Middle East Journal of Digestive Diseases
Volume:5 Issue: 3, Jul 2013

Hepatitis A virus (HAV) infection is a self-limiting disease caused by a 27-nm RNA virus from the picorna virus family. Its'' transmission is primarily via the fecal-oral route. The disease is usually mild and anicteric in children, however the rate of the icteric form, severity, and mortality increase in adult life. The estimated case-fatality rate in age over 40 years is approximately 2%, while this rate is less than 0.1% in the pediatric age group. Improvements in sanitation and hygiene will decrease the rate of infection and subsequent acquired immunity in the pediatric population which will increase the susceptibility to infection. Therefore the burden of disease will be increased in young age and adulthood.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, both in adults and in children. NAFLD represents a spectrum of liver diseases that range from hepatic steatosis to steatohepatitis and cirrhosis. However, NAFLD is more prevalent in overweight and obese individuals. Evidence thus far suggests that hepatic triglyceride accumula­tion is not always derived from obesity; gut microbiota can also play a role in the development of insulin resistance, hepatic steatosis, necroinflammation and fibrosis. On the other hand, probiotics can strengthen the intestinal wall, reducing its permeability, bacterial translocation, and endotoxemia according to animal and human studies. They can also reduce oxidative and inflamma­tory liver damage, while improving the histological state in certain situations. This review article focuses on research that has been conducted on probiotics and NAFLD, highlighting their efficacy as a novel therapeutic option for the treatment of this condition.

Hepatitis A is often asymptomatic in children, however it can become a serious disease in adults. For countries that do not have a universal vaccination strategy targeted vaccination for high risk groups is recommended. Health workers could be at a higher risk of infection with hepatitis A virus (HAV) compared to the general population. The aim of this study is to investigate the seroprevalence of hepatitis A among enrolled students in Tehran University of Medical Sciences in 2011. This study included all students enrolled in Tehran University of Medical Sciences during 2011. We checked serum samples for anti-HAV antibody and participants completed a simple questionnaire. From 1864 health sciences students enrolled in Tehran University of Medical Sciences, 1813 samples were analyzed for anti-HAV IgG antibody. The results showed that 970 (53.5%) were seronegative, 722 (39.8%) were seropositive, and 121 (6.7%) were equivocal. There were significantly higher seropositive results for males (54%) compared to females (37%; RR = 1.46; 95% CI: 1.31-1.62).The seroprevalence of HAV among enrolled medical science students is considerably lower than previous reports from Iran. Targeted vaccination for health sciences students prior to exposure should be seriously considered.

Disturbances in lipid metabolism which occur during hypothyroidism lead to the formation of gallstones. This study aims to evaluate the thyroid function pattern in patients with common bile duct (CBD) stones. This case-control study recruited 151 patients with preliminary diagnoses of CBD stone who underwent ERCP (cases). The control group comprised healthy people who met the study criteria in the same hospital. The control group underwent ultrasonography to exclude any asymptomatic bile duct lithiasis. A questionnaire that included demographic and anthropometrics data were completed by an assigned physician. Morning blood samples that followed 12 hours of fasting were taken from all participants for measurements of serum total thyroxin (T4), serum thyroid stimulating hormone (TSH), fasting blood sugar (FBS), triglycerides (TG), total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL). The mean TSH in patients (2.59 ± 4.86mg/dl) was higher than the control group (2.53± 4.13 9mg/dl). In subclinical hypothyroidism, serum TSH levels higher than 5 MU/L were found in 30.6% of cases compared with 22.5% of controls [OR: 1.53; 95 % confidence interval (95% CI): 0.968-2.438). Hypothyroidism was detected in 10.8% of the control group and in 11.3% of cases (OR: 1.87; 95% CI: 0.578-2.043). The mean total cholesterol levels in cases was higher than the control group (p=0.61).The levels of TG (p=0.05), HDL (73.35 vs. 46.41; p‹0.01) and LDL (64.81.88 vs. 111.04; p‹0.01) was statistically significant between both groups. There is an association between thyroid disorders and the presence of bile duct stones. Thyroid testing in patients with gallstone and bile duct stones is recommended because hypothyroidism may be a predisposing factor for stone passage from the gallbladder.

Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow obstruction (HVOO). BCS is an uncommon, life-threatening liver disorder. This study describes the clinical and etiological characteristics in addition to the long-term outcome of BCS in a single referral center in Tehran, Iran. We reviewed long-term outcome of patients who were diagnosed with BCS between 1989 and 2012 at Shariati Hospital, a tertiary hospital affiliated with Tehran University of Medical Sciences, Tehran, Iran. The diagnosis was confirmed by at least two imaging techniques. A comprehensive analysis of the clinical and paraclinical manifestations, etiology and long-term outcome of the disease was conducted. During the 22-year study period we identified 71 BCS patients, 28 (39%) males and 43 (60.1%) females, who ranged in age from 17 to 64 years (median: 29 years). We excluded 16 patients because of incomplete information or follow up. The remaining 55 cases were the subjects of this study. Underlying etiologies consisted of congenital thrombophilia factors in 50% (28 cases) which was defined as protein C deficiency (12 cases), protein S deficiency (3 cases), antithrombin deficiency (3 cases) and factor V Leiden mutation (10 cases). Etiology was unknown in 18% (10 cases). Acquired causes of thrombophilia were observed in 25% (14 cases) that consisted of 9 cases of myeloproliferative disease and 5 cases of autoimmune diseases. In 3 cases pregnancy was the only etiology. The main clinical presentations were abdominal pain in 33 (60%), abdominal distention in 21 (38.2%), and jaundice in 10 (18%) cases. The main clinical signs were ascites (76.4%), splenomegaly (34%), hepatomegaly (25.5%) and deep vein thrombosis (1.8%). All 55 patients were treated with anticoagulants (heparin followed by warfarin) and supportive care. Two cases underwent mesocaval shunting, 2 patients required transjugular portosystemic shunting (TIPS) and 5 were referred for liver transplantation. A total of 17 (30%) patients died during 22 years of follow up. BCS, although uncommon in Iran, is a challenging liver disease with an important burden. Medical therapy that includes anticoagulation seems to be effective in most cases although the prognosis is guarded. In long-term follow up, 40% of cases will need liver transplant or die from end stage liver disease.

Obesity is currently emerging as a global epidemic, affecting 10% of adult population worldwide. The primary objective of the current systematic review is to describe the trend of overall prevalence of obesity in Iranian women and menthrough a meta-analysis. We searched the medical literature published from 1990 to 2007 in Medline (PubMed), EMBASE database, and the Iranian digital library. All published reports of research projects, papers in relevant congresses, unpublished crude data analysis, proceedings, books and dissertations were reviewed. Data from eligible papers that fulfilled the qualification criteria entered meta-analysis (Random Model). Data from 209,166 individuals were analyzed. The overall prevalence of obesity in adults was 18.5% (95%CI: 15.1-21.8), respectively. The prevalence of obesity in men and women was 12.9% (95%CI: 10.9-14.9) and 26.2% (95%CI: 21.3-30.5), respectively. The trend of obesity was similar in both genders; women had almost a constantly higher risk of obesity than men during the recent two decades. In overall the risk of obesity was greater in women. The reported prevalence of obesity was less than the developed countries. Although, the trend has not been ascending in recent years, we may expect to observe a rapid rise in obesity prevalence in near future due to aging.

To investigate any possible relationship between serum leptin level and H. pylori infection in dyspeptic Iranian adults. A total of 153 dyspeptic patients referring to Firoozgar hospital for esophagogastroduodenoscopy were enrolled in the study. Serum leptin level was measured before endoscopy, after overnight fasting. Two biopsy specimens were taken from antrum for each patient during endoscopy: one to detect H. pylori infection by Rapid Urease Test (RUT) and the other evaluated by an expert pathologist, blind to the RUT results and patients. Serum leptin level was compared between H. pylori-positive negative groups. A total of 153 dyspeptic patients with the mean age of 43.2 ± 14.3 years were evaluated. The overall prevalence of H. pylori infection was 49.6%. H. pylori infection was significantly associated with serum leptin level (p ‹ 0.001). In addition, we found a significant relationship between serum leptin level and gender (p ‹ 0.02). Furthermore, serum leptin level was correlated with age (r=0.17, p =0.0031). However, the H. pylori -positive group was older in comparison to the H. pylori negative group (45.65 ± 13.9 vs. 40.7 ± 14.13, p=0.035). The two groups were not significantly different in terms of gender, height, weight or BMI. H.pylori infection may influence leptin production. Advanced age might expose the individual to H.pylori infection and consequently influence the leptin level.

Primary colorectal lymphoma (PCL) is a rare condition that accounts for asmall percentage of all gastrointestinal (GI) malignancies. There are several reports in the literature regarding the most common features of PCL. However, primary lymphoma in the rectosigmoid junction has been rarely reported. Our case was a 67-year-old male who presented with non-specific symptoms of bowel obstruction which, upon further workup, was diagnosed as a rare case of PCL located in the rectosigmoid junction.

Primary hepatic lymphoma is a rare malignancy usually presenting with symptoms of fever, hepatomegaly, jaundice and weight loss. This picture mimics infectious and inflammatory disorders and thus delays the diagnosis. Here, we present a 47-year old man with prolonged fever who underwent several investigations and, in the meantime, developed fulminant hepatic failure before the diagnosis could be reached.