Epidemiology, associated factors, and treatment experiences with dyspepsia in Iran: a review article

Dyspepsia is a common gastrointestinal symptom reported in 2.9-29% of the adult Iranian population. This symptom usually results from functional disease, but in one-third of cases an organic cause such as peptic ulcers, esophagitis, and in less than one percent gastric cancer can be found. The timing of an endoscopic evaluation, the value of acid reducing agents, herbal medicine and the role of Helicobacter pylori [HP] eradication are important challenges in the evaluation and management of dyspepsia. Overall, prompt endoscopic evaluation for cases over the age of 45 years, those who present with alarm symptoms, or non-responders to empirical acid reducing treatment is recommended. There are controversial results about the role of HP eradication on the relief of dyspepsia symptoms in our region, so the HP test and treatment strategy or eradication therapy for those with functional dyspepsia is not a suitable option for our country. There are promising reports regarding the effects of herbal medicine, and anti-depresants, which needs more research. Due to the limited value of alarm features for diagnosis of gastric cancer, we recommend prompt, low cost endoscopic evaluations in all dyspeptic cases over age 45 years

Epidemiological, demographic, and colonic extension of ulcerative colitis in Iran: a systematic review

Ulcerative colitis [UC], as the prototype of inflammatory bowel disease of the large bowel, is increasing in Iran and other developing countries. There are few studies that discuss the properties of this disease in the Islamic Republic of Iran. The result of this review may provide a general consensus about the epidemiological features of UC in Iran. This was a qualitative, systematic review that investigated the incidence, prevalence, and demographic properties of UC in Iran. We evaluated all published studies in the PubMed database, Iran Medex, Magiran, and Scientific Information Database [SID] that pertained to the epidemiology and demographic features of UC in Iran from January 1987 to January 2012. After searching with defined keywords and implementing the inclusion and exclusion criteria, 11 case series and 2 case-control studies fulfilled the criteria for inclusion. The estimated prevalence of UC is 15 per 10[5] persons, and the reported incidences were 3.04 and 3.25 per 10[5] persons in two Iranian provinces. The disease was more commonly observed in women and people in their fourth decade of life. Cigarette smoking conferred protection and familial association seemed to be similar to developed countries. UC did not appear to be more common among the higher socioeconomic class. In addition it less commonly involved the proximal colon and rectum. Although the data is limited, the prevalence and incidence of UC in Iran shows an increasing pattern similar to other countries in the region. There is no clear association with socioeconomic status. Milder forms of the disease are common in Iran. A comprehensive nationwide data bank is needed for a better definition of the disease characteristics

Liver histology and HBV DNA levels in chronically HBV infected patients with persistently normal alanine aminotransferase

Data on histological activity and HBV DNA levels in patients with chronic HBV infection and persistently normal alanine aminotransferase levels are sparse. We aimed to investigate the histological activity and HBV DNA levels in these patients. There were 132 patients with HBeAg negative chronic HBV infection and persistently normal alanine aminotransferase levels that were included prospectively. Data were dichotomized according to the median levels. Associations of histology with HBV DNA and other variables were assessed. A total of 80 patients were male. The median age was 36 years. The median baseline HBV DNA was 2.9Log10 IU/mL. There were 50 cases [38%] with a total score >/= 5, 53 cases [40.2%] had grade >/= 4 and 40 cases [30.3%] had stage >/= 2. A baseline HBV DNA <2000 IU/mL was seen in 24 cases [48%] of those with total score >/= 5, 28 cases [53%] of those with grade >/= 4 and 9 cases [22.5%] with stage >/= 2. Multivariate analysis of baseline HBV DNA above the median level significantly predicted the total score, grade and stage with an adjusted odds ratio of 5.43, 3.47, and 4.23, respectively when compared to below median values. A second liver biopsy was performed in 61 patients. The median time interval between the two biopsies was 40 months. Total scores of 23 cases [38%] progressed by >/= 2 scores and the HBV DNA of 18 cases [22.5%] increased by >/= 1 Log[10] IU when compared to baseline values. HBeAg negative chronic HBV infection with persistently normal alanine aminotransferase is not a silent disease. Active liver disease may be seen in such patients with viral loads less than 2000 IU/mL

Efficacy of hepatitis B virus surface antigen vaccine as a therapeutic tool, in inactive hepatitis B virus carriers

Available drugs are not able to eradicate intracellular viral DNA in patients with hepatitis B virus [HBV] infections. HBsAg vaccine could induce immunity and subsequently eradicate Hepatitis B virus in proportions of these patients. Our aim was to evaluate the efficacy of HBsAg as a mode of therapy in inactive carriers. Forty two consecutive patients of inactive carriers were enrolled. All patients underwent liver biopsies. The modified Ishak score of all cases were less than 4. Twenty microgram of recombinant HBsAg vaccine injected intradermally 3 times [at 0, one and 6 months]. Biochemical and serological variables evaluated initially and 6 months after the last injection. The mean age was 39.6 +/- 11.12. Male/female ratio was [67.4%]. Two out of 42 cases lost their HBsAg [4.74%]. The difference was significant comparing to one percent annual spontaneous HBsAg loss [p=0.014]. In addition serum albumin level was significantly increased after vaccination [p=0.009]. Rest of the biochemical and serological variables had no significant changes comparing pre and post vaccination. Intradermal injection of HBV surface antigen vaccine could induce significant HBsAg loss. This mode of therapy is cheap, physiologic and without complication. However, the results of this study should be confirmed in further large controlled trial