Middle East Journal of Digestive Diseases
Volume:10 Issue: 2, Apr 2018

Liver transplantation (LT) is the treatment of choice for patients with end-stage liver disease. Improvement in outcomes (allograft and patient survival) has led to widespread use of LT worldwide. This success is due to improvement in patient selection, transplantation surgery, anesthesia/postoperative care, and immunosuppression management. This review will focus on different aspects of LT, which every physician should know to provide better patient care.

BACKGROUNDChronic constipation is one of the most common gastrointestinal disorders. It has negative effects on the patients’ quality of life, and their productivity, and results in a high economic burden on the healthcare services. The aim of the present study was to estimate the prevalence of chronic constipation and its associated factors in pars cohort study (PCS).
METHODSA cross-sectional study was conducted on the baseline data of the PCS. Data gathering was done by structured questionnaire and physical examination. A total of 9264 subjects aged between 40 and 75 years were enrolled in the PCS. Diagnosis of chronic constipation was done using Rome IV criteria. Multivariable binary logistic regression was applied for data analysis.
RESULTSA total of 752 (8.1%) participants were diagnosed as having chronic constipation (9.3% of female and 6.7% of male participants). Older age (OR: 1.55, 95% CI:1.31-1.83), physical activity (OR: 0.56, 95% CI: 0.46-0.68), opium consumption (OR: 2.06, 95% CI: 1.63-2.60) , anxiety (OR: 1.38, 95% CI: 1.15-1.65), depression (OR: 1.22, 95% CI: 1.01-1.48), back pain or arthralgia (OR: 1.38, 95% CI: 1.14-1.67), insomnia (OR: 1.62, 95% CI: 1.36-1.93) and gastroesophageal reflux disease (OR: 1.51, 95% CI :1.28-1.78) were associated with the prevalence of constipation in the multivariable analysis.
CONCLUSIONChronic constipation was a common problem in the PCS population. Decreasing modifiable risk factors associated with constipation such as opium consumption and physical inactivity can reduce its prevalence and decrease burden of the disease.

BACKGROUNDInflammatory bowel disease (IBD), Crohn’s disease (CD), and ulcerative colitis (UC) are autoimmune inflammatory diseases of the alimentary tract, which seems to be caused by the interaction of environmental and genetic factors as well as diet and nutritional factors such as vitamin D. The aim of this study was to assess the vitamin D status and its associations with erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (hs-CRP) as inflammatory markers in patients with UC.
METHODSIn this analytical cross-sectional study 90 patients with mild to moderate UC who were resident of Tehran were assessed. 25(OH)D, parathyroid hormone (PTH), ESR and hs-CRP were measured. Dietary intake was assessed by 3-day 24h diet recall. Statistical analyses were performed using STATA (Version 12).
RESULTSThe average serum 25-OH-vitamin D3 was 33.1±8.3 ng/mL and 38.9 % of the patients were vitamin D deficient or insufficient (37.3 % of men and 41% of women). No significant correlation between serum 25(OH)D and hs-CRP, ESR, body mass index (BMI), and disease duration was found. There were no significant differences in serum 25(OH)D between men and women. Mean daily dietary vitamin D and calcium intakes were 189.5 Iu (95% CI: 176.0-203.1) and 569.5 mg (95% CI: 538.8-600.2) respectively.
CONCLUSIONIn this cross-sectional study 38.9% of the patients with mild to moderate UC were vitamin D deficient or insufficient and vitamin D level was not correlated to ESR and/or hs-CRP. More studies are needed to investigate the effect of vitamin D in the pathogenesis of UC or as a part of its treatment.

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Recently several parameters, such as serum ferritin, have emerged as possible predictors for the severity of NAFLD and insulin sensitivity. We aimed to investigate the value of serum ferritin level as a useful biomarker for the prediction of histopathological disease severity in non-alcoholic steatohepatitis (NASH), the necro-inflammatory form of NAFLD.
METHODSThis was a prospective cross sectional study in which demographic, clinical, histological, laboratory, and anthropometric data of 30 adult patients with biopsy-proven NAFLD/NASH were analyzed.
RESULTSIn our patients population with mean age of 37.9 years and mean BMI of 26.5, statistical analysis did not show a significant difference between the three grades of steatosis in the mean ferritin levels (p=0.559). It was also observed that ferritin level did not have a significant correlation with the stage of fibrosis (p =0.228). The mean transferrin saturation did not show significant difference in different stages and grades of NASH (p =0.260 and 0.944, respectively), either.
CONCLUSIONSerum ferritin level may not be useful as a single marker for the prediction of histopathological severity of disease in young patients with NASH who are not morbidly obese.

BACKGROUNDGenetic predisposition may have important role in pathogenesis of non-alcoholic fatty liver disease (NAFLD). Angiotensin II type I receptor (AGTR1) has been known to involve in the process of liver steatosis and fibrosis. This study aimed to investigate the association between AGTR1 A1166C polymorphism and NAFLD.
METHODSA cross-sectional study was conducted during May 2014-May 2015 among healthy adults referring to our radiology clinic for abdominal sonography. AGTR1 A1166C polymorphism was evaluated in subjects with NAFLD and healthy individuals using allelic discrimination method.
RESULTS58 subjects with NAFLD were compared with 88 healthy individuals without NAFLD. The frequency of AA and CC genotypes of AGTR1 was significantly higher in patients with NAFLD compared with controls (p=0.029 and 0.042, respectively). C allele was more detected in subjects with NAFLD compared with the healthy controls (OR: 2.1; 95% CI: 1.23-3.61, p =0.006). CC genotype (OR: 10.62; 95% CI: 1.05-106.57, p =0.045) and C allele (OR: 6.81; 95% CI: 1.42- 32.48, p =0.016) were also predictors of severe fatty liver disease in our study population.
CONCLUSIONOur results provide the first evidence that AGTR1 gene A1166C polymorphism not only is associated with NAFLD and but also may predict its severity.

BACKGROUNDPrevious studies have indicated an elevated level of serum Interleukin (IL)-22 in patients with autoimmune hepatitis (AIH). However, there are no experimental data on the master transcription factor (aryl hydrocarbon receptor) that plays an important role in the development of T helper type 22 (Th22) cells as major producers of IL-22. The aim of the present study was to examine the expression of aryl hydrocarbon receptor in patients with AIH and in normal controls.
METHODSLevels of mRNA transcripts were measured in the peripheral blood mononuclear cells of 18 patients with AIH and compared with 18 normal controls by a quantitative real-time polymerase chain reaction.
RESULTSmRNA expression of aryl hydrocarbon receptor was significantly higher in patients with AIH compared with the healthy control group (P=0.006).
CONCLUSIONTh22 cells may play an important role in the pathogenesis of AIH.

Gallbladder agenesis (GA) is a rare congenital anomaly. Only 50% of the cases with GA are symptomatic, presenting mostly in the 4th or 5th decade of life. The clinical presentation of GA and imaging findings are non-specific and often misinterpreted as other diseases such as ectopic gall bladder. This can lead to unnecessary surgery when the final diagnosis is usually made. Although GA can cause an identical pattern to acute cholecystitis in hepatobiliary scintigraphy, in certain clinical settings, scintigraphy can be helpful as a confirmatory study, especially to rule out the possibility of ectopic gall bladder. In our case, the combination of imaging findings including ultrasonography, computed tomography, and hepatobiliary scintigraphy led to accurate diagnosis avoiding further surgeries.

Scar endometriosis is one of the rare cases of surgery, which specifically occurs in gynecological surgeries. It is important to do a correct diagnosis in such rare cases to have an efficient treatment. The disease is commonly observed in child-bearing women with clinical manifestations such as acute abdomen or chronic and cyclic pelvic pain. Herein we reported a case of appendectomy scar endometriosis.

Liver involvement is the most frequent extra-renal manifestation in autosomaldominant polycystic kidney disease. The incidence of polycystic liver disease (PLD) among patients with chronic renal failure due to polycystic kidneys exceeds 50%. Most patients with liver cyst remain asymptomatic with preserved hepatic function. However, patients rarely develop pain and other complications. Jaundice caused by bile duct compression is a very rare complication and only few case reports exist in the literature. In this paper, we describe a 57-year-old man with endstage renal disease due to adult polycystic kidneywith multiple large hepatic cystswho developed obstructive jaundice.

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