Middle East Journal of Digestive Diseases
Volume:14 Issue: 3, Jul 2022

Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.

Despite all improvements in sanitation and exposure to antibiotics over time, Helicobacter pylori (HP) prevalence remains high, affecting the lives of about half of the world population, which can gradually lead to serious upper gastrointestinal disorders. Understanding HP’s epidemiologic patterns help us to better manage the burden of this infection and to plan more effectively regarding potential screening or eradication strategies. We, therefore, aimed to report the crude and age- and sex-standardized prevalence rate of HP infection, its trend, and possible associated factors among asymptomatic healthy individuals in Rafsanjan city, a low-incidence area of gastric cancer (GC) in the southeast of Iran, from July 2018 to December 2021.

This population-based cross-sectional descriptive study included 2,046 male and female subjects between 3 to 72 years who were in good health condition. Study participants were randomly selected from the Health Houses and each underwent a questionnaire-based interview and provided blood and feces samples. The presence of HP infection was detected by serum IgG antibodies and stool antigen test.

The overall and age- and sex-standardized prevalence rates of HP infection were 50.9% and 43%, respectively. The prevalence rate has notably decreased in all age groups compared with 2007. Also, it was significantly higher among men (P=0.033) and increased with advancing age (P<0.001). A higher population density living in a specific room area (P=0.012) increased the likelihood of HP infection.

To conclude, the prevalence of HP infection is decreasing over time in Rafsanjan city, which may be due to improvements in living standards in this area. A healthy lifestyle and adherence to hygienic principles, especially during childhood, may be required for a reduction in the prevalence of HP infection.

The aim of the study is to assess the correlation between a new antibody panel that is developed against glycans on Crohn’s disease (CD) and ulcerative colitis (UC) differentiative diagnosis and disease properties.

In the study, 137 CD and 122 UC patients and 90 controls were included. Antisaccharomyces cerevisiae IgG (ASCA), anti-laminaribioside IgG (ALCA), anti-chitobioside IgA (ACCA), and anti-mannobioside IgG (AMCA) were tested in serum.

While at least 1 of the other 3 serological markers was positive in 89% of ASCA-positive patients, at least 1 of the other 3 serological markers was positive in 77% of ASCA-negative patients. Positivity ratio for a single anticarbohydrate was ALCA 18 (22%), ACCA 5 (12%), and AMCA 16 (23%). A significant correlation was found between ASCA positivity (P<0.001) in operated patients and between ASCA, ALCA, and ACCA positivity (P<0.05) in patients with stricturing and fistulizing CD. According to the ROC analysis, ASCA was found to have the highest area under the curve (0.70-0.82) (correlation coefficient interval 95%). A significant correlation was found between ASCA, ALCA, and ACCA positivity and high serum antibody levels and disease activation (P<0.05).

ASCA, ALCA, and ACCA were found to be correlated with the disease complication and activation in CD. ASCA and ALCA were determined as the best markers in the differentiation between CD and UC.

Irritable bowel syndrome (IBS) is a chronic disabling condition without a well-defined etiology. Infectious gastroenteritis (IGE) has been linked to this syndrome. There are few data from Iran on this association.

In August 2018, an epidemic of IGE caused by Escherichia coli occurred in a village in the west of Shiraz in southern Iran. One year after this epidemic, the occurrence of IBS was surveyed in those who suffered from IGE based on Rome IV criteria in that village.

Of 179 patients included in the present study, 17 patients (9.5%) had postinfectious (PI)-IBS. There was no difference in age, sex, antibiotic use, hematochezia, duration of infectious diarrhea, fever, and weight loss at the time of IGE between those with and without PI-IBS.

PI-IBS is common after IGE, but no risk factor for its development was found in this study.

Patients with end-stage renal disease complain of many gastrointestinal (GI) problems. The goal of the current study was to compare the prevalence of GI disorders in a relatively large group of patients with end-stage renal disease (ESRD) with healthy participants.  

In a matched case-control study, 597 patients undergoing hemodialysis and 740 healthy participants were investigated. All subjects were asked to complete Rome III questionnaire, including five modules to evaluate GI disorders. The Hospital Anxiety and Depression questionnaire, as well as the 12-general health questionnaire for psychological disorders assessment, were used.

Our results showed that in patients undergoing hemodialysis, the prevalence of irritable bowel syndrome (IBS) (OR= 1.75), gastroesophageal reflux disease (GERD) (OR= 1.55), and dyspepsia (OR= 3.39) was significantly higher than in healthy control participants, while no significant difference was found in terms of constipation (OR= 0.88). The association remained significant for dyspepsia and IBS even after controlling for psychological disorders as important potential confounding variables. On the other hand, adjustment for psychological disorders led to an insignificant association between hemodialysis and GERD. Surprisingly a significant relationship was observed between constipation and hemodialysis after adjustment for mentioned psychological factors. 

Our results showed that there was a significant relationship between hemodialysis and some GI complaints such as IBS, dyspepsia, GERD, and bloating. Psychological disorders only influence GERD prevalence in patients undergoing hemodialysis.

Hemodialysis patients are at risk of viral infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency viruses (HIV). Current study aimed to determine the prevalence of HBV, HCV, and HIV among hemodialysis (HD) patients who attended the dialysis center in Fasa, Iran.

 Collectively, 2082 hemodialysis patients (1291 men, 791 women) took part in our 6-year follow-up study.

2082 HD patients with a mean age of 56.2 ± 17.8 were included in our study. One (0.09%) patient was HBsAg positive, two (0.18%) patients were anti-HCV positive, and one (0.09%) was anti-HIV positive. There was no significant correlation between the paraclinical parameters of men and women.

The present study showed a reduction in the prevalence of HBV, HCV, and HIV infections during 6 years of follow-up in hemodialysis patients.

A gluten-free diet (GFD) is the only effective treatment of celiac disease (CD) that is associated with body mass index (BMI) changes. This study aimed to determine how GFD duration affects the BMI of Iranian patients with CD.

In this prospective study, 215 patients with CD, who were on a GFD, were categorized into three groups according to the duration of compliance to GFD: 1. patients with less than 6 months of diet, 2. Patients who had a diet for 6 months to 2 years, and 3. patients with more than 2 years of diet. The BMI changes were assessed before and after adherence to the GFD.

Most patients’ weight remains in the same BMI category during different courses of GFD adherence. Patients who were underweight showed significant changes in their BMI following the diet in less than 6 months (P=0.033) and more than 2 years (P<0.001), and the number of weight gain cases increased over time.

There is a need for careful, updated, and personalized nutrition management of patients with CD in different periods of the diet. Conducting similar studies with larger sample sizes in different regions can lead to providing expert dietary counseling for patients with CD.

Hemorrhoidectomy is commonly associated with post-operative perianal pain. Local botulinum toxin injection by relaxing the smooth muscles of the perianal sphincter and reducing anal pressure can be effective in decreasing post-operative pain. This study evaluates the effectiveness of local botulinum toxin injection in controlling pain after hemorrhoidectomy.

This study was a double-blind, randomized clinical trial. A total of 40 patients undergoing hemorrhoidectomy who were referred to Shariati Hospital in 2019-2020 were enrolled as participants and divided into two groups. In one group, injection of botulinum toxin was done in intersphincteric area, and in the other group, there was no intervention after hemorrhoidectomy. SPSS software version 24 was used to analyze the data.

Local botulinum toxin injection (MASPORT® 500) significantly reduced post-operative perianal pain on the first, third, fifth, and seventh days after the operation compared with the second group (P<0.05). The mean pain scores in the first, third, fifth, and seventh days in the first and second groups were 7.60 (± 0.88) versus 8.25 (± 1.16), 40.5 (± 0.88) versus 6.05 (± 0.99), 2.45 (± 0.51) versus 3.05 (± 0.68), and 2.05 (±0.39) versus 1.70 (±0.57), respectively. Furthermore, pain during defecation was significantly lower for the experimental group (P < 0.05).

Local botulinum toxin injection effectively improves post-operative pain after hemorrhoidectomy. Further studies are needed to prove the clinical value of local botulinum toxin injection.

With a global prevalence of about 10%, gastric cancer is among the most prevalent cancers. Currently, there has been an ongoing trend toward investigating genetic disruptions in different cancers because they can be used as a target-specific therapy. We aimed to systemically review some gene expression patterns in gastric cancer.

The current systematic review was designed and executed in 2020. Scopus, PubMed, Cochrane Library, Google Scholar, web of knowledge, and Science Direct were searched for relevant studies. A manual search of articles (hand searching), reference exploring, checking for grey literature, and seeking expert opinion were also done.

In this review, 65 studies were included, and the expression pattern of HER2/ ERBB2, ER1/Erb1/EGFR, PIK3CA, APC, KRAS, ARID1A, TP53, FGFR2 and MET was investigated. TP53, APC, KRAS, and PIK3CA mutation cumulative frequency were 24.8 (I2=95.05, Q value=525.53, df=26, P<0.001), 7.2 (I2=89.79, Q value=48.99, df=5, P<0.001), 7.8 (I2=93.60, Q value=140.71, df=9, P=0.001) and 8.6 (I2=80.78, Q value=525.53, df=9, P<0.001) percent, respectively. Overexpression was investigated for HER1/ Erb1/EGFR, PIK3CA, APC, KRAS, ARID1A, TP53, CCND1, FGFR2, MET and MYC. The frequency of TP53 and HER2/ERBB2 were 43.1 (I2=84.06, Q value=58.09, df=9, P<0.001) and 20.8 (I2=93.61, Q value=234.89, df=15, P<0.001) percent, respectively.

More research is encouraged to investigate the genes for which we could not perform a meta-analysis.

Esophagitis dissecans superficialis (EDS) is an uncommon disease characterized by esophageal mucosal sloughing. EDS is a benign condition that usually resolves without residual pathology. Medication, chemical irritants, hot drinks, and autoimmune diseases have all been associated with EDS. Here a 60-yearold lady with post-COVID-19 EDS is presented. Her chief complaint was dysphagia and odynophagia for 2 weeks duration. EDS diagnosis was based on endoscopic findings and biopsy. Her problem was improved by a high dose of pantoprazole.

Isolated splenic tuberculosis (TB) in children is extremely rare, and congenital or acquired immunodeficiency is usually a predisposing factor for this disease. Herein, we report a case of isolated splenic TB in a 5.5-year-old child associated with Crohn’s disease. As far as we are aware, this association is reported for the first time in children. Clinicians should be aware and consider extra pulmonary TB, especially in endemic regions. In addition, evaluation of an underlying disorder in unusual presentations of TB is advisable.

Celiac disease (CeD) is an immune condition induced by the consumption of gluten-containing foods in genetically-predisposed persons. CeD, in addition to digestive disease, is a multisystem disorder. If untreated, it is potentially can be a dangerous disorder and lead to morbidity and even mortality. At present, the only treatment option is a lifelong gluten-free diet (GFD), and all authors recommended this regimen. To the best of our knowledge, there are rare reports of the complete remission of disorder on GFD and reintroduction of a normal diet in affected patients. In this report, we describe five patients with CeD who developed complete remission of clinical symptoms, histopathological changes, and serology on a gluten-containing diet. All patients had CeD based on a positive tissue transglutaminase antibody (TTG IgA) and typical histopathological changes in duodenal biopsy with the complete disappearance of symptoms on the GFD regimen. All patients followed GFD for a mean 4 (±0.54) years. In conclusion, this study has shown that some CeD patients diagnosed in adulthood can recover a normal mucosa after a long period of the gluten-containing diet without relapsing any clinical or biological symptoms of CeD.

Long-COVID refers to a collection of symptoms in COVID-19 patients which continue for at least 12 weeks after disease onset. The clinical manifestations are numerous and can affect nearly any organ of the body. Disease symptoms can be new or similar to that reported for acute COVID-19 and can occur in patients who had differing degrees of initial disease severity during acute infection.

A 65 years old male patient visited our hospital with the complaint of diffuse pain in the upper abdomen since 2 months with no associated vomiting, melena or weight loss. Preliminary blood investigations of the patient were normal. Ultrasound was done subsequently for the patient which showed cirrhotic appearance of liver with diffusely infiltrative mass lesion was seen in bilateral lobes of liver extending within the left and the right portal vein with prominent arterial supply on color doppler images (Figure 1a). A subsequent Contrast enhanced ultrasound (CE-US) was performed to characterize the lesion which showed the characteristic “threads and streaks sign” also known as "striated vascular sign" which was earlier classically described on Angiography1 for hepatocellular carcinoma. Threads and streaks sign is the specific appearance of multiple tortuous arterial collaterals supplying the tumoral thrombus forming arterioportal shunts which directly drain into the portal vein leading to early “chain –like” filling of the portal vein in arterial phase. Multiple small and thin blood spaces which develop inside as well as between the tumour and vessel wall are responsible for this appearance. The presence of this sign indicates the growth of the tumour within the vessels especially in cases with hepatocellular carcinoma2. We demonstrated this sign on CE-US (Figure 1b) which helped us clinch the diagnosis of hepatocellular carcinoma on ultrasound. On subsequent triple phase CT this appearance was replicated (Figure 1c) hence confirming the findings. Hepatocellular carcinomas are hypervascular tumours with predominant arterial supply which is often evident on Multiphase contrast CT/ MRI3. Arterioportal shunting is one of the most characteristic finding in these tumours and its correlates with the histopathological grade of the tumour as these shunts are seen more in well differentiated tumours4. Multiple antemortem and postmortem studies by Okuda et al5 suggest involvement of the inferior vena cava and the hepatic veins should be sought for in patients with hepatocellular carcinoma when the thread and streak sign is visible at either angiography or contrast-enhanced computed tomography (CT). We were able to demonstrate this sign on CE-US and hence its utility in patients with suspected liver lesion in patients with renal failure and non-availability of modalities like CT/ MRI to diagnose HCC is emphasized. This appearance however needs to be differentiated with bland thrombus of portal vein which shows no arterial phase enhancement and arterioportal shunting as well as other causes of arteriovenous shunts like regenerating liver in liver cirrhosis. Another limitation while evaluating this sign is that the similar appearance can also occur in other hypervascular tumours that might grow into a portal vein and develop arteriovenous shunting.