Gastroesophageal reflux disease and overall and cause-specific mortality: a prospective study of 50000 individuals

BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease [GERD] and mortality at the general population level and they have shown mixed results

This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran

METHODS: Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study [GCS]

We identified 3107 deaths [including 1146 circulatory and 470 cancer-related] with an average follow-up of 6.4 years and calculated hazard ratios [HR] and 95% confidence intervals [CI] adjusted for multiple potential confounders

RESULTS: Severe daily symptoms [defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants] were associated with cancer mortality [HR 1.48, 95% CI: 1.04-2.05]

This increase was too small to noticeably affect overall mortality

Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms

CONCLUSION: We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality

Selenium levels in rice samples from high and low risk areas for esophageal cancer

To assess the relationship between selenium [Se] concentration in rice and the incidence of esophageal cancer [EC] in a high risk area in Northern Iran. This ecological study was conducted in Golestan province of Iran in 2012. In this area, 45714 acres of land are cultivated by rice. A total of 69 rice samples were taken. We investigated Se concentrations by the voltammetric method. Statistical analysis was performed using the Pearson correlation test and Mann-Whitney U test. The mean [ +/- SD] Se level in rice samples was 0.229 [ +/- 0.145] mg/kg. The Se concentration was significantly higher in rice samples from high EC rate areas [0.35 mg/kg] compared with low risk areas [0.16 mg/kg] [p<0.001]. There was a significant positive correlation between the levels of Se in rice and the incidence rate of EC [p=0.03]. We found a high rice Se concentration and a significant positive relationship between rice Se levels and EC rates in the Golestan province of Iran. High soil and rice Se levels may play a possible role in the pathogenesis of EC in this area

gastro-esophageal malignancies in Northern Iran research project: impact on the health research and health care systems of Iran

The Gastro-Esophageal Malignancies in Northern Iran [GEMINI] research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations

Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study / 한국역학회지

OBJECTIVES: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran. METHODS: We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates. RESULTS: Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model. CONCLUSIONS: Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.

Goiter Frequency Is More Strongly Associated with Gastric Adenocarcinoma than Urine Iodine Level

PURPOSE: We designed our study to evaluate the hypothesis that gastric cancer is correlated with iodine deficiency or thyroid dysfunction. MATERIALS AND METHODS: We investigated the total body iodine reserve, thyroid function status and autoimmune disorder in 40 recently diagnosed gastric adenocarcinoma cases versus 80 healthy controls. The participants came from a region with high gastric cancer rate but sufficient iodine supply due to salt iodination. The investigation included urine iodine level, thyroid gland clinical and ultrasonographic examination, and thyroid function tests. RESULTS: Goiter was detected more frequently in the case group (P=0.001); such a finding, however, was not true for lower than normal urine iodine levels. The free T3 mean level was significantly lower in the case group compared to the control group (P=0.005). CONCLUSIONS: The higher prevalence of goiter rather than low levels of urinary iodine in gastric adenocarcinoma cases suggests that goiter, perhaps due to protracted but currently adjusted iodine deficiency, is more likely to be associated with gastric adenocarcinoma compared to the existing iodine deficiency itself.

Polycyclic aromatic hydrocarbons and esophageal squamous cell carcinoma

Esophageal cancer [EC] is the 8[th] most common cancer and the 6[th] most frequent cause of cancer mortality worldwide. Esophageal squamous cell carcinoma [ESCC] is the most common type of EC. Exposure to polycyclic aromatic hydrocarbons [PAHs] has been suggested as a risk factor for developing ESCC. In this paper we will review different aspects of the relationship between PAH exposure and ESCC. PAHs are a group of compounds that are formed by incomplete combustion of organic matter. Studies in humans have shown an association between PAH exposure and development of ESCC in many populations. The results of a recent case-control study in a high risk population in northeastern Iran showed a dramatic dose-response relationship between PAH content in non-tumor esophageal tissue [the target tissue for esophageal carcinogenesis] and ESCC case status, consistent with a causal role for PAH exposure in the pathogenesis of ESCC. Identifying the main sources of exposure to PAHs may be the first and most important step in designing appropriate PAH-reduction interventions for controlling ESCC, especially in high risk areas. Coal smoke and drinking mate have been suggested as important modifiable sources of PAH exposure in China and Brazil, respectively. But the primary source of exposure to PAHs in other high risk areas for ESCC, such as northeastern Iran, has not yet been identified. Thus, environmental studies to determining important sources of PAH exposure should be considered as a high priority in future research projects in these areas

None-endoscopic screening for esophageal squamous cell carcinoma- a review

Esophageal cancer [EC] is the eighth most common cancer and sixth most frequent cause of cancer mortality worldwide. Esophageal squamous cell carcinoma [ESCC] is the most common type of EC. ESCC develops by progression from premalignant lesions, which are called esophageal squamous dysplasia [ESD]. Prevention is the most effective strategy for controlling this disease. Generally, two methods may be defined for ESCC prevention. The aim of the first preventive method is to prevent the initiation of ESD by avoiding the known risk factors, or primary prevention. Secondary prevention focuses on detection of the disease in its early curable stage, thus preventing its progression into advanced stages. Endoscopy with iodine staining and biopsy is the diagnostic choice for ESD. However it is invasive and expensive, and not accepted by asymptomatic ESD cases. Therefore, it is necessary to find a non-endoscopic screening method. Despite the large number of studies conducted worldwide, no approved method has been developed for ESCC screening. Regarding the multi-factorial nature of ESCC, it is proposed that the use of a combination of various criteria, such as cytological examination, risk factors, genetic alteration, and molecular markers may result in the development of a comprehensive and effective ESCC screening program

Cancer incidence in golestan province: report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Golestan Province, at the western end of the Asian esophageal cancer [EC] belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry [GPCR]. The GPCR collected data from newly diagnosed [incident] cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer [IARC]. Age-standardized incidence rates [ASR] of cancers were calculated using the 2000 world standard population. From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean [SD] age was 55.5 [18.6] years, and 54% were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach [ASR:30.7], esophagus [24.3], and lung [15.4] were the most common cancers in males. In females, breast cancer [ASR:26.9] was followed by malignancies of the esophagus [19.1] and stomach [12.4]. The diagnosis of cancer was based on histopatho-logical reports in 71% and on death certificate only in 9% of cases. The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

Incidence of childhood cancers in Golestan province of Iran

This paper presents the incidence rates of childhood cancers using the data obtained from Golestan population based cancer registry [GPCR] between 2004 and 2006. GPCR registers only primary cancers based on standard protocols of the international association of cancer registries [IACR]. We collect data on newly diagnosed [incident] cancer cases from all public and private diagnostic and therapeutic centers of the whole province. CanReg-4 software was used for data entry and analysis. Totally 5076 cancer cases [all ages] were diagnosed in GPCR between 2004 and 2006. Of these, 139 [2.74%] were children [aged 0-14 years] with mean [ +/- SD] age of 8.06 [ +/- 4.48] years. The age standardized incidence rates for childhood cancer were 119.8 and 78.3 per 1000000 person-years in male and female children, respectively. Leukemia was the most common childhood cancer in Golestan province of Iran. Lymphomas and central nervous system tumors were the second and third ones, respectively. The incidence rates of childhood cancers were relatively high in Golestan province of Iran. So, controlling of childhood cancers should be mentioned as an important issue in health policy making in this area

Esophageal cancer in Iran: a review

Esophageal cancer is the second and third most common malignancy in Iranian males and females, respectively, claiming lives of approximately 5800 Iranians each year. Squamous cell carcinoma [SCC] is presently the most common type accounting for about 90% of all esophageal cancers in Iran. Recent studies have shown that there is a gradual increase in the incidence of adenocarcinoma of the distal esophagus along with gastric cardia adenocarcinoma. Thirty-five years ago, the age standardizied rate [ASR] of esophageal SCC in the city of Gonbad [Golestan Province, northeast of Iran] was found to be one of the highest rates for any single cancer that had been reported worldwide [ASR >100/10[5]/year]. Recent studies have shown that the incidence of SCC in Gonbad has declined to less than half of what it was in the past. This decline in the incidence of esophageal SCC parallels an improvement in the socioeconomic situation of people living in this region. According to recent cancer registry data in Iran there is still an obvious intracountry variability between the incidence of esophageal cancer in the south with an ASR of 3 for males and 2 for females in Kerman and 43 and 36 in the northeastern province of Golestan. The reasons for this very high rate of SCC in northeastern Iran have been the subject of several studies during the past 35 years. According to results of these studies the suspected risk factors are: low intake of fruits and vegetables, drinking hot tea, consumption of opium products and tobacco, H.pylori infection in the stomach, using unhealthy drinking water from cisterns and genetic susceptibility. The main suspected mutagens are polycyclic aromatic hydrocarbons [PAH] and N-nitroso compounds. In order to embark primary and secondary prevention of this fatal cancer, further prospective studies are presently underway in the region. The Golestan esophageal cancer cohort study which follows of 50,000 subjects is on going. We expect simple and feasible evidence based preventive strategies to be implemented in the future according to the results of this study

[Relation between drinking water hardness and the incidence of esophageal and gastric cancers]

Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates [ASR]. The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area

[Nutritional characteristics in patients with colorectal cancer in Golestan Province of Iran, a case-control study]

Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran. This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics [FFQ] was filled for each of the participants. Chi square test was used to assess the relationship between variables. In each of the two groups, 40.4% were females and 59.6% were males. The mean +/- SD age of age in cases and controls were 52.4 +/- 13.4 and 52.1 +/- 13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/day was significantly related to colorectal cancer [OR= 3.8; 95% CI: 1.2-11.3]. Colorectal cancer risk was higher in individual with frying cooking method [OR=3; 95% CI: 0.8-11.1]. The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day [95% CI: 1.5-28.8].No significant relationship was seen between vegetables consumption and the risk of colorectal cancer. This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan province in Northern of Iran

Prolongation of AV nodal refractoriness by Ruta graveolens in isolated rat hearts. Potenial role as an anti-arrhythmic agent

To evaluate concentration-dependent effects of total extract of Ruta graveolens and its purified alkaloid fraction on the nodal basic and functional properties. In the present experimental study, we used the Langendorff model for perfusion of isolated rat hearts to determine the effects of various concentrations of methanolic extract of Rue 1.25x10-6% weight per volume percent [W/V]; 2.5x10-6% W/V; 3.75x10-6% W/V and total alkaloid of Rue 0.25x10-6% W/V; 0.5x10-6% W/V on electrophysiological properties of cardiac tissue. Selective stimulation protocols were used to independently quantify atrioventricular AV nodal recovery, facilitation, and fatigue. We used 3 groups N=24 of isolated perfused rat AV nodal preparations to assess the effect of Rue extracts. The study was carried out in October 2006 in the electrophysiology laboratory of the Cardiovascular Research Center of Golestan University of Medical Sciences, Golestan, Gorgan, Iran. Our results showed that both the total plant extract and the alkaloid fraction of Ruta graveolens had a similar trend of action on nodal conduction time and refractoriness. Furthermore, we observed increased atrioventricular conduction time 83 +/- 4 to 108 +/- 5 msec and functional refractory period 157.6 +/- 3 to 163.7 +/- 4 msec at a maximum concentration of 3.75x10-6% W/V. The above results indicated a potential antiarrhythmic effect of Ruta graveolens in treating supra ventricular tachyarrhythmia

[Short-term survival rates of upper gastrointestinal cancers in rural areas of Golestan province, Iran]

Esophageal and gastric cancers are among the most common and fatal cancers. These are diagnosed at the latest phase and the prognosis is too poor. Due to the importance and high incidence rate of the upper gastrointestinal cancers in Golestan province, this study was conducted to explore the overall survival rate of these patients in rural area of this region. In this descriptive cross-sectional study, a total of 121 pathologically confirmed esophageal or gastric cancers, with rural place of residence, were retrieved from the cancer registry at the health department in Gorgan. After conducting interview with patients or their relatives, analysis of their sociodemographic and clinicopathologic features was performed. The median survival rate was compared regarding age groups and gender using Kaplan-Meier statistical test. Male to female ratio in esophageal and gastric group were 1.2 to 1 and 3.8 to 1, respectively. Short-term survival rates were 54.76% and 26.2% for esophageal cancer and 66.6% and 37.5% for gastric cancer. Collected information regarding patients' sociodemographic and clinicophathologic factors did not have significant association with patients' survival in both esophageal and gastric cancers. The mean survival rate in patient with gastric and esophageal cancers according to age and gender was not significant. This study showed that the overall short-term survival rates for upper gastrointestinal cancers are very low in Golestan province. Therefore the need for intervention the need and allocating more diagnosis and therapeutic resources for upper gastrointestinal cancers are required

Seroprevalence of hepatitis B virus and its co-infection with hepatitis D virus and hepatitis C virus in Iranian adult population.

CONTEXT: Hepatitis B virus (HBV) infection is one of the most prevalent public health problems worldwide (especially in developing countries). AIMS: This study was carried out to determine the seroprevalence of HBV and its co-infection with hepatitis D (HDV) and C (HCV) viruses in the northeastern part of Iran. SETTING AND DESIGN: A population-based cross-sectional study in Iran. MATERIALS AND METHODS: As many as 1,850 subjects were explored for HBsAg. Anti-HDV and anti-HCV antibodies were assessed in HBsAg-positive cases. STATISTICAL ANALYSIS USED: Proportions were compared by Chi-square and Fisher's exact tests. RESULTS: The mean age of subjects was 43.86 +/- 11.2 years. The age- and sex-standardized prevalence for HBsAg positivity was 9.7%. It was higher in males than in females (OR: 1.28; 95% CI: 0.9-1.7). The risk of infection in singles was significantly higher than in married cases (OR: 2.13). Eight (5.8%) of HBsAg-positive cases were infected with HDV and 17 (12.3%) were positive for anti-HCV antibody. CONCLUSION: This study demonstrates that the prevalence of HBsAg seropositivity in Golestan province of Iran is higher than the levels reported by WHO and previous studies from Iran. It is very important, especially for health providers and policy makers, to recognize the risk factors of HBV infection and its co-infection with HDV and HCV in this area and design effective preventive programs.

Silica and esophageal cancer in golestan province northeast of Iran

Association of silica with diseases like cancers has been determined previously. This study was designed to determine the quantity of silis in flour produced in Golestan province and its relation to the esophageal cancer. We took flour samples from all flour mills in Golestan province. Base-melting method in nickel cruise was used in 550°C; the extract was reduced with acid. The differences between silis concentration in various regions were compared. P-value <0.05 was assumed significant. Median silis concentration was 0.0030 grams, mean was 0.008760 +/- 0.004265 [SD] grams in each 100 grams flour. The differences in mean silis concentrations of various regions were not significant [P>0.05]. This study did not show high level of silica in the flour of Golestan province. We could not find significant differences between silica contaminations in the various areas. Further studies on the consumed bread and rice in the various regions of the province can be helpful