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Middle East Journal of Digestive Diseases. 2015; 7 (4): 201-215
in English | IMEMR | ID: emr-174209


Gastrointestinal and liver diseases [GILDs] are major causes of death and disability in Middle East and North Africa [MENA]. However, they have different patterns in countries with various geographical, cultural, and socio-economic status. We aimed to compare the burden of GILDs in Iran with its neighboring countries using the results of the Global Burden of Disease [GBD] Study in 2010. Classic metrics of GBD have been used including: age-standardized rates [ASRs] of death, years of life lost due to premature death [YLL], years of life lost due to disability [YLD], and disability adjusted life years [DALY]. All countries neighboring Iran have been selected. In addition, all other countries classified in the MENA region were included. Five major groups of gastrointestinal and hepatic diseases were studied including: infections of gastrointestinal tract, gastrointestinal and pancreatobilliary cancers, acute hepatitis, cirrhosis, and other digestive diseases. The overall burden of GILDs is highest in Afghanistan, Pakistan, and Egypt. Diarrheal diseases have been replaced by gastrointestinal cancers and cirrhosis in most countries in the region. However, in a number of countries including Afghanistan, Pakistan, Turkmenistan, Egypt, and Yemen, communicable GILDs are still among top causes of mortality and morbidity in addition to non-communicable GILDs and cancers. These countries are experiencing the double burden. In Iran, burden caused by cancers of stomach and esophagus are considerably higher than other countries. There is an overall overestima-tion of liver cancer and underestimation of other gastrointestinal and pancreatobilliary cancers. The diseases that are mainly diagnosed in outpatient settings have not been captured by GBD

Middle East Journal of Digestive Diseases. 2015; 7 (3): 121-137
in English | IMEMR | ID: emr-166601


The general pattern of epidemiologic transition from communicable to non-communicable diseases is also observed for gastrointestinal and liver diseases [GILD], which constitute a heterogeneous array of causes of death and disability. We aimed to describe the trend of GILD in Iran based on the global burden of disease [GBD2010] study from 1990 to 2010. The trend of number of deaths, disability, adjusted life years [DALYs] and their age-standardized rates caused by 5 major GILD have been reported. The change in the rankings of major causes of death and DALY has been described as well. The age standardized rates of death and DALYs in both sexes have decreased from 1990 to 2010 for most GILD. The most prominent decreases in death rates are observed for diarrheal diseases, gastritis and duodenitis, and peptic ulcer disease. Positive trends are observed for liver cancer, pancreatic cancer, and gall bladder cancer. Diarrheal diseases have retained their 1[st] rank among children under 5. Among adults, decreased ranks are observed for diarrheal diseases, appendicitis, gastritis and duodenitis, gall bladder diseases, pancreatitis, and all types of cirrhosis. The trends in age standardized rates of DALYs, deaths, and YLLs are negative for almost all GILD, and especially for diarrheal diseases. However, there is no upward or downward trend in rates of years lost due to disability [YLDs] for most diseases. Total numbers of DALYs and deaths due to acute hepatitis C, stomach cancer, and liver cancers are rising. The total DALYs due to overall digestive diseases except cirrhosis and DALYs due to cirrhosis are both somehow stable. No data has been reported for GILD that are mainly diagnosed in outpatient settings, including gastroesophageal reflux disease, irritable bowel syndrome, and non-alcoholic fatty liver disease. The results of GBD 2010 demonstrate that the rates of most GILD are decreasing in Iran but total DALYs are somehow stable. However, as diseases detected in outpatient settings have not been captured, the burden of GILD seems to be underestimated. Population-based studies at national level are required for accurate reports

Humans , Male , Female , Liver Diseases , Mortality , Cost of Illness
Middle East Journal of Digestive Diseases. 2015; 7 (3): 138-154
in English | IMEMR | ID: emr-166602


Gastrointestinal and liver diseases [GILD] constitute a noteworthy portion of causes of death and disability in Iran. However, data on their prevalence and burden is sparse in Iran. The Global Burden of Disease [GBD] study in 2010 has provided invaluable comprehensive data on the burden of GILD in Iran. Estimations of death, years of life lost due to premature death [YLL], years of life lost due to disability [YLD], disability-adjusted life years [DALY], life expectancy, and healthy life expectancy have been reported for 291 diseases, 67 risk factors, 1160 sequelae, for both sexes and 19 age groups, form 1990 to 2010 for 187 countries. In the current paper, 5 major categories of gastrointestinal [GI] and liver diseases have been investigated as follows: GI infectious diseases, GI and liver cancers, liver infections, chronic end stage liver disease, and other digestive diseases. Among women, 7.6% of all deaths and 3.9% of all DALYs were due to digestive and liver diseases in 2010. The respective figures in men were 7.8% of deaths and 4.6% of DALYs. The most important cause of death among children under 5 is diarrhea. Among adults between 15 to 49 years old, the main causes of death are GI and liver cancers and cirrhosis, while diarrhea still remains a major cause of DALY. Among adults 50 years and above, GI and liver cancers and cirrhosis are the main causes of both deaths and DALYs. Gastritis and duodenitis, diarrheal diseases, gall bladder and bile duct diseases, acute hepatitis A, peptic ulcer disease, appendicitis, and acute hepatitis A mainly cause disability rather than death. GBD study provides invaluable source of data on burden of GILD in Iran. However, there exist limitations, namely overestimation of burden of liver cancer and underestimation of the burden of GI diseases that are usually diagnosed in outpatient settings. The collaboration of scientists across the world and specifically those from developing countries is necessary for improving the accuracy of future updates of GBD in these countries

Humans , Male , Female , Liver Diseases , Mortality , Wounds and Injuries , Risk Factors , Developing Countries , Cost of Illness
Middle East Journal of Digestive Diseases. 2013; 5 (3): 146-150
in English | IMEMR | ID: emr-141388


Budd-Chiari syndrome [BCS] is defined as hepatic venous outflow obstruction [HVOO]. BCS is an uncommon, life-threatening liver disorder. This study describes the clinical and etiological characteristics in addition to the long-term outcome of BCS in a single referral center in Tehran, Iran. We reviewed long-term outcome of patients who were diagnosed with BCS between 1989 and 2012 at Shariati Hospital, a tertiary hospital affiliated with Tehran University of Medical Sciences, Tehran, Iran. The diagnosis was confirmed by at least two imaging techniques. A comprehensive analysis of the clinical and paraclinical manifestations, etiology and long-term outcome of the disease was conducted. Seventy one patients [43 female] with a diagnosis of Budd-Chiari syndrome were identified during the 22 year period of study. The age were ranged from 17 to 64 years [median: 29 years]. We excluded 16 patients because of incomplete information or follow up. The remaining 55 cases were the subjects of this study. Underlying etiologies consisted of congenital thrombophilia factors in 50% [28 cases] which was defined as protein C deficiency [12 cases], protein S deficiency [3 cases], antithrombin deficiency [3 cases] and factor V Leiden mutation [10 cases]. Etiology was unknown in 18% [10 cases]. Acquired causes of thrombophilia were observed in 25% [14 cases] that consisted of 9 cases of myeloproliferative disease and 5 cases of autoimmune diseases. In 3 cases pregnancy was the only etiology. The main clinical presentations were abdominal pain in 33 [60%], abdominal distention in 21 [38.2%], and jaundice in 10 [18%] cases. The main clinical signs were ascites [76.4%], splenomegaly [34%], hepatomegaly [25.5%] and deep vein thrombosis [1.8%]. All 55 patients were treated with anticoagulants [heparin followed by warfarin] and supportive care. Two cases underwent mesocaval shunt surgery, 2 patients required transjugular portosystemic shunt [TIPS] and 5 were referred for liver transplantation. A total of 17 [30%] patients died during 22 years of follow up. BCS, although uncommon in Iran, is a challenging liver disease with an important burden. Medical therapy that includes anticoagulation seems to be effective in most cases although the prognosis is guarded. In long-term follow up, 40% of cases will need liver transplant or die from end stage liver disease

Archives of Iranian Medicine. 2012; 15 (2): 70-75
in English | IMEMR | ID: emr-116676


The incidence of major risk factors of chronic kidney disease [CKD] in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran. In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged >/= 18 years, was analyzed. CKD was determined based on glomerular _ltration rate [GFR] and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated. 1557 subjects with a mean age of 56.76 +/- 12.04 years were enrolled in this study. Based on the modi_cation of diet in renal disease [MDRD] equation, 137 subjects [8.89%] were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus [DM], hypertension [HTN], ischemic heart disease [IHD], waist to hip ratio, myocardial infarction [MI], and cerebrovascular accident [CVA]. CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD