اکرم پورشمس

Colorectal cancer (CRC) is one of the most common cancers globally. Prevention, precise early detection and diagnosis, selecting the best treatment strategy, and correct prediction of prognosis are essential to reduce the burden of CRC and to improve the patients’ survival and quality of life. Along with the explosion of available clinical, omics, pathological, and radiological data, artificial intelligence (AI) has shown a great potential in CRC clinical management, and has provided clinicians with new auxiliary approaches to identify high-risk patients, to select personalized treatment strategies, and to predict prognosis. This review is a comprehensive study on the research progress and clinical applications of AI in management of CRC, including screening, diagnosis, treatment, and prognosis. In short, this review demonstrates the current status of the AI in CRC management. Limitations, challenges, and future prospects of AI in the clinical management of CRC are also discussed.

Cancer is the major cause of death in the world and the rate of mortality is higher in developed countries. Therefore, lifestyle could be effective in promoting the cancer. The pancreatic tumors, are 8th cause of mortality due to cancer, which have several types, among them ductal adenocarcinoma is the most common and includes 85% of cases. Since, it is almost impossible to diagnosis the tumor in early stages of the disease, it contributes to high rates of mortality, although if it diagnosis in early stage and the surgery performed for them only 10-20% of patients will be survived. Metastasis occurs when the tumor is smaller than 2 cm in size and because the pancreas is located in the depth of abdomen, typically, it happens after tumor is spread to other organs. A combination of medical imaging, blood tests, and examination of tissue samples are usually made for diagnosis and based on the cancer stage, surgery, radiotherapy and chemotherapy are chosen as treatment options. Some rare genetic variations can cause pancreatic cancer and about 5-10% of cases are linked to inherited genes. However, major risk factors are including age, obesity, tobacco smoking and diabetes. Smoking counts for about 25% of cases, and the diabetes is the main symptoms of pancreatic cancer, which observed in about 80% of cases. But, it is still unclear whether diabetes is a predisposing factor in pancreatic cancer, or the outcome of tumor progression. Recent studies have shown that, diabetes is unique in pancreatic cancer which is not related to common types. Currently, CA 19-9 is the only reliable tumor marker for pancreatic cancer that its frequency also increases in non-bad conditions, such as pancreatitis and obstructive jaundice, so is not sensitive and specific enough for diagnosis of this cancer. Due to researches continue to find more specific markers. In this review the etiology of pancreatic cancer, diabetes associated with this type of cancer and significant biomarkers for diagnosis will be considered.

Pancreatic cancer (PC) is classed as the 7th leading cause of cancer-related death in the world. Previous evidence indicates that hyperglycemia, insulin resistance, diabetes, and obesity are implicated in pancreatic carcinogenesis. Thus, evaluation of the dietary intakes in the etiology of PC can be useful to identify the risk factors of the disease.
Methods and Materials: We examined the association between total intake of fruits, vegetables, and dietary fiber and the risk of PC in 50,045 participants aged 40-75 years within the Golestan Cohort Study. Dietary data were collected using a validated semi-quantitative food-frequency questionnaire, which was administered at baseline. Cox proportional hazards models were used to estimate multivariate hazard ratio with 95% confidence interval.
During 383,630 person-years of follow-up and after excluding the participants with incomplete baseline information, a total of 48,676 adults were evaluated. Until October 30, 2014, 54 cases of PC were confirmed based on the exact cause of death using ICD10 criteria. After considering all potential confounding factors, there was only a statistically significant inverse association between the risk of PC for the highest tertile of daily fiber intake compared with the lowest tertile (HR=0.41; 95% CI= 0.15-1.05; P for trend= 0.05). However, the relationship between fruits and vegetables and PC risk was not statistically significant.
In summary, based on the findings of this study, increased dietary fiber may reduce the risk of PC. This result highlights the importance of a diet rich in fiber in order to prevent PC progression. Finally, given the limited number of studies in this field and inconclusive results, there is still a need for new prospective studies with long follow-up.

Pancreatic cancer (PC) is classified as one of the most deadly cancers. Since the role of diet in modifying the effects of known risk factors of PC has been well established¡ exploring the dietary intakes in relation to the etiology of PC can be useful for elucidating the mechanisms of the disease progression.
This study was conducted within the Golestan prospective cohort study. The estimated intake of total fat and various dietary fat sources was calculated using a validated semi-quantitative food frequency questionnaire. The relationship between these dietary intakes and risk of PC was examined using Cox Regression and hazard ratio (HR) with 95% confidence interval (CI 95%) was reported.
During 383¡630 person-years follow-up and after excluding subjects with incomplete baseline information¡ a total of 48¡676 adults were studied. Until October 30¡ 2014¡ 54 cases of PC were confirmed by medical professionals¡ based on the medical records and the exact cause of death using the criteria of the International Statistical Classification of Diseases and Related Health Problems 10 (ICD10). After adjusting for potential confounders we did not observe any statistically significant relationship between the intake of total fat and various dietary fat sources and risk of PC. There was only a significant positive association between the risk of PC and daily intake of butter¡ cream¡ and solid vegetable oil in the age-adjusted regression models (HR=2.10; 95% CI=1.04-4.21; P for trend=0.03). However¡ this relationship was not remained significant anymore in the fully adjusted models.
Based on the results of the current research¡ after taking into account all of the potential confounding factors¡ dietary intake of total fat as well as various dietary fat sources had no significant association with the risk of PC. However¡ it is likely that consuming substantially less saturated and trans fat sources such as dairy fats as well as solid vegetable oils may be beneficial to reduce the risk of this cancer.

BackgroundPancreatic cancer (PC) is ranked as the 7th Leading cause of cancer death in the world and is among one of the most deadly cancers. Several lines of evidence indicate that insulin resistance, diabetes, and obesity are implicated in its carcinogenesis process.
Methods and MethodsWe examined the association between consumption of carbohydrate foods and risk of PC in the 50,045 participants (21241 men and 28804 women aged 40 to 75 years) of the Golestan Cohort Study in northeastern Iran. Dietary data was collected using a validated semi-quantitative food-frequency questionnaire. Cox proportional hazards models were used to estimate multivariate hazard ratio with 95% confidence interval.
Results During 8.5 years (383,630 person-years) of follow-up and after excluding participants with incomplete data, a total of 48,676 adults (20,683 men and 27,993 women) were studied. Until October 30, 2014, 54 cases of pancreatic cancer were confirmed by a medical team, based the medical records and the exact cause of death based on ICD10 criteria. After adjusting for age, total energy intake, history of diabetes, smoking status, education, opium, body mass index, waist to hip ratio, ethnicity, gender, MET, residential area and socioeconomic status we did not observe any statistically significant relationship between consumption of total carbohydrate and carbohydrate foods including whole grains and refined grains, sugars and potatoes and risk of PC.
ConclusionBased on the results of the present study, dietary intake of total carbohydrate as well as various carbohydrate food sources had no significant association with the risk of PC. Finally, given the limited number of studies in this field and their inconclusive results, there is still a need for new prospective studies with long follow up.

As the incidence of obesity increases, less invasive weight loss methods rather than bariatric surgery will be needed. This article reviews the advances in endoscopy, results, benefits and side effects of these techniques for treating obesity. The endoscopic options for weight loss could be broadly grouped under the following categories: restriction procedures, malabsorption procedures, and neuromodulation. With the most common options were related to restriction procedures, which include intragastric balloons (BioEnterics Intragastric Balloon and Heliosphere BAG), endoluminal restriction gastroplasty by intermittent sutures or continuous sutures, and transluminal oral gastroplasty. Malabsorption procedures such as duodenojejunal sleeves are effective particularly in obese patients with diabetes mellitus. Electrical stimulation of stomach is effective on weight loss because of reduced gastric adaptation and a delay in gastric emptying. It is important to identify which endoscopic technique must be used, depending on the desirable outcomes. Currently, the most important issue is to develop an effective and standardized endoscopic procedure.

The prevalence of bariatric surgery procedures has increased dramatically in recent years and multiple specialties encounter bariatric patients. In this article, we outline the different options in bariatric surgery and summarized the recommendations for gastrointestinal assessment of candidates before and after bariatric surgery. The role of routine endoscopy was controversial in pre surgical evaluation but may alter the operation performed. Comprehensive pre-operative screening conducted by a multidisciplinary team including gastroenterologist was essential to prepare obese patients for successful outcome following surgery. The most commonly performed procedures were Roux-en-Y gastric bypass and adjustable gastric banding. We presented the early and late complications of bariatric surgery and recommendations for post-operative cares by gastroenterologist in this review article.

Pancreatic neuroendocrine neoplasms (PNENs) are increasing in the world. The annual incidence of PNETs is nearly 0.25 per 100 000 population. 1-2% of pancreatic neoplasms are PNENs.This article reviewed the available original and review literatures which had been published in Persian and English in websites of Google scholar, Iran doc and Pub Med with keywords neoplasm, pancreas, neuroendocrine and Iran since 1995 to 2014 year. The aim of this article was to compare the clinico-pathological characteristics of Iranian studies (seven articles) with other studies. Prevalence of PNENs was among 30-60 year and there was no gender preference in some studies. Abdominal pain was the most common manifestation of PNENs.60-70% of PNENs was functional in Iran. In mostly of imaging procedures, neoplasm was reported in pancreatic head. These neoplasms were with different rates of growth and aggressive behaviors. The clinical behavior of PNENs could be predicted according to clinical stage, grade and evidence of hormone syndromes. Neoplasm resection could be a cure for PNENs. Mean survival time depended on the extent of disease at diagnosis time and the differentiation of neoplasm. In one report of Iran, survival rate was 48% in non functional PNENs versus nearly 100% in functional PNENs (Insulinoma) during 3 years follow up.A team of specialists is necessary for successful and efficient treatment in PNENs field. Mean survival time in non-functional PNENs is shorter than functional form. Different results in clinical characteristics and neoplasm behavior in several studies maybe due to PNENs heterogeneity in the world. It’s unlikely that could present a prognostic model for PNENs.

Obesity was a dangerous chronic disease. Physicians recommended drug therapy just in a few of obese patients in spite of many health risks. Weight control can be improved comorbidities of obesity like hyperlipedemia, hyperinsulinoma, acanthosis nigricans and hypertension.This article reviewed the available original and review literatures which had been published in English in websites of Google scholar and Pub Med with keywords drug, obesity and adults during 2002 - 2014.Drug therapy could improve obesity treatment after an unsuccessful combination of diet, exercise, and behaviour modification. Choice of treatment was based on multiple factors including the degree of obesity and patient preference. Drug therapy should be selected for a BMI)Body Mass Index (greater than 30 kg/m2, or a BMI of 27 kg/m2 with comorbid conditions including diabetes mellitus, hypertension, dyslipidaemia and heart disease.Prescription of anti-obesity drugs should be monitored carefully. Orlistat was the only drug for the long-term treatment of obesity. The efficacy of lorcaserin appears more than orlistat. Phentermine and diethylpropion are only approved for the short term treatment of obesity. Some antidepressant, antiepileptic, and antidiabetic drugs could be caused weight loss. New generation of anti-obesity drugs were under developing and more focus on the safety and efficacy combination treatments. Weight loss > 12kg reported in few investigational drugs. Some of them were discussed in this article.Obesity treatment is selected based on the side effects risks. Mostly of the available drugs have few side effects which decrease with treatment. There isn’t a cure drug treatment for obesity now.

Insulinoma was a rare pancreatic neuroendocrine tumor. Insulinoma was more likely to present as one small size tumor in head of pancreas in middle age. Surgery was a curative treatment. The aim of this study was to present clinical characteristics of insulinoma tumors in pancreas and their outcomes after tumor resection from a referral endosonography center in Iran.

this was cross sectional study from Nov 2010 to Nov 2013، all patients with clinical and biochemichal diagnosis of insulinoma entered to the study. Various characteristics likes، symptoms، laboratory and imaging findings،pathologic reports and their outcomes after surgery were recorded in a standard check list. Patients were followed for up to three years. All statistical analyses were performed SPSS software.

A total of 42 patients (62% women; mean of age 40 years) were identified. All of patients reported Whipple’s triad. Mean time from initiating of symptoms untill diagnosis time was 14 months. The common blood type was O (n=22،52. 3%). The mean tumor size was 2. 7cm. 33. 4% of endosonography reports show a solid tumor in the head of pancreas. Finding shows (n=36، 85%) of patients were treated surgically. Insulinoma tumor was confirmed in the pancreatic sample. Insulinoma recurrence have not report during the mean follow-up of 343 days in patients after tumor resection.

In this study، insulinoma tumors of pancreas (non familial) were single with tumor size of less than 3 cm. Most of them located in the head of pancreas. Outcomes following complete resection of tumor were satisfactory and have not report tumor recurrence during up to 3 years follow up. These results were the same as reports from other countries.

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases related to the psychological status of the patient. The aim of this study is to assess the relation of GERD with general psychological wellbeing (GPWB). This population study was performed among adult residents of Tehran, Iran in 2013. We invited high school and university educated healthy appearing subjects who were members of a health surveillance study in district number 11 of Tehran to reply to the GPWB query. Participants were divided into two groups, GERD patients and controls. We compared the dimensions of GPWB among these two groups. A total of 135 persons with a mean age of 35.5 ± 13 years were recruited for study participation. Approximately 30% of men and 23% of women had at least weekly GERD symptoms. Anxiety was significantly more common among GERD patients than controls. General health and positive well-being were significantly impaired among GERD patients. Assessment of self-representation of wellbeing and distress in GERD patients and consideration of new, relevant therapeutic avenues are important for the control of GERD.

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.

Obesity is a tremendous, increasing health problem worldwide. There are multiple endoscopic treatments for obesity. This study is a systematic review of researches on these methods and an evaluation of their safety and efficacy. We conducted a MEDLINE electronic research to review relevant English articles and abstracts published in the previous ten years(up to September 2012) on endoscopic treatments for human obesity. Overall, we found 62 articles. Of these, 42 articles (n=6406 cases) evaluated the bioenteric intragastric balloon (BIB) method. The percent of excess weight loss (EWL%) was 7.6%-62.3% and proportion of weight loss (WL) was 5.4-28.5 kg over six months. A total of five articles (n=159 cases) researched the air filled gastric balloon technique and reported a WL of approximately 10-17 kg in six months. Another five articles (n=112 cases) studied the duodeno jejuna bypass liner (DJBL) method and showed an EWL% of 11.9%-40% and WL of 8.2-16.7 kg over a 3-month period. Researchers evaluated botulinum toxin A (BTX A) injections in nine articles (n=144 cases) with a WL in two months of 0-11 kg. In three articles (n=64 cases), endoscopic suturing of the stomach was evaluated with an EWL% of 58.1 kg in six months. Another three articles (n=99 cases) evaluated transoral gastroplasty with an EWL% of 24.4%-36% and WL of 14-24 kg over six months. We have located numerous studies on the BIB procedure with lengthy (up to 5 years) monitoring of cases. According to these studies, BIB is a short-term, effective weight loss treatment. BIB may be a suitable method for preoperative weight loss in patients who are candidates for bariatric surgery to decrease the risk of surgery; in cases who are not candidates for surgery due to the risk of surgery; or in patients with moderate obesity as a primary weight loss treatment to induce changes in the patient''s life style. DJBL and transoral gastroplasty sounds larger and more effects but additional long-term researches are needed to clarify the safety and efficacy of DJBL and transoral gastroplasty.

Northeastern Iran has a high incidence for squamous cell esophageal carcinoma (ESCC). The aim of the study is to the assess relationship between celiac disease (CD) and ESCC. This was a two-part, cross-sectional, case-control study performed during 2006-2011 in Gonbad, Golestan, Iran. Serum IgA anti-tissue transglutaminase antibody levels were measured for all participants in the cross-sectional study (adult general population) as well as in ESCC cases and their matched (age and gender) controls. Out of approximately 1.3% of the 2202 individuals selected from the general population, 0.8% of 258 ESCC cases and 0.2% of 457 controls had positive IgA anti-tissue transglutaminase antibody levels. The prevalence of CD in general population of Gonbad district is a little higher than other parts of Iran.relatively low prevalence of IgA anti-tissue transglutaminase antibody in ESCC cases in northeastern Iran does not support the presumption that CD is a major factor for the high incidence of ESCC in the region. However, as there is little higher prevalence of positivity for the antibody in ESCC cases than in controls, a cohort study of Celiac disease patients is much more suitable study to assess the relation between CD and ESCC.

More than 250,000 people die annually of pancreatic cancer, worldwide. The highest incidence and mortality rates of pancreatic cancer are reported in developed countries. In developing countries the rate have been stabilizing over the past two decades but in countries which rates have been low for decades is now increasing. Recognizing pancreatic cancer''s risk factors and its prevention are important roles in reducing pancreatic cancer mortality. Risk factors for pancreatic cancer are not well recognized. The aim of the study is to review the environmental risk factors of pancreas cancer.We performed a systematic review of the published literature to identify all studies that provided environmental risk factors in association with pancreatic cancer. we conducted MEDLINE search limited to last 5 years up to June 2011, for all relevant case -control, meta analysis, systematic review and cohort studies. Citations were limited to those published in the English language. Review and comment articles have been excluded.Sixty six independent studies met the predefined inclusion criteria. Seven studies out of 15 found positive association between cigarette smoking and pancreatic cancer.Five articles out of 10 reviewed articles found high alcohol intake as a risk factor for pancreas cancer and the other 5 articles found dose related association with pancreas cancer.Coffee: according to 2 reviewed studies coffee not only does not have a substantial impact on pancreatic cancer risk but also coffee drinking has been associated with a reduced risk of pancreatic cancer in men. Frequent intakes of red meat and well-cooked meatand Vitamin D deficiency have positive association with pancreatic cancer risk.Cigarette smoking is the most consistent risk factor for pancreas cancer in relevant studies about pancreas cancer risk factors.

No information is available indicating the association between major dietary patterns and risk of colon cancer in Iran. This study was performed to assess the relationship between major dietary patterns and risk of colon cancer in Isfahan, Iran. In this cross-sectional study, 96 individuals (48 with newly-diagnosed colon cancer and 48 healthy people) attending Poursina Hakim clinic were included. Usual dietary intakes were assessed by the use of a semi-quantitative food frequency questionnaire for the last year. Weight and height were measured according to standard protocols and body mass index was calculated. Factor analysis was used to identify major dietary patterns. Four major dietary patterns were identified; the first dietary pattern was greatly loaded with dried fruits, vegetables, legumes, fruits, fish, dairy and spices. The second dietary pattern contained higher amounts of cream, butter and animal fats while lower amounts of legumes, dairy and tea. The third dietary pattern was high in animal fats, tea and red meat and low in margarine and non-hydrogenated vegetable oils. The forth dietary pattern was greatly loaded with hydrogenated and non-hydrogenated vegetable oil and had lower amounts of olive, dairy and margarine. No significant association was found between major dietary patterns and risk of colon cancer before adjustment for confounders. After control for age, gender, total energy intake and even body mass index, no association was found, too. It is concluded that major dietary patterns in this population are not associated with the risk of colon cancer.

The incidence rate of Esophageal Squamouse Cell Cancer (ESCC) in eastern part of Golestan province in Iran is among the highest ones in the world. In order to discover the factors interplay in high rate of ESCC incidence, several case-control and cross-sectional studies were established in this area.As a cohort study has priority in detecting risk factors of a disease, a 10-year prospective cohort study was conducted in this area. 68,024 individuals of residents in eastern part of Golestan province in the range of 40-75 year-old were invited to participate in the study. In rural areas, all the eligibled subjects were invited while in Gonbad city; a randomized systematic clustering sampling was conducted based on family numbers. Of 50045 subjects, recruited in the study, 21,241 (42%) and 28,804 (58%) individuals were male and female, respectively. The mean age of participants was 52.12 ± 9.1 years. About 23.9% and 76.1% of participants were residents of Gonbad city and rural areas, respectively. Eastern part of Golestan province has one of the highest incidence rates of ESCC in the world. A 10-year cohort study could lower the incidence rate of ESCC by identifying and controlling the related risk factors.

Esophageal cancer is one of the major malignancies around the world. It is the 8th high frequency cancer and the 6th leading cause of cancer death worldwide. The etiology of esophageal carcinoma is thought to be related to the exposure of smoking, alcohol, nitrate and low socioeconomic status. In this study, the status of oral health was evaluated in the population living in the north east of Iran.

45862 inhabitants of Gonbad and Kalaleh districts, aged 40-75 years, who had no esophageal cancer, were included in the study, which was part of Golestan Cohort. Oral health status and socioeconomic condition were evaluated by trained physicians.

19362 (42.2%) were male and 26490 (57.8%) were female (mean age was 52.1 ±9.1 years). The mean number of existent teeth, missed teeth, decayed teeth and filling teeth were 13.3 ± 9.4, 18.4 ± 9, 4.7 ± 6 and 0.23 ± 1.1 respectively. There were significant relationship between male, low socioeconomic status and low educational level with poor oral health status.

Oral health was poor among inhabitants of Gonbad and Kalaleh districts, especially in men and was related to low socioeconomic status and illiteracy.

Food consumption pattern and lack of some nutrients is known as main environmental risk factor of esophageal cancer. We investigated nutritional risk factor and food consumption pattern of people who live in high risk area in Golestan province. We investigated food consumption pattern of more than 30 years old Gonbad and Kalale's people who recruited in Golestan cohort study. Assessment carried out with validated 117 items semi quantitative food frequency questionnaire. We also used Iranaian data bank for nutritional analysis. Multiple linear regressions used to compare between sex, Gender, place and ethnicity. From 30463 subjects, aged 52.2 women, Turkmen ethnicity and rural dweller was 57.7%, 75% and 73.6% respectively. Overweight and obesity were common among urban dweller women in compare to other groups. Energy induced from carbohydrate, fat and protein were 65%, 22% and 13% respectively. People in Golestan had lower intake of some nutrients such as Riboflavin, fiber and vitamin A than recommended dietary allowance by FAO/WHO. Govaresh/ Vol. 12, No. 4, Winter 2008; 239-243

To perform screening for colonic cancer and to diagnose other colic diseases, colonoscopies are required. Comfort of patient during colonoscopy is very important. Currently, there are two types of sedation used during colonoscopy-the general anesthesia and sedoanalgesia. Sedo-analgesia is the most frequently used type of sedation employed during colonoscopy worldwide. In a double-blinded randomized clinical trial, 145 patients underwent colonoscopy were randomly assigned to four treatment arms. Group A patients received 50 mg hydroxyzine orally. Group B patients received 50 mg hydroxyzine orally and 25 mg pethidine intravenously. Group C patients were administered 25 mg pethidine intravenously and patients in group D were given 25 mg pethidine plus 2.5 mg midazolam intravenously. The patient satisfaction was then evaluated using a GHAA-9 questionnaire and measuring the pain by a visual analogue scale. There were differences among the three groups. Sedation with hydroxyzine alone or in combination with pethedine resulted in a significantly better satisfaction (p‹0.05). The excellent score for the patient satisfaction was 84.3% in hydroxyzine group, 64.9% in hydroxyzine+pethidine group, 5.7% in pethidine group and 5.7% in pethidine+midazolam group. Oral hydroxyzine is more effective than combinations of a narcotic and benzodiazepine in provision of pain relief and achievement of patient satisfaction in colonoscopy. Hydroxyzine is an excellent alternative to traditional intravenous drugs.

Food and nutrient are known as main environmental risk factor of esophageal cancer. We investigated food items consumption pattern of people who live in high risk area in Golestan province.We investigated food consumption pattern of more than 30 years old Gonbad and Kalale's people who recruited in Golestan cohort study. Assessment carried out with validated 117 items semi quantitative food frequency questionnaire. Multiple linear regressions used to compare between sex, Gender, place and ethnicity.Among man, all 17 food groups and items consumption were more than women except for legume and green tea. Among rural dweller, more than urban dweller in cereal, meats, process meats, vegetable oil, green tea, sweets and salt consumption and Turkmen ethnicity had more than non-Turkmen in Cereals, process meats, diary, animal and vegetable fat, fruits, green tea and salt.Golestan population had higher intake in Cereal and sweets and lower intake in vegetable, fruits, legume and diary in compare to optimal recommended basket.

Although gastroesophageal reflux disease (GERD) is a common disorder, its etiologies are still largely unknown. There are limited data on the association between psychological status and GERD in the world, in general, and in Iran, in particular. This study was conducted to determine the role of psychological factors in causing GERD. 1,016 randomly-selected subjects were invited for a face-to-face interview. 1,000 persons participated in this study (age range: 18-40 years). Those who reported heartburn and/or regurgitation, at least once a week, during the last 12 months were defined as GERD patients. Controls were persons who did not complian of those symptoms. The psychosocial status was assessed by a reliable general health questionnaire for Iranian, GHQ-28. The prevalence of "at least weekly GERD" was 12.3%. Somatic disorders (OR: 3.50; 95% CI: 2.17-5.66), anxiety (OR: 4.02; 95% CI: 2.51-6.43), social disorders (OR: 1.95; 95% CI: 1.21-3.17), and depression (OR: 3.29; 95% CI: 1.95-5.50), increasing age and obesity were associated with developing GERD. The prevalence of GERD in northern Iran is more than that in most Asian countries and is comparable to Western countries. The result of this study indicates significant association between psychiatric disorders with reflux symptoms. The psychosocial factors may play important roles in the production of GERD symptoms.