Middle East Journal of Digestive Diseases
Volume:2 Issue: 2, Sep 2010

Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder noted in the general population worldwide. Its chronic nature, signs and symptoms which vary periodically from mild to severe have many negative effects on the quality of life for the sufferer; therefore the appropriate treatment of these patients is highly important. Patients should be informed by their doctors that the nature of the disease is benign, and educated on how to deal with and control symptoms of the disease. This article sets out a review of recent studies on the prevalence of IBS in Iran and appropriate methods for management of patients affected by IBS.

Epidemiology of diseases changes over time with changes in socio-economic status, culture and health care systems. Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are among the diseases whose epidemiology has changed over the past few decades in the west. Studies addressing the trend of GERD and PUD occurrence in Iran are lacking. We aimed to look at the time trends of GERD and PUD in a referral endoscopy clinic in Tehran, Iran. Methods All patients with dyspeptic symptoms who underwent upper GI endoscopy from 1993 to 2005 (inclusive) in a tertiary outpatient GI referral center in Tehran were enrolled. Erosive esophagitis (EE, used as a proxy for GERD as a whole), PUD, rapid urease test (RUT) status and demographic characteristics were recorded from the endoscopy reports according to the year the endoscopy was performed. Over a period of 13 years, 8,029 endoscopic examinations were performed. The most common endoscopic diagnosis was EE that occurred in 4,808 patients (59.8%) followed by duodenal ulcer in 2,188 (27.3%) and gastric ulcer in 88 (1.1%). Over 13 years (1995-2005), the proportion of EE increased from 14.1% in 1993 to 75.1% in 2005 among dyspeptic patients in this referral clinic. The proportion of each grade of GERD according to the Los Angeles classification was as follows: GERD-A 76.0%, GERD-B 20.9%, GERD-C 2.8% and GERD-D 0.3%. RUT positivity decreased from 71.4% to 9.5% during the study period. Conclusion This study shows a remarkable increase in EE with a concomitant decrease in PUD and RUT positivity among dyspeptic patients in Tehran over a decade. This change in trend is important for future health care planning.

Background Symptoms of gastro-esophageal reflux disease (GERD) affect health-related quality of life (HRQOL). When a questionnaire is translated into a new language, linguistic validation is necessary, yet insufficient, unless the psychometric characteristics have been verified. The aim of this study is to document the translation and psychometric validation of the Persian translation of the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire. Methods After translation and cultural adaptation of QOLRAD to Persian, fifty patients with clinical GERD from the Prospective Acid Reflux Study of Iran (PARSI) database who had at least one of the symptoms of acid regurgitation, heartburn, non-cardiac chest pain, or dysphagia for at least four weeks over the past three months completed the QOLRAD and Short Form Health Survey-36 (SF-36). After two weeks, QOLRAD was again completed by the patients. Cronbach alpha and Intra-class Correlation Coefficient (ICC) were used to test reliability and Pearson correlation was used to compare the dimensions of SF-36 and QOLRAD. Results The translation was approved by MAPI Research Institute. Fifty patients completed the SF-36 and QOLRAD questionnaires at the first visit. Mean (SD) age of the participants was 38.4 (14.6) years and 68% were females. The internal consistency and reliability of QOLRAD ranged from 0.78–0.92. The test-retest reliability of QOLRAD was from 0.87–0.93. Relevant QOLRAD domains significantly correlated with the majority of SF-36 domains, with the exception of sleep disturbance. Conclusion The psychometric characteristics of the Persian translation of QOLRAD were found to be good, with satisfactory reliability and validity.

Achalasia is the most recognized motor disorder of the esophagus. Because it is an uncommon disease, most studies have reviewed small numbers of patients. Here, we report demographic, clinical features and treatment outcomes in 700 achalasia patients. In all patients, diagnosis was established based on clinical, radiological, endoscopic and manometric criteria. A questionnaire was completed for each patient and included the patient’s age, gender, initial symptoms, frequency of different symptoms, presence of positive family history for achalasia, other accompanying diseases and treatment outcomes. In our study men were affected more than women (54.3% vs. 45.7%). Patients’ mean age was about 38 years. The most frequent symptoms noted were: dysphagia to solids and liquids, active regurgitation, passive regurgitation and weight loss, respectively. Women complained of chest pain more than men (59% vs. 47.1%, p=0.04). The vast majority of our patients were treated by pneumatic dilation (PD) of the LES and in long-term follow-up, 67% were in the responder group. Females responded better than males to PD. Dysphagia to solids is the most common symptom in patients with achalasia. Chest pain was significantly higher among women. PD is an effective treatment for achalasia with long-term efficacy in the majority of patients.

Little is known about HEV seroprevalence and its determinants in Iran. Considering the fact that Iran is among the countries in which HEV infection is endemic, a large-scale population-based study in this regard is justified. This survey was conducted in 2006 in Tehran and Golestan Provinces, Iran. Stored sera of subjects were tested for serological markers of anti-HEV. The baseline data were recorded in structured questionnaires. Weighted seroprevalence and weighted logistic regression coefficients were calculated. A total of 1423 samples were included. The overall seroprevalence in two provinces was 7.4%. Age with an odds ratio equal to 1.59 (95% CI: 1.26-2.02) and history of traditional phlebotomy with an odds ratio equal to 2.28 (95% CI: 1.13-4.60) were independent predictors of HEV seropositivity. Conclusi on Considering the high rate of HEV seroprevalence in Iran, further studies on the cost-effectiveness of vaccination among vulnerable groups are mandatory.

Increases in aminotransferases (transaminitis) are potential major adverse reactions seen with long-term use of methotrexate (MTX). The aim of this study, therefore was to evaluate the incidence of MTX induced hepatotoxicity and its risk factors among rheumatoid arthritis (RA) patients. Methods This retrospective study described 286 patients with RA who received ≥ 7.5 mg MTX weekly in an academic rheumatology clinic over a 15 year period. The results of serial liver function tests, concurrent MTX dose, cumulative dose and use of hepatotoxic drugs were collected and statistically analyzed according to a consecutive elevation in aminotransferases which occurred over at least a two week interval. During the study period, 286 patients (84.4% female) with mean age of 46.6±12.7 years (18-84 years) were enrolled. Transaminitis occurred among 23.7% of patients (incidence: 6.9 per 100 person-years) during 40.5±34.6 month’s exposure to MTX (989.6 person-years). The time difference between onset of therapy and occurrence of transaminitis was 22.1±22.0 months. The only significant factor related to the occurrence of transaminitis was the duration of MTX therapy. The average duration of treatment among patients with transaminitis (59.6±42.3 months) was greater than those with no transaminitis (p<0.001). The cumulative dose of MTX was significantly related to the occurrence of transaminitis (p<0.001). MTX hepatotoxicity is a common complication of long-term treatment with MTX. It is associated with mild liver enzyme elevation and related to the duration of therapy.

Iatrogenic perforation of the colon during elective colonoscopy is a serious complication. Surgical treatment remains the standard of care. We report a patient with a large colonic perforation that occurred during a screening colonoscopy, successfully repaired with laparoscopic methods. Although the safety and efficacy of this approach is not entirely established, laparoscopy can be used to treat iatrogenic colonic perforation when the defect is readily recognized, easily accessible for closure and the bowel preparation is excellent. A laparoscopic approach to treat iatrogenic colon perforation results in decreased morbidity and hospital stay, in addition to a shorter incision length compared to an open method. In those cases where it is feasible and the surgical skill exists, a laparoscopic attempt at colon repair should probably be the initial clinical approach

Retained surgical gauze is occasionally observed in general practice. Herein, we report a case with surgical gauze retained for over 13 years that created a fistula which drained pus into the stomach.

three year old boy presented with tetanus who additionally suffered from nonbloody diarrhea. Physical examination showed bilateral edema of the lower limbs. Laboratory data showed iron deficiency anemia, hypoalbuminemia, hypocalcaemia and hypogammaglobulinemia. Stool culture was negative for bacteria however fat droplets were detected in the patient’s stool. Endoscopic examination revealed white intestinal mucosa. Duodenal biopsy specimen showed dilated lymphatic channels in lamina propria