Effect of vitamin D[3] supplementation on TNF-alpha serum level and disease activity index in Iranian IBD patients

The aim of the study was to assess the effectiveness of vitamin D[3] [1, 25[OH][2]D[3]] treatment in IBD with regard to tumor necrosis factor-alpha [TNF-alpha] serum level and clinical disease activity index [CDAI]. Vitamin D has immune-regulatory functions in experimental inflammatory bowel disease [IBD] and vitamin D deficiency is common in IBD patients. This was a randomized clinical trial on 108 IBD patients with serum 25-OHD levels less than 30ng/ml, which divided into vitamin D and control groups. Vitamin D group received 50000 IU vitamin D[3] for 12 weeks. Before and after the study, TNF-alpha and 25-OHD serum levels were measured by ELISA method. Data were analyzed using paired t-test, chi-square test and Spearman correlation coefficient. P-values less than 0.05 were considered statistically significant. Before the intervention no significant difference was found between baseline characteristics and TNF-alpha serum level of two groups. After intervention TNF-alpha serum level reduced but this reduction was not statistically significant [p=0.07, 95% CI: -0.45 to 8.14]. The mean serum 25-OHD level of vitamin D increased from 15.54 to 67.89, which was statistically significant [p= 0.00, 95% CI: -61.40 to -43.30]. TNF-alpha level was also associated significantly with CDAI before [Spearman's rho: 0.3, p<0.0001] and after [Spearman's rho: 0.27, P=0.01] intervention. Oral supplementation vitamin D[3] significantly increased serum vitamin D levels and insignificantly reduced serum TNF-alpha level. More studies with larger samples would be beneficial to assess vitamin D[3] supplementation efficient effect in IBD

Effect of a combination of omeprazole plus sustained release baclofen versus omeprazole alone on symptoms of patients with gastroesophageal reflux disease [GERD]

Previous studies have reported the efficacy of baclofen in the treatment of Gastroesophageal Reflux Diseases [GERD]. The objective of present study is to evaluate the effect of co-administration of omeprazole 20 mg/d plus sustained Release baclofen [SR baclofen] vs. omeprazole 20 mg/d plus placebo on alleviation of symptoms in patients with a diagnosis of GERD. A prospective, double blind, placebo controlled trial included 60 patients with diagnosis of GERD have been done. Patients were randomly selected to receive either SR baclofen or a placebo in addition to omeprazole 20 mg/d for a period of 2 weeks. Patients were questioned regarding heartburn, regurgitation, chest pain and hoarseness at the base line and after 2 weeks. All patients tolerated the medications and no patients failed to complete the study due to adverse drug reactions. A total of 53 patients completed the study, 25 in SR baclofen and 28 in placebo group. After 2 weeks, 1 patient [4%] in SR baclofen group reported heartburn and regurgitation. However 13[46.4%] and 15 [53.6%] of patients in the placebo group had heartburn and regurgitation respectively. The analysis of the data shows that there is a significant difference between the two groups in heartburn and regurgitation [p < 0.0001, p < 0.0001 respectively]. Statistical analysis revealed a significant difference in two groups regarding total GERD score [p <0.0001]. The results of the present study suggest that a combination of SR baclofen and omeprazole may be a more effective treatment for heartburn and regurgitation than omeprazole alone

Coeliac in patients with gastrointestinal symptoms: a population-based study in Tehran

Determination of prevalence of celiac disease among patients with gastrointestinal symptoms was the main objective of this study. Other factors which cause digestive disorders in such patients were also studied. This cross sectional-descriptive study was conducted in Tehran province in 2006-2007; to conduct the study 5176 people were selected randomly. Out of them 670 patients with gastrointestinal symptoms were tested to determine the amount of IgA and tissue Transeglutaminase [tTg]. The amount of IgA tTG was measured in individuals with IgA deficiency. Out of 670 patients, 427 [63.37%] and 243 [36.37%] patients were women and men, respectively; their average age was 42.5. Anti-tTG test was diagnosed positive in 22 patients [17 women and 5 men] [3.3%]. Eight patients showed IgA deficiency. The result of IgG tTG test was found positive in three patients out of the abovementioned 8 patients. This study shows a high dispersion of celiac among Iranian patients with the gastrointestinal symptoms [3%]. Routine serologic tests are recommended for diagnosing the unknown cases of sensitivity to gluten

[Evaluation of the association between FokI and BsmI polymorphisms of vitamin D receptor gene and risk of colorectal cancer in Iranian patients referred to Taleghani hospital, Tehran]

There are several studies that have identified relationship between VDR gene polymorphisms and colorectal [CRC] or other kinds of cancers, such as breast and prostate cancers. The aim of our study was to evaluate the association of VDR gene polymorphisms, BsmI and FokI, with colorectal cancer risk among Iranian patients. In this case-control study, 110 DNA samples from Iranian CRC patients and 110 samples from healthy Iranian people. Genotyping of BsmI and FokI polymorphisms were performed by PCR-RFLP method. To confirm the RFLP results, 5% of samples were sequenced with direct sequencing method. The frequency of the VDR gene polymorphisms at BsmI and FokI restriction sites in CRC patients and healthy controls was almost similar. Allele distribution in patients and controls was same. There was no statistically significant difference in genotype or allele frequency between CRC patients and control group. VDR FokI and BsmI genotypes are not associated with increased risk of colorectal cancer in Iranian patients. However, these data remain to be confirmed by studies with larger sample size in Iran

Does allopurinol prevent post endoscopic retrograde cholangio pancreatography pancreatitis? a randomized double blind trial

Post endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis is a frequent complication either for diagnosis or treatment of pancreatobiliary diseases. A number of pharmacological agents have been tried for prevention or alleviation of the complication. Allopurinol with free radical scavenger property has been considered as an effective prophylactic agent in some clinical trials. Administration of allopurinol in these trials was done in a long period before doing ERCP. Hence allopurinol converts to oxupurinol in the liver rapidly; it seems that clinical judgment about the net effect of allopurinol on prevention of post ERCP pancreatitis is doubtful. In this randomized double blind clinical trial, effect of allopurinol on prevention or alleviation of clinical and laboratory signs of pancreatitis has been evaluated in 74 patients undergoing ERCP. Results showed that there is not any difference between allopurinol and placebo in occurrence and severity of post ERCP pancreatitis [P=0.97]. Also there is not any significant difference in amylase rises between 2 groups in 8 and 16 hours after ERCP [P=0.947, 0.287 respectively]. Beneficial effects of allopurinol in some of the previous studies may be attributed to its active metabolite [oxypurinol]. Further studies recommended about the net effect of allopurinol and oxypurinol in the complication

Economic burden of gastro-oesophageal reflux disease and dyspepsia: a community-based study

Gastro-oesophageal reflux disease [GERD] and dyspepsia are common digestive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran. The study was performed on a total of 18,180 adult subjects [age > 18 years] taken as a random sample in Tehran province, Iran [2006-2007]. A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months. GERD was found in 518 [41.9% males] patients and dyspepsia in 404 patients [38.9% males]. Further 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively [PPP, purchasing power parity dollars]. The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively. According to our results, hospitalisation and physician visits were the main cost of disease that could be minimized by revision of the insurance business in Iran

[Frequency of colorectal cancer in healthy individual's relatives: a cross-sectional population-based study]

Family history of colorectal cancer has been shown to be related to the risk of developing colorectal cancer. This risk depends on the number of affected relatives and the age at diagnosis. In this study we aimed to estimate the frequency of a positive family history of colorectal cancer in a random sample from Tehran population. This study was a community-based cross-sectional survey conducted from May 2006 to December 2007 in Tehran province, Iran. A total of 5,500 peoples [age >/= 20 years] drawn up randomly by random sampling according to postal codes and invited to participate in the study. All participants completed a detailed health data registry form on family history status of colorectal cancer. The mean age of men with a positive family history was significantly different from men with negative family history. There was no significant difference between mean age of women responders with or without positive family history. Among all participants [n=5,500], 162 responders [2.9%] had a history of colorectal cancer. Of 162, 67 responders [1.22%] had one and 4[0.07%] had two or more first-degree relative with colorectal cancer. Of 5,500 participants, 18 subjects [0.33%] reported having two or more first-degree relative with colorectal cancer or one first-degree relative with colorectal cancer diagnosed at age<50 years. Four subjects [0.07%] had three or more first-degree relative with colorectal cancer. Based on the findings, we estimate that more than 570,000 subjects in the Iran in the age group >/= 20 years have at least two to three times increased risk of developing colorectal cancer which should be identified and encourage to participate in screening and surveillance protocols of colorectal cancer

[Prognostic factors in gastric cancer using log-normal censored regression model]

Gastric cancer is one of the most common cancers in the world. Although its incidence is decreasing, it rarely is detected early, and the prognosis remains poor. The aim of this study was to evaluate prognostic factors in gastric cancer using log-normal regression model. This retrospective study was done on 746 patients with gastric adenocarcinoma from February 2003 through January 2007. Gender, age at diagnosis, family history of cancer, tumor size and pathologic distant of metastasis were entered to a log-normal model. Relative risk [RR] was employed to interpret the risk of death. Results indicated that patients who were upper than 45 years at diagnosis had an increased risk for death [RR= 1.01 95% CI, 1.01-1.03], followed by greater tumor size [RR= 1.64, 95% CI, 1.07-2.25] and pathologic distant metastasis [RR=2.14, 95% CI, 1.60-2.86] and similar results in multivariate analysis for greater tumor size [RR= 2.04, 95% CI, 1.23-3.33] and pathologic distant metastasis [RR= 2.01, 95% CI, 1.13-3.56]. This study showed that the early detection of patients in younger and in primary stages and grade of tumor is important to decrease the risk of death in patients with gastric cancer and increase the survival rate