ABSTRACT
Lichen planus is a dermatologic chronic inflammatory disease that usually involved the skin and mucosa. Esophageal lichen planus with stricture is rare presentation of this disease. It is usually associated with oral mucosal involvement and commonly presenting in middle-age female. In present case, we describe a 48-year-old woman with history of oral lichen planus who referred to us for progressive dysphagia for solid food .She had not history of other causes of dysphagia. Upper endoscopy revealed a benign stricture located in proximal of esophagus that comparable with lichen planus features. The patient underwent three sessions of wireguided bougie dilation that improved her symptoms totally. Lichen planus has to be considered in differential diagnosis in patients with dysphagia
ABSTRACT
Objective: This study was designed to examine the effect of metabolic syndrome [MetS] on health-related quality of life [HRQOL] in patients with suspected nonalcoholic steatohepatitis [NASH]
Subjects and Methods: Three hundred thirty-two patients [236 males and 96 females] with suspected NASH from the Amol cohort study were included in this study. MetS was diagnosed based on Adult Treatment Panel III criteria and HRQOL was measured using the 12-Item Short-Form Health Survey [SF-12] questionnaire [with 8 subscales and 2 summary components]. A multivariable linear regression model was used to assess the independent effect of MetS on HRQOL
Results: The mean age of the study population was 42 +/- 13 years [range 18-82]. The prevalence of MetS was 43.4% [n = 144] and the mean scores on the Physical Component Summary [PCS] and the Mental Component Summary were 72.4 +/- 20.86 and 42.7 +/- 12.42, respectively. The multivariable linear regression model showed that MetS was negatively associated with 4 subscales of HRQOL that included: role limitations due to physical problems [RP] [B = -14.05, p = 0.004], bodily pain [BP] [B = -7.37, p = 0.02], vitality [VT] [B = -7.72, p = 0.022], and role limitations due to emotional problems [RE] [B = -12.67, p = 0.005] after adjustment for other variables. Also, MetS had a borderline association with the general health and mental health subscales and the PCS [p < 0.1]
Conclusion: In this study, there was a strong association between MetS and 4 subscales [RP, BP, VT, and RE] of HRQOL in patients with suspected NASH; this could be considered as a part of health policy to improve general health
ABSTRACT
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
ABSTRACT
Actinomycosis is a rare and chronic infectious disease caused by a non- spore gram- positive, anaerobic bacterium that rarely infects the colon, in particular the left colon. A 53-year-old woman was referred to us due to chronic abdominal pain, bloating, a few episodes of bloody-mucous rectal discharge, and change of bowel habits. Her medical history and physical examination were unremarkable. Colonoscopy revealed a polypoid mass like lesion located 20 cm proximal to the anal verge above the rectosigmoid junction. Several biopsy samples were taken. Histopathological evaluation showed actinomycosis infection. Consequently the patient was treated with intravenous and then six months oral penicillin. Her complaints and colonic mass resolved totally. Diagnosis of colonic actinomycosis is not an easy task. It is advisable to keep this infection in mind among the differential diagnoses of unusual abdominal masses. Colonoscopy and histopathological examination can be the preferred modality for diagnosis of colonic actinomycosis infection
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Recent guidelines have proposed that there is a correlation between tissue transglutaminase [tTG] antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean +/- SD of the patients was 35.6 +/- 15.2 and 100 [62.9%] of them were women. 133 out of 153 patients had villous atrophy [Marsh IIIa-IIIc]. Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III [p for trend=0.003]. Our results showed that tTG titer more than 9 folds higher than the kit's cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture's recommended cut-off value it can be avoided. Meanwhile in case of high clinical suspicion, low tTG levels do not exclude diagnosis of celiac disease and further investigations including small intestinal biopsy should be considered
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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
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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.
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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.