Middle East Journal of Digestive Diseases
Volume:7 Issue: 1, Jan 2015

Successful clearance of hepatitis B virus (HBV) is a promising event in which host''s immune system will attempt to get rid of the virus. The immunological events of HBsAg seroclearance have attracted great attention in both natural history investigations and therapeutic trials. Recent genome-wide association studies (GWAS) has confirmed polymorphisms in the human leukocyte antigen (HLA)-DP locus associated with spontaneous HBV clearance. In this review the impact of host immune response in declining HBsAg during the natural history of the infection has been discussed.

There are hoarding documents for the biological importance of cyclooxygenase-2 (COX-2) in pancreatic carcinogenesis. We aimed to thoroughly investigate the DNA sequence variations of whole COX-2 exons in a large case-control study of pancreatic cancer by direct sequencing.The entire exonic regions of COX-2 including 10 exons were sequenced in the germline DNA of 96 patients with pancreatic cancer. Selected variants within exons six to seven (E6E7) amplicon from the test panel were genotyped in 96 controls.The COX-2 gene was demonstrated to be genetically conserved. Four missense mutations were found in three cases. However the common variant c.724-10_724-7delATTT (rs201231411) that is located in intron 6, showed significant difference between cases and controls (21 [21.9%] vs 11 [%11.5], p=0.05).This study determined that COX-2 has a conservative sequence, which is required for its enzymatic activity and supports the important role of this enzyme’s expression in pancreatic cancer rather than any changes in its activity. The effect of intronic variant rs201231411 on COX-2 expression could be analyzed in future studies.

Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. Many studies have reported that dyspeptic symptoms are associated with ingestion of some foods. Current treatments for functional dyspepsia have generally ignored the potential role of diet. This cross-sectional study was done at the Gastroenterology Department of Shahid Sadoughi Hospital, Yazd, Iran from September 2008 to March 2009. Based on the diagnostic criteria for functional dyspepsia symptoms presented to outpatient gastroenterology clinics, adult patients were invited to participate in this study. Upper GI endoscopy was performed in all the patients so as to rule out any gross pathology. The patients were asked about a list of nutrients including 114 foods which is commonly used in our area. Then, the effects of specific foods were identified on the relief or aggravation of the symptoms with four degrees: low, medium, high, and very high.Of 384 patients, 152 were men and 231 were women with a mean ± SD age of 39.16±14 years (range: 13-80 years). The foods that caused the highest aggravation of symptoms were sausage and bolognas, pickles vinegar, soft drinks, grain, tea, salt, pizza, watermelon, red pepper, and macaroni. However, the most frequent foods that led to the alleviation of symptoms were apples, rice, rock candy, bread, caraway seed, dates, honey, yogurt, quince, and walnut.This study shows that some foods, especially spicy, pickled, and high-fat foods, strongly induced dyspepsia and aggravated the symptoms in dyspeptic patients.

Different clinical and epidemiological studies using dual-energy X-ray absorptiometry have shown an increased prevalence of low bone mineral density in patients with inflammatory bowel diseases.The aim of this study was to assess the correlation between bone density and the disease activity in patients with ulcerative colitis. In this cross-sectional study, 52 patients with ulcerative colitis (duration of the disease less than 5 years) were invited to our research center, Golestan province, northeast of Iran, during February 2012 up to August 2012. A demographic checklist and Simple Clinical Colitis Activity Index was completed for each patients and 5 cc of blood sample was taken after obtaining the informed consent. We used colorimetry method for measuring serum calcium, UV method for serum phosphorus and ELISA for serum vitamin D. Dual-energy X-ray absorptiometry was done to evaluate the bone density.Data analysis was done using SPSS software version 16. Normality of data was assessed using Kolmogorov–Smirnov test. T and ANOVA tests were used if data had normal distribution. Mann-Whitney U or Kruskal-Wallis tests were used for the remaining data. Correlation between qualitative variables was evaluated by Chi-square test.The mean (±SD) age and disease activity of the patients were 37.72 (±12.18) years and 4.78 (±1.98), respectively. There were no correlation between disease activity and mean age. Low bone density was seen in 30.8%, 11.5%, and 15.4% in spine, femur neck, and hip, respectively. There was no relationship between Z-score of total hip, spine, and femur neck with disease activity, age, and duration of disease (p>0.05).Our results showed an acceptable rate of low bone density in patients with ulcerative colitis without any correlation with the disease activity index.

Constipation is one of the most frequent cause of patient visits to pediatric gastroenterology clinics. Early diagnosis and treatment is important. There are few studies about clinical manifestations of constipation in children. We aimed to find the relative frequency of gastrointestinal manifestations of constipation among constipated children. This cross-sectional study was carried out on children aged < 18 years old with chronic functional constipation referred to Imam Reza Clinic of Shiraz University of Medical Sciences. Children with organic causes of chronic constipation were excluded from study. Rome III criteria were used for defining constipation. The duration of study was 1 year starting from September 2010. Abdominal pain, fecal mass, rectal bleeding, anorexia, fecal soiling, retentive posture, withholding behavior, anal fissure, and peri-anal erythema were recorded for each case based on history and physical examination. Data were analyzed using SPSS software, version 13.0 (Chicago, IL, USA).Of 222 children with functional constipation, 124(55.9%) were girls and 98 (44.1%) were boys with a mean ± SD age of 5±3.12 years. The mean ± SD duration of constipation was 2.2±1.9 years. Large and hard stool was present in 93.7% of the patients. Painful defecation and withholding behavior were seen in 92.3% and 91.9% of the patients, respectively. Fecal impaction was more frequent among boys compared with girls (p<0.01). Fecal soiling was present in 40.8% of the boys and 28.2% of the girls (p =0.04).Large and hard stool, painful defecation and withholding behavior were the most frequent signs or symptoms among children with chronic functional constipation. Fresh rectal bleeding and anal fissure were the least frequent signs and symptoms in this group.

Small intestinal bacterial overgrowth (SIBO) may have a role in the pathophysiology of irritable bowel syndrome (IBS). So, the aim of this study was to assess the association between SIBO and IBS by using glucose breath test (GBT) in Kerman city as the first study in Iranian population.107 patients with IBS and 107 healthy individualswere enrolled in our study. All the participants underwent GBT. A peak of H2 values >20 p.p.m above the basal value after glucose ingestion was considered suggestive of SIBO. SPSS software version 17 was used for data analysis.P value < 0.05 was considered as statistically significant.Of the 107 patients with IBS, 40 had positive GBT (37.4%) compared with 14 (12.1%) out of the 107 control participants(p< 0.001). Dominant symptoms in patients with IBS were diarrhea in 36(33.6%), constipation in 12(11.2%), abdominal pain in 22(20.6%), bloating in 28(26.2%), and change in bowel habit in 9(8.4%) patients. There was not statistically significant difference among any of this IBS subgroups and positive GBT (P=0.44).There is a positive association between IBS and SIBO. We suggest a Placebo-controlled bacterial eradication study for identifying the role of SIBO in IBS.

Actinomycosis is a rare and chronic infectious disease caused by a non-spore gram- positive, anaerobic bacterium that rarely infects the colon, in particular the left colon.A 53-year-old woman was referred to us due to chronic abdominal pain, bloating, a few episodes of bloody-mucous rectal discharge, and change of bowel habits. Her medical history and physical examination were unremarkable. Colonoscopy revealed a polypoid mass like lesion located 20 cm proximal to the anal verge above the rectosigmoid junction. Several biopsy samples were taken. Histopathological evaluation showed actinomycosis infection. Consequently the patient was treated with intravenous and then six months oral penicillin. The patient was discharged after ten days.Diagnosis of colonic actinomycosis is not an easy task. It is advisable to keep this infection in mind among the differential diagnoses of unusual abdominal masses. Colonoscopy and histopathological examination can be the preferred modality for diagnosis of colonic actinomycosis infection.

Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Most of such incidents have been reported as case reports. This study reviews a case of postcholecystectomy clip migration. It can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most cases can be managed successfully with ERCP.

We report the case of a three-year-old girl who complained from dysphagia and post-prandial vomiting since she was 6months old. Several diagnostic work-ups were performed for her problem. Upper GI endoscopy was normal but barium swallow revealed an external pressure effect over upper part of the esophagus (figure 1) and the CT angiography of thoracic aorta showed that this external pressure effect was due to a vascular anomaly in the aberrant branching of subclavian artery in the right side directly from aortic arch transmitting from the posterior aspect of the esophagus (figure 2). So the patient underwent elective operation and thorough right posterolateral thoracotomy from 5th intercostal space, right subclavian artery was divided from its origin to aorta and end to side anastomosis was made to proximal part of right carotid artery. Site of previous origin on aorta also was closed. After 5 days the patient was discharged from the hospital with good condition without any complication.