Middle East Journal of Digestive Diseases
Volume:7 Issue: 2, Apr 2015

Human biorepositories are collection of biological samples and health information from a large number of participants generally in the cohort studies. The main purpose of established biobanks is organization of biomedical research for upgrading the knowledge of human disorders from cancer to infectious and rare disease. The studies of generation relationships and understanding the preclinical stages of ageing are also from the solution of bitobank.This review overview the significance and storage condition of biospecimens including whole blood, red blood cells (RBC), buffy coat, plasma, serum, DNA and RNA that derived from blood in human biobanks. These biological samples provide valuable information on the prevalence of germline mutations, epigenetic modifications or interaction between genes and proteins in associated with the development of certain types of disease. The quality of biospecimen in biobanks is a powerful tool for valid identification of biomarkers. Therefore optimum qualities of human biological samples in long time storage that have been assessed in several studies also indicate in this review.

The geographical incidence of IBD varies considerably. This study aimed to survey the epidemiologic features of IBD in Guilan province, North of Iran, during ten years duration.In this retrospective cross-sectional study, we assessed the documents of 868 patients with IBD referred to private and governmental clinics of Guilan province between 2002 and 2012. Variables such as demographic data, risk factors, diagnosis, extraintestinal manifestations and type of treatment were collected.Among 868 patients with IBD, 756 patients (87.1%) diagnosed as UC and 112 patients (12.9%) as CD. The mean age of patients with UC and CD was 46.73±15.79 and 40.15±14.27 years respectively. Male/female ratio in UC and CD was 0.92:1 and 0.75:1 respectively. The most common age of disease initiation in UC was 40-59 years and in CD 20-39 years (P<0.001). Extraintestinal manifestations were seen in 25.4 percent of patients with IBD. Most of patients were treated with combination of two drugs: salicylates and azathioprine (P<0.04). The incidence of IBD gradually increased during the past 4 years in Guilan province.This study showed that CD were presented significantly more common in younger patients than UC and totally the disease was slightly more common in female.

The eradication of Helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment.Forty-eight H. pylori-positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. They received pantoprazole (40 mg-bid), amoxicillin (1 g-bid), bismuth subcitrate (240 mg-bid), and clarithromycin (500mg-bid) for 10 days. Eight weeks after treatment, a 14C-urea breath test was performed for the re-evaluation of H. pylori eradication. Forty-three patients completed the study. H.pylori eradication rates were 79.2% (95% CI=65.00-89.53) and 88.4% (95% CI=74.91-96.11) according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. In developing countries such as Iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects.

In some studies inflammatory bowel disease (IBD) and celiac disease were considered to be associated and some belive that this association may influence the prognosis of IBD. However، there is a cosiderable controversy regarding this association. Therefore، we aimed to assess the association of these two common digestive diseases and evaluate the complications of this association. In this comparative study، 200 patients with ulceritive colitis (UC) and 206 patients with Crohn''s disease (CD) were evaluated for celiac disease using relevant diagnostic tests and pathologic studies. Total IgA، IgA tissue transgulaminase antibody and specific IgA anti endomysial antibody were asseyed. In cases of IgA deficiency، total IgG and IgG tissue TG and IgG anti endomyseal Ab were measured. Patients with increased specific IgA and IgG antibodies for celiac disease، underwent endoscopy and 4 standard samples were obtained. Our results were compared with the results of the prevalence study of celiac disease in the general population. Data were analyzed using analytic and descriptive statistics at a significance level of 5%. Among the studied patients، 1 patient with UC had elevated IgA anti tTG antibody and IgA anti-endomysial antibody who underwent endoscopy and celiac was confirmed on pathology. Hence، of the 200 patientswith UC، the diagnosis of celiac disease was confirmed in 1 patient (1:200) with no significant difference with the prevalence of celiac disease in the general population (1:166). However، none of our patients with Crohn''s disease had celiac disease (0:206). We found no significant difference in the prevalence of celiac disease between patients with UC and the general population. Since most of our participants had a mild level of Crohn''s activation، none of those with Crohn''s disease had celiac disease. Complications of IBD including sclerosing cholangitis، may be more common in patients with concurrent celiac disease. Therefore، it is recommended that celiac disease be considered in patients with severe and complicated IBD.

Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer. Clarithromycin resistance is a major cause of treatment failure. This randomized clinical trial aimed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H. pylori infection.In this randomized double blind clinical trial (RCT 2012102011054N2), a total of 120 patients were randomized to two groups of 60 patients each. Patients with proven H. pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e-Akram General Hospital in Tehran, Iran. The patients in the OBAG group received omeprazole (20 mg) twice daily, bismuth subcitrate (240 mg) twice daily, amoxicillin (1 gr) twice daily, and gemifloxacin (320 mg) once daily, and those in the OBAC group received omeprazole (20 mg) twice daily, 240 mg of bismuth subcitrate twice daily, amoxicillin (1 gr) twice daily, and clarithromycin (500 mg) twice daily for 10 days.Five patients from each group were excluded from the study because of poor compliance, so 110 patients completed the study. The intention-to-treat eradication rate was 61.6% and 66.6% for the OBAC and OBAG groups, respectively. According to the per protocol analysis, the success rates of eradication of H. pylori infection were 67.2% and 72.7% for OBAC and OBAG groups, respectively (p=0.568).The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen; hence, this new treatment could be considered as an alternative for the patients who cannot tolerate clarithromycin.

Due to the increased prevalence of celiac disease in chromosomal anomalies and other congenital anomalies, this study was conducted to evaluate the seroprevalence of celiac disease (CD) in patients with congenital heart defects (CHD).This case-control study was done on 1002 children in two groups of CHD patients (n=402) and controls (n=600). The serum tissue transglutamianse (TTG) levels were investigated. The two groups were compared in terms of TTG IgA levels and p<0.05 was considered as the significant level.The means of serum TTG IgA levels in children with CHD and the control groups were 19.17±46.67 and 7.77±10.02 u/mL respectively (p =0.001). After ANOVA analysis a significant difference between two cyanotic and acyanotic subgroups of cases and control groups was observed (p =0.000). The follow up tukey test showed only non-significant difference between the cyanotic and acyanotic cases. The frequency of TTG IgA with the consideration of 20 u/mL as cut-off point showed a significant association with groups (X2 =28.31 and p =0.000).According to the results the serum TTG IgA levels were significantly higher in patients with CHD than normal children and screening for CD in children with CHD is recommended.

Although complicated acute appendicitis is occasionally observed in general practice, the diagnosis of appendiceal abscess by colonoscopy is unusual. We report a case of appendiceal abscess with spontaneous drainage into the lumen of colon diagnosed during colonoscopy and resolved by the time of surgery.

Some dermatologic manifestations are common in ulcerative colitis (UC). Herein, we present a 36-year-old woman with ulcerative colitis and uncommon nasal mucosa pyoderma vegetans. The patient presented to our hospital with symptoms of active colitis and a concomitant 3×4×5 cm dermato-mucosal lesion in her left nasal lumen. After surgery of the mucosal lesion, the treatment for her active colitis was initiated with intravenous infliximab and oral asacol. After a 1-year follow-up, no sign of recurrence favoring mucosal lesion was noted and symptoms of ulcerative colitis were managed properly.

A 30-year-old man presented with a nine-months history of repetitive abdominal pain simulating dyspepsia. Nine months before presentation, a local physician saw him, and he performed upper gastrointestinal endoscopy for him, and was diagnosed as a case of mild gastritis with oral omeprazole, but without any benefit. So the patient was seen at another center and was evaluated by abdominal computerized scan (CT scan) and colonoscopy which both of them were normal. The patient was evaluated and treated also by psychiatrist as a case of functional disease.

We read with great interest the article published by Hosseini et al.1 in October issue of Middle East Journal of Digestive Diseases. Briefly, in this article, authors concluded that furazolidone based therapeutic regimens (in moderate and even high-dose) were not preferable for first-line treatment against H. pylori infection among the northern population in Iran.1 Altogether, some points we found may not support their final conclusion.