Govaresh
Volume:12 Issue: 3, 2008

Endoscopy of the upper gastrointestinal tract is the most accurate method for the diagnosis of most disease conditions associated with dyspepsia. However, endoscopy involves some discomfort, significant social inconvenience, and cost. Attempts to identify those patients most likely to benefit from endoscopy have met with variable success. To evaluate endoscopic findings of the upper gastrointestinal tract, performed in Firouzabadi Hospital, Tehran, Iran. This analytical cross-sectional study was performed on 4,859 patients who underwent upper gastrointestinal tract endoscopy in Firouzabadi Hospital, Tehran, between 1991 and 2001. Clinical variables of consecutive patients presenting with symptoms of dyspepsia who underwent upper gastrointestinal tract endoscopy examinations were recorded using a common endoscopy database. Of 4,859 patients studied, 46.7% were male and 53.3% were female. The most common chief complaint was epigastric pain (51.9%) followed by heartburn (14.2%) and melena (7.1%). Furthermore, the most frequent endoscopic finding was gastritis (23%) followed by esophagitis (14.8%) and peptic ulcer (13%). Regarding high sample size and a 10-years evaluation of endoscopic findings in our study leaded to considerable descriptive information in this subject. In addition, the relationships found in our study are of value.

Considering the unknown etiology of inflammatory bowel disease (IBD), the epidemiologic evaluation may help to identify the causative agents of the disease. Genetic (ethnic) and environmental (e.g., geographic) factors in Iran may influence the incidence of the disease. The objective of this study was to determine the demographic and clinical characteristics of the IBD in the city of Sari, northern Iran. All patients with IBD who referred to a private clinic of gastroenterology or Department of Gastroenterology of Imam Khomeini Hospital, Sari, Iran during 2000 to 2007 were included in this study. Age of onset, gender, level of education, resident place, extension of disease, extra-intestinal manifestations, the necessary surgical interventions, and associated diseases were assessed. Out of 302 IBD patients enrolled in this study, 265 (87.7%) had ulcerative colitis (UC), and 35 (11.5%) had Crohn's disease (CD). CD patients were younger than UC patients at the diagnosis. There was no significant difference between the gender and IBD involvement. Most of the patients aged between 20 and 40 years. Left-sided UC was the most common type (48.3%). Family history was positive in 3.4% of UC patients; it was negative among CD patients. Twenty-six (8.7%) patients with IBD had at least one extra-intestinal manifestation. The demographic and clinical characteristics of IBD are almost similar to other reports from developing countries. Although the true epidemiologic picture of IBD in Sari is still unknown, IBD is not as rare as was previously thought. Gradual acceptance of a Western lifestyle may be responsible for the observed continuing rise in the incidence of IBD.

Patients with gastroesophageal reflux disease (GERD) unresponsive to proton pump inhibitor (PPI) therapy are often labeled as having refractory GERD. One of the probable etiologies of refractory GERD is delayed gastric emptying. Refractory GERD associated with gastroparesis is a complex condition with no definitive treatment to date. We opted, for the first time, to test the hypothesis that whether endoscopic pyloric injection of botulinum toxin alleviates the symptoms of both disease conditions. Thirteen patients with refractory GERD plus gastroparesis -as confirmed by gastric emptying scintigraghy- underwent endoscopic pyloric injection of botulin. Injection significantly improved both gastroparesis- and refluxrelated symptoms in the majority of patients but the duration of symptom relief was relatively short. Responders to treatment had significantly higher total reflux symptom scores (before injection) than nonresponders. All but one of the patients in whom gastroparesis symptoms improved also had improvements in reflux symptoms-which supports our hypothesis. We believe that response to toxin injection is a reliable predictor of response to subsequent surgery (pyloroplasty or pyloromyotomy) following the recurrence of symptoms.

Cancer of the gallbladder is an uncommon but a fatal disease. Cholelithiasis has been identified as a major risk factor for this cancer. The objective of this study was to evaluate the association between the presence of cholelithiasis and gallbladder cancer. 1,136 patients who underwent cholecystectomy between 1993 and 2003 in Shariati Hospital, affiliated to Tehran University of Medical Sciences were retrospectively studied and the proportion of patients who has had cholelithiasis was determined. Finally, we identified those patients with cholelithiasis who were also diagnosed as gallbladder cancer. 1,055 (92.8%) patients underwent cholecystectomy for cholelithiasis; 1.4% of these patients had also pathology-proven cancer. On the other hand, during this period, 20 patients with gallbladder cancer were diagnosed; the initial diagnosis in 70.5% of these patients were cholelithiasis. In only 5% of cancer patients, the diagnosis of neoplasia was made initially. Although a very small portion of those with gallbladder stone will develop cancer, most of patients with gallbladder cancer present with signs and symptoms of gallbladder stone which may imply a close correlation between these two conditions. Therefore, prophylactic cholecystectomy may be beneficial for patients with chronic gallbladder stone.

A 56-year-old woman came in with abdominal pain, nausea, vomiting, fever, 15 kg weight loss and accelerated asthma for which she had used zafirlukast and a high dose of prednisolone. During taper down of her prednisolone, her condition deteriorated. She developed generalized wheezing, diffuse abdominal pain, and left foot drop. Lab examination revealed eosinophilia, elevated red cell sedimentation rate and positive P-ANCA. Considering her asthma, involvement of her sinuses apparent on paranasal sinus computed tomography, development of mononeuritis multiplex and her lab findings, the diagnosis of Churg-Strauss vasculitis was made. High dose prednisolone and endoxane pulse therapy were started. After 3-4 days, her fever and other symptoms resolved dramatically. After three months of follow-up, she is doing well on maintenance therapy and had no symptoms. This syndrome may develop during tapering of prednisolone in those who use leucotrienes.

Host genetic and environmental factors are involved in development of gastric cancer. Tumor necrosis factor (TNF)-α| has a key role in Helicobacter pylori-induced gastritis. We analyzed the association between TNF-α polymorphism and the risk of gastric cancer in an Iranian population residing in northeastern Iran.In a case-control study, the genotyping was carried out by PCR-RFLP in 108 patients with gastric cancer and 100 randomly-selected healthy individuals. The polymorphic sites studied include promoter region of TNF-α at position 308 (G-A transition). H. pylori infection was determined by ELISA assay in 100 patients.The frequencies of TNF-α 308 GG, AG and AA genotypes were 67%, 29% and 4% for controls and 75.9%, 13.2% and 10.2% for patients. AG genotype significantly reduced the risk of gastric carcinoma (p=0.008). There was no association between TNF-α 308 polymorphisms and the risk of diffuse type gastric carcinoma. Carriers of AG genotype wereassociated with a decreased risk of intestinal type gastric carcinoma (OR=0.25, 95% CI: 0.08-0.7). With stratification of patients according to H. pylori infection status, there were no significant differences in the frequencies of genotypes between those with H. pylori-negative gastric carcinoma and controls. However, the frequency of AG genotype was significantly higher among controls than H. pylori-positive cases (OR=0.230, 95% CI: 0.06-0.8). In contrast, AA genotype was significantly more frequent among H. pylori-positive cases compared to the controls (OR=4.1, CI: 1.04-16.4).Our results suggest an association between TNF-α 308 polymorphism and the risk of gastric cancer in Iranians. The effect is prominent among H. pylori-infected patients and intestinal type of gastric carcinoma.

Celiac disease occurs primarily in whites of northern European ancestry. Previous beliefs aboutepidemiology of celiac disease in Iran has changed after recent studies on the disease. The aim of this study is to find the frequency of celiac disease among patients with irritable bowel syndrome.During one-year period (2006-07), patients with irritable bowel syndrome with Rome II criteria referred to the University Clinic in Bandar Abbas, Hormozgan, South of Iran, were studied to identify those who had also celiac disease. Serologic tests were used to screen patients for celiac disease. If the serologic test became positive, a duodenal biopsy was taken to confirm the diagnosis.150 patients fulfilling Rome II criteria for irritable bowel syndrome were evaluated. 19 (12.7%) patientswere found to have tissue transglutaminase (tTG) antibody; out of these 19 patients, 15 (10% of total cases) had abnormal intestinal pathology according to the modified Marsh classification,5 had type I, 6 type II, 3 type IIIA and 1 had type IIIB lesions.Celiac disease is a relatively common finding among patients with irritable bowel syndrome.

In recent years, tuberculosis has had a significant rise, caused mainly by the epidemic of acquired immunodeficiency syndrome. The anorectal tuberculosis is a very rare presentation. Herein, we presented a 67-year-old man who has had renal transplantation and presented with hematochezia and painful defecation since 6 months before. Biopsy was taken from the lower rectal ulcerated lesion. Histopathology revealed granulomatous lesion in the submucosa and presence of acid fast bacilli in Ziel-Nelson staining. The involvement of rectal wall without any other primary sites of tuberculosis showed the primary nature of rectal tuberculosis.