Govaresh
Volume:18 Issue: 2, 2013

Obesity is a tremendous, increasing health problem worldwide. There are multiple endoscopic treatments for obesity. This study is a systematic review of researches on these methods and an evaluation of their safety and efficacy. We conducted a MEDLINE electronic research to review relevant English articles and abstracts published in the previous ten years(up to September 2012) on endoscopic treatments for human obesity. Overall, we found 62 articles. Of these, 42 articles (n=6406 cases) evaluated the bioenteric intragastric balloon (BIB) method. The percent of excess weight loss (EWL%) was 7.6%-62.3% and proportion of weight loss (WL) was 5.4-28.5 kg over six months. A total of five articles (n=159 cases) researched the air filled gastric balloon technique and reported a WL of approximately 10-17 kg in six months. Another five articles (n=112 cases) studied the duodeno jejuna bypass liner (DJBL) method and showed an EWL% of 11.9%-40% and WL of 8.2-16.7 kg over a 3-month period. Researchers evaluated botulinum toxin A (BTX A) injections in nine articles (n=144 cases) with a WL in two months of 0-11 kg. In three articles (n=64 cases), endoscopic suturing of the stomach was evaluated with an EWL% of 58.1 kg in six months. Another three articles (n=99 cases) evaluated transoral gastroplasty with an EWL% of 24.4%-36% and WL of 14-24 kg over six months. We have located numerous studies on the BIB procedure with lengthy (up to 5 years) monitoring of cases. According to these studies, BIB is a short-term, effective weight loss treatment. BIB may be a suitable method for preoperative weight loss in patients who are candidates for bariatric surgery to decrease the risk of surgery; in cases who are not candidates for surgery due to the risk of surgery; or in patients with moderate obesity as a primary weight loss treatment to induce changes in the patient''s life style. DJBL and transoral gastroplasty sounds larger and more effects but additional long-term researches are needed to clarify the safety and efficacy of DJBL and transoral gastroplasty.

Quality of life is a main outcome in psychosomatic disorders. Several psychological factors are mentioned for predicting the quality of life in patients who suffer from irritable bowel syndrome (IBS). The aim of this study is to determine the relationship between type D personality and quality of life in patients with IBS. This study enrolled 90 (52 women) IBS patients who referred to the gastroenterology clinics of Imam Khomeini and Laleh hospitals from September to December 2012. We used the Type D Personality and IBS Quality of Life questionnaires to evaluate patients. Data were analyzed by Pearson correlation and multi-variable regression models. Overall, 61% of patients were H. pylori positive. The mean anti-Thyroid peroxidase level in the H. pylori positive group We observed a relationship between type D personality and quality of life in patients with IBS (r=0.504, p<0.01). The results showed a 26% variation in quality of life predicted by type D personality (p<0.01, R2=0.26). According to the results, type D personality is one of the predictors of quality of life in patients with IBS. Therefore, it is important to consider psychological factors when choosing the appropriate treatment for IBS patients.

The current research is performed to compare the effectiveness of two methods of cognitive behavior therapy and mindfulness based therapy in decreasing symptoms of patients who suffer from irritable bowel syndrome. This was a quasi-experimental design study that consisted of an experimental group subdivided into two groups (pre- and final test) and a control group. Based on convenience sampling we randomly assigned 36 persons, 20 males and 16 females, n=12 per group, μ=32 years of age, to one of the three groups. Irritable bowel syndrome symptoms significantly decreased between the two treatment groups and the control group (p˂0.05), which we attributed to the benefits of mindfulness based therapy. Therapists should consider modern psychotherapy techniques such as mindfulness based therapy as potential methods for decreasing the clinical symptoms of irritable bowel syndrome. Older techniques are not always perfect or effective.

Celiac, one of the most important malabsorbtion diseases caused by a reaction to gluten, results in inflammation of the small intestine and malabsorbtion.Two atypical microscopic colitis, collagenousand lymphocytic, have completely normal endoscopic appearances. Celiac disease should be excluded in all patients with lymphocytic colitis, particularly if diarrhea does not respond to conventional therapy. The objective of this study is to compare the serologic level ofanti-TTG antibody in patients with microscopic colitis who have referred to a GI sub-specialty center with the normal population in Sanandaj, Iran during 1391. This was a case control study conducted on 60 patients diagnosed with microscopic colitis who referred to SanandajTohid Clinic in 1391. Participants were chosen by census sampling. At the time of referral, demographic data was obtained and documented. Patients’ blood samples were taken and IgA tissue trans-glutamate levels checked by the Elisa method. Participants with positive antibodies were considered celiac positive.The control group consisted of patients with no GI complaints (diarrhea), weight loss or anemia. Controls were matched for age and sex, and analyzed for celiac serology with the microscopic colitis group. From 60 patients with microscopic colitis (32 male, 28 female) there were 53 patients with lymphocytic colitis and 7 who had collagenous colitis. Of these, 9 (15%) lymphocytic patients were positive for celiac serology. No patients with collagenous colitis tested positive for celiac serology.From 120 healthy cases (64 male, 56 female), 3 (2.5%) were positive for celiac serology. The mean age was 35.8±13.1 years for patients with microscopic colitis and 35.1±12 years for healthy controls. Of 23 patients who underwent small intestinal biopsies, 13 (56.5%) were positive for celiac disease. The rate of positive serology tests for Celiac is higher in patients diagnosed with microscopic colitis in comparison to healthy individuals in Kordestan Province.Patients with microscopic colitis that is non-responsive to treatment should be assessed for celiac disease by antibody testing or biopsy. Patients diagnosed with celiac disease that is non-responsive to a gluten-free diet should be assessed for microscopic colitis.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease that results in segmental stenosis of the bile ducts, cholestasis and fibrosis. During the previous two decades, patients with steroid responsive PSC have been presented in a few case reports and studies. This study aims to evaluate and compare IgG4 levels in patients with ulcerative colitis (UC), with and without PSC. This cross-sectional study enrolled 116 patients with UC who referred to the Gastrointestinal Clinic of Imam Khomeini Hospital, Tehran, Iran. Patients with allergic diseases such as asthma and atopic dermatitis as well as those with autoimmune disorders such as vasculitis and systemic lupus erythmatosus were excluded. After signing an informed consent form, 5cc blood sample was taken for serum IgG4 evaluation. Patients with clinical or laboratory signs of PSC underwent Magnetic resonance cholangiopancreatography (MRCP) after which patients were divided into two groups (with and without PSC) according to the results of their MRCP findings. IgG levels more than 157 mg/dl were considered elevated. SPSS software package version 16 was used for data analysis. A significance level of 0.05 was considered statistically significant. There were 57(49.1%) male participants, of which 24 (20.7%) had evidence of PSC. Among these, 7 (29.1%) had elevated IgG4 titers. Of participants, 92 did not have PSC. From this group, 9 (9.7%) had elevated IgG4 levels. This difference was statistically significant (P=0.012). The odds ratio was 3.9 (CI: 1.28-12.1) and the area under the curve for IgG4 in predicting PSC in the ROC curve was 0.65. There was a significant relationship between IgG4 titer and colitis extension in both groups. However there was no significant relationship regarding the severity of colitis (P=0.247). It is necessary to evaluate IgG4 titers in all patients with PSC because of its treatable nature. Determining IgG4 levels in all UC patients can be a predicting factor for PSC. Thus additional cohort studies with larger numbers of participants are recommended.

Inflammatory bowel disease (IBD) is a chronic relapsing, idiopathic disorder of the gastrointestinal tract of an unknown etiology. Ulcerative colitis (UC) and Crohn''s disease (CD) have become important health problems. Current medical therapy of IBD has advanced dramatically with the introduction of new biologic therapies in addition to the optimization of conventional therapies that include drugs such as immunosuppressors and 5-aminosalicylic acid (5-ASA), and a better identification of factors involved in the pathogenesis of IBD.The aim of this review is to provide a brief historical perspective of the available evidence for the use of various medications in IBD followed by a recent literature update. The intent is to enhance the clinician''s perspective regarding IBD treatment.

Annular pancreas is a rare congenital condition of the pancreas where the pancreatic tissue either partially or completely covers the duodenum by forming a ring. Endoscopic Ultrasound is rarely considered as the first diagnosis tool for annular pancreas. We here present a 48 years old man who was primarily provisionally diagnosed with pancreatic mass and was planned for pancreatoduodenectomy. But upon using endoscopic ultrasound a confirmative diagnosis of annular pancreas was reached.

Kindler syndrome is a rare hereditary disorder that predominantly involves the skin and mucous membrane. Acral skin blistering, progressive photosensivity, skin atrophy and poikiloderma that begin from infancy and childhood are considered to be characteristic manifestations. Urethral, anal, esophageal, mouth and laryngeal mucosa may be involved in this syndrome, thus periodontitis and gingival involvement, anal, esophageal or urethral strictures may be present in this disease.Although gastrointestinal tract involvement in patients with Kindler syndrome is possible, it is rare in the literature. We report the case of a 34-year-old male with Kindler syndrome who had referred with dysphagia. Upper gastrointestinal endoscopy revealed an esophageal web in the upper third of the esophagus. Endoscopic dilatation of the esophageal web was performed by using a mechanical dilating bougie.Two months after esophageal dilatation we found significant improvement in the patient''s dysphagia according to the validated Mayo Dysphagia Questionnaire (MDQ).