MIDDLE EAST JOURNAL OF DIGESTIVE DISEASES (MEJDD)
Year:2016 | Volume:8 | Issue:3|Papers Count:10

Liver fibrosis is a potentially reversible response to hepatic insults, triggered by different chronic diseases most importantly viral hepatitis, alcoholic, and nonalcoholic fatty liver disease. In the course of the chronic liver disease, hepatic fibrogenesis may develop, which is attributed to various types of cells, molecules, and pathways. Activated hepatic stellate cell (HSC), the primary source of extracellular matrix (ECM), is fundamental in pathophysiology of fibrogenesis, and thus is the most attractable target for reversing liver fibrosis. Although, liver biopsy has long been considered as the gold standard for diagnosis and staging of hepatic fibrosis, assessing progression and regression by biopsy is hampered by its limitations. We provide recent views on noninvasive approaches including serum biomarkers and radiologic techniques.

29th of May has been convened as the World Digestive Health Day (WDHD) by the World Gastroenterology Organization (WGO) since 2005. This event is an opportunity to raise public awareness on topics related to gastrointestinal tract diseases and health. The theme of 2016 is “diet and the gut”.The traditional approach to diet in gastroenterology practice is to advise patients to avoid certain foods to control their symptoms and /or diseases.The classic example of causative role of food in a disease is celiac disease for which the main management is gluten free diet (GFD).1 In patients with lactase or fructase deficiency, ingestion of lactose or fructose would lead to flatulence. Many such patients have learned to avoid certain foods. Food allergy is yet another example of food as a cause of disease. Examples include milk and wheat allergy. The latter should not be confused with celiac disease because of different pathogenesis and clinical presentations.

BACKGROUND Standard anti-Helicobacter pylori (H. pylori) treatment fails in the eradication of the organism in almost 10-35% of the patients and has different side effects. Recent studies have proposed that probiotic supplementations with or without prebiotic may improve the eradication rate and diminish the side effects, although it is still a controversial issue. We aimed to investigate the effect of probiotic with prebiotic supplementation on the eradication rate and side effects of antiH. pylori quadruple therapy.METHODS 76 patients with a positive biopsy specimen forH. pylori were enrolled.They were randomized to receive quadruple therapy of bismuth, clarithromycin, amoxicillin, and omeprazole for 14 days and also the synbiotic or the placebo.We asked them to answer study questionnaires at the beginning and during the treatment. Finally, urea breath test was done 8 weeks after the treatment.RESULTS The eradication rate was significantly better in the synbiotic group by intention-to-treat analysis (p<0.05). Treatment side effects such as diarrhea, nausea, vomiting, epigastric pain, flatulence, constipation, and taste abnormality were similar in both groups but anorexia was significantly better in the synbiotic group (p<0.05).CONCLUSION The eradication rate was significantly better in the synbiotic group by intention-to-treat analysis (p<0.05). Treatment side effects such as diarrhea, nausea, vomiting, epigastric pain, flatulence, ut could improve the eradication by augmenting the treatment tolerance and compliance.

BACKGROUND Hepatitis E virus (HEV) is one of common causes of viral hepatitis worldwide with higher prevalence in tropical and subtropical regions. Although epidemics of HEV have been reported from Iran, there are variable reports of this infection out of epidemics from different parts of Iran. This study aimed to determine the seroprevalence of HEV in Iran.METHODS In this systematic review and meta-analysis we searched PubMed, Scopus, Science direct, Google Scholar, Scientific Information Databank (SID), IranMedex, and Magiran for all relevant studies published in either English or Persian languages, up to 2015. Pooled seroprevalence estimates with a DerSimonian-Laird random-effects model were calculated. Statistical heterogeneity among the included studies was evaluated by Cochrane Q statistic and I2.RESULTS 38 studies fulfilled the inclusion criteria compromising 18461 participants. The pooled seroprevalence rate of HEV in Iran was estimated about 10% (95% CI=0.09- 0.12) with maximum and minimum of 46% (95 % CI=0.42-0.50), and 0.01% (95 % CI=0.000-0.002), respectively.CONCLUSION HEV is common in Iran although the prevalence is lower than some neighbor countries.

BACKGROUND: Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial.AIM: To determine the association between reflux disease and gastritis pattern in patients withHelicobacter pylori (H. pylori) infection.METHODS: 470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas.RESULTS: H. pyloriinfection rate was 367 (78.1%) with mean age of 59.8 ± 11.4 years. Of them 131 patients (35.7%) were male. Reflux disease was detected in 273 (74.4%) patients.216 (58.9%) and 102 (27.8%) patients had non-erosive reflux disease (NERD) and gastroesophageal reflux disease (GERD), respectively. Corpus predominant and antral predominant gastritis were seen in 72 (19.6%) and 129 (35.2%) patients, respectively. Antral gastritis was significantly associated with GERD (p<0.01). In regression analysis, antral predominant gastritis had a significant association with GERD (OR=1.92, 95%CI: 1.22-3.12). The same result was observed in mild to moderate antral and greater curvature gastritis (OR=1.26, 95%CI: 0.25-6.40 and OR=3.0, 95%CI: 0.63-14.17, respectively).CONCLUSION: According to these finding, we could suggest that the pattern of gastritis could be associated with reflux disease and GERD.

INTRODUCTION: Due to limitation of colonoscopy in assessing the entire bowel and patients’ intolerance in inflammatory bowel disease (IBD), in the current study, we aimed to prospectively compare the accuracy of 99mTc (V) -dimercaptosuccinic acid (DMSA) and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations.METHODS Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent 99mTc (V) -DMSA scintigraphy and colonoscopy. The accuracy of 99mTc (V) -DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated.RESULTS A total of 22 patients with ulcerative colitis (UC) and 8 patients with Crohn’s disease (CD) were evaluated in our study. Sensitivity, positive likelihood ratio (PLR), and positive predictive value (PPV) of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively.Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio (NLR)=0.41, PPV=84.21%, and negative predictive value (NPV)= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively.CONCLUSION The 99mTc (V) -DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC.

BACKGROUND: Helicobacter pylori (H. pylori)is one of the most common bacterial infections worldwide. We designed a study to compare the efficacy of 14-day hybrid regimen with 10-day concomitant therapy forH. pylori eradication in Iran.METHODS 252 patients with naïveH. pylori infection were randomly divided to receive either hybrid regimen (pantoprazole 40 mg, and amoxicillin 1 gr twice daily for 14 days, accompanied by clarithromycin 500 mg, and metronidazole 500 mg, twice daily just during the last 7 days) or concomitant regimen (pantoprazole 40 mg, amoxicillin 1 gr, clarithromycin 500 mg, and metronidazole 500 mg, all twice daily for 10 days).8 weeks after therapy, 14C- urease breath test was performed to confirm eradication.RESULTS: According to intention to treat analysis, the eradication rates were 87.3% (95% CI: 81.4–93.1) and 80.9% (95% CI: 74-87.8) in hybrid and concomitant groups, respectively (p=0.38). Per-protocol eradication rates were 89.3% (95% CI: 83.8-94.7) and 83.1% (95% CI: 76.3-89.8), respectively (p=0.19). The rates of severe side effects were not statistically different between the two groups (4% vs.8.7%).CONCLUSION: 14-day hybrid therapy can be considered as a nearly acceptable regimen with few severe side effects in Iran. However, it seems that the efficacy of this therapy is decreasing as the resistance rates to antibiotics are increasing. We suggest further studies to assess the efficacy of a more prolonged concomitant therapy forH. pylori eradication in Iran.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are potentially malignant tumors, however their behavior and response to treatment is dependent on the type of mutation and immunohistochemical expression of antigens. It is recommended to perform routine molecular and immunohistochemical tests in KIT and platelet derived growth factor receptor alpha (PDGFRA) molecules for making decision regarding targeted therapy and prediction of the behavior of the tumor.Objectives: There has been no study from Iran regarding the PDGFRA mutational analysis in GISTs. In this study, for the first time from Iran, we performed immunohistochemical and molecular analysis of PDGFRA: molecule on GISTs.METHODS: In a cross-sectional study during 7 years (2008-2014) on 50 untreated non-recurrent non-metastatic newly diagnosed GISTs, molecular analysis and immunohistochemical staining for PDGFRA were performed and findings were compared with different clinicopathological characteristics.RESULTS: During the 7 years, 50 cases of GISTs according to the above mentioned criteria were found.17 cases were negative for KIT mutation. Of them, 15 (30%) were positive for either exon 12 or 18 mutation of PDGFRA. These cases showed more epithelioid morphology and the number of mitotic figures were lower than PDFRA negative GISTs. Also according to the criteria for risk assessment, it seems that PDGFRA mutant GISTs are rarely in the high risk category.CONCLUSION: PDGFRA mutant GISTs are common in Iranian population and it is recommended to perform mutation analysis for PDGFRA in every GIST with wild type KIT and epithelioid morphology.

Pancreatic stent proximal migration is a well known complication of pancreatic duct stenting, which occurs in about 5-6% of cases. Serious complications should be avoided by retrieval of the stent via different endoscopic techniques. We report a new technique previously reported only once (in a pancreatic duct with underlying pathology), to remove the proximally migrated pancreatic stent in a normal pancreatic duct by SpyGlass Direct Visualization System (Boston Scientific, Natick, Massachusetts, USA) and SpyBite Forceps (Boston Scientific, Natick, Massachusetts, USA).

Wegener’s granulomatosis is an uncommon inflammatory disease that manifests as vasculitis, granulomatosis, and necrosis. It usually involves the upper and lower respiratory tracts and kidneys. Although it may essentially involve any organ, gastrointestinal (GI) involvement is notably uncommon.A 20-year-old male patient presented with epigastric pain, vomiting, hematemesis, and melena. On physical examination, he was pale. There was no abdominal tenderness or organomegaly. Upper GI endoscopy revealed dark blue-colored infiltrative lesions in prepyloric area. Evaluation of the biopsy sample showed mononuclear cell infiltration in the submucosal area, hyperplastic polyp, and chronic gastritis. High dose proton pump inhibitor and adjunctive supportive measures were given but no change in the follow-up endoscopy was detected. During hospital course, he developed intermittent fever and serum creatinine elevation.12 days after admission, he developed dyspnea, tachypnea, and painful swelling of metacarpophalangeal joints, and maculopapular rash in extensor surface of the right forearm. Chest radiography showed pulmonary infiltration. Serum c-ANCA titer was strongly positive and skin biopsy revealed leukocytoclastic vasculitis. The patient received methylprednisolone pulse, which resulted in complete recovery of symptoms and gastric lesion.The present case indicates that GI bleeding may be the first manifestation of Wegener’s granulomatosis. Moreover, it should be emphasized that gastric biopsy is not characteristic or diagnostic in such patients.