Govaresh
Volume:17 Issue: 1, 2012

The majority of dyspeptic patients do not have identifiable disease, which is also known as functional dyspepsia. The therapeutic approach to patients with functional dyspepsia is still a matter of debate; prokinetic agents are commonly used for symptom relief. This study aims to evaluate the efficacy of domperidone and pyridostigmine (an inhibitor of cholinesterase) in patients with functional dyspepsia.This was a single-blind, randomized clinical trial performed on 117 patients (December 2007 to November 2009) diagnosed with functional dyspepsia according to ROME II criteria. The effects of 4 weeks of treatment with domperidone (10 mg tid), pyridostigmine (60 mg tid), and placebo were compared. We scored each patient according to VAS to rank the severity of 8 different upper GI symptoms (epigastric fullness, early satiety, gnawing, nausea, vomiting, belching, bloating, and epigastric pain) both before and at the end of treatment. Data were entered into SPSS software version 16 and analyzed. p ‹ 0.05 was considered significant.At the end of treatment, the total dyspeptic symptom score decreased from 24 to 13. According to ANOVA, there were significant differences between the 3 groups in 3 out of 8 symptom scores of bloating (p=0.039), early satiety (p=0.006), and nausea (p=0.016). The post hoc test determined that domperidone was more effective than pyridostigmine and placebo in improvement of early satiety (p=0.038 and p=0.014, respectively). Domperidone was more effective than pyridostigmine in the control of nausea (p=0.024). Domperidone (p =0.023) and pyridostigmine (p=0.042) were superior in relieving bloating symptoms compared to placebo. Overall, in the control of GI symptoms domperidone was more effective than placebo (p=0.045).Domperidone and pyridostigmine are useful in improving bloating, early satiety, and nausea. However they are similar to placebo in controlling epigastric pain, fullness, belching and gnawing.

Endoscopic ultrasonography (EUS) has a pivotal role in staging and diagnosis of different gastrointestinal (GI) disorders. Although this equipment is not readily available and not all gastroenterologists are trained in this technique, the importance and efficacy of this imaging modality is obvious for all gastroenterologists. We report the indications and prevalence of lesions visualized by EUS, in a EUS center.We evaluated the demographic characteristics, indications, and recorded EUS diagnosis of patients during a 5 year (2007-2011) period.During the study period, 3198 patients (51.2% males) underwent EUS. Upper GI endosonography, within which, pancreatobiliary disorders followed by gastric cancer were the most common indications for patient referral. The rate of patient referral for EUS increased yearly.EUS is an accurate method for the diagnosis of different GI abnormalities. The most common cause for patient referrals are benign pancreatobiliary disorders.

The purpose of this study was to determine reliability and construct validity of a Persian version of the Gastrointestinal Symptoms Rating Scale (GSRS) in 2 samples of patients with functional gastrointestinal disorders (FGID) and healthy persons. The clinical sample consisted of 143 patients diagnosed with FGID who were referred to the Psychosomatic Disorders Clinic. Controls consisted of 108 healthy individuals (without digestive diagnoses) matched by age, gender, marital and educational status. The results of the factor structure or construct validity that used the principal components analysis with varimax rotation was 4 factors of diarrhea, abdominal pain, constipation, and indigestion in patients with FGID, which showed a 61.53 variance. Among the 6 factors of indigestion, abdominal pain, constipation, diarrhea, hungry pain, and nausea in healthy persons there was a 73.32 variance. Reliabilities of the GSRS and its dimensions were satisfactory with Cronbach-Alpha. The Persian version of the GSRS has favorable reliability and validity.

Colorectal cancer is the second cause of mortality in developed countries. The p53gene and some of it's polymorphisms are among the causes for cancer development.The purpose of this study is to evaluate the relationship between the p53 codon 72 polymorphism in colorectal adenocarcinoma specimens compared with controls. We performed a case-control study among 112 patients with colorectal carcinoma and 112 controls in Rasht, Iran. Different genotypes of codon 72 were determined by allele-specific polymerase chain reaction (PCR). The frequency of the Arg/Arg genotype of the p53 codon 72 polymorphism was 35.7%, for Arg/Pro it was 50.9%, and for Pro/Pro it was 13.4% in colorectal cancer patients. Among controls, the Arg/Arg genotype was seen in 37.5%, Arg/Pro was noted in 50%, and Pro/Pro was seen in 12.5% (p = 0.95). When tumor location was taken into consideration, 68.8% of the Arg/Arg carrier genotypes were associated with an increased incidence of left colon cancer. There was a significant statistical relationship between expression of the Arg allele in colorectal cancer samples and metastases (p = 0.003). The majority of colorectal cancer patients with p53 Arg homozygosity had left-sided colon cancer. There was also a relation between p53 Arg homozygosity, lymph node involvement, and metastases. Thus, we have suggested that the correlation between this polymorphism, tumor risk, and metastasis should be studied to determine its effectiveness as a diagnostic factor.

Esophageal cancer is one of the prevalent cancers in East Azerbaijan Province. The aims of this study are to estimate the survival rate of patients with esophageal cancer by treatment modalities and tumor location, as well as risk factors such as cigarette smoking, family history, age at diagnosis, and gender.In a cross-sectional study we evaluated 142 patients diagnosed with esophageal cancer (89 men, 53 women) who referred to the Educational Center in Tabriz, Iran. Demographic data, risk factors, histology, tumor location, stage and treatment modalities were collected. We followed patients for one year after diagnosis. The Kaplan-Meier method was used to estimate survival probability and Cox proportional hazards model for multivariate analysis of risk variables.Mean age of patients was 65.63±11.98 years. A past history of cigarette smoking was positive in 50.4% of all patients, of which 66% were women. The lower third of the esophagus was the most common site of involvement. One year survival rate of our patients was 43%, with a low median survival time of 10 months. Age, gender, and tumor location did not show any significant effects on patient survival. Patients treated with surgery or chemoradiotherapy alone as well as those who smoked cigarettes had shorter survival.Although the survival rate is low in esophageal cancer patients in our province, the life expectancy among those patients can be increased by proper selection of the treatment modality.

ABO blood groups are associated with some important chronic diseases. Obesity as a major risk factor of chronic non-communicable diseases is rising rapidly in Iran as well as in developing countries. Understanding the risks for obesity is important for its control. This study seeks to determine if there is any association between ABO blood groups and body mass index (BMI).Weight, height and blood groups were determined for participants of the Golestan Cohort Study in order to find any associations between ABO blood groups and BMI.Prevalences of overweight and obesity in participants (mean age: 52.1±8.0 years) were 33.9 and 25.4, respectively. Mean weight and BMI were significantly higher in blood group A, females and those of Turkman ethnicity. After adjustments for age, sex and ethnicity, there was no association noted between BMI and ABO blood group.The prevalence of obesity and overweight in Iran is high, as seen in developing countries. There is no association between BMI and ABO blood groups in the Golestan cohort population, but Turkman ethnicity and female gender are associated with higher BMI.

Linguatula serrata (L. serrata), an aberrant arthropod of the Pentastomida phylum, inhabits the canine respiratory system as its final host. Intermediate hosts include humans and herbivores. Humans can be infected via consumption of raw or under-cooked liver or lymph nodes of sheep, goats, and cattle. A few human cases have been reported from Iran. Here, we have reported a case of pentastomiasis infection in a 55-year-old man who presented with fever, abdominal pain, abdominal distension, and weight loss. Small bowel transit revealed partial obstruction in the small intestine. Abdominal CT scan showed increased small bowel wall thickness. Both laparoscopy and biopsy findings favored parasitic granuloma from a pentastomiasis infection. He was administered praziquantel and albendazole. After two weeks of therapy the patient recovered.

The association of Takayasu arthritis (TA) and inflammatory bowel disease is rare. Early diagnosis and treatment may influence patient survival. This report describes a 35-year-old woman who had been treated for ulcerative colitis (UC) that manifested with weight loss, upper limb cluadication and vertigo. The diagnosis of TA was made according to the American College of Rheumatology criteria. The patient received corticosteroids and cyclophosphamide; however she experienced two additional cerebral events and died after four months. Although the association of TA with UC is rare, we recommend it be considered in young patients with UC who suffer from unexplained weight loss and other constitutional symptoms or cerebrovascular accidents.