Epidemiologic and demographic survey of celiac disease in khuzestan province

BACKGROUND: Celiac disease presents with a wide spectrum of symptoms

This study clarifies different aspects of celiac disease along with the most common patterns of celiac presentation in Khuzestan Province, Iran

METHODS: Patients' information was obtained by evaluation of their files from the archives of the Khuzestan Celiac Society and records at gastroenterologists' offices in this province

RESULTS: Overall, there were 103 [40 males, 63 females] patients included in this study. Patients' mean ages were 33 +/-11 years [males] and 31.6 +/- 11.7 years [females]. In terms of geographic distribution, 54.1% resided in the center of the province followed by 26.5% who were residents of the northern area. The rate of employment among men was 70.6% whereas it was 8.3% for women. In terms of education, 21.9% of men and 33.3% of women had academic educations. The rate of matrimony was 80.6% [n=29] for men, 65.4% [n=38] for women and 3.4% [n=2] who were divorced. Mean height was 164 +/- 14 cm in men and 157.5 +/- 10 cm in women. Mean BMI at the time of presentation was 22.7 in men and 22.6 in women. The most common gastrointestinal [GI] complaints in male patients were diarrhea [35%], reflux [20%], bloating [17.5%], abdominal pain [15%], vomiting [15%] and constipation [7.5%]. Female patients experienced diarrhea [49.2%], abdominal pain [31.7%], bloating [31.7%], vomiting [19%], constipation [9.5%] and reflux [7.9%]. The most common concomitant non-GI disorders among male patients were anemia [17.1%], thyroid disease [14.3%], and weight loss (14.3%); women experienced anemia [33.9%], thyroid disease [12.5%], and weight loss [7.1%]. Approximately half of the patients exhibited symptoms for more than five years prior to diagnosis and 90% were diagnosed by gastroenterologists. Of these, 43% had normal endoscopy results. The most common serologic markers were anti-TTG [69.9%], anti-EMA [27.7%]

CONCLUSION: Physicians, prior to attributing patients' symptoms to irritable bowel syndrome [IBS] should be aware that patients who present with long-term nonspecific symptoms might possibly have celiac disease. During endoscopy, the threshold for obtaining biopsies should be low

Evaluation of N-acetyl cysteine for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective double blind randomized pilot study

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography [ERCP] that can occasionally be fatal. Multiple drugs have been examined for the prevention of this side effect, with generally uncertain results. This study is an effort to prevent this complication by the use of oral N-acetyl cysteine [NAC]. A total of 100 patients who were candidates for ERCP were divided randomly into two groups. In the NAC [N] group, patients received 1200 mg NAC with 150 cc water orally 2 h before ERCP. In the placebo [P] group, 150 cc water was prescribed as a placebo. We measured serum amylase and lipase levels before and 24 h after ERCP. The prevalence of pancreatitis and duration of admission in each group were determined and compared. In group N there were 5 [10%] cases of pancreatitis, whereas in group P there were 14 [28%] cases, which was significant [risk reduction ratio: 2.8; p=0.02].The average admission time was 1.16 +/- 0.55 days in group N and 1.18 +/- 0.44 days in group P, which was not significant. There were significant differences in the prevalence of acute pancreatitis between the two groups. In addition, the number of need to treat [NNT] consisted of five cases for NAC. With regards to the above results and the safety profile of NAC, it could be used as a therapeutic agent for the prevention of post-ERCP pancreatitis. We recommend that the results of this study be verified by additional clinical trials

[Evaluation of the efficacy of intra-nasal midazolam for sedation during upper endoscopy: a randomized clinical pilot study]

Background: upper endoscopy, as an important diagnostic and occasional therapeutic tool is invasive. Sedation of patients during the endoscopy procedure with minimal side effects could raise patient tolerability, allowing for ease and increased effectiveness of this procedure

Materials and Methods: in this study, 105 patients who were candidates for the upper endoscopy procedure were randomly divided into two groups: [A] midazolam [n=53] and [B] placebo [n=52]. Group A patients received 5 mg of midazolam dissolved in 5 cc distilled water and group B received 5 cc of distilled water, via an intra-nasal drip. After 40 to 45 minutes, the upper endoscopy was performed. During the endoscopy, patients were monitored and the endoscopy time, gag reflex stimulation, heart rate, arterial oxygen saturation [SPO2], amnesia and patient justification were recorded and compared

Results: the average age in group A was 39.3 years; for group B, it was 39.9 years. There were no statistically significant results for average endoscopy time [p=0.23], gag reflex stimulation [p=0.27], heart rate [p=0.09], SPO2 [p=0.49], amnesia [p=0.12], and patient justification [p= 0.1] between both groups

Conclusion: according to the results of this study, it seems that intra-nasal midazolam is not effective for patient sedation. This field needs additional evaluation

Body mass index and ABO blood groups among different ethnicities of the Golestan cohort study subjects

ABO blood groups are associated with some important chronic diseases. Obesity as a major risk factor of chronic non-communicable diseases is rising rapidly in Iran as well as in developing countries. Understanding the risks for obesity is important for its control. This study seeks to determine if there is any association between ABO blood groups and body mass index [BMI]. Weight, height and blood groups were determined for participants of the Golestan Cohort Study in order to find any association between ABO blood groups and BMI. Prevalences of overweight and obesity in participants [mean age: 52.1 +/- 8.0 years] were 33.9 and 25.4, respectively. Mean weight and BMI were significantly higher in blood group A, females and those of Turkman ethnicity. After adjustments for age, sex and ethnicity, there was no association noted between VMI and ABO blood group. The prevalence of obesity and overweight in Iran is high, as seen in developing countries. There is no association between BMI and ABO blood groups in the Golestan cohort population, but Turkman ethnicity and female gender are associated with higher BMI