A web-based patient education system and self-help group in Persian language for inflammatory bowel disease patients.

BACKGROUND AND AIMS: To study the use patterns of a Persian web-based patient education system for inflammatory bowel disease (IBD) patients in Iran. METHODS: A web-based patient education system was developed with Persian content in three sections: general, ulcerative colitis (UC), and Crohn's disease (CD). The website included a forum for patients to communicate as a self-help group. A customized web tracking system recorded web use statistics. Polls at the bottom of each page collected the visitors' opinion on the extent of helpfulness and readability of page contents. Web use data were analyzed for an 18-month period from October 2004 to April 2006. RESULTS: Having excluded page visits from search engine robots, the website's homepage was visited 4452 times (mean of monthly visits: 234, range: 102-330). The web pages titled Anatomy of gastrointestinal system, Nutrition in IBD, Diagnostic tests, How to cope with IBD, and IBD in women were the most favorite in general section. The web page titled IBD treatment was the most visited in both CD and UC sections followed by the web pages on cause of disease, diagnostic procedures and complications in CD section; and those titled symptoms, cause of disease and risk factors in the UC section. Overall, the content evaluation polls received 294 hits (from 186 unique visitors) of which, 196 (67%) were from patients, 30 (10%) from patients' relatives/friends, 21 (7%) from doctors, and 47 (16%) from other groups. During the 18-month period, 47 patients registered in the self-help forum, 24 threads were opened, and 97 posts (33 in CD and 64 in UC section) were sent. CONCLUSIONS: Considering the increasing trend of Internet use in developing countries like Iran, and the consequent increase in the proportion of Internet-using patients, and finally the time constraints gastroenterologists face answering patients' questions; similar websites seem to be effective ways of patient education in close future.

High prevalence of reflux oesophagitis among upper endoscopies of Iranian patients.

BACKGROUND AND AIM: To reinvestigate the prevalence of reflux esophagitis among upper endoscopies in a series of Iranian patients, considering the high prevalence of reflux esophagitis (76%) reported by an earlier Iranian study and the scanty data regarding prevalence of gastroesophageal reflux disease from Iran and the Middle East. METHODS: Patients referred for upper endoscopy to an outpatient gastroenterology clinic in Tehran (May 2005-January 2006) were interviewed using a questionnaire before endoscopy. Gastroesophageal reflux disease was defined as having any degree of reflux esophagitis on endoscopy, or having heartburn or regurgitation on a weekly basis during the preceding 3 months. Reflux esophagitis was diagnosed and graded using Los Angeles classification. Check-up patients were excluded. Gastroesophageal reflux disease, nonerosive reflux disease, and reflux esophagitis groups were compared with non-gastroesophageal reflux disease patients with regard to the following factors: sex, age, body mass index (BMI), hiatus hernia, smoking, alcohol use, and level of education. RESULTS: Out of 501 consecutive patients undergoing upper endoscopy (195 men, 306 women; mean+/-SD of age, 44.7+/-15 years; mean+/-SD of BMI, 24.9+/-4.4), 50 and 48% had reflux esophagitis with and without exclusion of the patients on acid-suppressing drugs in the past 2 weeks, respectively. Most had grade A (90%) or B (9%) reflux esophagitis. Only one patient (0.2%) had Barrett's esophagus. By Rome-II criteria, 116 had dyspepsia symptoms (predominant), of whom 41% had reflux esophagitis. High BMI (>25) and hiatus hernia both showed statistically significant associations with gastroesophageal reflux disease, whereas nonerosive reflux disease and reflux esophagitis were associated only with high BMI and hiatus hernia, respectively. Although the nonerosive reflux disease patients were of a lower education level than non-gastroesophageal reflux disease patients, no significant association of education level with gastroesophageal reflux disease and reflux esophagitis was found. CONCLUSION: This study showed a significantly higher prevalence of reflux esophagitis among Iranian upper-endoscopy outpatients compared with the findings of non-Iranian studies.

A cost analysis of functional bowel disorders in Iran.

BACKGROUND AND AIMS: The objective of this work is to evaluate the health care utilization and cost of different types of functional bowel disorder (FBD) in a population of Iranian patients and compare the costs in consulters and non-consulters. MATERIALS AND METHODS: A consecutive sample of 1,023 patients in an outpatient gastroenterology clinic in central Tehran were interviewed, using two questionnaires based on the Rome II criteria, from December 2004 to May 2005 to detect FBD patients and to determine the frequency of health resource utilization (physician visit, hospitalization, laboratory tests, imaging studies, and drugs) and productivity loss (days off work or with low functionality) due to FBD symptoms in the past 12 months. Societal perspective was used and cost per person per year was estimated in purchasing power parity dollars (PPP$). RESULTS: The direct costs (for consulters, non-consulters; data presented in this order) were: irritable bowel syndrome (IBS; $92.04, $1.04), unspecified functional bowel disorder (FBD; $100.94, $0.39), functional constipation ($57.23, $1.04), and functional abdominal bloating ($71.35, $0.63). Indirect costs (for consulters, non-consulters) were: IBS ($811.85, $669.09), unspecified FBD ($705.85, $263.47), functional constipation ($587.48, $97.49), and functional abdominal bloating ($147.88, $38.60). Total yearly costs of IBS and functional constipation for urban adult population of Iran were roughly estimated at 2.94 billion PPP$ and 89.2 million PPP$, respectively. CONCLUSIONS: As proven in developed countries, FBD and especially IBS seem to put a heavy burden on the economy of a developing country like Iran. Further population-based studies are needed for more precise estimations.

Symptom patterns and relative distribution of functional bowel disorders in 1,023 gastroenterology patients in Iran.

BACKGROUND AND AIMS: There are scanty data on functional bowel disorder (FBD) patterns in Iran. This first-time study tried to provide preliminary data on relative distribution of different types of FBD and their symptom patterns in Iranian patients. METHODS: A consecutive sample of 1,023 patients in an outpatient gastroenterology clinic in central Tehran was interviewed using two questionnaires based on Rome II criteria from December 2004 to May 2005 to detect FBD patients. RESULTS: Of 1,023 gastroenterology patients, 410 met Rome II criteria for FBD; functional constipation, 115 (28%); irritable bowel syndrome (IBS), 110 (27%) [IBS-C, 29%; IBS-D, 11%; IBS-A, 60%]; functional bloating, 102 (25%); unspecified FBD, 76 (18%); and functional diarrhea, 7 (2%). FBD had no association with age or level of education, while it was more frequent in women (P=0.001). FBD was also more frequent among those with a history of abdominal/pelvic surgery (P=0.021). IBS patients had a lower mean of age compared with non-FBD group, while patients with constipation were older (Mann-Whitney U test, P=0.006). Constipation-related symptoms were the most frequent symptoms among IBS patients. Constipation (<3 defecations/week) was also the most frequent change in bowel habit in bloating and unspecified FBD patients. Fourteen percent of IBS consulters and 8.7% of functional constipation consulters met Rome II criteria for dyspepsia (disregarding the ruling out of upper gastrointestinal organic disease). Only 20% of patients with functional constipation were consulters. CONCLUSIONS: Population-based studies at provincial levels are essential to clarify FBD patterns in each provincial district in the country.

A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer.

BACKGROUND: Gastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran). The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients. METHODS: In this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day. RESULTS: No statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p < 0.003). Moreover, rebleeding rate was significantly lower in omeprazole group (15%) than in cimetidine group (50%) (p < 0.001). CONCLUSION: This study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074), shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization.

Knowledge of disease and health information needs of the patients with inflammatory bowel disease in a developing country.

BACKGROUND AND AIMS: This study was performed to have a first-time assessment on the knowledge level of a population of inflammatory bowel disease (IBD) patients in a developing country like Iran and to identify their health information preferences. METHODS: One hundred over 18-year-old IBD patients presenting to an outpatient gastroenterology clinic in Tehran from April to November 2004 were asked to complete Persian-translated version of 24-item Crohn's and Colitis Knowledge (CCKNOW) score questionnaire and an additional questionnaire collecting their favorite disease-related knowledge topics. RESULTS: All of the patients (64 females, 36 males) wished to know more about their disease. The cause of IBD and the medications were the most favorite knowledge topics. The mean and median of CCKNOW score of the patients was 4.65 and 4.0 (out of 24), respectively. Women showed significantly higher scores than men (p=0.006). There was also a weak positive correlation between the level of education and CCKNOW score (Spearman's rho=0.23, p=0.02). No significant correlation was found between age, duration of disease, self-estimated level of suffering from disease, and CCKNOW score. The most severe knowledge deficit was evident in knowledge on IBD complications. CONCLUSION: Despite the overt inclination of Iranian IBD patients to know more about their disease, their knowledge levels were significantly lower than the IBD patients in developed countries. The more profound knowledge deficit in IBD complications may lead to disastrous aftermaths such as late diagnosis of colorectal cancer induced by prolonged IBD. Vigorous patient education programs for the Iranian IBD patient are suggested focusing on areas of knowledge deficit and their favorite topics.

Internet use by a referral gastroenterology clinic population and their medical information preferences.

BACKGROUND: Internet use is growing rapidly in Iran. However, little is known about the rate of Internet access and Internet use habits of gastroenterology patients and their health information preferences in the country. METHODS: A two-part questionnaire was presented to a convenience sample of 401 consecutive outpatients (mean age: 43.7 years) of a referral gastroenterology clinic in Tehran from February 21 to March 13, 2004. RESULTS: Of all literate patients (92%), 62% self-estimated their disease-related knowledge as nothing to little. The most common sources of information were media (62%) and printed materials (58%). Printed material (57%) and media (35%) were the most preferred means of receiving health information; the Internet was the most preferred means among Internet users and almost all of them were interested in getting online medical services. The cause (65%) and treatment (56%) of disease were the most favorite knowledge topics. Of all patients 28% could use Internet. Males, more educated and younger subjects were more likely to use the Internet. Of the Internet users, 37% had already performed at least one search for medical information. CONCLUSION: Though Internet is not yet a popular means of patient education in Iran, considering the speedy growth of Internet use and its undeniable advantages and prospects in a young country like Iran, it seems wise for private and public health sectors to start more vigorous planning to develop web-based patient education systems run by trusted bodies and encourage and cultivate its use among patients.

An economic analysis of premarriage prevention of hepatitis B transmission in Iran.

BACKGROUND: To assess the economic aspects of HBV (hepatitis B virus) transmission prevention for premarriage individuals in a country with cultural backgrounds like Iran and intermediate endemicity of HBV infection. METHODS: A cost-effectiveness analysis model was used from the health care system and society perspectives. The effectiveness was defined as the number of chronic HBV infections averted owing to one of the following strategies:1) HBsAg screening to find those would-be couples one of whom is HBsAg positive and putting seronegative subjects on a protection protocol comprising HBV vaccination, single dose HBIG and condom protection.2) HBsAg screening as above, in addition to performing HBcAb screening in the HBsAg negative spouses of the HBsAg positive persons and giving the protocol only to HBcAb negative ones.Sensitivity and threshold analyses were conducted. RESULTS: The cost of each chronic infection averted was 202$ and 197$ for the strategies 1 and 2, respectively. Sensitivity analysis showed that strategy 2 was always slightly cheaper than strategy 1. The discounted threshold value for the lifetime costs of chronic liver disease, above which the model was cost saving was 2818$ in strategy 1 and 2747$ in strategy 2. CONCLUSIONS: Though premarriage prevention of HBV transmission in the countries with cultural backgrounds similar to Iran seems cost saving, further studies determining precise costs of HBV infection in Iran can lead to a better analysis.