Colorectal neoplasms in symptomatic patients without evidence of bleeding: a prospective study in an Iranian population.

BACKGROUND: Colorectal cancer (CRC) is a preventable disease with a high mortality and morbidity. Data on its prevalence are lacking in Iran, as well as for adenomatous polyps. This study was conducted to estimate prevalence of CRC in patients with long lasting colonic symptoms (except for known risk factors for cancer and those with rectal bleeding) who underwent total colonoscopy. METHODS: This prospective study was carried out in Imam Hospital, Tabriz University of Medical Sciences, Iran. The recruitment procedure involved 228 individuals aged more than 30 who visited a gastroenterologist because of lower gastrointestinal tract symptoms and had criteria for a colonoscopy. The endoscopist visualized the caecum in all, documented by a photo of caecum and/or specimen of the terminal ileum. The Chi square test and multiple logistic regression analysis were used to determine the significance of associations between different symptoms and colonoscopic findings. RESULTS: Thirty four subjects (14.9%) were found to have colorectal neoplasia and 112 (49.1%) had a completely normal colon. Adenomatous polyps were detected in 27 patients, which included 15.6% of men and 7.0% of women. Most of them were tubular (58.3%) and severe dysplasia was reported in only 3 cases (11.1%). Mean age of patients with a polyp (51.1+/-12.5 years) was not significantly different compared to others (p=0.381) nor mean duration of symptoms (21.1 months, p=0.435). Cancer was detected in 7 (3.1%) of our study population, the mean age of 65.7+/-6.0 years in this case being significantly elevated (p<0.0005). None of the symptoms were predictors of cancer or polyps. This result was the same by a multivariate analysis including age, gender and duration of the symptoms. CONCLUSION: The low prevalence of colorectal neoplasms as well as the less advanced pattern of adenomas in Iran are compatible with other data from Asia and the Middle East, contrasting with western countries.

Clinicopathologic characteristics of esophageal cancer patients in northwest Iran--very low incidence of adenocarcinomas.

AIMS: Iran is one of the known countries with a high incidence of esophageal cancer in Asia .We have recently shown that the incidence of Barrett's esophagus, a precancerous lesion for esophageal adenocarcinoma (AC) is very low in the northwest of the country. Therefore, we hypothesized that esophageal AC would also be lower than in the Western world. The aim of this study was to assess the clinicopathologic characteristics of esophageal cancer in comparison the data from western populations. METHODS: This mixed (prospective-retrospective) study enrolled 350 consecutive patients with esophageal cancers (216 endoscopically and pathologically documented, including 134 surgically proven cases) from May 2000 to May 2006, in our referral center in Tabriz, in the northwest of Iran. We localized the tumors in esophagus and esophago-gastric junction. Type III gastric cardial cancers were excluded. RESULTS: The mean age of the patients was 61+/-12.36 (min 16, max 83). The male to female ratio was almost equal (51.7% vs 48.3%). The lower third of the esophagus was involved in 62% of the patients and esophageal ACs accounted for 18.9% of the cases. However, distinct esophageal adenocarcinomas was only seen in two and in the remainder gastric cardia was also involved. SCC was more frequent in females, and adenocarcinoma in males (x 2=8.89, df=2, p=0.012. Among 134 operated cases, resection was feasible in 74.6%. CONCLUSION: In this Iranian population, the incidence of esophageal adenocarcinoma is very much lower than in Western countries.

Distribution of cancer and adenomatous polyps in the colorectum: study in an Iranian population.

OBJECTIVE: There is consensus that the majority of colorectal carcinomas (CRCs) arise from adenomatous polyps. Therefore, for management of colorectal cancer, diagnosis and endoscopic resection of adenomas is advised. If the same etiologic factors are operating for polyps and cancers their anatomical distributions should be the same. The present study was conducted to determine whether the distribution of adenomas is consistent with that of CRCs and for comparison with other studies, especially in Western populations. MATERIALS AND METHODS: We reviewed, retrospectively , endoscopically reported anatomic sites of all adenomatous polyps and CRCs which were histologically confirmed from Jan 1992 to Dec 2005 in Tabriz, the North-west of Iran. One hundred and forty-three CRC's and 180 adenomatous polyps (in 145 patients) were found. Patients with polyposis syndromes were excluded the analysis. Age and sex of patients, size and anatomic sites of polyps and cancers were studied. RESULTS: The average ages of patients with adenomas and cancers were 46.3(SD 14.7) and 53.9(SD 13.3)years, with 55.5% and 62.2% in males, respectively. In both cancer and adenoma cases the most common presenting symptoms were rectal bleeding and bloody diarrhea ( 52.4% , 16.9% and 39.2% , 15.8% for cancers and adenomas, respectively) without any significant difference(0>05). The vast majority of adenomas (85%) and cancers (81.7%) were left sided (p>0.05). The propensity for polyps to be found in the descending colon was of borderline significance (p=0.07). The cecal segment uniquely demonstrated cancers(p=0.01) without any polyps. CONCLUSION: A similar anatomic distribution pattern and left shift of colorectal adenomas and cancers in this Iranian population is compatible with most other Asian countries. However, because of the occurrence of the neoplasms in the right colon total colonoscopy should still be considered for screening purposes.

Endoscopic and histologic findings in Iranian patients with heartburn.

BACKGROUND: Heartburn is a common manifestation of gastroesophageal reflux disease. Barrett's esophagus and esophageal adenocarcinoma, known complications of this disease, appear to be less prevalent in Asia than in Western countries. We looked for endoscopic and histologic evidence of Barrett's esophagus in Iranian patients with heartburn. METHODS: During September 2001 to September 2003, endoscopy was done in all patients with heartburn, either lasting longer than 3 months (n=1182) or for 1-3 months but resistant to 4 weeks of omeprazole therapy (n=66). Biopsy was taken from columnar-lined mucosa above the GE junction, at 5 cm above the Z line in normal- appearing mucosa, and from any abnormal areas. RESULTS: Of the 1248 patients (mean age 45 [SD 15.5] years, 750 men; duration of heartburn 68 [SD 87.5] months), 960 (66.5%) had erosive esophagitis and 30 (2.4%) had Barrett's esophagus, including 10 and 20 with long- and short-segment involvement, respectively. Of 134 patients with normal-appearing mucosa, 122 had histologic evidence of esophagitis. CONCLUSION: Barrett's esophagus may be less common in Iran than in Western countries, despite presence of severe heartburn and erosive esophagitis.

Demographic and anatomical survey of colorectal polyps in an Iranian population.

OBJECTIVE: Asian countries generally have low incidences of colorectal cancers (CRCs). One approach to prevention is based on recognition and removal of polyps. The aim of this study was to determine basic demographic features, anatomic distribution and characteristics of colorectal polyps in a local Asian population for comparison with western data. METHODS: We here performed a retrospective chart review of 194 patients with colorectal polyps detected by endoscopy [total colonoscopy in 136 cases (73.1%), and flexible sigmoidoscopy in the remainder] during 1992-2005, focusing on descriptive statistics for categorical variables, including distribution pattern and histology. Cold biopsy in 14 cases, piecemeal endoscopic resection in 5 patients, and usual snare polypectomy in the remainder were performed. Patients with polyposis syndromes were excluded from the analysis. RESULTS: The average age of patients was 43.2 yr (range 2-80) with 71% being males. Most of the polyps were presented in 5th decade (p=0.029). A total of 32 (17.2%) had synchronous proximal polyps (15% adenomas), and 154 cases had solitary polyps. The vast majority of the polyps were left sided and the most frequent type was adenoma (63%), with a villous component in 37.1%. Coexistent cancer was seen in 10.9% of cases. CONCLUSION: In this Iranian population, the majority of polyps are left sided. The incidence of adenomas and their histology appear comparable to data for western patients, but with a significantly lower rate for synchronous neoplastic lesions.