فهرست مطالب
Gastroenterology and Hepatology From Bed to Bench Journal
Volume:16 Issue: 3, Summer 2023
- تاریخ انتشار: 1402/06/22
- تعداد عناوین: 14
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Pages 245-258Aim
This study aimed to estimate the survival rates among Iranian gastric cancer patients and to evaluate if the survival has improved during the last three decades.
BackgroundGastric cancer is one of the most common cancers in Iran with high mortality.
MethodsA systematic review and meta-analysis of all published studies addressing gastric cancer survival in Iran was performed. International databases of Scopus, Web of Science, PubMed, and Iranian databases were included in the study. The study included databases from their inception till February 2022. Due to the inherent heterogeneity, we used a random effect model to pool the survivals in three categories of one, three, and five-year survivals.
ResultsThirty-three studies with total cases of 17,207 were included in the study. The overall (pooled) one, three, and five-year survivals were estimated as 58.9% (95% CI: 0.52, 0.66), 29.9% (95% CI: 0.25, 0.35), and 18.2% (95% CI: 0.15, 0.23), respectively. Results of subgroup analysis for the calendar years of study showed that the one, three, and five-year survival rates increased during the last three decades but the results were not statistically significant. There was the disparity in survival based on geographic distribution.
ConclusionThe results of our study which has pooled many studies for a long period of time clearly indicate that the survival rates of gastric cancer patients have improved. As the improvement of survival may be due to many factors, more studies is needed to understand the dynamic behind this improvement.
Keywords: Gastric cancer, Stomach cancer, Survival, Iran, Meta-analysis -
Pages 259-269
Primary Sclerosing Cholangitis (PSC)is a chronic cholestatic liver disease which is associated with Inflammatory Bowel Disease (IBD)in 70% of cases. It seems PSC/IBD is a distinct phenotype that is different from PSC, and IBD alone. Hence, we review the epidemiology, pathogenesis, natural course and management of PSC/IBD before and after LT for PSC. Extensive colitis, rectal sparing, backwash ileitis, and mild symptomsare the characteristics of IBD coexisting with PSC. Moreover, PSC patients with concurrent IBD have higher risk of cholangiocarcinoma, and colorectal neoplasia predominantly in right colon and at younger age. Therefore, it is essential to monitor these individuals continuously. It is interesting to note that the course of IBD (ulcerative colitis) after liver transplantation (LT)for PSC varies greatly, and some patients may develop worsening colitis after LT despite immunosuppressive regimens. As well, management of these patients was discussed in this review.
Keywords: Primary sclerosing cholangitis, Inflammatory bowel disease, Liver transplantation, Cholangiocarcinoma, Colorectal neoplasia -
Pages 270-281
Acute pancreatitis, a potentially fatal disease, with symptoms including nausea and/or vomiting, indigestion, and abdominal pain, is known to range from a mild self-limiting state up to a more severe and lethal form. This review aims toprovide a clearer picture to improve understanding the role of viral agents in the development of acute pancreatitis.Common databases including PubMed, Google Scholar, and Scopus were used for the literature search. In this review search terms including virus, viral, infection, and specific descriptive terms for a virus were considered in different combinations. Various causative agents are recognized in the development of acute pancreatitis as one of the most frequent gastrointestinal diseases, such as gallstones, alcoholism, and hypertriglyceridemia. Microbial pathogens with about 10% of acute pancreatitis cases, mainly viruses, among other factors, are thought to play a role in this regard. Once the pancreatitis diagnosis has been made, depending on thecausative agent, the management approach and specific interventions affect the final outcome. Virus-induced acute pancreatitis in patients should be considered. Advanced diagnostic tests such as PCR, in situ hybridization, and biopsy can help for a betterunderstanding of the role of viruses in causing acute pancreatitis. Improvement in the tests will lead to timely diagnosis, treatment, and better management of pancreatitis.
Keywords: Acute pancreatitis, Virus, Gastrointestinal, Abdominal pain -
Pages 282-291Aim
This study aimed to determine the effects ofacupressure on the intestinal function of patients undergoing Coronary Artery Bypass Graft (CABG) surgery.
BackgroundStudies indicated that cardiovascular patients are prone to constipation. Acupressure is one of the therapeutic and palliative approaches that can be used by doctors, nurses, and even patients themselves.
MethodsThe present three-group randomized clinical trial study was conducted on 90 patientsundergoing CABG surgery. In the intervention group, 48 hours after surgery the patients received acupressure points LI4 and ST25 twice a day (10 am and 6 pm) for three sequential days. In the sham group, the patients received acupressure at a 1.5 cm distance from the LI4-ST25 points, and the patients in the control group received only the usual care. This research used a demographic and medical information questionnaire, Rome IV scale, Bristol stool scale, symptom registration checklist, and daily excretion assessment checklist. The intestinal function indices were completed 24 hours after surgery (before intervention), 48, 72, 96, and 120 hours after surgery.
ResultsAll three intervention, sham, and control groups were without defecation in 24 hours (before intervention) and 48 hours aftersurgery. There was a significant difference between the three intervention, sham, and control groups in the number of stools after 72 hours, 96 hours, and 120 hours after the intervention (p<0.001). Also, a significant difference was observed among the three groups in terms of stool consistency 96 hours after the start of the intervention (p=0.032) and 120 hours after the start of the intervention (p<0.001).
ConclusionThe results showed that patients had a significant improvement in the number of bowel movements and stool consistency in the intervention group.In acute conditions, acupressure on LI4-ST25 points can positively affect intestinal function when patients are hospitalized in the intensive care unit.
Keywords: Coronary artery bypass graftsurgery, Acupressure, Constipation, Bowel function -
Pages 292-296Aim
The current study purposed to evaluate the autologous platelet-rich plasma (PRP), and platelet-rich fibrin glue (PRFG) effect on the treatment of complex, and recalcitrant anal fistula (AF) which was not cured by several surgeries.
BackgroundAF has remained one of difficult challenges for centuries. Surgery is the common treatment method for it, but the risk of fecal incontinence and recurrence is still a distressing complication for patients and surgeons. New procedures were published in the scientific literature, each with advantages and disadvantages. According to reports, an effective therapy option is the autologous fibrin glue that is rich in platelets.
MethodsAutologous PRP and PRFG were prepared from 10 patients’ own blood. The surgeon curetted the tract of anal fistula for the deepithelialisation till hemorrhage occurred; PRP was injected around the fistula into the tissue, and PRFG was interpositioned in the tract. Age, number of previous surgeries, complications, number of PRP and PRFG administrations, and duration of halting the discharge were among the information gathered. Patients were followed up between 10 months to 84 months after treatment.
ResultsNo complications were observed during and after the injection. During the period of follow-up, AF leakage was stopped for 6 patients, but not for 4 patients.
ConclusionSince autologous PRP injection, and PRFG interposition is a safe, effective, and minimally invasive procedure for resistant AF to surgeries; it can be used, along with surgery to increase the healing rate of complex anal fistula.
Keywords: Anal fistula, Platelet rich plasma, Fibrin glue, Healing -
Pages 297-306Aim
This study aimed to find lncRNAs and mRNAs that were expressed differently by combining microarray datasets from different studies. This was done to find important target genes in gastric cancer for anti-cancer therapy.
BackgroundGastric cancer (GC) is the fourth most frequent and second-most deadly malignancy worldwide. Thus, genetic diagnosis and treatment should focus on genetic and epigenetic variables. Based on several studies, disordered expression of non-coding RNAs (ncRNAs), such as lncRNAs, regulate gastric cancer invasion and metastasis. Besides, lncRNAs cooperatively regulate gene expression and GC progression.
MethodsWe obtained differentially expressed mRNAs (DEmRNAs) and lncRNAs (DElncRNAs) from three GC tissue microarray datasets by meta-analysis and screened genes using the "Limma" package. Then, using the RNAInter database, we allocated DEmRNAs to each DElncRNA. ClusterProfiler and GOplot programs were used to analyze function enrichment pathways and gene ontologies for final DEmRNAs.
ResultsA total of 9 differentially expressed lncRNAs (DElncRNAs) (5 up-regulated and 4 down-regulated), and 856 DEmRNAs (451 up-regulated and 405 down-regulated) between tumor and adjacent normal samples were found. Finally, 117 differentially expressed mRNAs were predicted as interactors of six DElncRNAs (H19, WT1-AS, EMX2OS, HOTAIR, ZEB1-AS1, and LINC00261).
ConclusionIn order to promote cancer therapeutics and give knowledge on the process of carcinogenesis, our study projected a network of drug-gene interactions for discovered genes and presented relevant prospective biomarkers for the prognosis of patients with stomach cancer.
Keywords: Biomarker, Gastric cancer, Messenger RNA (mRNA), Long non-coding RNAs (lncRNAs), Microarray analysis -
Pages 307-318Aim
This study aimed to examine the environmental factors associated in Iranian patients withinflammatory bowel disease(IBD).
BackgroundThe role of environmental factors in the development of IBD remains uncertain.
MethodsIn this case-control study, the patients with IBD referred to the Taleghani Hospital, Tehran, Iran, were recruited from 2017 to 2019. Controls were matched by sex. Data were collected using the designed questionnaire and also valid questionnaire suchPittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) for sleep quality and anxiety/depression, respectively. Conditional logistic regression models were used to estimate adjusted odds ratios (ORs).
ResultsThe study population included 200 individuals: 100 (50%) IBD patients and 100 (50%) controls. Age under 50, marital status, sleep difficulties, vitamin D insufficiency, anxiety/depression, dietary fiber deficit, post-menopausal hormone treatment, oral contraceptives, and antibiotics were all prognostic factors for IBD on the univariate analysis (P< 0.005). In multivariate analysis, the risk of IBD was significantly increased with 50 years (OR: 6.699, 95%CI: 3.271-8.662, P=0.017), abnormal sleep status (OR: 6.383, 95%CI: 3.389-7.19, P=0.001), and using oral contraceptive (OR: 7.426, 95%CI: 5.327-9.865, P=0.001). However, the risk of IBD was significantly decreased with older age (OR: 0.795, 95%CI: 0.697-0.907, P=0.001) and married status (OR: 0.008,95%CI: 0.001-0.438, P=0.018).
ConclusionData suggest that the environmental factors play a significant role in the etiology of IBD and probably on the disease course. While the evidence for some factors is strong, many factors require further supportive data.
Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Hygiene hypothesis, Risk factors -
Pages 319-325Aim
Determining critical dysregulated proteins in liver cancer wasthe main aim of this study.
BackgroundLiver cancer is a common health problem characterized by difficulties in early diagnosis and rapid progression. Due to the lack of targeted drugs and the other features of the disease, the survival rate for patients is extremely low.
MethodsThe related dysregulated proteins for liver cancer were retrieved from the STRING database. The queried proteins were included in a network by Cytoscape software, and the central nodes of the network were enriched via gene ontology.
ResultsAmong 11 introduced central nodes (GAPDH, TP53, EGFR, MYC, INS, ALB, IL6, AKT1, VEGFA, CDH1, and HRAS), HRAS and AKT1 were highlighted as critical dysregulated proteins which can be considered as possible biomarkers.
ConclusionAnalysis revealed that AKT1, HRAS and the related biochemical pathways (especially “HIF-1 signaling pathway”) are the possible diagnostic and therapeutic agents of liver cancer.
Keywords: Liver cancer, AKT1, HRAS, Biomarker, Gene ontology -
Pages 326-335Aim
This study aimed to determine the psychometric properties of Persian version of Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ).
BackgroundIn addition to somatic symptoms and complaints, patients with irritable bowel syndrome have specific dysfunctional behaviors that lead to disease persistence and functional disturbance.
MethodsParticipants included 170 patients with irritable bowel syndrome, who were diagnosed based on ROM-IV criteria and selected from patients referring to the Gastrointestinal Disorders Clinic, as well as 100 persons from the general populationin Isfahan in 2020. Both groups completed the 26-item Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). Also, questionnaires including the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), Irritable Bowel Syndrome-Quality of Life IBS-QOL, Illness Perception Questionnaire (IPQ-R), Irritable Bowel Syndrome-Patient Satisfaction (IBS-SAT), Hope Scale, Interpersonal Forgiveness Inventory (IFI), and Dysfunctional Attitude Scale-26-item (DAS-26) were completed to determine the validity of IBS-BRQ. Tests of internal consistency, principal components analyses (PCAs), differentiation analysis, and correlation were used to determine its reliability, along with criterion and construct validity.
ResultsIBS-BRQ was valid and reliable in both groups with a high degree of internal consistency. Cronbach's alpha was obtained in the sample of patients with IBS and the total sample of participants 0.87 and 0.95 respectively. This scale differentiated significantly between IBS patients and non-patients (p<.001). The criterion validity was high as evidenced by a high correlation with DAS-26 (r=0.53, p<0.001), IBS-QOL (r=0.76, p<0.001), IBS-SSS(r=0.44, p<0.001), IPQ-R(r=0.56, p<0.001), and reverse correlation with IFI (r=-0.031, p<0.001), IBS-SAT(r=-0.23, p<0.001), and HOPE (r=-0.49, p<0.001).
ConclusionThe Persian version of the IBS-BRQ proved to be a well-defined behavioral response measure in IBS patients with high validity and reliability, making it a suitable measure to be used in future IBS clinical research in Iran.
Keywords: Psychometric properties, Irritable bowel syndrome, Behavioral responses questionnaire -
Pages 336-340
Gastric hemangioma (GH) is a rare benign tumor that may cause to upper gastrointestinal bleeding. Furthermore, this conditioncould lead life-threatening conditions thus should be recognized sooner to minimize unnecessary invasive surgical intervention, and accident. We reported a 48 years old man which came to emergency room (ER) with the chief complaint of hematemesis and black stool accompanied by abdominal pain, cold sweat, body weakness and enlarger stomach. Physicalexamination showed slightly icteric eye, and conjunctival pallor. On palpation, the epigastric and right upper quadrant was tender, and occult blood was detected in the excrement. A minor microcytic hypochromic anemia, absolute neutrophilia, hypoalbuminemia, and an increase in urea and creatinine were determined by laboratory tests. Moreover, the esophagogastroduodenoscopy was performed, and showed broad mass with dilated blood vessels. The histopathological examination result showed gastric mass with the histological erythrocyte extravasation. The diagnosis was hematemesis melena owing to cavernous GH with differential diagnosis of hematoma, and other gastric mass, with anemia gravis. For the treatment, patient received fluid resuscitation, omeprazole, tranexamic acid, somatostatin, and antibiotics. He received two kolfs transfusion of packed red cell. Gastric hemangiomas are benign vascular tumors that can lead to severe gastrointestinal bleeding. These benign tumors are lesions that develop as a result ofendothelial cell proliferation, and concomitant pericytic hyperplasia, which leads to a collection of dilated vessels. The cavernous subtype of GHs often comprises of bigger blood-filled areas and larger blood vessels. It is more likely for the cavernous GH to rupture, leading to substantial bleeding. Endoscopic assessment is important in the patients with upper GI bleeding, and GH appear as well-circumscribed vascular submucosal mass. Although this disease is benign with a lower recurrence, we suggest forfurther surgical treatment and the requirement for long-term follow-up to assess the outcome.
Keywords: Gastric cavernous hemangioma, Endoscopy, Histopathology -
Pages 341-346
Based on the analysis of patients with Peutz-Jeghers syndrome (PJS), Serine threonine kinase11 (STK11)is known as a tumor suppressor gene, which is involved in cell polarization, regulation of apoptosis, and DNA damage response. In this case report study, weexamined STK11 gene sequencing in a 42-year-old woman with mucocuta neous pigmentation and positive family history. Endoscopy and colonoscopy showed >1000 polyps throughout the stomach/colon (PJ-type hamartomas). The larger polyp in the stomach was resected and the small bowel imaging detected multiple jejunum/ileum small polyps. The data released from the sequencing results revealed five alterations in exons 1 to 5. The major mutation in stop codon was reported as converted to the amino acid tryptophan (TRP) to tyrosine (TER). The TGG codon was converted to TAG by mutation. Finally, another novel mutation in STK11 stop codon as a ‘de novo’ variant was seen. It is predicted that stop codon mutations make the affected person susceptible to developing colorectal cancer.
Keywords: Peutz-Jeghers syndrome (PJS), STK11gene, Novel mutation, Sequencing, Genetic analysis -
Pages 347-356
Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps, and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation (2). Knowing this significance, the present study aims to present a brief review on classification, probability of endoscopic resection,complications of endoscopic polypectomy, as well as proper surveillance after polypectomy.
Keywords: Colorectal polyps, Paris classification, JNET classification, NICE classification, Kudo pit pattern, Deep mural injury -
Pages 357-359