Time trends of gastro-esophageal reflux disease [GERD] and peptic ulcer disease [PUD] in Iran

Epidemiology of diseases changes over time with changes in socio-economic status, culture and health care systems. Gastroesophageal reflux disease [GERD] and peptic ulcer disease [PUD] are among the diseases whose epidemiology has changed over the past few decades in the west. Studies addressing the trend of GERD and PUD occurrence in Iran are lacking. We aimed to look at the time trends of GERD and PUD in a referral endoscopy clinic in Tehran, Iran. All patients with dyspeptic symptoms who underwent upper GI endoscopy from 1993 to 2005 [inclusive] in a tertiary outpatient GI referral center in Tehran were enrolled. Erosive esophagitis [EE, used as a proxy for GERD as a whole], PUD, rapid urease test [RUT] status and demographic characteristics were recorded from the endoscopy reports according to the year the endoscopy was performed. Over a period of 13 years, 8,029 endoscopic examinations were performed. The most common endoscopic diagnosis was EE that occurred in 4,808 patients [59.8%] followed by duodenal ulcer in 2,188 [27.3%] and gastric ulcer in 88 [1.1%]. Over 13 years [1995-2005], the proportion of EE increased from 14.1% in 1993 to 75.1% in 2005 among dyspeptic patients in this referral clinic. The proportion of each grade of GERD according to the Los Angeles classification was as follows: GERD-A 76.0%, GERD-B 20.9%, GERD-C 2.8% and GERD-D 0.3%. RUT positivity decreased from 71.4% to 9.5% during the study period. This study shows a remarkable increase in EE with a concomitant decrease in PUD and RUT positivity among dyspeptic patients in Tehran over a decade. This change in trend is important for future health care planning

population-based seroepidemiological study on hepatitis E virus in Iran

Little is known about HEV seroprevalence and its determinants in Iran. Considering the fact that Iran is among the countries in which HEV infection is endemic, a large-scale population-based study in this regard is justified. This survey was conducted in 2006 in Tehran and Golestan Provinces, Iran. Stored sera of subjects were tested for serological markers of anti-HEV. The baseline data were recorded in structured questionnaires. Weighted seroprevalence and weighted logistic regression coefficients were calculated. A total of 1423 samples were included. The overall seroprevalence in two provinces was 7.4%. Age with an odds ratio equal to 1.59 [95% CI: 1.26-2.02] and history of traditional phlebotomy with an odds ratio equal to 2.28 [95% CI: 1.13-4.60] were independent predictors of HEV seropositivity. Considering the high rate of HEV seroprevalence in Iran, further studies on the cost-effectiveness of vaccination among vulnerable groups are mandator

Hepatocellular carcinoma in the world and the Middle East

Hepatocellular carcinoma [HCC] is a major worldwide public health concern. Despite recent advances, there has been little success in improving the survival of HCC patients. Due to advances in diagnostic modalities and the increasing incidence of chronic viral hepatitis and nonalcoholic fatty liver disease [NAFLD], both of which are well known risk factors of HCC, the prevalence of HCC is increasing in developed countries and it is expected that this trend will continue in the future. In Middle Eastern countries the prevalence of this cancer is lower compared to sub-Saharan Africa and some Far East countries; however it is documented that the prevalence of this cancer in some parts of the Middle East is also increasing. In the current review, the prevalence and burden of this disease worldwide, particularly in Middle Eastern countries, and risk factors for HCC are discussed