Middle East Journal of Digestive Diseases
Volume:1 Issue: 1, Jan 2009

Helicobacter pylori is the main etiologic agent in most gastritis and peptic ulcers. The ideal regimen for the treatment of H. pylori infection has not yet been defined. This study was designed to evaluate the eradication rate of H. pylori infection using a short-term and cost effective furazolidone-based regimen in a previously sensitive area to furazolidone drug. In a randomized single blinded clinical trial study, 135 patients with an endoscopically verified H. pylori-positive peptic ulcer disease were randomly assigned to a quadruple therapy of «furazolidone, 200 mg; bismuth subcitrate, 240 mg; tetracycline, 500 mg and omeprzole, 20 mg» twice daily for either 14 or 7 days. Six-eight weeks after cessation of therapy, H. pylori eradication was assessed by 13C-urea breath test. H. pylori eradication rate in 7-day and 14-day groups were 71% and 65%, respectively using intention to treat test with no significant difference between the two groups. H. pylori eradication rate had no significant correlation with age, sex and smoking habit. Our study showed that furazolidone-based regimen could not yield an acceptable eradication rate in the area sensitive to furazolidone previously. Eradication failure was attributed to several reasons including inadequate choice of drugs, insufficient knowledge of best therapeutic choices; poor patients’ adherence to treatment and primary H. pylori resistance to the most commonly employed antibiotics.

Acute obstruction of the colon continues to be a lethal disease with little improvement in the mortality rate over the past 50 years. So, this study was undertaken to define the causes of colon obstruction and their probable changes after years. From 1979 to 2004, all records of patients with definite diagnosis of intestinal obstruction at all hospitals affiliated to Shiraz University of Medical Sciences in Shiraz, southern Iran were reviewed retrospectively. One thousand-hundred and seventy-two patients with diagnosis of intestinal obstruction entered our study. Two-hundred records were diagnosed as large bowel obstructions (16.5%) and 80% were male (volvulus: 84%, cancer: 60%). Their age range was 16-105 years, (mean=48 years). Volvulus occurred in 152 (76%) patients (sigmoid, 87%; cecum, 9%; transverse colon, 2.5% and splenic flexure, 1.3%). Colon cancer was diagnosed in 30 patients (15%); and the other causes were adhesion, 3.5%; hernia, 1.5%; fecal impaction, 2%; TB, 1% and ileosigmoid knot, 1%) compromising the remained 9% of cases. Sigmoid volvulus was the most common cause of colonic obstruction in south of Iran and male predominance was seen in both volvulus and cancer groups

The association between oral Lichen planus (OLP) as a common oral disease and HCV infection as an etiological factor in the development of hepatocellular carcinoma has been widely reported. However, there are wide geographical variations in the reported prevalence. This study was performed to determine the prevalence of L. planus in HCV+ patients in Shiraz, southern Iran. Seventy-six HCV+ positive patients (59 males and 17 females) aged between 28 and 58 years were enrolled as the case group and 90 HCV-patients (79 males and 11 females) aged between 26 and 62 years entered the study as the control group. An enzyme linked immunosorbent assay (ELISA) was used to determine the presence of anti-HCV antibodies in all subjects in both groups. To confirm positive diagnoses, a polymerase chain reaction test (PCR) was performed. Oral cavity of all patients was clinically examined for the presence of different types of erosive and keratotic lesions of OLP. Erosive and keratotic lesions of OLP were detected in buccal mucosa of two cases (2.6%) in the case group and in one patient of the control group (1.1%). There was no statistically significant relationship between OLP and HCV infection in Shiraz (P value=0.57). Further studies are needed to focus on other groups in different regions of Iran to determine whether testing for HCV infection is necessary in patients with OLP.

In view of high prevalence of GI cancers in Lorestan Province, western Iran, and a large number of esophageal cancer patients in this region, this study was done to determine the frequency of various GI cancers in the area. In a cross-sectional study, all patients from Lorestan Province for whom endoscoppy and colonoscopy were performed and biopsy was provided entered our study. Distribution of cancers in terms of age, sex, site of involvement and type of pathology was determined. Of 3088 endoscopic patients, 408 cases (13.2%) were with GI cancers. The most prevalent one was esophageal cancer with 216 cases (52.93%) followed by gastric and colon cancers. All the studied cancers were more common among men than women. The most frequently observed pathology was squamous cell carcinoma (SCC) in esophageal cancer and adenocarcinoma in gastric and colon cancers. The most prevalent GI cancer in the present study was esophageal cancer followed by gastric and colon cancers. So further studies concerning prevalence and ethiology of GI cancers are needed to be undertaken

The relationship between subfertiltiy and celiac disease has been well described and may be the only presenting feature of celiac disease. Therefore, this study was designed to show the prevalence of celiac disease in unexplained infertility among Iranian patients in Tehran, Iran. This case-control study includes 125 patients with primary unexplained infertility and 125 fertile women as controls who referred to Shariati Hospital, affiliated to Tehran University of Medical Sciences Infertility Clinic. The total serum IgA and IgA anti-TTG were measured. In the case of positive TTG, a duodenal biopsy was performed to confirm the diagnosis. Four patients (3%) with unexplained infertility had positive TTG and in three (2.4%), biopsy of small intestine was compatible with celiac disease. None of the women in the control group had positive TTG. A few studies suggest that celiac serologic tests should be considered for infertile patients. But the absence of a significant statistical difference in the incidence of celiac disease between subject and control groups in the present study suggests a need for further studies with large sample size to address the issue

Acute mesenteric ischemia (AMI) is a catastrophic disorder of gastrointestinal tract with high mortality. Due to recognition in advanced stages and late treatment of patients, the disease is still a highly fatal one. This study was conducted to determine the characteristics of the disease in the region. In a retrospective study, all patients’ records of public and private hospitals in Shiraz, southern Iran, with the impression of acute abdomen, bowel gangrene or abdominal pain, and patients with risk factors for the disease, who were admitted from March 1989 to March 2005, were reviewed and those with AMI were enrolled in the study. Among 10,000 patients’ records, 105 patients with AMI were identified. Mean age of patients was 57 years. The most common symptom was abdominal pain (98.09%). Heart disease was seen in 44.7% of cases. The mortality rate was lower in patients undergoing mesenteric angiography (P=0.014). When the site of lesion was exactly defined, venous thrombosis was found to be the most common type (41.9%). AMI was a common cause of acute abdomen in our area especially in the elderly with venous thrombosis as the most common type. Early diagnosis especially with early use of mesenteric angiography and treatment may decrease the mortality from AMI.

Besides medical therapy, surgical interventions plays an important role in the treatment of inflammatory bowel disease (IBD), but they also involve complications and advantages. This study was undertaken to determine the characteristics and outcome of surgery in patients with IBD. All the files of the patients admitted in Nemazee and Faghihi hospitals with the final diagnosis of IBD during the past 10 years were reviewed. The history of surgery, the indication and the outcome were recorded. Among 246 IBD patients, 226 (91%) were ulcerative colitis (UC) and 20 (8.1%) were Crohn’s disease (CD). Among UC patients who underwent surgery due to active disease, 23.8 % were unresponsive to medical therapy, 5.5% experienced severe bleeding and 2% were at the risk of cancer. Types of surgery were proctocolectomy and ileostomy (2%), colectomy and ileorectal anastomosis (37%) and total proctocolectomy and ileoanal anastomosis with pouch (62%). Complications were obstruction (11%), anal stenosis (31%), pouchitis (21%) and developed pouch dysfunction (10%). In cases of CD, 35% underwent surgery, 2 patients due to obstruction, 2 due to perianal fistule, l due to enterocutatieous fistule and fissure, 2 underwent hemicolectomy and 1 underwent resection of small bowel and ileo-ileostomy. Strict follow up is recommended for the patients who are at risk of developing cancer to be managed appropriately.

In medicine, especially in pediatrics, it is necessary to perform regular epidemiologic studies in different geographic regions. This study was performed in Nemazee Hospital, Shiraz, southern Iran to determine the gastrointestinal (GI) disease spectrum, the mortality and also the rate of matching final diagnosis with the initial impression in pediatric GI ward. Of all the children older than 1 month (2731) who were admitted in Nemazee Hospital during one year, 653 patients were suffering from GI diseases. A questionnaire was used on admission and patients were followed till discharge or death. 56.8% of patients were male (M:F ratio=1.31). Patients with GI diseases (except 355 diarrhea cases) were 298 (59.9% male) with an age range of 31 days to 22 years (mean=5.67; SD=5.05 years). Sixty seven percent of patients admitted to GI ward were from Fars Province, southern Iran. The most common GI diseases were hepatitis (9.14%), gastroesophageal reflux (7.66%), intestinal polyp (6.68%), cirrhosis (6.38%) and primary peritonitis (5.47%). Definite diagnosis was achieved in 91.2 % and in 46.7 % of patients it was compatible with the initial impression. While the total mortality rate was 5.3%; this rate was 3% for the patients in GI ward. GI diseases are the common cause of pediatric admissions with low mortality and the final diagnosis is not compatible with the initial one in most cases

Postoperative portal vein thrombosis is a rare complication which occurs most often after hepatobiliary surgery. To date, few cases following laparoscopic cholecystectomy have been reported. In this paper we present a case of portal vein thrombosis diagnosed with abdominal CT scan on the seventh day following laparoscopic cholecystectomy. The patient was administered therapeutic intravenous heparin with resolution of symptoms

45-year-old prisoner violently inserted a 30 cm bottle into his rectum in the prison. He complained of lower abdominal fullness and inability to pass stool. His vital signs were stable and the abdominal examination did not reveal any peritoneal sign. Multiple longitudinal ulcer like anal fissures were also remarkable in different positions of the anal wall extending to the rectum. Attempts were made to take out the bottle using forceps under sedation but it failed. The bottle was finally removed under general anesthesia via low midline laparotomy and a transverse sigmoidotomy which was closed primarily. Postoperative course was unremarkable