[Prevalence of Helicobacter pylori and intestinal metaplasia in consecutive gastritis patients; over the period of 7 years]

Helicobacter pylori [H. pylori] is the cause of most cases of peptic ulcers and gastric cancers and cause some of the most important cause of stomach cancer and lymphoma. The objective of this study was to evaluate the time trend of Helicobacter pylori prevalence and presence of intestinal Metaplasia over the period of 7 years in gastritis Iranian patients

Materials and Methods: In this cross-section study data related to H. pylori and intestinal Metaplasia [IM] among 14,860 consecutive gastritis patients, who referred to the gastrointestinal department of Tehran's Taleghani Hospital in Iran, was examined across the sex and age group

Results: The overall prevalence rate among patient with H. pylori infection was 83.5% [12406/14860] and 11,394 [84.1%] of them were related to the gastritis. The prevalence rate of H. pylori among patient with gastritis significantly higher [p<0.05] compared to patients without gastritis. In addition, the prevalence decreased with age while the presence of intestinal metaplasia increased with age [p<0.05]

Conclusion: The results of this study showed that the prevalence of H. pylori infection in Iranian population has declined in recent years; nevertheless it seems to be highly prevalent in Iran. We also find a significant positive relationship between H. pylori infection and IM with gastritis. There is no association between sex and infection but in contrast with the most studies its prevalence decreased with age

Lack of BRAF-V600E mutation in stage I and II of colorectal cancer

Aim: We aimed to explore the frequency of BRAF V600E mutation in Iranian patients with colorectal cancer [CRC] as well as its association with clinic pathological characteristic of patients

Background: CRC is the third leading cause of cancer related death. There is a growing body of data showing the association of BRAF V600E mutation with malignant transformation and clinical outcome of different tumors, including CRC. These findings suggest that BRAF V600E mutation can be used as diagnostic and/or prognostic biomarker for management of cancer patients

Patients and methods: A total of 85 patients with sporadic tumor were recruited. Braf V600E mutation was investigated using sequencing of extracted DNAs from formalin-fixed paraffin-embedded [FFPE] tumor tissues. Electropherograms were analyzed using Laser-gene 6 software

Results: More than 95% of patients were in stage I and II and none of them were in stage IV. Patients were mostly below 55 years old and tumors were dominantly located in the distal colon. Of note, no BRAF V600E mutations were detected in our population

Conclusion: Our results showed no V600E mutation in the BRAF gene in stage I and II of CRC patients. Further studies in multi-center settings are warranted to examine the prognostic and/or predictive value of this marker in different stages of colorectal cancer patients

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

experimental model of colitis induced by dextran sulfate sodium from acute progresses to chronicity in C57BL/6: correlation between conditions of mice and the environment

Aim: To induce acute colitis progresses to chronicity in C57BL/6 mice by dextran sulfate sodium

Background: Murine models are essential tools to understand IBD pathogenesis. Among different types of chemically induced colitis models, the dextran sulfate sodium [DSS]-induced colitis model is the most common model of IBD, due to its simplicity

Patients and methods: Male C57BL/6 mice 6-8 weeks old, were collected and matched by age with controls. C57BL/6 mice treated with 2 cycles of 3.5% DSS for 4 days and 4 days of pure water between each cycle. After that, mice were sacrificed and the entire colon was removed. Small sections of the colon were fixed in formaldehyde, embedded in paraffin and sectioned with a microtome. Sections were stained with hematoxylin eosin to analyses the degree of inflammation

Results: After the first cycle oral administration of DSS, mice with severe and visible rectal bleeding and diarrhea entered into the acute phase. After day 4-5, bleeding and diarrhea were improved and mice entered into the chronic phase with peak levels of weight loss. Macroscopically, the inflammation was predominantly located in the distal colon. Microscopically, examination of the distal colon sections showed a decrease number of goblet cells, loss of crypts, signs of surface epithelial regeneration and moderate to severe infiltration of inflammatory cells in the mucosa

Conclusion: In order to achieve an experimental colitis model, our protocol is recommended for future therapies in IBD experimental modeling

Duodenal adenocarcinoma might be the cause of intractable nausea and vomiting in patient with coeliac disease

Coeliac disease [CD] is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease [CD]. We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year, presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy

[DNA microsatellite instability and mismatch repair germ line mutation in Iranian patients with hereditary non-polyposis colorectal cancer]

HNPCC [hereditary non-polyposis colorectal cancer] is the most common type of hereditary colorectal cancers. Germ line mutations in different DNA mismatch repair genes [MMR] and microsatellite instability [MSI] are associated with HNPCC. But still there has not been any report from Iran. The purpose of this study is to evaluate MSI and MMR gene mutation among a group of Iranian patients with the clinical diagnosis of HNPCC. In this cross-sectional study 94 patients [m/f=1.41] who fulfilled at least on of the Bethesda criteria were assessed. MSI analysis was performed in all cases. SSCP was used as screening test in all cases to select highly probable MMR mutation for DNA sequencing. Information analyzed by Chi2, Fisher exact, independent t-test with SPSS16 and EPI6 soft wares. MSI analysis shows 41.5% MSI-H, 17% MSI-L, and 41.5% MSS in this study. There were 18 [19.1%] band shift in SSCP results, which was include 8 mutations after DNA sequencing. The pattern of MMR mutations in Iranian patients differs from the reports of other countries. The evaluation of the histopathology and clinical features of colorectal cancer burdens in Iran and also the frequency additional HNPCC genes remain as a point of concern

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

[ case report of rare colorectal adenocarcinoma with skin metastasis presentation]

Skin metastasis from abdominal cancers occurs as infiltration or paraneoplastic syndromes. Liver and lung are the most common locations of distant metastases of colorectal cancer [CRC], but CRC skin metastases are very rare. We describe a 55-year old patient with wide spread cutaneous metastasis from a previously treated known case of adenocarcinoma of the colon. Interestingly, liver and lung, as the most common site of metastasis of CRC, had not been involved. Although, skin metastasis is a worse prognostic factor, its occurrence in CRC patient doesn't necessarily present end stage disease. So, it could be treated by early diagnosis of susceptible cutaneous lesions

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

[ case report of junctional epidermolysis bullosa with gastrointestinal symptoms]

Epidermolysis bullosa is an uncommon disease with a wide spectrum of severity. Here we report a patient presenting with unusual symptoms. The patient is a 22 years old female with progressive dysphasia and odynophagia to solids and liquids and a history of spontaneously remitting blisters caused after mild trauma from her childhood till she was 13 years old. Subepidermal blisters were diagnosed as junctional type of epidermolysis bullosa by histopathology. Physicians should have a high index of suspicion regarding epidermolysis bullosa in patients presenting with dysphagia and cutaneous blisters

Gastritis cystica polyposa in an unoperated stomach, treated by endoscopic polypectomy

Gastritis cystic polyposa is a rare and peculiar polypoid lesion arising at a gas-troenterostomy site, and almost always on the gastric side. It is characterized by elongation of the gastric foveolae along with hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. Esophagogastroduodenoscopy in a 47-year-old woman without any history of gastric operation revealed a pedunculated polyp approximately 2 cm in diameter, in a background of erythematous gastric folds along the anterior wall of the fundus. Polypectomy was performed, with endoscopic impression of hyperplastic or fundic gland polyp, without any complications. Histopathological findings were consistent within gastritis cystic polyposa[GCP]. A mild Helicobacter pylori colonization in gastric pits was seen. GCP could occur in an unoperated stomach and treated by endoscopic polypectomy. However, removal and histopathologic confirmation of these lesions are necessary

[Three novel germline mutations in the MLH1 mismatch repair gene in patients with hereditary non-polyposis colorectal cancer]

Hereditary non-polyposis colorectal cancer is the most common cause of early onset of hereditary colorectal cancer. In the majority of Hereditary non-polyposis colorectal cancer families, microsatellite instability and germline mutation in one of the DNA mismatch repair genes in clouding MSH2, MLH1, MSH6 and PMS2 are found. The Objective of this study was to determine the involvement of mismatch repair genes mutations in Iranian population, and microsatellite instability profile in patients with colorectal cancer. We analyzed 592 patients with colorectal cancer. The entire coding sequence of each gene was analyzed using direct sequencing. We were able to find three novel MLH1 germline mutations in three Iranian patients suffering from Hereditary non-polyposis colorectal cancer. The first was a transversion mutation c.346A>C [T116P], which occured in the highly conserved HATPase-c region of MLH1 protein. The second was also a transversion mutation c.736A>T [I246L], which caused an amino acid change of Isoleucine to Leucine. The third mutation [c.2145,6 delTG] was frame shift mutation, and resulted in an immature stop codon in five codons downstream. All of these three mutations were detected in MLH1 gene. In all patients, an abnormal expression of MMR proteins was related to the above mutations. MSI assay revealed high instability in microsatellite for two patients and microsatellite stability for one patient. These novel mutations may imply the different characteristics of hereditary non-polyposis colorectal cancer in Iranian population as compared to reports from the western countries