Govaresh
Volume:11 Issue: 3, 2007

IBS is the most common disorder diagnosed by gastroenterologists, which is seen in approximately 40-50% of patients seeking care from a specialist. Several randomized controlled trials, have assessed the therapeutic effect of anti-depressant drugs, but there is not enough evidence to prove their effectiveness. Fifty cases meeting Rome II criteria for IBS with predominance of pain and diarrhea were included in this study. Organic causes were ruled out by detailed history, physical examination, laboratory tests, small bowel transit and rectosigmoidoscopy. Participants were then randomly assigned to receive either Amitriptyline or placebo. Subjects were followed using a simple symptom score system before, after 1 and 2 months of treatment. At the end of the 2nd month, Amitriptyline showed more influence in reduction of flatulence, mucus passing and incomplete defication feeling, than placebo (p‹0.05). Also, symptoms general improvement rate was 39% and 15% in Amitriptyline and placebo groups respectively (p‹0.001).The rate of side-effects in the two groups did not have significant differences (p›0.05). Amitriptyline is an effective and well-tolerated treatment for pain and diarrhea predominant IBS.

Gastroesophageal Reflux Disease (GERD) is a common disorder in the western population but detailed population-based data in Iran is limited. The aim of this study was to investigate the prevalence of GERD in Esfahan. A population-based study was conducted in 2004. Major GERD symptoms (heartburn and acid regurgitation) were assessed through an interview by six trained medical students based on a systematic clustering among adult inhabitants (n=2400) in Esfahan and included any family member between 20-70 years old. Existenxe of any major GERD symptoms in the past 12 months was used to diagnosis GERD. Prevalence of daily, weekly and monthly GERD symptoms were 12.1%,12.9% and 21.5% respectively. GERD symptoms occurred in 19.3% of men and 27.3% of women (p-value: 0.002). Body Mass Index (BMI) was 24.71±3.04 in GERD group compared to normal population which was 24.1±3.11 (p = 0.001). GERD symptoms are frequent among Esfahan population. The prevalence of GERD was affected by the gender category and BMI.

Different genes such as vitamin D receptor (VDR) gene have some roles in IBD susceptibility. Some studies have recognized the relation of VDR gene polymorphisms with inflammatory and autoimmune disorders. Determining the frequency of these polymorphisms and their possible relation with IBD can improve understandings about genetic background of these diseases. The objective of this study was to assess the association of VDR gene polymorphisms (Apa I, Taq I, Bsm I, Fok I) with IBD in Iran.

In this case-control designed study 100 UC, 50 CD patients and 150 sex and age matched healthy controls, hospital base, were selected. These patients were referred to "Taleghani Hospital" during a one year period (2004-2005). Assessment of VDR gene polymorphisms was performed by PCR-RFLP method.

Only the frequency of the Fok I polymorphism was significantly higher in UC and CD groups. The frequency of the polymorphic allele f was higher in UC and CD groups comparing with controls (p=0.019, OR=1.581 and p‹0.001, OR=2.642, respectively). The f/f genotype was significantly more frequent in UC and CD patients comparing with controls (p=0.010, OR=2.774 and p‹0.001, OR = 5.947, respectively). There were no significant differences between frequencies in patients and controls in other polymorphisms.

There is a relation between Fok I polymorphism in VDR receptor gene and IBD in Iran but no association was observed with other 3 polymorphisms.

Hepatitis C is one of the most important etiological factor in chronic liver disease which could lead to the progressive liver cirrhosis and hepatocellular carcinoma. The purpose of this study is to determine the prevalence of Hepatitis C in east of Golestan province (north-east of Iran). 2123 inhabitants from north-east of Iran of general population have been studied using randomized selection. The taken samples were fresh serum searching for Hepatitis C Virus Antibody (HCV Ab) via ELISA method. A recombinant immunoblot assay (RIBA) was done for the positive HCV Ab samples tested with ELISA as the next step. A total of 2123 samples (female: 1387) with mean age of 41.3| ¡| 14.8 years and 960 rural and 1141 urban were studied. Fifty six samples (female:44) were HCVAb positive (ELISA), twenty of fifty six samples were also RIBA positive (female: 18 equal 81.8% and male: 4 equal 18.2%). According to ELISA result the prevalence of HCVAb positive samples in female was 3.1% (44 of 1387 samples) and in male was 1.6 (12 of 714 samples). As a total result we reached out that the prevalence of Hepatitis C through ELISA method was around 2.6%. This number reduced to 1% considering RIBA positive samples which is the definite test in Hepatitis C diagnosis. This study is the first Hepatitis C determination in general population in Iran. A comparison between the Hepatitis C prevalence in north east Iran and other part of the world showed that Iran relatively has a lower prevalence (Asia: 3.55% Africa: 5.17% America: 1.9%). No other Hepatitis C evaluation study has been done in any other part of Iran.

Disseminated B cells Burkitt's lymphoma with stomach, breast and eyelid involvement Burkitt's lymphoma in adult is rare and has a progressive pattern in advanced stages. The current case is a 19 year old lady who was admitted in a hospital due to GI bleeding shown as melena. An upper gastrointestinal Endoscopy report remarked a tomural mass lesion and also multiple masses in breast and abdomen Were found in computerized tomography escan. A B cells Burkitt's lymphoma diagnosis came up after biopsies of stomach and breast masses which was confirmed by immunophenotyping done with flowcytometry (CD20, Ki67 = 100%).

Achalasia is the most recognized esophageal motor disorder with an unknown etiology. Symptoms rather than physical findings are hallmarks of the disease. Modalilies for treatment include pharmacologic, botulinum toxin injection, pneumatic dilation and surgery. To review the diagnostic and therapeutic options currently available for achalasia. A medline search identified the original articles and reviews published in the English language literature. We also reviewed our research center (Digestive Disease Research Center) articles. Pre and post treatment symptom score and timed esophagogram are important for assessment of treatment success rate. Pharmacotherapy, injection of botulinum toxin, pneumatic dilation and cardiomyotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strengths and weaknesses which make them each suitable in certain population, but pneumatic dilation and surgery are the most effective options. The optimal treatment for achalasia remains an area of controversy. In our opinion preumatic dilation is the best primary treatment in majority of Achalasia patients and Botulinum toxin injection and surgery should be reserved for patients that pneumatic dilation is high risk or ineffective in them.

Oxaliplatin (OX) significantly enhanced the antitumor activity of 5-FU in patients with advanced colorectal cancer and recently some phase II trials have evaluated the feasibility and efficacy of oxaliplatin in neoadjuvant setting for treatment of locally advanced rectal cancer. On the other hand various studies have demonstrated that the overexpression of thymidylate synthase (TS) can induce resistance to 5-FU in colorectal carcinoma. The aim of this study was to assess the value of TS expression as a predictive factor in the efficacy of neoadjuvant chemoradiation with and without oxaliplatin in rectal cancer.This study was performed in 61 patients (that ultimately 50 patients had including criteria) with locally advanced rectal adenocarcinoma that inferior margin of the tumor had to be located no farther than 6 cm from the anal verge. Preoperative radiotherapy was delivered to the pelvis with CO 60 to 50/4 Gy. All patients received simultaneous chemotherapy: 5-fluorouracil (5-FU), 300 mg/square meter i.v. 24 h infusion during radiotherapy on days 1-5 every week. Thirty patients received oxaliplatin 50-60 mg /square meter weekly during radiotherapy.TS expression was assessed by immunohistochemical staining technique in pretreatment specimen, and the patients were categorized into TS (+) and TS (-) groups. A total of 23 of 50 tumors showed TS positive status at biopsy (46 %). Overall 36 patients (72%) achieved pathologic response (40% complete and 32% partial) that was significantly better in the TS (-) group than in the TS (+) group (85.1 vs 56.5%, p=0.024) and in the OX (+) group than in the OX (-) group (86.6 vs 50%, p=0.005). Among TS (-) patients there was no difference in pathologic response (88.2 vs 80%, p=0.561) or sphincter preservation (76.4 vs 80%, p= 0.831) as a result of whether oxaliplatin therapy was carried out or not. But among the TS (+) patients there was a significant gain in pathologic response (84.6 vs 20 %, p=0.002) and sphincter preservation (84.6 vs 40 %, p= 0.026) in favor of oxaliplatin group. Our study indicate that oxaliplatin can improves poor outcome of TS positive rectal cancer and TS expression may be used for selecting patients for oxaliplatin containing neoadjuvant chemoradiation protocols that can have major role in the tumor down staging and preservation of sphincter and ultimately better quality of life.

The prognosis of patients with decompensated cirrhosis due to hepatitis B is very poor. It has been shown that lamivudine can improve liver function and delay the need for liver transplantation in HBeAg-positive patients with decompensated cirrhosis. However, information regarding long-term use of lamivudine in HBeAg-negative patients with cirrhosis is limited. The primary objective of this study was to evaluate the long-term efficacy of lamivudine in HBeAg-negative/HBeAb-positive patients with decompensated cirrhosis. 54 consecutive HBeAg-negative/HBeAb-positive patients with decompensated cirrhosis were enrolled into this study. All patients were treated with 100 mg lamivudine per day. Significant clinical improvement was defined as a decrease of at least 2 points in Child-Pugh-Turcotte (CPT) score. Repeated-measure one-way analysis of variance was used to evaluate the effect of time interval of lamivudine treatment on different variables. Kaplan-Meier survival analysis and Mantel-Cox test were used to further analyze the data. The mean±SD age of patients was 50.6±13.2 years. There were 40 male and 14 female patients. The median follow-up was 29 (range: 6-64) months. CPT score, MELD score and blood chemistries changed significantly after 6 months of therapy. The favorable changes were continued up to 2 years. In spite of worsening after 3 years, within subject effects measured by repeated-measure ANOVA, were significant for patients who have received lamivudine for 4 years or more. Long-term lamivudine therapy improves liver function in HBeAg-negative/HBeAb-positive patients with decompensated cirrhosis.