire est le plus sollicité, et que les fondations d’une longue survie sont posées. Comprendre ce qui se passe au cours de cette première année — les succès, les défis et les stratégies pour y faire face — est essentiel pour les patients et leurs familles. Pour les patients francophones d’Afrique du Nord et d’Afrique de l’Ouest qui envisagent une transplantation hépatique, Mumbai s’impose comme une destination de référence mondiale. L’Inde a développé une expertise chirurgicale et hépatologique de premier rang, avec des coûts bien inférieurs à ceux de l’Europe ou des États-Unis, et une accessibilité facilitée par des liaisons aériennes directes depuis Casablanca, Tunis, Alger, Lagos ou Abidjan. Le Dr Chetan Kalal, à l’Hôpital Gleneagles de Mumbai, accompagne ces patients à chaque étape du processus. Qu’est-ce que la survie à 1 an après une transplantation hépatique ? La survie à 1 an est le principal indicateur de succès en transplantation hépatique. Selon les données des grands registres mondiaux (European Liver Transplant Registry, UNOS/OPTN), les taux de survie à 1 an pour une transplantation hépatique réalisée dans un centre expérimenté dépassent 90 % pour les receveurs adultes, quelle que soit l’indication principale. Ces résultats reflètent les progrès considérables réalisés depuis les débuts de la chirurgie de transplantation dans les années 1960–70 : meilleure sélection des donneurs et des receveurs, perfusion de préservation avancée, immunosuppression ciblée, et soins intensifs post-opératoires spécialisés. À l’Hôpital Gleneagles de Mumbai, les taux de survie à 1 an sont comparables aux standards internationaux des centres de référence. Les principales causes de complications dans la première année La première année après la greffe concentre la majorité des risques. Les causes les plus fréquentes de complication ou de perte du greffon sont : Le rejet aigu : survient typiquement dans les premières semaines ou les premiers mois. Il est traité par bolus de corticoïdes (méthylprednisolone) ou, en cas de rejet résistant, par des immunosuppresseurs plus puissants comme les anticorps anti-thymocytes (ATG). Selon les lignes directrices de l’EASL, un rejet aigu bien pris en charge n’affecte pas la survie à long terme s’il est diagnostiqué rapidement. Les infections : l’immunosuppression nécessaire pour protéger le greffon augmente le risque d’infections bactériennes (dans les 30 premiers jours), fongiques (surtout dans les 2 premiers mois) et virales — notamment le cytomégalovirus (CMV). Une prophylaxie antivirale par valganciclovir est systématique dans les centres modernes. Les complications biliaires : sténoses ou fuites de la voie biliaire surviennent dans 5 à 20 % des cas selon les séries. Elles peuvent être traitées par cholangiopancréatographie rétrograde endoscopique (CPRE) ou par radiologie interventionnelle. Les complications vasculaires : la thrombose de l’artère hépatique (TAH) est la plus redoutée, survenant dans 2 à 5 % des cas. Elle peut nécessiter une retransplantation d’urgence si elle n’est pas détectée précocement. Un suivi echo-doppler hebdomadaire est indispensable durant les premières semaines. La récidive de la maladie initiale : l’hépatite C, autrefois une cause majeure de perte du greffon, est aujourd’hui maîtrisée grâce aux antiviraux à action directe (DAA) avec des taux de guérison supérieurs à 95 %. La stéatohépatite non alcoolique (NASH/MASLD) peut récidiver si le syndrome métabolique n’est pas contrôlé. L’immunosuppression : équilibre délicat et suivi rigoureux L’immunosuppression post-transplantation repose généralement sur une trithérapie initiale : inhibiteur de calcineurine (tacrolimus ou ciclosporine), mycophénolate mofétil (MMF), et corticoïdes. Le tacrolimus est aujourd’hui le pilier central, avec des niveaux cibles stricts mesurés par dosage sanguin (taux résiduels). Les lignes directrices de l’AASLD et de l’EASL recommandent une décroissance progressive des corticoïdes, généralement stoppés dans les 3 à 6 mois après la greffe, afin de réduire le risque de diabète post-transplantation, d’hypertension, d’ostéoporose et d’infections. Le suivi des taux de tacrolimus, la surveillance de la fonction rénale et la détection précoce du rejet sont les piliers du suivi à 1 an. Il est crucial de ne jamais interrompre ou modifier son immunosuppression sans avis médical. Même une seule dose oubliée peut déclencher un épisode de rejet. Les patients qui voyagent à l’étranger après leur transplantation — notamment ceux qui retournent au Maroc, en Algérie, en Tunisie ou en Afrique de l’Ouest — doivent emporter leur carnet de suivi, une liste de leurs médicaments (nom générique et posologie), et les coordonnées de leur centre référent à Mumbai. Nutrition et style de vie dans la première année après la greffe La sarcopénie (perte de masse musculaire) est fréquente chez les patients atteints de cirrhose avancée avant la greffe. La récupération nutritionnelle post-transplantation est un déterminant majeur de la survie à long terme. Les recommandations de l’ESPEN (European Society for Clinical Nutrition and Metabolism) préconisent : Un apport protéique de 1,2 à 1,5 g/kg/jour dans la phase de récupération immédiate Une reprise précoce de la nutrition orale ou entérale dès le premier jour post-opératoire si possible La supplémentation en vitamine D, calcium et magnésium (déplétion fréquente sous tacrolimus et corticoïdes) Une activité physique progressive, supervisée par un kinésithérapeute dès la sortie des soins intensifs Le Dr Kalal est co-auteur de travaux publiés

Dr Chetan Kalal shares his clinical perspective on managing ACLF in Mumbai — how to diagnose it correctly, what changes outcomes, and when to refer for transplant evaluation.

In 2023, NAFLD was renamed MASLD. Dr. Chetan Kalal explains what changed, the full new taxonomy (MASLD, MASH, MetALD), and what it means for your treatment.

India has 40–50 million chronic Hepatitis B carriers. Dr. Chetan Kalal explains who needs testing, when to start antivirals, and how to prevent reactivation.

Fatty liver in thin people — lean MASLD — is more common than most patients realise, especially in South Asians. Dr. Chetan Kalal explains causes, diagnosis, and treatment.

World Liver Day 2026 | “Solid Habits, Strong Liver” Your Liver Isn’t Failing Suddenly. It’s Being Damaged Daily.Most people don’t “get” liver disease. They grow into it—quietly, predictably, and often preventably. As a clinician, I rarely meet patients at the beginning of their liver problem. I meet them years later—when the disease has already progressed, when fatigue has become normal, when reports have been ignored, and when “it’s nothing serious” has quietly turned into something that is. The uncomfortable truth is this: your liver doesn’t fail overnight. It adapts—until it can’t. The Silent Epidemic We’re Ignoring Liver disease today is no longer rare, nor is it confined to alcohol use. The fastest-growing problem is fatty liver linked to lifestyle and metabolism—seen in working professionals, young adults, even people who don’t look “unhealthy.” There are no early warning signs that force you to act.No pain that makes you stop.No dramatic symptoms that demand attention. That silence is not safety. It is delay. The Daily Patterns That Add Up Most liver damage doesn’t come from one bad decision. It comes from repeated, normalized habits: Late-night eating has become routine. But your liver is not designed to process heavy meals at midnight. It is meant to repair and reset. Constant disruption leads to metabolic overload. Sugary “health” drinks—fruit juices, packaged smoothies, even protein beverages—are often perceived as safe. In reality, excess sugar is converted into fat within the liver, contributing directly to fatty liver disease. Frequent painkiller use, often taken casually for headaches or body aches, adds cumulative stress. One tablet is not the problem. Habitual use is. Crash diets and extreme fasting promise rapid weight loss but create metabolic instability. The liver does not respond well to sudden extremes. Physical inactivity, even in those who are not visibly overweight, is enough to drive fat accumulation in the liver over time. Individually, these may seem harmless. Together, they form a pattern the liver cannot indefinitely compensate for. Food Myths vs Liver Reality Public discourse around diet is filled with confusion. Ghee is not the enemy—but excess is.Fruit is not harmful—but fruit juice in large amounts is.Carbohydrates are not the problem—but imbalance is. Your liver does not follow trends. It responds to metabolic load—how much energy comes in, how it is processed, and whether it is used or stored. When intake consistently exceeds need, the excess is stored as fat in liver cells. Over time, this can trigger inflammation and scarring. The issue is rarely a single food. It is the pattern of consumption. When “Fatty Liver” Stops Being Harmless Fatty liver is often dismissed as mild or reversible—and it can be, if addressed early. But there is a point where it progresses: Fat accumulation → inflammation → fibrosis (scarring) → cirrhosis This transition is silent. Patients do not feel fibrosis developing. They do not feel early cirrhosis. By the time symptoms such as swelling, jaundice, or fluid accumulation appear, the disease is already advanced. The real risk lies not in having fatty liver. It lies in ignoring it for years. Alcohol vs Sugar: The Wrong Debate Alcohol is a well-known liver toxin. Its effects are direct and dose-dependent. Sugar, particularly in processed and liquid forms, acts differently—but no less significantly. It drives fat production within the liver and contributes to long-term metabolic injury. The modern risk is not choosing between alcohol or sugar. It is exposure to both, often combined with inactivity. One damages faster. The other affects more people over time. When Should You Seek Medical Advice? Waiting for symptoms is a mistake. Consider evaluation if you have: Persistently abnormal liver tests Fatty liver along with diabetes or excess weight Unexplained fatigue or heaviness Regular alcohol intake with abnormal reports Repeated reassurance without clear explanation “Normal” reports are not always reassuring if trends are ignored.And “mild” abnormalities are not always harmless. What Actually Helps Your Liver There is no miracle diet or quick fix. What works is consistent, sustainable correction: Regular meal timing rather than erratic eating Reducing liquid sugars and processed foods Structured physical activity, not occasional bursts Thoughtful use of medications Periodic, properly interpreted health checks These are not dramatic interventions. But they are effective. A Final Word Your liver does not demand attention. It earns it—slowly, silently, often too late. World Liver Day should not be a reminder of disease. It should be a reminder of responsibility. Because the difference between a healthy liver and a failing one is rarely fate. It is pattern.