Govaresh
Volume:27 Issue: 4, Winter 2023

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disease. Traditional treatment strategies have relied on repeated administration of high doses of drugs, including antibiotics, non-steroidal anti-inflammatory drugs, biological drugs, and immunomodulators aimed at reducing inflammation. Some of these drugs are effective in reducing early inflammatory symptoms, but their long-term efficacy decreases due to the accumulation of toxic substances. Therefore, the development of new therapeutic methods is needed. Exosomes are small extracellular vesicles that are secreted by cells and carry macromolecules and bioactive substances and play a role in the physiological and pathological processes of the body. So far, many efforts have been made to understand their biology and potential clinical applications in various diseases, including autoimmune diseases. Recent studies have shown that the therapeutic functions of exosomes may affect pathways related to IBD such as immune responses, barrier functions, and gut flora. This review describes recent advances in the development of exosomes and their therapeutic application in IBD.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors, such as adalimumab (ADA) and infliximab, are among the most effective biological drugs for inducing and maintaining remission in patients with moderate to severe inflammatory bowel disease (IBD). Studies have shown that the effectiveness of infliximab is increased with the concomitant use of immunosuppressive drugs. However, little is known about ADA. Our aim was to compare the efficacy of monotherapy with biosimilar ADA and combination therapy with ADA+azathioprine (AZA) in IBD patients.

In this retrospective cohort study, the medical records of anti-TNF-naïve IBD patients referred to a tertiary hospital in Tehran during 2019-2020 who received biosimilar ADA (CinnoRA®) were reviewed. We compared the effectiveness of treatment, serum levels of ADA, anti-adalimumab antibodies, and laboratory data between the two monotherapy and combination therapy groups.

A total of 65 patients were enrolled. Fifty-six (86.2%) patients had ulcerative colitis, and the remaining had Crohn’s disease. 50 patients (76.9%) received combination therapy, and 15 (23.1%) were in the monotherapy group. The rate of clinical remission in the combination therapy group (50%) did not differ significantly from the monotherapy group (40%). The drug levels were in the therapeutic range (≥7.5 µg/mL) in 57.5% of patients in the combination therapy group and 76.9% of those in the monotherapy group. The antibody test result was positive in 40% of patients taking AZA+ADA and 10% of patients in the ADA group, neither were significantly different.

Adding AZA may not play a significant role in improving the therapeutic effectiveness of ADA in treating IBD.

Acute pancreatitis is one of the most common complications following endoscopic retrograde cholangiopancreatography (ERCP), which can be life-threatening if the treatment is postponed. This study aimed to evaluate the effect of non-steroidal anti-inflammatory drugs (suppository diclofenac) on preventing post-ERCP pancreatitis (PEP).

In this double-blind, randomized clinical trial, 219 patients referred to our ERCP unit who passed inclusion and exclusion criteria were randomly assigned to two groups: group A (103 patients) received a diclofenac suppository 30 minutes before and immediately after ERCP. In Group B (116 patients), a diclofenac suppository was prescribed only before the procedure. Patients were evaluated regarding clinical signs and symptoms of pancreatitis for 24 hours. Also, serum amylase level was checked at baseline, 6, and 24 hours after the procedure. The study protocol was approved by the Ethics Committee of the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.190). Also, the study protocol was registered in the Iranian Registry for Clinical Trials (IRCT20191231045969N2).

The PEP was seen in three patients in group A and seven patients in group B, which was not significantly different (P=0.341). The severity of pancreatitis was mild in all patients except one in group B, who developed moderate PEP. Moreover, in 97.71 % of cases, ERCP was successful for the first time, and in 94.18 % of group A and 89.66% of group B, no complications of bleeding or perforation were detected.

Administration of rectal diclofenac before and after ERCP had no significant effect on the prevention of pancreatitis compared with pre-ERCP administration.

The efficacy of endoscopic retrograde cholangiopancreatography (ERCP) has increased significantly over time. However, there are few studies evaluating the success rate of ERCP in Iran.

We aimed to evaluate the success rate, adverse events, and mortality of ERCP in an academic medical center. This cross-sectional study was conducted over 2 years between February 2018 and January 2020 and 347 patients were enrolled. The success rates and causes of procedure failure were recorded by the endoscopists. The patients were followed up for all adverse events until discharge.

Eventually, 302 patients ended the study. The most common indication for ERCP was CBD stone (73.2%). The ERCP procedure was successful in 240 (79.5%) patients. Unsuccessful outcomes were due to cardiovascular conditions (n=7) and endoscopic problems (n=34). Of 34 cases of impossible cannulation, in 32 (10.6%) cases, the papilla was found but cannulation was not possible and in 2 (0.7%) cases it was not possible to access the papilla. The mean (SD) age of the patients with unsuccessful ERCP was significantly higher than successful cases (P=0.001). The times of cannulation, cannulation attempts, and dye injection were significantly higher in unsuccessful procedures as compared with successful procedures (P=0.014, P=0.001, and P=0.001, respectively). The mean time of cannulation (minute) was 5.05 in successful ERCPs and 11.99 in unsuccessful cases (P=0.014). Failure of ERCP was significantly associated with adverse events during ERCP (P=0.001). The most common adverse event was post-ERCP pancreatitis (PEP) (14.6%) and severe cases were 3.6%. PEP was significantly associated with sex (P=0.034). There was no mortality during the study.

We found that ERCP could be a safe and effective procedure, especially for patients under 65 years. The overall success rate and adverse events were compatible with the available data in the literature.

Despite the importance of a gluten-free diet (GFD) in the management of celiac disease (CD), non-adherence is quite common and varies in different societies. The aim of this study was to survey adherence to a GFD and identify the barriers in the adult celiac population in Shiraz.

In this cross-sectional study, the patients diagnosed with CD were determined through serum levels of tissue transglutaminase IgA (tTg-IgA) and immunoglobulin A (IgA). In patients with positive anti-tTG, small bowel biopsies were taken. A gastroenterologist routinely assesses CD patients at Shiraz Celiac Clinic. Also, an expert general practitioner describes a list of forbidden food to patients. Adherence to a gluten-free diet was evaluated using interview and tTg-IgA level.

Adherence to a gluten-free diet was 58.2% among 170 participating patients aged 15 to 71 years. There was no significant difference in sex (P=0.730), current age, and age at the time of diagnosis (P>0.05) between the adherent and non-adherent groups. However, the adherence among the unemployed (P=0.036) and highly educated ones was significantly higher than others. More patients adhered to the gluten-free diet for 1-3 years (63.7%), so after three years, less adherence was seen (50%). The most reason for non-adherence was lack of proper access and labeling, cost, and feeling different from others.

Advances in the catering/food industry, increasing economic support and awareness about CD, GFD, and gluten-free products, as well as removing barriers such as inaccessibility and cost, can improve adherence to a GFD.

Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. According to previous studies, NAFLD can cause kidney dysfunction and the formation of urinary tract stones. In this study, the relationship between NAFLD and renal stone formation based on the sex and age of patients was investigated using non-contrast computed tomograms.

This study was performed in 2020 on 907 patients who were referred to Golestan Hospital and underwent computed tomography (CT) evaluation without contrast of the abdomen and pelvis. The statistical relationship between NAFLD and renal stone disease was assessed using the Chi-square test.

Participants in this study included 582 men (64.2%) and 325 women (35.8%). The frequency of NAFLD patients with renal stones was significantly higher than NAFLD patients without renal stones (82.1% vs 17.9%, P <0.0001). The frequency of renal stones in severe NAFLD was significantly higher than in patients with mild NAFLD (100% vs 78.8%; P=0.008). The risk of developing renal stones in patients with NAFLD disease increases with age compared with patients without NAFLD (P<0.009). Renal stones in patients with NAFLD were not affected by sex (P=0.487).

These results show a significant association between NAFLD and renal stone formation in male and female populations. Also, this association is strengthened by the increase in the severity of NAFLD; therefore, NAFLD can be an independent risk factor for renal stone disease, and renal stone disease can be associated with metabolic syndrome or one of its components.

Gastrointestinal stromal tumors (GISTs) are the most common gastrointestinal mesenchymal neoplasms. The risk factors for GISTs are older age and inherited genetic syndromes. Moreover, lifestyle-related or environmental causes of GISTs are unknown, and due to the lack of a similar study in the Babol region, we decided to investigate the frequency of GISTs in hospitals in Babol.

The present study is a cross-sectional study performed on 30 cases of GISTs in the pathology archive of hospitals in Babol from March 21, 2010, to March 20, 2021. Patients’ information such as age, sex, family history, smoking, and clinical signs were evaluated.

In this study, the prevalence of GISTs was 5.81 per thousand. 16 (53.3%) patients were in the group of less than 57-year-olds, and 14 (46.7%) patients were aged more than 57 years. 18 (60%) patients were males and 12 (40%) were females. The stomach was the most common site of the stromal tumor, with a frequency of 16 (53.3%) cases. While the second and third categories were the esophagus with 10 (33.4%) cases and the intestine with 4 (13.3%) cases, respectively. Abdominal pain in 17 (56.7%) patients with stromal tumors was reported as the most common symptom.

This study showed that the frequency of GISTs was similar to the results of studies inside and outside Iran. In addition, the prevalence of stromal tumors in the 50s and men was similar to other studies.

A data-driven colorectal cancer screening strategy based on a personalized approach can improve health outcomes. This study aims to develop an information road map for personalized colorectal cancer screening in Iran.

This study is a mix-method research (MMR) which consisted of three phases: phase I, the development of a checklist with 275 items for assessing required data elements of personalized colorectal cancer screening; phase II, situational analysis of colorectal cancer screening dataset according to the checklist; phase III, development of national information roadmap for personalized colorectal cancer screening with in-depth interview and focus groups.

Personalized datasets of colorectal cancer screening were defined in four dimensions, including a clinical dataset, a genetic dataset, a demographic dataset, and a social determinant dataset. In the next step data elements of colorectal cancer screening based on personalized datasets were analyzed. Of the 275 items, only 96 items are recorded. In the final step, a national information roadmap of personalized colorectal cancer screening with 6 levels was developed.

Personalized screening based on integration dataset play a key role in the successful implementation of the screening program. Implementation of a national roadmap can assist to improve the quality of data in personalized screening.

Screening for colorectal cancer (CRC) is a cost-effective approach to the detection of CRC at an early stage and prevents deaths from cancer. Despite the undeniable benefits of CRC screening, noticeably eligible individuals do not welcome screening programs. Results of the study in the US in 2018 indicated nearly one-third of adults ages 50-75 years did not participate in CRC screening.