فهرست مطالب

Middle East Journal of Digestive Diseases - Volume:10 Issue: 4, Oct 2018

Middle East Journal of Digestive Diseases
Volume:10 Issue: 4, Oct 2018

  • تاریخ انتشار: 1397/07/25
  • تعداد عناوین: 10
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  • Ashraf Mohamadkhani * Pages 205-212
    The brain-intestinal axis concept describes the communication between the intestinal microbiota as an ecosystem of a number of dynamic microorganisms and the brain. The composition of the microbial community of the human gut is important for human health by influencing the total metabolomic profile. In children with autism spectrum disorder (ASD), the composition of the fecal microbiota and their metabolic products has a different configuration of the healthy child. An imbalance in the metabolite derived from the microbiota in children with ASD affect brain development and social behavior. In this article, we review recent discoveries about intestinal metabolites derived from microbiota based on high-yield molecular studies in children with ASD as part of the "intestinal brain axis”.
    Keywords: Autism spectrum disorder (ASD), Intestinal microbiota, Fecal metabolites, ASD children
  • Farzaneh Iravani, Neda Hosseini, Majid Mojarrad * Pages 213-219
    Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder worldwide. It includes wide range of diseases from different subtypes of simple steatosis to non-alcoholic steatohepatitis (NASH), which may be complicated by liver fibrosis, cirrhosis, or hepatocellular carcinoma. Of the epigenetic factors that play a key role in the progression of it, is microRNAs (miRNAs). MiRNAs are short non-coding RNAs of 22-23 nucleotides in length, which regulate a large number of genes that have a critical role in regulation of lipid and cholesterol biosynthesis in hepatocytes. MiRNAs can be used as a very powerful biomarker to diagnosis and follow-up any disorder, such as NAFLD and NASH with a high specificity and sensitivity. The aim of this study was to review the role of different miRNAs in the pathophysiology of NASH and NAFLD.
    Keywords: MicroRNAs, NAFLD, NASH, Biomarker
  • Iftikhar Ahmed *, Wael Kassem, Yazen Salam, Manuele Furnari, Tina Mehta Pages 220-229
    BACKGROUND: Cytomegalovirus (CMV) infection is common in individuals with inflammatory bowel disease (IBD) and is responsible for relapse, increased severity, and poor outcome if left untreated. Ganciclovir is the mainstay of treatment but data regarding its use, mode of administration, and duration of treatment is poorly described. We reviewed the practice of treating CMV colitis with different regimes of ganciclovir at a district NHS hospital to compare the clinical outcome. METHODS: 35 patients with IBD and concurrent diagnosis of CMV infection were evaluated. The parameters studied were clinical outcome in term of clinical response, length of hospital stay, readmission, or colectomy with three different regimes of ganciclovir, in addition to treatment for IBD. RESULTS: 35 patients with IBD (ulcerative colitis=23, Crohn’s disease=5, Indeterminate colitis=7) and positive diagnosis of CMV infection were studied. Clinical outcome with two weeks of intravenous (IV) ganciclovir regime was superior than one week of IV ganciclovir and two weeks of oral Valganciclovir in term of clinical response on day 15 (95.8% vs 74%, 24.3%, respectively p=0.45) and colectomy rate within 3 months (6.25% vs 27.3%, vs 25%, respectively). CONCLUSION: CMV colitis is associated with poor outcome in patient with IBD if left untreated. 2 weeks IV ganciclovir was associated with a better outcome than 1 week of IV treatment or oral treatment.
    Keywords: Cytomegalovirus colitis, Inflammatory bowel disease, Indeterminate colitis, Ganciclovir
  • Mahsa Khodadoostan, Sina Sadeghian *, Ali Safaei, Milad Kabiri, Sara Shavakhi, Ali Reza Shavakhi, Ahmad Shavakhi Pages 230-235
    BACKGROUND: Minimal hepatic encephalopathy (MHE) is the mildest type of hepatic encephalopathy in patients with cirrhosis. Patients with MHE have normal clinical and physical examination but they show some neurocognitive dysfunctions that affect their quality of life negatively. The aim of the current study is to diagnose MHE in patients with cirrhosis and its associated factors. METHODS: This is a cross-sectional study on 120 known cases of cirrhosis referred to hospitals affiliated to Isfahan University of Medical Sciences during 2014-17. The patients' cirrhosis severity was evaluated using laboratory tests and physical examinations based on MELD(Model for End-stage Liver Disease) and Child-Pugh criteria. The Patients’ demographics were filled in a checklist. All included patients with cirrhosis were asked to respond to the questions of Psychometric Hepatic Encephalopathy Score (PHES) test. RESULTS: Mean age of the patients was 51.2±9.7 years. 62 (51.7%) patients were men and 58 (48.3%) patients were women. The mean score of the patients based on MELD criteria was 14.03±6.09. 26.7% of the patients presented MHE. Mean age of the patients with MHE was statistically less than the patients without MHE (p value<0.001). Mean score of MELD criteria among the patients with diagnosis of MHE was significantly higher than the other group (p value<0.001). The patients' Child class was statistically associated with MHE (p value<0.001). Men were significantly more affected than women (p value=0.03). CONCLUSION: MHE was associated with MELD score and Child class of the patients with cirrhosis. The noticeable point was reversible association of age with MHE. Further studies are recommended.
    Keywords: Cirrhosis, Minimal hepatic encephalopathy, MELD score, Child-Pugh class
  • Seyed Mohammad Valizadeh Toosi, Ahmad Reza Elahi Vahed, Iradj Maleki *, Zohreh Bari Pages 236-241
    BACKGROUND: Proton pump inhibitors (PPIs) are now widely prescribed for the management of patients with acute upper gastrointestinal bleeding; although its optimal dose and route of administration has remained a controversial issue. The aim of this study was to assess the clinical effectiveness of high dose oral versus intravenous (IV) PPI after successful endoscopic therapy in patients with bleeding peptic ulcer disease. METHODS: 178 patients with active upper gastrointestinal bleeding due to a peptic ulcer with stigmata of high risk for re-bleeding entered the study. After successful endoscopic hemostasis, they were randomized to receive either high dose oral pantoprazole (80 mg stat and 80 mg twice daily for 3 days) or high dose intravenous pantoprazole (80 mg IV infusion within 30 minutes and 8 mg per hour for 3 days). After the 3rd day, the patients in both groups received oral pantoprazole 40 mg twice daily for one month. The end points were comparing the rate of re-bleeding or mortality, and the need for blood transfusion or surgery during the first month between the two groups. RESULTS: There were not significant statistical differences between the two groups in the volume of blood transfusion, mean duration of hospital stay, need to surgery, or mortality rates. However, the rates of re-bleeding were 2.3% (2:88) in the IV group and 3.3% (3:90) in the oral group (p=0.6). CONCLUSIONS: According to our findings, it seems that high dose oral PPI can be a good alternative to high dose IV PPI in patients with bleeding peptic ulcer who are at high risk of re-bleeding. Due to the lower cost and the availability of oral PPIs, their use can be economically much more affordable.
    Keywords: Proton pump inhibitor, Peptic ulcer, Hemorrhage, Endoscopic therapy
  • Eskandar Hajiani, Pezhman Alavinejad *, Nahid Avandi, Abdol Rahim Masjedizadeh, Ali Akbar Shayesteh Pages 242-248
    BACKGROUND: Considering the importance of Helicobacter pylori (H. pylori) eradication, this clinical trial was designed to prospectively evaluate the efficacy of levofloxacin-based, sequential therapy in comparison with quadruple therapy for eradicating H. pylori. METHODS: Overall 156 patients with dyspepsia and H. pylori infection were included in this study and were randomly allocated to either 10-day sequential therapy group (group A) to receive pantoprazole (40 mg twice daily), amoxicillin (1 gr twice daily), levofloxacin (500 mg twice daily), and tinidazole (500 mg twice daily) (PALT) or 14-day quadruple therapy group (group B) to receive pantoprazole , clarithromycin , bismuth subcitrate, and amoxicillin (PABC). At the end of the study the eradication rate in each group was assessed by urea breath test (UBT). RESULTS: Age range of the participants was 18-65 years (average 36.9 years) and 50% of them (78 patients) were men. 78 patients were allocated to group A and 78 patients to groupe B. After antibiotic therapy, all the patients received acid suppression therapy with Proton PumpInhibitor (PPI) for 4 weeks and then the eradication rate was confirmed by UBT (Heli FAN plus 13C, Germany). Before performing UBT, all the participants were requested to halt consumption of PPI for at least 1week. During the treatment there was not any major complication but in group A (sequential therapy), two patients complained of minor complications including musculoskeletal pain. None of the patients in group B had any complaint or side effect. The rate of H. pylori eradication in group A was 78.2% (61 patients) while this rate in group B was 83.3% (65 patients) with no significant difference between the two groups (p=0.42). In subgroup analysis, the rate of eradication among men in group A and B were 76.9% and 89.7%, respectively (p = 0.22) while the eradication rate among women were 79.4% and 76.9%, respectively (p =1.00). CONCLUSION: It seems that levofloxacin base sequential therapy does not have any advantage in comparison with quadruple regimen and until finding any more effective short course therapy for H. Pylori eradication; we encourage quadruple regimen to be used as the first line therapy.
    Keywords: H. Pylori, eradication, sequential therapy, levofloxacin
  • Bita Geramizadeh *, Ali Kashkooe Pages 249-253
    BACKGROUND: Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of gall bladder cancers are detected incidentally only after pathological examination of the surgical specimens. In this study we investigated the characteristics of incidental gallbladder cancers in our center and also reviewed the current literature regarding the diagnosis and treatment of such incidentally detected tumors in the gall bladder. METHODS: We retrospectively reviewed all of the cholecystectomy specimens in the archives of Pathology Department in the hospitals affiliated to Shiraz University of Medical Sciences in the study period (2010-2016). Clinicopathological characteristics were extracted from the patients’ clinical charts, which included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome. RESULTS: During these 7 years we identified 18 cases of incidental gall bladder cancer, consisted of 13 women and 5 men with the age range of 32 to 85 (62.5±14.2) years detected after pathological study of the resected gall bladders among more than 4800 resected gall bladders. During the period, only two patients were operated on with the impression of gall bladder adenocarcinoma, which was not included in the study. Ten cases were T1 and eight were T2 at the time of surgery. They have been followed up for 1-7 years, during which, six cases of T2 died. All of the T1 cases are alive and symptom free. CONCLUSION: By increasing laparoscopic cholecystectomies in our center we observed 0.37% incidental cases of gall bladder adenocarcinoma. Preoperative diagnosis of this cancer in early stages is very difficult and needs high degree of suspicion. The most important predictor of prognosis is the stage of the cancer at the time of surgery. To the best of our knowledge, this is the first report of incidental gall bladder cancer from Iran.
    Keywords: Incidental, Gall bladder, Adenocarcinoma, Cholecystectomy
  • Complications of Colonoscopy and its management: A Single Gastroenterologist Experience
    Anahita Sadeghi, Reza Malekzadeh * Pages 254-257
    BACKGROUND: Colonoscopy is a widely used procedure and although is generally safe, it could have both gastrointestinal and non-gastrointestinal complications. The aim of this report is to assess the major complications of colonoscopies performed by one expert gastroenterologist and their management in Tehran Iran. METHODS: We have recoded the rates of adverse events and their management in all the colonoscopies performed by a single expert gastroenterologist during 23 years (1994-2017). Demographic factors including age, race, and sex, and colonoscopy findings and patients’ comorbidities were recorded. RESULT: During 23 years, 9012 colonoscopies and about 1700 polypectomies were performed. The number of serious complications was six (0.07%). Colonic perforation occurred in five patients (0.06%); three of whom had undergone polypectomies. All cases of colonic perforation were managed by surgery and all were discharged with no complications. One patient suffered from cardiac arrest just after colonoscopy in the recovery room and died 20 days after colonoscopy (0.01%). CONCLUSION: Although the rate of adverse events after colonoscopy was low, it is still an important concern in developing screening recommendations in low and middle-income countries.
    Keywords: Colon perforation, Colonoscopy, Complication, Screening, Colon Cancer
  • Ahmad Hormati, Maryam Jameshorani *, Saeid Sarkeshikian, Mohammad Reza Ghadir, Faezeh Alemi Pages 258-262
    Accumulation of free fluid in the peritoneal cavity is called ascites. The first step in identifying its etiology is to determine the serum-ascites albumin gradient (SAAG). According to this parameter, a high SAAG is regarded as a gradient greater than 1.1 g/dL. This condition has some differential diagnoses such as liver cirrhosis, Budd-Chiari syndrome, heart failure, and idiopathic portal fibrosis. In the present article, we present a young man with abdominal distention due to a high SAAG. Further evaluation of the abdominal and thoracic cavity revealed a mass in the posterior mediastinum, which had compressed the inferior vena cava and left atrium and led to Budd-Chiari syndrome. Evaluation of the biopsy sample showed fibrosarcoma.
    Mediastinal fibrosarcomas, though rare, should be considered in the differential diagnosis of mediastinal masses.
    Keywords: Ascites, Budd-Chiari Syndrome, Fibrosarcoma
  • Farhad Zamani, Amirhossein Boghratian, Ali Zare Mehrjardi, Farshad Naserifar, Jamshid Vafaeimanesh * Pages 263-266
    Collagenous gastritis is hardly ever found in children and adults. Based on the extent of collagenous changes in the bowel, various symptoms may develop including iron deficiency, anemia, and abdominal pain in most of the patients. We present a 30-year-old man with persistent abdominal pain and anemia due to collagenous gastritis.
    Keywords: Collagenous gastritis, abdominal pain