Middle East Journal of Digestive Diseases
Volume:6 Issue: 4, Oct 2014

It is hypothesized that poor zinc nutritional status is associated with an increased risk of esophageal cancer (EC), but current evidence is contradictory. Since some factors may influence zinc absorption, its status may be better evaluated thorough biomarkers. The objectives of this study were to perform a systematic review on the association of zinc biomarkers with EC in observational studies and to evaluate the efficacy of zinc supplements in preventing EC in randomized trials.The MEDLINE database was searched in December 2013 for studies written in English with relevant keywords. Articles which met inclusion criteria were included in this study.Eleven observational studies that measured zinc biomarkers and eight randomized trials which evaluated supplements containing zinc, met our inclusion criteria. The majority of studies suggested that higher zinc status was inversely associated with EC risk.Most of the evidence for this hypothesis comes from case-control studies, which may introduce bias. Cohort studies are needed to establish whether poor zinc status is associated with increased risk for EC. Findings from trials are inconclusive as there is no data from single agent trials. However, the evidence is not still strong enough to conclude a protective role of zinc in EC.

Hepatitis B virus (HBV) infection is the most common cause of end stageliver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries remains largely unknown. Therefore, the hepatitis B cohort study (HBCS), nested as part of the Golestan Cohort Study (GCS), Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course ofchronic hepatitis B with reference to its epidemiology, viral/host genetic interactions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen (HBsAg) was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree relatives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS.

Furazolidone has been used as an alternative for clarithromycin or metronidazole in Helicobacterpylori (H. pylori) eradication regimens. In Iran, 14-day Furazolidone-containing quadruple regimens have shown promising eradication rates, but short-course, low dose therapies are always attractive. Therefore, we designed a study to compare the efficacy of two 10-day triple regimens containing moderate and high dose furazolidone for H. pylori eradication.Two hundred and ten patients with peptic ulcer disease who were naïve to H. pylori treatment were included. They were randomized into 2 groups: 105 patients received omeprazole 20mg, amoxicillin 1000mg, and furazolidone 200mg(OAF-400), all twice a day for ten days.And the remaining 105 patients received omeprazole 20mg twice a day, amoxicillin 1000mg twice a day and furazolidone 200mg three times a day for ten days(OAF-600). Urease breath test was performed 8 weeks after the treatment to confirm H. pylori eradication. The intention-to-treat eradication rate was 76.19% in group OAF-400 and 80.95% in group OAF-600 (p=0.38). Per protocol eradication rates were 81.63% and 89.47%, respectively (p= 0.11).Severe adverse effects were reported by 8.6% of the patients in group OAF-400 and 5.7% of the patient in group OAF-600 (p=0.1). However, the total side effects (including mild, moderate, and severe ones) were significantly more prevalent in the OAF-600 group (p=0.001).None of our triple furazolidone-based regimens (moderate- and high-dose) could achieve the standard eradication rate, and therefore, cannot be considered as a suitable option for first-line treatment.

Patients with ulcerative colitis (UC) carry autoantibodies such as perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). The aim of the present study was to evaluate the target antigens for p-ANCA in Iranian patients with UC.p-ANCA target antigens including elastase, lactoferrin, cathepsin G, myeloproxidase, lysozyme, and bactericidal permeability increasing protein (BPI) were determined in 113 patients with UC using enzyme-linked immunosorbent assay (ELISA).59.2% of the patients were positive for at least one antigen and p-ANCA directed against lactoferrin, elastase, lysozyme, cathepsin G, BPI, and myeloproxidase in 31.5%, 25.9%, 8.3%, 7.4%, 5.6%, and 0% of the patients, respectively.The highest prevalence of p-ANCA was observed against lactoferrin and elastase. Also, myeloproxidase was not an antigen for p-ANCA among our patients.

In spite of the increasing trend in opioid abusers worldwide, the prevalence of narcotic bowel syndrome (NBS) is undetermined. We aimed to estimate the prevalence of NBS and other opioid bowel dysfunction (OBD) in opioid abusers in Kerman, southeast Iran. According to the best of our knowledge, this is the first study to assess the prevalence of NBS in opioid abusers. By referring to addiction treatment centers in Kerman city and in a cross-sectional study, 577 subjects with opium or opioid subtracts abuse were included in our study. A validated questionnaire was used for OBD assessment and diagnosis of NBS was made according to both the presence of chronic abdominal pain despite increasing the opioid dose and ruling out other causes of abdominal pain. SPSS software version 16 was used for data analysis. p value<0.05 was considered as statistically significant.Constipation, regurgitation, and heartburn were the most gastrointestinal complaints that were found in 132(22.9%), 123(21.3%) and 91(15.8%) subjects, respectively. Only 16(2.8%) participants fulfilled all the NBS criteria. Simultaneous use of non-narcotic sedative drugs increased the risk of NBS significantly (the odds ratio 3:1 and p=0.049).NBS is not rare among opioid abusers and should be considered as a cause of chronic abdominal pain in this group.

Recent studies suggest that rare codon clusters are functionally important for protein activity.Here, for the first time we analyzed and reported rare codon clusters in Hepatitis C Virus (HCV) genome and then identified the location of these rare codon clusters in the structure of HCV protein. This analysis was performed using the Sherlocc program that detects statistically relevant conserved rare codon clusters.By this program, we identified the rare codon cluster in three regions of HCV genome; NS2, NS3, and NS5A coding sequence of HCV genome. For further understanding of the role of these rare codon clusters, we studied the location of these rare codon clusters and critical residues in the structure of NS2, NS3 and NS5A proteins. We identified some critical residues near or within rare codon clusters. It should be mentioned that characteristics of these critical residues such as location and situation of side chains are important in assurance of the HCV life cycle.The characteristics of these residues and their relative status showed that these rare codon clusters play an important role in proper folding of these proteins.Thus, it is likely that these rare codon clusters may have an important role in the function of HCV proteins. This information is helpful in development of new avenues for vaccine and treatment protocols.

The reported rates of Barrett’s esophagus (BE) ranged from 2.6% to 23% in Indian patients with gastro-esophageal reflux disease (GERD) symptoms. The role of methylene blue chromoendoscopy during endoscopy, either for the diagnosis of Barrett’s esophagus or for the detection of dysplasia and early cancer, remains controversial. Our study was designed to find out the endoscopic as well as histological prevalence of BE in India in a specified patient population affected by GERD, and whether methylene blue chromoendoscopy improves detection of specialized intestinal metaplasia in endoscopically suspected Barrett’s esophagus in GERD patients.Three hundred and seventy eight patients with characteristic symptoms of GERD from Northern India were subjected to upper endoscopy. On endoscopic suspicion of columnar lined epithelium (CLE) either 4-quadrant conventional biopsies at 2 cm interval or Methylene Blue (MB) directed biopsies were obtained randomly. The two groups were compared for the detection of Specialized Intestinal Metaplasia (SIM), which was diagnosed if the intestinal goblet cells were present.Out of 378 patients with GERD, 56 (14.81%) were suspected of CLE on endoscopy. After taking biopsy samples from the 56 patients, only 9 (2.38%) had specialized intestinal metaplasia on histopathological examination. Five (15.15%) patients in the conventional group and four (17.39%) patients in the chromoendoscopy group (P=0.55) were diagnosed as having BE. On univariate analysis the predictors of SIM were symptoms of reflux and length of CLE.The prevalence of biopsy proven BE and CLE in Northern India was 2.38% and 14.81%, respectively in patients with symptoms of GERD. The results of MB directed biopsies were similar to conventional biopsies in detecting SIM.

Brunner’s gland hamartoma is a rare benign tumour of the duodenum. It was first described by Cruveilhier in 1835. Presently around 200 cases have been reported in literature. No sex predilection is seen. Patients usually present in the fifth to sixth decades of life. They may be clinically silent or may present with variable symptoms and occasionally obstructive symptoms and chronic pancreatitis. Endoscopic presentation can be nodular, polypoid or diffuse glandular proliferation with thickening of duodenal wall and hence can be misdiagnosed as malignancy. We describe a case of duodenal tumor reported outside (on biopsy) as well differentiated adenocarcinoma which out as Brunner gland hamartoma upon complete resection. Brunner gland hamartoma may sometimes have a very unusual presentation. Extensive pre-operative evaluation is necessity to avoid radical surgical procedure.

A 57-year-old woman was referred with chief complaint of pallor and lethargy for 9 months. Laboratory investigation was notable for anemia and occult blood in the stool exam. Her past medical history was unremarkable. Endoscopy of the upper gastrointestinal tract showed a large fungative reddish mass measuring 7 x 6 cm in the body of the stomach and multiple variable size polyps in the antrum (figure 1). The patient underwent hemi-gasterectomy. Billroth I. Gross examination of the stomach showed a large polypoid mass measuring 8x7x6 cm (figure 2) with erosive surface in some areas.

A 29-year-old housewife presented with abdominal pain and abnormal results on liver function tests (table 1). The patient was from a rural area (Garmsar, Iran) and there was no family history of a similar disease. Her family owned various animals most notably jackals, dogs, and cats. The animals were not receiving regular veterinary check-ups, preventive care, or even vaccinations.