Introduction: Celiac disease (CD) or gluten-sensitive enteropathy is a malabsoption of nutrients due to hyoersesitivity of gluten. Some etiologic facrors are environmental, immunologic and genetic factors. The frequancy of Celiac disease is not studied in western regions of Iran, therefore this study is done to determine the frequancy of Celiac disease in general population of rural regions of Arak.Materials and Methods: This is a descriptive, cross-sectional study in which 700 people between 20-56 years old in rural regions of Arak were selected by multistage random sampling (364 male and 336 female). After completing questionnaires, blood samples were collected and serum IgA levels (to rule out IgA deficiency), and serum t-TG Ab were assessed. All cases that had positive serologies and those who had high clinical probability of having Celiac disease underwent second duodenal segment biopsy. Data was presented using mean, standard deviation and frequency distribution.Results: Serum IgA levels were normal in all samples. 8 cases were positive for t-TG Ab, 38 cases had high normal levels of t-TG Ab and the others had less than 6 Au/ml t-TG Ab. Only in patients with high normal serology, histology was positive. 1% (10 in 1000 people) of all studied subjects demonstrated intestinal lesions due to Celiac disease. Most of them were asymptomatic.Conclusion: CD frequency in rural regions of Arak in people between 20-65 years old was 10 among 1000 cases. This frequency is the same as studies done in northern and southern regions of Iran but was higher comparing to the other parts of the word. This amplifiles the importance of screening of CD in Iran. Also the sensitivity and specificity of t-TG Ab was found high because all cases with high normal levels of t-TG Ab were approved by histology.

Background: Celiac disease may be presented with dyspepsia. This study was done to evaluate the prevalence of celiac disease and its association with different types of dyspepsia and also the need for duodenal biopsy in patients with non-ulcer dyspepsia.Methods: All patients with dyspepsia were classified as ulcer dyspepsia (duodenal ulcer and gastric ulcer) and non-ulcer dyspepsia (dysmotility-like non-ulcer dyspepsia and ulcer-like non-ulcer dyspepsia). Distal duodenal biopsy was done for all patients. Then, specific serologic factors for celiac disease (Anti-Gliadin Antibody and tissue Transglutamines Antibody) were checked in patients with villous atrophy. Finally, the prevalence of celiac disease and its association with different types of dyspepsia were evaluated.Findings: Of the 810 patients with dyspepsia, 703 had non-ulcer dyspepsia and 107 had peptic ulcer. Six (5.6%) of the patients with peptic ulcer and 54 (7.7%) of patients with non-ulcer dyspepsia had villous atrophy and positive Anti-Gliadin Antibody or tissue Transglutamines compatible with celiac disease, but there was no significant deference between celiac disease and different types of dyspepsia (P > 0.05). In non-ulcer dyspepsia, odds ratio for Celiac disease was 1.4, in comparison with the peptic ulcer.Page count: During endoscopic examination for non-ulcer dyspepsia, if indicated, endoscopists should carefully inspect the duodenum for CD findings. Although, routine serologic screening can not be recommended; it may be appropriate for the patients with refractory dyspepsia.

Introduction: Coeliac disease (CD) is an autoimmune enteropathy triggered by gluten. Several hepatic disorders have been described in association with coeliac disease. Nodular regenerative hyperplasia (NRH) of the liver is a rare disorder and is a cause of non-cirrhotic portal hypertension.Case report: A 22 y/o lady presented with portal hypertension, after all causes of chronic liver disease ruled out we checked for coeliac and it was positive. Liver biopsy was done and was compatible with nodular regenerative hyperplasia (NRH) of the liver.Conclusion: As far as we know this is one of the rare cases of nodular regenerative hyperplasia of the liver in a patient with coeliac. Only three cases have been reported until now and seem we should think about coeliac in any patient suffering from chronic liver disease with unknown cause.

Introduction: The screening of patients with dyspepsia, may allow an early identification of affected individuals. The aim of this study was to determine the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy.Materials and Methods: From November 2007 to October 2008, 407 patients who underwent endoscopy for any reason (193 male, 214 women; mean age36.1 years) were studied in this work. Histological characteristics in duodenal biopsy specimens for celiac disease were evaluated according to the modified Marsh Classification1999. In addition, all patients were tested for total immunoglobulin A and antitransglutaminase (tTG) antibodies. The patients with IgA deficiency were tested with IgG tTG. Results: Duodenal histology showed the malabsorption pattern (Marsh I-IIIc) in 26 (6.4%) cases and 33 cases had serological positive test for tTGA. In term of the serological analysis, 10 out of 33 tTGA positive patients had malabsorption pattern (Marsh I,-IIIc), and all of them had a positive tTGA (2.45%). Four of the 407 recruited patients were IgA deficient and none of them were positive for IgG tTG.Conclusion: In this study, about 6.4% of patients had malabsorption pattern and 8.1 % presented with positive serology for CD. However, both histology and serology were positive in 10/407 (2.45%). The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease.

Background: Non alcoholic fatty liver disease probably is the most common liver disorder in the world. The causes of NAFLD may be divided into two broad categories: drugs and metabolic abnormalities. Because previous studies reported relatimship between celiac and NAFLD/ we have studied this association in this article.Methods: This study was performed between September 2007 and Desember 2008. We measured human anti-tissue transglutaminase IgA antibody titratage by ELISA technique in 95 NAFLD inflicted patients, with out any risk factors for NAFLD, then patients with positive ATTG underwent upper endoscopy with duodenal biopsy.Results: Positive ATTG was found in 6 out of 80 patients (7.5%). Endoscopy was performed in 6 patients. Duodenal biopsy was normal in 2 patients (33.3%) and 4 patients (66.7%) had abnormal duodenal biopsy. Two patients were in Marsh stage 1 and one in Marsh stage 2 and a nother one in Marsh stage 3. None of them had symptoms suggestive of celiac disease.Conclusion: This present study shows that positive ATTG is not rar in patients with NAFLD. we recommend serum ATTG  should be check in patients with NAFLD without any obvious etiology, also upper endoscopy with duodenal biopsy should be taken for all patients with positive ATTG.

Introduction: Irritable Bowel Syndrome (IBS) is a common clinical syndrome that presents with abdominal pain, diarrhea and constipation, and flatulence which may be intermittent. Also celiac disease, an enteropathy due to gluten sensitivity, presents with diarrhea resulting from mal-absorption, which should be considered as a differential diagnosis of IBS. If celiac is diagnosed in a patient suspicious to IBS, the treatment method will be changed completely. This study was designed to evaluate celiac disease in IBS patients.Methods: A cross-sectional study was conducted on 125 patients 15-50 years old suffering from IBS with diarrhea- predominant clinical picture, who were referred to Yazd gastroenterology clinics. The study data including age, gender and results of anti TTG measurement were collected and analyzed by SPSS 13.Duodenal biopsy was performed in patients that were positive for anti TTG for confirmation of diagnosis.Results: 125 patients suffering from IBS with diarrhea- predominant clinical picture entered the study.Their mean age was 29.85±9.22 years.74 subjects (59.2%) were males and 51 (40.8%) were females. Four patients showed positive anti TTG (3 males and 1 female). Duodenal biopsy was performed and diagnosis of celiac disease was confirmed in all four patients (3 with March II and with March I grade). Totally the frequency of celiac disease was 3.2% in this study. There was no significant relationship between age, gender and anti TTG results, which can be explained by small sample size.Conclusion: According to the results of the study and the frequency of celiac, it is not an uncommon and rare disease, so it should be considered as one of the differential diagnoses of IBS.

The incidence rate of Primary Biliary Cirrhosis (PBC) is 100 to 200 cases per 1, 000, 000 individuals and the majority of cases are reported among women with the mean age of about 50 years. Cholestatic properties are predominant in PBC and this disease is usually detected by progressive hepatic failure. The current case was about a 57-years-old woman presented with a sudden decrease in consciousness level, who had experienced a cholecystectomy operation 1 week prior to admission due to severe abdominal symptoms. Brain CT Scan and LP were normal and the neurologic examinations were also symmetrical.The patient was treated primarily for basilar infarction disease. As the levels of serum ALK. P, AST and ALT increased, hepatic encephalopathy was considered the possible cause of decrease in the consciousness level. Following complementary examinations and the dia-gnosis confirmation, the patient's consciousness level was restored to normal after the treatment of hepatic encephalopathy.Ultrasonography showed a small liver with rough parenchymal appearance (considered hepatic cirrhosis). PBC was reported as the main cause of hepatic cirrhosis in pathologic examinations. Further assessments showed that the patient was also suffering from celiac sprue.