Gluten associated dyspepsia; serology and histological characteristics

The aim of this study was to assess the prevalence of celiac disease [CD] in dyspeptic patients. Although severe mucosal abnormality with villous atrophy [lesions Marsh III] is the histology gold standard for the diagnosis of CD, non-specific microenteropathy [Marsh I-II] with positive serology is also common Patients with dyspepsia, specific CD antibodies and microenteropathy, could have CD. From November 2007 to October 2008, 407 randomly chosen patients who underwent diagnostic upper gastrointestinal endoscopy for dyspeptic symptoms [193 male, 214 women; mean age 36.1 years] were studied. Small bowel biopsies were performed in all of them. Histologic characteristics in duodenal biopsy specimens for CD were evaluated according to the modified Marsh Classification. All the patients were also tested for serum total immunoglobulin A and anti-transglutaminase [tTG] antibodies. Those with IgA deficiency were tested for IgG tTG. Duodenal histology showed Marsh I-IIIc lesions in 6.4% cases. 4 patients [0.98%] were IgA deficient and none of them were positive for IgG tTG. Serology showed positive results for tTGA in 8% of the patients and 2.5% of them had abnormal histology [Marsh I-IIIc] compatible with CD. The results of this study showed that milder enteropathy [Marsh 0-II] have a low specificity for CD. The prevalence of CD among dyspeptic individuals is significantly [2.5%] higher than in the general population [1%] and CD should be investigated in these patients

[Celiac disease in dyspeptic patients]

The screening of patients with dyspepsia, may allow an early identification of affected individuals. The aim of this study was to determine the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. From November 2007 to October 2008, 407 patients who underwent endoscopy for any reason [193 male, 214 women; mean age36.1 years] were studied in this work. Histological characteristics in duodenal biopsy specimens for celiac disease were evaluated according to the modified Marsh Classification1999. In addition, all patients were tested for total immunoglobulin A and antitransglutaminase [tTG] antibodies. The patients with IgA deficiency were tested with IgG tTG. Duodenal histology showed the malabsorption pattern [Marsh I-IIIc] in 26 [6.4%] cases and 33 cases had serological positive test for tTGA. In term of the serological analysis, 10 out of 33 tTGA positive patients had malabsorption pattern [Marsh I,-IIIc], and all of them had a positive tTGA [2.45%]. Four of the 407 recruited patients were IgA deficient and none of them were positive for IgG tTG. In this study, about 6.4% of patients had malabsorption pattern and 8.1% presented with positive serology for CD. However, both histology and serology were positive in 10/407 [2.45%]. The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease

[NOD2 novel mutations in Iranian Crohn's patients]

Despite the reported role of three common mutations of the CARD15/NOD2 gene including R702W, G908R and 1007fs in Crohn's disease [CD], only about 30% of Iranian CD patients carry one of these three variants [R702W]. The aim of this study was to screen the hot points of NOD2 gene to find any novel sequence variations in Iranian patients with CD. Eighty non-related Crohn's patients from Iranian origin, referred to a tertiary center in a three-year period [2006-2009], were enrolled in this study. The hot points of NOD2 gene [including exons 4 and 8] were evaluated by direct sequencing after amplification of related sequences with polymerase chain reaction [PCR]. A total of 17 sequence variations were identified among these exons of NOD2 gene including 7 novel ones. Three of these new mutations had an allele frequency more than 5%. All new mutations were a consequence of a single nucleotide change, 4 resulted in an aminoacid change while one formed a stop coden. No deletion or insertion mutation was observed in this part of the gene. This study demonstrated the existence of uncommon NOD2 variants in Iranian patients with CD. It is possible that these mutations play a role in susceptibility to CD in Iranian population

Quadruple versus common triple-treatment regimens for Helicobacter pylori eradication in the Iranian population: a randomized study

Selection of the best drug regimens for effective eradication of Helicobacter pylori [H.pylori] infection, especially in patients at risk of peptic ulcer relapses and development of complications of peptic ulcer disease, is challenging. This study assessed and compared the efficacy of the two common proton pump inhibitor [PPI]-based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. A total of 330 patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols: [1] a 14-day quadruple therapy [OMAB group] comprising omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1g and bismuth subcitrate 240 mg; [2] a 14-day triple regimen [OCP group] comprising omeprazole 20 mg plus clarithromycin 500 mg and penbactam 750 mg; and [3] a 14-day triple regimen [OCA group] comprising omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g, all given twice daily. Cure was defined as a negative urea breath test at least 6 weeks after treatment. The intention-to-treat H.pylori eradication rates achieved with both OCP regimen [87.0%] and OCA treatment [88.8%] were significantly higher than the OMAB treatment protocol [56.0%]; however, no significant difference emerged in eradication rates between the two triple-treatment schedules. No significant differences were found in most side effects between the groups. Two-week quadruple therapy showed a lower eradication rate compared with common triple-treatment schedules when used as a first-line eradication treatment for H.pylori infection in the Iranian population