[Evaluation of the mean percentages of the peripheral blood gamma delta t lymphocytes in the healthy subjects and celiac patients in Isfahan]

An elevation in the mean percentages of the gamma delta T lymphocytes per total T cells in the epithelium of the small intestine has a diagnostic value for celiac disease. This study aimed to measure the percentages of the peripheral blood gamma delta T lymphocytes in the adults' celiac disease and healthy controls.In this case-control study the absolute numbers of the peripheral blood lymphocytes obtained from the controls [n = 21] and celiac patients [n=15] were studied, Using a cell counter. The proportions of the gamma-delta T lymphocytes were evaluated by the flow cytometer method. The results showed that there was not significant I difference in the percentages of the gamma-delta T lymphocytes between celiac patients and healthy individuals. [p value= 0.84] Collectively, the data show that the percentages of the peripheral blood gamma delta T lymphocytes could not be helpful for celiac disease diagnosis

Phenotypical characterization of the peripheral blood T cells in patients with celiac disease: does it differentiate suspicious celiac disease cases?

The present study aimed to study the immunological changes seen in the intestinal epithelium of the celiac patients could also be detected in the peripheral blood lymphocyte populations. Celiac disease [CD] is a small bowel enteropathy caused by permanent wheat gluten intolerance. One of the earliest signs of CD is an increase in the numbers of the intestinal intraepithelial lymphocytes [iIEL]. In this case-control study, totally 13 untreated subjects with acceptable criteria for CD without any complication and 16 healthy subjects without any positive criteria for CD were selected. Peripheral blood T cells were analyzed by two-color flow cytometry in both groups. The mean age of patients was 33.6 +/- 3.4 years and two patients had Marsh IIIB, five patients had Marsh IIIA and six patients had Marsh II histology class. The mean percentages of the gamma delta]TCR[+] T cells in the patients were significantly higher than the controls [p=0.015]. However, the mean percentages of the [alpha beta]TCR[+] T cells were significantly lower in the untreated patients than the controls [p=0.025]. There were no significant difference between the mean percentages of lymphocytes expressing the CD3, CD4 and CD8 molecules in the patients and the controls. The change in the percentages of the peripheral blood T cells expressing the [gamma delta]TCR and [alpha beta]TCR in the celiac patients could be used in conjunction with the other serological markers to identify new CD cases

Immunohistochemical analysis of mismatch repair proteins in iranian colorectal cancer patients at risk for Lynch syndrome

Hereditary non-polyposis colorectal cancer [HNPCC] is a common hereditary cancer predisposing syndrome has molecular and clinicopathological features still have remained ambiguous within Iranian populations. We discuss in this article some molecular and clinicopathological features of the condition. The study was a descriptive retrospective and designed on 1659 colorectal cancer [CRC] patients were screened based on early-onset disease and Amsterdam II criteria during 14 years [2000-2013]. Immunohistochemistry [IHC] staining was set up to detect expression of mismatch repair [MMR] genes on paraffin-embedded tissue sections of 31 HNPCC-CRC tumors. SPSS 19 software was used to analyze the data. IHC-MMR staining was absent in 7/31 individuals [22.6%] of which 4 cases showed IHC-Absent [IHC-A] in both MSH2 and MSH6 [57.1%], in 2 cases both MLH1 and PMS2 had negative staining [28.6%], and just in one case, MSH6 was defective [14.3%]. The frequency of CRC among IHC-A and IHC-Present [IHC-P] families was 67.5% and 27.9%, respectively. Also the most frequent extracolonic cancers in IHC-A group were: stomach [10%], small bowel [5%], and prostate [5%]; and in IHC-P group: stomach [18.4%], lung [10.9%], and breast [7.5%]. Average age of IHC-A individuals at diagnosis was 38.0 versus 45.3 years in IHC-P individuals. Overall, 20.8% and 57.1% of our index CRCs were localized proximal to the splenic flexure in IHC-P and IHC-A groups, respectively. Given the lack of enough information about molecular aspects of hereditary cancer syndromes like HNPCC in Iran, more evaluations are necessary on larger samples using complementary techniques such as MSI-testing and mutation analyses

Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease [ADPKD] is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/ or chronic pancreatitis and cholangitis

Should we look for celiac disease among all patients with liver function test abnormalities?

Celiac disease [CD] has been found in up to 10% of the patients presenting with unexplained abnormal liver function tests [LFT]. As there is no precise data from our country in this regard, we investigated the prevalence of CD in patients presenting with abnormal LFT. From 2003 to 2008, we measured IgA anti-tissue transglutaminase [t-TG] antibody [with ELISA technique] within the first-level screening steps for all patients presenting with abnormal LFT to three outpatient gastroenterology clinics in Isfahan, IRAN. All subjects with an IgA anti-tTG antibody value of>10 ?/ml [seropositive] were undergone upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. CD was defined as being seropositive with Marsh I or above in histopathology and having a good response to gluten free diet [GFD]. During the study, 224 patients were evaluated, out of which, 10 patients [4.4%] were seropositive for CD. Duodenal biopsies were performed in eight patients and revealed six [2.7%] cases of Marsh I or above [four Marsh IIIA, two Marsh I], all of them had good response to GFD. The overall prevalence of CD among patients with hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis was determined as 10.7% [3/28], 3.4% [2/59], and 5.3% [1/19], respectively. Serological screening with IgA anti-tTG antibody test should be routinely performed in patients presenting with abnormal LFT and especially those with chronic liver diseases including hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis

Is routine duodenal biopsy necessary for the detection of celiac disease in patients presenting with iron deficiency anemia?

Iron deficiency anemia [IDA] is one of the well recognized presentations of celiac disease [CD]. According to the lack of data from our population in this regard, we determined the prevalence of CD in patients presenting with IDA to see if it is worthwhile to do a precise screening for CD in such patients. This cross-sectional study was conducted on patients referred with IDA to Poursina Hakim Gastroenterology Clinic, Isfahan [IRAN]. All included patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Also, patients were evaluated for IgA anti-tissue transglutaminase [t-TG] antibody with enzyme-linked immunosorbent assay [ELISA] technique. CD was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten free diet [GFD]. During the study, 130 patients with the mean age of 35.5 +/- 13.7 [67.7% female [20.4% post-menopausal]] were undergone seropathological studies. According to histopathological study and a clinical response to GFD, 13 patients [10%] were ultimately diagnosed with CD. Nine patients [6.9%] were seropositive, from which, five patients [3.8%] were ultimately diagnosed as CD cases. IgA anti-tTG became negative in all of these patients after six months of GFD. CD should be considered in any adult patient presenting with unexplained IDA, even if not accompanied with gastrointestinal symptoms. Routine duodenal biopsy performed during diagnostic upper gastrointestinal endoscopy is worthwhile in order to investigate for CD as an underlying cause of IDA in adult patients

Linguistic validation of the irritable bowel syndrome-quality of life questionnaire for Iranian patients

There is a growing interest of clinical and epidemiological researches in the field of functional gastrointestinal disorders in our society. Accordingly, validated and culturally adapted instruments are required for appropriate measurement of variables specially the quality of life. The aim of our study was the linguistic validation of the Irritable Bowel Syndrome-Quality of Life questionnaire [IBS-QOL] for Iranian IBS patients with Persian language. Following the standard forward-backward translation method, the IBSQOL was translated into the Persian language and completed by 141 IBS patients. Patients also completed the IBS Symptom Severity Scale [IBS-SSS] and Hospital Anxiety and Depression Scale [HADS]. One-week retest was performed on 30 randomly selected patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient [ICC], respectively. To analyze the discriminant validity, the IBS-QOL scores was correlated to the IBS-SSS and HADS scores. According to the results, reliability analyses were acceptable for all of the IBS-QOL domains [Cronbach's alpha=0.68 to 0.90 and ICCs=0.77 to 0.91]. Discriminant validity was supported by the presence of correlations of the IBS-QOL scores with disease severity [r=-0.628], depression [r=-0.692], and anxiety [r=-0.711] scores; P<0.001. These results indicate that the Persian version of the IBS-QOL is a reliable instrument with sufficient psychometric requirements to assess quality of life in Iranian IBS patients with Persian language