Clinical manifestations of irritable bowel syndrome in Iranian men and women: a comparative study

Irritable Bowel Syndrome [IBS] is one of the most prevalent gastrointestinal disorders which includes the majority section of general practitioners or gastroenterologists visits. The type or prevalence of clinical signs and symptoms of the syndrome may be different among males and females. we decided to assess and compare the frequency of different signs and symptoms of IBS in men and women. It is a cross sectional study which was performed in a private gastroenterology clinic in Tehran. 76 males and 116 females who suffered from Irritable Bowel Syndrome were selected, and the clinical signs and symptoms were compared. Finally, the data were analyzed using Chi-Square test. Among the gastrointestinal signs, abdominal pain, nausea, belching, and bitter taste with women/men ratio equal to 1.2, 2, 1.7, and 1.4 respectively [p<.05] were more prevalent in females, while flatulence and mucus discharge were observed in males more than females [men/female ratio 1.3, 1.6 respectively] [p<.05]. Extragastrointestinal manifestations such as palpitation, anxiety, and depression were more common in females [women/men ration 1.7, 1.3, and 1.7 respectively]. The sensitivity of ROME II criteria in males and females was 96.3% and 92% respectively, while the sensitivity of Manning criteria was 93.4% in men and 80.2% in women. Clinical manifestations of Irritable Bowel Syndrome are different between males and females. It seems that Manning criteria is more diagnostic in men suffering IBS

[ epidemiologic study of microscopic colitis in a university related clinic]

Microscopic colitis has been generally recognized as lymphocytic colitis and collagenous colitis: two inflammatory diseases of large intestine without a definite origin. The colon appears normal by colonoscopy. So, biopsy of the colonic mucosa is mandatory for diagnosis. As a descriptive design we assessed epidemiological, clinical and laboratory findings of patients diagnosed as microscopic colitis from 2001 to 2003, retrospectively. This study had been conducted in one of the University related clinics in Tehran. Results: In this setting, 12 patients were diagnosed as microscopic colitis [3 collagenous colitis, and 9 lymphocytic colitis]. Most of these patients were female [11 patients]. The average of the patients' age at the time of the diagnosis was: 47.6 +/- 18.1 years. The delay of diagnosis was distributed from 2 months to 27 years [average: 8 years]. The most prominent complaint was diarrhea [100%]. Most of the cases were presented as a chronic intermittent manner [6 patients- 50%]. Hyperthyroidism, atrophic gastritis, and type 1 diabetes mellitus, each of them were detected in 3 separate patients. After treatment initiation, recurrence of the disease was not seen during 2 years of follow-up. Most of the time, microscopic colitis is mis-diagnosed as irritable bowel syndrome. Clinical suspicion plays the main role in diagnosis of microscopic colitis cases among patients with watery diarrhea and normal colonoscopy

[Non-alcoholic steatohepatitis [NASH]]

The term "Non- Alcoholic Steatohepatitis [NASH]" is applied when sonographic and pathologic view of liver shows alcoholic hepatitis changes without history of alcohol consumption. Radiologic findings can easily make the diagnosis and liver biopsy confirms the initial suspicion. It is showed that up to 43.5% of patients with asymptomatic abnormal liver transferases levels have some degrees of NASH, which suggest the importance of being familiar with the issue and how to approach and treat it. NASH is commonly accompanied with diabetes mellitus [especially type II], obesity and hyperlipidemia. These findings support the theory in which insulin resistance is the mainstay of NASH pathophysiology. The natural history of NASH is unclear but surely it is far better than alcoholic related liver disease. It is estimated that up to 8% of patients would meet cirrhosis, considering risk factors such as obesity and features found in biopsy specimen. Steatosis, polymorphonuclear lobular inflammation, ballooning degeneration, hyaline- Mallory bodies and cirrhosis are among different pathologies seen in biopsy. It is important to rule out other chronic liver diseases including drug induced liver disease, chronic viral hepatitis, and metabolic and autoimmune liver diseases to establish the diagnosis of NASH. There is no definite treatment for NASH. Therapeutic measures are categorized as reducing risk factors and using hepatocellular protective agents. The former includes weight reduction, treating hyperinsulinemia and diabetes, control of hypertriglyceridemia and leptin. Protective agents are anti-oxidants like vitamin E and/ or C, probucol, silymarin, ursodeoxycholic acid, reducing iron load, N-acetyl cystein, food supplements and cytokines. Increasing rate of NASH is reported among children and adolescences, which could be due to growing amount of obesity in these age groups