Govaresh
Volume:18 Issue: 3, 2013

Irritable bowel syndrome (IBS) is one of the most common causes of abdominal pain, diarrhea, and constipation.This disorder results in numerous clinic visits. IBS is a health problem with a high social and economic burden due to the lack of an effective treatment. Its etiology consists of biological, psychological and social factors.There is increasing evidence that psychotherapy, in particular cognitive behavioral therapy (CBT) which is a type of self-management intervention, can significantly improve IBS symptoms and disability compared tocommon medical treatment. Changes to cognition rather than mood and changing the negative perception of IBS patients appears to be a particularly important treatment mechanism. In this study we review current and emerging CBT and its efficacy in IBS patients.

This study assessed the effects of hypnotherapy in conjunction with pharmacotherapy versus pharmacotherapy on the quality of life in patients diagnosed with irritable bowel syndrome (IBS).This clinical trial used the convenience sampling method to enroll 34 IBS patients. Patients were selected according to Rome III criteria and divided into two groups: i) hypnotherapy plusstandard medical treatmentand ii) standard medical treatment. The QOL-IBS scale assessed patient quality of life at baseline, post-treatment and at the six month follow-up. Data were analyzed using analysis of covariance (ANCOVA).There were significant differences observed between both groups at the post-treatment and follow-up stages in terms of quality of life (p<0.05).Standard medical treatment in addition to hypnotherapy can be used to improve quality of life in IBS patients.

(H.pylori) infection is a common bacterial infection in humans. Approximately half of the Helicobacter pylori people throughout the world are infected by this gastric microbial pathogen. The outcome of H.pylori infection varies from gastritis to peptic ulcers, duodenal ulcers and gastric malignancies. This study aims to estimate the prevalence of H.pylori infection and iron deficiency anemia, and the possible association between these two variables among children aged 2-12 years from Ardabil, Northwest Iran. In this analytical and cross-sectional study, we randomly selected 960 children that ranged in age from 2-12 years that referred to pediatric clinics in Ardabil during February, 2011 to February, 2012. Patients'' blood and stool samples were collected to assess for H.pylori infection and iron deficiency anemia. H.pylori infection was evaluated by the Helicobacter pylori Stool Exam Antigen Test (HPAT). To determine the presence of iron deficiency anemia, we measured patients'' serum levels of Hemoglobin(Hb), Serum Iron(SI), Ferritin and Total Iron Binding Capacity(TIBC). Data were analyzed by SPSS (version 18) software.Of the 960 participants, we detected H.pylori infection in 360 (37.5%) cases, 140 (38.9%) were males and 220 (61.1%) were females. Iron deficiency anemia was present in 80 (7.3%) cases. Of these, only 25 (6.9%) were positive for both H.pylori infection and iron deficiency anemia.This study confirmed a high prevalence of H.pylori infection among 2-12 year-old children. We observed a significant relationship between H.pylori infection and gender (p=0.001). There was no significant association between H.pylori infection and iron deficiency anemia (p=0.278).

Irritable bowel syndrome (IBS) is a disorder of the gastrointestinal system that presents with special gastrointestinal signs and lack of an organic etiology. Quality of life (QOL) is one of the most important outcomes of IBS. Several psychological factors are mentioned as effective in determining QOL in IBS patients. The goal of this study is to determined the relationship between illness perception and QOL in patients with IBS.This study enrolled 96 patients, 40 males(41.7%) and 56 females(58.3%) who referred to the gastroenterology clinics of Imam Khomeini and Laleh hospitals from September to December 2012 Tehran, Iran. Participants completed a Brief Illness Perception Questionnaire (Brief- IPQ) and an IBS-specific QOL (IBS-QOL-34) questionnaire. Information collected by the questionnaire swereanalyzed with Pearson''scorrelation and regression analysis.Results of the analysis performed by Pearson''s correlation showed a significant association between patient''s illness perception and QOL among those with IBS. Among the subscales of illness perception, the Consequence (p‹0.01,r=0.63), Emotion (p‹0.01,r=0.55), Concern (p‹0.01,r=0.31), Timeline(p‹0.01,r=0.30), and Identity (p‹0.01,r=0.20) subscales showed the most significant correlation with QOL. There was no relation observed between Illness Comprehensibility, Treatment Control, and Personal Control subscales with QOL.Patient''s illness perception seems to play a role in determining QOL among IBS suffers. Therefore psychological intervention based on the patient''s illness perception is recommended for IBS patients.

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Sarcoidosis involving the gastrointestinal (GI) tract is extremely rare. This is a rare case report of an individual with symptomatic gastroduodenal sarcoidosis. A 34-year-old male with a six-month history of epigastric pain, nausea, early satiety and weight loss presented to our clinic. An upper endoscopy was performed which showed a cardia ulcer that measured approximately 10 mm along with multiple superficial erosions and patchy erythema in all parts of the gastroduodenal mucosa. Biopsies of the stomach and duodenum revealed severe active chronic noncaseating granulomatous gastritis and duodenitis. Stains for Helicobacter pylori, acid fast bacteria, and fungi were negative. An upper GI series showed thickened gastric folds with narrowing of the gastric body and antrum with lack of distensibility. The plasma level of angiotensin converting enzyme (ACE) was elevated. Corticosteroid therapy was started with rapid abatement of his symptoms. In cases of refractory epigastric pain, especially if other organ involvement, gastroduodenal sarcoidosis should be considered.

The hepatoprotective effects of silymarin have been confirmed by various researchers worldwide; however few studies are available about the therapeutic impact of silymarin on the level of aminotransferases in patients with nonalcoholic steatohepatitis (NASH). Our purpose is to determine whether silymarin improves the serum level of aminotransferases in patients with NASH. his was a double blind, randomized, placebo-controlled trial performed on 100 patients with NASH. Subjects were randomized to receive silymarin (140 mg/q12h) for three months or placebo, given in the same manner. A blood sample was drawn at baseline (before treatment) and after completion of the treatment schedule to assess serum aminotransferase levels. We measured body mass index (BMI) before and after administration of the treatments for both groups of patients. There were insignificant changes in BMI for both groups. The mean serum alanine aminotransferase (ALT) level in the case group significantly changed from 84.06 to 68.54 IU/mL following treatment with silymarin (p)Administration of silymarin can effectively reduce liver aminotransferases without any changes in BMI in patients with NASH disease.

Ezetimibe inhibits the resorption of dietary and biliary cholesterol in the small intestine and decreases insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Acarbose has been used in type 2 diabetes mellitus and metabolic syndrome. This study aims to compare the therapeutic effects of ezetimibe and acarbosein decreasing liver transaminase levels in patients with NAFLD. This was a single center, double-blind, parallel-group study conducted at Bu-Ali Sina Hospital, Qazvin, Iran. In this trial, we enrolled, by simple randomization, a total of 62 patients diagnosed with NASH. There were 29 patients treated with ezetimibe and 33 who were treated with acarbose over a ten-week period. Ezetimibe treatment significantly reduced ALT, AST, triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-sensitivity C-reactive protein (hsCRP), and serum insulin levels and the insulin resistance homeostasis model assessment (HOMA-IR) index compared to patients treated with acarbose (p)Both ezetimibe and acarbose improved metabolic and biochemical abnormalities in patients with NASH, however these effects were more prominent with ezetimibe.

Menetrier''s disease or hypertrophic gastritis is a premalignant rare disease that often presents with hypertrophy in the gastric folds, hypoalbuminemia and decreased acid secretion. There are a few papers worldwide that report concomitant Menetrier''s disease and ulcerative colitis (U.C), however none are from Iran. This is the first case reported in Iranian literature. The pathogenesis of this coexistence is unknown. We report the case of a 28-year-old woman with intermittent bilateral edema of the lower extremities, weight loss and epigastric pain associated with chronic intermittent diarrhea and one episode of nocturnal dysentery. Paraclinical evaluations showed hypoalbuminemia, low serum protein level, severe 25 OH vitamin D deficiency, a positive Helicobacter pylori urea breath test and negative cytomegalovirus (CMV) IgM antibody. Histologic, radiologic and endoscopic findings were consistent with Menetrier''s disease associated with U.C. The patient was prescribed mesalazine, asacol suppositories and pantoprazole.During a follow up visit the patient noted improvement in her symptoms. She was referred to a surgeon to discuss additional possible therapeutic treatments.