Frequency of Celiac Disease in Patients With Increased Intestinal Gas (Flatulence)

Excessive flatulence which impairs social performance in patients is one of the common reasons for referrals to gastroenterology clinics. Celiac Disease is a rare but important cause of increased intestinal gas (bloating) and if not diagnosed, patients face complications such as malabsorption, anemia, osteoporosis and even intestinal lymphoma. This study aimed to determine the frequency of Celiac Disease in patients with excessive flatulence.One hundred and fifty patients with a chief complaint of experiencing flatulence more than 15 times a day and lasting for three months were referred to the gastroenterology clinic of Rasoul-e-Akram Teaching Hospital. Serological tests for Celiac Disease, Anti TTG Ab (IgA-IgG) were requested and the patients with positive tests underwent upper GI endoscopy. Biopsies of the second part of the duodenum were then sent to the laboratory.From one hundred and thirty patients who completed the study, 92 (70.7) were female. Mean age of the patients was 32 ± 13 years. Anti TTG Ab was found in 5 patients (3.85). Only 2 patients (1.5) had a documented positive pathology for Celiac Disease.According to the results of this study and other studies, we conclude that Celiac Disease is an uncommon etiology for excessive flatulence but it is of importance to investigate it in excessive flatulence patients

Comparison of quadruple and triple Furazolidone containing regimens on eradication of helicobacter pylori

Background: The effectiveness of classic standard triple therapy regimen of helicobacter pylori (H. pylori) eradication has decreased to unacceptably low levels, largely related to development of resistance to metronidazole and clarithromycin. Thus successful eradication of H. pylori infections remains challenging. Therefore alternative treatments with superior effectiveness and safety should be designed and appropriately tested in all areas depending on the native resistance patterns. Furazolidone has been used successfully in eradication regimens previously and regimens containing furazolidone may be an ideal regimen. Methods: H. pylori infected patients with proven gastric or duodenal ulcers and /or gastric or duodenal erosions at Imam Khomeini Hospital in Sari/Northern Iran, were randomly allocated into three groups: group A (OABF) with furazolidone (F) (200 mg bid.), group B (OABM-F) metronidazole (M) (500 mg bid.) for the first five days, followed by furazolidone (F) (200 mg bid.) for the second five days and group C (OAF) with furazolidone (F) (200 mg tid.). Omeprazole (O) (20 mg bid.) and amoxicillin (A) (1000 mg bid.) were given in all groups; bismuth (B) (240 mg bid.) was prescribed in groups A&B. Duration of all eradication regimens were ten days. Eight weeks after treatment, a 14C-urea breath test was performed for evaluation of H. pylori eradication. Results: A total of 372 patients were enrolled in three groups randomly (124 patients in each group); 120 (97) patients in group A (OABF), 120 (97) in group B (OABM-F) and 116 (93) in group C (OAF) completed the study. The intention-to-treat eradication rates were 83.7 (95 CI= 77.3-90.4), 79.8 (95 CI= 72.6-87), and 84.6 (95 CI= 78.2-91.1) and per-protocol eradication rates were 86.6 (95 CI= 80.5-92.8), 82.5 (95 CI= 75.6-89.4), and 90.5 (95 CI= 85.1-95.9) for groups OABF, OABM-F, and OAF, respectively. No statistical significant differences were found in case of severe drug adverse effects between the above mentioned three groups (p> 0.05). The most common side effects, namely nausea and fever, occurred in all groups, but more frequently in group C (OAF) (p< 0.05). Conclusion: In developing countries such as Iran, furazolidone-based regimens can substitute clarithromycinbased regimens for H. pylori eradication because of a very low level of resistance, low cost and high effectiveness. Considering per-protocol eradication rate of ten days OAF regimen, and the acceptable limit of ninety percent, we recommend this regimen in developing countries such as Iran to be substituted of classic standard triple therapy. In order to minimize rare serious adverse effects, one week high dose OAF regimen should be taken into consideration in other studies

Comparison of hepatitis C virus risk factors in genotypes 1a and 3a

Background: One of the most important causes of chronic liver disease is hepatitis C virus (HCV), which causes liver cirrhosis and hepatocellular carcinoma. To control the prevalence of the disease, knowledge and information in risk factor of HCV are required. The aim of this study was to compare the risk factors of infection between HCV patients with genotypes 1a and 3a. Methods: This is an observational analytical study. HCV patients who referred to the clinic of hepatology, Rasoul-e-Akram University Hospital from July 2015 to July 2017, were assigned to the genotype 1a and 3a. Demographic (age, sex, family history), clinical (cirrhosis, hepatocellular carcinoma) and laboratory data, history of intravenous drug and alcohol usage, and history of imprisonment were gathered and compared between two groups. All the patients completed the informed consent form. Data analysis was performed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). P value less than 0.05 was considered statistically significant. Results: Overall, 97 HCV patients were included in this study. Mean age was 45±12 years and 78 (80) of patients were male. Among them, 58 (60) and 39 (40) had genotype 1a and 3a. respectively. History of injection drug usage was recorded in 34/39 (87) of patients with genotype 3a, and significantly higher in genotype 3a as compared to genotype 1a OR adj: 3.1, CI (1.3-6.2). Also, in this study, genotype 3a was significantly recorded in younger patients OR adj: 1.7, CI (1.2-4.1). However, cirrhosis and hepatocellular carcinoma was more common in patients with genotype 1a as compared to genotype 3a OR adj: 2.05, CI (1.6-5.4) and OR adj: 2.8, CI (1.3-5.7) respectively. Conclusion: According to the results of this study, hepatitis C virus transmission risk factors differed in genotypes 3a and 1a. Genotype 3a is found among young patients with a history of intravenous drug usage and genotype 1a in patients with cirrhosis and hepatocellular carcinoma. © 2018, Tehran University of Medical Sciences. All rights reserved

Comparison of hepatitis C virus risk factors in genotypes 1a and 3a

Background: One of the most important causes of chronic liver disease is hepatitis C virus (HCV), which causes liver cirrhosis and hepatocellular carcinoma. To control the prevalence of the disease, knowledge and information in risk factor of HCV are required. The aim of this study was to compare the risk factors of infection between HCV patients with genotypes 1a and 3a. Methods: This is an observational analytical study. HCV patients who referred to the clinic of hepatology, Rasoul-e-Akram University Hospital from July 2015 to July 2017, were assigned to the genotype 1a and 3a. Demographic (age, sex, family history), clinical (cirrhosis, hepatocellular carcinoma) and laboratory data, history of intravenous drug and alcohol usage, and history of imprisonment were gathered and compared between two groups. All the patients completed the informed consent form. Data analysis was performed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). P value less than 0.05 was considered statistically significant. Results: Overall, 97 HCV patients were included in this study. Mean age was 45±12 years and 78 (80) of patients were male. Among them, 58 (60) and 39 (40) had genotype 1a and 3a. respectively. History of injection drug usage was recorded in 34/39 (87) of patients with genotype 3a, and significantly higher in genotype 3a as compared to genotype 1a OR adj: 3.1, CI (1.3-6.2). Also, in this study, genotype 3a was significantly recorded in younger patients OR adj: 1.7, CI (1.2-4.1). However, cirrhosis and hepatocellular carcinoma was more common in patients with genotype 1a as compared to genotype 3a OR adj: 2.05, CI (1.6-5.4) and OR adj: 2.8, CI (1.3-5.7) respectively. Conclusion: According to the results of this study, hepatitis C virus transmission risk factors differed in genotypes 3a and 1a. Genotype 3a is found among young patients with a history of intravenous drug usage and genotype 1a in patients with cirrhosis and hepatocellular carcinoma. © 2018, Tehran University of Medical Sciences. All rights reserved

Combination of laser and human adipose-derived stem cells in repair of rabbit anal sphincter injury: a new therapeutic approach

Background: Anal sphincter injury leads to fecal incontinence. Based on the regenerative capability of laser and human adipose-derived stem cells (hADSCs), this study was designed to assess the effects of co-application of these therapies on anal sphincter recovery after injury. Design: Male rabbits were assigned to equal groups (n = 7) including control, sphincterotomy, sphincterotomy treated with laser (660 nm, 90 s, immediately after sphincterotomy, daily, 14 days), hADSCs (2 × 106 hADSCs injected into injured area of the sphincter immediately after sphincterotomy), and laser + hADSCs. Ninety days after sphincterotomy, manometry and electromyography were performed, sphincter collagen content was evaluated, and Ki67, myosin heavy chain (MHC), skeletal muscle alpha-actin (ACTA1), vascular endothelial growth factor A (VEGFA), and vimentin mRNA gene expression were assessed. Results: The laser + hADSCs group had a higher resting pressure compared with the sphincterotomy (p  0.05). In the laser + hADSCs group, motor unit numbers were higher than those in the laser group (p < 0.0001) but did not differ from the hADSCs group (p = 0.075). Sphincterotomy increased collagen content, but the muscle content (p = 0.36) and collagen content (p = 0.37) were not significantly different between the laser + hADSCs and control groups. Laser + hADSCs increased ACTA1 (p = 0.001) and MHC (p < 0.0001) gene expression compared with laser or hADSCs alone and was associated with increased VEGFA (p = 0.009) and Ki67 mRNA expression (p = 0.01) and decreased vimentin mRNA expression (p < 0.0001) compared with laser. Conclusion: The combination of laser and hADSCs appears more effective than either treatment alone for promoting myogenesis, angiogenesis, and functional recovery after anal sphincterotomy.Arash Sarveazad, Asrin Babahajian, Abazar Yari, Chris K. Rayner, Marjan Mokhtare, Arash Babaei-Ghazani, Shahram Agah, Bahar Mahjoubi, Jebreil Shamseddin, and Mahmoud Yousefifar

Gastroenterologist role in bariatric surgeries

The prevalence of bariatric surgery procedures has increased dramatically in recent years and multiple specialties encounter bariatric patients. In this article, we outline the different options in bariatric surgery and summarized the recommendations for gastrointestinal assessment of candidates before and after bariatric surgery. The role of routine endoscopy was controversial in pre surgical evaluation but may alter the operation performed. Comprehensive pre-operative screening conducted by a multidisciplinary team including gastroenterologist was essential to prepare obese patients for successful outcome following surgery. The most commonly performed procedures were Roux-en-Y gastric bypass and adjustable gastric banding. We presented the early and late complications of bariatric surgery and recommendations for post-operative cares by gastroenterologist in this review article

Review of current anti-obesity drugs in obese adults

Background : Obesity was a dangerous chronic disease. Physicians recommended drug therapy just in a few of obese patients in spite of many health risks. Weight control can be improved comorbidities of obesity like hyperlipedemia, hyperinsulinoma, acanthosis nigricans and hypertension. Materials and Methods: This article reviewed the available original and review literatures which had been published in English in websites of Google scholar and Pub Med with drug, obesity and adults during 2002-2014. Results: Drug therapy could improve obesity treatment after an unsuccessful combination of diet, exercise, and behaviour modification. Choice of treatment was based on multiple factors including the degree of obesity and patient preference. Drug therapy should be selected for a BMI) Body Mass Index (greater than 30 kg/m2, or a BMI of 27 kg/m2 with comorbid conditions including diabetes mellitus, hypertension, dyslipidaemia and heart disease.Prescription of anti-obesity drugs should be monitored carefully. Orlistat was the only drug for the long-term treatment of obesity. The efficacy of lorcaserin appears more than orlistat. Phentermine and diethylpropion are only approved for the short term treatment of obesity. Some antidepressant, antiepileptic, and antidiabetic drugs could be caused weight loss. New generation of anti-obesity drugs were under developing and more focus on the safety and efficacy combination treatments. Weight loss > 12kg reported in few investigational drugs. Some of them were discussed in this article. Conclusion: Obesity treatment is selected based on the side effects risks. Mostly of the available drugs have few side effects which decrease with treatment. There isn't a cure drug treatment for obesity now. © 2015, Iranian Association of Gastroenterology and Hepatology. All rights reserved

Clinical and Radiographic Evaluation of Styloid Process and Eagle Syndrome in Shiraz: Prevalence, Morphology and Symptoms

Introduction: Eagle syndrome, which can be a source of craniofacial pain, is caused by elongation of styloid process more than 25 mm. The present study aimed to assess the structural characteristics and prevalence of elongated styloid process (ESP), Eagle syndrome and the related symptoms in the adults aged above 20 years in Shiraz. Methods: In this cross- sectional study, 500 panoramic radiographs were evaluated in regard with styloid process length and morphology. In the presence of any symptoms in patients with ESP, they were clinically evaluated. Those symptoms reproduced by tonsillar fossa palpation were regarded relevant to ESP. Results: The prevalence of ESP was 35.2%, which &nbsp;was proved not to be sex-dependent. Individuals aged 40-60 years and those with more than 60 years had respectively 1.76 (1.16-2.66, CR: 95%) and 2.01 (1.10-3.66, CR: 95%) times greater chance for ESP compared to those aged below 40. The most and the least prevalent structural morphologies were continuous calcification and multiple pseudo articulation respectively. Eagle syndrome was observed in 1.8% of the study population. Moreover, headache, dizziness, and foreign body sensation were respectively reported as the most evaluated symptoms. Conclusion: ESP was demonstrated to occur commonly in the study population which can get more prevalent by increasing age. With respect to avoiding unnecessary treatments, clinical examination of patients seem to be essential in order to differentiate Eagle syndrome from other sources with the same complications

The effects of helicobacter pylori eradication on modification of metabolic syndrome parameters in patients with functional dyspepsia

Background Helicobactor pylori (H. pylori) have the potential role in the pathogenesis of various extra-gastric disorders such as metabolic disorders. But, it is now questioned about whether H. pylori eradication reduces or induces the risk for metabolic disorders especially in patients with dyspepsia. Hence, the present study aimed to assess the effects of H. pylori eradication on criteria of metabolic syndrome. Methods H. pylori infected patients with dyspepsia were included. The patients were treated with omeprazole (20 mg, q12 h), amoxicillin (1 g, q12 h), and clarithromycin (500 mg, q12 h) for two weeks, then H. pylori eradication was evaluated by C14 Breathing test (UBT) 6 weeks after the end of the treatment. Demographic data, clinical manifestation and metabolic parameters were recorded before and three months after completing treatment regimen. The data was analyzed by SPSS version 16.0. Results Of 110 patients were initially enrolled, 91 patients completed the study. Overall eradication rate was 61.5. Significant differences in the serum level of total cholesterol(180.7 ± 34 vs. 172.1 ± 28, p = 0.001), LDL(107.0 ± 25 vs. 100.8 ± 20, p &lt; 0.001), HDL(46.2 ± 8.7 vs. 48.9 ± 8.6, p &lt; 0.001), fasting blood sugar (93.7 ± 12 vs. 90.9 ± 10, p = 0.001), hemoglobin A1c(5.37 ± 0.52 vs 5.25 ± 0.53, p = 0.006), and as well as for waist circumference(92.2 ± 14 vs. 91.4 ± 13.9, p = 0.03) was found after treatment. Data for body weight, systolic and diastolic blood pressure and triglyceride level remained without any significant changes. Conclusion H. pylori eradication could relatively reduce the risk of metabolic syndrome criteria such as fasting blood sugar, hemoglobin A1c, lipid profile and waist circumference. © 2017 Diabetes Indi