فهرست مطالب

Middle East Journal of Digestive Diseases
Volume:9 Issue: 2, Apr 2017

  • تاریخ انتشار: 1396/01/15
  • تعداد عناوین: 9
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  • Shahram Nemati, Shahram Teimourian Pages 69-80
    Inflammatory bowel disease (IBD) is the consequence of an aberrant hemostasis of the immune cells at the gut mucosal border. Based on clinical manifestation, laboratory tests, radiological studies, endoscopic and histological features, this disease is divided into three main types including Crohn’s disease (CD), Ulcerative colitis (UC), and IBDunclassified (IBD-U). IBD is frequently presented in adults, but about 20% of IBD cases are diagnosed during childhood called pediatric IBD (PIBD). Some patients in the latter group emerge the first symptoms during infancy or under 5 years of age named infantile and very early onset IBD (VEO-IBD), respectively. These subtypes make a small fraction of PIBD, but they have exclusive phenotypic and genetic characteristics such that they are accompanied by severe disease course and resistance to conventional therapy. In this context, understanding the underlying molecular pathology opens a promising field for individualized and effective treatment. Here, we describe current hypotheses on IBD pathophysiology then explain the new idea about genetic screening technology as a good potential approach to identify the causal variants early in the disease manifestation, which is especially important for the fast and accurate treatment of VEO-IBD.
    Keywords: Very early onset inflammatory bowel disease, Genetic screening approach, Next generation sequencing
  • Hamidreza Joshaghani, Honey Sadat Mirkarimi, Sima Besharat, Gholamreza Roshandel, Omid Sanaei, Mojgan Nejabat Pages 81-85
    Background
    There is a critical role for trace elements in cancer prevention. Since northeast Iran is known as a high risk area for esophageal cancer, this study was designed to compare the serum levels of some trace elements in high and low rate areas of Golestan province.
    Methods
    We used 240 fasting serum samples obtained in 2011 from eastern and western parts of Golestan province during the non-communicable diseases’ screening program. To carry out laboratory examinations, the samples were firstly deproteinated and then the concentrations of the intended elements were measured by an atomic absorption spectrometer. A total of 227 samples were used in the present study and the remaining 13 samples were excluded due to inappropriate conditions.
    Results
    The mean serum level of zinc in the high-risk region was significantly lower than that in the low-risk region. But no significant difference was detected in serum levels of copper, magnesium, and manganese in the low-risk and high-risk regions.
    Conclusion
    As this study was an ecological study with no comparison between patients with cancer and healthy population, its results cannot be used for the general population. Therefore, complementary studies including case-control studies are suggested for further evaluation of the relationship between these elements and the incidence of esophageal cancer.
    Keywords: Ecological study, Esophageal cancer, Serum levels, Copper, Magnesium, Manganese, Zin
  • Behnam Rabiee, Farzin Roozafzai, Gholam Reza Hemasi, Hossein Poustchi, Hossein Keyvani, Mahmood Reza Khonsari, Hossein Ajdarkosh, Mansooreh Maadi, Fatemeh Sima Saeedian, Farhad Zamani Pages 86-93
    Background
    Type II diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD.
    Methods
    In this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran (N=6143). The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin.
    Results
    In men, the prevalence (95% confidence interval) of T2DM was 5.34% (4.35%-6.34%) and 15.06% (13.12%-17.00%) in individuals without and with NAFLD, respectively (p
    Conclusion
    The prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM.
    Keywords: Non, alcoholic fatty liver disease, Diabetes mellitus, Non, communicable disease, Prevalence, Iran
  • Farina Mohammad Hanif, Rajesh Kumar Mandhwani, Nasir Hassan Luck, Zaigham Abbas, Muhammed Mubarak, S.Mudassir Laeeq, Abbas Ali Tasneem Pages 94-99
    Background
    Celiac disease (CD) is usually missed, if the serology is negative. We aimed to evaluate the clinicopathological characteristics of seronegative CD (SNCD) and its response to gluten-free diet (GFD) in adult patients.
    Methods
    This observational study was carried out at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from 2009 to 2015. All consecutive adult patients (≥17 years) with features of marked villous atrophy (Marsh class≥III) on duodenal biopsy, negative tissue transglutaminase IgA and IgG antibodies (anti-tTg IgA and IgG) and human leukocyte antigen (HLA) DQ2 or DQ8 serotypes were studied. Clinical characteristics, laboratory parameters, and response to GFD were analyzed by SPSS software version 20. Median and interquartile range (IQR) were used for summarizing quantitative data. Frequency (percentages) was used for qualitative data.
    Results
    A total of 12 patients with median age of 31.5 years (IQR: 19.75-46.75 years), of whom five (41.6%) were men were studied. The presenting complaints were: weight loss in 11 (91.6%) and abdominal pain in 9 (75%) patients. Anemia was observed in 10 (83.3%) patients with median hemoglobin of 9.5 g/dL (IQR: 6.3-13.25 g/dL). Median alanine transaminase (ALT) was 21 U/L (IQR: 13–27 U/L) and median albumin was 3 g/dL (IQR: 2.4-3.6 g/dL). Anti-tTg IgA and IgG were negative in all patients. HLA DQ serotyping showed homozygous DQ2 and DQ8 in four and one patients, respectively; while heterozygous DQ2 and DQ8 in five and two patients, respectively. All patients were advised to receive GFD. Nine (75%) patients showed complete clinical response. Two patients were non-compliant and one with non-alcoholic fatty liver disease (NAFLD)-related cirrhosis had partial clinical response. Out of the nine responders, two patients showed response within 6 months while the remaining showed improvement over a year period.
    Conclusion
    TThe diagnosis of SNCD is rewarding as it responds favorably to GFD in most patients. HLA serology provides an important tool for diagnosis of this entity.
    Keywords: Celiac disease, Weight loss, Gluten free diet, Tissue transglutaminase IgA antibodies, HLA DQ2, HLA DQ8
  • Clarithromycin versus Gemifloxacin in Quadruple Therapeutic Regimens for Helicobacter Pylori Infection Eradication
    Fariborz Mansour Ghanaei, Zahra Pedarpour, Afshin Shafaghi, Farahnaz Joukar Pages 100-106
    Background
    Helicobacter pylori (H. pylori) infection is a major casual factor in any peptic diseases. Clarithromycin as one of the drugs recommended for the infection eradication regimen has shown different levels of resistance. The present study is comparing the effectiveness of clarithromycin- and gemifloxacin - based quadruple regimens in H. pylori eradication.
    Methods
    This was a prospective double blind randomized clinical trial on patients with clear indication of H. pylori eradication. The patients were randomly divided into two groups: “BPAC group” treated with bismuth subcitrate (240 mg), pantoprazole (20 mg), amoxicillin (1 gr), and clarithromycin (500 mg), all twice daily, and the “BPAG group” treated with bismuth subcitrate, pantoprazole, and amoxicillin with same doses as “BPAC group” and gemifloxacin (320 mg daily) all for 10 days. Three months after the end of therapy, 14C Urea breath test was performed to confirm the eradication. All the patients were assessed for compliance and drug side effects. Based on per protocol (PP) and intention-to-treat (ITT) methods, data were analyzed and a P value 0.05 was considered as statistically significant. This project has been registered in the Iranian registry of clinical trials (IRCT).
    Results
    Three patients were excluded from the survey and finally, 179 patients (89 patients in BPAC group and 90 patients in BPAG group) including 71(39.66%) men with the mean age of 46.4±12.3 years completed the treatment period. The incidence of side effects between the two study groups did not differ significantly. The success rate of BPAC regimen eradication was remarkably greater than BPAG regimen (ITT analysis; 89% vs 77%, respectively; CI 95%: 1.072-5.507, P
    Conclusion
    The results showed that gemifloxacin is not a good alternative for clarithromycin in H. pylori eradication regimens in our region.
    Keywords: Helicobacter pylori infection, Eradication regimens, Clarithromycin, Gemifloxacin
  • Elham Behrangi, Parvin Mansouri, Shahram Agah, Nasser Ebrahimi Daryani, Marjan Mokhtare, Zahra Azizi, Mona Ramezani, Masoumeh Rohani Nasab, Zahra Azizian Pages 107-110
    Background
    Alopecia areata is an immune mediated inflammatory hair loss, which occurs in all ethnic and age groups, and both sexes. However no significant etiology has been known for this disease. Helicobacter pylori (H. pylori), is an organism colonized in gastric mucosa. This bacterium has been associated with certain extra-digestive dermatological conditions. The causal relationship between alopecia areata and H. pylori infection has been discussed in literature. Therefore, we conducted this study to evaluate the prevalence of H. pylori infection in patients with alopecia areata and assess the risk of this infection in patients with this disease in order to determine its potential roles in the physiopathology of this disease.
    Methods
    Between 2014 and 2015, we prospectively studied 81 patients with alopecia areata and 81 healthy volunteers with similar age and sex. Patients without any history of H. pylori infection were included in the study and underwent urease breath test. All results were analyzed using SPSS software (version 21.0) and p value
    Results
    81 patients and 81 controls with the mean age of 34.9±11.6 and 38.2±13.4 years were studied (p=0.097). 48 (59.3%) and 45 (55.6%) individuals were male, in cases and control groups respectively (p =0.634). The result of urea breath test (UBT) was positive in 43 (53.1%) patients in cases and 27 (33.3%) individuals in control group, which was significantly different (p =0.011). The risk of H. pylori infection in alopecia areata was 2.263 (95% CI: 1.199-4.273).
    Conclusion
    The results of our study showed significant difference between H. pylori infection in individuals with and without alopecia areata, which shows that H. pylori contamination may be effective in physiopathology of alopecia areata. Therefore these results should be tested in large multivariable cohorts and controlled trials to reach more accurate evidence in the future and to generalize this idea to larger population.
    Keywords: Helicobacter pylori, Alopecia areata, Urease breath test
  • Abtin Doroudinia, Mehrdad Bakhshayesh Karam, Atosa Dorudinia, Payam Mehrian, Farahnaz Agha Hosseini Pages 111-113
    Synovial sarcoma is an uncommon soft tissue tumor occurring mainly in the periarticular region of the extremities in young adults. It happens less frequently in the head and neck, mediastinum, lungs, heart, and digestive tract. A 28-year-old man two months after total esophagectomy with final diagnosis of esophageal synovial sarcoma was referred to our Positron Emission Tomography (PET-CT) department for the evaluation of treatment response and further treatment planning. To our knowledge this case is the 11th case of esophageal synovial sarcoma, being reported in the literature. We presented the 11th case of esophageal synovial sarcoma. Synovial sarcomas are very rare tumor entities, particularly in the gastrointestinal tract and are likely to be mistaken with other more common tumors such as gastrointestinal stromal tumors.
    Keywords: Non-Hodgkin lymphoma, T cell lymphoma, Intestinal perforation
  • Mohammad Javad Zahedi, Sara Shafieipour, Masood Dehghani, Nazanin Eslami Pages 114-117
    Currently, surgery is less needed for the treatment of refractory peptic ulcer disease (PUD) or its complications. So, the complications of PUD surgery have been clearly declined. Here in, we present a 42-year-old man with chronic watery diarrhea and significant weight loss during 2 years after gastrojejunostomy for the treatment of obstructive PUD. Small bowel gastrointestinal series showed rapid transit without passage of contrast in the parts of small bowel. The patient was scheduled for exploratory laparotomy. During the surgery a large fistula was detected between the stomach and transverse colon, which was repaired. At the follow-up 6 months after the surgery, the patient did not have any history of recurrence of diarrhea and had 10 kg weight gain. Gastrocolic fistula is a very rare complication of surgical management of PUD. Barium enema is the most helpful imaging procedure for the diagnosis of gastrocolic fistula and surgery after correction of nutritional status is suggested especially for malnourished patients.
    Keywords: Gastrocolic fistula, Gastric surgery, Peptic ulcer, Complications
  • Cyriac, Abby Philips, Lijesh Kumar, Mathew Philip, Prasanth Menon Pages 118-119
    A 48-year-old man, diagnosed case of portal hypertension secondary to alcohol related cirrhosis of the liver, presented to the gastrointestinal (GI) Bleed Unit, with jaundice and worsening abdominal distension for a period of five days. Clinical examination revealed an emaciated patient in grade 2 hepatic encephalopathy with pulse rate 98 per minute and mean arterial pressure 66 mmHg in the right supine brachial region, with Child Pugh score 10 and Model for End Stage Liver Disease score 18. Upper GI endoscopic evaluation revealed small low risk esophageal varices without active bleeding or stigmata of recent hemorrhage and normal colonoscopy. Bedside diagnostic paracentesis revealed bloody aspirate with fluid hematocrit 17% and fluid red blood cell count of 35,000 per mm3 suggestive of hemoperitoneum. An urgent computed tomography (CT) angiography of the abdomen revealed shrunken dysmorphic liver with hyper dense free fluid and dependent clots in pelvis without active bleeding. Interestingly, multiple thread-like structures with contrast opacification in venous phase were noted in the distal duodenum and jejunal region [black arrows (Figure 1A, maximal intensity projection, CT coronal) and corresponding white arrows (Figure 1B, CT curved planar reformation, 3-dimensional)] along with multiple contrast opacified mesenteric and retroperitoneal vessels (Figure 1C, asterisk). Commencement of broad spectrum antimicrobials, blood transfusions, and terlipressin with serial hemoglobin monitoring, and abdominal girth charting was undertaken. The patient had an uneventful recovery from the bleeding episode and is currently listed in the deceased donor liver transplantation program.