Epidemiological and clinical characteristics of inflammatory bowel disease in patients from Northwestern Iran

There are few reports from Iran about the epidemiology and clinical features of inflammatory bowel disease [IBD]. This study aims to determine the epidemiologic profile and clinical features of IBD in Northwest Iran referral centers. In a cross-sectional setting, we evaluated 200 patients with definitive diagnoses of IBD who referred to Tabriz educational hospitals during the period of 2005 to 2007. Demographic characteristics as well as patients' clinical profiles were evaluated. Disease activity and severity were determined by the Crohn's Disease Activity Index and Truelove and Witt's classification of ulcerative colitis [UC]. The related probable demographic factors were tested. Of the 200 IBD patients, 183 [91.5%] were diagnosed with UC and 17 [8.5%] with Crohn's disease [CD]. There was a positive first degree relative of IBD in 10.9% of UC and 11.8% of CD patients. Abdominal pain was the primary presenting symptom in 25.7% of UC patients and in 58.8% of those with CD. Among UC patients, left-sided colitis was the main feature [52.5%]; while in patients with CD, colon involvement was predominant [52.9%]. There was no significant contributor for activity or severity of disease noted among demographic factors. The occurrence of UC was much higher than CD. The onset of IBD occurred in younger ages with a predominance in males. Left-sided colitis in UC and colon involvement in CD was common. Mostly, the pattern of IBD was mild to moderate with good response to pharmacotherapy. Disease activity and severity were unaffected by demographic features

Effects of low dose zinc supplementation on biochemical markers in non-alcoholic cirrhosis: a randomized clinical trial

The present study aimed to evaluate the effects of low dose zinc [Zn] supplementation on biochemical markers and underlying disease status in non-alcoholic cirrhotic patients. We enrolled 60 cirrhotic patients in a double-blind, placebo-controlled, randomized clinical trial. All patients in the interventional group [n = 30] received long-term, low dose Zn supplementation [50 mg elemental Zn sulfate daily]. The control group [n = 30] received placebo [starch]. Child-Pugh scores and biochemical markers were assessed for both interventional and control groups at the first day and the end of the 90th day of the interventional period. A per-protocol analysis was performed after excluding all participants who did not receive or complete the randomized intervention. The mean differences of quantitative variables between and within groups were evaluated by independent samples t-test and paired-samples t-test, respectively. SPSS version 13.00 was used for statistical analysis. In the initial evaluation, 16 [53.30%] patients from the interventional group had a Child-Pugh score of 5-8 and 14 [46. 70%] had a score of 9-12. In the control group 18 [60.00%] had a Child-Pugh score of 5-8 and 12 [40.00%] scored 9-12. After three months the mean Child-Pugh score in the interventional group showed a significant improvement [from 6.56 +/- 0.21 to 5.72 +/- 0.22, P = 0.001] whereas in the control group despite no significant decline, the mean Child-Pugh score increased slightly [from 6.25 +/- 0.27 to 6.67 +/- 0.31, P = 0.14]. Zn supplementation significantly decreased copper [Cu; P = 0.01] and creatinine [Cr; P < 0.0001] levels. In this study, we determined that low dose Zn supplementation could prevent deterioration of clinical status of cirrhosis and prevent excess Cu accumulation in non-alcoholic cirrhotic patients. Zn supplementation produces metabolic effects and trends towards improvements in liver function, hepatic encephalopathy, and nutritional status

Bone density and bone metabolism in patients with inflammatory bowel disease

Patients with inflammatory bowel disease [IBD] are at high risk for low bone mineral density [BMD]. This study aimed to evaluate BMD in IBD patients and its relationship with bone metabolism in a group of Iranian patients. A cross-sectional study was conducted on patients with IBD to assess BMD status and serum biochemical factors. After getting the demographic data from 200 patients, they were screened using dual-energy X-ray absorptiometry of the lumbar spine [L2-L4] and femoral neck for BMD status. Serum levels of calcium, phosphate, alkaline phosphatase [ALP], and 25-hydroxyvitamin D [25-OH vitamin D] were measured to assess the bone metabolism status. Two hundred patients with IBD were enrolled in the study. One hundred and eighty three [91.5%] patients were identified as having ulcerative colitis [UC] and 17 [8.5%] as having Crohn's disease [CD]. Based on the lumbar and femoral neck bone mass densitometry, 148 [74.4%] patients had low BMD at either lumbar spine or femoral neck. Of these, 100 patients [50.3%] were osteopenic and 48 patients [24.1%] were osteoporotic. A 58.6% and 61% of patients with UC had low BMD in the lumbar and femoral neck, respectively. These results for those with CD were 76.5% and 70.6%, respectively. The mean of femoral neck and lumbar T-scores in patients with UC were -1.14 and -1.38, and in patients with CD were -1.24 and -1.47, respectively [P > 0.05]. The mean [ +/- SD] levels for calcium [Ca] in UC and CD were in the normal range. The mean [ +/- SD] levels of ALP and 25-OH vitamin D in both the groups were in the normal range, and in comparison between groups [UC and CD], no significant differences were observed [P = 0.20 for ALP and P = 0.44 for 25-OH vitamin D]. In the assessment of correlation between biochemical markers and BMD, an inverse correlation between lumbar T-score and ALP or 25-OH vitamin D only in patients with UC was observed. The high prevalence of low BMD in the Iranian population with IBD needs attention. The subclinical vitamin D deficiency may contribute to bone loss in IBD patients, which is more pronounced in patients with UC in this study because of the small population of patients with CD

Nutritional status and blood trace elements in cirrhotic patients

To determine the levels of zinc, copper, iron, albumin and zinc to copper ratio in sera of patients in different stages of cirrhosis and to find possible correlation between trace elements and anthropometrics measurements with liver cirrhosis presence and progression. This cross-sectional analytic study was carried out on sixty continuous patients with liver cirrhosis referred to hepatology clinic, Tabriz University of Medical Sciences. The mean of daily calorie and protein intake was determined by Nutrition III software and compared to recommended dietary allowances [RDA], body composition was determined by bioelectrical impedance analysis [BIA] and serum Zn, Cu and Fe levels were determined by atomic absorption spectrophotometery and albumin level of serum was measured by calorimetric method. Among sixty studied patients, 39 were male and 21 were female. 53.8% of male patients were in Child-Pugh class B while 23.8% of female patients were in Child-Pugh class B. The mean energy and protein intake of all patients was lower than RDA values and there was no significant correlation between the mean of protein and energy intake with severity of liver cirrhosis. The serum levels of Zn, Albumin and Zn/Cu ratio in patients with Child-Pugh class B were significantly lower than those with Child-Pugh class A. In general, these results suggested that changes in liver cell pathology compounded by functional impairment may alter the metabolism of trace metals, in particular, zinc