prevalence of non-alcoholic fatty liver disease and diabetes mellitus in an Iranian population

Background: type II diabetes mellitus [T2DM] and non-alcoholic fatty liver disease [NAFLD] are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD

Methods: in this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran [N=6143]. The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin

Results: in men, the prevalence [95% confidence interval] of T2DM was 5.34% [4.35%-6.34%] and 15.06% [13.12%-17.00%] in individuals without and with NAFLD, respectively [p <0.001]. In women without NAFLD, the prevalence was 8.27% [6.83%-9.71%] while in the presence of NAFLD, the prevalence was 27.21% [24.59%-29.83%], [p <0.001]. In univariate analysis, the chance of having T2DM was 3.700 [3.130-4.380] times more in patients with NAFLD compared with subjects without NAFLD [p<0.001]. This chance was reduced [Odds Ratio=1.976, 95% CI: 1.593-2.451, p <0.001] after removing the effects of other variables

Conclusion: the prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM

atypical presentation of acute appendicitis: a 77 years old man with left lower quadrant pain

With an occurrence of 7%, appendicitis is one of the most common abdominal emergencies requiring surgery. Since the variation in positions and length of the appendix may produce varying symptoms and signs which mimic other diseases, having knowledge of the variations in the position of the appendix is of significant importance

Here, we present a 77-year-old man with acute appendicitis presenting with lower abdominal pain, fever, chills, and dys-uria. Physical examination revealed tenderness and rebound tenderness in the left lower quadrant more pronounced in the right lower quadrant with Icukocyiosis on blood tests. Both ultrasonography and abdominopelvic computed tomography scan demonstrated a severe inflammation at paracecal mesenteric fat with extension to para sigmoid portion which was in favor of diverticulitis rather than appendicitis

A 2-week treatment with intravenous antibiotic regimen was initiated for the patient and from the second day of antibiotic therapy, the patient's fever and abdominal pain improved. A second CT-scan performed three weeks after completion of a 14-day course of antibiotics, revealed a dilated long appendix [diameter: 12mm, length: 10 cm] with extension of its tip to the medial wall of sigmoid. Physicians should consider appendicitis when evaluating an acute abdomen to prevent any delay in diagnosis of atypical presentations and decrease the mortality and morbidity related to the complications

Association between pattern of gastritis and gastroesophageal reflux disease in patients with helicobacter pylori infection

Background: Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial

Aim: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori [H. pylori] infection

Methods: 470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas

Results: H. pylori infection rate was 367 [78.1%] with mean age of 59.8 +/- 11.4 years. Of them 131 patients [35.7%] were male. Reflux disease was detected in 273 [74.4%] patients. 216 [58.9%] and 102 [27.8%] patients had non-erosive reflux disease [NERD] and gastroesophageal reflux disease [GERD], respectively. Corpus predominant and antral predominant gastritis were seen in 72 [19.6%] and 129 [35.2%] patients, respectively. Antral gastritis was significantly associated with GERD [p<0.01]. In regression analysis, antral predominant gastritis had a significant association with GERD [OR=1.92; 95%CI: 1.22-3.12]. The same result was observed in mild to moderate antral and greater curvature gastritis [OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively]

Conclusion: According to these finding, we could suggest that the pattern of gastritis could be associated with reflux disease and GERD

survay case of pylephlebitis associated with diverticulitis

Pylephlebitis was a rare condition with high rates of morbidity and mortality. It is defined as thrombosis of the hepatic and portal veins that complicates intra-abdominal infections, however prompt diagnosis plays a significant role in the treatment of pylephlebitis and the disorder can be diagnosed by means of ultrasound or contrast tomography, it was often missed due to nonspecific clinical presentation including fever, abdominal discomfort and fatigue. When it came to treatment, despite controversies about the use of anticoagulants, administration of antibiotics and anticoagulants was still the mainstay of treatment. In this report, we described a 67-year-old man with chief complaint of bouts of high fevers and mild abdominal tenderness located in right lower quadrant. The patient suffered from pylephlebitis secondary to cecal diverticulitis. Our patient's symptoms did not resolve with antibiotic therapy thus he had surgical resection of the infection focus and received anticoagulation. To put in a nutshell, as early diagnosis and treatment are essential steps for proper management of pylephlebitis and preventing its adverse complications, it is of high importance to keep this differential diagnosis in mind in patients with abdominal sepsis sings

Prevalence of non-alcoholic fatty liver disease and its predictors in north of Iran

Nonalcoholic fatty liver disease [NAFLD] is one of the aspects of metabolic syndrome [MetS]. Due to the increase of MetS in Iran, this study was conducted to determine the prevalence of NAFLD, its potential predictors and their sex distribution in north of Iran, Amol. In 2008 this population based cross-sectional study included 5023 adult individuals who were randomly selected from Amol healthcare centers. Blood analysis and hepatic sonography was performed for each individual and Clinical histories were reviewed. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Chi-square test, univariate and multivariate logistic regression were used to analyze data. The prevalence of NAFLD and metabolic syndrome was 43.8% and 29.6% respectively. Both NAFLD and metabolic syndrome were significantly more prevalent in women. There was a stronger association between these two factors in women which may indicate MetS has a much more potency to result in NAFLD in women. The strongest predictors of NAFLD in men were waist circumference>102 cm, serum ALT >/= 40 [U/L] and the age group of 40-60 years. The strongest predictors of NAFLD in women were waist circumference >88 cm, the age groups of 40-60 and >60 years. The observed prevalence is alarming because almost 7out of 10 subjects with MetS had NAFLD. As high waist circumference was an important predictor of NAFLD in both sexes, health care policies to reduce the incidence of obesity in the country will have an important impact on the occurrence of NAFLD

Lymphoid follicular hyperplasia as a cecal mass: a case report and review of the literature

We described a case of lymphoid follicular hyperplasia that arose from the ileum of a 52-year-old woman. Her colonoscopy revealed a large mass in the cecum associated with multiple polypoid lesions in the ileum. Histologic examination demonstrated severe lymphocytic infiltration and lymphoid follicles with regular germinal centers, without evidence of malignancy. A right hemicolectomy was performed, which confirmed the diagnosis of lymphoid follicular hyperplasia

Thyroid dysfunction and choleduocholithiasis

Disturbances in lipid metabolism which occur during hypothyroidism lead to the formation of gallstones. This study aims to evaluate the thyroid function pattern in patients with common bile duct [CBD] stones. This case-control study recruited 151 patients with preliminary diagnoses of CBD stone who underwent ERCP [cases]. The control group comprised healthy people who met the study criteria in the same hospital. The control group underwent ultrasonography to exclude any asymptomatic bile duct lithiasis. A questionnaire that included demographic and anthropometrics data were completed by an assigned physician. Morning blood samples that followed 12 hours of fasting were taken from all participants for measurements of serum total thyroxin [T4], serum thyroid stimulating hormone [TSH], fasting blood sugar [FBS], triglycerides [TG], total cholesterol, low density lipoprotein [LDL] and high density lipoprotein [HDL]. The mean TSH in patients [2.59 +/- 4.86mg/dl] was higher than the control group [2.53 +/- 4.13 9mg/dl]. In subclinical hypothyroidism, serum TSH levels higher than 5 MU/L were found in 30.6% of cases compared with 22.5% of controls [OR: 1.53; 95% confidence interval [95% CI]: 0.968-2.438]. Hypothyroidism was detected in 10.8% of the control group and in 11.3% of cases [OR: 1.87; 95% CI: 0.578-2.043]. The mean total cholesterol levels in cases was higher than the control group [p=0.61].The levels of TG [p=0.05], HDL [73.35 vs. 46.41; p<0.01] and LDL [64.81.88 vs. 111.04; p<0.01] was statistically significant between both groups. There is an association between thyroid disorders and the presence of bile duct stones. Thyroid testing in patients with gallstone and bile duct stones is recommended because hypothyroidism may be a predisposing factor for stone passage from the gallbladder

Association between Helicobacter pylori and serum leptin in Iranian dyspeptic patients

To investigate any possible relationship between serum leptin level and H. pylori infection in dyspeptic Iranian adults. A total of 153 dyspeptic patients referring to Firoozgar hospital for esophagogastroduodenoscopy were enrolled in the study. Serum leptin level was measured before endoscopy, after overnight fasting. Two biopsy specimens were taken from antrum for each patient during endoscopy: one to detect H. pylori infection by Rapid Urease Test [RUT] and the other evaluated by an expert pathologist, blind to the RUT results and patients. Serum leptin level was compared between H.pylori-positive negative groups. A total of 153 dyspeptic patients with the mean age of 43.2 +/- 14.3 years were evaluated. The overall prevalence of H.pylori infection was 49.6%. H.pylori infection was significantly associated with serum leptin level [p<0.001]. In addition, we found a significant relationship between serum leptin level and gender [p<0.02]. Furthermore, serum leptin level was correlated with age [r=0.17, p=0.0031]. However, the H.pylori-positive group was older in comparison to the H.pylori negative group [45.65 +/- 13.9 vs. 40.7 +/- 14.13, p=0.035]. The two groups were not significantly different in terms of gender, height, weight or BMI. H.pylori infection may influence leptin production. Advanced age might expose the individual to H.pylori infection and consequently influence the leptin level

Fulminant hepatic failure due to primary hepatic lymphoma: a case report

Primary hepatic lymphoma is a rare malignancy usually presenting with symptoms of fever, hepatomegaly, jaundice and weight loss. This picture mimics infectious and inflammatory disorders and thus delays the diagnosis. Here, we present a 47-year old man with prolonged fever who underwent several investigations and, in the meantime, developed fulminant hepatic failure before the diagnosis could be reached

[Frequency of babA2 genotype in helicobacter pylori from patient with gastroduodenal diseases in Firoozgar Hospital in Tehran]

Blood group antigen binding adhesin [babA2], is essential for attachment of Helicobacter pylori [H. pylori] to the epithelial cell layer and is the most important adhesin of H. pylori. The prevalence rate of the babA2 gene varies in different geographic areas. The aim of this study is to determine the frequency of the babA2 gene in patients with different clinical outcomes. We obtained two gastric biopsy specimens from each patient who suffered from gastrointestinal disease. Rapid urease test [RUT] was performed using one biopsy and the remaining biopsy was delivered to the laboratory for DNA extraction. Prevalence of the babA2 gene was determined using gene specific primers. A total of 56 strains [68.3%] of H. pylori were babA2 positive. The prevalence of babA2 in gastric cancer patients [84.6%] was higher than seen with gastric ulcer [66.7%], duodenal ulcer [61%], and gastric patients [66.7%]. There was no correlation between the babA2 genotype and clinical outcomes. We found that babA2 gene was more prevalent in gastric cancer but no correlation was demonstrated. However, previous studies have demonstrated a correlation of babA2 with severe H. pylori-associated diseases such as duodenal ulcers and gastric cancer. This discrepancy may be related in part to geographic diversity or sample size.

Unusual location of varices presenting with obscure gastrointestinal bleeding: a case report

Esophagogastric varices are a frequent complication of portal hypertension. Bleeding from ectopic varices of the ileum is not only life-threatening, but its accurate diagnosis is also difficult. We have presented the case of a 31-year-old man with massive hematochezia. He was a known case of non-cirrhotic portal hypertension since 15 years prior. Conventional examination that included angiography did not define the site of bleeding. Hence, the patient underwent an intraoperative enteroscopy. The varices were located at the distal part of the ileum. Segmental resection of the ileum was performed and the patient was discharged in good condition seven days later. Intraoperative enteroscopy could be considered in the diagnostic and therapeutic management of ectopic varices.

[ main complications of ERCP]

Endoscopic retrograde cholangiopancreatography [ERCP] is a specific technique used to study the pancreatobiliary system that is performed in hepatogastroenterology centers. Recent, common uses for therapeutic ERCP are largely due to advanced imaging techniques such as magnetic resonance cholangiopancreatography and endosonography. In the United States alone, over 500,000 therapeutic ERCP are performed annually. Due to its potential for complications, all practitioners should be well-educated about the indications for ERCP, its contraindications, sedations, patient monitoring during and after ERCP, and the necessary co-operation amongst medical personnel. As a diagnostic and therapeutic procedure, there are potential complications directly related to the severity of the disease and complexity of the procedure. In this paper, we present a review of primary ERCP complications.

unusual presentation of Vanek's tumor: a case report

We report the case of a 54-year-old Iranian man who presented with melena from three months prior to admission. Esophagogastroduodenoscopy and colonoscopy were normal. Double balloon enteroscopy showed a pedunculated tumor located in the jejunum. He underwent laparotomy and resection of a 9.5 cm tumor from the distal jejunum. Histopathologic evaluation confirmed the diagnosis of an inflammatory fibroid polyp [IFP].

Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a widespread chronic health condition which is significantly more prevalent in women. We conducted a gender difference analysis by comparing findings of men and women to determine whether any significant differences exist or not. METHODS: This single-center study was conducted in Tehran, Iran during 2009-2010. IBS was diagnosed on the basis of Rome III criteria. A simple "10 point" objective questionnaire was used. RESULTS: A total number of 144 IBS patients including 44 (30.6%) males and 100 (69.4%) females with the mean age of 37.50 +/- 11.50 years, were assessed. The only differently observed symptom was nausea which was significantly more prevalent in females (49% vs 18.2%, P < 0.001). The commonest subtype of IBS in male patients was diarrhea predominant IBS (38.6%); while, constipation predominant IBS was the most frequent type among females (38%). Moreover, the frequency of loose, mushy or watery stools within the last 3 months was significantly higher among males (2.11 +/- 1.67 vs 1.37 +/- 1.50, P = 0.009). CONCLUSIONS: We report that gender is important in IBS. Although qualitative comparison of different subtypes of IBS between male and female failed to meet the statistically significant level, the answers to the corresponding questions of ROME III IBS module suggest the higher prevalence of bowel movements and looser stool in males. Moreover, nausea was reported more often by females.

Association Between Irritable Bowel Syndrome and Restless Legs Syndrome: A Comparative Study With Control Group

BACKGROUND/AIMS: As a common gastrointestinal (GI) disorder, irritable bowel syndrome (IBS) has been reported to be associated with some psychological and neurological factors. This study aimed to evaluate the prevalence rate of restless legs syndrome (RLS) in a sample of IBS patients and to compare this prevalence with that of matched healthy controls. METHODS: This prospective comparative study was conducted in Tehran, Iran during 2010-2011. Based on the Rome III criteria, a total number of 225 definite IBS patients and 262 age- and sex-matched healthy controls were recruited in the final assessment to compare the prevalence rate of RLS between the 2 groups. RESULTS: RLS was significantly more frequent in IBS group (25.3% vs 6.5%, P < 0.001) which led to an odds ratio (OR) of 4.89 (95% CI, 2.75-8.70). IBS patients with co-morbid RLS significantly suffered more from stomach pain (96.5% vs 86.3%, OR = 4.36 [95% CI, 1.00-19.12]), nausea (40.4% vs 21.4%, OR = 2.48 [95% CI, 1.30-4.73]) and vomiting (10.5% vs 2.4%, OR = 4.82 [95% CI, 1.31-17.76]). CONCLUSIONS: By enrolling a considerable number of IBS patients and healthy controls, our study showed a significantly higher prevalence of RLS in IBS patients. Surprisingly, a higher prevalence rate of RLS was also accompanied with a more severe discomfort and stomach pain in IBS patients. It seems that screening patients with IBS for RLS may lead to greater identification of RLS and improved treatment for both conditions.