Gastroenterology and Hepatology From Bed to Bench
Year:2015 | Volume:8 | Issue:1|Papers Count:24

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Cancer research is an attractive field in molecular biology and medicine. By applying large-scale tools such as advanced genomics and proteomics, cancer diagnosis and treatment have been improved greatly. Cancers of esophagus, gastric, and colon accounted for major health problem globally. Biomarker panel could bring out the accuracy for cancer evaluation tests as it can suggest a group of candidate molecules specified to particular malignancy in a way that distinguishing malignant tumors from benign, differentiating from other diseases, and identifying each stages with high specificity and sensitivity. In this review, a systematic search of unique protein markers reported by several proteomic literatures are classified in their specific cancer type group as novel panels for feasible accurate malignancy diagnosis and treatment. About thousands of introduced proteins were studied; however, a small number of them belonged to a specific kind of malignancy. In conclusion, despite the fact that combinatorial biomarkers appear to be hopeful, more evaluation of them is crucial to achieve the suitable biomarker panel for clinical application. This effort needs more investigations and researches for finding a specific and sensitive panel.

The cancers in the digestive system including gastric cancer, colorectal cancer, liver cancer, esophageal cancer and pancreatic cancer are one of the most common cancers in Asia. The burden of GI cancer is increasing in Asia because of aging, growth of the population and the risk factors including smoking, obesity, changing lifestyle and high prevalence of H pylori, HBV and HCV. In most Asian countries, cancer control programs or early detection and treatment services are limited despite this increase. There are many people in the developing countries inside Asia who have no health insurance and many of them are too poor to go for screening tests, early detection or medical treatments. Therefore, it is important for the health organizations and governments in each country to recognize these groups and reduce the incidence and mortality of gastrointestinal cancers, using simple and economic screening test, vaccination and changing risk factors such as smoking, diet and lifestyle by education programs.

Aim: The purpose of this paper is to explore themes for enhancing socially accountability in medical education.Background: Medical education in Iran experience new challenges due to the enormous influence of changes in technology, development of new methods of teaching and learning, student requirements, patient management, financial credit constraints, and social and economic developments. For responding to these, use of strategic thinking in order to make appropriate decisions is the only solution. Strategic plans need to formulate practical guides which can help accountable to people's reasonable expectations.Patients and methods: For this qualitative study, along with the 14th national conference on Medical Education in Iran, the opinions of experts were obtained during seven expert panels’ group discussions, each lasting four hours and including 10 participants. Data were collected by audiotapes, which were then transcribed. Data analyzed using a thematic content analysis approach. Peer and member checking during analysis and data triangulation from other recent studies were used to increase the findings’ trustworthiness.Results: Among more than hundred meaning units groups identified the following eight main themes as affecting the social accountable medical education in Iran: organization of responsive education councils; development of community based courses; development in field training; organization of educational processes; homogeneity in educational rules and regulations; budget management, educational outcomes; educational programs in departments and groups.Conclusion: This study have found the main themes that might affecting social accountable medical education in Iran, where Iranian policymakers should consider those when plan to make changes in medical education and could potentially adopt the proven useful policies and strategies of other countries.

Background: The most frequent form of inflammatory bowel disease (IBD) in dogs is represented histologically, by lymphoplasmacytic enteritis (LPE), a histological category, often associated with other morphologic alterations including lymphangiectasia (LE). However, literature data on this latter topic are quite scarce and have mostly been obtained in single reports or in small series.Aim: We evaluated some morphologic parameters of intestinal villi and lacteals in a large cohort of dogs, and correlated them with serum albumin and cholesterol values.Patients and methods: We investigated 136 dogs (94 with LPE, and 42 with gastrointestinal problems different from IBD) and analyzed their clinical, laboratory (albumin and cholesterol values), endoscopic, and histologic variables.Results: The LPE group showed significantly impaired clinical, laboratory, endoscopic, and histologic variables compared to controls. Affected dogs showed significant correlations between canine inflammatory bowel disease activity index (CIBDAI) scores and endoscopic and histologic variables. Moreover, the grade of hematologic changes were strongly related to the intestinal histologic variables, in particular those concerning villous and lacteals morphology.Conclusion: Dogs with LPE had intestinal histologic abnormalities (height, width, height/width ratio, calculated for both villi and lacteals), whose degree correlated with the severity of hypoalbuminemia and hypocholesterolemia. Evaluation of endoscopic and histologic variables in association to the clinical findings may reveal useful insights for the pathogenesis of LPE and, hopefully, might lead to more targeted therapeutic approaches.

Aim: The aim of this study is to find-out the possible etiologies in Iranian infants less than three months in Shiraz, South of Iran.Background: Cholestatic jaundice most probably occurs due to a pathological condition and the most frequent causes in early infancy are neonatal hepatitis and biliary atresia. Early diagnosis and treatment of infantile cholestasis can improve prognosis of liver diseases by prevention of the complications of these disorders.Patients and methods: In this retrospective study, 122 infants under 3 months of age with cholestasis were studied in Nemazee Hospital (affiliated to Shiraz University of Medical Sciences) during the years 2001-2011. Demographic data, duration of jaundice, liver biopsy and the causes of cholestasis were recorded.Results: There were 76 males (62.3%) and 46 females (37.7%) with a mean age of 54.4±23.7 days. The most common clinical finding was jaundice that was seen in all patients (100%).The onset of jaundice was the first day to the fifty two days of age, with an average age of 15.6±16.1 days. Other findings included hepatomegaly in 92 patients (76.4%), clay-color stool in 54 (44.3%), and splenomegaly in 29 patients (23.8%). In this study, the most common causes of cholestasis were biliary atresia (30=24.6%), idiopathic neonatal hepatitis (30= 24.6%) and bile ducts paucity (16=10.3).Conclusion: The results of this study showed that biliary atresia and neonatal hepatitis are the most common causes of infantile cholestasis in this area. It is recommended that biliary atresia should be discriminated from other forms of neonatal cholestasis.

Aim: The aim of the study was to assess the effectiveness of vitamin D3 [1, 25(OH)2D3] treatment in IBD with regard to tumor necrosis factor-alpha (TNF-a) serum level and clinical disease activity index (CDAI).Background: Vitamin D has immune-regulatory functions in experimental inflammatory bowel disease (IBD) and vitamin D deficiency is common in IBD patients.Patients and methods: This was a randomized clinical trial on 108 IBD patients with serum 25-OHD levels less than 30ng/ml, which divided into vitamin D and control groups. Vitamin D group received 50000 IU vitamin D3 for 12 weeks. Before and after the study, TNF-a and 25-OHD serum levels were measured by ELISA method. Data were analyzed using paired t-test, chi-square test and Spearman correlation coefficient. P-values less than 0.05 were considered statistically significant.Results: Before the intervention no significant difference was found between baseline characteristics and TNF-a serum level of two groups. After intervention TNF-a serum level reduced but this reduction was not statistically significant (p=0.07, 95% CI: -0.45 to 8.14). The mean serum 25-OHD level of vitamin D increased from 15.54 to 67.89, which was statistically significant (p= 0.00, 95% CI: -61.40 to -43.30). TNF-a level was also associated significantly with CDAI before (Spearman’s rho: 0.3, p<0.0001) and after (Spearman’s rho: 0.27, P=0.01) intervention.Conclusion: Oral supplementation vitamin D3 significantly increased serum vitamin D levels and insignificantly reduced serum TNF-a level. More studies with larger samples would be beneficial to assess vitamin D3 supplementation efficient effect in IBD.

Aim: We evaluated the effectiveness of a synbiotic in the treatment of childhood functional abdominal pain (FAP).Background: Probiotics are effective in the treatment of functional gastrointestinal disorders in adult patients, but there is lack of information in children.Patients and methods: Children with FAP, based on the Rome III criteria (n=115, aged 6-18 years), were randomized to receive either synbiotic (Bacillus coagulans, Unique IS-2, 150 million spore plus FOS, 100 mg) twice daily or placebo for four weeks. Treatment response was defined as³2-point reduction in the 6-point self-rated pain scale or “no pain”. Physician-rated global severity and improvement were also evaluated. Patients were followed for a total of 12 weeks.Results: Eighty-eight patients completed the trial (45 with synbiotic). Response rate was higher with synbiotic than placebo after medication (60% vs. 39.5%, P=0.044), but was not different between the two groups at week 12 (64.4% vs. 53.4%, P=0.204). Difference between the two groups regarding the physician-rated global severity over the study period was not statistically significant (z=-1.87, P=0.062). There was no significant difference between the two groups in physician-rated global improvement (week 4, P=0.437; week 12, P=0.111). Receiving synbiotic (OR 2.608, 95% CI: 1.01-6.68) and baseline pain score (OR 2.21, 95% CI: 1.19-4.10) were predictors of treatment response after medication.Conclusion: The synbiotic containing Bacillus coagulans and FOS seems to be effective in the treatment of childhood FAP. Further trials are recommended in this regard.

The spectrum of gluten related disorder might be much broader than currently believed. It is unknown why non-coeliac gluten sensitivity affects individuals at different ages. It is quite possible that triggering factors like infection might play an essential role in manifestation of this disorder. Similar to secondary lactose intolerance, gluten intolerance might be a common occurrence behind persistent symptoms after gastroenteritis. Presenting symptoms may depend on etiological factors and the affected portion of gastrointestinal (GI) anatomy. Therefore symptoms might be related to the upper GI tract like functional dyspepsia, or the lower GI tract like diarrhoea and constipation or a combination of both as in our patients. This case highlights that intolerance to gluten may develop in people who experience gastroenteritis and there is potential of at least partial recovery from this condition with elimination of lactose and gluten. Clinical recovery with a concomitant gluten and lactose (mainly milk) free diet over a period of time might be an effective strategy in treating these patients.

Elemental diet (ED) has been used widely in the treatment of gastrointestinal disorders, especially with the management of Crohn's disease. This modality of diets provides all essential nutrients, and contains protein in the form of free amino acids that are theoretically easily absorbed. High output ileostomies are a rare but important complications of stoma formation following bowel surgery. Treatments could be challenging and include anti-diarrhoeals, octreotide and proton pump inhibitors. There is very little research regarding the use of elemental diets in the treatment of patients with post-operative high ileostomy outputs. Adequate management of high output ileostomies might prevent significant morbidity. In this case report, we describe a patient who underwent a subtotal colectomy for ulcerative colitis complicated by refractory high ileostomy output despite maximal standard medical therapy for years. The ileostomy output was dramatically reduced following the introduction of an elemental diet. This case suggests a possible role for the introduction of an elemental diet in the management of high output ileostomies. Besides presenting this case with high output ileostomy, we reviewed the role of ED in other gastrointestinal disorders.

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