Gastroenterology and Hepatology From Bed to Bench
Year:2016 | Volume:9 | Issue:4|Papers Count:15

Celiac disease (CD) shows an increased prevalence in female, particularly during the fertile period. Celiac disease should be researched in infertility, spontaneous and recurrent abortions, delayed menarche, amenorrhea, early menopause, and children with low birth-weight. Celiac disease is still little considered during the evaluation of infertility. Up to 50% of women with untreated CD refer an experience of miscarriage or an unfavorable outcome of pregnancy. Celiac patients taking a normal diet (with gluten) have a shorter reproductive period. Women with undiagnosed CD had a higher risk of small for gestation age infants very small for gestational age infants and preterm birth when compared with women with noted CD. The link between NCGS and infertility is actually unknown. The goal of our work is to perform an actual review about this topic and to increase the awareness in the medical population to research celiac disease in selected obstetric and gynecological disorders.

Aim: Our aim was to survey the rate and risk factors for Hepatitis C virus interfamilial transmission among families with one index case. Background: The role of intrafamilial transmission in Hepatitis C virus epidemiology is still debated. Patients and methods: A cross-sectional study was conducted on 34 families (236 members) of HCV infected patients from Fars province, spring to summer 2013. All subjects were first evaluated for the risk factors of exposure and then their serum was checked for the presence of HCV antibody and the genome, using ELISA and PCR. The genotype of all PCR positive cases was also determined by a commercial assay. Two independent sample t test and Chi-Square test were used to compare groups together. Results: In 18 out of 34 families, HCV antibody was detected (52. 9%) in new members. Among them, HCV transmission in 11 families (32%) was also confirmed by PCR. Having a history of intravenous drug abuse (P=0. 006) and incarceration (P=0. 01) showed to be important risk factors for interfamilial transmission. Hence, blade/needle sharing (P=0. 016) just following molecular assay and sex (P=036) only in the serologic analysis were also determined as significant risk factors. Furthermore, based on serologic results, medium socioeconomic state was further associated with this manner of transmission (P=0. 019 and P=0. 328). Interestingly, among relatives, 13 cases were brothers while just 5 cases were couples. The genotypes 3a and 1a were more prevalent among the population. Conclusion: In conclusion, our finding highlighted a noticeable role of interfamilial transmission for HCV spread and supports the significant role of close relatives, especially brother relationship in this spread. Hence, the socioeconomic state was associated with the transmission rate of virus in the family.

Aim: This study was performed to evaluate the efficacy, safety and complications of electrotherapy compared with conventional hemorrhoidectomy (Ferguson technique). Background: Ferguson hemorrhoidectomy is always associated with considerable pain and postoperative complications. Still, the electrotherapy method in which the hemorrhoidal tissue is not removed may not improve critical complications. Patients and methods: This randomized clinical trial was performed on patients with hemorrhoids referring to hospitals affiliated to the Kerman University of Medical Sciences during 2014-2015. One hundred and twenty patients presented with symptomatic hemorrhoids grade I, II, III, and IV were randomized into two groups. Group 1 (60 patients) underwent electrotherapy using 30 mA direct current and group 2 (60 patients) were submitted to Ferguson hemorrhoidectomy. The groups were compared regarding postoperative pain severity and complications, including recurrent symptoms, infection and recovery time to return to normal activities. The p≤ 0. 05 was considered statistically significant. Results: More than 70% of patients in group 2 complained of severe pain, but in group 1, no more than 30% of patients experienced severe pain up to 6 hours post-surgery and 70% complained of mild pain 2-3 days post-surgery. Twenty four-hour hospitalization in group 2 and group 1 were 97% and 78%, respectively, whilst patients in electrotherapy group could be treated as outpatients. The mean return time to usual activities was 15 and 1. 5 days for group 2 and 1, respectively. Conclusion: Electrotherapy with a direct current of 30 mA significantly reduce postoperative pain and the recovery period. This method showed a good success rate and less complication than the Ferguson method. As a result, because of more effectiveness, less pain, as well as shorter recovery time and getting back to normal activities, we recommend this procedure for the treatment of symptomatic hemorrhoids grade I, II, and III.

Aim: The aim of this study is to investigate the Protein-Protein Interaction Network of Celiac Disease. Background: Celiac disease (CD) is an autoimmune disease with susceptibility of individuals to gluten of wheat, rye and barley. Understanding the molecular mechanisms and involved pathway may lead to the development of drug target discovery. The protein interaction network is one of the supportive fields to discover the pathogenesis biomarkers for celiac disease. Material and methods: In the present study, we collected the articles that focused on the proteomic data in celiac disease. According to the gene expression investigations of these articles, 31 candidate proteins were selected for this study. The networks of related differentially expressed protein were explored using Cytoscape 3. 3 and the PPI analysis methods such as MCODE and ClueGO. Results: According to the network analysis Ubiquitin C, Heat shock protein 90kDa alpha (cytosolic and Grp94); class A, B and 1 member, Heat shock 70kDa protein, and protein 5 (glucose-regulated protein, 78kDa), T-complex, Chaperon in containing TCP1; subunit 7 (beta) and subunit 4 (delta) and subunit 2 (beta), have been introduced as hub-bottlnecks proteins. HSP90AA1, MKKS, EZR, HSPA14, APOB and CAD have been determined as seed proteins. Conclusion: Chaperons have a bold presentation in curtail area in network therefore these key proteins beside the other hubbottlneck proteins may be a suitable candidates biomarker panel for diagnosis, prognosis and treatment processes in celiac disease.

Aim: The aim of this study is to demonstrate the relation between the expression of liver alpha-amylase and obesity. Background: Alpha-amylase catalyses the hydrolysis of 1, 4-alpha-glucosidic linkages in polysaccharides and has three main subtypes, including: salivary, pancreatic, and hepatic. Hepatic alpha-amylase is involved in glycogen metabolism, and has a role in obesity and its management. In this study, we aimed to analyze the expression of liver alpha-amylase in overweight and obese mouse. Material and methods: In this study, NMRI male mice were randomly divided into two groups. The sample group (obese) took a high-fat and carbohydrate diet, while the control group (normal) took a laboratory pellet chow for eight weeks. During this period, their weight was measured. After eight weeks, liver hepatocytes were isolated using an enzymatic digestion method. Immunocytochemistry (ICC) and flow cytometry analysis were performed to measure alpha amylase protein expression in mouse liver hepatocyte cells. Results: A significant difference in the body weight was observed between the two groups (p<0. 05). The qualitative protein expression of liver alpha-amylase was found to be higher in the obese group in both tests (immunocytochemistry and flow cytometry). Animals from the test group presented higher alpha-amylase expression, which suggests that this hepatic protein may constitute a potential indicator of susceptibility for fat tissue accumulation and obesity. The present data demonstrates an increased expression of liver amylase in obese mice. Conclusion: These results suggest that liver amylase secretion might be useful for predicting susceptibility to obesity induced by consumption of a high-fat and carbohydrate diet.

Aim: To estimate the change in years of life lost (YLL) due to gastric cancer mortality after correcting for misclassification in registering causes of death using the Bayesian method. Background: For evaluating the health status of a country and determining priority of risk factors, some epidemiologic indicators are needed. Due to premature death, YLL is one of the most widely used indicators. To have an exact estimate of YLL, an accurate death registry data is needed, but the Iranian death registry is subject to misclassification error. Material and methods: Gastric cancer mortality data from 2006 to 2010 for Iran were extracted from national death statistics. The rate of misclassification in registered causes of deaths was estimated, using Bayesian method for each year. Then YLL of gastric cancer is estimated for different age-sex categories before and after implementing Bayesian method. Results: Using Bayesian method, the estimated misclassification rate for gastric cancer in cancer without label group were 5%, 3%, 3%, 7% and 7% respectively from 2006 to 2010. Estimated Years of life lost due to gastric cancer before correcting misclassification were respectively 111684. 93, 114957. 31, 112391. 93, 112250. 53 and 113300. 92 person-years for years 2006 to 2010. After correcting misclassification, the total YLL of gastric cancer increased to 1535. 19, 921. 11, 908. 39, 2566. 39 and 2507. 00 person-years, respectively from 2006 to 2010. Conclusion: If health policy makers ignore the existence of misclassification in registered causes of death, they may underestimate the burden of some causes of death and overestimate some others.

Aim: This study investigated subtypes of Cryptosporidium in patients with gastrointestinal complaints in Tehran, Iran. Background: Cryptosporidium, an intracellular protozean parasite, is among the major causative agents of gastroenteritis disorders in humans. It also causes water-borne and food-borne outbreaks of diarrheal diseases. Patients and methods: A total of 1685 fecal samples were collected from patients with gastrointestinal complaints who had been referred to clinical laboratories Tehran, Iran. The primary diagnosis was established by the detection of oocysts using the modified Ziehl-Neelsen staining method and following that, the positive microscopically samples were selected for sequence analysis of the partial 60 kDa glycoprotein (gp60) gene. Results: Out of 1685 collected samples, 7 (0. 4 %) were positive for Cryptosporidium oocysts. Sequence analysis of gp60 gene in seven Cryptosporidium isolates revealed that two subtype families were identified, IIa and IId. Five (of 7) isolates belonged to the subtype family IIa and the remaining two isolates belonged to IId. Two sub-types were recognized within the subtype family II, a including IIaA16G2R1 (3/5), IIaA17G1R1 (2/5), while IIdA17G1d was the only subtype within IId subtype family. Conclusion: The predominance of zoonotic subtype families of C. parvum species (IIa, IId) in this study highlights the importance of zoonotic transmission of cryptosporidiosis in the country.

Aim: The aim of this study was to investigate the VRE frequency and the rate of each gene in isolated enterococci from patients with intestinal infection in the central region of Iran. Background: Enterococci infections are a public health growing concern due to the glycopeptide antibiotics resistance especially vancomycin. Genes, vanA, B, and H contribute to the influence of vancomycin-resistant enterococci (VRE). Patients and methods: This study was conducted from January to July 2014 in Shahrood university hospital. Enterococci isolation and its antibacterial susceptibility were performed by culturing in Aesculin Azide agar and Kirby-Bauer method, respectively. Vancomycin-resistant genes were screened through conventional PCR, and subsequently sequenced. Results: Among 265 specimens, 100 isolates revealed enterococci, in which E. faecalis (91%) and E. faecium (9%). The isolated enterococci were resistant to vancomycin (6%) and chloramphenicol (21%), whereas their large proportions (94% to 100%) were multi-drug resistant. All VRE isolates belonged to E. faecalis, conversely, the E. faecium were susceptible to the same antibiotic. Both vanA and vanH genes were identified in all VRE isolates, although, no vanB gene was indicated. Homology analysis of sequenced amplicons verified the full length compatibility to the worldwide reported genes. Conclusion: The present study revealed VR E. faecalis in gastroenteritis patients and resistance factor for vanA and vanH genes are coordinated. Since enterococci isolates were all multidrug resistance, increase in VR E. faecalis vanA / vanH in this area could be expected.

Aim: This case– control study investigated the various PAI markers, phylogenetic groups and antimicrobial susceptibility among DEC and commensal E. coli isolates. Background: Diarrheagenic Escherichia coli (DEC) is an emerging agent among pathogens that cause diarrheal diseases and represents a major public health problem in developing countries. The major difference in virulence among DEC pathotype and commensals may be related to the presence of specific genomic segments, termed pathogenicity islands (PAIs). Patients and methods: A total of 600 stool specimens from children (450 with and 150 without diarrhea) were collected and various PAI markers, phylogenetic groups and antimicrobial resistance profile among DEC and commensal E. coli isolates were detected. Results: One hundred sixty eight (90. 3%) isolates were resistant to one or more antimicrobial agents. PAI markers were detected in a substantial percentage of commensal (90%) and DEC isolates (99. 3%) (P> 0. 05). The most prevalent PAI marker among DEC and commensal isolates was HPI (91. 9% DEC vs. 68% commensal). We found a high number of PAI markers such as SHI-2, She and LEE that were significantly associated with DEC. Several different combinations of PAIs were found among DEC isolates. Comparison of PAIs among DEC and commensal isolates showed that many DEC isolates (94. 8%) carried two or more PAI markers, while 76% of commensals had only one PAI marker (P< 0. 05). According to the phylogenetic classification, group B2 was the most commonly found in the DEC isolates. Furthermore, our results showed that group B2 can be present in commensal isolates (18%). Conclusion: These results indicate that PAI markers are widespread among commensal and DEC isolates and these commensal isolates may be reservoirs for transmission of these markers.

Aim: This study was aimed to characterize putative differences of fecal microbiota between irritable bowel syndrome (IBS) and gastroenteritis patients and healthy controls. Background: New evidence proposed that gut microbiota has a deep effect on the balance between health and disease. Patients and methods: The presence of Clostridium difficile, Campylobacter spp., Enterobacteriacea and Staphylococci were detected in the samples using selective and specific culture media. Microscopic examination of the samples was done to detect Actinomycetes, yeasts, Bifidobacteria, Fusobacterium spp., as well as white blood cells, red blood cells, mucus and epithelial cells. Results: Results of this study showed relatively higher frequency of Citrobacter spp., Lactobacilli, and Actinomycetes in the IBS patients. Elevated levels of WBC, RBC secretion, and increased amounts of Klebsiella, Escherichia coli and Citrobacter spp. were characterized in the patients with gastroenteritis compared with the control group. Conclusion: Depletion of gram positive cocci and gram negative bacilli also suggested dysbiosis of intestinal microbiota in these patients.

A 33-year-old male with abdominal distention after meals was admitted to the hospital. He had a history of surgery for hydatid liver cyst. The cyst was located at the liver hilum and there were portal venous thrombosis and cavernous transformation. It had been treated with partial cystectomy, omentoplasty and albendazole. Two years later at the admission to our center, his laboratory tests were in normal ranges. Abdominal imaging methods revealed splenomegaly, portal vein thrombosis, cavernous transformation and the previously operated hydatid liver cyst. Upper gastrointestinal endoscopy demonstrated esophageal and gastric fundal varices. Due to his young age and low risk for surgery, the patient was planned for surgical treatment of both pathologies at the same time. At laparotomy, hydatid liver cyst was obliterated with omentum and there was no sign of active viable hydatid disease. A meso-caval shunt with an 8 mm indiameter graft was created. In the postoperative period, his symptoms and endoscopic varices were regressed. There were four similar cases reported in the literature. This one was the youngest and the only one treated by a surgical shunt. Hydatid liver cysts that located around the hilum can lead to portal vein thrombosis and cavernous thrombosis. Treatment should consist of both hydatid liver cyst and portal hypertension. To the best of our knowledge, this was the first case of surgically treated portal vein thrombosis that was originated from a hydatid liver cyst.

Chronic anemia is common in liver cirrhosis. In this setting, the pathogenesis of anemia is complex and multifactorial. Spur cell anemia is a serious disorder in cirrhotic patients and is associated with poor prognosis. Liver transplantation constitutes the only therapeutic tool. We report a case with severe spur cell anemia in alcoholic liver cirrhosis. In the attempt to investigate the origin of the disorder, we have evaluated the lipoprotein profile and found a significant reduction of apolipoprotein AI and HDL3 subclass as a possible cause of the disease.

A 77-year-old male with a history of metastatic scalp angiosarcoma presented with intractable gastrointestinal bleeding from a jejunal mass detected on capsule endoscopy. He underwent laparoscopic-assisted resection of the mass. Intraoperatively, an isolated small bowel mass with bulky lymphadenopathy was seen and resected en bloc. Pathology showed a 6. 8cm high-grade metastatic angiosarcoma with nodal involvement and negative margins. Angiosarcoma is a sarcoma with a grim prognosis. The incidence is 2% of all soft tissue sarcomas; cutaneous lesions comprise 27% of manifestations and usually appear on head and neck. Risk factors include lymphedema, neurofibromatosis, vinyl chloride, arsenic, and anabolic steroids. Overall 5-year survival is 30-35% and is higher in patients younger than 60, those without metastasis, tumors less than 5 cm, and favorable histology. Angiosarcoma metastasis to small bowel is rare but nodal involvement is even more unusual, reported only three times in the literature. This case is the first with nodal involvement to present at a resectable stage. To diagnose disease when still at a resectable stage, a high index of suspicion must be maintained with any gastrointestinal symptoms in a patient with a history of angiosarcoma. Laparoscopic-assisted resection is safe for the resection of small bowel angiosarcoma.

Question A 73-year-old male, referred by his GP with dyspepsia unresponsive to proton pump inhibitors. His past medical history included COPD, ischemic heart disease, Iron deficiency anaemia (IDA) investigated with colonoscopy and a colonic polyp removed 2012.

To The Editor: Early studies have not revealed a link between Helicobacter pylori and iron deficiency (1). A recent study from your journal revealed a significant association between H. pylori infection and iron deficiency anemia in patients with celiac disease. But the conclusion of this study was that H. pylori infection and iron deficiency anemia is poorly reflected in practice to celiac disease patients (2).