Clinical Phenotype and Disease Course of Inflammatory Bowel Disease in Iran: Results of the Iranian Registry of Crohn's and Colitis (IRCC).

BACKGROUND: Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East. METHODS: We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries. RESULTS: In total, 9746 patients with ulcerative colitis (UC) (n=7793), and Crohn's disease (CD) (n=1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of stricturing behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF). CONCLUSION: In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations.

The chemokine CCL28 is elevated in the serum of patients with celiac disease and decreased after treatment.

Accumulating evidence show that many inflammatory cytokines are involved in pathophysiology of celiac disease (CD). CCL28 known as mucosa associate epithelial chemokine (MEC) is produced by mucosa and chemoattracts IgA-producing B cells into the mucosa. However, its levels in patients with CD have not yet been elucidated. CCL28 levels and anti-tTTG (IgA) were detected in the serum of 28 new cases of CD, 32 cases of treated patents and 32 normal individuals by Elisa. Moreover, the effect of gluten on intestinal cells, Caco-2, was examined by RT-PCR. Our data show that (i) the levels of CCL28 is significantly higher in patients with CD than normal individuals, (ii) CCL28 levels is reduced in patients with CD who had gluten-free diets. Accordingly, we observed that CCL28 expression is upregulated in a dose-dependent manner when the Caco-2 cells were cultured in the presence of gluten. In conclusion, gluten enhances CCL28 expression and that CCL28 could be a novel biomarker for diagnosis and following up the patients with CD. However, further investigation in a larger number of patients is required.

Evaluation of trace element concentration in cancerous and non-cancerous tissues of human stomach.

Gastric cancer has a high mortality rate in west of Iran. Various environmental elements are proposed as cancer risk factors including trace elements. Trace elements can induce initiation or progression of carcinogenesis via oxidative stress and DNA injury. The aim of this study was to measure and compare some trace element concentration (Ca, Cu, Fe, As, Mg, Ni, Cd and Cr) in gastric cancer tissues and normal tissues. For this purpose, 35 patients with gastric cancer and 30 without any cancer were biopsied. Biopsies were taken from cancerous tissue and non-cancerous tissue of gastric cancer patients and gastric tissue of normal patients. The analysis of trace elements was performed using Inductively coupled plasma mass spectrometry (ICP-MS). Data analysis was carried out using SPSS and STATA 12 software. The research found that the concentrations of Fe, Mg, and As were higher in cancerous tissues compared with non-cancerous tissues whereas Cr, Cu, Ca, and Ni concentrations were higher in non-cancerous tissues of cancerous patients. When comparisons were made for cancer and normal samples, copper was the only metal, which was significantly higher in cancerous samples (p < 0.05) and Cr mean concentration in normal tissues was significantly higher compared with cancerous tissues (P = 0.02). Chi-Square test showed that there was no significant relationship in the demographic information between cancerous and normal patients except for location with K2 = 7.604. Increased Cu and As concentration in gastric patients (both tissues) propose that these elements may have carcinogenic effects, although further study is suggested.

Efficacy of Zinc Sulfate in Peptic Ulcer Disease: A Randomized Double-Blind Clinical Trial Study.

INTRODUCTION: Peptic ulcer is a common disease that affects millions of people worldwide. Considering its global prevalence finding new approach for treating is important. AIM: The aim of this study was to investigate the effect of zinc sulfate on gastric and duodenal ulcer treatment. MATERIALS AND METHODS: This double-blind clinical trial study was done on 90 patients who were admitted to the gastrointestinal endoscopy clinic of Tohid hospital in Sanandaj, Iran. All patients were diagnosed with gastric and duodenal ulcers. They were randomly divided into two-intervention and control groups, using block randomization with block sizes of 4. Patients and researcher were unaware of the grouping. To assess the level of zinc, blood samples were taken. In case of positive Rapid Urease Test (RUT), triple therapy regimen including amoxicillin, clarithromycin and omeprazole was administered for two weeks. For intervention group in addition to "triple therapy", an oral dose of Zinc Sulfate 220mg capsules were administered daily, while the control group received placebo capsules. RESULTS: A total of 54.5% and 57% of the patients in the intervention and control groups had gastric ulcer respectively. The Rapid Urease Test (RUT) result of 72.7% of intervention group and 83.3% of control group was positive (p = 0.24). Serum zinc level of 20.9% of intervention group and 35.7% of control group was lower than the normal level (p = 0.13). The mean of serum zinc level of intervention group and control group were 81.9 and 78.9 mg dL respectively (p = 0.4). After intervention, peptic ulcer in 81.8% of the intervention group and 83.3% of the control groups were improved (p= 0.85). Response to treatment were higher in patients with normal zinc levels compared to patients with abnormal levels (77.5% vs. 22.5%, p=0.019). CONCLUSION: A daily dose of 220mg zinc sulfate was not significantly effective on peptic ulcer. However, patients with normal zinc levels had better ulcer treatment.

The value of endoscopic ultrasound in a 47-year-old man with cystic lesions of the liver and pancreas.

Most neuroendocrine tumors (NETs), like other tumors, are clinically silent, producing symptoms only as a consequence of tumor growth. Pancreatic NETs account for only 1% of pancreatic cancers by incidence, while representing 10% of all pancreatic cancers by 28-year limited duration prevalence. Here, we present a 47-year-old man with abdominal pain, icterus, itching and 8 kg weight loss during 5 months. Elevated liver enzymes, direct bilirubin and alkaline phosphatase were observed. Magnetic resonance cholangiopancreatography showed a prominence at the head of the pancreas and also liver cysts. Endoscopic ultrasound of the pancreas was performed and a specimen was obtained via fine needle aspiration. Immunohistochemical staining was performed and the result was compatible with NET. The patient referred to receive chemotherapy.

Primary sclerosing cholangitis associated with elevated immunoglobulin-g4: a preliminary study.

Background. Immunoglobulin IgG4-associated cholangitis (IAC) disease is a systemic disease histologically characterized by extensive T lymphocytes and IgG4 positive plasma cell infiltration in various organs. Prevalence of IAC in PSC patients was reported to be between 7% and 11.6% in a few previous studies. This study was carried out to evaluate frequency of serum IgG4 level in PSC patient referred to the gastroenterology ward of Taleghani educational hospital in Tehran, Iran. Material and Methods. This study was a prospective analytical cross-sectional study. Clinical presentation, laboratory values, imaging changes, inflammatory bowel disease (IBD), esophageal varices, ascites, and child score in newly PSC patients with elevated IgG4 were determined and compared with PSC patients with normal levels of IgG4. Data was analyzed by using SPSS software. The frequency and standard deviations were calculated. Differences among groups were evaluated by using the chi-square, fisher exact, and Mann-Whitney U tests. Results. 34 patients with PSC were examined in the study period, of which 9 cases (26.5%) had high IgG4 levels. Most of the patients were male, 23 cases (67.6%) and nonsmoker, 26 cases (76.5%). Patient average age was 47 years old (range 21-67 years). There was not any significant relationship among patients with IAC and PSC patients in terms of variables such as age, smoking, presence of IBD, ascites, esophageal varices, child score, and imaging findings (P > 0.05). Conclusion. IAC should be suspected in cases of unexplained biliary strictures with increased serum IgG4. Testing PSC patients for IgG4 and treating those who have high levels with corticosteroids in clinical trials should be considered in future studies.

A 12 year old boy with recurrent episodes of pneumonia: triple A syndrome.

Triple A syndrome (Allgrove syndrome) is a rare inherited autosomal recessive disease with a typical triad including adrenocorticotrophic-hormone-resistant glucocorticoid insufficiency, reduced or absent tearing (alacrima) and achalasia and a wide range of symptoms can be detected due to multi organ involvement. This report describes the case of a Triple Asyndrome, a12 year-old boy with a history of recurrent episodes of pneumonia and growth retardation due to failure to timely diagnosis of his problem.

Comparing the performance of QuantiFERON-TB Gold and Mantoux test in detecting latent tuberculosis infection among Iranian health care workers.

OBJECTIVES: The risk of transmission of Mycobacterium tuberculosis from patients with tuberculosis to health care workers (HCWs) has been well documented but little is known about the prevalence of latent tuberculosis infection (LTBI) in Iranian HCWs. The aim of this study was to determine the prevalence of LTBI among HCWs by using IFNgamma-release assay and compare the results with those of tuberculin skin test (TST). METHODS: Two hundred HCWs were evaluated with both TST and QuantiFERON-TB Gold In Tube test (QFT-GIT). The obtained data were analyzed by SPSS v.16 Software. RESULTS: The participants were 73 males and 127 females with the mean age of 34.36±8.26 years. TST was positive in 105 cases (52.5%) and the QFT results were positive in 17 cases (8.5%). There was poor agreement between the two tests (53%, κ = 0.115). Induration diameter of TST ≥ 10 mm and working duration ≥ 10 years were independent predictors for positive QFT (p = 0.004). CONCLUSIONS: Due to the fact that BCG vaccination has been administered routinely to all HCWs in Iran, specific tests should be introduced for high risk groups. QFT thus seems to be more effective for LTBI diagnosis than TST among HCWs with BCG immunization history.