Govaresh
Volume:17 Issue: 3, 2012

Non-alcoholic steatohepatitis (NASH) is a common liver disease that, in the absence of treatment may progress to cirrhosis. There is a strong association of NASH with insulin resistance; thus insulin sensitizer drugs have been used for this disease. The aim of this study was to compare the effect of pioglitazone with metformin on liver transaminases, the HOMA Index, and adiponectin in patients with NASH. Mterials and This double-blind clinical trial was performed on 80 patients diagnosed with NASH according to imaging and abnormal liver function tests. Patients were divided into two groups (n=40) based on block randomization. In one group patients received metformin (500 mg, bid) and the other group received pioglitazone (30 mg, qd) for 4 months. AST, ALT, alkaline phosphatase, FBS, and lipid profiles were evaluated before the study and at two and four months after. HOMA Index and adiponectin levels were evaluated before the study and at four months later. Data analysis was carried out with SPSS using repeat measurement and ANCOVA tests. p‹0.05 was considered significant. We included a total of 40 patients (37 males) in the pioglitazone group and 40 patients (31 males) in the metformin group in this study. There was no significant difference in both groupsin terms of age, sex, and weight. ALT and alkaline phosphatase levels decreased significantly in the pioglitazone group compared with the metformin group. There was no significant difference in both groups in AST, FBS, TG, LDL, HDL, and HOMA Index levels. After treatment, the adiponectin level in the metformin group was less than the pioglitazone group. The results showed that pioglitazone was more effective than metformin and led to a greater reduction in the level of liver transaminases. Pioglitazone and metformin had the same effect on FBS and HOMA Index. Both drugs reduced adiponectin levels, but this effect in pioglitazone group was less than the metformin group.

Infections attributed to Helicobacter pylori (H. pylori) involve almost half of the world''s population. One of the effects is auto-antibody induction and cross-reaction with numerous proteins in the body. As a result of its widespread prevalence and importance, this study evaluates the associations between H. pylori and thyroid auto-antibodies. This study enrolled 100 patients who were candidates for gastroesophageal endoscopies that referred to the Yazd Gastrointestinal Clinic. Patients underwent the following laboratory analyses: urease test, anti-H. pylori (IgG), TSH, T4, T3 and thyroid auto-antibodies (anti-thyroglobulin, anti-thyroid peroxides). Patients were divided into two groups of H. pylori positive and negative according to the results of the anti-H. pylori IgG and urease tests.. The level of thyroid auto-antibodies and thyroid function were compared between groups. Data were analyzed with chi-square and t-tests. SPSS software version 17 was used for data analysis. Overall, 61% of patients were H. pylori positive. The mean anti-Thyroid peroxidase level in the H. pylori positive group was significantly more than the negative group (p‹0.01). In addition, 19.7% of H. pylori positive patients and 5.1% of H. pylori negative patients had positive anti-TPO levels, which the difference between both groups was significant (p‹0.04). There was no significant difference in thyroid function between the two groups. Although no significant difference in thyroid function was seen in the two groups more patients tested positive for anti- TPO levels in the H. pylori positive group, which was suggestive of thyroid auto-antibody induction by H. pylori

Functional dyspepsia and digestive disorders are common, debilitating and costly. Little information about the role of stress management in terms of cognitive-behavioral treatment of dyspepsia is available. The purpose of this study is to investigate the effectiveness of cognitive-behavioral stress management on functional dyspepsia symptoms and quality of life in patients who referred to digestive Clinics in Ahvaz, Iran. This was a quasi-experimental study. The clinical approach to the pre-test, post-test and follow-up was performed with the control group. We selected 30 patients diagnosed with functional dyspepsia based on Rome- III diagnostic criteria. Patients were randomly divided into two experimental group and a control group. There were significant differences between the experimental and control groups in terms of functional dyspepsia and quality of life that was obtained both at stages of past treatment and at follow-up (p‹0.001). Stress management using cognitive-behavioral therapy is a reliable model for improving symptoms and quality of life in patients with functional dyspepsia

The patient was a 67-year-old female who presented with severe rectal bleeding since three days prior to hospital admission. She complained of mild abdominal pain. Rectal examination revealed the presence of fresh blood and a clot. She had a normal upper endoscopy. A colonoscopy showed a large clot with bloody secretions up to the cecum, with no obvious origin. Because of the severity of bleeding, a laparotomy was performed. Resection included large areas of the ileum and jejunum which were involved. Pathology report was remarkable for diffuse large B cell lymphoma.

Endoscopic retrograde cholangiopancreatography (ERCP) is a specific technique used to study the pancreatobiliary system that is performed in hepatogastroenterology centers. Recent, common uses for therapeutic ERCP are largely due to advanced imaging techniques such as magnetic resonance cholangiopancreatography and endosonography. In the United States alone, over 500,000 therapeutic ERCP are performed annually. Due to its potential for complications, all practitioners should be well-educated about the indications for ERCP, its contraindications, sedations, patient monitoring during and after ERCP, and the necessary co-operation amongst medical personnel. As a diagnostic and therapeutic procedure, there are potential complications directly related to the severity of the disease and complexity of the procedure. In this paper, we present a review of primary ERCP complications.

Liver cirrhosis is an end-stage condition fornumerous chronic liver diseases. Limited data exists on the epidemiology,natural history and complications of liver cirrhosis in Ahvaz, Iran. In a cross-sectional study we have retrospectively evaluated 165 patients from September 1, 1999 until September 1, 2008. Patients with evidence of cirrhosis of the liver seen on abdominal ultrasound were enrolled. The diagnosis was based on clinical, functional and morphological data.The etiological profile was established by determining viral and autoimmune markers, and by metabolic screening.Patientswho were not confirmed to be cirrhotic were excluded from this study. All cases were studied to determine etiological factors, complications and disease prognosis. Data were recorded on a questionnaire. A total of 165 patients were studied, of which there were 114(67%)males and 51(33%) females. The mean age was 47 years. The majority of patients [70 cases (42.4%)] had evidence of HBV infection. Of HBs Ag-positive patients, 31(43.2%) were HDV Ab positive with a mean age of 41.6 years. There wasno significant difference by sex among cirrhotic patients (p›0.05). Other cases included 23 (14%) patients withautoimmunehepatitis (AIH), 15(9.1%)hadHCV infection, 2(1.2%)had evidence of Wilson''s disease and no etiological factors were recorded in 55 (33.3%) patients. Ascites was present in 32% of cases, splenomegaly in 29%, esophageal varices in 38%, fundal varices in 2%, peptic ulcer in 8%, acute variceal hemorrhage in 8%, various grades of hepatic encephalopathy in 1%, and hepatocellular carcinoma in 6% of patients. When cirrhotic patients were grouped according to Child-Pugh classification,19% were in class A, 30% were in class B, and 51% comprised class C. HBV infection was the major risk factor for cirrhosis in this study and ascites was the most common complication. There were more patients with Child-Pugh class C cirrhosis than thoseinclasses B and A. A multidisciplinary approach for the prevention and control of the increase in HBV infection must be adopted in order to inform the publicaboutthe seriousness of itscomplications and possible modes of transmission.

The amount of literature concerning the implication of the red cell distribution width (RDW) in the assessment of ulcerative colitis (UC) activity is rather limited. The aim of this study is to investigate the potential role of RDW in the evaluation of UC disease activity. A total of 96 patients with UC and 51 age and sex-matched healthy volunteers were included in a cross-sectional study. Clinical disease activity was defined using the numerical Disease Activity Index (DAI). In addition to RDW, serum C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts (PLT) were measured. AThere were 47 (about 49%) patients with that had active UC. The RDW was significantly higher in patients with UC than in controls (p=0.001) and active versus patients in remission (p‹0.001). RDW was significantly correlated with DAI scores, ESR, CRP and PLT in active patients. There was a significant correlation between RDW with DAI scores and CRP levels in patients who were in remission. RDW was elevated in UC patients in comparison with healthy controls and increased markedly in active disease. It was also strongly correlated with clinical disease activity scores and inflammatory parameters such as ESR and CRP. RDW, as a cost-effective tool, may be an additional parameter to assess disease activity in UC.

Hepatopulmonary syndrome (HPS) refers to arterial hypoxemia caused by pulmonary vasodilation, which is a consequence of portal hypertension. HPS is associated with increased morbidity and mortality; thus, it is important to diagnose this entity as soon as possible for treatment to be administered. In a cross-sectional study, 40 children (6 months to 14 years old) with chronic liver disease were enrolled. In all patients, measurements of Oxygen saturation (SaO2) were performed with a pulse oximeter in the supine position (SPO2) and then in the upright position (ΔSPO2). Children were divided into three groups: i) those with both SPO2›96% and ΔSPO2›4%; ii) children with either SPO2›96% or ΔSPO2› 4%; and iii) those with neither of these signs. Then, contrast-enhanced echocardiography (CEE) and arterial blood gas (ABG) were performed. Finally, the prevalence of mild to moderate HPS was calculated in the three groups. There were 30 patients who had neither of the two signs, of which 9 had HPS. Ten patients had one of the two signs, in whom 4 had HPS. None of the patients had both signs. The sensitivity of the pulse oximetry was 30%, specificity was 77%, positive predictive value was 38% and negative predictive value was 70%. There is a significant prevalence of HPS in cirrhotic patients which effects prognosis. Based on our study results, we have determined that pulse oximetry could not be a reliable screening procedure in mild to moderate HPS. It is recommended to use gold standard tests (echocardiography and arterial blood gasometry) for the screening and diagnosis of HPS in children.

We report the case of a 54-year-old Iranian man who presented with melena from three months prior to admission. Esophagogastroduodenoscopy and colonoscopy were normal. Double balloon enteroscopy showed a pedunculated tumor located in the jejunum. He underwent laparotomy and resection of a 9.5 cm tumor from the distal jejunum. Histopathologic evaluation confirmed the diagnosis of an inflammatory fibroid polyp (IFP).