Middle East Journal of Digestive Diseases
Volume:10 Issue: 3, Jul 2018

Currently, liver fibrosis and its complications are regarded as critical health problems. With the studies showing the reversible nature of liver fibrogenesis, scientists have focused on understanding the underlying mechanism of this condition in order to develop new therapeutic strategies. Although hepatic stellate cells are known as the primary cells responsible for liver fibrogenesis, studies have shown contributing roles for other cells, pathways, and molecules in the development of fibrosis depending on the etiology of liver fibrosis. Hence, interventions could be directed in the proper way for each type of liver diseases to better address this complication. There are two main approaches in clinical reversion of liver fibrosis; eliminating the underlying insult and targeting the fibrosis process, which have variable clinical importance in the treatment of this disease. In this review, we present recent concepts in molecular pathways of liver fibrosis reversibility and their clinical implications.

BACKGROUNDAfter the introduction of the Rome IV criteria for the diagnosis of irritable bowel syndrome (IBS), studies on the clinical significance of the new criteria in the settings of a large study has been scarce.
Herein we used the infrastructures provided by one the largest cohort studies in Iran to evaluate the epidemiological features related to IBS.
METHODSA total of 9264 participants, were enrolled in the initial registry. Diagnosis of IBS was done using the Rome IV criteria. Individuals with IBS were compared with a control group. Since the study included a large sample size of patients, we used the penalized smoothly clipped absolute deviation (SCAD) regression analysis to construct a model for the evaluation of factors associated with IBS.
RESULTSOverall, data of 9163 participants entered the final analysis. In total, 1067 (11.6%) individuals were diagnosed with IBS, among which 57 (5.3%) were diarrhea dominant (IBS-D), 380 (35.6%) were constipation dominant (IBS-C), and 630 (59%) did not mention having any of the two (IBS-U).
In the regression model, back pain/arthralgia (OR:1.98, 95% CI: 1.65-2.40), insomnia (OR:1.65, 95% CI: 1.40-1.93), depression (OR:1.64, 95% CI: 1.38-1.95), female sex (OR:1.58, 95% CI: 1.27-1.96), anxiety (OR:1.43, 95% CI: 1.21-1.69), and being married (OR:1.23, 95% CI: 1.03-1.48), were associated with higher rates of IBS. We found that IBS prevalence displays a peak at the age of 41 years for both men and women.
CONCLUSIONThe present study provides a background for follow-up studies to be conducted in order to evaluate causality between IBS and some major diseases such as liver disease. We also found that opium use, although not statistically significant, in addition to sex, education, back/joint pain, depression, insomnia, anxiety, and marital status might be a contributing factor in IBS.

BACKGROUNDColorectal cancer (CRC) is one of the most common cancers worldwide. Recently treatments of advanced CRC have been immensely improved. In this study we reported the current state of advanced CRC in Iran regarding treatment and outcomes from 2000 to 2016.
METHODS370 subjects with stage III or IV of the disease were included in this study. Pathological subtypes other than adenocarcinoma were excluded. Demographics and other relevant clinical data were collected.
RESULTSMean age at diagnosis was 55.4±12.6 years. Significant differences regarding the age, sex, primary tumor complication and location, lymph node involvement, and tumor size were not detected between patients with stage III and IV. Overall survival rate at 5 years was 69.5% (95% confidence interval: 60.8%-76.6%) and 21.73% (95% CI: 12.46%-32.70%) for patients with stage III and IV, respectively. Analysis of prognostic factors revealed that tumor grade was an independent factor predicting poorer outcome (poorly differentiated vs. well or moderately differentiated). Furthermore, in stage IV of the disease, IVb subgroup was found to be associated with a poorer outcome compared with stage IVa.
CONCLUSIONEven with the acceptable survival rates and more effective treatments, it seems that clinico-pathological characteristics have yet the most important prognostic effect in advanced CRC.

BACKGROUNDAchalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in achalasia is still unknown. One hypothesis is that certain neurotropic viruses and autoimmune factors cause the inflammatory response in myenteric network, which consequently destroy neural cells. This study was designed to find the evidence of viral causes of achalasia.
METHODSIn this case-control study, 52 patients with achalasia and 50 controls referred to Shariati Hospital, were evaluated for the genome of neurotropic viruses, HPV, and adenovirus by polymerase chain reaction (PCR) and reverse transcription (RT) PCR techniques.
RESULTSGenome assessment of neurotropic DNA viruses turned out negative in the patients, however, the genome of HSV-1 (Herpes simplex virus) was found in tissues of six controls. No neurotropic RNA viruses were observed in the tissue samples and whole blood of both the patients and controls. Among non-neurotropic viruses, adenovirus genome was positive in tissues of two out of 52 patients and three out of 50 controls. In addition, one out of 52 patients and two out of 50 controls were positive for HPV infection in tissues.
CONCLUSIONWe could not detect any significant relationship between achalasia and HPV, adenovirus, and neurotropic viruses in the cases. Nevertheless, it does not exclude the hypothesis of either an alternate viral species or resolved viral infection as the etiology of achalasia.

BACKGROUNDColorectal cancer (CRC) is one of the most common cancers among men and women worldwide. Cancer metastasis is the main cause of death in patients with cancer. NEBL(nebulette, Gene ID: 10529) protein interacts with thin filaments in the cell and may functionally destabilize focal adhesion composition. There are some studies on NEBL gene expression alteration in cancer. In the presented study we aimed to analyze NEBL gene expression in patients with colorectal cancer to explore possible association of this gene with clinicopathological features in CRC.
METHODSSixty-seven fresh samples of colorectal tumors and adjacent normal tissues were collected from Iranian patients with CRC. Real time polymerase chain reaction was performed to measure the level of NEBL gene expression and its association with clinico-pathological features.
RESULTSA significant overexpression with 3 fold increse was seen in NEBL mRNA level in tumoral tissues compared with the adjacent normal tissues. In addition there was a significant association between NEBL gene expression with lymph node metastasis in patients with CRC.
CONCLUSION The overexpression of NEBL has the capacity to be considred as a prognostic biomarker in patients with CRC.

BACKGROUNDDespite progress in the health indexes in recent years, health inequalities remain as a global challenge within and between regions and countries. This study is the first to quantify the socioeconomic inequity in gastroesophageal reflux disease (GERD) using the concentration index.
METHODSIn this cross-sectional study, we used baseline data (7012 subjects) from the Fasa Cohort Study (the Southern Iran). The principal component analysis was used to construct socioeconomic status of the participants. The concentration index and concentration curve were used to measure socioeconomic-related inequality in GERD. Decomposition of concentration index was also done to identify the contribution of each explanatory variable to the wealth-related inequality in GERD prevalence.
RESULTSThe prevalence of GERD was 16.9% (95% CI: 15.9-17.7%). The overall concentration index for GERD was 0.093 (95% CI: 0.062-0.166]. Correspondingly, this figure for men and women were 0.116 (95% CI: 0.062-0.171%) and 0.091 (95% CI: 0.044-0.137%), respectively. The main contributors of socioeconomic-related inequality in GERD prevalence were socioeconomic status (64.4%), alcohol drinking (29%), and age (8.4%).
CONCLUSIONGERD is significantly more concentrated among richest people. There was significant socioeconomic inequality in GERD according to some individual factors. These inequalities need to be addressed by policy makers to identify the vulnerable subgroups and to reduce the disease burden in the community.

Skin metastases from colorectal carcinoma are rare and signal advanced disease. Skin metastasis refers to growth of cancer cells in the skin originating from an internal cancer. In most cases, cutaneous metastasis develops after the initial diagnosis of the primary internal malignancy and late in the course of the disease. In very rare cases, skin metastasis may occur at the same time or before the primary cancer has been discovered and may be the prompt for further thorough investigation. The incidence of skin metastasis varies but is somewhere between 3-10% in patients with a primary malignant tumor. Most common ones are melanoma (45%), breast cancer (30%), nasal sinus cancers (20%), cancer of the larynx and cancer of the oral cavity (12%) cases. Here we present a case of 39-year-old man presented to us with multiple subcutaneous lesions over the chest and forehead. Fine needle aspiration cytology of skin nodules revealed metastatic adenocarcinoma features. Further imaging of the abdomen with computed tomography (CT) revealed circumferential narrowing of caecum and ascending colon. The patient was managed with palliative right hemicolectomy in view of constipation and palliative chemotherapy as systemic treatment. An extensive review of the English literature did not reveal extensive data on metastatic subcutaneous nodules leading to diagnosis of colon cancer.

A 14-year-old girl visited our hospital with pyrexia of unknown origin. In view of suspicion of tuberculosis, various haematological and radiological investigations were done. Further examinations revealed titres positive for lupus anticoagulant syndrome. Contrast-enhanced computed tomography (CT) of the chest and abdomen was also advised for further evaluation, which revealed type II SVC (superior vena cava) obstruction. Contrast-enhanced CT of the abdomen revealed an interesting observation in the left lobe of the liver, which is known as the hot spot sign.

We read with interest the article by Saidi and colleagues on current challenges of liver transplantation (LT) in Iran. The authors have truly pointed out the increasing need for LT in Iran, but some of the issues they raised as challenges need to be looked more carefully.
The authors claimed that there was no national registry for LT in Iran. Indeed Ministry of Health and Medical Education of Iran (MOHME) has an active registration system in place for all transplanted patients including solid organ transplantation recipients for more than two decades. Despite gradual but progressive improvement of this system, there is still space for improvements. Recently this system has been linked to drug providing system, which further facilitates providing the subsidized immunosuppressive drugs to these patients.