Middle East Journal of Digestive Diseases
Volume:1 Issue: 2, Sep 2009

Ba ckground Gastrointestinal and liver diseases (GILD) are among the most common causes of morbidity in Iran and constitute a substantial proportion of mortality which imposes enormous economic consequences. Our purpose is to collect information and report current statistics on physician visits, hospitalizations, and deaths due to common GILD in Iran. Methods Data on the leading causes of death were obtained from the Iranian Ministry of Health, Office of Health Statistics. A total of 213,322 deaths were reported from March 2003 to February 2004 (excluding mortality from the Bam earthquake) which equaled 4.4 deaths per 1000 population. Of these, 36,575 were due to accidents. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases (ICD-10; 1992). The leading causes of hospitalization were obtained from the database of the GILD ward in Shariati Hospital, one of the largest and best known gastroenterology referral hospitals in Iran. Similarly, leading causes of out-patient referrals were identified from a large multi-physician outpatient clinic in Tehran. R esults The five leading gastrointestinal causes of death in order of frequency were: gastric cancer, hepatobiliary cancer, liver cirrhosis, esophageal cancer, and colorectal cancer. The five leading causes of hospitalization in the GILD ward of Shariati Hospital were: liver cirrhosis, hepatitis, peptic ulcer disease, cholycystitis and cholangitis, and colorectal cancer. The most common outpatient diagnosis was gastroesophageal reflux disease followed by irritable bowel syndrome (IBS), duodenal ulcer (DU), non-ulcer dyspepsia, and chronic hepatitis B (HBV). C onclusion Gastrointestinal and liver malignancy along with chronic liver disease constitute the main GILD reasons for hospitalization and deaths in Iran. Gastroesophageal reflux disease, IBS, and chronic HBV are the most common GILD outpatient diagnoses.

Ba ckground The only curative therapy for end-stage liver disease is transplantation but due to a shortage of available donor livers the waiting list mortality is high. This study aimed to evaluate the outcome and characteristics of patients on the waiting list for liver transplantation in Shiraz, southern Iran during the period from April 2004 to March 2007. Methods Medical records of all chronic liver disease patients ≥14 years that were on the waiting list for liver transplantation at the Nemazee Hospital Organ Transplant Center during April 2004 to March 2007 were reviewed. Hospital records were used to retrieve demographic, clinical and laboratory data. Records of the referring gastroenterologists provided information about the etiology and complications of liver disease. The patients were followed at the end of the study period by clinic visits or telephone contact. R esults There were 646 patients on the waiting list for liver transplant during April 2004 to March 2007. Hepatitis B was the most common etiology of liver disease (31.2%). Of those on the waiting list, 144 patients 22.3%) underwent liver transplant and 166 (25.7%) died while waiting for a transplant. The mean waiting period for transplant was 6.6 months. Receiving a transplant was correlated with the etiology of liver disease and Rh blood group (p<0.05) but had no significant association with gender or ABO blood type. Among non-transplanted patients, survival was lower in those who had a history of encephalopathy, SBP or uncontrolled ascites and in patients with a Child-Turcotte-Puph (CTP) class C and/or a Model of End-stage Liver Disease (MELD) score≥15. C onclusion Hepatitis B virus is the most common cause of end-stage chronic liver disease amongst patients on the waiting list for liver transplant in Shiraz, southern Iran. Patients with a MELD score≥15 particularly those with a history of SBP, hepatic encephalopathy or uncontrolled ascites are recommended for waiting list enrollment.

Ba ckground Hirschsprung’s disease (HD) is a congenital disease in which intestinal ganglionic cells are absent, leading to intestinal obstruction. The disease has various clinical manifestations and different lengths of bowel may be involved. Our aim was to study Hirschsprung’s clinical presentations and its rate of intestinal involvement in hospitalized patients in a six year course study in Gilan, a northern province of Iran. Methods We studied patients diagnosed with HD who were referred to the Gilan Surgery Referral Center in Poursina Hospital from 1995 until 2001. In this cross sectional descriptive-analytical study, all data were collected from patients’ files and questionnaires. Data included demographics, clinical presentations, diagnostic methods, involved intestinal segments, type of surgical procedure, and surgical complications. R esults There were 58 cases of HD during this six year period that underwent surgery. Of these, 19 patients were female and 39 were male whose ages ranged from one day to 18 years old. A variety of clinical findings such as: constipation, abdominal distension, failure to pass meconium, diarrhea, and other less common manifestations were present. We found three different pathological types: rectosigmoid, ultra short segment and total colonic involved segment. No differences between disease presentations were discovered among these three types. The following surgical procedures were performed: Swenson, Soave–Boley, and Lynn. Early complications, which occurred during the first month following surgery, were anastomotic leakage, wound infection, hemorrhage and anastomosis stenosis. Late complications, occurring at least one month after surgery, comprised the following: long-term constipation, enterocolitis, incontinence, and obstruction due to adhesion. No significant difference between the complications of these surgical procedures and any accompanying anomalies were found. C onclusion Most patients had chronic constipation and abdominal distension regardless of the types of involvement, age or clinical presentations. There were few associated anomalies amongst the patients. In some cases, surgical complications were less than those seen in other studies; therefore, it seemed that the performed procedures had fewer complications or may have been performed at the appropriate time.

Ba ckground A substantial proportion of the mortality in patients with type 2 iabetes mellitus (T2DM) is related to non-alcoholic fatty liver disease (NAFLD) and its complications. Insulin resistance is a major etiologic factor for the development of fatty liver. We aimed to study the prevalence of NAFLD among T2DM patients and its relation to insulin resistance. Methods Patients with T2DM that were referred to a tertiary referral center in Tehran from February 2003 to August 2005 were evaluated. Patients with characteristic findings on ultrasonography were considered as having fatty Livers. The Homeostasis Model Assistant - Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated as measures of insulin resistance. R esults Of the 172 patients included in the study, 96 (55.8%) had evidence of fatty livers, 6 of which (3.5% of total) presented with elevated liver enzymes. BMI and triglyceride levels in the fatty liver group were significantly higher than patients with normal livers (p=0.002 and 0.036, respectively). The HOMA-IR and QUICKI indexes were not significantly different between the two groups. C onclusion Fatty liver is a common finding among T2DM patients. The degree of insulin resistance does not appear to be predictive of fatty liver among this population.

Ba ckground Pilonidal disease is a common condition that affects younger people in which over half of the affected patients present with a sacrococcygeal abscess. This study was performed to compare the outcome of excision and primary closure with that of rhomboid excision and flap procedure in patients with uncomplicated pilonidal disease. Methods A total of 90 consecutive patients with pilonidal disease were randomly divided into: group 1 who underwent the rhomboid fasciocutaneous transposition flap procedure (n=45) and group 2 who underwent excision and primary closure (n=45). Length of hospital stay and postoperative complications, which included surgical site infection, seroma and hematoma, as well as the time to resumption of work and early recurrence were compared for all patients. R esults Duration of hospital stay (p<0.001) and time to resumption of work (p<0.001) was less for group 1. During a median follow-up of 12 months, no recurrence was detected in patients in group 1 whereas six patients developed recurrence in group 2 (p=0.013). C onclusion Rhomboid fasciocutaneous transposition flap procedure, with its acceptable long-term results and shorter hospital stay, is preferable to simple excision and primary closure in the treatment of uncomplicated pilonidal disease.

Ba ckground Helicobacter pylori (H. pylori) infection usually occurs during childhood, especially in developing countries. The aim of this study was to evaluate the prevalence of H. pylori infection among children in primary schools of Rasht, a northern Iranian city. Methods This cross-sectional study was conducted among 961 primary school students in Rasht. Samples were randomly selected and stored at -20ºC until analysis. The stool assay was performed using the HP AgT kit. R esults Overall 475 boys and 486 girls, aged 7 to 11 years were evaluated. A total of 384 (40%) children were diagnosed as H. pylori positive by the stool test. A higher prevalence of H. pylori was found in the stools of individuals who consumed well water and municipal tap water when compared to boiled water (p<0.05). There was no significant difference between the rate of H. pylori infection and individuals’ ages, gender or socioeconomic levels. C onclusion The results of this study suggest that the source of drinking water may play a role in transmission of H. pylori. Transmission can be minimized with the use of boiled or mineral water.

No treatment has been proven to be effective in nonalcoholic fatty liver disease (NAFLD) and/or steatohepatitis (NASH). Numerous studies have addressed this issue. However conclusive recommendations cannot be drawn solely from the currently available studies. Hence we performed this systematic review to determine which of the available therapeutic modalities are supported by adequate evidence in terms of decreasing the adverse clinical outcomes of interest. A specific strategy was utilized to perform a computerized literature search in MEDLINE; of which، a total of 375 studies were retrieved. According to current literature، modifying the potential risk factors such as obesity، hyperlipidemia، and poor diabetic control in all patients is considered the treatment of choice. Certain treatments can be recommended under special circumstances and some medications، although used clinically، are not supported by adequate evidence to be recommended for the treatment of NAFLD/NASH

Ba ckground Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders characterized by non-specific symptoms such as abdominal pain and altered bowel habits with no known organic pathology. Its prevalence varies in different communities. We performed this study to determine the prevalence of IBS in medical students who attended Gilan University of Medical Sciences (GUMS). Methods Medical students of GUMS were studying during 2002 academic year were enrolled in this cross-sectional study. Within a specifically designed schedule, trained general practitioners performed student interviews. The interviewers used a structured questionnaire based on the Rome II criteria. Data were analyzed using SPSS-10 software. Results were presented as percentages and the mean±SD and level of significance was denoted as a p-value <0.05. R esults This study included 422 students, 148 (35.1%) males and 274 (64.9%) females, trained in various educational levels at GUMS whose mean age was 23.7±2.9 years. The prevalence of IBS was 12.6% (53 of 422). IBS was more prevalent in females than males [15% (41 of 274) vs. 8.1% (12 of 148); p<0.05]. Reported a Physician 37.7% of cases visit in comparsion to 17.6% of non IBS case (p<0.05). C onclusion This study shows a higher prevalence of IBS in medical students than in other sections of the Iranian population. A prevalence of 12.6% in medical students, who are in an active phase of life, requires careful planning to provide alleviation.

Postoperative portal vein thrombosis is a rare complication which occurs most often after hepatobiliary surgery. To date, few cases following laparoscopic cholecystectomy have been reported. In this paper we present a case of portal vein thrombosis diagnosed with abdominal CT scan on the seventh day following laparoscopic cholecystectomy. The patient was administered therapeutic intravenous heparin with resolution of symptoms.