Combination of diclofenac and aggressive hydration for the prevention of post-ERCP pancreatitis

Aim: To investigate whether aggressive hydration can increase the efficacy of prophylactic non-steroid anti-inflammatory drugs [NSAIDs] in prevention of post-ERCP pancreatitis

Background: NSAIDs are recommended for the prevention of PEP; however, whether aggressive hydration can have additional benefits in this regard is not known

Methods: Patients candidate for ERCP received either pre-procedural rectal diclofenac [100 mg] alone [n = 112] or in combination with aggressive hydration by lactate ringer's [n = 107] as prophylactic method. PEP was defined based on increase in serum levels of pancreatic enzymes [from baseline to 24 hours following the procedure] accompanied with symptoms

Results: PEP was occurred in 3 patients in the diclofenac only group and in 1 patient in the diclofenac + hydration group with no significant difference [2.7% vs. 0.9%, P = 0.622]. Serum amylase levels decreased over time in the diclofenac + hydration group but not in the diclofenac only group. Also, serum lipase levels decreased more rapidly over time in the diclofenac + hydration group compared to the diclofenac only group

Conclusion: Combination prophylactic therapy with NSAIDs plus aggressive hydration does not seem to have additional clinically important benefits in preventing PEP. Studies with larger sample of patients are required in this regard

Detection of minimal hepatic encephalopathy in iranian patients with cirrhosis

Background: Minimal hepatic encephalopathy [MHE] is the mildest type of hepatic encephalopathy in patients with cirrhosis. Patients with MHE have normal clinical and physical examination but they show some neurocognitive dysfunctions that affect their quality of life negatively. The aim of the current study is to diagnose MHE in patients with cirrhosis and its associated factors

Methods: This is a cross-sectional study on 120 known cases of cirrhosis referred to hospitals affiliated to Isfahan University of Medical Sciences during 2014-17. The patients' cirrhosis severity was evaluated using laboratory tests and physical examinations based on MELD [Model for End-stage Liver Disease] and Child-Pugh criteria. The patients' demographics were filled in a checklist. All included patients with cirrhosis were asked to respond to the questions of Psychometric Hepatic Encephalopathy Score [PHES] test

Results: Mean age of the patients was 51.2 +/- 9.7 years. 62 [51.7%] patients were men and 58 [48.3%] patients were women. The mean score of the patients based on MELD criteria was 14.03 +/- 6.09. 26.7% of the patients presented MHE. Mean age of the patients with MHE was statistically less than the patients without MHE [p value < 0.001]. Mean score of MELD criteria among the patients with diagnosis of MHE was significantly higher than the other group [p value < 0.001]. The patients' Child class was statistically associated with MHE [p value < 0.001]. Men were significantly more affected than women [p value = 0.03]

Conclusion: MHE was associated with MELD score and Child class of the patients with cirrhosis. The noticeable point was reversible association of age with MHE. Further studies are recommended

Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial

Non-alcoholic steatohepatitis [NASH] is a clinicopathological entity that is being recognized more frequently in recent years. This study aimed to evaluate the effects of Metformin, with and without a probiotic supplement on liver aminotransferases in patients with NASH. Sixty four patients 18-75 years with NASH confirmed by biopsy and histological assessment were enrolled to study. Patients were randomized to one of the following treatments for 6 months: Group I, probiotic [Protexin two tablets per day] plus Metformin 500 mg two tablets per day [Met/Pro], or group II, Metformin 500 mg two tablets per day plus two placebo tablet [Met/P]. After 6 month alanine aminotransferase [ALT], aspartate aminotransferase, and ultrasound grading of NASH were assessed. In group I, serum alanine aminotransferase [ALT: 133.7 +/- 70 vs. 45.2 +/- 32.5; P < 0.00], and aspartate aminotransferase activity [AST: 123.1 +/- 72 vs. 44.2 +/- 33.9; P < 0.001], and ultrasound grading of NASH [P < 0.001] all decreased significantly by the end of the treatment period. In group II, while serum alanine aminotransferase [ALT] was not significantly reduced [118.4 +/- 67.9 vs. 112.5 +/- 68.7; P < 0.064], aspartate aminotransferase activity [AST: 125.3 +/- 71 vs. 113.4 +/- 71; P < 0.001], and ultrasound grading of NASH did fall significantly [P < 0.01]. Body mass index [BMI], fasting blood sugar [FBS], cholesterol, and triglyceride fell significantly in both groups. Probiotic combination with Metformin improves liver aminotransferases better than metformin alone in patients with NASH

Prevalence of hepatitis A in Iranian patients with chronic liver disease

Acute hepatitis A in patients with chronic liver diseases [CLD] may lead to a more severe outcome for which routine vaccination is recommended in many regions. Nevertheless, studies of HAV seroprevalence and exposure predictors in populations with CLD are scanty in our region. We studied 200 patients with CLD between September 2005 and September 2006. Patients were stratified on the basis of age, gender, size of family, place of residency and etiology of liver disease. The HAV seroprevalence in patients with CLD was compared with age- and sex-matched controls. Independent predictors of HAV exposure were identified by logistic regression analysis. Of 200 patients, HAV seroprevalence was available for 190 [96.5%]. Hepatitis B and C, alcohol, autoimmune hepatitis and Wilson's disease were the causes of CLD. Most of the seronegative patients aged 10-20 years. The overall HAV seroprevalence was 97.3% in controls. None of the risk factors were identified as independent predictors. Age stratified seroprevalence of HAV in patients with CLD is close to that of the general population. High prevalence of HAV must be considered in vulnerable travelers to our country

Genetic diversity and drug resistance of helicobacter pylori strains in Isfahan, Iran

Resistance to antimicrobial agents, particularly metronidazole and clarithromycin, is frequently observed in Helicobacter pylori and may be associated with treatment failure. This resistance rate varies according to the population studied. The aim of this study was to assess the pattern of antimicrobial resistance of H. pylori isolates from dyspeptic patients in Isfahan. Antral gastric biopsies from 230 dyspeptic patients were cultured. Susceptibility testing to commonly used antibiotics performed on pure cultures of 80 H. pylori-positive isolates by Modified Disk Diffusion Method [MDDM]. Genomic DNA extracted and subjected for study of entire genomic pattern using Random Amplified Polymorphic DNA- Polymerase Chain Reaction [RAPD-PCR]. The overall rates of primary resistance were 30.0%, 8.75%, 6.25%, 3.75%, 3.75%, and 2.50% for metronidazole, ciprofloxacin, clarithromycin, azithromycin, tetracycline, and amoxicillin, respectively. Multiple antibiotic resistances were observed in 8 of 27 resistant isolates [29.6%] that mainly were double resistance with the prevalence of 6.25%. No association between antimicrobial resistance and either the gender, age or clinical presentation of the patients were detected. In RAPD-PCR, great diversity observed in 27 resistant strains isolated from different patients and this heterogeneity was not significantly different from susceptible strains. Primary H, pylori resistance to metronidazole in our population was lower than the developing world and even other parts of Iran, to ciprofloxacin was considerable in comparison with results in most other countries. Moreover, antibiotic resistance had no effect on genomic pattern of H. pylori isolates. Finally, pretreatment H. pylori isolates susceptibility testing is highly recommended

Seroprevalence of hepatitis E in patients with chronic liver disease from East Azerbaijan, Iran

Superinfection with HEV in patients with chronic liver disease [CLD] can cause severe hepatic decompensation leading to increased morbidity and mortality. This study aimed to determine seroprevalence of HEV infection among CLD patients compared to blood donors from Azerbaijan, north-west of Iran. CLD patients and a group of age matched blood donors with normal liver function tests were evaluated for the presence of anti-HEV IgG antibody in their sera for evidence of hepatitis E. The risk factors were estimated. The mean age of CLD patients was 48 years [range: 10-87]. 27.5% of patients were HEV IgG-positive. Among the controls 19.7% were positive for anti-HEV IgG. By multivariate analysis, there was no association between positive anti-HEV IgG and etiology of chronic liver disease, gender, literacy, accommodation, and number of family members in patients or controls. Mean age of patients infected with HEV in both groups was significantly more than the seronegative ones. We found high seroprevalence of HEV-antibody among blood donors and CLD patients in our study, so we recommend more attention to hygiene of food and water. In addition, such patients should be informed about the potential risks and simple ways to prevent the disease in their regular life and travels. This issue must be concerned in cases of "acute on chronic" hepatitis in CLD patients

Seroprevalence of anti-helicobacter pylori antibodies in hepatitis B and C patients with cirrhosis: a case-control study

Cirrhosis is terminal stage of many chronic liver diseases like hepatitis C and hepatitis B. In some studies the role of helicobacter pylori has been demonstrated in progress of cirrhosis and its complications, but none of the previous studies has investigated the role of socioeconomic conditions of patients in childhood period in this issue. In a case-control study, we examined 100 cirrhotic patients due to hepatitis [49 hepatitis B and 51 hepatitis C patients] and 101 socioeconomically matched healthy controls presenting to Taleghani Hospital for IgG antibody to helicobacter pylori. IgG antibody to helicobacter pylori was present in 73% of cirrhotic patients and 52% of control group [P < 0.003]. Odds ratio for the presence of IgG antibody to helicobacter pylori in cirrhotic men comparing with healthy men was 3.2 [95%CI: 1.4-7.4]. The relative frequency of IgG antibody to helicobacter pylori found to be higher in cirrhotic patients than in controls with regard to socioeconomic condition in childhood

Abdominal pain due to lead-contaminated opium: a new source of inorganic lead poisoning in Iran

Although the incidence of occupational and adult lead poisoning has declined, the problem still exists. We encountered three patients with lead poisoning in Iran, all of whom associated with presented with diffuse abdominal pain, which was at times colicky in nature, anemia, constipation, nausea, vomiting, and slightly abnormal liver biochemistries. A history of opium ingestion was present in each of these patients. None of the patients reported known occupational exposure to toxins. Diagnoses of lead poisoning were confirmed through the detection of elevated blood lead levels. The cause of lead poisoning was attributed to the ingestion of contaminated opium. Opium adulterated with lead had not been previously recognized as a source of lead poisoning in Iran. It is, therefore, pointed out that lead poisoning should be considered as a differential diagnosis for acute abdominal colic of unclear cause in patients with opium addiction