Is Interstitial Cells of Cajal-opathy Present in Gastroparesis?

Gastroparesis (GP), defined as delayed gastric emptying in the absence of any mechanical obstruction, is a challenging clinical condition, mainly because of limited treatment options. Studies in animal models of delayed gastric emptying as well as patients with gastroparesis revealed depletion or ultrastructural changes of interstitial cells of Cajal (ICC) in the gastric tissue, recently termed ICC-opathy. ICC are the pacemakers of the gastrointestinal tract and are involved in the transmission of the neuronal signaling to the smooth muscles. Therefore, lack of ICC could be one explanation of delayed gastric emptying in gastroparetic patients. How frequently ICC changes are observed in gastroparesis is not yet clear. In this review, the data on gastric ICC counts and morphology in animal models and patients with gastroparesis are discussed.

Lack of association between interleukin 12 C[-1188]A polymorphism and irritable bowel syndrome

Irritable Bowel Syndrome [IBS] is a functional gastrointestinal disorder, characterized by recurrent abdominal pain and altered bowel habits. This study was performed to investigate the important role of interleukin-12 [IL-12] in intestinal inflammation. For this study seventy one patients with IBS and 140 controls were investigated. The allele and genotype frequencies of IL-12 C[-1188]A were determined using polymerase chain reaction with sequence-specific primers. The allele A was more common that the allele C in both groups of patients and controls. There was not any significant difference on IL-12 alleles and genotypes between patients and controls. The AA genotype was the most common genotypes, which was seen in 57.4% of the patients and 51.4% of the controls [p=0.53]. Although frequency of the CC genotype in the control group was lower than the patient group, this difference was not significant [5.7% vs. 11.5%, respectively, p=0.16]. Considering the lack of association between IL-12 C[-1188]A polymorphism and IBS, this cytokine gene polymorphism may not have significant role in the pathophysiology of disease

Extensive subcutaneous emphysema due to colonic perforation following colonoscopy

During colonoscopy, subcutaneous emphysema may occur as a result of colonic perforation into retroperitoneal area. In this report, a 54-year-old woman with sigmoid colon perforation following colonoscopy is described. Subcutaneous emphysema was the first manifestation of the perforation in this case. Initially, the patient received supportive, non-surgical treatment, but due to development of acute abdominal signs and symptoms in later stages, the patient underwent surgical treatment

frequency of non-organ-specific autoantibodies in patients with chronic hepatitis C and its relation with disease severity and response to therapy

Increased levels of non-organ-specific autoantibodies are frequently seen in patients suffering from chronic hepatitis C [CHC]; however, the etiology and its effects on the course of the disease and response to therapy are largely undetermined. Particularly, it seems of utmost importance to define whether this increase is solely an insignificant coincidence or a major finding which have an impact on the course of the disease. Materials and methods: Fifty-two patients with CHC [case group] and 52 aged- and sex-matched IBS patients [controls] were enrolled. The sera of all subjects were checked for non-organ-specific autoantibodies, including antinuclear antibody [ANA], anti-smooth muscle antibody [ASMA], anti-mitochondrial antibody [AMA], and anti-liver/kidney microsomal antibody [ALKM]. All cases underwent a liver biopsy and treated with a 12-month course of combination therapy with interferon and ribavirin. The mean age of cases and controls was 32.8 +/- 12.7 and 31.6 +/- 14.1 years, respectively. The overall frequency of non-organ-specific antibodies was significantly higher in anti-HCV positive patients in comparison with controls [36.5% vs 7.7%, p < 0.001]. Seropositivity of ANA and ASMA was significantly higher in patients with CRC than in controls [11.5% vs. 1.9%, p < 0.05 and 13.5% vs. 1.9%, p < 0.027, respectively]. There was no significant relationship between seropositivity of different autoantibodies and patients' age and sex, duration of disease and serum aminotransferases levels. Nor this seropositivity had significant relationship with grade and stage of the liver disease and response to treatment, while serum globulin level was significantly higher in ANA positive patients. Seroprevalence of ANA and ASMA seems to be higher in patients with CHC but its impact on the severity of disease and response to therapy is the subject for further investigations. Keywords: Hepatitis C, Autoantibody, Response to treatment, Aminotransferases

Mortality resulting from poisoning with depilatory agent in patients who referred to Loqman Hakim hospital

Traditional depilatory agent has been rarely used as a means of suicidal attempt in Iran. Its complications arise from its corrosive effect, and systemic arsenic intoxication. This study was conducted to assess intoxication and mortality rate with depilatory agent in 1370-1382. In this retrospective study we collected published statistics from poisoning department of Loqman Hakim hospital and analized the patients' registries. The number of poisoned patients' referred to Loqman Hakim hospital increased from 12000 in 1370 to 24000 in 1382. Meanwhile the relative frequency of poisoned patients with depilatory agent in comparison to all of the poisoning in mentioned time was decreased [0.6% in 1370 to 0.4% in 1382]. 97% of patients used it for suicide attempt. During these years mortality rate from poisoning increased from 0.99% in 1370 to 1.27% in 1382, but mortality rate from depilatory agent decreased from 22% to 5.7%. After 1377 no case of surgery has been observed as a treatment whereas during previous years about 20% of patients need surgery. Elimination of arsenic from depilatory agent caused in decreasing of complications [Including surgical intervention] and mortality rate among the poisoned with this substance

Gastrointestinal complications in two patients with common variable immunodeficiency

Common variable immunodeficiency [CVID] is a primary immunodeficiency disease characterized by hypogammaglobulinemia and recurrent bacterial infections especially in respiratory and gastrointestinal systems. We present here 2 cases of CVID with gastrointestinal complications. Case 1 is a 25-year-old man with a history of chronic diarrhoea from childhood. Ultrasonography revealed ascites, with liver size smaller than normal. Liver biopsy showed non-specific hepatitis. Lymphoid proliferation and Histiocytosis were reported in his ascites cytology. Moreover friability in colonoscopy due to moderate active chronic colitis was detected. Case 2 is a 26-year-old man with chronic diarrhoea since 8 years. Abdominal sonography revealed increased liver echogenicity, increased liver size, and some enlarged lymph nodes beside pancreas. Colonoscopy revealed friability and decreased vascularity while biopsy showed moderate active chronic colitis. Lymph node biopsy showed unusual immunologic reaction. Moreover, small bowel transition test showed nodularity. CVID should be considered in any patient with gastrointestinal manifestations especially chronic diarrhoea in association with recurrent bacterial infections in other organs. Diagnostic delay results in more morbidity and complications in untreated patients

efficacy and side effects of therapy peginterferon alpha-2a [pegasys] combined with ribavirin in chronic hepatitis C patients: an open label clinical trial

Background and aims: peginterferon alpha-2a is a known standard therapy for patients with chronic HCV infection. However, efficacy and safety of this treatment is still unclear in regional settings. This study was designed to clarify efficacy and safety of peg-interferon based therapy in Iranian patients

Methods: 23 patients were treated with Peginterferon alpha-2a in combination with ribavirin for 48 weeks. The patients were observed for adverse effects and response to therapy during treatment and 24 weeks after the end of therapy

Results: early virologic response, end of treatment response, and sustained virologic response rates were 86.9 % [20/23], 82.6 % [19123], and 78.3 % [18123] respectively- The most common adverse effects in descending order were flue-like symptoms [74%], mood changes [48%], and weight loss [43%]

Conclusion: combination therapy with Peginterferon alpha-2a and ribavirin for 48 weeks is an effective treatment with minimal adverse effects