[ Case-Control study on the risk factors of IBD in 258 Iranian patients]

Ulcerative colitis [UC] and Crohn's disease [CD] are chronic inflammatory bowel diseases [IBD] with uncertain etiology thought to be triggered by interactions between various environmental, genetic and immunologic factors. Role of different factors in IBD are controversial. The aim of this study is to determine the possible risk factors in a group of Iranian patients with IBD. Ninety five consecutive cases of CD and 163 cases of UC were included. Age matched controls were randomly selected. A total of 489 controls for UC and 285 controls for CD were enrolled. A standard record concerning many variables was completed. Logistic regression analysis was used to evaluate potential confounding variables. A statistically significant protective effect for smoking in UC was found [OR=0.18 95% CI=0.064-0.504, p < 0.05]. The risk of UC increases with prolonged exposure to OCP [OR=0.99, 95% CI=0.98-0.99, p< 0.05]. In patients with CD, 15 cases [15.8%] reported a previous history of appendectomy compared with 19 controls [6.7%] [OR=2.6, 95% CI= 1.2-5.4, p < 0.05]. Tonsillectomy was reported by 16 patients [16.8%] with CD compared with 25 controls [8.8%] [OR= 2.1, 95% CI= 1.07-4.1, p < 0.05]. The logistic regression analysis showed that both appendectomy and tonsillectomy are risk factors in CD. No association with other variables was found for either disease. Current smoking was a significant protective factor in UC. We observed a relationship between duration of OCP use and UC. Duration of using OCP in UC cases was significantly more than controls. Both appendectomy and tonsillectomy were risk factors in CD in this study

[Case report: calcified pancreatic tumor in a 41 year-old male]

Endocrine tumors of the pancreas [Islet-cell tumors] are rare with neuroendocrine origin. The patient was a 41- year- old man, admitted with chief complains of epigastric mass feeling, dull abdominal pain, lack of appetite and weight loss up to 2-3 kg since 6 months ago. In physical examination, a mass was detected in epigaster and left upper quadrant [LUQ]. In abdominal x-ray, a calcified mass was seen in LUQ. For better evaluation, abdominal CT was performed in which, a large calcified mass in pancreas tail was reported. Finally, by means of immunohistochemical markers, the neuroendocrine carcinoma of the pancreas was confirmed. In spite of the rareness of calcification in these tumors, it is also necessary to consider malignancies when encountering a large calcified mass in pancreas

[ effect of amitriptyline in patients with pain and diarrhea predominant irritable bowel syndrome: a double-blind randomized controlled study]

IBS is the most common disorder diagnosed by gastroenterologists, which is seen in approximately 40-50% of patients seeking care from a specialist. Several randomized controlled trials, have assessed the therapeutic effect of anti-depressant drugs, but there is not enough evidence to prove their effectiveness. Fifty cases meeting Rome II criteria for IBS with predominance of pain and diarrhea were included in this study. Organic causes were ruled out by detailed history, physical examination, laboratory tests, small bowel transit and rectosigmoidoscopy. Participants were then randomly assigned to receive either Amitriptyline or placebo. Subjects were followed using a simple symptom score system before, after 1 and 2 months of treatment. At the end of the 2nd month, Amitriptyline showed more influence in reduction of flatulence, mucus passing and incomplete defication feeling, than placebo [p<0.05]. Also, symptoms general improvement rate was 39% and 15% in Amitriptyline and placebo groups respectively [p<0.001].The rate of side-effects in the two groups did not have significant differences [p>0.05]. Amitriptyline is an effective and well-tolerated treatment for pain and diarrhea predominant IBS

Effect of eradicating Helicobacter pylori on gastroesophageal reflux disease

The effect of helicobacter pylori either in provoking or protecting GERD is unclear and the results of studies are conflicting. We aimed to study the effect of H.pylori eradication on GERD by 24-hour ph monitoring. 14 patients with duodenal ulcer or erosive duodenitis without any endoscopic and clinical evidences of GERD were enrolled. 24-hour ph monitoring were performed before and 12 month after H-Pylori eradication. The score was based on DeMeester scoring system. H.Pylori was diagnosed by rapid urease test before eradication and by urea breath test [UBT] after eradication. The mean age was 41.6..10.2 years. The mean scores of 24-hour ph monitoring were 6.8..4.3 and 5.4..3.9 before and after eradication, respectively. The differences were not statistically significant [NS]. Epigastric pain changed significantly before and after the therapy [p<0.01]. H.pylori eradication did not have any effect on scores of 24-hour esophageal ph monitoring. Epigastric pain significantly decreased after eradication