ABSTRACT
Many studies have reported an association between periodontal infections and some systemic diseases such as respiratory and cardiovascular diseases. Some studies found a direct association between chronic gastritis caused by Helicobacter pylori [HP] infection and poor periodontal health
Methods: In a cross-sectional study from November 2014 to December 2015 in Kerman, the largest province in southeast Iran, patients with dyspepsia who were candidate for diagnostic upper gastrointestinal [GI] endoscopy were included in our study. Decayed, Missing, and Filled Teeth [DMFT] index and Loe plaque index that are two popular indexes in dental epidemiology were used to assess the oral health by a dentist before the upper GI endoscopy. According to the Loe plaque index, score: 0= no plaque, score: 1= a film of plaque attaching to the free gingival border and near area of the tooth, score: 2= moderate reposition of deposits within the gingival pocket, score :3= plenty of soft matter within the gingival pocket +/- on the tooth and gingival border. Scores
Results: According to Sidney's classification 77 [89.5%] patients had superficial gastritis, 3 [3.5%] had atrophic gastritis, and 6 [7%] had intestinal metaplasia. HP was found in 80.2% of the gastric mucosal biopsy samples. There were not statistically significant relationship between Sidney's classification, presence of HP in gastric mucosal biopsies, and hygiene indicators [p>0.05]. No relation was found between the DMFT index and superficial gastritis, atrophic gastritis, and intestinal metaplasia [p>0.05]. Gastric infection with HP was found in 70%, 75%, and 100% of patients with mild, moderate, and sever DMFT index, respectively
Conclusion: Our study showed that there might be a relation between poor oral hygiene and gastric precancerous lesions. In addition, HP infection in gastric histopathology might be associated with periodontal disease
ABSTRACT
Currently, surgery is less needed for the treatment of refractory peptic ulcer disease [PUD] or its complications. So, the complications of PUD surgery have been clearly declined. Here in, we present a 42-year-old man with chronic watery diarrhea and significant weight loss during 2 years after gastrojejunostomy for the treatment of obstructive PUD. Small bowel gastrointestinal series showed rapid transit without passage of contrast in the parts of small bowel. The patient was scheduled for exploratory laparotomy. During the surgery a large fistula was detected between the stomach and transverse colon, which was repaired. At the follow-up 6 months after the surgery, the patient did not have any history of recurrence of diarrhea and had 10 kg weight gain. Gastrocolic fistula is a very rare complication of surgical management of PUD. Barium enema is the most helpful imaging procedure for the diagnosis of gastrocolic fistula and surgery after correction of nutritional status is suggested especially for malnourished patients
ABSTRACT
Background: Improving life is the main goal of therapeutic interventions for chronic diseases. Although we needed to determine quality of life by various variables. This study aimed to determine quality of life in patients with Irritable Bowel Syndrome [IBS] in Kerman
Materials and Methods: This is a cross sectional study of 143 patients with IBS referred to a specialist, assessed by IBS-QOL.34. Data analyzed by descriptive statistics, Pearson correlation coefficients, t-test and ANOVA, using SPSS software. p.Value <0.05 was considered as statistically significant
Results: In this study from 143 samples, 82 were females [57.3%] and 61 males [42.7%]. Quality of life score in patients was 37.16 +/- 16.72, and there was significant difference in terms of employment and education level [p.value<0.05]
Conclusion: Among patients with IBS, quality of life is far from desired. Therefore, health care providers should consider psychosocial support alongside medical management for achieving better quality of life in these patients
ABSTRACT
Background: Gastroesophageal reflux disease [GERD] is one of the most common gastrointestinal problems worldwide
The aim of this study was to evaluate the clinical spectrum, prevalence, and some of the variables that are supposed to be the risk factors of this chronic disorder
Methods: This population- based cross-sectional study was conducted in a one-stage randomized clustered sample of adult inhabitants in Kerman city in 2011-2012. A total of 2265 subjects with age range of 15-85 years were enrolled
Face to face interview was performed for all the subjects. GERD was defined as at least weekly heart burn and/or acid regurgitation during the past year. Association of GERD with factors like demographic variables, medical condition, diet and life habits were analyzed
Results: A total of 2265 subjects including 988 [43.8%] male and 1275 [56.3%] female patients were evaluated. The prevalence of GERD was 28%. The prevalence was higher in female patients and with aging. There was also a significant association between GERD and the following risk factors: lower educational level [p 0.000l], higher body mass index [p =003], presence of depression [p<0.000 1], and anxiety [p <0=0001]
Conclusion: GERD as a common disorder in our region was seen more in elderly and female patients and was associated with some anthropometric, metabolic, medical conditions, and behavioral habits
ABSTRACT
Small intestinal bacterial overgrowth [SIBO] may have a role in the pathophysiology of irritable bowel syndrome [IBS]. So, the aim of this study was to assess the association between SIBO and IBS by using glucose breath test [GBT] in Kerman city as the first study in Iranian population. 107 patients with IBS and 107 healthy individuals were enrolled in our study. All the participants underwent GBT. A peak of H2 values >20 p.p.m above the basal value after glucose ingestion was considered suggestive of SIBO. SPSS software version 17 was used for data analysis. P value < 0.05 was considered as statistically significant. Of the 107 patients with IBS, 40 had positive GBT [37.4%] compared with 14[12.1%] out of the 107 control participants [p< 0.001]. Dominant symptoms in patients with IBS were diarrhea in 36[33.6%], constipation in 12[11.2%], abdominal pain in 22[20.6%], bloating in 28[26.2%], and change in bowel habit in 9[8.4%] patients. There was not statistically significant difference among any of this IBS subgroups and positive GBT [p=0.44]. There is a positive association between IBS and SIBO. We suggest a Placebo-controlled bacterial eradication study for identifying the role of SIBO in IBS
ABSTRACT
Although Helicobacter pylori and non-steroidal anti-inflammatory drugs [NSAIDs] are the main causes of peptic ulcers disease [PUD], recently the prevalence of idiopathic peptic ulcer [IPU] is increasing in most parts of the world. The aim of this study was to assess the prevalence of IPU in Kerman, the center of largest province in south-east Iran. We included 215 patients with peptic ulcer in our study. Combined methods rapid urease test [RUT], histology, and real time polymerase chain reaction [PCR] was performed on endoscopic samples of peptic ulcers. NSAID use was determined by medical history. SPSS software version 16 was used for data analysis, p value<0.05 was considered as statistically significant. Of 215 consecutive patients with peptic ulcer, four [1.8%] had H.pylori-negative and NSAID-negative PUD. There were not significant differences between patients with IPU and patients with peptic ulcer associated with H.pylori or NSAIDs regarding the sex, age, cigarette smoking, and opioid abuse. Our study showed that in contrast to other reports from western and some Asian countries, the prevalence of IPU is low in Kerman and H.pylori infection is still the major cause of PUD. We recommend a large and multi-central study to determine the prevalence of IPU in Iran
ABSTRACT
Ulcerative colitis [UC] is a multi-factorial autoimmune disease. P-glyco-protein is encoded by the multidrug resistance 1 [MDR1] gene. The C3435T polymorphism in the MDR1 gene is correlated with low P-glycoprotein expression. Additionally, vitamin D has regulatory effects on the immune system. The aim of our study was to determine the association between the C3435T MDR1 polymorphism and UC and to detect the vitamin D serum levels in patients with UC. One hundred healthy controls and 85 patients with UC were evaluated. Polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] was used to detect the C3435T MDR1 polymorphisms. Serum levels of vitamin D were measured by Enzyme-linked immunosorbent assay [ELISA]. The research was performed in Kerman, Iran, from 2011 to 2013. We could not find any association between the C3435T MDR1 polymorphism and susceptibility to UC. There was a significant decrease in serum levels of vitamin D in patients with UC compared with healthy controls [p<0.001]. Controversies regarding the association between the C3435T MDR1 polymorphism with UC have been reported in different populations. The difference between our results and others may be attributed to the heterogeneity of the Iranian population and the sample size. Additionally, our data indicated that UC might be correlated with vitamin D insufficiency. Therefore, the administration of vitamin D might be suggested as a valuable treatment for patients with UC
ABSTRACT
Chronic constipation is a common problem worldwide that negatively impacts quality of life. Because of the effects of psychological and cultural factors on the function of the bowel tract and the vast variety of ethnicities and diet among the Iranian people, the present study describes the occurrence of constipation and its associated factors in Kerman, the largest city in Southeast Iran. This was a cross-sectional study conducted in Kerman, Iran from 2011 to 2012 that included 2191 adults who were randomly selected and interviewed face to face using a validated questionnaire based on Rome III criteria. Demographics, cigarette smoking, opium dependence, amount of fiber consumption, physical activity and psychological factors were assessed. Inclusion criteria was ages 15 to 85 years old. Exclusion criteria was the presence of any metabolic and/or neuro-muscular disease that caused constipation. All data were analyzed with Stata11 software, with a confidence interval of 95%. A p-value of 0.2]. Although the prevalance of constipation in Iran is estimated to be lower than Western countries, new changes in life style can cause an increase in the burden of constipation in the future
ABSTRACT
In spite of the increasing trend in opioid abusers worldwide, the prevalence of narcotic bowel syndrome [NBS] is undetermined. We aimed to estimate the prevalence of NBS and other opioid bowel dysfunction [OBD] in opioid abusers in Kerman, southeast Iran. According to the best of our knowledge, this is the first study to assess the prevalence of NBS in opioid abusers. By referring to addiction treatment centers in Kerman city and in a cross-sectional study, 577 subjects with opium or opioid subtracts abuse were included in our study. A validated questionnaire was used for OBD assessment and diagnosis of NBS was made according to both the presence of chronic abdominal pain despite increasing the opioid dose and ruling out other causes of abdominal pain. SPSS software version 16 was used for data analysis. p value<0.05 was considered as statistically significant. Constipation, regurgitation, and heartburn were the most gastrointestinal complaints that were found in 132[22.9%], 123[21.3%] and 91[15.8%] subjects, respectively. Only 16[2.8%] participants fulfilled all the NBS criteria. Simultaneous use of non-narcotic sedative drugs increased the risk of NBS significantly [the odds ratio 3:1 and p=0.049]. NBS is not rare among opioid abusers and should be considered as a cause of chronic abdominal pain in this group
Subject(s)
Animals, Laboratory , Animals , Insecta , Narcotics , Opioid-Related Disorders , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Abdominal Pain , Constipation , HeartburnABSTRACT
The incidence of inflammatory bowel disease [IBD] varies among different societies. The aim of this study is to determine the incidence rate of IBD in Kerman, a city in Southeast Iran. All medical records that indicated a new diagnosis of ulcerative colitis [UC] or Crohn's disease [CD] were retrieved from the gastrointestinal endoscopy and pathology departments of 12 centers from October 2011 to September 2012. The incidence rate of UC in Kerman was estimated at 4.98/100,000 [95% CI: 2.44-6.94]. The mean age of patients was 39.4 years and male to female ratio was 0.89:1.0. UC patients had the following prevalence: cigarette smoking [30%], appendectomy [36%] and oral contraceptive [OCP] use [78.9%]. The incidence rate of CD was 0.8/100,000 [95% CI: 0.6 4-1.14]. The mean age at diagnosis was 33.3 years and male to female ratio was 0.5:1.0. Cigarette smoking was reported in 33.3%, appendectomy in 66.6% and OCP useing in 75% of CD patients. Rectal and distal colitis, left side colitis and extensive colitis was seen in 20 [55.4%], 12 [33.3%] and 4 [11.1%] of patients with UC, respectively. All patients with CD had large intestinal involvement and one case [16.6%] had ileocolonic disease. Our study has shown that the incidence rate of both UC and CD in Kerman is lower than Western populations but it is the same as some Asian countries. Characteristics of disease involvement in this study are similar to other studies that have been conducted in Iran and elsewhere.
Subject(s)
Humans , Male , Female , Incidence , Urban Population , Developing Countries , Cross-Sectional StudiesABSTRACT
Blue Rubber Bleb Nevus Syndrome is a rare disorder that is characterized by multiple recurrent vascular malformations of skin and gastrointestinal tract. The affected patients may present with diverse manifestations including iron deficiency anemia. We report this syndrome in a 22-year-old man that was referred to our hospital for iron deficiency anemia with unknown cause and vascular malformations in the skin and gastrointestinal tract. Because of stable hemoglobin level, we decided to treatment him by iron supplementation and close follow up. We report this case along with a review of literature
Subject(s)
Humans , Male , Anemia, Iron-Deficiency/etiology , Vascular Malformations/etiology , Review Literature as Topic , Skin Neoplasms , Gastrointestinal NeoplasmsABSTRACT
Inflammatory bowel disease, an autoimmune disease, has two clinical manifestations including Crohn's disease and ulcerative colitis [UC]. IL-17 has been the target of intensive research in autoimmune diseases. The influence of Toll like receptor 4 [TLR-4] gene polymorphisms on IL-17 production has also been revealed in UC patients and tissue inflammation in mice. To investigate the association between the TLR-4 gene polymorphisms, Asp299Gly and Thr399Ile and IL-17 serum levels with ulcerative colitis. Additionally, we aimed to study modulation effects of forenamed gene polymorphisms on IL-17 serum levels in UC patients and controls. A total of 256 healthy controls and 85 UC patients enrolled in our study. DNA was extracted and PCR-RFLP technique was employed to determine Asp299Gly and Thr399Ile polymorphisms in TLR-4 gene and IL-17 serum levels were measured by ELISA method. There was no significant difference between the frequency of Asp299Gly A>G and Thr399Ile C>T in UC patients and controls. While IL-17 serum levels in UC patients were significantly higher than controls [p=0.003], no significant difference in IL-17 levels between different genotypes existed. Additionally, a significant inverse relationship was observed between hemoglobin level and IL-17 serum levels in UC patients [p=0.039]. Increased IL-17 serum levels in our UC patients might be explained through the synergistic activity of IL-17/IL-23 axis and pro-inflammatory cytokines, causing severe clinical outcome in patients with IBD. The prolonged excretion of blood in stool driven by inflammatory process which causes iron metabolism disorder and anemia may elucidate the inverse correlation between hemoglobin and IL-17 serum levels in UC patients. Lack of association between the TLR-4 gene polymorphisms and UC in our study was consistent with the results from other Caucasian populations
ABSTRACT
Crohn's disease [CD] and ulcerative colitis [UC] are two major clinical presentations of inflammatory bowel disease [IBD]. Many novel candidate genes have been found to be associated with increased risk for IBD. Recently IL-23 receptor gene is identified as an IBD associated gene in genome-wide studies. To ascertain whether rs7517847 and rs1004819 SNPs in the IL-23 receptor gene are associated with UC in our population in Kerman, south east of Iran. A total of 85 patients with UC and 100 healthy controls enrolled in our study. Endoscopic procedure was performed for all patients to determine their disease severity. IL-23 receptor genotyping at positions rs7517847 and rs1004819 was done by PCR-RFLP technique. The results of this study showed no association between the studied polymorphisms in the IL-23 receptor gene and UC in our population. However, we found a significant association between rs7517847 gene polymorphism in IL-23 receptor and two important clinical variables including blood in stool and bowel movements in UC patients. The rs7517847 gene polymorphism in IL-23R may be related to the presence of blood in stool and bowel movements in patients with UC. Further functional analysis with other known IL-23 receptor genotypes and/or other candidate genes is necessary to confirm any genetic association with UC in our population
ABSTRACT
Gastric ulceration is induced by various forms of stress like surgery, ischemia and trauma. The female sex has more resistance to stress and the gastrointestinal lesions happen fewer than male sex. The purpose of this study was to evaluate the role of estradiol and progesterone on the gastric acid and pepsin levels following traumatic brain injury [TBI] induction. Materials and Methods Diffuse TBI was induced by Marmarou method in female rats. Rats randomly assigned into 9 groups: intact, OVX [ovarectomized rat], Sham+OVX, TBI [intact rats under TBI], TBI+OVX [ovarectomized rats under TBI] and treated OVX rats with vehicle [sesame oil], E2 [estradiol], P4 [progesterone] or E2+P4 combination. The acid content and pepsin levels of each gastric washout sample were measured 5 days after the TBI induction. There was no significant difference in gastric acid output between groups either after TBI induction or after treatment with E2 or P4 or E2+P4. Gastric pepsin levels were increased in Sham+OVX, TBI [P< 0.001] and TBI+OVX [P< 0.05] compared to intact group. Gastric pepsin levels were significantly lower in E2 and E2+ P4 treated rats than vehicle treated group [P< 0.01]. P4 treatment increased gastric pepsin level compared to TBI+OVX group [P< 0.05] and this increment was higher than rats that were treated with the E2 and E2+P4. These results suggest that protective effect of estradiol and E2+P4 combination against mucosal damage after TBI, might be mediated by inhibition of pepsin secretion
ABSTRACT
Patients with ulcerative colitis are at increased risk of inflammation. Interleukin 23 [IL-23] is a newly identified cytokine with increased expression in inflamed biopsies of colon mucosa in patients with Crohn's disease; however, there is inconsistent evidence on its role in ulcerative colitis. We aimed to compare serum IL-23 level in patients with ulcerative colitis and normal controls and determine if serum IL-23 level increases with the severity of disease according to endoscopic findings. We quantified serum IL-23 levels from 60 patients with ulcerative colitis and 20 control individuals. All patients underwent endoscopic procedure to define the severity of disease. Patients were then stratified into 2 groups of "Mild" and "Severe" according to the endoscopic findings. For comparison of serum IL-23 levels, Platelet count, ESR and CRP between the groups, Mann-Whitney U test and independent sample t test were employed, as appropriate. Pearson's and spearman's correlation tests were employed to test the association of IL-23 with platelet count, CRP and ESR in patients. Our findings showed that serum IL-23 levels were increased in patients with ulcerative colitis compared to normal control. Moreover, patients in "Severe" group had higher serum IL-23 levels and ESR compared with those in "Mild" group. There was no significant sexual dimorphism in any of studied variables. We suggest that IL-23 plays an important role in the pathogenesis of ulcerative colitis and is a marker of disease activity in these patients
ABSTRACT
H. pylori is a human pathogen that colonizes the epithelium of the stomach. The host immune response may influence the disease process, where cytokines play important roles in the development of disease. In this study, the concentrations of selected cytokines in the gastric antrum and stomach body mucosa and also in the serum were evaluated. Eighty patients according to their rapid urease test were divided into two groups: H. pylori positive [n=39] and H.pylori-negative [n=41]. The concentrations of cytokines in biopsies and serum were determined by ELISA method. The mean TNF-alpha and IFN-gamma levels in the infected group were significantly higher than that of uninfected patients. In contrast, IL-10 level in most patients was undetectable. The mean antral of stomach TNF-alpha and IFN-gamma levels were significantly higher than that of the stomach body. IFN-gamma serum level showed positive correlation with antrum and stomach body levels, whereas no correlation was found in TNF-alpha in different samples. Higher levels of TNF-alpha and IFN-gamma in antral indicate that the colonization of bacteria in the antrum may be higher than stomach body [culture results from two sites support this statement]. Increased serum level of IFN-gamma indicates the activation of circulating-T cells against infection. Induced H. pylori-related TNF-alpha is concentrated is gastric mucosa and this pathogen does not cause any significant change in the serum level of this cytokine. Therefore H. pylori by inducing certain inflammatory cytokines but not IL-10 may contribute the process of disease development
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Gastric Mucosa/immunology , Interleukin-10/analysis , Interferon-gamma/analysis , Tumor Necrosis Factor-alpha/analysis , Helicobacter pylori , Lymphocyte ActivationABSTRACT
Clarithromycin resistance in Helicbacter pylori has been found to be associated with point mutations in 23s rRNA gene leads to reduced affinity of the antibiotic to its ribosomal target or changing the site of methylation. The aim of this study was to determine the most important point mutations in 23s rRNA gene in H. pylori that are closely related to clarithromycin resistance among such isolates. Sixty three H. pylori isolates, obtained from gastric biopsy speciemens in Kerman, Iran, were used to evaluate their susceptibility to clarithromycin by disk diffusion test, and to detect the most common point mutations in 23s rRNA gene associated with clarithromycin resistance by Polymerase chain reaction-amplification and restriction fragment length polymorphism [PCR-RFLP] and 3'-mismatch PCR. 31.7% of the H. pylori isolates were resistant to clarithromycin, and each of the resistant isolate had at least one of the most common point mutations in 23s rRNA gene associated with calrithromycin resistance. According to our results three common point mutation in 23s rRNA gene in H. pylori are closely related to clarithromycin resistance. There was an absolute relation between 23s rRNA gene point mutations and clarithromycin resistance in this study. Helicbacter pylori resistance to clarithromycin can cause failure in the eradications of the bacteria. The resistance of the bacteria is expanding in most parts of the world including Iran