Middle East Journal of Digestive Diseases
Volume:12 Issue: 2, Apr 2020

Recent evidence has demonstrated a strong interplay and multifaceted relationship between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD). CVD is the major cause of death in patients with NAFLD. NAFLD also has strong associations with diabetes and metabolic syndrome. In this comprehensive review, we aimed to overview the primary environmental and genetic risk factors of NAFLD, and CVD and also focus on the genetic aspects of these two disorders. NAFLD and CVD are both heterogeneous diseases with common genetic and molecular pathways. We have searched for the latest published articles regarding this matter and tried to provide an overview of recent insights into the genetic aspects of NAFLD and CVD. The common genetic and molecular pathways involved in NAFLD and CVD are insulin resistance (IR), subclinical inflammation, oxidative stress, and atherogenic dyslipidemia. According to an investigation, the exact associations between genomic characteristics of NAFLD and CVD and casual relationships are not fully determined. Different gene polymorphisms have been identified as the genetic components of the NAFLD-CVD association. Some of the most documented ones of these gene polymorphisms are patatin-like phospholipase domain-containing protein 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), hydroxysteroid 17-beta dehydrogenase 13 (HSD17B13), adiponectin-encoding gene (ADIPOQ), apolipoprotein C3 (APOC3), peroxisome proliferator-activated receptors (PPAR), leptin receptor (LEPR), sterol regulatory element-binding proteins (SREBP), tumor necrosis factor-alpha (TNF-α), microsomal triglyceride transfer protein (MTTP), manganese superoxide dismutase (MnSOD), membrane-bound O-acyltransferase domain-containing 7 (MBOAT7), and mutation in DYRK1B that substitutes cysteine for arginine at position 102 in kinase-like domain. Further cohort studies with a significant sample size using advanced genomic assessments and next-generation sequencing techniques are needed to shed more light on genetic associations between NAFLD and CVD.

We assessed dietary intakes in the high- and low-risk areas for esophageal cancer (EC) in Golestan province, Northern Iran.

Considering the EC rates, Golestan province was divided into high- and low-risk regions. Data on households' food consumption were obtained from the Statistical Center of Iran. We used multivariable logistic regression to assess the relationships between consumption of main food and EC risk. Adjusted odds ratios (aOR) were calculated. Joint point program was used for time trend analysis and average annual percent changes (AAPC) were reported.

Overall, 11910 households were recruited during 2006-2015. 4710 (39.5%) households were enrolled from the high-risk region. There were significant positive relationships between high consumption of sweets (aOR=1.62; 95% CI: 1.24-2.10), oil/fat (aOR=1.36; 95% CI: 1.04-1.79), and red meat (aOR=1.33; 95% CI: 1.07-1.65) with EC risk. We found significant negative relationships between high consumption of dairy products (aOR=0.62; 95% CI: 0.46-0.82), vegetables (aOR=0.66; 95% CI: 0.50-0.87) and fruit (aOR=0.72; 95% CI: 0.55-0.95) with the risk of EC. Time trend analysis showed a significant increasing trend in the proportions of households with low consumption of vegetables (AAPC=4.71, p=0.01) and dairy products (AAPC=5.26, p =0.02) in the low-risk region for EC.

Dietary intakes may be important etiological factors for EC in Northern Iran. Further studies are warranted to assess the role of dietary factors in this high-risk population.

There are controversial ideas about the application of metabolic indices for the prediction of non-alcoholic steatohepatitis (NASH). In this study, we evaluated some novel metabolic indices for the screening of NASH.

This prospective case-control study was performed in a gastroenterology outpatient clinic. Consecutively selected patients with persistently elevated aminotransferase levels and evidence of fatty liver in ultrasonography were enrolled. Those with other etiologies of aminotransferase elevation were excluded. The remaining was presumed to have NASH. The control group consisted of age and sex-matched subjects with normal liver function tests and liver ultrasound examinations.

Finally, 94 patients with steatohepatitis and 106 controls were included in the project. The mean liver fat content (LFC), aspartate aminotransferase, and alanine aminotransferase levels were significantly lower in the control group than in the NASH group. LFC was independently associated with the presence of NASH in logistic regression analysis. LFC had a good area under the curve for the prediction of NASH in ROC (receiver operating characteristic curve) analysis.

LFC seems to be a reliable metabolic index for the detection of patients with NASH.

Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections worldwide, which is associated with peptic ulcer disease and gastric cancer. In this study, we compared the efficacy of 10-day versus 12-day concomitant therapy as the first-line treatment for H. pylori eradication in Iran.

218 patients with peptic ulcer disease and naïve H. pylori infection, were randomly divided into two groups to receive either 10-day or 12-day concomitant regimens, composed of pantoprazole 40 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and metronidazole 500 mg, all given twice daily. Eight weeks after treatment, H. pylori eradication was assessed by 14C- urea breath test. The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170521034070N2).

212 patients completed the study. According to the intention to treat analysis, the eradication rates were 83.6% (95% CI: 76.6-90.5) and 88.8% (95% CI: 82.8-94.7) in 10-day and 12-day concomitant therapy groups, respectively (p =0.24). Per-protocol eradication rates were 85.9% (95% CI: 79.3–92.4) and 92.6% (95% CI: 87.6–97.5), respectively (p =0.19). The rates of severe side effects were not statistically different between the two groups (3.6% vs. 8.1%; p=0.428).

12-day concomitant therapy could achieve ideal eradication rates by both intention to treat and per-protocol analyses. In order to reduce the cost of drugs and the rate of adverse effects of therapy, among 10-day and 12day regimens, 12-day concomitant therapy seems to be a good alternative to 14-day concomitant therapy that has been suggested by international guidelines

End-stage cirrhosis is an irreversible condition, and liver transplantation is the only treatment option in for the affected patients. Respiratory problems and abnormal breathing are common findings among these patients. In this study, for the first time, we examined the relationship between the severity of liver cirrhosis and respiratory drive measured by mouth occlusion pressure (P0.1).

This was a cross-sectional study conducted on 50 candidates for liver transplantation who were referred to the pulmonary clinic of Imam Khomeini Hospital for pre-operative pulmonary evaluations. Arterial blood gas analysis (ABG), pulmonary function tests, and measurement of P0.1 were performed for all patients. The severity of liver disease was assessed using the Model for End-Stage Liver Disease (MELD) score.

The median P0.1 was 5 cm H2O. P0.1 was negatively associated with PaCO2 (r=-0.466, p=0.001) and HCO3- (r=-0.384, p =0.007), and was positively correlated with forced expiratory volume at 1s (FEV1)/ forced vital capacity (FVC) (r=0.282, p =0.047). There was a strong correlation between P0.1 and MELD score (r=0.750, p <0.001). Backward multivariate linear regression revealed that a higher MELD score and lower PaCO2 were associated with increased P0.1.

High levels of P0.1 and strong direct correlation between P0.1 and MELD score observed in the present study are suggestive of the presence of abnormal increased respiratory drive in candidates for liver transplantation, which is closely related to their disease severity.

The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome.

A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs.

Median weight gain and the amount of calorie delivered during NICU stay in subjects of NST-supported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant.

NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Gossypiboma refers to inadvertently retained foreign objects after surgical operations. High body mass index and emergency surgery are risk factors of the condition. Presenting symptoms are usually non-specific and it may result in serious complications such as bowel obstruction. Removal can be attempted with endoscopic or surgical approaches depending on the site and presence of complications. This case highlights the need for considering gossypiboma in patients presenting with abdominal symptoms after recent abdominal surgery. Herein we report the case of a 30-year-old woman with abdominal pain two months after mini-gastric bypass surgery. Cross-sectional imaging showed a hyperdense area in the small bowel concerning for malignancy. However, upper endoscopy revealed a 10×40 cm retained surgical gauze in the afferent loop that was successfully retrieved. Although rare, retained foreign body should be considered in the differential diagnosis of postoperative abdominal pain.

Actinomycosis is a rare bacterial disease characterized by chronic or subacute suppurative inflammation. Abdominal actinomycosis is rarer and accounts for approximately 20% of all actinomycosis cases. In the literature, patients who underwent surgery for actinomycosis mimicking malignant tumors have been reported. Most of these patients had mucosal trauma and inflammation signs. It is often difficult to diagnose abdominal actinomycosis preoperatively and often impossible to distinguish it from a malignant tumor. We present a case that preoperatively was diagnosed as a malignant tumor but pathological evaluation reported to be diverticulitis and actinomycosis. This case can increase the awareness about this disease, which is possible to be treated non-surgically.

Here we report a case of a 62-year-old man who presented to the gastrointestinal clinic during the past 6 months with symptoms of chronic abdominal pain, accompanied by dyspepsia and weakness. He suffered from type 2 diabetes and hypertension and had received drug treatment for both diseases. Over the past year, he had repeatedly taken non-steroidal anti-inflammatory drugs (NSAIDs) due to arthralgia without the use of gastric acid inhibitors. He refused the presence of melena or bleeding when describing his condition. Physical examination showed that he only had a sensitivity of the upper abdomen, and in blood tests, microcytic anemia with serum iron level 7.1 μg/dL and iron deficiency with serum ferritin level 10 ng/mL, and hemoglobin 10.1 g/L were detected. He was examined for gastrointestinal microcytic anemia and the symptoms. Esophagogastroduodenoscopy showed normal esophagus, erosive gastritis, normal duodenum, and Double pylorus. Colonoscopy was normal. The endoscope passed both channels separately and the bulb of the duodenum was seen. (figure 1). The patient's double pylorus was confirmed by contrast radiography (figure 2). Also, urea testing of rapid Helicobacter pylori was conclusive, while histological studies of the gastric corpus and antrum revealed that chronic active gastritis was present in both and many Helicobacter pylori bacteria were found in H&E staining. The patient was treated to eradicate Helicobacter pylori with clarithromycin 500 mg, amoxicillin 1 g, and omeprazole 20 mg, twice daily for 14 days. Eradication was confirmed by a carbon-13 breath test, two months after treatment. Proton pump inhibitors were continued to be used once daily and NSAIDs use was restricted. Symptoms disappeared after a few weeks of treatment and the patient's anemia normalized after 6 months of treatment with the iron pill.

A 26-year-old female patient was admitted to our hospital, complaining of obstipation, nausea, and vomiting for the past 3 days. She had no significant medical and clinical history. The patient had no history of previous abdominal operations or medication use. Distension of the abdomen was the only finding on clinical examination. Plain abdominal radiography showed air-fluid levels and abdominal computed tomography (CT) showed the clustered terminal ileum and cecum, with dilatation at the proximal parts (figure 1). The findings of laboratory tests were within normal limits. Exploratory laparotomy was performed. At laparotomy, we found that loops of ileum and cecum were trapped in a fibrotic sac with a diameter of nearly 10 cm (figure 2).