[Results and outcomes of band ligation among 95 cases with esophageal varices in Taleghani Hospital between 2002 and 2007]

Endoscopic Variceal Ligation [EVL] is considered the selective method of therapy for patients who suffer from esophageal varices. In this article we evaluated the results and outcomes of patients who underwent EVL with multiband ligators due to their esophageal varices. We studied 95 cases of esophageal varices who underwent EVL at Taleghani Hospital between 2002 and 2007. EVL was applied because of active bleeding, primary or secondary prophylaxis for esophageal varice of grade 2 or above. The process was repeated every 3-4 weeks until the varices were occluded or become to grade 1 varices or small thrombosed ones. Their demographaic data were gathered and analyzed as well as all the 1 informations about their recent procedure. Our studied subjects had the mean age of 51.53 +/- 15.31 [ranged from 15 to 81]. The average number of sessions for performing EVL were 1.81 +/- 1.07 [ranged between 1 and 8 times]. The mostprevalent cause for applying EVL was active bleeding. Complications were significantly more in patients whom were candidated for EVL by reason of active bleeding, compared to those who underwent EVL for either primary or secondary prophylactic reasons [P=0.02]. Among cases who had developed any complications, the numbers of ligation sessions were significantly more than other patients [2.58 +/- 1.25 vs 1.40 +/- 0.66, P<0.001]. There was no case of death due to this mode of therapy. EVL as a selective mode of therapy for treatment of esophageal varices possesses a few cosequential complications and its application, therfore, is reasonable

[ effect of omeprazole on the number and size of after-endoscopic band ligation ulcers of esophageal varices]

Endoscopic variceal ligation [EVL] is an effective option in treatment of esophageal varices bleeding or elective ablation. Although the after-EVL ulceration is well recognised, the effect of acid suppression on ulcer healing is not determined, definitely. In this study, we tried to evaluate the efficacy of Omeprazole as the most available protone pomp inhibitor [PPI] on the numbers and size of after-EVL esophageal ulcers in patients electively underwent this procedure. We performed a randomised placebo-controled trial of Omeprazol after elective EVL. Fifty consecutive cirrhotic patients who were cadidated for EVL randomly enrolleded in and were divided equally into case [25] and control [25] groups. After endoscopy and EVL, case subjects received Omeprazole [20 mg twice a day] for 2 weeks and control subjects received placebo for the same period as well. All the patients underwent a follow up endoscopy 13-15 days after EVL. Forty two patients [20 cases and 22 controls] completed the study. Numbers and size of ulcers were evaluated throughin the follow up endoscopy. Numbers of ulcers were significantly higher in control group [3.15 vs. 2.59, p=0.03]. The ulcers in Omeprazole group were on average half as large as in the placebo group [37.08 mm[2] vs.73.74 mm[2], p<0.0001]. After elective EVL, Omeprazol-treated Patients experienced a significant reduction in number and size of their post-banding ulcers. It seems that Omeprazole reduces the numbers and size of after-EVL ulcers

[Liver steatosis and chronic hepatitis-B infection: viral and host risk factors]

Liver steatosis and chronic hepatitis B infection are the most common causes of chronic liver diseases in Iran. There have been a limited number of studies throughout the world, evaluating the association of hepatitis B infection and steatosis. We studied the association between some of viral and host factors and the presence of steatosis among patients with chronic hepatitis B infection. In this analytical cross-sectional study, 71 patients with chronic hepatitis B infection were preliminarily assessed by liver biopsy. The patients were divided into two groups based on either presence or absence of steatosis in liver tissue. These two groups were compared in terms of different host and viral factors along with their stage of fibrosis. Of 71 patients, 30 [42.3%] had significant steatosis [in >5% of hepatocytes, according to Brunt classification]. Sex and gender were not significantly different in 2 groups. The mean BMI, serum levels of FBS, cholesterol, TG, GGT, were significantly higher in steatosis group compared to those of non-steatosis one [P<0.05]. In contrast, the mean levels of AST, ALT, ALK-P were not significantly different in these groups. The frequency of HBeAg positivity and the mean level of viral load of two groups had no significant difference. There was also no significant difference in the mean stages of fibrosis between two groups. It seems that certain metabolic hosts factors such as BMI, FBS, cholesterol, TG, GGT are associated with steatosis in patients with chronic hepatitis B infection while such an association was not found with the evaluated viral factors. We suggest further investigations to evaluate the role of other factors [such as HBV genotype] in the future

[Frequency of helicobacter pylori among patients with diabetes mellitus]

It is believed that diabetes mellitus [DM] increase the susceptibility to Helicobacter Pylori [HP] infection, but there is little information about the role of DM in being infected patients with HP. We studied the frequency of HP in diabetic patients referred to Taleghani hospital during 2003-2004. In this case-control study, frequency of HP in diabetic patients referred to Taleghani hospital was studied. Case group consisted of 84 patients with documented diabetes mellitus and control group included dyspeptic patients without DM who were been matched to the case group. Both case and control groups underwent endoscopy. Patients who had history of using antibiotics during the previous month or proton pump inhibitors during the past week were excluded. Urease test was performed in all patients. In negative unease test, biopsy was taken to evaluate histological study of HP. Mean age of case and control groups were 47.5+/-10.2 and 47.6+/-10 years, respectively. In both groups, male to female ratio was 46 to 36. Nineteen patients [22.6%] have diabetes type1 and others [77.4%] have diabetes type 2. Frequency of HP in case and control groups were 47 [51.1%] and 45 [48.9%], respectively and there was no significant differences between two groups. Odds ratio for being infected with HP in diabetic patients was 0.95 [95%CI: 0.7- 1.3]. This study didn't demonstrate any relation between DM and HP in adult patients. So, high frequency of dyspepsia in diabetic patients can be attributed to other factors such as autonomal disorders

[Clinical characteristics of a utoimmune hepatitis]

Autoimmune hepatitis [AIM] is a self-perpetuating hepatocellular inflammation of unknown cause. It is characterized by the presence of interface hepatitis on histologic examination, hyper gammaglobulinemia, and autoantibodies in serum. This study was performed to determine clinical and laboratory profile of AIH in Iran. The medical records of patients with AIM from 4 gastroenterology clinics in Tehran were retrospectively reviewed from September 1988 to May 2003. Forty-six patients with AIM whose medical records were complete were selected for final review. Of the 46 patients, 38 [82%] were female. The median age at presentation was 24 years. All patients fell into the category of AIM type-I. Seventeen percent had associated autoimmune diseases with diabetes type-I and autoimmune hemolytic disease being more common. The onset was acute in 5% and chronic in 87% with the remaining 8% being asymptomatic. The most common symptoms were icterus [59%] and fatigue [33%] and the most common signs were splenomegaly [33%] and hepatomegaly [30%]. In all cases, HBV and HCV serum markers were negative and serum levels of ferritin and copper were within normal limits. High serum levels of AST, total billirubin and alkaline phosphatase were detected in 93%, 39% and 74%, respectively while hyper gammaglobulinemia was found in 67%. SMA, ANA, PANCA and A MA were positive in 50%, 37%, 4% and 13%, respectively. AIH type-I is more common in Iran than in the United States and Europe and other types are seen rarely. Younger age at presentation, less frequent acute onset disease and lower rate of autoantibody positivity and hyper gammaglobulinemia may merit attention