Middle East Journal of Digestive Diseases
Volume:12 Issue: 3, Jul 2020

The liver plays a pivotal role in maintaining the homeostasis of various organ systems. Also, end-stage liver disease and its complications are major causes of morbidity and mortality among adults. Individuals who develop a chronic liver disease are at increased risk of progression to multi-organ dysfunction, including the pulmonary system. The clinical complications of pulmonary problems related to the presence of liver disease range from mild (such as hypoxemia) to life-threatening diseases (such as portopulmonary hypertension and hepatopulmonary syndrome). Herein, the major pulmonary complications related to liver cirrhosis and considerations for performing liver transplantation are reviewed.

The use of herbal and synthetic compounds can be effective in improving the areas and repair of tissues that have been affected during the processes like what happens in ulcerative colitis (UC) as a common inflammatory disorder. According to the beneficial effects of aloe vera, in this study, we aimed to assess the therapeutic effects of oral aloe vera gel on acetic acid-induced colitis in rats by histopathological and molecular analysis of Bax, and BCL-2 genes expression (using RT-PCR technique) in colon tissue samples.

This experimental study comprised 32 adult male Sprague Dawley rats weighting 220 ± 20 g that were randomly divided into four groups as follows. The control group (healthy rats), colitis group in which UC was induced by transrectal administration of 3% acetic acid with no treatment, oral form of sulfasalazine group in which UC was induced by transrectal administration of 3% acetic acid, then was treated by oral administration of sulfasalazine 500 mg/kg body weight, and the fourth group which received oral form of aloe vera gel (200 mg / kg) for 21 days, respectively after induction of UC. Then, the therapeutic effects of treatment groups were compared with the control group and the colitis group with no treatment, by the assessment of histopathological and molecular changes in the colon tissues of rats on the 7th, 14th, and 21st days. Finally, the collected data were analyzed using statistical tests.

 Histologically, aloe vera gel treatment could reduce and heal colon tissue damages in induced colitis. Also, this gel reduced apoptosis in rat’s colon with acetic acid-induced colitis, which showed in significantly decreased in Bax mRNA expression and significantly increased BCL-2 mRNA expression compared with the colitis group with no treatment.

Aloe vera gel has a significant effect on the treatment of UC in rat because of the beneficial effect that was found from aloe vera such as decreasing the severity of colitis as evidenced by histopathological findings, and with respect to apoptosis and gene expression that were related to wound healing process, and suppression of the elevation of Bax mRNA with the upregulation of Bcl-2, which can be considered effective in the treatment of UC.

 The Crohn’s Disease Endoscopic Index of Severity (CDEIS) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) are two validated endoscopic scoring system to evaluate patients with inflammatory bowel diseases (IBD). We conducted this study to evaluate the correlation between clinical symptoms and lab tests with these indexes in patients with Crohn’s disease (CD) and ulcerative colitis (UC).

 In this analytical study, 373 consecutive patients referred to Shahid Mohammadi Hospital with IBD were enrolled. All patients underwent complete ileocolonoscopy, and the endoscopic severity indexes (CDEIS and UCEIS) were calculated, and their relation with clinical symptoms and lab tests was evaluated.

 Fever observed only in six patients (1.6%). It was associated with significantly higher CDEIS and UCEIS (p = 0.02 and p < 0.001, respectively). Also, diarrhea was correlated with significantly higher UCEIS (p < 0.001). The mean fecal calprotectin was 647.64 ± 409.37 µg/g in CD and 567.30 ± 342.49 µg/g in UC patients. Higher calprotectin level was observed in patients with higher CRP level (p = 0.001), erythrocyte sedimentation rate (ESR) level, CDEIS, and UCEIS (r = 0.438; 0.473; and 0.517; respectively, all with p < 0.001).

 Our study showed that although fever and diarrhea are associated with higher endoscopic severity scores in patients with IBD, no clinical symptom could reliably predict the endoscopic results, alone. Furthermore, higher fecal

Multiple sclerosis (MS) is a chronic disease with significant morbidity. A wide spectrum of risk factors has been suggested that triggers the development of MS. Among them, several viral infections have been implicated to play a role in MS pathogenesis. We aimed to evaluate the relationship between viral diseases, including Epstein–Barr virus (EBV), human herpes virus 6 (HHV-6), cytomegalovirus (CMV), and hepatitis B virus (HBV) and MS in the present case-control study.

About 100 patients with confirmed MS and age- and sex-matched individuals were selected as case and control groups, respectively. The patients were randomly selected from individuals diagnosed by neurologists based on the clinical signs and symptoms and imaging procedures.

 More than 100 patients with MS and patients who were referred for other causes were analyzed for the presence of DNA of EBV, HHV6, CMV, and HBV separately. 9.37% of the control group had a positive test for the DNA of EBV in a real-time polymerase chain reaction (PCR), while the frequency of positive test result was zero in the case group (p = 0.0012). HBV DNA was not detected in both the case and control groups. The prevalence of CMV was 0.88 and zero in the control and case groups, respectively (p = 0.3410). For HHV6, 9.73 % of the control group had a positive result, while this test was positive in 5.88% of the patients with MS (p = 0.2959).

 We detected a significantly higher number of individuals with DNA of EBV in their blood among the control group compared with the case group. In conclusion, the results suggest a surprisingly adverse association between MS and EBV, and no association was found between the presence of DNA of HBV, CMV, and HHV6 and MS.

Functional gastrointestinal system diseases (FGIDs) are a group of childhood disorders, our knowledge of which is relatively limited. More importantly, the different subgroups among such a disease group are closely interrelated, and their natural courses and interrelations have yet to be fully clarified. Functional constipation and gastroesophageal reflux disease (GERD) are most frequently seen among this group. However, evidence as to whether any relationship exists between them is limited. In this study, we tried to examine the existence or absence of this relationship.

 First, patients with functional constipation were identified based on ROME III criteria, which included 205 patients. All patients were classified into two groups of 185 and 20 patients based on their ability to respond to the questions. Then age, sex, duration of constipation, treatment, and symptoms associated with reflux were examined based on the GERD questionnaire (in case group 185) and I-GERD (in case group 20). Score > 11 in the GERD questionnaire and score > 15 in the I-GERD questionnaire were considered as reflux disease. The variables that were evaluated using Chi-square and Fisher exact tests using SPSS software version 19 included age, sex, the onset of constipation, constipation duration, duration of treatment of constipation, ROME III criteria, and symptoms associated with reflux.

 In the current study 205 subjects were included (girls = 49.8%, boys = 50.2%). The mean age of the children was 5.51 ± 3.15 years. Among the Rome III criteria, the most frequent were retentive posturing, painful defecation, history of large stool defecation, defecation less than 2 times per week, stool accumulation in the rectum, and fecal incontinency more than once a week, respectively. The lowest symptom among people with chronic constipation was fecal incontinency. Also, 46.8% of all patients in the study had a positive familial history. In general, there were 29 patients (14.1%) with reflux out of the 205 patients with functional constipation. In the present study, no significant relationship was found between Rome III criteria and reflux.

 The frequency of GERD among cases with constipation was 14.1%. There was no significant relationship between Rome III criteria and reflux.

Sugar-rich foods are of the main components of daily human meals. These foods with high sugar and low water content kill bacteria. However, osmotolerant yeasts survive and multiply. The aim of this study was to examine the occurrence of intracellular Helicobacter pylori (H. pylori) and Staphylococcus spp. in yeast isolates from sugar-rich foods.

 Thirty-two yeast isolates from fresh fruits, dried fruits, commercial foods, and miscellaneous foods were identified by the sequencing of amplified products of 26S rDNA. Fluorescence microscopy and LIVE/DEAD bacterial viability kit were used to examine the occurrence of live bacteria inside the yeast’s vacuole. Immunofluorescence assay was used to confirm the identity of intracellular bacteria as H. pylori and Staphylococcus. Polymerase chain reaction (PCR) was used for the detection of 16S rDNA of H. pylori and Staphylococcus in the total DNA of yeasts.

 Yeasts were identified as members of seven genera; Candida, Saccharomyces, Zygosaccharomyces, Pichia, Meyerozyma, Metschnikowia, and Wickerhamomyces. Intravacuolar bacteria were stained green with a bacterial viability kit, revealing that they were alive. Immunofluorescence assay confirmed the identity of intracellular H. pylori and Staphylococcus spp. PCR results revealed that among the 32 isolated yeasts, 53% were H. pylori-positive, 6% were Staphylococcus-positive, 18.7% were positive for both, and 21.8% were negative for both.

 Detection of H. pylori- and Staphylococcus-16S rDNA in yeast isolates from dried fruits, and commercial foods showed the occurrence of more than one kind of endosymbiotic bacterium in yeasts’ vacuoles. While the establishment of H. pylori and Staphylococcus in yeast is a sophisticated survival strategy, yeast serves as a potent bacterial reservoir.

 Measuring serum alanine aminotransferase (ALT) enzyme is a routine clinical test commonly used to evaluate abnormalities in the body in general, and in the liver function in particular. Higher ALT levels are associated with some metabolic disorders. The upper limit normal (ULN) is considered as a reliable threshold for the definition of high ALT.

To assess the existing evidence on the ULN for ALT in the general population.
DATA SOURCE: PubMed (Medline), EMBASE, Scopus, and Web of Science (ISI) were searched using a specified search strategy.

 We collected documents published from 1980 to 2018 in the English language, focusing on human samples at the population level and extracted the data after qualitative evaluation.

We conducted this study in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We used specific search terms and their combinations to find documents from relevant databases. We used a snowballing approach to find documents not captured in the main phase of the search. Two authors separately conducted the search, screened the articles, and selected documents that were qualified for data extraction based on the defined inclusion criteria. Finally, data extraction was conducted by two authors using PRISMA checklist. Reported ULNs for ALT and 95% confidence intervals (CIs) were documented in previously developed datasheets.

Out of 15242 studies, 47 articles were included for data extraction and analysis. Data were sparse and lacked the consistency to precisely estimate ULN for serum ALT. The ULN of ALT was significantly diverse across various geographical locations and sexes. The lowest value of ULN for ALT was 19 IU/L in Chinese children (age range: 7 to < 10 years), and the highest value of ULN for ALT was 55 IU/L in children from Ghana aged < 5 years. LIMITATIONS: The main limitation of the current systematic review was the scarcity of the reported measures for ULN of ALT.

 Based on the results of the current systematic review, it is suggested that the normal range of ALT be redefined, but this redefinition should be done according to the localized data. In order to redefine the ULN for ALT, regional differences, methods used in ALT measurements, and ULN determination should be considered.

Abdominal and pelvic abscesses can occur due to a number of reasons, the most common being surgery. They are associated with significant morbidity and mortality. The treatment approach for these types of collections is often the initiation of broad-spectrum antibiotics, accompanied by drainage. Multiple diagnostic and therapeutic modalities have been described, including; percutaneous, transvaginal, endoscopic, and surgicaldrainage. Due to the complexity of pelvic anatomy, minimally invasive approaches such as percutaneous drainage are usually difficult. Pelvic abscesses have been historically drained through surgery. Endoscopic ultrasound (EUS)-guided interventions have emerged as an alternative for the management of difficult abdominal and pelvic abscesses. Endoscopic interventions have classically included diagnostic and therapeutic aspiration, utilizing drainage catheters with or without placement of plastic stents. More recently, the use of lumen apposing self-expanding metal stents has become a treatment option for deep pelvic abscesses. Lumen opposing metal stents (LAMS) have a saddle-shaped design with two large-diameter flanges on both ends of the stent to anchor the stent edges within the respective lumens as well asa central waist that allows for communication between the two lumens. LAMS were originally designed for transmural pancreatic fluid collection drainage; however,they have been successfully implemented for numerous other off-label uses, including the drainage of pelvic and abdominal abscesses. We present the case of a 34-year-old womanwho presented with a septated abscess located between the urinary bladder and the rectum, which was successfully and definitively drained with LAMS.