GOVARESH Journal
Year:2006 | Volume:11 | Issue:1|Papers Count:9

Background: Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders, characterized by non-specific symptoms such as abdominal pain and altered bowel habit without any organic pathology. Its prevalence varies in human communities. We performed this study to determine the prevalence of IBS in medical students of Gilan University of Medical Sciences (GUMS).Materials and Methods: Medical students of GUMS in 2002 enrolled in this cross-sectional study. Under a schedule they were interviewed by trained general practitioners with structured questionnaire, which based on Rome II criteria. Data was analyzed by SPSS-10 software. Results were presented into percentage and mean ± SD. Level of significance was denoted as p value less than 0.05.Results: This study included 422 students training in various educational levels of GUMS, 148 (35.1%) males and 274 (64.9%) females whose mean age was 23.7±2.9 years. Prevalence of IBS was 12.6% (53 of 422 with 95%, CI 9.5%-16.1%). IBS was more prevalent in females than males (15% (41 of 274) vs. 8.1% (12 of 148)) (p<0.05).Conclusions: This study shows higher IBS prevalence in medical students than other published Iranian reports. Prevalence of 12.6% in students, who are in active phase of life, necessitates planning to help this population.

Background: Esophagus cancer (EC) accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in the Caspian Littoral. The global histologic pattern of the disease has changed recently. The intent of this study was to determine the incidence of EC over the past decade in Eastern Azerbaijan, a northwestern province of Iran, in western side of the Caspian Littoral and to assess the alteration of the histological pattern of the disease.Materials and Methods: In a retrospective study, all of 1792 pathologically documented EC of all registered cancer, surgery, pathology, and radiotherapy centers of the province over a period of 9 years (from March 1994 to March 2003) were enrolled in the study. The data concerning demographic characteristics, EC risk factors, and histological findings were recorded. The incidence and relative incidence of pathological subtypes in indigenous population of the province (excluding immigrants) were determined. The interaction of main risk factors and tumor histology of the patients were assessed over the years of study.Results: The average incidence of EC was 7 cases per 100,000 persons per year. Adenocarcinoma and SCC account for 12.8% and 86.9% of cases. The proportions of different genders and histological types remained unchanged during these years. The frequency of nonsmoker patients has increased compared to smokers over the years. In nonsmoker subgroup of patients the relative incidence of adenocarcinoma as compared with that of squamouscell carcinoma has increased over the last 5 years of study.Conclusions: Esophageal cancer incidence rate in western side of Caspian littoral is as high as its western side. The frequency of nonsmoker patients has increased compared to smoker patients and the proportion of adenocarcinoma cases is increasing in this subgroup.

Background: Irritable Bowel Syndrome (IBS) is one of the most prevalent gastrointestinal disorders which includes the majority section of general practitioners or gastroenterologists visits. The type or prevalence of clinical signs and symptoms of the syndrome may be different among males and females. we decided to assess and compare the frequency of different signs and symptoms of IBS in men and women.Materials and Methods: It is a cross sectional study which was performed in a private gastroenterology clinic in Tehran. 76 males and 116 females who suffered from Irritable Bowel Syndrome were selected, and the clinical signs and symptoms were compared. Finally, the data were analyzed using Chi-Square test.Results: Among the gastrointestinal signs, abdominal pain, nausea, belching, and bitter taste with women/men ratio equal to 1.2, 2, 1.7, and 1.4 respectively (p<.05) were more prevalent in females, while flatulence and mucus discharge were observed in males more than females (men/female ratio 1.3, 1.6 respectively) (p<.05). Extra gastrointestinal manifestations such as palpitation, anxiety, and depression were more common in females (women/men ration 1.7, 1.3, and 1.7 respectively). The sensitivity of ROME II criteria in males and females was 96.3% and 92% respectively, while the sensitivity of Manning criteria was 93.4% in men and 80.2% in women.Conclusions: Clinical manifestations of Irritable Bowel Syndrome are different between males and females. It seems that Manning criteria is more diagnostic in men suffering IBS.

Background: Irritable Bowel Syndrome (IBS) is a very common disorder. Some researches have pointed to an interaction between psychiatric disorders and IBS. Present study aimed to determine psychiatric disorders in patients with IBS compared to normal controls among an Iranian population.Materials and Methods: All freshmen students (n=3012) of Tehran University invited to the study at 2001. A trained general practitioner interviewed the entire students for IBS based on Rome II criteria. A gastroenterologist visited the students who had Rome II criteria and ordered laboratory exams that are necessary for ruling out organic diseases. After confirming IBS patients, a matched control group by sex and age was selected. A psychologist who was blind to IBS diagnosis interviewed all cases and controls using a reliable 28- items General Heath Questionnaire. Chi-Square analysis used to compare psychiatric disorders in the cases and controls. P-value less than 0.05 determined as significant.Results: A total of 3008 students (female; 1785, male; 1223) participated to the study and 143 had Rome II criteria for IBS (4.7%, 95% CI 4-5.6%).Finally 46 (female; 31) with IBS and 97 (female; 62) controls underwent psychologic interview.Somatic symptoms, anxiety, depression, social dysfunction and mental disorder were reported by 41.3%, 34.8%, 15.2%, 43.5% and 41.3% respectively in IBS patients and 14.4%, 14.4%, 5.2%, 21.6% and 13.4% among control group respectively. All psychiatric disordoers were significantly more common among IBS patients than controls.Conclusions: Mental health in IBS patients is impaired. This fact could be primary or secondary. Control of psychiatric disorders may improve IBS symptoms.

Background: Los Angeles classification is widely adopted as a means of unifying endoscopic observation for GERD. We assessed the inter- and intra-observer variability of LA classification.Materials and Methods: Two-hundred fifty-four still images of the lower esophagus taken by an expert endoscopist (RM) were randomly selected and presented to 9 gastroenterologists (2 females, 6 experts, 3 trainees). They were asked to report the images according to LA classification. After 2 weeks the images were re-ordered and the same people were asked to report them again. Kappa-statistics was calculated for intra- and inter-observer variability.Results: Mean kappa for intra-observer agreement was 0.54 for experts and 0.55 for trainees (p = NS). Mean intra-observer kappa was greater among females than males (0.70 vs 0.50 respectively, p=0.05). Mean inter-observer kappa was 0.20 and 0.31 for experts and trainees respectively (p = NS). Mean inter-observer weighted kappas were 0.25 and 0.07 (p = 0.007) for males and females respectively. Analyzing data for source of the discrepancy showed that the least reproducible reading was GERD-A both for intra- and inter-observer agreement calculations. Conclusions: According to our data, the LA classification, although a major advance in reporting GERD, has a poor to fair reproducibility. There was no difference between experts and trainees in using the LA classification. Females seem to be more consistent in their readings, but have less agreement with others. Despite the inherent short-comings of kappa statistics and the limitation caused by the possible quality of the still images, revision of the LA system seems to be advisable.

Background: Gastrointestinal and liver diseases (GILD) are among the most common causes of morbidity and substantial proportion of mortality with enormous economic consequences in Iran. We aimed to collect and report the most recent statistics on deaths, symptoms, physician visits, and hospitalizations for common gastrointestinal and liver diseases in gastrointestinal referral centers of Tehran.Materials and Methods: Data on the leading causes of death were obtained from Iranian Ministry of Health, office of Health Statistics, (Table 1). A total of 189,747 deaths in the 23 (out of the 28) provinces of the country) were reported during March 2003 to February 2004. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases (ICD-10; 1992). The leading causes of hospitalizations were obtained from the database of the GI ward of Shariati hospital, one of the biggest and well known GI referral hospitals in Iran, through years 2000 to 2004. Data on the leading symptoms prompting an outpatient clinic visit and related physician's diagnosis were gathered from a large multi-physician outpatient clinic, located in Tehran, during 2000-2004.Results: The first 5 leading gastrointestinal causes of death in the country were: stomach cancer, hepatobiliary cancers, cirrhosis of liver, esophageal cancer and colorectal cancer respectively. The first 5 leading causes of hospitalizations in GI ward of Shariati Hospital were cirrhosis of liver, hepatitis, peptic ulcer diseases, cholycystitis & cholangitis and colorectal cancer. The most common outpatient diagnosis was GERD followed by IBS, DU, Non-ulcer Dyspepsia, and chronic hepatitis B. Conclusions: GI and liver malignancy along with chronic liver diseases constitute the main GI and liver etiology for hospitalization and death in Iran. Gastroesophageal reflux disease, IBS , DU, Non ulcer Dyspepsia, and Chronic HBV are the most common outpatient diagnosis in Iran.

The patient is a 69 years old female presented with chest pain and rapidly progressive dysphagia. Then she suffered of hematemesis and aphagia. In evaluation of patient, a intramural hematoma obstructing esophageal lumen was demonstrated which was accompanied with mucosal ulceration and bleeding. It appears that this complication occurred in the context of concomitant use of alendronate with aspirin in this patient.

Many extra-intestinal manifestations are associated with celiac disease. One of the most important of them is hepatobiliary abnormalities. This association is recently under consideration. We report a 34-year-old man with elevated liver enzymes and primary diagnosis of nonalcoholic fatty liver disease. Further follow up revealed celiac disease as the proper diagnosis in this patient.