Govaresh
Volume:19 Issue: 1, 2014

Constipation isa common clinical problem that can be functional or organic in origin. Thiscondition sometimes overlaps with irritable bowel syndrome. Initially, theclinician should differentiate between true and false constipation by clinicaland preclinical evidence such as colonic transit time. Numerous patients believethat all defecation problems are called constipation and use laxatives without aprescription. A vast majority of constipated patients have improvement in theirsymptoms following life style modification and the use of simple laxatives.However onset of recent constipation in patients over the age of fifty shouldbe considered as an organic disease unless proven otherwise. In these patients,colon cancer must be ruled out. Those with irritable bowel syndrome cantransiently face constipation, for which supportive care is sufficient. In thisreview we explain the diagnosis, workup and treatment of constipation.

Hepatitis B and C infections have remained major global health burdens during the most recent century. The viral agents responsible for these diseases share common modes of transmission with human immunodeficiency virus (HIV) such as needle-sharing in IV drug abusers. Coinfection of hepatitis B or C with HIV increases the rate of progression of chronic liver disease. Given the lack of data in Iran, in particular Khorasan Razavi Province, with regards to this coinfection, the present study evaluates the frequency distribution of hepatitis B and C coinfection with HIV infection and their modes of transmission. This was a retrospective study based on available data at the Gastrointestinal and Liver Diseases Center, Emam Reza Hospital, Mashhad, Iran. We used questionnaires to collect demographic data from 749 patients infected with hepatitis B or C who refered to this clinic between 2005 and 2008. The available sera of these patients were tested for the coexistence of HIV infection with hepatitis B or C infections. The results were analyzed with SPSS version 16 software. From 749 patients infected with hepatitis B or C viruses, 650 were infected with hepatitis B (64.9% male and 35.1% female). There was no HIV antibody detected in any of the patients'' sera who had hepatitis B infection. Among the 106 patients with hepatitis C infection (84% male and 16% female), only one (0.9%) who was an IV drug abuser tested positive for HIV infection. Hepatitis B/hepatitis C coinfection was found in 7 (0.9%) patients. With regards to the risk factors of viral transmission among those with hepatitis B infection, the most common was a positive family history of hepatitis B (37.2%). Other risk factors in order of decreasing frequency included a history of venesection and tattooing (13.8%), transfusions (7.1%), IV drug abuse (2.6%), needle stick accidents (2.3%), and high-risk sexual activity (0.6%). In those with hepatitis C infection, a history of IV drug abuse was the most common risk factor (40.6%), followed by a history of transfusions (28.3%), venesection or tattooing (16%), surgery (13.2%), needle stick accidents (4.7%), hepatitis C infection in a family member (2.8%), and unsafe sexual contact (0.9%). There was a significant difference in the transmission risk factor ratio between hepatitis B and C patients (p=0.001, χ2=261/590) The most common risk factor for transmission of hepatitis B and C infections in patients who presented to Emam Reza Hospital, a referral center in Mashhad, was a positive family history of hepatitis B infection and IV drug abuse, respectively. The prevalence of HIV coinfection amongst patients with hepatitis B or C infections was low. However, further studies with larger populations are required.

Chronic liver disease comprises a wide range of diseases characterized by inflammation of the liver and progression of cirrhosis. This study aims to assess the relationship between behavioral disorders and quality of life in patients with liver cirrhosis. The available sampling method was used to divide participants into two groups of 100 patients and 100 healthy individuals, matched for age, sex and education. Patients with cirrhosis were recruited from a subspecialty clinic in Imam Reza (AS) Hospital in Mashhad. The control group consisted of healthy participants. Participants completed the Beck Depression Inventory, State Anxiety Inventory-Trait Spielberger, Toronto Alexithymia Questionnaire and SF-36 Quality of Life Questionnaire. Research data were analyzed by Pearson correlation and multiple regression analyses. There was no significant difference between the two groups in terms of demographic variables. However significant differences existed between the variables of anxiety, depression and alexithymia. The patient group had higher depression levels compared to healthy controls. Multiple regression analysis showed behavioral disorders, 30% of the variance in quality of life in patients with liver cirrhosis explain. These findings suggest that behavioral disorders are associated with quality of life in patients with liver cirrhosis. These results also have important implications in the field of psychopathology, prevention, and treatment of patients with cirrhosis of the liver.

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases related to the psychological status of the patient. The aim of this study is to assess the relation of GERD with general psychological wellbeing (GPWB). This population study was performed among adult residents of Tehran, Iran in 2013. We invited high school and university educated healthy appearing subjects who were members of a health surveillance study in district number 11 of Tehran to reply to the GPWB query. Participants were divided into two groups, GERD patients and controls. We compared the dimensions of GPWB among these two groups. A total of 135 persons with a mean age of 35.5 ± 13 years were recruited for study participation. Approximately 30% of men and 23% of women had at least weekly GERD symptoms. Anxiety was significantly more common among GERD patients than controls. General health and positive well-being were significantly impaired among GERD patients. Assessment of self-representation of wellbeing and distress in GERD patients and consideration of new, relevant therapeutic avenues are important for the control of GERD.

Ulcerative colitis (UC) is a chronic inflammation of the colon that results from an abnormal response by the body’s immune system. Our previous study has shown that oral Matricaria recutita L. aqueous external because of its anti-inflammatory compounds decreased a number of UC inflammatory indices. In the present study, we evaluate the effect of rectal aqueous extract on a model of acute experimental colitis and compare it with prednisolone. Experiments were performed on six groups (n=7) of male Wistar rats (230-280 g). Of these, three groups were rectally administered different doses of extract (20, 30 and 60 mg/kg), the fourth group received oral prednisolone, the fifth group received vehicle and the last group was considered as the control group. To induce colitis, the rats fasted for 36 hours after which they received ether as an anesthesia. At the last stage, 2 ml of 4% acetic acid was instilled via the anus. After 24 hours, macroscopic study confirmed the colitis induction. The doses of 30 and 60 mg/kg of extract significantly reduced the colon weight/length ratio. The same effect was observed with prednisolone (1.14 mg/kg). Extract at all doses (20, 30 and 60 mg/kg) significantly reduced the ulcer index compared to the sham group. Extract (60 mg/kg) effectively decreased the severity and extent of inflammation compared to the prednisolone group. Intracolonic injection of Matricaria recutita L. aqueous extract was effective in treatment against acetic acid-induced colitis in rats.

Helicobacter pylori (H. pylori) is a global pathogen with a widely varied prevalence (30%-80%) among different countries and populations. This study aims to determine the prevalence of H. pylori in the population of Arak, Iran. This was an epidemiologic cross-sectional population-based study with multistage sampling. The population of Arak according to the 2006 census was 615,722 (493,845 urban and 121,857 rural residents). In this survey, five urban and four rural Health Service Centers were randomly selected. The study population was divided between these centers based on the population of individuals covered by these centers. Subsequently, clustered samples were randomly chosen according to Health Care Unit Family Codes and the Right Hand Rule. After obtaining informed consent and completion of a demographic questionnaire, 5 cc of venous blood was taken from each participant for the H. pylori IgG antibody test. In this study IgG antibody against H. pylori was measured by ELISA. Of 1187 participants, 1150 (853 urban and 297 rural) completed the study. Overall, 673 (58.5%) were positive for H. pylori. The prevalence of H. pylori infection increased with age from 43.9% among those <20 years old to >70% in participants over 50 years old (p=0.002). A total of 57% urban samples and 63.3% rural samples were H. pylori positive (p=0.028(. There was no relationship between H. pylori infection and education level (p=0.37), career (p=0.39) and income, (p=0.29) in either the urban or rural areas [p=0.64 (education level), 0.48 (career), and 0.57 (income)]. Our study showed a lower prevalence of H. pylori compared to some Asian countries, however this prevalence was more common than Western countries. Using disinfected tap water in both urban and rural areas in addition to improved access to general health care might have a role in this relative lower prevalence.

Vitamin B12 deficiency is an unusual disease in younger individuals. This case report has demonstrated how a patient with vitamin B12 deficiency can present with unusual symptoms. Two episodes of severe abdominal pain were identified in a 35-year-old man in the emergency ward. During both episodes surgical consultations were requested. A gastroduodenoscopy revealed macroscopic atrophic gastritis and pathology reports showed mucosal atrophy in the gastric corpus with evidence of intestinal metaplasia. Laboratory data showed a low level of vitamin B12 in the patient’s serum. In rare cases, vitamin B12 deficiency can present with severe abdominal pain associated with abdominal rigidity.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries worldwide. Stones can be spilled from the gallbladder during LC. These stones can be left in the peritoneal cavity or trapped at the trocar site. The potential late sequelae and associated morbidity are not well documented. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder through the abdominal wall. We describe one case that underwent LC and presented with dropped gallstones.