Govaresh
Volume:16 Issue: 4, 2012

Treatment regimens for the eradication of H. pylori as suggested in Western studies may not be applicable for Iran. Herein, we conduct a systematic review to ascertain the efficacy of eradication therapy regimens used for Iranian patients and introduce the more successful treatment regimens for Iranians.This review was a comprehensive search of English and Farsi electronic databases conducted from June to September 2011.A total of 11 trials were included in our study. In these, there were 28 different eradication regimens studied. Of the 28 regimens, 8 had an H. pylori eradication rate of over 85% and in 3 the eradication rate was greater than 90%. In Iran, the regimens that contained amoxicillin-furazolidone or amoxicillin-clarithromycin for two weeks were the most effective for H. pylori eradication, although the furazolidone-based regimen was less expensive.For first-line treatment, the amoxicillin-furazolidone-based regimen for 2 weeks is cost-effective for H. pylori eradication in Iranian patients.

BackgroundCeliac disease is an autoimmune disorder which causes malabsorption in genetically susceptible patients who consume gluten. Celiac disease is not limited to the gastrointestinal system, and exhibits different signs and symptoms in other organs. Malabsorption of calcium and vitamin D can cause osteomalacia and secondary hyperparathyroidism. Celiac disease is no longer a rare disease and is more frequent in the Middle East. It is expected that 1% of the in general population has celiac disease. This study aims to determine the prevalence of osteopenia and osteoporosis in Iranian patients with celiac disease.Materials and MethodsIndividuals with intestinal and extra-intestinal problems who had positive serologic tests for anti-tissue transglutaminase or antiendomysial antibody were offered endoscopic duodenal biopsy to confirm their diagnoses of celiac disease. Biopsy-proven celiac disease patients between the ages of 20 to 60 years were enrolled. Exclusion criteria were as follows: 1) the use of drugs such as corticosteroids, anticonvulsants, heparin, cyclosporine, statins, and β-blockers, 2) the presence of any neoplasm, and 3) any metabolic disorder such as diabetes, hyperthyroidism, Cushing''s, and immobility. After obtaining informed consents, we evaluated 76 patients diagnosed with celiac disease. All enrolled patients underwent BMD measurement of the hip, femoral neck, and spine using dual-energy X-ray absorptiometry (bone densitometry with DEXA scan).ResultsA total of 76 patients with celiac disease of ages 20 to 60 years old (mean: 33 years old) underwent bone densitometry. Of these, 66% were female and 33% were male. There were 44 patients (57%) who had normal bone density in the spine, 17 (22.4%) who had osteopenia, and 15 patients (20%) had osteoporosis. In the femoral neck, 38 patients (50%) had normal bone densitometry, 25 (32.9%) had osteopenia, and 12 (15.8%) had osteoporosis. Low bone mineral density (osteoporosis or osteopenia) was seen in 48% of our patients in the femoral neck and 43% in the spine.ConclusionThe prevalence of osteoporosis among celiac disease is much higher than the general population. Of the study patients, 55% had osteopenia in the femoral neck or spine and 36% had osteoporosis in the femoral neck or spine. The prevalence of osteoporosis is elevated enough to justify a recommendation for osteoporosis screening of all patients with celiac disease.

The use of anticoagulant and antiplatelet agents has become more prevalent during the past decades. These drugs may potentially cause gastrointestinal (GI) bleeding. Thus, there is an increasing need for GI endoscopy in patients who take these medications. In patients who take anticoagulant and antiplatelet agents, the appropriate conditions under which endoscopic procedures should be performed remain unclear. In this manuscript, we reviewed studies regarding this context in an attempt to present a practical guideline for management these patients.

The peak age of onset of inflammatory bowel disease (IBD) is simultaneous with the peak reproductive years. Patients have many concerns about the impact of IBD on fertility and pregnancy outcomes. The most important reason for voluntary childlessness is the fear of side effects from medications for IBD. Decision making for medical therapy is a complex equation. It is important to summarize available information about the management of IBD during pregnancy and its interactions. Among IBD patients, those undergoing surgery are at risk for reductions in fertility. Patients with ileal pouches-anal anastomosis (IPAA) experience higher rates of infertility. Disease activity at the time of conception is the main determinant of the impact of IBD on adverse pregnancy outcomes. In different nations, disease activity and relapse depend on many factors and may even be slightly lower during pregnancy. The recommended mode of delivery in IBD is still controversial. However, there is an increased rate of cesarean sections in women with IBD. Choosing the appropriate method of delivery should be based on the obstetrician''s opinion, however active perianal disease and the presence of an ileoanal pouch are two major exceptions. If women remain on their maintenance therapy, there would be no increased risk of a flare-up during the postpartum period. In most patients, maintaining remission with medication outweighs the risks of their adverse effects. However, the pros and cons must be discussed with the patient and decisions should be made on an individual basis. Among all drugs used in IBD treatment, only methotrexate (MTX) and thalidomide are contraindicated in pregnancy.

More than 250,000 people die annually of pancreatic cancer, worldwide. The highest incidence and mortality rates of pancreatic cancer are reported in developed countries. In developing countries the rate have been stabilizing over the past two decades but in countries which rates have been low for decades is now increasing. Recognizing pancreatic cancer''s risk factors and its prevention are important roles in reducing pancreatic cancer mortality. Risk factors for pancreatic cancer are not well recognized. The aim of the study is to review the environmental risk factors of pancreas cancer.We performed a systematic review of the published literature to identify all studies that provided environmental risk factors in association with pancreatic cancer. we conducted MEDLINE search limited to last 5 years up to June 2011, for all relevant case -control, meta analysis, systematic review and cohort studies. Citations were limited to those published in the English language. Review and comment articles have been excluded.Sixty six independent studies met the predefined inclusion criteria. Seven studies out of 15 found positive association between cigarette smoking and pancreatic cancer.Five articles out of 10 reviewed articles found high alcohol intake as a risk factor for pancreas cancer and the other 5 articles found dose related association with pancreas cancer.Coffee: according to 2 reviewed studies coffee not only does not have a substantial impact on pancreatic cancer risk but also coffee drinking has been associated with a reduced risk of pancreatic cancer in men. Frequent intakes of red meat and well-cooked meatand Vitamin D deficiency have positive association with pancreatic cancer risk.Cigarette smoking is the most consistent risk factor for pancreas cancer in relevant studies about pancreas cancer risk factors.

The incidence of inflammatory bowel disease (IBD) may have changed over time. The incidence and prevalence of IBD appears to be lower in Asia and South America. Although once believed to be infrequent in Iran, there has been a rising trend in IBD over the past two decades. However, in Iran there is no data about the incidence and prevalence of IBD. Demographic and clinical features, extension of disease in new patients with UC that referred to Shahid Mohammadi Hospital Gastroenterology Clinic and one private clinic, the only gastroenterology centers in Hormozgan Province, were assessed over a two-year period (2004-2006). There were 37 patients seen in 2004-2005 and 42 patients in 2005-2006, who were diagnosed with UC. The estimated incidence of UC was at least 3.25:100,000. The mean±SD age at diagnosis was 32.8±16 years, with a male to female ratio of 0.8. Most patients presented with rectal bleeding. The rectum was affected in 36.2% of cases and rectosigmoid colitis was reported in 29%, left-sided colitis in 26%, and pancolitis in 8.7% of cases. Geographic variation of the incidence of IBD within a country has also been observed and the incidence of IBD may have changed over time. The true epidemiologic profile of IBD in Iran is unknown, but with the continuing rise in IBD, more attention should be directed for evaluation of this disease

The portal system and azygos vein are the main drainage systems during portal hypertension. This study aims to compare the diameter of these veins by endoscopic ultrasonography (EUS) inpatients with and without chronic liver disease (CLD). During one year, patients with CLD enrolled as the study group. Patients who underwent EUS for other reasons during the same period served as controls. In cases with CLD, we assessed the relationship between degrees of hepatic dysfunction (Child-Pugh class), history of variceal bleeding, presence of hyponatremia, thrombocytopenia, and endoscopic grading of varices with the sizes of the portal, splenic, and azygos veins on EUS. During the study period, there were 63 patients (20 females and 43 males) with CLD and 85 control subjects (42 females and 43 males) enrolled. The mean ages of cases was 45.60 ± 14 years and controls was 48.5 ± 15 years. The most common cause of CLD was post-necrotic cirrhosis due to hepatitis B virus. Patients with CLD had significantly higher mean portal, splenic, and azygos vein diameters than the control group (p ‹ 0.001). With azygos, portal, and splenic vein diameters of 10, 11 and 9 mm, sensitivity for the diagnosis of portal hypertension was 66%, 71%, and 66%, while specificity was 94%, 99% and 99%, respectively. Splenic and portal vein dilation, and thrombocytopenia significantly correlated with variceal bleeding (p ‹ 0.05).Conchusion: EUS allows for the collection of valuable quantitative data from the portal system, the diagnosis of portal hypertension, and follow up of patients with CLD.

A 78-year-old woman presented with epigastric pain following the use of non-steroidal anti-inflammatory drugs (NSAIDs) for joint pain relief. She underwent UGI endoscopy. During UGI endoscopy she suffered from severe retching despite the use of sedatives. At 6 hours after the procedure, she developed raccoon eyes with chemosis. Biopsy from the gastrointestinal (GI) mucosa revealed amyloidosis.

Encapsulating peritoneal sclerosis (EPS) is a rare, acquired condition that has been described interchangeablywith peritoneal encapsulation (PE) as well as abdominal cocoon. EPS causes complications for peritoneal dialysis (PD) patients. In EPS, the small intestine is covered by a fibrotic and inflammatory peritoneal capsule that either partially or completely encases the bowel. For EPS, there is no agreement in the literature as to whether the treatment of choice should be surgery or conservative therapy. However in the obstructive phase the treatment of choice is surgery due to the impossibility of conservative treatment. Here, we report the case of a 64-year-old woman who presented with several episodes of intestinal obstruction and peritonitis. Computed tomography (CT) of the abdomen did not show significant characteristic features of EPS. Exploratory laparotomy was performed, freeing the small bowel of adhesions and encapsulation. For EPS, adequate clinical knowledge and a high degree of suspicion are crucial for a correct diagnosis and appropriate management.