Govaresh
Volume:14 Issue: 2, 2009

Coeliac disease (CD) is characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine by an inappropriate immune response to dietary gluten proteins. The aim of this study was to assess the prevalence of CD in our endoscopy unit by taking routine duodenal biopsies during upper GI endoscopy.Materials and Nine hundred and thirteen patients referred to our clinic during a period of 18 months. Patients were divided into three subgroups according to their indications for endoscopy. Group I involved 142 patients with classical symptoms. Group II included 50 patients with the so-called associated disorders of CD and Group III was composed of 573 patients with atypical gastrointestinal symptoms. In all patients upper GI endoscopy was performed and biopsy specimens were taken from second part of duodenum. Seven hundred and sixty five patients were available for follow up. Nine patients were found to have CD (5 men, 4 women).The prevalence of CD in group I, II and III were 9/142 (6.3 %), 0/50 (0%), and 0/573 (0%) respectively. Significant differences in the prevalence of CD among these three subgroups were recognized (P‹0.05). Patients should be selected for duodenal biopsies considering their clinical presentations, endoscopic findings, taking biopsies from all patients without any indications does not seem to be appropriate.

There are many preparation regimens for bowel cleansing. Given their adverse effects, none of them have been considered perfect by the endoscopists. The aim of this study was to compare the effects of two bowel cleansing regimens on clean colonic preparation the subjectswell being and electrolyte balance.Materials and Atotal number of 280 patients were randomly assigned to receive either magnesium sulfate (group A, N = 140) or polyethylene glycol (group B, N = 140) as a bowel preparation regimen for colonoscopy. Patients in group A received 120 ml magnesium sulfate 33%. Patients in group B received 2 liter Polyethylene Glycol one day before and 2 liter Polyethylene Glycol on the day of procedure. The quality of preparation was graded by an endoscopist who was blinded to the type of preparation. The simplicity of preparation method, taste of the preparation and their adverse effects were also recorded by an independentblinded investigator, using a questionnaire before the colonoscopy. Blood samples were taken from subjects before and after colonoscopy. The quality of bowel cleansing was significantly higher in group A (P=0.039). There was no significant difference between the two regimens regarding their side effects and the simplicity of preparation method. However, preparation taste was reported significantly worse in group A (p ‹0.001). Blood samples showed that creatinine and urea decreased more in groupAand potassium decreased more in group B, but all were within the normal limits. Considering our results magnesium sulfate with regard to price and availability is recommended for bowel preparation.

Coeliac disease is triggered by ingestion of gluten-containing cereals in genetically susceptible subjects. The aim of the study was to analyze correlation between serum antiendomysial antibody and antiglidin antibody and the grade of pathology in small intestine mucosa in children with celiac disease. This cross-sectional analysis was carried out in a group of 40 children (23 boys, 17 girls) with age range of 1.5- 14 years. The IgA-EMA, IgAAGA and total IgA were evaluated in all subjects. All patients underwent endoscopic small intestine biopsy. Histopathologic assessment was evaluated with Marsh criteria. EMA and AGA were positive in 77.5 and 87.5%, respectively. The most common clinical presentations were underweight, chronic diarrhea and anemia. Histopathological assessment of small intestine mucosal biopsy revealed Marsh I, II, IIIa, IIIb and IIIc in 15%, 27.5%, 40%, 12.5% and 5%, respectively. From two serological tests, EMA showed a statistically significant correlation with the grade of pathology. Sensitivity of antiendomysial antibody was 100% in Marsh III. This study demonstrated significant correlation between the presence of serum antiendomysial antibodies and the grade of pathology in small intestine mucosa.

Pharmacotherapy and psychotherapy were previously used to increase the quality of life and decrease the severity and frequency of symptoms in patients with irritable bowel syndrome (IBS). The aim of this study was to compare the effect of using relaxation in addition to pharmacotherapy to reduce the severity and frequency of symptoms and to increase the quality of life in IBS patients with diarrhea (IBS-D). This study was a randomized clinical trial. We had 64 IBS-D patients who were selected according to the ROME III criteria and were divided into two groups, randomly. In one group, they only took citalopram and other routine medicines (group A) and in the other group, along with medicines, relaxation therapy was used (group B). Therewas a significant difference in quality of life (QOL) between the two groups in both post-treatment and follow-up stages (p‹0.05) and there was a significant difference in post-treatment stage between groupAand group B in severity and frequency of symptoms (p‹0.05) but not in follow up stage (p›0.05). Adding relaxation therapy to routine drugs in IBS-D patients could improve their quality of life and decrease the severity and frequency of symptoms although cessation of this new treatment may lead to relapse of symptoms.

FamilialMediterranean Fever (FMF) is a hereditary syndrome characterized by recurrent attacks of fever and serositis. Liver involvement in FMF has been reported in association with amyloidosis or rarely with vasculitis.In this report, a 32 year-old man with recurrent attacks of fever, abdominal pain and arthralgia is described who had moderate increase in liver transaminases only during disease flares. FMF was diagnosed based on clinical picture, positive MEFV mutation and response to colchicine. Meanwhile, liver enzymes normalized after colchicine treatment. Despite a thorough work up, no known underlying liver disease was found to account for transaminitis.It seems that the only explanation for abnormal liver enzymes in this FMF case is transient hepatitis during FMF attacks which has already been described in few case reports on liver involvement in FMF.

Reye's syndrome is defined as fatty liver degeneration and acute encephalopathy following diffused abnormal mitochondrial activity. We reported a two year old girl admitted with lethargy and meningismus Despite no evidence of blood sugar decrease, history of previous viral disease or drug use, complete tests showed Reye syndrome as the final diagnosis. Conservative protocols and treatment including carnitine and antibiotic therapy were administered and finally, the patient was discharged in good condition. Normal blood sugar, no evidence of previous viral infection or drug use are uncommon manifestations in Reye's syndrome which were present in this case. Treatment included carnitine and antibiotic therapy with considerable response.

Osteoporosis is a preventable and treatable disorder, reported with higher prevalence patients with ulcerative colitis but their relationship is controversial. Osteoporosis in these patients may be attributes to corticosteroid use, malnutrition and reduced intake of calcium and Vitamin D, lower levels of sex hormones, chronic inflammation and inflammatory cytokines. The aim of study was to compare bone mineral density (BMD) of femoral neck and lumbar spine in ulcerative colitis patients with age and sex matched controls. This was a case-control Fifty patients with ulcerative colitis referred to Shariati Hospital and four private clinics from 2003 to 2006, were selected. Patients with history of long term corticosteroid use and postmenopausal women were excluded. The short term corticosteroid users (less than 3 month in the past 2 years) were included. Age and sex matched healthy Shariati Hospital staffs and their families were selected as control group. The Bone Mineral Density (BMD) was measured in lumbar spine (L1-L4), femoral neck and total hip sites. The effect of different factors such as age, sex and short-term corticosteroid use and disease duration and disease activity on BMD was evaluated in patient group. All variables were encoded and analyzed by SPSS -13. There was no significant difference between the case and the control groups in BMD of lumbar spine, femoral neck and total hip. There was no difference in decrease of BMD between males and females (P:NS). Short term corticosteroid use and disease activity at the time of densitometry had no impact on BMD of lumbar spines, femoral neck and total hip. (P:NS). Disease duration had negative effect on BMD of lumbar spine, femoral neck and total hip (P≤0.02). Aging decrease BMD of lumbar spine and femoral neck and total hip in these patients (P≤0.03). Ulcerative colitis patients that are not prolonged users of corticosteroids, dont need screening for osteoporosis unless in special circumstances such as aging and long disease duration.

The gastrointestinal tract is the most frequently involved extranodal location for MALT* lymphomas, but MALT lymphomas of the large intestine are rarely observed. A treatment for colorectal MALT lymphoma has not yet been established. In colonic MALT lymphomas, the literature suggests that surgical resection of localized lesion may be the best choice. In the present case, combination of multi-agent chemotherapy and radiotherapy was effective, though a long-term follow-up is definitively needed. In this report, a 56 year-old man with MALT lymphoma manifesting in colonoscopy as multiple mucosal discolorations and some localized granularity of the rectum mucosa is presented.