Ectopic location of the ampula of Vater within the pyloric channel

The ampulla of Vater is commonly located in the posteromedial wall of the second portion of the duodenum. At times, the ampulla of Vater may be found at uncommon sites such as the third and fourth portions of the duodenum, the duodenal bulb and the stomach. We found the ampulla of Vater in the pyloric channel in a 44 year old patient who had undergone surgery for acute cholecystitis. An intra-operative T-tube cholangiography revealed distal narrowing. The major papilla was not found during endoscopic retrograde cholangiopancreatography [ERCP] and a more accurate T-tube cholangiography revealed that the common bile duct opened in the distal stomach, probably in the pylorus. Finally the ampulla opening was located in the pylorus by methylene blue injection through the T-tube at endoscopy. This rather unusual location of the ampulla of Vater has implications for gastroenterologists performing ERCP

Comparing different brands of omeprazole with pantozole in GERD patients

Gastro-esophageal reflux disease [GERD], a chronic and relapsing condition with increasing prevalence, can affect quality of life very drastically [1, 2, 3, 4, 5, 6, 7] therefore different studies have been done to compare the effectiveness of each drug in comparison to the others and to determine the priority of each one to others regarding the efficacy and fewer side effects [15]. In this study we aimed to make a comparison between Pantoprazol and different brands of omeprazol regarding their efficacy and meanwhile determine if different brands of omeprazole can have various effects on different cases. In this clinical trial One-hundred GERD patients were studied to compare the effects of pantozole and three different brands of omeprazole regarding their efficacy in treating GERD symptoms. Among all cases 64.3% were female and mean age was 37.1 years [min: 16, max: 76, standard deviation: 15.0]. 15.1%, 36.0%, 29.1% and 12.8% had BMI less than 20, 20-25, 25-30 and more than 30 consecutively. Both follow ups were successful in 73.5% while 14.2% had just one successful follow up and 12.2% were excluded from the study because they had no successful follow up after first visit. 25.5% were treated with A, 24.5% with B, 25.5% with C and 24.5% with D. Although the response rate in different drug groups showed various results, the differences were not statistically significant [all P values> 0.05]. Sex and BMI category of patients had no significant effect on response rate between patients [all P values> 0.05]. According to our data, Pantozole, Exiprazole, Dr Abidi's Omeprazole and Losec have similar efficacy for control of GERD symptoms among Iranian patients with GERD

Digestive and liver disease statistics in Iran

Gastrointestinal and liver diseases [GILD] are among the most common causes of morbidity in Iran and constitute a substantial proportion of mortality which imposes enormous economic consequences. Our purpose is to collect information and report current statistics on physician visits, hospitalizations, and deaths due to common GILD in Iran. Data on the leading causes of death were obtained from the Iranian Ministry of Health, Office of Health Statistics. A total of 213,322 deaths were reported from March 2003 to February 2004 [excluding mortality from the Bam earthquake] which equaled 4.4 deaths per 1000 population. Of these, 36,575 were due to accidents. Causes of death were reported on the basis of the 10th revision of the International Classification of Diseases [ICD-10; 1992]. The leading causes of hospitalization were obtained from the database of the GILD ward in Shariati Hospital, one of the largest and best known gastroenterology referral hospitals in Iran. Similarly, leading causes of out-patient referrals were identified from a large multi-physician outpatient clinic in Tehran. The five leading gastrointestinal causes of death in order of frequency were: gastric cancer, hepatobiliary cancer, liver cirrhosis, esophageal cancer, and colorectal cancer. The five leading causes of hospitalization in the GILD ward of Shariati Hospital were: liver cirrhosis, hepatitis, peptic ulcer disease, cholycystitis and cholangitis, and colorectal cancer. The most common outpatient diagnosis was gastroesophageal reflux disease followed by irritable bowel syndrome [IBS], duodenal ulcer [DU], non-ulcer dyspepsia, and chronic hepatitis B [HBV]. Gastrointestinal and liver malignancy along with chronic liver disease constitute the main GILD reasons for hospitalization and deaths in Iran. Gastroesophageal reflux disease, IBS, and chronic HBV are the most common GILD outpatient diagnoses

Treatment of non-alcoholic fatty liver disease [NAFLD]: a systematic review

No treatment has been proven to be effective in nonalcoholic fatty liver disease [NAFLD] and/or steatohepatitis [NASH]. Numerous studies have addressed this issue. However conclusive recommendations cannot be drawn solely from the currently available studies. Hence we performed this systematic review to determine which of the available therapeutic modalities are supported by adequate evidence in terms of decreasing the adverse clinical outcomes of interest. A specific strategy was utilized to perform a computerized literature search in MEDLINE; of which, a total of 375 studies were retrieved. According to current literature, modifying the potential risk factors such as obesity, hyperlipidemia, and poor diabetic control in all patients is considered the treatment of choice. Certain treatments can be recommended under special circumstances and some medications, although used clinically, are not supported by adequate evidence to be recommended for the treatment of NAFLD/NASH

Prevalence and risk factors of gastroesophageal reflux disease in Tabriz, Iran

Gastroesophageal reflux disease [GERD] is one of the most common gastrointestinal problems in the west while different reports indicate an increase in the prevalence in Iran. The aim of this study was to estimate the prevalence and clinical spectrum of GERD in staff of a referral hospital and evaluate the risk factors. This cross-sectional study using a modified Mayo clinic questionnaire was performed on staff of Imam Hospital, Tabriz, Iran on a pilot of 50 subjects, and a randomly selected group consisted of 522 subjects in the year 2005. GERD symptoms were defined as at least weekly heartburn and/or acid regurgitation during the past year. Response rate was 95%. Mean age of responders was 40.02 +/- 10.72 yr. The prevalence of recurrent heartburn and/or acid regurgitation experienced at least weekly and monthly was 26.8% and 34.1%, respectively. They were not related to age and gender. The severity of symptoms was mainly reported of a mild to moderate degree. 45% of the cases reported at least one of the atypical symptoms. There was no relation between marriage status and prevalence of GERD. On the other hand, GERD was less common among cases with no family history of upper gastrointestinal disease. The prevalence of frequent GERD was more common among medical staff. Increased BMI [but no recent weight gain or lose] was associated with higher prevalence of GERD symptoms only in women. Interestingly 33% of our population had a history of using antacid or PPIs which was more among cases with frequent GERD symptoms. This study revealed a high prevalence of frequent GERD symptoms in a selected population of Tabriz. Atypical symptoms should be considered in this area

[Determination of the normal range of the number of intraepithelial lymphocytes in the duodenal mucosa of healthy Iranian individuals]

An increase in the number of intraepithelial lymphocytes [IEL] in the duodenal mucosa is an important criterion for the histological diagnosis of celiac disease [CD]. We determined the normal range for intraepithelial lymphocytes [IEL] in the second part of duodenum in healthy Iranian population. Four biopsy samples of the endoscopically normal appearing mucosa at the second part of duodenum were obtained from 50 individuals referred to Shariati hospitals [48 for epigastric pain, 2 for esophageal varices]. They had no sign, symptoms and evidence for malabsorption or small intestinal disorders in history, physical examination, Laboratory tests and IgA anti tissue transglutaminase [t.T.G]. Four-micrometer thick sections were stained with Hematoxillineosine [H and E] and immunohistochemistry [IHC] for leukocyte common antigen [LCA]. At least 500-600 cells from the tip and body of villi were counted separately and the number of IEL was given as mean/ 100 epithelial cells. The mean for IEL count in total villi in IHC method was 21/100 [23/100 in tip, 21/100 in body, p = 0.058] and 19/100 in H and E method [19/100 in tip, 18/100 in body, p =0.035] [p = 0.006]. Considering total villi, the normal upper limit [Mean+2SD] was calculated to be 35/100 in IHC and 34/100 in H and E stained sections and normal upper limit of confidence interval [the 95 percentile] was 39/100 in IHC and 37/100 in H and E stained sections. The villus height to crypt depth ratio was 3/94 in average. Respectively in IHC and H and E methods, the amounts equal or less than 35/100 and 34/100 are considered as normal., values between 35-39/100 and 34-37/100 as border line and counts more than 39/100 and 37/100 represent a pathology. Although the difference between two staining methods was statistically significant, considering cost effectiveness, we recommend H and E staining for routine clinical practice

[Impact of immunosuppressive treatment on liver fibrosis in autoimmune hepatitis]

Impact of treatment on progression of fibrosis in autoimmune hepatitis [AIH] is unknown. We assessed the changes in liver fibrosis before and after treatment among these patients. Nineteen AIH patients who had paired liver biopsies were studied. Of these, seven had been treated with 6 months of Cyclosporine-A and the rest with 6 months of prednisolone for induction of remission. Thereafter all had been maintained on azathioprine. Biopsy specimens before and after treatment, were reviewed by one pathologist and scored by the Ishak method. Mean fibrosis stage before and after treatment were compared. Also, factors predicting significant fibrosis [stage >/= 3] and cirrhosis [stage >/= 5] at presentation were assessed. Mean interval between biopsies was 3.38 years. Mean fibrosis stage decreased from 4.53 to 2.16 following treatment [p< 0.001]. Mean decrement in inflammatory grade was 8 scores [range: 4-10] in patients in whom fibrosis improved, and 2 scores [range: 0-4] in patients in whom fibrosis did not decrease after treatment [p< 0.001]. ALT to platelet ratio was the best predictor of significant fibrosis and also cirrhosis. Fibrosis commonly improves after immunosuppressive treatment in AIH. ALT to Platelet ratio can predict accurately the presence of significant fibrosis and cirrhosis in AIH