Frequency and risk factors of primary sclerosing cholangitis among patients with inflammatory bowel disease in North-East of Iran

To identify primary sclerosing cholangitis [PSC] predisposing factors in order to prevent inflammatory bowel disease [IBD] progression to PSC. IBD is commonly associated with PSC and there is no effective therapy for PSC except for liver transplantation. This retrospective study was conducted on 447 IBD patients from IBD Clinics of Ghaem and Emam Reza Hospitals. Data were collected by interview and through a review of the patients' medical records. Patients were divided into two groups: those with IBD and PSC [IBD-PSC] and those without PSC. Variables were compared between two groups and those with statistically significant differences in IBD-PSC group were considered as predictive factors for the development of PSC. The frequency of PSC in IBDs was 4.3% and all were ulcerative colitis. The mean age of patients with PSC was 39.1 +/- 11.33 years. The male to female proportion in PSCs was 3.8:1 and in IBDs was 0.9:1. There were statistically significant associations between PSC and gender, IBD duration and UC extension, mucocutaneous involvement, oral contraceptive pills [OCP] consumption, history of surgery and history of PSC in the first- degree relatives. PSC frequency among IBD patients in North-East of Iran was 4.3%. It is recommended to limit OCP consumption in IBD patients. Identification and modification of probable predisposing risk factors, as well as early diagnosis of PSC are necessary

Causes of persistently elevated alanine aminotransferase levels in patients who presented to two referral hospitals in Mashhad, Iran during 2011

Worldwide, chronic liver disease is a major cause of morbidity and mortality. Causes of elevated serum alanine aminotransferase [ALT] levels vary depending on the population under study. The aim of this study is to evaluate the frequency and causes of persistently elevated ALT levels in patients of the Gastroenterology [GI] Clinics in Ghaem and Emam Reza Hospitals in Mashhad, Iran. A total of 100 consecutive patients with persistently elevated ALT levels that referred to the GI Clinics at Ghaem and Emam Reza Hospitals in 2011 were studied. Elevated levels were defined as ALT >/= 40 U/L at least twice within six months. A comprehensive history that included previous surgeries, transfusion, alcohol consumption and medications was obtained. Patients underwent physical examinations, laboratory analyses and ultrasonography studies. When necessary, liver biopsies were performed. Patients' mean age was 44.4 +/- 11.83 years. Females comprised 62% of cases. Patients presented with the following conditions: non-alcoholic fatty liver disease [NAFLD, 55%], hepatitis B [17%], autoimmune hepatitis [13%], hepatitis C [4%], autoimmune hepatitis and hepatitis C [2%], overlapping autoimmune disease [2%], Wilson disease [1%], celiac disease [1%], alcoholic hepatitis [1%], primary biliary cirrhosis [PBC, 1%], primary sclerosing cholangitis [PSC, 1%], and cryptogenic [2%]. NAFLD was the most common cause of persistently elevated serum ALT levels in this study.

Splenic artery aneurysm as an unusual cause of new onset ascites: a case report

Splenic artery aneurysm [SAA] is a rare and potentially life-threatening clinical entity that carries a risk of rupture and peritoneal hemorrhage. When ruptured, it typically manifests as abdominal pain with hemodynamic instability. This is a report about a 29-year-old male admitted for evaluation of recent-onset ascites following the spontaneous resolution of a transient episode of severe epigastric and left upper quadrant pain with syncope the preceding day. Paracentesis revealed bloody fluid. Abdominal computed tomographic angiography [CTA] and magnetic resonance venography [MRV] showed a three centimeter SAA. During admission, prompt exploratory laparotomy was performed that revealed excessive intraperitoneal hemorrhage due to a ruptured SAA. The pathology report confirmed that the SAA had developed secondary to atherosclerosis. Careful history taking together with appropriate imaging tests and emergent surgical intervention led to a timely diagnosis and the patient's survival.

Autoimmune pancreatitis: a case report

Autoimmune pancreatitis is a fibro-inflammatory form of chronic pancreatitis. It is diagnosed by the combination of imaging studies such as a CT scan and pancreatography, laboratory analyses that include IgG4 and/or autoantibodies, histopathological evaluations and positive response to corticosteroid therapy. We report the case of a 41-year-old female with a history of jaundice and increasing abdominal pain for two weeks prior to her clinic visit. Laboratory results were significant for an increase in alkaline phosphatase [ALP] and erythrocyte sedimentation rate [ESR]. Magnetic resonance cholangiopancreatography [MRCP] confirmed areas of stenosis and dilatation in the pancreatic duct and in the intra- and extra-hepatic bile ducts similar to primary sclerosant cholangitis. Laboratory analyses showed increased levels of IgG4 with the presence of antinuclear antibodies.