GOVARESH JOURNAL
Year:2003 | Volume:7 | Issue:41|Papers Count:10

Gastric cancer is a frequent cancer worldwide especially in Japan and South America with an incidence of 10 to 70 people per 100000 per year. Since the end of the Second World War, its incidence is decreasing in France and currently it is responsible for less than 10% of cancer mortality in this country. H. pylori, host genetic characteristics & diet are known to be involved in the pathogenesis of this cancer. Whether H. pylori should be eradicated in all infected individuals or in selected patients is not known. Relatives of patients with documented gastric cancer and patients with another gastro-intestinal cancer bearing H. pylori should be considered at higher risk for developing gastric cancer and may require H. pylori eradication.

Objective: Coeliac disease (CD) is one of the most important causes of chronic diarrhoea. The prevalence of CD in patients with chronic diarrhoea in Iran remains unknown. The aim of this study was to evaluate the prevalence of CD among 100 Iranian patients with chronic watery diarrhoea.Methods: One hundred consecutive patients with chronic watery diarrhoea of more than 6 weeks attending an academic center in Iran were enrolled. Patients with bloody diarrhoea and renal failure were excluded. IgA endomysial antibody (lgA EMA), IgA antigliadin antibody (lgA AGA), and total serum IgA were tested in all patients. Patients with negative IgA EMA were evqluatedfor other causes of chronic diarrhoea. Patients who had positive IgA EMA underwent upper gastrointestinal endoscopy and duodenal biopsy. Patients with a positive IgA EMA were advised to follow a Gluten free diet (GFD) strictly for 6 months, and then clinical symptoms, serologic and hematologic tests were re-assessed.Results: A total of 100 patients (55 men, and 45 women) with chronic watery diarrhoea were studied. Mean age of the patients was 31 years. Total serum IgA was in the normal range in all participants. Twenty patients (12/45 women; 8/55 men) had positive IgA EMA. Fourteen of them had a positive IgA AGA too. Coeliac disease was diagnosed in 19 patients (19%). Small intestinal Crohn's disease, small intestinal lymphoma and idiopathic enteropathy were the next common, causes of chronic diarrhoea. In patients with coeliac disease, after 6 months of GFD 15 patients (75%) had complete clinical response, 3 (15%) had good response, and 1 (5%) had partial response. One patient did not follow GFD.Conclusion: Prevalence of CD is high among adult Iranian patients with chronic diarrhoea. GFD can eliminate or reduce diarrhoea in a substantial proportion of them.

Background & Aim: Autoimmune hepatitis (AIH) is a chronic necro-inflammatory disease of the liver with unknown etiology. It is relentlessly progressive to end stage liver disease within months to years, unless appropriately treated. Even with appropriate and timely therapy the disease may be progressive and decrease the patient's survival. We assessed the survival rate in 22 Iranian AIH patients who received treatment at various time intervals after initiation of their disease.Methods and Patients: In a descriptive, cross-sectional, retrospective study, we assessed the survival rate of 22 patients with AIH who were being followed in a private gastroenterology clinic in Tehran. These patients had been diagnosed and treated over a 10 years period (from 1991 to 2001). Their demographic, clinical, para-clinical and survival data were retrieved and analysed using the SPSS software for windows.Results: Mean age of the patients was 21.7 years and 86.4% were female. They were followed for a mean of 3.1 years. The actuarial survival rates were as follow: 100% survived the first year, 95.0% survived for 3 years, 86.9% for 4 years, and 79.7% for 6 years. All have been treated with prednisolone and Azathioprine.Conclusion: Survival rate in our patients is comparable to that reported from the western countries (the United Kingdom and Germany).

Background and Aim; Hepatic steatosis and nonalcoholic steatohepatitis (NASH) are frequent in obese population. Intestinal bypass surgery is a treatment modality for morbidly obese patients. The aim of this study was to determine and compare the prevalence and severity of NAFLD in patients undergoing a modified intestinal by pass (MIB) surgery.Methods: 43 consecutive morbidly obese patients (32 female, 11 male) with mean age; 34.7±9.5 year and mean BMI; 45.8±7.3 kg/m2 underwent MIB operation by a surgeon. In MIB the proximal end of the blind intestinal loop is connected to the gall bladder.A liver biopsy was obtained from 30 patients at the operation time. A repeated liver biopsy was performed after 16±0.5 months in 13 patients who accepted a postoperative liver biopsy. The degree of steatosis (0-4), necro- inflammation (0-18) and fibrosis (0-6) was scored in the all liver biopsies by a single liver pathologist.Results: Of the original liver biopsies 20% had normal histology, 43.3% had mild to moderate steatosis and 36.7% had NASH. The liver histology was remained without any change in 23.1%, showed some partial decrease in NAFLD severity in 38.5% and some increase in NAFLD severity in other 38.5%. The changes were not significant and no body suffered from a serious liver failure during our follow up.The average BMI dropped to 27.4 and 30.7 kg/m2 after 2 and 5 years consequently.Conclusion: Although about 40% of the patients had NASH, but MIB surgery did not accentuate NAFLD severity.

Introduction: Eradication of H. pylori with the quadruple regimen, consisting of a proton pump inhibitor, bismuth salt, amoxicllin, and metronidazde has been successful in Iran. However occurrence of resistant strains to metronidazde leads to failure of this regimen. In such cases recruitment of a substitute for rpetranidazole appears inevitable.Material and methods: Furazolidone efficacy was compared to metronidazole, clarithromycin, amoxicillin, and tetracycline in 70 H.pylori isolates from dyspeptic patients in vitro.Results: Thirty three percent of the isolates exhibited resistance to metronidazole but all were susceptible to furazolidone.Conclusion: It appears that no cross resistance appears between metronidazole and furazolidone, indicating that H.pylori strains do not acquire furazolidone resistance phenotype as readily as metronidazole resistance. The results of this study suggest that furazolidone could be considered as an appropriate substitute for metronidazole.

Hepatic fibrosis and cirrhosis is the consequence of many types of chronic liver disease, and at its final stage when liver nodule and scarring develops is generally considered to be irreversible. Here, we describe three chronic hepatitis B patients with clinical, biochemical, and histologic evidences of cirrhosis. They underwent treatment with interferon-alfa or lamivudine and had follow-up liver biopsy while in clinical, biochemical, and virologic remission. Biopsy specimens were randomly coded in unpaired manner according to patient and were read c, independently by two pathologists using the modified hepatitis activity index (with a maximum stage of 6). The mean interval between biopsies was 5.5 years. The mean alanine aminotransferase level decreased from 113.7 U/L to 28.3 U/L. The mean bilirubin level decreased from 2.4 mg/dL to 0.9 mg/dL, and the mean prothrombin time decreased from 16.3 seconds to 12.3 seconds. The mean Child-Pough score decreased from 8 to 5. The mean fibrosis score decreased from 5.8 to 0.5 (P=0.004), and the mean grading score from 10.8 to 3.2 (P=0.017). In conclusion, cirrhosis due to chronic hepatitis B may be reversible in some patients who respond to antiviral therapy.

Gastrointestinal problems like bloating, diarrhea and vomiting are not uncommon among diabetic patients. Diabetic neuropathy of GI tracts is considered as the main cause and so the fundamental of the treatment. This reported case is a known type I diabetes mellitus (IDDM) with longtime complaints of iron deficiency anemia and vague abdominal pain, diarrhea and bloating which had not respond to conventional treatment. More accurate investigation revealed Celiac disease and gluten free diet alleviated the symptoms and improved his lab findings.Sometimes some autoimmune diseases occurred simultaneously in one patient so it is not unexpected that Celiac disease is more common in IDDM patients than normal population (2.5 to 6% vs. 0.2 to 0.38%). So it is wise to investigate anti- gliadin and anti endomysial antibodies (AGA & AEA) in any diabetic patient with GI complaints and perform an entroscopy and jejunal biopsy if both are positive. In the other hand almost one third of celiac patients are asymptomatic, so other features like failure to thrive (FTT) in children, iron and folate deficiency anemia, multiple hypoglycemic episodes and osteoporosis should raise the suspicion against Celiac in diabetic patients. The newest recommendations suggest periodical evaluation of Celiac in IDDM patients. Diminished symptoms in symptomatic patients and improvement of lab findings, better control of blood glucose level, less hypoglycemia and lower chance of undesirable outcomes like osteoporosis and lymphoma are results of gluten free diet in such patients.