Epidemiologic and demographic survey of celiac disease in khuzestan province

BACKGROUND: Celiac disease presents with a wide spectrum of symptoms

This study clarifies different aspects of celiac disease along with the most common patterns of celiac presentation in Khuzestan Province, Iran

METHODS: Patients' information was obtained by evaluation of their files from the archives of the Khuzestan Celiac Society and records at gastroenterologists' offices in this province

RESULTS: Overall, there were 103 [40 males, 63 females] patients included in this study. Patients' mean ages were 33 +/-11 years [males] and 31.6 +/- 11.7 years [females]. In terms of geographic distribution, 54.1% resided in the center of the province followed by 26.5% who were residents of the northern area. The rate of employment among men was 70.6% whereas it was 8.3% for women. In terms of education, 21.9% of men and 33.3% of women had academic educations. The rate of matrimony was 80.6% [n=29] for men, 65.4% [n=38] for women and 3.4% [n=2] who were divorced. Mean height was 164 +/- 14 cm in men and 157.5 +/- 10 cm in women. Mean BMI at the time of presentation was 22.7 in men and 22.6 in women. The most common gastrointestinal [GI] complaints in male patients were diarrhea [35%], reflux [20%], bloating [17.5%], abdominal pain [15%], vomiting [15%] and constipation [7.5%]. Female patients experienced diarrhea [49.2%], abdominal pain [31.7%], bloating [31.7%], vomiting [19%], constipation [9.5%] and reflux [7.9%]. The most common concomitant non-GI disorders among male patients were anemia [17.1%], thyroid disease [14.3%], and weight loss (14.3%); women experienced anemia [33.9%], thyroid disease [12.5%], and weight loss [7.1%]. Approximately half of the patients exhibited symptoms for more than five years prior to diagnosis and 90% were diagnosed by gastroenterologists. Of these, 43% had normal endoscopy results. The most common serologic markers were anti-TTG [69.9%], anti-EMA [27.7%]

CONCLUSION: Physicians, prior to attributing patients' symptoms to irritable bowel syndrome [IBS] should be aware that patients who present with long-term nonspecific symptoms might possibly have celiac disease. During endoscopy, the threshold for obtaining biopsies should be low

High dose versus low dose intravenous pantoprazole in bleeding peptic ulcer: a randomized clinical trial

The appropriate dose of proton pump inhibitors for treatment of patients with upper [GI] bleeding remains controversial. This study compares high-dose versus low-dose intravenous proton pump inhibitor [PPI] infusion for prevention of GI bleeding complications. A total of 166 patients with bleeding peptic ulcers underwent therapeutic endoscopy using concomitant therapy by argon plasma coagulation [APC] and diluted epinephrine injection. Patients were randomly divided into two groups: high-dose pantoprazole [80 mg bolus, 8 mg per hour] and low-dose pantoprazole [40 mg bolus, 4 mg per hour] infused for three days. Initial outcomes were rebleeding, need for surgery, hemoglobin drop more than two units, and hospitalization for more than five days. Secondary outcome included mortality rate. Overall, 166 patients [83 patients per group] enrolled in the study. The average age of patients in the high-dose group was 59.5 +/- 15.6 years and 52.3 +/- 13.3 years in the low-dose group [p=0.58]. Males comprised 69.7% of patients. In the high-dose group, the mean number of units of transfused blood was 3.3 +/- 1.71 and in the low-dose group, it was 2.82 +/- 1.73 [p=0.50]. There were 36 [43.37%] patients in the high-dose group and 40 [48.19%] in the low-dose group who were hospitalized for more than 5 days [p=0.53]. Rebleeding was observed in 27 [32.53%] patients in the high-dose group and in 21 [25.30%] in the low-dose group [p=0.30]. There were no significant differences observed in drop in hemoglobin of more than two units [p=0.15], mortality [p=0.99] and surgery [p=0.75] between the two groups. For controlling peptic ulcer bleeding, there is no difference between high dose and low dose pantoprazole infusion

[Evaluation of the efficacy of intra-nasal midazolam for sedation during upper endoscopy: a randomized clinical pilot study]

Background: upper endoscopy, as an important diagnostic and occasional therapeutic tool is invasive. Sedation of patients during the endoscopy procedure with minimal side effects could raise patient tolerability, allowing for ease and increased effectiveness of this procedure

Materials and Methods: in this study, 105 patients who were candidates for the upper endoscopy procedure were randomly divided into two groups: [A] midazolam [n=53] and [B] placebo [n=52]. Group A patients received 5 mg of midazolam dissolved in 5 cc distilled water and group B received 5 cc of distilled water, via an intra-nasal drip. After 40 to 45 minutes, the upper endoscopy was performed. During the endoscopy, patients were monitored and the endoscopy time, gag reflex stimulation, heart rate, arterial oxygen saturation [SPO2], amnesia and patient justification were recorded and compared

Results: the average age in group A was 39.3 years; for group B, it was 39.9 years. There were no statistically significant results for average endoscopy time [p=0.23], gag reflex stimulation [p=0.27], heart rate [p=0.09], SPO2 [p=0.49], amnesia [p=0.12], and patient justification [p= 0.1] between both groups

Conclusion: according to the results of this study, it seems that intra-nasal midazolam is not effective for patient sedation. This field needs additional evaluation

Evaluation of N-acetyl cysteine for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective double blind randomized pilot study

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography [ERCP] that can occasionally be fatal. Multiple drugs have been examined for the prevention of this side effect, with generally uncertain results. This study is an effort to prevent this complication by the use of oral N-acetyl cysteine [NAC]. A total of 100 patients who were candidates for ERCP were divided randomly into two groups. In the NAC [N] group, patients received 1200 mg NAC with 150 cc water orally 2 h before ERCP. In the placebo [P] group, 150 cc water was prescribed as a placebo. We measured serum amylase and lipase levels before and 24 h after ERCP. The prevalence of pancreatitis and duration of admission in each group were determined and compared. In group N there were 5 [10%] cases of pancreatitis, whereas in group P there were 14 [28%] cases, which was significant [risk reduction ratio: 2.8; p=0.02].The average admission time was 1.16 +/- 0.55 days in group N and 1.18 +/- 0.44 days in group P, which was not significant. There were significant differences in the prevalence of acute pancreatitis between the two groups. In addition, the number of need to treat [NNT] consisted of five cases for NAC. With regards to the above results and the safety profile of NAC, it could be used as a therapeutic agent for the prevention of post-ERCP pancreatitis. We recommend that the results of this study be verified by additional clinical trials

Liver cirrhosis seen in GI clinics of Ahvaz, Iran

Liver cirrhosis is an end-stage condition fornumerous chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis in Ahvaz, Iran. In a cross-sectional study we have retrospectively evaluated 165 patients from September 1, 1999 until September 1, 2008. Patients with evidence of cirrhosis of the liver seen on abdominal ultrasound were enrolled. The diagnosis was based on clinical, functional and morphological data. The etiological profile was established by determining viral and autoimmune markers, and by metabolic screening. Patients who were not confirmed to be cirrhotic were excluded from this study. All cases were studied to determine etiological factors, complications and disease prognosis. Data were recorded on a questionnaire. A total of 165 patients were studied, of which there were 114[67%] males and 51[33%] females. The mean age was 47 years. The majority of patients [70 cases [42.4%]] had evidence of HBV infection. Of HBs Ag-positive patients, 31[43.2%] were HDV Ab positive with a mean age of 41.6 years. There was no significant difference by sex among cirrhotic patients [p>0.05]. Other cases included 23 [14%] patients with autoimmune hepatitis [AIH], 15[9.1%] had HCV infection, 2[1.2%] had evidence of Wilson's disease and no etiological factors were recorded in 55 [33.3%] patients. Ascites was present in 32% of cases, splenomegaly in 29%, esophageal varices in 38%, fundal varices in 2%, peptic ulcer in 8%, acute variceal hemorrhage in 8%, various grades of hepatic encephalopathy in 1%, and hepatocellular carcinoma in6% of patients. When cirrhotic patients were grouped according to child-pugh classification, 19% were in class A, 30% were in class B, and 51% comprised class C. HBV infection was the major risk factor for cirrhosis in this study and ascites was the most common complication. There were more patients with Child-Pugh class C cirrhosis than thoseinclasses B and A. A multidisciplinary approach for the prevention and control of the increase in HBV infection must be adopted in order to inform the public about the seriousness of its complications and possible modes of transmission.