Govaresh
Volume:28 Issue: 3, Autumn 2023

Colon cancer ranks third among the most common cancers. In Iran, this disease ranks fourth in men and second in women. The incidence and mortality caused by this cancer are different in different geographical areas. It is known to reduce the incidence of colon cancer by performing screening methods because most cases originate from polyps that can be seen and removed in colonoscopy before they become malignant. Also, screening methods are able to detect cancer in its early stages and reduce the death rate caused by this disease. However, the implementation of screening programs worldwide, including in Iran, has always faced problems such as the cost of diagnostic equipment, insurance coverage, health infrastructure, human resources, and, most importantly, acceptance by the people. Today, different methods are used for colon cancer screening in different countries, and the choice of these methods depends on several factors, including the prevalence and incidence of this disease, economic resources, and health infrastructure in each region. The purpose of this study was to investigate the common methods for colon cancer screening so that, according to the current situation and considering the screening facilities available in Iran, the best method can be suggested to cover more and more people who need screening.

As congenital gastrointestinal diseases are pretty common and can lead to fatal consequences when combined with congenital heart diseases, we conducted a study in Iran to explore the relationship and prevalence of these two conditions. Our objective was to identify the types and frequency of congenital heart diseases in children who also have gastrointestinal anomalies.

This was a cross-sectional analytical study. The research population was the patients referred to the Gastrointestinal Clinic of Hazrat Masoumeh Children's Subspecialty Hospital during the 2011-2017. In this study, the echocardiography in the patients’ files performed by a pediatric heart specialist was examined, and in the next step, the patients were divided into two groups with and without heart disorders. Gastrointestinal abnormalities were also recorded in the relevant checklist. Finally, the recorded information was entered into SPSS software version 22, and Chi-square and Fisher exact tests were used to compare the qualitative findings. The significant level for all tests was considered to be 0.05.

The average age of the children in this study was 7.93±7.74 months. 105 boys (54.7%) and 87 girls (45.3%) were examined. 167 children (87%) had cardiovascular abnormalities and 25 children (13%) had no abnormalities. The most common types of cardiovascular abnormalities were 69 (35.9%) septal defects, 36 (18.8%) atrial septal defects, and 22 (11.5%) pulmonary valve stenosis. The least frequent abnormalities were cardiomyopathy in three (1.6%) and ventricular inter-atrial septal defects along with atrial septal defects in one (0.5%) patient There was not a significant correlation between congenital heart diseases and frequency of closed anus, rectovaginal fistula, Hirschsprung, anal stenosis, rectal prolapse, perianal fistula, esophageal atresia, pyloric hypertrophy, intestinal obstruction, annular pancreas, biliary atresia, diaphragmatic hernia, Meckel's diverticulum.(P>0.05). A significant relationship was found only between omphalocele and pyloric hypertrophy with the presence of cardiovascular disorders (P<0.05).

The results showed that congenital heart diseases have a high prevalence in infants with gastrointestinal anomalies, so cardiac examination is mandatory in all infants with gastrointestinal anomalies.

Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy, with an incidence ranging from 0.016% to 8% depending on the type and purpose of the procedure. Several patient-related, endoscopist-related, and procedure-related factors increase the risk of ICP, which most commonly occurs in the sigmoid colon. Following specific guidelines for colonoscopy performance and quality can help prevent ICP. Early diagnosis is essential, and imaging modalities such as radiography or CT scan may be needed to evaluate the extent of damage. The management of ICP depends on the size and location of the perforation, the presence of peritonitis or sepsis, the underlying colon pathology, and the patient's general condition. Endoscopic, surgical, or conservative methods may be used, but surgical consultation should always be sought urgently. Surgery is usually indicated for large perforations, signs of peritonitis, inadequate bowel preparation, severe comorbidity, failure of conservative treatment, underlying colon disease requiring surgery, transplant recipients, or immunocompromised patients. Laparoscopic-assisted exploration is the preferred surgical technique for ICP. The timing of a follow-up colonoscopy depends on the indication for the initial colonoscopy that led to ICP.

Celiac disease is a small bowel disorder that occurs upon exposure to dietary gluten and is followed by reduced absorption capacity of the intestine. Serological tests are usually used to assess the prevalence of the disease; however, serological tests without pathological results cannot give a precise assessment. In this regard, we attempted to determine the prevalence of celiac disease in the northern regions of Iran by performing a biopsy among adults with positive serological tests.

This was a population-based cross-sectional study. Serum level of tissue transglutaminase IgA (or, tTg-IgA) was assessed in 5148 individuals, and those with a positive serological test (serum anti-tTG IgA > 20 IU/mL) underwent a biopsy during upper gastrointestinal (GI) endoscopy. Symptoms and other accompanying disorders were also assessed in this study.

Among the 5148 participants, 23 patients (12 men) had positive anti-tTG IgA test (0.4%) with a mean age of 45.90 ± 12.45 years. The most common symptoms among the 23 individuals were abdominal distension (100%), abdominal pain (78.26%), chronic constipation (60.86%), and three (13.04%) of them had iron deficiency. 16 individuals out of the 23 accepted to undergo a biopsy during upper GI endoscopy. The pathology results showed that eight (four men) of them had biopsy-proven celiac disease (0.15%). The second serum IgA anti-tTG test was negative in individuals with negative pathologies.

The prevalence of celiac disease in Northern Iran was 0.4% and 0.15% based on serological and pathological results, respectively. Half of the patients with positive serum IgA anti-tTG test had negative pathological results, indicating the need to rely on a pathological assessment for a definite diagnosis.

Cytokeratins, a family of intermediate filament proteins, are critical components of the cytoskeletal structure in epithelial cells. Among these, cytokeratin 20 (CK20) has garnered substantial attention as a potential biomarker in colorectal cancer (CRC) due to its role in distinguishing various subtypes of gastrointestinal epithelial cells. Therefore, we aimed to investigate the relationship between immunohistochemical expression of CK20 and colorectal adenocarcinoma prognostic factors.

This cross-sectional study included 50 tissue blocks from patients with colorectal adenocarcinoma. Demographic and clinicopathological information was extracted from the patients’ pathology report and recorded in a checklist. Then CK20 expression was examined using immunohistochemistry.

The present study included 50 patients with colorectal adenocarcinoma, including 23 (46%) men and 27 (54%) women, with a mean age of 50 ± 11.2 years. Immunohistochemical expression of the CK20 marker was negative in 15 patients (30%), but 16 patients (32%) and 19 patients (38%) had focal and diffuse positive expression of this marker, respectively. In other words, the expression of this marker was positive in 40 patients (70%). Based on the results of the present study, a significant correlation between clinicopathological features such as tumor grade, lymphovascular invasion, perineural invasion, and lymph node involvement with the expression of the CK20 marker was reported (P < 0.05).

In general, based on the results of the present study, there is a significant association between the expression of CK20 and clinicopathological factors, so it is possible to use the CK20 marker in determining the prognosis of colorectal adenocarcinoma, however, more studies with a larger sample size will be required in the future.

Metabolic-associated fatty liver disease (MAFLD) is the concurrent presence of fatty liver disease (FLD) with overweight or obesity and/or type 2 diabetes mellitus. We aimed to determine the frequency and characteristics of MAFLD in patients with FLD.

This cross-sectional study was conducted on 143 patients with FLD referred to the gastrointestinal clinic of Shahid Rahimi Hospital in Khorramabad, Iran in 2021-2022. After obtaining a detailed medical history and in case of clinical suspicion of FLD, the levels of functional liver enzymes, fasting blood sugar (FBS), and lipid profile were measured. Furthermore, an ultrasound study of the liver was performed. The degree of insulin resistance was determined by the Homeostasis Model Assessment (HOMA) index. The data were gathered in a checklist and analyzed using SPSS software version 22.

The mean FBS was 93.15 ± 16.21 mg/dL, and the mean serum insulin levels were 7.88 ± 15.81 mmol/L. The mean triglyceride level was 82.13 ± 172.13 mg/dL, and the mean high-density lipoprotein was 37.27 ± 7.15 mg/dL. In this study, 105 patients (73.4%) had high HOMA indexes. Serum alkaline phosphatase, alanine transaminase, and cholesterol levels were significantly higher in patients with high HOMA index than in those with normal index (P values = 0.004, 0.047, and 0.039, respectively).

There appears to be a strong relationship between insulin resistance and impaired liver function in patients with FLD, indicating the necessity for managing insulin resistance in these patients.

Abdominal tuberculosis is one of the most critical and life-threatening ailments affecting the digestive system. Distinguishing it from other gastrointestinal disorders is paramount due to the potential complications of treatment overlap. Therapies such as corticosteroids and anti-tumor necrotic factor (anti-TNF) agents, effective against various diseases, can unintentionally exacerbate and propagate tuberculosis.
The case in focus involves a 22-year-old man initially presented with abdominal pain. The clinical, endoscopic, and pathological assessments led to a diagnosis of Crohn’s disease. Subsequently, the patient underwent treatment. However, 6 months into the treatment, the patient developed abdominal distension and ascites, necessitating hospital admission and re-evaluation.
A comprehensive series of investigations revealed a diagnosis of military tuberculosis. The patient was subsequently administered four anti-tuberculosis drugs, resulting in a complete resolution of symptoms. This case underscores a crucial point: administering anti-TNF agents can inadvertently contribute to tuberculosis dissemination. Hence, a meticulous assessment to exclude tuberculosis before initiating such treatment is paramount.

Acute pancreatitis (AP) is a life-threatening condition for which a wide range of etiological factors are considered. While gallstones and alcohol consumption are the leading causative agents, infectious microorganisms are assumed to be involved in some AP cases. During the ongoing coronavirus disease-2019 (COVID-19) pandemic, a coincidence of mild AP and COVID-19 has been reported, and hereby, we present the first cases of COVID-19/AP comorbidity from Iran.

We present two cases of AP that occurred in patients with COVID-19 without any other risk factors with different outcomes. One of them had a mild AP and recovered, while the other patient suffered from a severe AP and expired. Also, it was noted that the first patient did not have any COVID-19 symptoms but abdominal pain, which probably was related to AP.

Based on this report, COVID-19 can be considered in the AP cases that do not have an underlying risk factor, regardless of the severity of AP and the presence of COVID-19 symptoms.

Alpha-fetoprotein (AFP) is a serum glycoprotein created during gestation and is produced from the fetal liver and yolk sac. In some cases, AFP elevation has been associated with chronic and acute liver diseases and a limited number of cancers. AFP is a useful tumor marker in tumor diagnosis. This study presents a 46-year-old woman with no remarkable medical history who developed acute liver failure (ALF) due to the use of over-the-counter herbal medicine and was referred to our hospital for liver transplantation (LT). Imaging evaluations and laboratory test results demonstrated no evidence of malignancy or carcinoma. After LT, the histopathological report revealed no evidence of malignancy. The AFP level led into the normal range within 1 week after surgery. An increase in AFP serum level often occurs after cancer and malignancy, but in some cases, it can also occur after noncancerous diseases. As we reported in this case, the increase in AFP occurred after ALF and returned to its normal range after LT.