Iranian Registry of Crohn's and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East

BACKGROUND/AIMS: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn's and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. METHODS: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach's α. RESULTS: All sections of questionnaire had Cronbach's α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). CONCLUSIONS: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.

False negative and false positive rates in common bile duct brushing cytology, a single center experience

Aim: In this study we tried to find out the accuracy of biliary tract brushing cytology in our center as the largest referral center in the south of Iran

Background: Common bile duct brushing cytology has been introduced as the method of choice for the diagnosis of pancreaticobiliary malignancies. However, there have been controversial reports about the sensitivity, specificity and overall accuracy of this method in the English literature

Methods: During the study period [2012-2016] there has been 166 cases of common bile duct brushing cytology taken during endoscopic retrograde cholangiopancreatography [ERCP]. One case has been excluded because of inadequate number of cells in the cytology smear. All the smears have been stained by routine cytologic stains and screened by cytotechnologists and diagnosed by expert cytopathologist. Final diagnosis by biopsy has been considered as the gold standard

Results: According to the final histologic diagnosis as the gold standard, there were 22 false negative and 7 false positive cases. All of the false positive cases have been suspected cases in the background of primary sclerosing cholangitis. The most common final diagnosis of false negative cytologic diagnoses has been intrahepatic cholangiocarcinoma in which no malignant cell has been identified in the presence of adequate number of normal ductal epithelial cells

Conclusion: Common bile duct brushing cytology is the method of choice for the diagnosis of pancreaticobiliary tract malignancies; however, having high specificity [90%], the sensitivity is low [56%]. Cytologic diagnosis of biliary tract malignancies should be made with caution in the patients with primary sclerosing cholangitis. Also it is important to know that high false negative rate is present in common bile duct brushing cytology especially in the cases of intrahepatic cholangiocarcinoma without extension into extrahepatic ducts

Developing a novel risk-scoring system for predicting relapse in patients with ulcerative colitis: a prospective cohort study

Objectives: Ulcerative Colitis [UC] follows a natural clinical course of relapses and remissions. The aim of this study was to construct a risk-scoring formula in order to enable predicting relapses in patients with UC

Methods: From October 2012 to October 2013, 157 patients from Shiraz, southern Iran who were diagnosed with UC and in remission were enrolled. At 3-month intervals, multiple risk factors of hemoglobin, complete blood counts, serum iron and albumin, erythrocyte sedimentation rate, and faecal calprotectin levels, sex, age, cigarette smoking, positive family history of inflammatory bowel diseases, past history of appendectomy, extra-intestinal accompanying diseases, extent of disease at the beginning of study, number of previous relapses, duration of disease and duration of remission before the study were assessed. Univariate and multivariate logistic regression were applied to fit the final model. The new risk-scoring system accuracy was assessed using receiver-operating-characteristics [ROC] curve analysis

Results: Seventy four patients [48.1%] experienced a relapse. Multivariate analysis revealed that relapses could significantly be predicted by the level of fecal calprotectin [OR=8.1], age [OR=9.2], the Seo activity index [OR=52.7], and the number of previous relapses [OR=4.2]. The risk scoring formula was developed using the regression coefficient values of the aforementioned variables

Conclusion: Four predictor variables were significant in the final model and were used in our risk-scoring formula. It is recommended that patients who achieve high scores are diligently observed, treated, and followed up

Hidden Source for Upper Gastrointestinal Bleeding

A 50-year-old lady presented with bloody vomiting and melena since four days prior to admission. Her medical history was significant only for hypertension which was controlled by a 5 mg daily dose of amlodipine. She occasionally took NSAIDs. On admission, the physical exam revealed only mild tachycardia and pallor. Hemoglobin was 9.7 g/dl, which subsequently declined to 7.9 g/dl. The first upper gastrointestinal [GI] endoscopy was remarkable for a paraesophageal hiatal hernia, with no site of bleeding detected. The second upper GI endoscopy did not find any source for bleeding. A third endoscopic examination revealed a new finding [Figures A and B]

Establishment of a population-based registry of inflammatory bowel diseases in Fars province, Iran

Inflammatory bowel diseases [IBD] are debilitating diseases that lead to a variety of problems in a patient's daily life and are a huge burden for the health care system. Since this group of diseases are multifactorial and complex, long-term longitudinal studies are clearly needed to understand them better. A population- based registry [IBD-FaR] has been established in Fars, a southern Iranian province, with the intent to create a reliable data source. This registry will be of considerable help in future planning of health care resources necessary to deal with IBD and to enable investigators to test their theories on the origin and/or treatment of IBD. This registry is managed by both the Gastroenterohepatology Research Center and Health Policy Research Center at Shiraz University of Medical Sciences. A governing committee is responsible for decisions regarding budget allocations and use of data. The designed questionnaire includes a consent form, basic history data, risk factors, related procedures, medical therapy, and follow-up data. The establishment process has two parallel phases: in the first phase, data is collected from numerous sources, including annual hospital discharge data, referral from university affiliated physicians and private practices, pathologic reports, death certificates, self-referral, and insurance system data. In the interview, the questionnaire is completed and blood samples are taken. The gathered data are entered in a custom-designed, computerized data base. In the second phase, annual follow up interviews will be conducted. New IBD patients are also being registered. This phase will continue indefinitely, in order to include new incident cases. Briefly, from May 2011 until December 2011, there were 188 patients [94 [50%] females and 94 [50%] males] diagnosed with IBD who were registered in IBD-FaR. Patients' age range was between 15 and 80 years. A total of 164 [87.2%] patients out of 188 were registered as diagnosed with ulcerative colitis [UC] and 23 [12.2%] were registered as having Crohn's disease [CD]. Most patients 164 [87.2%] had negative family histories of IBD. By retrospective and prospective data collection methods, this central database of IBD cases can determine the incidence, prevalence, and demographic characters of IBD in a defined population. It can facilitate future research to identify etiology, disease process, new treatment options, factors affecting prognosis, recurrences, optimal health care, morbidity and mortality of IBD, and at last but not least, provide educational and social support for patients by educational materials and organizing nongovermental organizations [NGOs]

Endoscopic cyanoacrylate injection for the treatment of bleeding gastric varices: the first Iranian series

Gastric varices are a major cause of gastrointestinal bleeding and death in patients with portal hypertension. N-butyl-2-cya-noacrylate injection is a new method for controlling bleeding gastric varices. This study aims to investigate the prognosis and complications of cyanoacrylate therapy for bleeding gastric varices. We conducted a prospective study between May 2009 and January 2010 at our center affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. All patients with gastric variceal bleeding were enrolled in the study. N-butyl-2-cyanoacrylate injection was performed for treatment of the bleeding, and patients underwent monthly endoscopies to determine the outcomes. There were 13 patients with portal hypertension and gastric variceal bleeding included in the study. Initial hemostasis was obtained in all patients but more than one injection was needed in seven patients. Two patients developed re-bleeding and two died of advanced cirrhosis and other accompanying diseases. No major complications were observed after treatment with N-butyl-2-cyanoacrylate. This method can be safely used in treatment of gastric variceal bleeding

Seroprevalence study of hepatits A virus in Fars province, southern Iran

There are several studies on seroprevalence of hepatitis A virus [HAV] in adults in the Middle East. To determine seroprevalence of HAV among adult population in Fars province, southern Iran. In a cross-sectional study, we checked anti-HAV antibody [IgG] in subjected refereed to our health care centers to perform laboratory tests before getting determined. Some risk factors like level of education, type of residence, job, numbers of family members, and access to treated water were also evaluated in these participants. From 1050 subjects studied, 927 [88.2%] had ant-HAV antibody; 123 [11.8%] were antibody negative. Among subjects aged <20 years, the anti-HAV seroprevalence was the lowest [79.3%] followed by subjects aged 20-30 years [91.3%] and those >30 years [99%] [p= 0.01]. 85.1% of studied individuals in urban areas had anti-HAV IgG while 95.9% of subjects in rural regions were anti-HAV positive [p=0.001]. The seroprevalence of HAV antibody was significantly associated with number of family members [p=0.001]. HAV is highly prevalent in our region especially in rural areas. It is better to vaccinate the children for HAV by the time they receive HBV vaccine or when they are five years

Il-1 beta [+3953 C/T] and IL-8 [-251 A/T] gene polymorphisms in H.pylori mediated gastric disorders

Previous studies imply that IL-1 and IL-8 gene variations may play a crucial role in the genetic predisposition to different gastric disorders upon H. pylori infection. The aim of this study was to determine the potential association between the prevalence of certain polymorphic sites and the risk of gastric disorders in Iranian population. One hundred and forty three unrelated individuals with different gastric disorders and 374 normal individuals with no gastric disorders and with a negative serology test for H. pylori [control group] were studied for the association between IL-1 beta [+ 3953 C/T] and IL-8 [-251 A/T] gene polymorphisms and H. pylori - mediated gastritis and gastric ulcer. An analysis of genotype frequency for these genes was performed using RFLP- PCR. Based on the data obtained from culture and pathologic findings, the patients were classified into three subpopulations: H pylori [+] non-ulcerative gastritis [+], H. pylori [+] ulcerative gastritis [+] and H. pylori[-] non-ulcerative gastritis [+]. A significantly higher frequency of TT genotype [p=0.02] in IL-1 beta +3953 in H.pylor[+] ulcerative gastritis [+] was revealed compared to the control group. There were no significant differences among other subpopulations. No significant differences in allele and genotype frequencies of IL-8 [-251A/T] were found among the patients. The data suggest that TT genotype in IL- 1 beta +3953 may be a major contributing genetic risk factor for H. pylori induced gastric ulcer. Moreover, the role of other bacterial and host response factors, such as bacterial adherence peptides, host chemokines, and genes involved in gastric acid secretion, must be further investigated in different ethnic populations

Successful pregnancies in two orthotopic liver transplant [OLT] recipients in Iran; two case reports

Pregnancy and parenting have been part of human life throughout history and liver transplant recipients are not any exception. This paper reports successful pregnancies in two liver transplant recipients in Iran. Case Presentation: The first case was a 34-year old woman who had undergone orthotopic liver transplantation [OLT] at Shiraz Namazi Educational Hospital in 2002. She decided to get pregnant seven years after the operation. During pregnancy, immunosuppressive therapy continued, except Mycophenolate Mofetil which has an absolute contra-indication in pregnancy. The patient was followed up during pregnancy by the transplant team as well as a gynecologist. She faced no significant complications and the liver function was stable during pregnancy. She later underwent a Cesarean section in the 38th week of gestation and the newborn was a healthy girl weighing 2480g with an Apgar score of 8 at the time of birth. There were no evidences of prematurity or structural abnormalities in the newborn. The second case was a 31-year old primipara who had received an orthotopic liver transplant [OLT] in Shiraz in 2002. She had a smooth pregnancy without any complications and the newborn was a boy weighing 3100g with Apgar scores of 8 and 10 at the time of birth and 5 minutes thereafter, respectively. As the number of transplant recipients is growing along with the number of recipients who are in their fertility years, it is vital to ensure a proper medical care by a coordinated multidisciplinary team during pregnancy

Discrimination of dominant helicobacter pylori strains isolated from patients with different gastroduodenal pathologies by protein profiling

It is not clear what factors determine divergent outcomes of infections caused by H. pylori. In the present study, the protein profiles of different strains of H. pylori, isolated from three groups of patients with ulcerative disease, non-ulcerative gastritis and cancer disease, were analyzed using 1D-SDS-PAGE. The patterns of different H. pylori strains were highly divergent. About 30.76% [7 bands] of the 26 observed protein bands were common in all strains isolated from 3 groups of the patients. While the similarity for the strains inside each group were 75% [15 from 20], 76.47% [13 from 17] and 78.57% [11 from 14] for cancerous, ulcerative and nonulcerative group, respectively. Some of the observed bands were significantly specific for each group. Therefore, we speculated that some H. pylori strains might be more associated with a specific disease than others, giving the clustering of some, but not all, strains within each disease group. In conclusion, this study showed that protein profile can be a characteristic in discrimination of dominant strains in different gastric clinical status. Specific and dominant proteins of different strains isolated from three groups of patients under study were candidates for further exploration for laboratory tests, which analyze disease-specific H. pylori strains, and for diagnosis of the different diseases and outcomes associated with this widespread bacterium