Middle East Journal of Digestive Diseases
Volume:4 Issue: 4, Oct 2012

Upper gastrointestinal bleeding (UGIB) is defi ned as bleeding that results from lesions located above the ligament of Treitz and is a common cause for emergency hospital admissions in patients with gastrointestinal disorders. UGIB also increases the risk of morbidity and mortality in patients already hospitalized for other reasons. According to epidemiological surveys of acute UGIB in Iran, peptic ulcer is the most common endoscopic diagnosis. Gastric and duodenal erosion accounts for 16.4%-25% of etiologies. Other relatively common causes of UGIB are variceal hemorrhage, Mallory-Weiss tears, and arterial and venous malformations. However, in 9%-13.3% of patients, the endoscopy is normal.

Postoperative relapse is a common feature of Crohn''s disease (CD) in Western countries but its frequency and risk factors have not been studied in the Middle East where there is a rapid upsurge in the incidence of CD. This study aims to research the frequency and risk factors of its recurrence after surgery among 566 Iranian patients with CD in Tehran, Iran.All 566 patients diagnosed with Crohn''s disease that enrolled in Digestive Diseases Research Center (DDRC) Inflammatory Bowel Disease (IBD) from April 1991 until November 2011 were included in our study. We reviewed clinical data that included time of surgery, possible risk factors and follow up after surgery. Multivariate regression analysis was performed to seek possible risk factors for early postoperative recurrence.The mean age of patients was 30.85 (range: 12-88) years at the onset of enroll­ment. During a mean follow up of 55 months, 139 (24.5%) out of 566 Crohn''s disease patients underwent at least one surgery while 32 (23%) required addi­tional surgery during the period after their first surgical intervention. Cigarette smoking was a risk factor for both initial (p=0.001) and additional surgery (p‹0.0001). The penetrating behavior of Crohn''s disease, in addition to its ef­fect on surgery (p‹0.001), showed a significant influence on disease recurrence (p‹0.0007) along with perianal involvement which was significantly associ­ated with relapse (p=0.001). Although disease duration of more than ten years was a significant risk factor for surgery (p=0.043) its effect on recurrence was insignificant (p=0.059).The rate of initial and additional surgery is much lower in this region of the world, which is partially due to the relatively new occurrence of Crohn''s dis­ease in the Middle East. Cigarette smoking, disease duration over ten years, penetrating behavior of CD, and perianal disease were the main risk factors for surgery.

All conditions that interfere with blood flow at any level within the portal system can lead to portal hypertension. For better management of this disorder, it is important to determine the underlying cause. In previ­ous studies, extra-hepatic disorders have been reported as the main cause of portal hypertension in children. In this study, we investigate the under­lying causes of portal hypertension in children.This prospective, descriptive study investigated the etiology of 45 children with portal hypertension who referred to Nemazee Hospital Pe­diatric Gastroenterology Ward from 2005 to 2007. The underlying causes of portal hypertension were determined by liver biopsy, abdominal so­nography, abdominal computed tomography scan, and liver Doppler so­nography.In this study, 42 of 45 patients (93.3%) developed portal hypertension due to intrahepatic diseases. Extra-hepatic portal hypertension was de­tected in 3 (6.7%) patients with portal vein thrombosis.Intrahepatic diseases were the most common etiology of portal hyper­tension among children who referred to our center.

The process of neoplastic transformation in the stomach has been reported to be associated with decreased expression of normal mucins of the gastric mucosa and denovo expression of mucins that are normally expressed in other organs. This association may be used as a means to bring new insights into biologic behavior and genetic pathways in the development of gastric cancer. There are controversial reports about differences in the genetic pathway and behavior of gastric cancer in younger patients in comparison with older ones. This study aims to determine if there is any difference in mucin profiles among different age groups with gastric cancer.Over a five-year (2003-2008) period, 43 cases of gastric cancer ≤50 years were referred to our center. Of these, 40 had adequate tissue for additional study, whereas three cases lacked a sufficient amount of tumor tissue for immunohistochemistry (IHC) analysis. A group of 40 gastric cancer patients above the age of 50 years were gender-matched with the first group. Expressions of MUC-1, MUC-2, MUC-5AC, and MUC-6 were evaluated by IHC for the total 80 gastric cancer cases.The expressions of the mucins did not show a significant difference between the two age groups.Gastric cancer in both young and old age adults was not significantly different in terms of mucin profiles. Our results have shown that younger age is not predictive of gastric cancer phenotype, which can be an indicator of the lack of difference in the genetic pathways and molecular alterations in these two age groups.

This study aimed to determine the common etiologies and character­istics of lower gastrointestinal (GI) bleeding in children from Southern Iran.This five-year prospective cross-sectional study was performed from March 2006 to March 2011 in Nemazee Hospital. All pediatric patients (10 years) and the findings were reported separately in each group. Each patient underwent a colonoscopy and several mucosal biopsies were taken. Demographic and clinical information as well as colonoscopy and pathology findings were reported.Overall, we included 363 pediatric patients with a mean age of 71.9±58.4 months (range: 1-216 months). There were 215 (59.2%) boys and 148 (40.8%) girls. The most common colonoscopy finding was sig­moid colon polyp in 91 (25.1%) patients followed by descending colon petechia in 78 (21.5%) patients, whitish rectal lesions in 45 (12.4%) pa­tients, and sigmoid and rectal ulcers in 37 (10.2%) patients. Biopsy sam­ples were non-specific in 96 (26.4%) patients. The most common patho­logical finding was juvenile polyp in 84 (23.1%) patients followed by lymphoid nodular hyperplasia in 55 (15.2%) patients and solitary rectal ulcers in 25 (6.9%) patients.We found that lower GI bleeding was more common among 2-10 year-old children and was rarely encountered in neonates. Hematochezia was the most common form of presentation followed by bloody diarrhea and occult blood. The most common colonoscopy finding was sigmoid colon polyps and the most common pathological findings were juvenile polyps.

This study has been designed to investigate the clinical association between gastro esophageal reflux disease (GERD) and chronic otitis media (COM) in adults and also the role of GERD treatment on the outcome of COM surgery.In a randomized clinical trial, 58 patients with COM who were candidates for surgery were evaluated for GERD and divided in two groups; GERD posi­tive (case) and GERD negative (control) patients. The GERD positive patients were randomized to either receiving medical treatment for GERD or not prior to surgery. The surgical outcomes were assessed at 3 and 6 months after COM surgery in the three groups.Fifty-eight (26 males) patients were enrolled. Forty-two (72.4%) of these had GERD according to a validated questionnaire. Three months after surgery audi­tory recovery in GERD negative patients was significantly higher [16(100%)] than those suffering from GERD [28 out of 42 (66.7%)], p=0.008. The figures remained similar at six months follow up as well (100 % vs. 72.5% in GERD negative and positive patients respectively, p=0.002).In the GERD-positive group, 8 of 18 (44.4%) patients who did not receive GERD treatment before tympanomastoidectomy recovered after three months whereas, while 20 of 24 (83.3%) patients who received GERD treatment re­covered during this time (p‹0.001). At six months 44.4% of non-treated GERD patients had auditory recovery as compared to 95.5 % of those treated for GERD (p‹0.01).Our data show that the effect of GERD on the outcome of COM surgery may be considerable. On the other hand, treating COM patients for GERD medi­cally for two months before tympanoplasty improves the surgical outcomes. Therefore, we suggest that COM patients be evaluated for GERD before un­dergoing tympanoplasty and if GERD is present, they be treated medically for a couple of months before undergoing surgery.

Hepatocellular carcinoma (HCC) is very rare during pregnancy and has a worse prognosis in pregnant women compared to those who are not pregnant. We present a case of HCC in a 41- year-old pregnant patient who was referred to our academic hospital. The patient presented with chief complaints of abdominal pain, jaundice, edema and hypertension. Laboratory results were notable for elevated liver enzymes and features of microangiopathic hemolytic anemia with normal alpha fetoprotein (AFP) and elevated cancer antigen 125 (CA125). At laparotomy for termination of pregnancy, multiple massive lesions were detected in the liver. Histologic evaluation showed features of HCC. HCC must be included in the differential diagnosis of any pregnant patient who presents with elevated liver enzymes and hemolysis.

We report the cases of two patients diagnosed with Morgagni hernia who presented with nonspecific abdominal symptoms. Both underwent laparo­scopic surgery that used a dual-sided mesh, polyvinylidene fluoride (PVDF; Dynamesh IPOM®). The procedures were successful and both patients were discharged with no complications. There was no recurrence in 18 months of follow up.Herein is the report of these cases and a literature review.