جستجوی مقالات مرتبط با کلیدواژه « gastrointestinal » در نشریات گروه « پزشکی »

Gastrointestinal cancers can cause major health problems globally since their burden is increas-ing in many countries. We aimed to investigate the trend of years of life lost due to gastrointestinal cancers in Fars Province, southern Iran during the 2004-2019.

In this cross-sectional survey study, we obtained the information regarding all deaths due to gastro-intestinal cancers in Fars Province from the electronic population-based death registration system (EDRS).Years of Life Lost(YLL) was calculated using the YLL template of 2015 by the WHO. To examine the trend for different years, join point regression based on the log-linear model was used. Joinpoint regression analysis describes changing trends over successive periods of time and the increasing or decreasing rate within each period.

During the years of 2004-2019, 9742 deaths due to gastrointestinal cancers occurred in Fars Prov-ince. 6013 (61.72%) cases were male and 3729 (38.28%) cases were female (Male / Female Sex Ratio: 1.61). Overall, 4152 cases (42.63%) were due to gastric cancer and 2112 cases (21.68%) were due to liver cancer. Total years of life lost due to premature death from gastrointestinal cancers during the 16-year study period was 73565 yr (2.33 per 1000 persons) in men, 52766 yr (1.71 per 1000 persons) in women, and 126331 yr (2.02 per 1000 persons) in both sexes.

Among all cancers, the highest mortality rates in both sexes belong to gastric cancer. This study showed the trend of YLL rate of malignant neoplasms of liver and intrahepatic bile ducts, esophagus, oral cavity, and colon cancer were increasing in both sexes, however, the trend of YLL rate for malignant neo-plasms of the small intestine was decreasing in both sexes. Variation of GI cancers patterns and trends around the Fars Province indicated that a more comprehensive control plan is needed to control these variations

Food allergy is an increasing health problem in children. Previous studies have reported conflicting results about the diagnostic value of atopy patch test (APT) in food allergies.

To investigate the accuracy of APT in identifying non-IgE-mediated gastrointestinal food allergy to pasteurized cow's milk, heated cow's milk, white and yolk egg, soy, wheat, walnut, sesame, pistachio, almond, peanut, date and cumin which are popular food ingredients in Iran.

This study was performed on children with GI allergic problems who did not improve after at least 4 weeks of cow's milk protein elimination. Atopic patch test (APT) was performed and the elimination diet was considered according to APT results and after resolving symptoms, introduction of each accused food was done sequentially.

53 children under 7 years old with mean age of 19.6 months underwent APT and the results were verified by open oral food challenge. Sensitivity in the rage of 59%-95%, specifity of 80.7-92.8, positive predictive values of 75-96.4 and negative predictive value of 23-80.7% were calculated depending on the type of food. Compared to the heated raw cow's milk, the pasteurized/homogenized cow's milk reaction was significant.

APT can be included in the diagnostic workup of non-IgE-mediated GI allergy because it's safe and has great accuracy. However, several aspects require further investigation especially to enable the standardization of the technique. We should be aware of allegenicity of our foods due to processing and geographic region.

Multiple myeloma (MM) is a neoplastic proliferation of immunoglobulin-producing plasma cells that have multiple presentations due to the infiltration of plasma cells in the bonemarrowand other organs. Commonmanifestations include anemia, bone pain, fatigue, and hypercalcemia. MMpresented with rectorrhagia is very rare.

A74-year-oldwomanwith a history of rectorrhagia episodes from about nine months ago presented with severe anemia, weakness, and lethargy. The findings of endoscopy and colonoscopy did not justify the patient’s manifestation, and finally, due to thrombocytopenia and anemia, a bone marrow biopsy was performed, and multiple myeloma was diagnosed.

Although GI bleeding in Multiple myeloma is a very rare manifestation, this diagnosis must be considered in the differential diagnosis of patients with unexplained and refractory GI bleeding.

Acute pancreatitis, a potentially fatal disease, with symptoms including nausea and/or vomiting, indigestion, and abdominal pain, is known to range from a mild self-limiting state up to a more severe and lethal form. This review aims toprovide a clearer picture to improve understanding the role of viral agents in the development of acute pancreatitis.Common databases including PubMed, Google Scholar, and Scopus were used for the literature search. In this review search terms including virus, viral, infection, and specific descriptive terms for a virus were considered in different combinations. Various causative agents are recognized in the development of acute pancreatitis as one of the most frequent gastrointestinal diseases, such as gallstones, alcoholism, and hypertriglyceridemia. Microbial pathogens with about 10% of acute pancreatitis cases, mainly viruses, among other factors, are thought to play a role in this regard. Once the pancreatitis diagnosis has been made, depending on thecausative agent, the management approach and specific interventions affect the final outcome. Virus-induced acute pancreatitis in patients should be considered. Advanced diagnostic tests such as PCR, in situ hybridization, and biopsy can help for a betterunderstanding of the role of viruses in causing acute pancreatitis. Improvement in the tests will lead to timely diagnosis, treatment, and better management of pancreatitis.

Patientsmayexperience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs.

This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room.

This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography. Patients were randomly divided into 2 groups. The dexmedetomidine group received dexmedetomidine (1 g/kg) for 25 minutes with propofol (0.5 mg/kg) and fentanyl (1 g/kg) at the start of the procedure. The midazolam group received midazolam (0.03 mg/kg) with propofol (0.5 mg/kg) and fentanyl (1 g/kg). Heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2) were recorded before and 5, 10, and 15 minutes after starting the procedure. The Ramsay Sedation Scale (RSS) and the need for an additional dose of propofol were recorded during the procedure. The Numeric Pain Rating scale (Ambesh score) scores were recorded at the beginning, immediately after, and 1 hour after the procedure. Nausea and vomiting were assessed using the Visual Analogue Scale in cooperation with the patient.

The dexmedetomidine group had significantly higher SpO2 and RSS scores during sedation than the midazolam group (P = 0.02). Overall, specialist satisfaction was higher in the dexmedetomidine group than in the midazolam group. There was no clinically significant difference in pain score and nausea and vomiting frequencies between the 2 groups.

Dexmedetomidine is more effective than midazolam for sedation during gastrointestinal endosonography.

There is no agreement on the route of administration and the drug of choice for providing adequate sedation for pediatric invasive procedures.

We compared the utility, safety, and sedation effects of intranasal midazolam and oral ketamine.

This double-blind clinical trial was performed on 100 children aged 2 to 14 years who were candidates for upper gastrointestinal (GI) endoscopy. Patients were randomly assigned to two groups: ketamine (4 mg/kg orally) and midazolam (0.1 mg/ kg intranasal). Sedation score, fear levels, children’s behavior at the time of separation from parents, and vital signs were recorded.

Higher systolic blood pressure was seen in children who received ketamine (P=0.012) and lower arterial oxygen saturation in the midazolam group (P=0.023). Also, the level of sedation showed no significant difference between the groups.

Based on the results, administering oral ketamine or intranasal midazolam before endoscopy induced a similar sedation score in children. Also, both methods could be safe and non-invasive modalities for sedation.

Household food insecurity (HFI) which has still been one of the major global public health issues is related to adverse health outcomes in individuals. Therefore, this study aimed to determine the prevalence of HFI and its associated factors in Iranian patients with esophageal and gastric cancers.

The data of this cross-sectional study was obtained from 315 patients with esophageal and gastric cancers who were selected from a gastrointestinal cancer-based cohort study conducted in Firoozgar hospital, in Tehran. Food insecurity (FI) was measured using the Iranian version of the HFI questionnaire that was completed by a trained interviewer. The multivariable logistic regression model was used to determine the independent association of each factor with HFI. A P value lower than 0.05 was considered statistically significant.

The mean ± SD of participants’ age was 63.2 ± 12.6 years and 65.4% were men. Most of the patients (75.8%) suffered from gastric cancer and 24.2% from esophageal cancer. The overall prevalence of FI among participants’ households was 35.2%. There was an independent significant association between wealth index (WI) and HFI after the use of the multivariable logistic regression model, in such a way that the odds of FI in the poorest, poor, moderate, and rich patients’ households were respectively, 6.41, 5.05, 2.74 and 2.04 times higher compared with the richest households.

More than a third of participants’ households struggled with FI, which was found to have a higher prevalence in low-economic households. Therefore, health policymakers should intervene in food-insecure households by developing, establishing, and implementing strategies and control programs to improve affordable food access.

This study aimed to compare the efficacy and toxicity of perioperative chemotherapy regimens including epirubicin, cisplatin, 5-fluorouracil (ECF), docetaxel, cisplatin, 5-fluorouracil (DCF), leucovorin, 5-fluorouracil, oxaliplatin (FOLFOX), and 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) to identify the most effective chemotherapy regimen with less toxicity.

Experimental approach:

 This retrospective cohort study (2014-2021) was based on 152 eligible resectable gastric cancer patients who had received one of the perioperative mentioned chemotherapy regimens and followed for at least two years. The primary endpoint of this study was overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and R0 resection.

Of included patients, 21%, 33.7%, 24.3%, and 21% had received ECF, DCF, FOLFOX and FLOT, respectively. After the median 30-month follow-ups, OS was higher with the FLOT regimen in comparison with other regimens (hazard ratio = 0. 276). The median OS of the FLOT regimen was 39 months. Besides, the median OS was 28, 25, and 21 months for DCF, FOLOFX, and ECF regimens, respectively. Moreover, a median PFS of 24, 18, 17, and 14 months was observed for FLOT, DCF, FOLFOX, and ECF regimens, respectively (Log-rank < 0.001). FLOT regimen showed 84. 4% ORR which was notably higher than other groups.

Conclusions and implications:

 For resectable gastric cancer patients, the perioperative FLOT regimen led to a significant improvement in patients’ OS and PFS versus ECF, DCF, and FOLFOX regimens. As such, the FLOT regimen could be considered the optimal option for managing resectable gastric cancer patients.

The ectopic endometrial tissue can be found in different places with no symptoms (such as intestinal endometriosis) and common symptoms such as abnormal bleeding, dysmenorrhea, and chronic pelvic pain. Early diagnosis and treatments, especially with surgical procedures, play an important role in patients’ recovery. We describe a 39-year-old woman with intermural and submucosal endometriosis. The compressive effect of the mass in the rectosigmoid colon caused digestive symptoms. After necessary procedures such as colonoscopy, computed tomography (CT) and endoscopic ultrasonography (EUS), we performed surgery, and the distal colon was resected. Ovarian cysts caused by endometrial tissue displacement can have symptoms similar to gastrointestinal stromal tumors (GISTs) if they are large enough to push through the gastrointestinal (GI) system. These symptoms can be diarrhea, abdominal tenderness, and so on. Surgery is the best diagnostic way for endometriomas and one of the diagnostic ways in GISTs. Also, with considering the drug resistance of GISTs to the current chemotherapy, the best treatment is also surgery. Location and tissue involvement of masses of the GI system are important points that should be considered in the differential diagnoses. In this way, early diagnosis and timely treatment, especially surgical, will have the best prognosis for the affected patients.

The classic celiac disease (CD) presentation in individuals with iron deficiency anemia (IDA) has been changed given the large percentage of subtle or asymptomatic cases. The study objective was to assess the predictive factors influencing the diagnosis and severity of villous atrophy in individuals with CD and IDA referred for a diagnostic endoscopy.  

This was a retrospective observational, cross-sectional analysis of the medical records of 499 individuals with IDA in 2 centers in Basrah, Iraq, who referred for possible diagnosis of CD within 10 years (2006-2016). The relationship of the severity of anemia, demographic characteristics, symptomatology, and celiac serological results on the final diagnostic endoscopic evaluation was evaluated using a univariate analysis, at a P value ≤ 0.05. The study adopted the Marsh classification for celiac disease diagnosis where Marsh type 3 represents the definite celiac disease.  

  The definite diagnosis was seen in 44.5% of the cohort (n = 222), with asymptomatic cases representing 22.5% of cases (n = 50). The mean age was (27 ± 11) years, with significant association to (female gender, age ≤45 years, positive celiac serology, and severity of anemia). After adjustment of the variables, the Marsh type was significantly correlated with positive celiac serology, low hemoglobin, and presence of gastrointestinal symptoms.  

The positive celiac serology, low hemoglobin <9 g/L, and the presence of gastrointestinal symptoms are strong predictors of the severity of villous atrophy (Marsh type).

Gastrointestinal endoscopy is a useful diagnostic method in children. The level of anxiety in children is one of the important factors on the patient's acceptance of endoscopy. This study aimed to investigate the effect of a pre-endoscopy preparation program on children's anxiety and parental satisfaction. This clinical trial study investigated 76 children aged 6 to 18 years and their parents referred to the endoscopy unit of Besat Hospital, Hamadan, Iran, in 2019. The patients were randomly assigned into two equal groups. The experimental group was trained using pamphlets and face-to-face training before endoscopy, and then the two groups were compared in terms of children's anxiety and parental satisfaction. The data were collected using the Demographic Information Questionnaire, Spielberger State-Trait Anxiety Inventory, and Parental Satisfaction Questionnaire. Before the intervention, the mean±SD values of the state anxiety in the experimental and control groups were 48.92±2.81 and 49.18±2.86, respectively, and it was statistically lower in the experimental group (P=0.042). Moreover, after the intervention, the mean±SD values of the trait anxiety in the experimental and control groups were 48.47±31.10 and 49.86±2.87, and there was no statistically significant difference between the two groups (P=0.339). Parents' satisfaction in the experimental group was higher than that in the control group, which was statistically significant (P<0.001).Implications for Practice: The pre-endoscopy preparation program reduced the anxiety of the children. Findings can be utilized in planning to improve their parents' satisfaction.

The present study aimed to examine the prevalence of the diseases and the reasons for outpatient referral of gastrointestinal patients to the subspecialty gastroenterology center of Ziaeian Hospital in Tehran.

In the present cross-sectional study, the main causes of outpatient referrals in 2019 were extracted from the data bank of Ziaeian Hospital. The final diagnosis of all patients is based on the first visit, subsequent referrals, and the diagnostic procedures performed.

The present study examined the data collected from 1072 patients. The results showed that 70% of the participants (756 patients) were female, and the patients in the age group of 41-50 years had the highest frequency accounting for 23.9% of the patients (259 persons). Besides, the most commonly diagnosed diseases in the whole population and both sexes were functional dyspepsia (35.72%), reflux (14.73%), irritable bowel syndrome (8.02%), and anal fissure (8.02%). Furthermore, the early onset symptoms were abdominal pain (44.8%), retrosternal pain and burning (12.7%), bleeding (8.1%), and defecatory disorders (7.5%).

The findings of the study can have some implications for preventive planning and interventions and the allocation of health resources. 

The coronavirus was first identified as the cause of pneumonia in Wuhan, a town in the Hubei Province of China, in December 2019. It usually has respiratory symptoms such as myalgia, headache, cough, and dyspnea. In the medical literature, digestive symptoms and liver disease have been reported in Coronavirus disease in 2019 (COVID-19) patients. In this review article, we summarized the recent studies of gastrointestinal and hepatic manifestations and management of COVID-19. The most common gastrointestinal symptoms were poor appetite/anorexia, nausea/vomiting, diarrhea, and abdominal pain. Elevated aminotransferase has been reported in patients with COVID-19. COVID-19 gastrointestinal and hepatic management is usually symptomatic except for high-risk populations such as patients with inflammatory bowel disease or autoimmune hepatitis, which require special attention.

Any prediction of a person’s ability to succeed in a motor skill depends on the detection and accurate measurement of the basic abilities for the performance of that skill. Task analysis is needed to determine the psychomotor skills and abilities required to perform an action. This study aimed to determine the components of psychomotor abilities for diagnostic upper gastrointestinal (GI) endoscopy through procedural task analysis (PTA) and expert review.

A multisource, multimethod task analysis was conducted in six metropolitan teaching hospitals affiliated with the adult gastroenterology and hepatology training centers in the Islamic Republic of Iran in 2019. Observation, video-recording, and think-aloud protocols were used while diagnostic upper GI endoscopy was performed. To confirm the accuracy of the PTA, the incorporated the views of the adult gastroenterology and hepatology subspecialty experts through the checklist of PTA assessment criteria. Finally, to determine the psychomotor abilities for each stage of the procedure, the study incorporated a panel of experts from occupational therapy, physical education, physical medicine, and adult gastroenterology and hepatology subspecialty.

Of the 15 psychomotor abilities examined, 11 were determined for upper GI endoscopy procedure, of which six cases (including visuospatial and perceptual abilities, hand–eye coordination, multilimb coordination, finger dexterity, arm–hand steadiness, and manual dexterity) were the most frequent.

PTA techniques and subsequent expert review were used to identify the components of psychomotor abilities for diagnostic upper GI endoscopy. It is suggested that PTA is performed for other procedures, and after psychomotor abilities are specified, proportional tests are developed.

Gastrointestinal (GI) tract is the most common site for extranodal lymphoma. The primary GI lymphoma pattern in Iran is different from western countries and has been changed during the past 40 years.

This study was done to determine the clinical and pathological characteristics of primary GI lymphoma in Tehran, Hamedan, and Mashhad regions in Iran.

In this cross-sectional comparative-descriptive study, 200 patients with primary GI lymphoma in Tehran, Hamadan, and Mashhad regions from 2011 to 2016 were enrolled in a consecutive manner, where the clinical and pathological characteristics of cases were determined.

Among 200 patients, 141 (70.5%) subjects were male and 59 (29.5%) subjects were female. The mean age at diagnosis was 54.3 ± 19.3 years. Also, 84%, 8.5%, and 7.5% of the patients’ specimens were from Tehran, Hamedan, and Mashhad, respectively. The stomach was the principal involved location in approximately half of the cases. Diffuse large B-cell lymphoma (DLBCL), was the main subtype that was observed in 64% of the cases. Treatment in 72% of cases was a combination of surgery and chemotherapy. The 5-year survival was assessed in 147 patients with a rate of 68%.

Primary GI lymphoma is seen more in male subjects younger than 60 years of age with non-specific symptoms. Also, DLBCL and MALToma are the main histologic types, and the 5-year survival for all cases is 68.0%. The clinical symptoms showed no specific pattern and accordingly, patients with weight loss and abdominal pain should be considered in in differential diagnosis of malignant lymphoma.