Middle East Journal of Digestive Diseases
Volume:4 Issue: 1, Jan 2012

BACKGROUNDGastroesophageal reflux disease is a common, chronic disease worldwide. The weekly prevalence of reflux in developed countries is 10% to 48%. It has previously been reported as 5% in Asian countries, but new reports show a higher level in both Asian and Arab countries. In Iran, reflux has increased over the last two decades. There are few studies concerning the prevalence of reflux in Iran. This study aims to review reports about the prevalence of reflux in Iran, as it may be different in various parts of the country. By evaluation of the existing articles, this study will reach a general conclusion about the reflux prevalence in Iran.METHODSThis was a qualitative, systematic review that estimated the prevalence rate of reflux in Iran. In August 2010, we reviewed all electronic database published studies that concerned the epidemiology of reflux prevalence in Iran by searching PubMed, Scientific Information Database (SID), Iran Medex, and Magiran.RESULTSIn our search, using specified key words and selection criteria, 15 articles fulfilled the inclusion criteria and were included in the study.CONCLUSIONAccording to the results, the data related to the estimated prevalence in Iran have a wide range. The weekly prevalence rate of 21.2% in the Tehran study is the best estimate for reflux in Iran. It seems that reflux is more common in Iran when compared to other Asian countries, and similar to reflux in Western countries. Due to the absence of comprehensive studies in Iran, we recommend that researchers conduct accurate, comprehensive, multi-dimensional studies in order to estimate reflux prevalence and its burden in Iran.

BACKGROUNDNonalcoholic steatohepatitis (NASH) is a common liver disease that can progress to cirrhosis or hepatocellular carcinoma. It is estimated that up to 3% of the Iranian population have this condition. Although the pathogenesis of NASH is incompletely understood, there is significant evidence pointing to the importance of insulin resistance. Metformin is an oral hypoglycemic agent known to improve insulin resistance. This study examines the effectiveness of metformin on biochemical and histological improvement among NASH patients in a randomized double blind controlled trial.METHODSThis study enrolled 33 biopsy-proven NASH patients. Other causes of liver disorders were excluded. Subjects were randomized to receive either metformin, 500 mg twice daily, or an identical-looking placebo. Overweight patients were also instructed to lose weight. Treatment continued for 6 months. Patients were regularly visited and liver enzyme levels recorded. Compliance and any adverse drug effects were recorded.RESULTSIn the metformin group, the mean aspartate aminotransferase (AST) level dropped from 61.2 IU/L to 32.7 IU/L and the mean alanine aminotransferase (ALT) level dropped from 85.1 IU/L to 50.8 IU/L. The mean AST level in the placebo group dropped from 54.3 IU/L to 37.9 IU/L, whereas the mean ALT level dropped from 111.8 IU/L to 55.4 IU/L in the placebo group. The decrease in liver enzymes was significant in both groups, but the magnitude of decrease was not significantly different.CONCLUSIONThe improvement observed in liver enzyme levels is totally attributable to weight loss. Metformin had no significant effect on liver enzyme levels.

BACKGROUNDThe sitting position, rather than squatting, during defecation has been hypothesized to be a risk factor for colorectal cancer (CRC).METHODSWe conducted a case-control study to test this hypothesis. A total of 100 CRC cases from two hospitals in Iran and 100 control subjects, selected from the coronary care unit (CCU) of those same hospitals were selected for this study. We administered a detailed questionnaire to the study subjects asking about history of toilet use and other relevant confounders.RESULTSIn logistic regression analysis, the crude and adjusted ORs (95% CIs) for using sitting toilets in any decade were 1.20 (0.89 - 1.61) and 1.07 (0.72 - 1.59), respectively. Also, the crude and adjusted ORs (95% CIs) for using 10 more years of sitting toilets were as 1.16 (0.92 - 1.47) and 1.02 (0.74 - 1.40), neither of which indicated a statistically significant increase in risk.CONCLUSIONOur study did not support an appreciable role for using sitting toilets as risk factors for CRC.

BACKGROUNDDigestive and liver diseases (LD) are among the most common causes of mortality and morbidity in Iran and throughout the world. We have aimed to report the etiology and outcome of gastrointestinal and LD that needed admission in a typical tertiary referral hospital in Tehran during the last decade.METHODSShariati Hospital Gastroenterology and Liver Disease Department (GI & LD) was established in 1974. Information on admitted patients in this department, such as age, gender, clinical, laboratory and imaging results, final diagnosis (according to ICD-10), and hospital outcome have been regularly collected by a special summary form since 1999. For this study, the results were analyzed and compared for two, 5-year time periods, 2000-2004 and 2005-2009.RESULTSThere were 5880 patients (64.60% male) with a mean age of 51.8 years (range: 12 to 90 years) who were admitted. The hospital mortality rate was 6.80%, of which 71.53% were male. The most common cause of hospital admission (39.25%) and mortality (38.55%) was chronic LD. The most common etiologies for admission in both genders were HBV and cryptogenic or non-alcoholic fatty LD(NAFLD) induced cirrhosis of the liver. Other common etiologies were gastrointestinal bleeding, HCV-induced cirrhosis, and CBD stones in male patients; CBD stones, gastrointestinal bleeding and autoimmune hepatitis in female patients. The rate of admission due to HBV-related LD decreased from 21.73% to 11.15%, while admission due to NAFLD-related liver (cryptogenic) disease remained unchanged (11.60% to 10.49%). The rate of admission for pancreatic cancer increased from 1.71% to 4.56%, CBD stones from 6.96% to 10.22%, cholangitis from 3.37% to 6.93%, acute pancreatitis from 2.54% to 4.65%, and Crohn's disease from 1.93% to 2.72%.CONCLUSIONEnd-stage LD secondary to viral, autoimmune and NAFLD constitute the etiology of up to 50% of admissions and mortalities in Shariati Hospital for both genders. While the admission rate of HBV-related LD is declining, the rate of NAFLD-related LD remains stable. The rates of admission for pancreatic cancer, CBD stone, cholangitis, acute pancreatitis and crohn disease increased over the decade.

BACKGROUNDGastroesophageal reflux disease (GERD) is a common problem seen in pediatrics and adolescents. The BravoTM pH Monitoring System is a capsule that detects and quantifies the severity of reflux disease. This test is also valuable for evaluation of patients with extra-gastrointestinal manifestations of GERD such as asthma, chronic cough, hoarseness, aspiration pneumonia, and pre/post fundoplication surgery. This study evaluates the safety and reliability of this procedure in children.METHODSFrom January 2002 to December 2010, 219 patients (85 males and 134 females), ages 6-18 years underwent upper endoscopy with biopsies and placement of the BravoTM capsule.RESULTSIn 201 out of 219 patients, the BravoTM pH monitoring procedure completed within 48 hours without any complaints. In 3 out of 219 patients, the pH dropped to less than 2 after 30 minutes. This indicated that the capsule moved from the esophagus to the stomach. One other patient deleted all data while playing with the recorder at home. In another patient, there was recorder malfunction. Three patients presented with chest pain, one with chest and back pain and nine patients had a mild sensation of sub-sternal pain for two hours or less. None of the patients needed to retrieve the capsule.CONCLUSIONBravoTM capsule pH monitoring of the esophagus is reliable, safe, well tolerated and free from significant complications, and preferred by young adolescents. With the BravoTM capsule, adolescents can attend school and continue their normal physical activities without interruption.

BACKGROUNDInflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn's disease (CD), are debilitating and chronic disorders with unpredictable courses and complicated treatment measures. Therefore, an efficient treatment protocol seems necessary as therapeutic prophylaxis for these disorders.This study aims to determine the healing effect of Teucrium polium(T. polium) in acetic acid-induced UC in an experimental dog model.METHODSFrom September to December 2010, eight male (20-25 kg) crossbred dogs were used for induction of UC by 6% acetic acid, transrectally. After one week, three biopsies (10, 20 and 30 cm proximal to the anal verge) were taken from the colon of each animal for histological studies. In the presence of UC, 400 mg/kg/day of T. polium extract was administered orally and transrectally (via enema) for 30 days in six of the dogs. The remaining two dogs were used as controls and did not receive T. polium. Multiple biopsies were taken 7, 14, and 30 days after discontinuation of T. polium in the same manner as before treatment.RESULTSAfter administration of acetic acid, we noted the presence of multiple ulcers, diffuse inflammation, PMN infiltration in the lamina propria, glandular destruction and goblet cell depletion. Treatment with T. polium restored the colonic architecture with an increased number of healthy cells and a reduction in inflammatory cells. Damage of the surface epithelial cells and mucosal layer of the lumen were reversed,which lead to faster ulcer healing.CONCLUSIONT. polium may be a treatment choice for UC and can broaden the current therapy options for UC.

Chronic hepatitis C might lead to several immunological dysfunctions. Studies have shown a positive association between hepatitis C virus (HCV) infection and psoriasis. These results suggest that the infection may be one of the triggering factors for the development or exacerbation of psoriasis. Here, we present a case of chronic HCV infection with psoriasis who developed exacerbation of skin lesions during therapy with peginterferon alpha-2a plus ribavirin. We discuss the management, course and results of HCV treatment in this patient

In this case report, we present the first diagnosed case of Galloway- Mowat syndrome in Iran. A 7 month old infant boy with microcephaly that had prominently stunted head growth after birth, gastroesophageal reflux, multiple craniofascial characters, hypothyroidism and nephrotic syndrome diagnosed at 5 months of age associated with rapid decline in renal function and heavy proteinuria in 2 months.

A 34-year-old HIV positive-man was admitted to the hospital due to fever and abdominal pain. Constant and generalized abdominal pain started 3 months prior to admission (PTA) in upper quadrants of abdomen followed by mild odynophagia, early satiety and more than 20 kg weight loss since then. Intermittent fever begun 7 days PTA and cough, sputum and dyspnea started since 5 days PTA. His general condition deteriorated and became drowsy 2-3 days PTA, so was referred to our center by patient's accompanies. Patient was a known case of intravenous heroin and a recent case of crack user. He smoked cigarette more than 2 packs a day and drinks alcohol occasionally. On admission day he looked toxic and lethargic. BP:95/60 mmHg, PR:128/min, RR:28/min, Temperature:41.5°c and O2 saturation in room air: 92%. Physical Exam (P/E) of skin revealed multiple tattoos and some scars. Head and neck P/E were normal. P/E of heart showed tachycardia without murmur. There were fine crackles in lower zone of left lung associated with generalized wheezing. On abdominal examination, there was abdominal distension with shifting dullness, hepatomegaly (8cm below costal margin) and generalized tenderness without guarding or rebound. There was two plus pitting edema in lower extremities. Peripheral lymphadenopathy was not detected.Patient was admitted to intensive care unit. Abdominal Ultrasound showed liver enlargement with two large heterogeneous mass. Common bile duct and portal vein diameters were normal. Gall bladder was normal and moderate ascites was detected. In transthoracic echocardiography (TTE) ejection fraction was normal and there was no vegetation. In upper GI endoscopy esophageal candidiasis was seen. Colonoscopy was unremarkable, urine analysis was normal, and urine culture and blood culture results were negative.

Over seven decades ago, as the result of endeavors of a group of leading literary and scientific figures the Farhangestan-e-Awwal (First Academy of Iran) was established in May 1935 and its activity continued until 1953. Presented here is a brief historical account of the establishment of the First Academy of Iran as well as a look at the biographical sketches of physicians at the academy.