Association between two single base polymorphisms of intercellular adhesion molecule 1 gene and inflammatory bowel disease

Aim: The present study evaluated the association between G241R and K469E polymorphisms of intercellular adhesion molecule 1 gene and inflammatory bowel disease in Iranian population

Background: Inflammatory bowel disease including ulcerative colitis and Crohn's disease, is a chronic idiopathic inflammatory disease of the gastrointestinal tract. There are two single base polymorphisms of intercellular adhesion molecule 1gene, G241R and K469E, reported to be associated with inflammatory disorders

Patients and methods: In this case-control study, 156 inflammatory bowel disease patients [110 ulcerative colitis and 46 Crohn's disease patients] and 131 healthy controls were enrolled. Two polymorphisms of intercellular adhesion molecule 1gene, including G241R and K469E, were assessed by polymerase chain reaction followed by restriction fragment length polymorphism

Results: The E469 allele of K469E polymorphism was significantly more frequent in Crohn's disease patients compared to controls [P< 0.05, OR= 1.83; 95% CI: 1.13 to 2.96]. The mutant homozygote genotype of K469E polymorphism [E/E] was also significantly more frequent in Crohn's disease patients compared to controls [P< 0.05, OR= 4.23; 95% CI: 1.42 to 12.59]. No difference was observed in the frequency of K469E polymorphism among ulcerative colitis patients compared to controls. There were no significant differences in genotype and allele frequencies of G241R polymorphism among ulcerative colitis and Crohn's disease patients compared to control subjects

Conclusion: According to our findings, K469E polymorphism of intercellular adhesion molecule 1 gene may probably participate in the pathogenesis of Crohn's disease in Iran

Gastric atrophy: use of OLGA staging system in practice

Aim: This study used the OLGA system to characterize the histology pattern of gastritis in dyspeptic outpatients with a mean age of 45 years from regions with different gastric cancer risks

Background: Several classification systems have been purposed for understanding the status of the gastric mucosa. Currently, the Sydney system is the most widely employed. Nevertheless, the applicability of the Sydney system in therapeutic and prognostic areas is a matter of debate. Given this shortcoming an international group of gastroenterologists and pathologists developed a new system named Operative Link on Gastritis Assessment [OLGA]

Patients and methods: In this cross-sectional comparative study the OLGA system was used to characterize the histology pattern of gastritis in 685 dyspeptic patients referring to the department of gastroenterology of a training hospital

Results: No significant correlation was found between active inflammation and total OLGA score [P > 0.05]. Also, no statistically significant correlation was found between activity and intestinal metaplasia, dysplasia, atrophy, and cancer [P > 0.05]. Even though, there is a positive correlation between mild chronic inflammation and total OLGA score, no correlation has been identified between chronicity and dysplasia or cancer [P > 0.05]. Nearly, In all cases with no dysplasia OLGA score was zero but all patients with gastric cancer OLGA score was more than two

Conclusion: Generally, the activity is not a useful factor in predicting prognosis and its loss of relation with total OLGA score does not make OLGA score any less predictable

Time trend analysis and demographic features of inflammatory bowel disease in Tehran

This retrospective study is aimed to review demographic and clinical characteristics of IBD to elucidate the probable factors associating with IBD development in Taleghani Hospital in Iran since 2001 during a 12-year-period. Ulcerative colitis [UC] and Crohn's disease [CD] are two major idiopathic entities of inflammatory bowel disease [IBD]. Previous studies have reported an increased incidence of IBD in Middle East countries. In the present study 1914 patients with UC, 318 patients with CD and 25 with indeterminate colitis [IC] were included. Demographic information, clinical features, extraintestinal manifestations, complications and extension of disease were collected and interpreted for all participants. According to the time of registration, patients were divided into seven groups. Statistical analysis was performed using the chi-square test. In seven groups of IBD patients, disease registry was estimated for UC, CD, and total IBD during a 12-year-period. From 2001 to 2005, a relative increased registry was observed among UC patients. However, in the years 2006 and 2007 a significant reduction in the number of patients was reported. Then an increasing trend was observed in UC patients. UC presented mostly with diarrhea, hematochezia and bloody diarrhea, while most of CD patients complained of abdominal pain. Evaluation of data related to registered IBD patients in Iran shows that probable incidence and prevalence of IBD [UC and CD] is increasing compared to previous decades

Helicobacter pylori Stool Antigen Levels and Serological Biomarkers of Gastric Inflammation are Associated with Cardio-Metabolic Risk Factors in Type 2 Diabetic Patients

BACKGROUND: Helicobacter pylori infection and subsequent gastric inflammation have been proposed as risk factors for the development of insulin resistance and cardiovascular disease. In this study we assessed the possible association of H. pylori bacterial load, and serum biomarker of gastric inflammation with cardiometabolic risk factors in diabetic patients. METHODS: In this cross-sectional study, 84 H. pylori-infected type 2 diabetic patients were assessed for anthropometrics, biochemical and clinical measurements. Pearson correlation test, linear, and logarithmic regression curve estimation models were used to assess the association of H. pylori stool antigen (HpSAg) levels, and pepsinogen I (PGI) to pepsinogen II (PGII) ratio with fasting serum glucose, insulin, serum lipid and lipoprotein parameters, malondialdehyde, high-sensitive C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body weight, waist circumference and lipid accumulation product (LAP) index. RESULTS: The mean age of participants was 54+/-10 years, and 44% were men. Mean HpSAg levels and PGI/PGII ratio were 0.24+/-0.23 microg/mL and 9.9+/-9.0, respectively. Higher HpSAg as well as lower PGI/PGII was correlated with higher anthropometric measures and LAP. A significant negative correlation between PGI/PGII ratio and blood pressure (r=-0.21 and r=-0.22, systolic and diastolic, respectively, P<0.05), serum insulin (r=-0.17, P=0.05), and hs-CRP (r=-0.17, P=0.05) was observed. A significant linear association between PGI/PGII ratio with serum triglycerides (beta=-0.24, P<0.05), serum high density lipoprotein cholesterol (HDL-C; beta=0.43, P<0.01), and triglycerides/HDL-C ratio (beta=-0.28, P<0.05) were observed. CONCLUSION: Higher H. pylori bacterial load and lower PGI/PGII ratio was associated with higher levels of cardiometabolic risk factors in H. pylori infected type 2 diabetic patients.

Association of Helicobacter pylori with central serous chorioretinopathy in Iranian patients

Aim: This study was conducted to investigate a possible association between H. pylori infection and CSR

Background: Helicobacter pylori infection is one of the most common infections worldwide. Central Serous Chorioretinopathy [CSR] is a serious macular detachment that usually affects young people. The etiopathogenesis of the disease is still not completely understood

Patients and Methods: A prospective study was performed and we evaluated a total of 35 CSR patients and control group of138 patients who referred to gastroenterology research center of Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Central serous chorioretinopathy was diagnosed on the basis of findings in ophthalmic examinations and confirmed by fluoresce in angiogram. All patients underwent a 13C-urea breath test [UBT] to detect H. pylori infection. Patients were defined as H. pylori infected, if breath test was positive

Results: The mean duration of symptoms before diagnosis was 8.3 +/- 2.5 days. Overall, no statistically significant difference was found between left and right eyes, bilateral CSR was observed in 5 patients [14.2%].The incidence of H. pylori infection was 85.7% in CSR patients and 55.1% in control subjects [p=0.001]. Odd's ratio was 4.895

Conclusion: These results indicate that the prevalence of H. pylori infection is significantly higher in patients with CSR than in controls. No effect of age or sex was seen on H.pylori test results. Further multiple centers, randomized, case control trials are necessary to confirm the potential contributory role of the H. pylori infection in the pathogenesis of CSR as a possible association between infectious agents and endothelial dysfunction

Comparison of half-dose and full-dose triple therapy regimens for Helicobacter pylori eradication in patients with end-stage renal disease

The aim of this study was to compare the half-dose and full-dose triple therapy regimens for Helicobacter pylori [Hp] eradication in patients with end-stage renal disease. H. Pylori is one the most important causes of dyspepsia in patients with end-stage renal disease [ESRD]. Sixty-six patients with ESRD were enrolled in the study with Hp infection and peptic disease with a need of Hperadication. Patients were randomly assigned to full-dose [A=35 patients] or half-dose group [B=31 patients]. Patients received clarithromycin 500 mg, amoxicillin 1000 mg and omeprazole 20 mg twice daily in group A and clarithromycin 250 mg and amoxicillin 500 mg twice daily and omeprazole 20 mg once daily in group B for two weeks. Patients provided stool samples 4 weeks of completing study to assess the success of Hp eradication by Hp-specific stool antigen. Finally, the rate of eradication and complications were compared between two groups. The successful Hp eradication was achieved in 26 patients [74%] in group A and in 22 patients [74%] in group B. The difference between 2 groups was not statistically significant [p=0.973] [per protocol analysis]. Half-dose triple-therapy with clarithromycin, amoxicillin and omeprazole is as effective as full-dose triple-therapy to eradicate the Hp in patients with ESRD. According to lower toxicity level, complications and cost in half-dose regimen in this subset of patients, this protocol is advised

Evaluation of the benefit of addition of clidinium C to a Helicobacter pylori eradication regimen

This study aimed to evaluate the success of H.pylori eradication therapy in patients with dyspepsia by therapeutics regimes with and without clidinium C. Helicobacter pylori infections are reported in all parts of the world. Appropriate antibiotic therapy can treat infection. The ideal treatment regimen has not been specified. In a randomized, double blind clinical trials study, 250 patients with dyspepsia were enrolled. All patients were treated by Omeprazole, Metronidazole, Amoxicillin and Bismuth [OMAB] for two weeks. One tablet clidinium C before each meal was added to this regimen in the intervention group [A]. Urea Breath Test [UBT] was carried out after 8-12 weeks after treatment for evaluation of H.pylori eradication. 132 patients in the intervention group [A] and 118 patients in the control group [B] were enrolled to the study. The rate of eradication in group A was significantly higher than group B [62.1% vs. 50%, p=0.04]. The results supported the effect of clidinium C for increasing of helicobacter pylori eradication, but further studies need to be performed

Penbactam for Helicobacter pylori eradication: a randomised comparison of quadruple and triple treatment schedules in an Iranian population

Selection of the best drug regimens for eradication of Helicobacter pylori infection especially in patients at risk of peptic ulcer relapses and the development of complications is challenging. This study assessed and compared the efficacy of the two common PPI based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. Three hundred and thirty patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols all given twice daily: [a] A 14-day quadruple therapy [OMAB group] comprising omeprazole 20 mg, metronicazole 500 mg, amoxicillin 1 g, and bismuth subcitrate 240 mg; [b] A 14-day triple regimen [OCP group] comprising omeprazole 20 mg plus clarithromycine 500 mg and penbactam 750 mg and [c] A 14-day triple regimen [OCA group] comprising omeprazole 20 mg plus clarithromycine 500 mg and amoxicillin 1 g. Cure was defined as a negative urea breath test at least six weeks after treatment. The per-protocol eradication rates achieved with both OCP regimen [87.0%] and OCA treatment [90.8%] were significantly higher than the OMAB treatment protocol [56.0%]; however, no significant difference emerged in eradication rates between the two triple treatment schedules. No significant differences between the groups were found in most side-effects. Two-week quadruple therapy showed a lower eradication rate compared to common triple treatment schedules when used as first-line eradication treatment for H. pylori infection in Iranian population

New sequential versus triple treatment schedules for Helicobacter pylori eradication in Iran

Selection of the best approach for the treatment of Helicobacter pylori [H. pylori] infection that encompasses higher eradication and lower failure rates leads to a decline in its related complications and disorders. To understand the relative efficacy of new sequential therapy compared with standard triple therapy as two common regimens, we have performed a randomized, controlled trial to compare these two treatment protocols in an Iranian population. This study enrolled 220 patients aged 18-81 years old with dyspepsia or peptic ulcers who were candidates for endoscopy and referred to Taleghani Hospital, Tehran, Iran. Patients were randomized to receive one of two treatment regimens, a 14-day new sequential therapy that consisted of omeprazole [20 mg], amoxicillin [1.0 g], and ciprofloxacin [500 mg] administered twice daily for the first seven days, followed by omeprazole [20 mg], amoxicillin [1.0 g], and furazolidon [200 mg] administered twice daily for the remaining seven days. The second regimen comprised a proton pump inhibitor [PPI]-based triple therapy of omeprazole [20 mg], amoxicillin [1.0 g], and clarithromycin[500 mg] administered twice daily for 14 days. Overall, 10 patients in PPI-based triple therapy group and 16 patients in the 14-day new sequential group stopped treatment and did not undergo 13C-urea breath testing [UBT]. Among the remaining patients, the eradication rate with the PPI-based triple therapy was 89.0%, whereas it was 91.5% with the 14-day new sequential therapy which was not significantly different. No significant differences were found in eradication rates between genders in each treatment group. Adverse effects were mainly mild and comparable between the two treatment regimens. It seems that sequential regimen is at least as effective as standard therapy and can be used as an alternative treatment for H pylori eradication.

relation between the level of interleukin-23 with duration and severity of ulcerative colitis

In this study, we determined the relationship between the serum level of IL-23 and the severity of ulcerative colitis [UC] among our population. A recent major breakthrough for describing the pathogenesis of intestinal tissue injury in inflammatory bowel disease [IBD] is the pathway related to interleukin-23 [IL-23]. We performed a prospective case-control study on a total of 85 new patients with ulcerative colitis, recruited from a general referral hospital. Forty ethnically matched healthy controls were also enrolled among hospital staffs and analyzed. Serum IL-23 level was quantified using an electrochemiluminescence immunoassay [ECLIA] method with an immunoassay analyzer. The mean serum IL-23 level in the group with ulcerative colitis was significantly higher than the healthy individuals [347.5 +/- 130.9 pg/ml versus 233.5 +/- 86.3 pg/ml; p<0.001]. There was a positive correlation between the serum level of IL-23 and disease duration [r = 0.27, p = 0.04]. Also, a direct relationship was found between the serum level of IL-23 and the severity of disease [mean IL-23 in mild UC = 296.2 +/- 51.2 pg/ml; in moderate UC = 356.1 +/- 142.9 pg/ml; and in severe UC=399.3 +/- 163.8 pg/ml, p=0.04]. Serum level of IL-23 is directly correlated with the duration and severity of ulcerative colitis

Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: a randomised clinical trial

Uraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori [HP]. Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance [CrCl] and eradication of HP infection with new sequential and standard triple therapeutic regimens. A total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens: A 14-day standard triple therapy with 20 mg omeprazole bid, 1000 mg amoxicillin bid and 500 mg clarithromycin bid and a new sequential regimen with 20 mg omeprazole bid and 1000 mg amoxicillin bid both for 14 days, 500 mg ciprofloxacin bid for the first 7 days and 200 mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30 mg dl[-1] One hundred and sixty two out of 180 HP-positive patients [54.3% male, 51.6 +/- 12.1 years] completed treatment in the four groups and were studied. According to renal function they were classified into group A [n = 39], haemodialysis [HD] patients; group B [n = 37], CrCl <30 mg dl[-1] without HD; group C [n = 36], CrCl between 30 and 60 mg dl[-1]; and group D [n = 50], control subjects with CrCl >90 mg dl[-1]. HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens. HP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported

Antibiotic susceptibility profile of Helicobacter pylori isolated from the dyspepsia patients in Tehran, Iran

Helicobacter pylori is an important pathogen for gastroduodenal diseases. Infection with H. pylori can be limited by regimens of multiple antimicrobial agents. However, antibiotic resistance is a leading cause of treatment failure. The aim of this study has been to determine the resistance patterns of H. pylori strains isolated from gastric biopsies of patients with dyspepsia by agar dilution method, in Tehran, Iran. H. pylori isolates from patients with gastrointestinal diseases were evaluated for susceptibility testing by agar dilution method. Susceptibility testing was performed to commonly used antibiotics including clarithromycin, tetracycline, amoxicillin, metronidazole and ciprofloxacin. Among 92 patients with dyspepsia, H. pylori strains were isolated from 42 patients. Seventeen [40.5%] of the isolates were resistant to metronidazole [MICs >/= 8 microg/1], whereas one isolate [2.4%] was resistant to amoxicillin [MICs

Clinical and histological presentation of helicobacter pylori and gluten related gastroenteropathy

Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. Among 250 patients, 232 [93%] had histological evidence of Helicobacter pylori infection. Histological abnormalities [Marsh I to IIIc] were present in 24 [10%]. Of 24 patients, 20 [83%] with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 [10%] had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 [3.6%] had microscopic and macroscopic enteritis [Marsh I to IIIc]. Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations

[NOD2 novel mutations in Iranian Crohn's patients]

Despite the reported role of three common mutations of the CARD15/NOD2 gene including R702W, G908R and 1007fs in Crohn's disease [CD], only about 30% of Iranian CD patients carry one of these three variants [R702W]. The aim of this study was to screen the hot points of NOD2 gene to find any novel sequence variations in Iranian patients with CD. Eighty non-related Crohn's patients from Iranian origin, referred to a tertiary center in a three-year period [2006-2009], were enrolled in this study. The hot points of NOD2 gene [including exons 4 and 8] were evaluated by direct sequencing after amplification of related sequences with polymerase chain reaction [PCR]. A total of 17 sequence variations were identified among these exons of NOD2 gene including 7 novel ones. Three of these new mutations had an allele frequency more than 5%. All new mutations were a consequence of a single nucleotide change, 4 resulted in an aminoacid change while one formed a stop coden. No deletion or insertion mutation was observed in this part of the gene. This study demonstrated the existence of uncommon NOD2 variants in Iranian patients with CD. It is possible that these mutations play a role in susceptibility to CD in Iranian population

Quadruple versus common triple-treatment regimens for Helicobacter pylori eradication in the Iranian population: a randomized study

Selection of the best drug regimens for effective eradication of Helicobacter pylori [H.pylori] infection, especially in patients at risk of peptic ulcer relapses and development of complications of peptic ulcer disease, is challenging. This study assessed and compared the efficacy of the two common proton pump inhibitor [PPI]-based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. A total of 330 patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols: [1] a 14-day quadruple therapy [OMAB group] comprising omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1g and bismuth subcitrate 240 mg; [2] a 14-day triple regimen [OCP group] comprising omeprazole 20 mg plus clarithromycin 500 mg and penbactam 750 mg; and [3] a 14-day triple regimen [OCA group] comprising omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g, all given twice daily. Cure was defined as a negative urea breath test at least 6 weeks after treatment. The intention-to-treat H.pylori eradication rates achieved with both OCP regimen [87.0%] and OCA treatment [88.8%] were significantly higher than the OMAB treatment protocol [56.0%]; however, no significant difference emerged in eradication rates between the two triple-treatment schedules. No significant differences were found in most side effects between the groups. Two-week quadruple therapy showed a lower eradication rate compared with common triple-treatment schedules when used as a first-line eradication treatment for H.pylori infection in the Iranian population