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Abstract Despite several studies on the link between dietary inflammatory potential and risk of several conditions, limited studies investigated the association between pro-inflammatory diet and ulcerative colitis (UC). The objective of the present study was to examine the link between food-based dietary inflammatory potential (FDIP) and odds of UC in Iranian adults. This case–control study was carried out among 109 cases and 218 randomly chosen healthy controls. UC was diagnosed and confirmed by a gastroenterologist. Patients with this condition were recruited from Iranian IBD registry. Age- and sex-matched controls were selected randomly from participants of a large cross-sectional study. Dietary data were obtained using a validated 106-item semi-quantitative food frequency questionnaire (FFQ). We calculated FDIP score using subjects’ dietary intakes of 28 pre-defined food groups. In total 67% of subjects were female. There was no significant difference in mean age between cases and controls (39.5 vs. 41.5y; p = 0.12). The median (interquartile range) of FDIP scores for cases and controls were − 1.36(3.25) and − 1.54(3.15), respectively. We found no significant association between FDIP score and UC in the crude model (OR 0.93; 95% CIs 0.53–1.63). Adjustment for several potential confounders in multivariate model did not change this association (OR 1.12; 95% CIs 0.46–2.71). We failed to observe any significant association between greater adherence to a pro-inflammatory diet and risk of UC in this study. Prospective cohort studies are needed to further assess this relationship.

Abstract Limited data are available on the association of dietary calcium intake and ulcerative colitis (UC). We aimed to investigate the relation between dietary calcium intake and UC prevalence in Iranian adults. In this population-based case–control study, diagnosed patients with UC by gastroenterologists that were registered in the Iranian inflammatory bowel disease registry were included as cases. Age and sex-matched healthy controls were selected from Study on the Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN) dataset. Dietary calcium intakes of participants were examined through a validated food frequency questionnaire. We included 327 middle-aged participants (109 cases and 218 controls) in the analysis; 52.1% of them were females. After adjustments for potential confounders, individuals in the third tertile of dietary calcium intake had 92% lower odds of UC, compared to those in the first tertile (OR = 0.08, 95% CI 0.02–0.27). Our analysis based on recommended dietary allowances (RDAs) intake showed that dietary Ca intake deficiency was related to increased odds of UC (OR = 9.5, 95% CI 2.98–30.91). Stratified analysis by gender revealed that these associations were significant in both genders; although the results were stronger in the male population. A Significant decreasing trend was observed for odds of UC in tertiles of dietary calcium intakes, in both males and females. Higher dietary calcium intake was associated with lower UC prevalence in Iranian adults. Inadequate dietary calcium intake was also linked to elevated odds of UC. Further prospective investigations are needed to affirm these findings.

Background/Aim: Despite the inflammatory nature of inflammatory bowel disease (IBD), limited data are available on the association of inflammatory potential of the diet and risk of ulcerative colitis (UC). We aimed to investigate the association of inflammatory potential of the diet (IPD) score and odds of UC in a case-control study.Methods: Patients with UC were enrolled from Iranian IBD registry, whose disease was confirmed by a gastroenterologist. Controls were selected randomly from the Study of the Epidemiology of Psycho Alimentary Health and Nutrition (SEPAHAN) study, a large population-based study on more than 8,000 apparently healthy individuals. Dietary intakes of 28 food items obtained from a validated dish-based food frequency questionnaire (FFQ), were used to compute IPD score.Results: This case-control study was carried out among 109 cases and 218 randomly chosen controls. Mean age of cases and controls was 39.5 ± 10.0 and 41.5 ± 11.8 y, respectively. Totally, 52% of study participants were female and 48% were male. After controlling for age, sex, and body mass index (BMI), we found that the patients with UC were more likely to be in the highest quartile of IPD score compared with controls (OR: 2.83; 95% CI: 1.41–5.69, P-trend < 0.001). This association strengthened after additional adjustment for education, smoking, medical history, and physical activity (OR: 3.48; 95% CI: 1.32–9.10, P-trend = 0.003). When we took dietary habits into account, the association was slightly attenuated (OR: 3.33; 95% CI: 1.20–9.20, P-trend = 0.005).Conclusions: We found that adherence to a pro-inflammatory diet was positively associated with greater odds of UC. Further studies are required to confirm these findings.

A few cases with esophageal bezoar have been reported in achalasia. We describe here a rare case of esophageal pharmacobezoar after ingestion of ferrous sulfate capsules in a patient with achalasia. A 29-year-old woman presented with severe dysphagia since five days earlier. She had history of achalasia since 3 years ago but had refused any treatment option. After about 3 weeks of ferrous sulfate capsules ingestion, she developed severe dysphagia and was referred to a gastroenterologist. Physical examination was unremarkable. A barium swallow revealed dilated esophagus and bird’s beak appearance. Esophagogastroduodenoscopy (EGD) showed dilated esophagus and soft black color bezoar in distal part of esophagus. The bezoar was retrieved with basket. In the next endoscopic session, achalasia balloon dilation was successfully applied. Ferrous sulfate capsules can cause pharmacobezoar in patients with achalasia. Esophageal bezoar should be considered in differential diagnosis of untreated achalasia and acute exacerbation of dysphagia.

BACKGROUND Cholecystitis is a common surgical condition. Recently, several authors have reported that DNA of bile tolerant Helicobacter spp. has been found in the human bile colonizing the biliary tract. The aim of this study was to evaluate the association between the presence of Helicobacter spp. and gallstone cholecystitis. METHODS In this case-control study, gallstones, bile, and gallbladder mucosa were collected from 25 patients without gallstone disease, 24 with acute cholecystitis, and 28 with chronic cholecystitis. The presence of Helicobacter pylori (H. pylori), Helicobacter bilis (H. bilis), Helicobacter hepaticus (H. hepaticus), and Helicobacter pullorum (H. pullorum) were investigated by polymerase chain reaction (PCR) using species-specific primers. RESULTS In this study, 77 subjects with acute and chronic cholecystitis and control groups with a mean age of 46.85 ± 14.53 years, including 58 (67.25%) women and 19 (32.75%) men were included. DNA of 10 Helicobacter spp. was detected in the bile of the patients with cholecystitis including eight H. pylori and two H. bilis. However, we could not detect H. hepaticus and H. pullorum DNA in the samples. Moreover, there was an association between H. pylori and acute cholecystitis (p = 0.048), which was found to be stronger in 31-40-year-olds group (p = 0.003). CONCLUSION We found an association between the presence of H. pylori DNA and acute gallstone cholecystitis. There is not statistically significant correlation between three enterohepatic Helicobacter spp. (H.bilis, H. hepaticus, and H. pullorum) and cholelithiasis. Given the low sample size of the patients, more studies are required to clear the clinical role of Helicobacter spp. in the gallstone disease and cholecystitis.

Background: Hepatitis B virus (HBV) vaccination is a well-known, safe and effective way for protection against HBV infection; however, non-responders remain susceptible to infection with HBV. This is so important in patients with any kind of chronic liver disease, especially chronic hepatitis C virus (HCV) patients in whom acute HBV infection may lead to decompensation of liver disease. Some of the studies have shown that immunogenicity of HBV vaccination is decreased in these patients. The aim of this study was to evaluate the efficacy and safety of double dose vaccination of HBV in these patients, compared with standard dose vaccination in similar patients and healthy adults. Methods: A total of 64 patients with chronic HCV infection were randomized into 2 groups of 32. Group A received standard dose HBV vaccine, at 0, 1, 6 months, whereas group B received double dose HBV vaccine. Group C consisted of 32 healthy adults who also received standard dose vaccination. At 1 month after the end of vaccination, Hepatitis B surface antibody (HBsAb) titer was checked in all participants and the results were compared. Results: There was no significant difference in age or sex among three groups. The response rate in groups B and C was 100% (all had HBsAb titer >10 mIU/mL), while in group A, 4 patients (12.5%) were non-responders (HBsAb titer < 10 mIU/mL). The difference in response rate was statistically significant between Group A and the other two groups (P < 0.05). Conclusions: The efficacy of standard dose HBV vaccination in patients with chronic HCV infection was suboptimal. Using double dose vaccination in these patients was an effective way to increase the antibody response.

Background: Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis and Crohn's disease. These disorders have distinct pathologic and clinical characteristics but their pathogenesis remains poorly understood. Some studies showed a relationship between IBD and thromboembolic disorders. The prevalence of thromboembolic disorders has been reported as 39% in autopsies. In addition, there is a relation between IBD and level of fibrinogen. This study was conducted to understand the relation between IBD and fibrinogen levels in Iranian patients. Methods: This cross-sectional study was performed in Ayatollah Kashani Hospital, Isfahan, Iran during 2010-2011. Hospitalized patients with a diagnosis of IBD according to Leonard Jones criteria were invited to participate in this study. Individuals who used anticoagulants, heparin, or oral contraceptive pills (OCPs), pregnancy women and patients with cancer were excluded. Venous blood samples were collected and fibrinogen levels were measured in the laboratory. Finally, the data was analyzed by SPSS18. Findings: : The mean ± SD levels of fibrinogen in the ulcerative colitis, Crohn's disease and control groups were 347.8 ± 11.7, 286.4 ± 88.5 and 346.6 ± 109.2, respectively. According to analysis of variance (ANOVA), a statistically significant difference existed between the three groups (P = 0.023). Conclusion: Based on the results of this study, serum fibrinogen levels in the ulcerative colitis group were not different from the control group. However, the levels in the Crohn's disease group were lower than the control group. Thus, further studies must be performed to precisely understand the relation between IBD and fibrinogen levels.

Background: Hepatorenal syndrome (HRS) is known as development of acute renal failure in a patient who usually has advanced liver disease. The aim of the present study was to determine the safety and the efficacy of noradrenalin in comparison with midodrine-octreotide in patients with HRS. Methods: This study was registered to the Iranian Registry of Clinical trials (IRCT). This study was a single-center, randomized, clinical trial that performed in Alzahra hospital, Isfahan, Iran. Since March 2011 to January 2012, twenty-three patients were enrolled in the study. Eligible patients were allocated in 2 groups. In the first group, patients received infusion of NA with the dose of 0.1-0.7 μg/kg/min, and in the other groups, patients received octreotide 100-200 μg subcutaneously 3 times daily and midodrine 5-15 mg orally 3 times daily. In both study groups, patient received albumin infusion in addition to noradrenalin or midodrine-octreotide. Results: Complete response of HRS was observed in 8 of the 11 patients (73%) treated with noradrenalin and in 9 of the 12 patients (75%) treated with midodrine-octreotide (P > 0.05). HRS recurred after treatment withdrawal in 2 of 11 in NA and 3 of 12 in MO group. That shows no significant difference between 2 groups (P > 0.05). Conclusion: We deduce that NA has the same efficacy and safety with MO and can induce a complete response in high percentage of the patients. Moreover, we observed no significant differences in the recurrence rate and outcomes after 3 months among the patients in both study groups; this result could support the use of NA in HRS management. The IRCT ID is: IRCT201107217085N1.

Background: There is an association of celiac disease (CD) with several gastrointestinal illnesses. We aimed to determine the prevalence of CD in patients with inflammatory bowel disease (IBD) to evaluate the value of the routine serological tests for CD in these patients. Materials and Methods: patients with IBD underwent screening test for CD. The screening test was based on IgA anti-tTG antibody evaluated by ELISA method and IgA EMA (endomysial antibody) measured by the indirect immunofluorescence method. Fisher exact and chi-square and t tests were used for data analysis. Results: the study was conducted on 100 patients, with a mean age of 34.74 ± 12.03 (SD) years. The mean simplified Crohn′s disease activity index was 90 ± 17 (SE) and the mean colitis activity index was 3.46± 0.96 (SE). Seventeen patients (17%) had IgA anti-tTG antibody levels above the cutoff point (> 20). Thirty-two patients were positive for IgA EMA. IgA EMA was positive in nine IgA anti-tTG positive patients (three patients with Crohn′s Disease and six ones with ulcerative colitis). Then, the prevalence of serologic CD was 9% that was higher than that of general population. A significant correlation was found between the results of IgA EMA and those of IgA anti-tTG (P=0.001) whereas Fisher exact test revealed significant difference between frequency distribution of positive and negative results of IgA EMA and IgA anti-tTG in patients with ulcerative colitis and Crohn′s disease (P=0). Conclusion: the prevalence of serologic CD in general population in Iran has been reported to be 0.6-0.96%. Then, its prevalence in our sample size was about ten times more than that in general population.

مقدمه: هلیکوباکتر پیلوری شایع‌ترین میکروب کلونیزه کننده‌ی دستگاه گوارش است. جهت اثبات عفونت از روش‌های مختلفی نظیر سرولوژی، آزمایش آنتی‌ژنی مدفوعی و آزمایش تنفسی اوره استفاده می‌شود. هدف از این مطالعه، بررسی و مقایسه‌ی آثار و هزینه‌های آزمایش‌های تشخیصی فوق بود. روش‌ها: 94 بیمار زن و مرد بالغ که اندیکاسیون انجام اندوسکوپی داشتند، وارد مطالعه شدند. در صورتی که نتیجه‌ی حداقل دو آزمایش تشخیصی بیمار (بافت شناسی، آزمایش سریع اوره‌آز، آزمایش آنتی‌ژن مدفوعی یا آزمایش تنفسی اوره) مثبت بود، وی از نظر عفونت با هلیکوباکتر پیلوری مثبت در نظر گرفته شد. یافته‌ها: دقت آزمایش آنتی‌ژن مدفوعی 91 درصد، آزمایش تنفسی اوره 82 درصد و سرولوژی 52 درصد بود. نتیجه‌گیری: به دلیل هزینه‌ی کمتر و دقت بالاتر، آزمایش آنتی‌ژن مدفوعی آزمایش ارجح در تشخیص عفونت با میکروب هلیکوباکتر پیلوری، قبل از درمان می‌باشد.

Background: Many studies in various populations showed the correlation between the level of CA-125, CA15-3, CA19-9 and a.Fetoprotein with the stage of liver fibrosis in chronic hepatitis and cirrhosis. This study was done to evaluate this correlation in Iranian community. Methods: This cross–sectional study was performed on 30 patients with chronic hepatitis that referred for liver biopsy to the gastroenterology department of Isfahan Alzahra hospital from September 2009 to September 2010. Clinical data and routine laboratory tests at the time of liver biopsy were collected, and serum AST, ALT, CA-125, CA15-3, CA19-9 and a.Fetoprotein levels were assayed. Fibrosis staging was assigned according to the HAI (Histological activity index). Data were analyzed by multivariant logistic regression, Spearman’s Ranke Correlation Coefficient, and generalized linear model tests. Findings: Increased CA15-3, CA19-9 and a.Fetoprotein levels were correlated significantly with liver fibrosis staging (P value was 0.008 and 0.004 and 0.038 respectively). We did not find a significant correlation between serum level of CA125 and liver fibrosis staging (P = 0.079). Conclusion: Our findings suggested that elevated CA15-3, CA19-9 and a.Fetoprotein levels were associated with advanced fibrosis. Because of small sample size, we can not recommend these tumor markers as a tool for diagnosis of liver fibrosis staging. But it should be considered that elevation of mentioned markers in patients with advance cirrhosis necessarily does not mean the presence of concomitant malignant tumor.

There is a growing interest of clinical and epidemiological researches in the field of functional gastrointestinal disorders in our society. Accordingly, validated and culturally adapted instruments are required for appropriate measurement of variables specially the quality of life. The aim of our study was the linguistic validation of the Irritable Bowel Syndrome-Quality of Life questionnaire (IBS-QOL) for Iranian IBS patients with Persian language. Following the standard forward-backward translation method, the IBS-QOL was translated into the Persian language and completed by 141 IBS patients. Patients also completed the IBS Symptom Severity Scale (IBS-SSS) and Hospital Anxiety and Depression Scale (HADS). One-week retest was performed on 30 randomly selected patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. To analyze the discriminant validity, the IBS-QOL scores was correlated to the IBS-SSS and HADS scores. According to the results, reliability analyses were acceptable for all of the IBS-QOL domains (Cronbach's alpha=0.68 to 0.90 and ICCs=0.77 to 0.91). Discriminant validity was supported by the presence of correlations of the IBS-QOL scores with disease severity (r = -0.628), depression (r = -0.692), and anxiety (r = -0.711) scores; P < 0.001. These results indicate that the Persian version of the IBS-QOL is a reliable instrument with sufficient psychometric requirements to assess quality of life in Iranian IBS patients with Persian language.

Background: Inflammatory bowel disease (IBD) incidence has been increased in Iran as a developing country. Surveillance is a standard method for accessing valid data about disease epidemiology to make relevant decisions for disease control, prevention, and management. We designed Isfahan IBD Surveillance Project (IISP) to make a surveillance system in this area. Methods: The project is designed in 3 phases. At the first phase, a model of step-wise approach (core, expanded core, and optional variables) for IBD surveillance was designed and implemented among IBD patients registered at a major referral gastrointestinal diseases clinic in Isfahan. Data bank program and its software were designed with suitable and multifunctional features. A total of 352 IBD cases were registered to data bank and analyzed as a pilot study of IISP. Results: A total of 352 IBD patients, including 245 ulcerative colitis (UC), 80 Crohn's disease (CD), and 27 indeterminate colitis, were registered to the data bank. Bloody stool and abdominal cramp were the most common presentation symptom among UC and CD, respectively. Extensive pancolitis was the most prevalent phenotype (40%) of UC. Over two-thirds of our IBD patients were in remission states. Biologic agents had been prescribed in about 10% of patients during disease. Primary sclerosing cholangitis was detected in about 7% and 10% of CD and UC patients, respectively. Conclusions: Valid data from a standard surveillance system are a relevant, trustworthy tool for making decision by health policy-makers. Integrated comprehensive interventional programs for disease control and management is the second phase of IISP.

Background: The purpose of this study is to compare validity of 5 diagnostic tests of helicobacter pylori with each other: stool antigen test, urea breath test (UBT), rapid urease test (RUT), serology and histology. Methods: A total of 94 patients who had indication of endoscopy entered the study. All of the 5 tests were performed for each patient. When the results of at least 2 tests were positive (except serology), Helicobacter pylori infection was considered to be positive. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under receiver operating characteristic (ROC) curve of these 5 tests were determined. Results: The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under ROC curve of these 5 tests are as below, respectively. Histology: 89%, 78%, 93%, 91%, 85% and 0.881; RUT: 93%, 75%, 95%, 94%, 86% and 0.831; serology: 50%, 54%, 46%, 61%, 52% and 0.563; stool antigen test: 96%, 83%, 98%, 96%, 91% and 0.897; UBT: 89%, 73%, 92%, 90%, 82% and 0.892. Conclusions: Stool antigen test is the most accurate test for Helicobacter pylori diagnosis before eradication of these bacteria.

Background: Ulcerative colitis (UC) is a disabling disease with increasing incidence in Iran. In spite of combined medical therapy, some patients eventually undergo total colectomy. Infliximab has proved itself as a rescue therapy and even as an early aggressive therapy for severe extensive UC. Meantime, there are concerns about its complications. The aim of this study was to evaluate the efficacy of infliximab in Iranian refractory UC patients. Methods: This multi centric case-series study included 29 UC patients receiving two to three of the drugs prednisolone, AZT/6MP and 5ASA but yet having flare-ups. At first, the extent of colon involvement was determined by colonoscopy; then the drug was administered at baseline, 2nd week and 6th week and colonoscopy repeated afterwards. Clinical and laboratory data were also recorded. Results: In first endoscopy 18 patients (62%) out of 29 suffered from pancolitis and none had normal results. In sec-ond examination (done on 19 patients), one was normal and only 8 of 18 (27.6%) had pancolitis. Considering missing cases, at least in 33.3% of patients the drug has reduced the extreme extent of colon involvement. Also a wilcoxon signed ranks test revealed significant reduction of the disease extension after this treatment (p = 0.008). There were only one leucopenic and one hypotensive reactions in short term. The drug showed effectiveness in the term of disease modi-fying, too. Conclusions: These data show the usefulness of the drug in refractory UC. Longer follow ups and controlled trials are needed.

The most common gastrointestinal involvement in eurofibromatosis is due to tumoral lesions which may resent with gastrointestinal bleeding or obstruction. We report a case of concurrent ulcerative colitis and eurofibromatosis.A 39 year-old woman, known case of neurofibromatosis, was admitted to our department with complaint of chronic bloody diarrhea. After thorough clinical examination and paraclinical assessments, ncluding colonoscopy and biopsy, ulcerative colitis was confirmed as the cause of gastrointestinal bleeding. Another rare finding in this patient was bilateral neurofibroma in psoas muscle that was detected on abdominal spiral Computer Tomography scan.KEYWORDS: Ulcerative Colitis, Neurofibromatosis, Von Recklinghausen’s Disease, Mast Cells, Bilateral urofibroma, Psoas Muscle.

Background Helicobacter pylori (H. pylori) is a gram negative curved bacilli colonized in the human stomach. It causes duodenal ulcer, gastritis and is associated with adenocarinoma. There might be a possible relationship between cagA, vacA and ice a genes and clinical outcomes. The aim of this study was to identify the frequency of vacA genotypes of H. pylori isolated from the upper gastrointestinal. Methods One hundred H. pylori strains were isolated from patients with different gastrointestinal disease who admitted to Isfahan Al-zahra hospital. Vac A alleles were typed using PCR with specific primers. Findings There were four Vac A mosaicsms, including 28 for s1a/m1 (28%), 23 for s1b/m1 (23%), 26 for s1a/m2 (26%) and 23 for s1b/m2 (23%), s2 form was not found. Conclusion The results showed there is no significant relationship between different genotypes of vacA and the related diseases. Key words: Helicobacter pylori, vac A, Adenocarinoma, Duodenal ulcer, Normal /Gastritis, PCR

BACKGROUND: Hepatitis C (HCV) is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers (IDU), especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non-prisoners. METHODS: A cross-sectional study was conducted on consenting IDUs inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5 ml blood was drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCVAb (ELISA) was checked by a single technician. Chi-square, Fisher's exact test and multivariate analysis were used where appropriate. RESULTS: Five-hundred and eighteen subjects were enrolled. About 74.5% were prisoners and 89.6% were male. Overall, 59.5% were positive for HCVAb (93.2% males and 6.8% females, P < 0.02). HCV seropositivity was higher among prisoners compared to non-prisoners (78.3% vs. 30.6%, respectively, P < 0.001). Also, it was higher in IUD older than 45 year-old compared to those younger than 30 year-old (77.8% vs.54.2%, respectively, P = 0.002). Multivariate analysis showed significant association of HCV seropositivity with imprisonment (OR: 9.32, 95% CI: 5.60-15.51), sharing syringes (OR: 2.00, 95% CI: 1.26-3.17) and duration of intravenous drug use (OR: 0.86, 95% CI: 0.80-0.92). CONCLUSIONS: HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor for HCV and the infected IDUs going back to the society could be an important source of HCV. Taking effective strategies (education of high risk groups, provision of sterile syringes, identification and treatment of infected IDUs) to reduce the risk of this public health problem is needed urgently. KEYWORDS: Hepatitis C, intravenous drug abuse, prison.

هليکوباکتر پيلوری عامل اصلی گاستريت مزمن بوده و ارتباط زيادی با بيماريهای زخم معده بويژه زخمهای دئودنال و همچنين آدنوکارسينومای معده دارد. در حدود 50 درصد مردم دنيا به اين باکتری آلوده­اند. از جمله فاکتورهای بيماريزايی اين باکتری، پروتئينی است که محصول ژن cagA می­باشد. اين پروتئين بسيار ايمنوژن است و آنتی بادی ضد آن در سرم افراد مبتلا قابل تعيين است. ميزان عفونت متفاوتی با سويه­­های cagA مثبت در بين مناطق مختلف و جمعيت­های مختلف وجود دارد و تاکنون مطالعه­ای برای تعيين و ميزان شيوع ژنوتيپ cagA هليکوباکتر پيلوری در ايران صورت نگرفته است. با تعيين فراوانی نسبی ژنوتيپ cagA می­توان گامهای مؤثری در پيشگيری زخم معده و سرطان معده برداشت نتايجدر این مطالعه از100 نفر(60 مرد و 40 زن) بيماران مراجعه کننده به بيمارستان الزهرا شهر اصفهان ، با نظر پزشک فوق تخصص گوارش، پس از معاينه بالينی، نمونه بيوپسی گرفته شد و نمونه­ها پس از انتقال به آزمايشگاه، کشت داده شد و برای تعيين ژنوتيپcagA کلنی­های ظاهر شده، آزمايش PCR انجام شد وبا استفاده از روشهای آماری مجذور کای و آناليز واريانس يک طرفه برای تعيين ارتباطآدنوکارسينوما، زخم اثنی عشر و نرمال گاستريت و سن و جنس با ژنوتيپcagA انالیز گردید. . نتايج ما نشان داد که ارتباطی بين وجود ژن cagA و اين بيماريها وجود نداشت. تحقيق حاضر همچنان نشان داده شد که بين ژنوتيپ cagA و جنس رابطه معنی داری وجود ندارد.آناليز آماری داده­ها با استفاده از Logistic regression نشان داد که بين ژنوتيپ cagA و سن، ميزان تحصيلات، محل سکونت و مثبت بودن تست اوره­آز سريع، رابطه معنی داری وجود نداشت(pvalue>0.05). ولی بين سن و بيماری آدنوکارسينوما ارتباط معنی داری وجود داشت. (pvalue>0.05 BACKGROUND: Helicobacter pylori causes chronic active gastritis, peptic ulcer, non-cardia gastric cancer and mucosal– associated lymphoid tissue (MALT) lymphoma. Different genotypes of Helicobacter pylori are confirmed from disease geographical areas. Its association with clinical disease remained controversial. The aim of the present study was to investigate the relationship of the cagA genotype of Helicobacter pylori isolates with clinical manifestations and its relation to age and sex of patients. METHODS: A total of 100 patients (60 male and 40 female) biopsy specimens were obtained from 3 groups of patients (40 chronic active gastritis, 40 duodenal ulcers and 20 non-gastric gastric cancers). Biopsies were cultured on specific medium and after growth colonies were confirmed as Helicobacter pylori. DNA extraction and polymerase chain reaction (PCR) were used to detect the presence or absence of cagA gene. RESULTS: From a total of 100 positive samples of H. pylori, cagA genes were detected in 68% of patients and 32% of samples were negative. Mean age of normal gastritis, duodenal ulcer and gastric adenocarcinoma was 44.94, 44.97 and 67.5 years, respectively. CONCLUSIONS: The present study showed no significant relationship between cagA genotype of H. pylori and chronic active gastritis, duodenal ulcer and non-cardia gastric cancer as well as sex of patients. But, in gastric adenocarcinoma, there was significant discrepancy between ages of patients in comparison with the other two groups. KEY WORDS: Helicobacter pylori, cagA, virulence factors.

Caroli’s disease (CD) is a rare congenital abnormality characterized by dilatation of intra hepatic bile ducts, which causes stone formation, recurrent cholangitis and higher risk for biliary malignancy. Association of this anomaly with congenital hepatic fibrosis is named Caroli’s syndrome (CS). The monolobar involvement of CS is a very rare condition, curable by partial hepatectomy. We report a 40-year-old woman with recurrent epigastric pain without icterus with normal AST, ALT and alkaline phosphates for 5 years due to left lobe Caroli syndrome which was diagnosed by CT scan and MRCP. Then, the patient underwent successful operation (left hepatic resection). After 8 months follow up, she was symptom free. Because the presentation of unilobar CS may be as late as middle age, this congenital anomaly should be considered in differential diagnosis of patients with recurrent epigastric pain without icterus in this age group and MRCP is a useful diagnostic tool. KEY WORDS: Caroli’s disease, Caroli’s syndrome, congenital hepatic fibrosis, magnetic resonance cholangiopancreatography.

There is a growing interest of clinical and epidemiological researches in the field of functional gastrointestinal disorders in our society. Accordingly, validated and culturally adapted instruments are required for appropriate measurement of variables specially the quality of life. The aim of our study was the linguistic validation of the Irritable Bowel Syndrome-Quality of Life questionnaire (IBS-QOL) for Iranian IBS patients with Persian language. Following the standard forward-backward translation method, the IBS-QOL was translated into the Persian language and completed by 141 IBS patients. Patients also completed the IBS Symptom Severity Scale (IBS-SSS) and Hospital Anxiety and Depression Scale (HADS). One-week retest was performed on 30 randomly selected patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. To analyze the discriminant validity, the IBS-QOL scores was correlated to the IBS-SSS and HADS scores. According to the results, reliability analyses were acceptable for all of the IBS-QOL domains (Cronbach's alpha=0.68 to 0.90 and ICCs=0.77 to 0.91). Discriminant validity was supported by the presence of correlations of the IBS-QOL scores with disease severity (r = -0.628), depression (r = -0.692), and anxiety (r = -0.711) scores; P < 0.001. These results indicate that the Persian version of the IBS-QOL is a reliable instrument with sufficient psychometric requirements to assess quality of life in Iranian IBS patients with Persian language.

Background: Musculoskeletal manifestations (MSM) of inflammatory bowel diseases (IBDs) are usually the most frequent extraintestinal manifestations. However, they are not paid enough attention during regular office visits. This cross-sectional study aimed to draw a clinical picture of MSM and their relationships with other findings in patients with IBD. Materials and Methods: Patients of our IBD cohort between March 2012 and September 2013 were consecutively evaluated. Those with current or past history of any MSM were examined by a rheumatologist. The outcome of interest was different MSMs. Distribution of IBD manifestations between the two groups of patients with (n = 20) and without (n = 253) MSM was compared. Logistic regression analysis was employed to find the relationships of demographic, clinical, and laboratory findings with MSM. Results: Two hundred and seventy-three patients were enrolled. Forty-two patients (15.4%) had extraintestinal manifestations of which twenty patients (7.5%) had at least one MSM. 7/20 patients (35%) versus 22/253 (8.7%) had other extraintestinal manifestations (P = 0.0001). 12/20 patients (57%) had arthritis (polyarthritis, 33% and oligoarthritis, 67%). The most frequent involved joints were knee and ankle observed in 8 (40%) and 7 (35%) patients, respectively. The inflammatory back pain was recorded in 5/20 patients (25%) whereas two patients (10%) had ankylosing spondylitis. In regression analysis, oral aphthous (odds ratio [OR] =8.8 [95% confidence intervals (CI), 1.7–45], P = 0.009) and other extraintestinal manifestations (OR = 5.2 [95% CI, 1.3–20], P = 0.02) were significantly related with arthritis. Conclusion: The most frequent extraintestinal manifestations in patients with IBD were MSM. Knee and ankle were the most frequent involved joints. Extraintestinal manifestations were determinant variables of arthritis.

Introduction: It has been previously reported that ulcerative colitis (UC) could be associated with cytomegalovirus (CMV) infection. There is controversy among different studies; however, this study is conducted in Isfahan. We evaluated the frequency distribution of CMV infection in Iranian patients with active UC comparison to normal individuals. Materials and Methods: This case-control study was conducted on 22 patients with active UC and 22 age- and sex-matched controls (F: M = 1). Samples were taken from colonoscopic specimens and tested with sensitive primers of the CMV using the polymerase chain reaction method, the most sensitive method for detecting CMV infection. Results: Patients and controls were similar in age (35.9 ± 11.03 years in the case and 40.8 ± 11.3 years in the control group) P=0.153. CMV DNA was found in 13.6% of the subjects in each group; therefore, total percentage of CMV infection was 13.6%. Six cases with CMV infection were three males and three females with age of 38.5 ± 11.02 years (compared to 38.3 ± 11.5 years in noninfected subjects P=0.968). Conclusion: In our study, Iranian patients with active UC did not have a higher rate of CMV infection than controls.

Background: The effects of occupational exposure on liver function in oil refinery workers are not well known. In this study we evaluated the liver enzyme abnormalities among coal tar refinery workers. Methods: The oil refinery workers in central part of Iran (Isfahan city) underwent routine annual medical examination from 2006 to 2007. A total of 66 cases with abnormal levels of aminotransferases were included in this cross-sectional study. Liver diseases including viral, metabolic and autoimmune hepatitis were excluded by detailed investigations. The relationships of different findings and liver enzymes were evaluated through inferential statistics. Finding: All patients were male with the mean age of 36.7 ± 4.8 years. Thirty eight subjects had dyslipidemia (61.3%). There were significant correlations between triglyceride or cholesterol concentrations and aminotransferases levels. From 40 cases, 35 cases (87.5%) demonstrated ultrasonographic fatty livers. Also, significant correlations were found between cholesterol and Gamma-glutamyl transpeptidase (GGT) levels. There were not significant differences in levels of aminotransferases among different type of work (P > 0.05). Conclusion: Direct occupational exposure to oil refinery products may play an important role in liver enzyme abnormalities. Exposure to coal tar components such as phenols, poly aromatic hydrocarbons chemicals may be a risk factor for NASH (Non-alcoholic Steato-hepatitis). Liver biopsy and long term follow-up can be helpful for definite diagnosis and determination of prognosis.