Iranian Registry of Crohn's and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East

BACKGROUND/AIMS: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn's and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. METHODS: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach's α. RESULTS: All sections of questionnaire had Cronbach's α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). CONCLUSIONS: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.

Target antigens for perinuclear antineutrophil cytoplasmic antibodies in Iranian patients with ulcerative colitis

Patients with ulcerative colitis [UC] carry autoantibodies such as perinuclear antineutrophil cytoplasmic antibodies [p-ANCA]. The aim of the present study was to evaluate the target antigens for p-ANCA in Iranian patients with UC. p-ANCA target antigens including elastase, lactoferrin, cathepsin G, myeloproxidase, lysozyme, and bactericidal permeability increasing protein [BPI] were determined in 113 patients with UC using enzyme-linked immunosorbent assay [ELISA]. 59.2% of the patients were positive for at least one antigen and p-ANCA directed against lactoferrin, elastase, lysozyme, cathepsin G, Bactericidal permeability increasing protein, and myeloproxidase in 31.5%, 25.9%, 8.3%, 7.4%, 5.6%, and 0% of the patients, respectively. The highest prevalence of p-ANCA was observed against lactoferrin and elastase. Also, myeloproxidase was not an antigen for p-ANCA among our patients

[NOD2 novel mutations in Iranian Crohn's patients]

Despite the reported role of three common mutations of the CARD15/NOD2 gene including R702W, G908R and 1007fs in Crohn's disease [CD], only about 30% of Iranian CD patients carry one of these three variants [R702W]. The aim of this study was to screen the hot points of NOD2 gene to find any novel sequence variations in Iranian patients with CD. Eighty non-related Crohn's patients from Iranian origin, referred to a tertiary center in a three-year period [2006-2009], were enrolled in this study. The hot points of NOD2 gene [including exons 4 and 8] were evaluated by direct sequencing after amplification of related sequences with polymerase chain reaction [PCR]. A total of 17 sequence variations were identified among these exons of NOD2 gene including 7 novel ones. Three of these new mutations had an allele frequency more than 5%. All new mutations were a consequence of a single nucleotide change, 4 resulted in an aminoacid change while one formed a stop coden. No deletion or insertion mutation was observed in this part of the gene. This study demonstrated the existence of uncommon NOD2 variants in Iranian patients with CD. It is possible that these mutations play a role in susceptibility to CD in Iranian population

Abdominal pain due to lead-contaminated opium: a new source of inorganic lead poisoning in Iran

Although the incidence of occupational and adult lead poisoning has declined, the problem still exists. We encountered three patients with lead poisoning in Iran, all of whom associated with presented with diffuse abdominal pain, which was at times colicky in nature, anemia, constipation, nausea, vomiting, and slightly abnormal liver biochemistries. A history of opium ingestion was present in each of these patients. None of the patients reported known occupational exposure to toxins. Diagnoses of lead poisoning were confirmed through the detection of elevated blood lead levels. The cause of lead poisoning was attributed to the ingestion of contaminated opium. Opium adulterated with lead had not been previously recognized as a source of lead poisoning in Iran. It is, therefore, pointed out that lead poisoning should be considered as a differential diagnosis for acute abdominal colic of unclear cause in patients with opium addiction

Occult Hepatitis B as a Cause of Cryptogenic Cirrhosis

Background: occult hepatitis B virus [HBV] infection is characterized by presence of HBV infection with undetectable hepatitis B surface antigen [HBsAg]. Diagnosis of occult HBV infection requires sensitive HBV-DNA PCR assay. Recently it has been shown that occult hepatitis B may be a cause of cryptogenic liver disease. The aim of this study is the investigation of occult HBV infection among patients with cryptogenic liver disease

Methods: 65 consecutive paraffin-embedded liver tissues from cases referred to RCGLD [Research Center for Gastroenterology and Liver Diseases] and THC [Tehran Hepatitis Center] during the years 2001 and 2002 for liver biopsy because - of elevation of alanine aminotransferase [ALT] levels for more than six months were studied. Among these, 12 patients with cryptogenic liver disease were found. Human tissue DNA could be extracted in 7 of 12 patients. In these patients liver biopsies were reviewed and HBV-DNA and HBsAg and HBcAg were assayed in liver tissue by polymerase chain reaction [PCR] and immunohistochemistry [IHC], respectively

Results: histologically, chronic hepatitis, cirrhosis and nonspecific changes were reported. HBVDNA was detectable in 4 patients but IHC was negative in all. The frequency of occult HBV infection was more than 50%

Conclusions: occult HBV infection is common among patients with cryptogenic liver disease. In these patients, HBV-DNA may be detected more frequently among patients with more advanced liver pathology [cirrhosis] and more aggressive clinical course [decompensated cirrhosis]

Non HFE-related hemochromatosis; a case report from Iran

Hemochromatosis, especially with cardiac and liver problem, is rare in Iran. We report a young female with pulmonary hypertension and abnormal liver function tests due to non HFE- related hemochromatosis