Collagenous gastritis, a rare cause of dyspepsia resistant to treatment

Collagenous gastritis is hardly ever found in children and adults. Based on the extent of collagenous changes in the bowel, various symptoms may develop including iron deficiency, anemia, and abdominal pain in most of the patients.

We present a 30-year-old man with persistent abdominal pain and anemia due to collagenous gastritis

Metabolic syndrome is associated with health-related quality of life in suspected patients with nonalcoholic steatohepatitis

Objective: This study was designed to examine the effect of metabolic syndrome [MetS] on health-related quality of life [HRQOL] in patients with suspected nonalcoholic steatohepatitis [NASH]

Subjects and Methods: Three hundred thirty-two patients [236 males and 96 females] with suspected NASH from the Amol cohort study were included in this study. MetS was diagnosed based on Adult Treatment Panel III criteria and HRQOL was measured using the 12-Item Short-Form Health Survey [SF-12] questionnaire [with 8 subscales and 2 summary components]. A multivariable linear regression model was used to assess the independent effect of MetS on HRQOL

Results: The mean age of the study population was 42 +/- 13 years [range 18-82]. The prevalence of MetS was 43.4% [n = 144] and the mean scores on the Physical Component Summary [PCS] and the Mental Component Summary were 72.4 +/- 20.86 and 42.7 +/- 12.42, respectively. The multivariable linear regression model showed that MetS was negatively associated with 4 subscales of HRQOL that included: role limitations due to physical problems [RP] [B = -14.05, p = 0.004], bodily pain [BP] [B = -7.37, p = 0.02], vitality [VT] [B = -7.72, p = 0.022], and role limitations due to emotional problems [RE] [B = -12.67, p = 0.005] after adjustment for other variables. Also, MetS had a borderline association with the general health and mental health subscales and the PCS [p < 0.1]

Conclusion: In this study, there was a strong association between MetS and 4 subscales [RP, BP, VT, and RE] of HRQOL in patients with suspected NASH; this could be considered as a part of health policy to improve general health

prevalence of non-alcoholic fatty liver disease and diabetes mellitus in an Iranian population

Background: type II diabetes mellitus [T2DM] and non-alcoholic fatty liver disease [NAFLD] are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD

Methods: in this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran [N=6143]. The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin

Results: in men, the prevalence [95% confidence interval] of T2DM was 5.34% [4.35%-6.34%] and 15.06% [13.12%-17.00%] in individuals without and with NAFLD, respectively [p <0.001]. In women without NAFLD, the prevalence was 8.27% [6.83%-9.71%] while in the presence of NAFLD, the prevalence was 27.21% [24.59%-29.83%], [p <0.001]. In univariate analysis, the chance of having T2DM was 3.700 [3.130-4.380] times more in patients with NAFLD compared with subjects without NAFLD [p<0.001]. This chance was reduced [Odds Ratio=1.976, 95% CI: 1.593-2.451, p <0.001] after removing the effects of other variables

Conclusion: the prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM

Assessment of personality in inflammatory bowel disease by using minnesota multiphasic personality inventory-2-restructured questionnaire

Background: inflammatory bowel diseases [IBDs], including ulcerative colitis and Crohn's disease, are chronic and debilitating conditions that their prevalence are growing. These diseases have association with psycho-cognitive factors. This study aimed to evaluate the personality traits of such patients by applying the Minnesota Multiphasic Personality Inventory-2-Restructured Questionnaire

Materials and Methods: we included 100 patients with biopsy proven IBD in this case control study. 100 individuals [57 subjects of the patients' family members and 43 subjects of non-family members] were considered as controls. We applied MMPI 2RF to evaluate the personality traits of the participants. ANOVA was used to compare the mean scales between the three groups

Results: of this fifty scale-questionnaire, only the scales of emotional inadequacy [mean = 59.83 +/- 10.42, p = 0.047], demoralization [mean = 63.00 +/- 11.21, p = 0.025], malaise [mean = 64.99 +/- 14.58, p = 0.001], cognitive complaints [mean = 64.66 +/- 15.25, p = 0.008], self-doubt [mean = 57.55 11.04, p = 0.34], and neuroticism [mean = 61.43 +/- 11.94, p = 0.048] had a significant difference between the three groups

Conclusion: the patients with IBD had a higher scales of emotional inadequacy, demoralization, malaise, cognitive complaints, self-doubt, and neuroticism than the controls of non-family and family members. However the differences were significant only between patients with IBD and their non-family controls. We suggest regular psychological and psychiatric counseling for patients with IBD

Association between nicotinamide phosphoribosyltransferase and de novo lipogenesis in nonalcoholic fatty liver disease

Objective: Jh//s study explored the association between serum nicotinamide phosphoribosyltransferase [NAMPT] and hepatic de novo lipogenesis [DNL] in nonalcoholic fatty liver disease [NAFLD] and determined whether or not this association is sex dependent

Subjects and Methods: In this cross-sectional study, 62 consecutive patients [32 males, 30 females] with NAFLD were recruited. Serum NAMPT [by ELI-SA], palmitic acid, and the DNL index of erythrocyte membranes as markers of hepatic DNL [by gas chromatography] were analyzed

The controlled attenuation parameter [CAP] and body impedance analyzer were used to assess hepatic and body fat respectively. Univariate and multiple linear regressions [to adjust for confounders] were used to analyze the association of serum NAMPT with palmitic acid, DNL index, CAP, and body fat

Results: The respective values of serum NAMPT [2.44 +/- 1.03 vs. 2.45 +/-1.13 ng/mL,p = 0.98], DNL index [3.11 [2.60-3.71 ] vs. 3.05 [2.40-3.59],p = 0.90], and pal-mitic acid [20.55% [15.34-24.04] vs. 22.64% [21.15-25.95], p = 0.07] were not significantly different between men and women, but those of CAP [326 [300-340] vs. 300 [261.25-329], p = 0.002] and body fat [37.71 +/- 3.80 vs. 26.60 +/- 5.70, p < 0.001] were significantly higher in women. In women, serum NAMPT had a significant negative association with the DNL index [p = -0.56, p = 0.01]. The DNL index also hada significant negative association with body fat [P = -0.46, p = 0.02]

In men, the only significant association was the positive association between serum NAMPT and CAP [p = 0.35, p = 0.035]

Conclusion: Higher serum NAMPT in women was associated with a lower hepatic DNL index, while in men it was associated with higher hepatic fat and had no association with the DNL index. Therefore, the serum NAMPT level interpretation for NAFLD prognosis is probably sex dependent

Association between pattern of gastritis and gastroesophageal reflux disease in patients with helicobacter pylori infection

Background: Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial

Aim: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori [H. pylori] infection

Methods: 470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas

Results: H. pylori infection rate was 367 [78.1%] with mean age of 59.8 +/- 11.4 years. Of them 131 patients [35.7%] were male. Reflux disease was detected in 273 [74.4%] patients. 216 [58.9%] and 102 [27.8%] patients had non-erosive reflux disease [NERD] and gastroesophageal reflux disease [GERD], respectively. Corpus predominant and antral predominant gastritis were seen in 72 [19.6%] and 129 [35.2%] patients, respectively. Antral gastritis was significantly associated with GERD [p<0.01]. In regression analysis, antral predominant gastritis had a significant association with GERD [OR=1.92; 95%CI: 1.22-3.12]. The same result was observed in mild to moderate antral and greater curvature gastritis [OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively]

Conclusion: According to these finding, we could suggest that the pattern of gastritis could be associated with reflux disease and GERD

Clinical, endoscopic, and histopathological aspects of sigmoid actinomycosis; a case report and literature review

Actinomycosis is a rare and chronic infectious disease caused by a non- spore gram- positive, anaerobic bacterium that rarely infects the colon, in particular the left colon. A 53-year-old woman was referred to us due to chronic abdominal pain, bloating, a few episodes of bloody-mucous rectal discharge, and change of bowel habits. Her medical history and physical examination were unremarkable. Colonoscopy revealed a polypoid mass like lesion located 20 cm proximal to the anal verge above the rectosigmoid junction. Several biopsy samples were taken. Histopathological evaluation showed actinomycosis infection. Consequently the patient was treated with intravenous and then six months oral penicillin. Her complaints and colonic mass resolved totally. Diagnosis of colonic actinomycosis is not an easy task. It is advisable to keep this infection in mind among the differential diagnoses of unusual abdominal masses. Colonoscopy and histopathological examination can be the preferred modality for diagnosis of colonic actinomycosis infection

Correlation of tissue transglutaminase antibody with duodenal histologic marsh grading

Recent guidelines have proposed that there is a correlation between tissue transglutaminase [tTG] antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean +/- SD of the patients was 35.6 +/- 15.2 and 100 [62.9%] of them were women. 133 out of 153 patients had villous atrophy [Marsh IIIa-IIIc]. Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III [p for trend=0.003]. Our results showed that tTG titer more than 9 folds higher than the kit's cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture's recommended cut-off value it can be avoided. Meanwhile in case of high clinical suspicion, low tTG levels do not exclude diagnosis of celiac disease and further investigations including small intestinal biopsy should be considered

Clinical and pathological features of non-functional neuroendocrine tumors of pancreas: a report from Iran

Pancreatic neuroendocrine tumors [PNETs] are rare tumors with variable malignant potential, prognosis, and survival. We aimed to assess the characteristics of patients with non- functional PNET in our hospital. From Nov 2010 to Nov 2013, all patients who came to endosonography unit of Shariati hospital, Tehran, Iran, and had pancreatic lesions were assessed. Tumor samples were obtained through fine needle aspiration. Various characteristics of the non- functional PNET were recorded and patients were followed up to three years. Twenty eight non func-PNET cases, aged 37-72 years were identified, 15 [53.6%] of whom were men. Fifteen [53.6%] tumors were located in the head and 5[17.8%] in the body of the pancreas. The mean tumor size was 3.9 Cm and 10.7%, 28.6%, 32.1%, and 28.6% of the patients were at stages I, II, III and IV, respectively. Of the patients, 12 [43%] underwent surgery, 3 [10.7%] received chemotherapy, and 13 [46.4%] received no treatment. During the mean follow-up of 16 months, the disease had progressed in 3 [10.7%] patients and 10 [35.7%] had died. In univariate analysis, tumor size>3Cm and Ki-67>20% were correlated with survival rate but not in multivariate analysis. Iranian patients with non- functional PNET present similar characteristics to world patients. There is a need to establish efficacy of tumor samples which are obtaining through fine needle aspiration for assessing tumor grading

Prevalence of non-alcoholic fatty liver disease and its predictors in north of Iran

Nonalcoholic fatty liver disease [NAFLD] is one of the aspects of metabolic syndrome [MetS]. Due to the increase of MetS in Iran, this study was conducted to determine the prevalence of NAFLD, its potential predictors and their sex distribution in north of Iran, Amol. In 2008 this population based cross-sectional study included 5023 adult individuals who were randomly selected from Amol healthcare centers. Blood analysis and hepatic sonography was performed for each individual and Clinical histories were reviewed. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Chi-square test, univariate and multivariate logistic regression were used to analyze data. The prevalence of NAFLD and metabolic syndrome was 43.8% and 29.6% respectively. Both NAFLD and metabolic syndrome were significantly more prevalent in women. There was a stronger association between these two factors in women which may indicate MetS has a much more potency to result in NAFLD in women. The strongest predictors of NAFLD in men were waist circumference>102 cm, serum ALT >/= 40 [U/L] and the age group of 40-60 years. The strongest predictors of NAFLD in women were waist circumference >88 cm, the age groups of 40-60 and >60 years. The observed prevalence is alarming because almost 7out of 10 subjects with MetS had NAFLD. As high waist circumference was an important predictor of NAFLD in both sexes, health care policies to reduce the incidence of obesity in the country will have an important impact on the occurrence of NAFLD

Systemic EBV T-cell lymphoproliferative disease of young adults

T/NK cell proliferative EBV associated disease is a rare one which is more common in eastern Asian countries. EBV is originally associated with B cells, and EBV associated T cell lymphoma is so rare. Hence we decided to describe a patient treated with misleading diagnoses such as TB and sarcoidosis for almost two years. The liver was biopsied after admission in this center, and gastric and colonic biopsy was also performed due to gastrointestinal bleeding. Diffuse infiltration of chronic inflammatory cells was seen, especially lymphocytes some of which were atypical. T lymphocyte markers were seen in these cells by immunohistochemical staining. Further studies demonstrated T lymphocytes associated with EBV to be positive which is very rare event. Although going under chemotherapy, there were no response and the patient died

Thyroid dysfunction and choleduocholithiasis

Disturbances in lipid metabolism which occur during hypothyroidism lead to the formation of gallstones. This study aims to evaluate the thyroid function pattern in patients with common bile duct [CBD] stones. This case-control study recruited 151 patients with preliminary diagnoses of CBD stone who underwent ERCP [cases]. The control group comprised healthy people who met the study criteria in the same hospital. The control group underwent ultrasonography to exclude any asymptomatic bile duct lithiasis. A questionnaire that included demographic and anthropometrics data were completed by an assigned physician. Morning blood samples that followed 12 hours of fasting were taken from all participants for measurements of serum total thyroxin [T4], serum thyroid stimulating hormone [TSH], fasting blood sugar [FBS], triglycerides [TG], total cholesterol, low density lipoprotein [LDL] and high density lipoprotein [HDL]. The mean TSH in patients [2.59 +/- 4.86mg/dl] was higher than the control group [2.53 +/- 4.13 9mg/dl]. In subclinical hypothyroidism, serum TSH levels higher than 5 MU/L were found in 30.6% of cases compared with 22.5% of controls [OR: 1.53; 95% confidence interval [95% CI]: 0.968-2.438]. Hypothyroidism was detected in 10.8% of the control group and in 11.3% of cases [OR: 1.87; 95% CI: 0.578-2.043]. The mean total cholesterol levels in cases was higher than the control group [p=0.61].The levels of TG [p=0.05], HDL [73.35 vs. 46.41; p<0.01] and LDL [64.81.88 vs. 111.04; p<0.01] was statistically significant between both groups. There is an association between thyroid disorders and the presence of bile duct stones. Thyroid testing in patients with gallstone and bile duct stones is recommended because hypothyroidism may be a predisposing factor for stone passage from the gallbladder

Association between Helicobacter pylori and serum leptin in Iranian dyspeptic patients

To investigate any possible relationship between serum leptin level and H. pylori infection in dyspeptic Iranian adults. A total of 153 dyspeptic patients referring to Firoozgar hospital for esophagogastroduodenoscopy were enrolled in the study. Serum leptin level was measured before endoscopy, after overnight fasting. Two biopsy specimens were taken from antrum for each patient during endoscopy: one to detect H. pylori infection by Rapid Urease Test [RUT] and the other evaluated by an expert pathologist, blind to the RUT results and patients. Serum leptin level was compared between H.pylori-positive negative groups. A total of 153 dyspeptic patients with the mean age of 43.2 +/- 14.3 years were evaluated. The overall prevalence of H.pylori infection was 49.6%. H.pylori infection was significantly associated with serum leptin level [p<0.001]. In addition, we found a significant relationship between serum leptin level and gender [p<0.02]. Furthermore, serum leptin level was correlated with age [r=0.17, p=0.0031]. However, the H.pylori-positive group was older in comparison to the H.pylori negative group [45.65 +/- 13.9 vs. 40.7 +/- 14.13, p=0.035]. The two groups were not significantly different in terms of gender, height, weight or BMI. H.pylori infection may influence leptin production. Advanced age might expose the individual to H.pylori infection and consequently influence the leptin level

Fulminant hepatic failure due to primary hepatic lymphoma: a case report

Primary hepatic lymphoma is a rare malignancy usually presenting with symptoms of fever, hepatomegaly, jaundice and weight loss. This picture mimics infectious and inflammatory disorders and thus delays the diagnosis. Here, we present a 47-year old man with prolonged fever who underwent several investigations and, in the meantime, developed fulminant hepatic failure before the diagnosis could be reached

usage of opioids and their adverse effects in gastrointestinal practice: a review

Opium is one of the oldest herbal medicines currently used as an analgesic, sedative and antidiarrheal treatment. The effects of opium are principally mediated by the micro-, kappa- and delta-opioid receptors. Opioid substances consist of all natural and synthetic alkaloids that are derived from opium. Most of their effects on gastrointestinal motility and secretion result from suppression of neural activity. Inhibition of gastric emptying, increase in sphincter tone, changes in motor patterns, and blockage of peristalsis result from opioid use. Common adverse effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, dependency and tolerance, and respiratory depression. The most common adverse effect of opioid use is constipation. Although stool softeners are frequently used to decrease opioid-induced bowel dysfunction, however they are not efficacious. Possibly, the use of specific opioid receptor antagonists is a more suitable approach. Opioid antagonists, both central and peripheral, could affect gastrointestinal function and visceromotor sensitivity, which suggests an important role for endogenous opioid peptides in the control of gastrointestinal physiology. Underlying diseases or medications known to influence the central nervous system [CNS] often accelerate the opioid's adverse effects. However, changing the opioid and/or route of administration could also decrease their adverse effects. Appropriate patient selection, patient education and discussion regarding potential adverse effects may assist physicians in maximizing the effectiveness of opioids, while reducing the number and severity of adverse effects

Unusual location of varices presenting with obscure gastrointestinal bleeding: a case report

Esophagogastric varices are a frequent complication of portal hypertension. Bleeding from ectopic varices of the ileum is not only life-threatening, but its accurate diagnosis is also difficult. We have presented the case of a 31-year-old man with massive hematochezia. He was a known case of non-cirrhotic portal hypertension since 15 years prior. Conventional examination that included angiography did not define the site of bleeding. Hence, the patient underwent an intraoperative enteroscopy. The varices were located at the distal part of the ileum. Segmental resection of the ileum was performed and the patient was discharged in good condition seven days later. Intraoperative enteroscopy could be considered in the diagnostic and therapeutic management of ectopic varices.

[ main complications of ERCP]

Endoscopic retrograde cholangiopancreatography [ERCP] is a specific technique used to study the pancreatobiliary system that is performed in hepatogastroenterology centers. Recent, common uses for therapeutic ERCP are largely due to advanced imaging techniques such as magnetic resonance cholangiopancreatography and endosonography. In the United States alone, over 500,000 therapeutic ERCP are performed annually. Due to its potential for complications, all practitioners should be well-educated about the indications for ERCP, its contraindications, sedations, patient monitoring during and after ERCP, and the necessary co-operation amongst medical personnel. As a diagnostic and therapeutic procedure, there are potential complications directly related to the severity of the disease and complexity of the procedure. In this paper, we present a review of primary ERCP complications.