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Background: Helicobacter pylori infection can be a risk factor for non-cardia gastric cancer. In the present study, we aimed to assess the rate of Helicobacter pylori infection, its virulence factor and precancerous lesion among over 50 years old, dyspeptic patients with normal endoscopy. Methods: A total of 620 patients over 50 years of age with dyspepsia that referred to Shahid Sadoughi Hospital, Yazd, Iran from December 2018 to January 2019 were evaluated. One hundred fifty patients with normal appearance endoscopy were selected, and six gastric biopsy specimens were taken from each subject. Data were analyzed using chi-square and logistic regression tests. Results: A total of 150 patients with mean age of 65.8±11.9 years old participated in this study. Sixty-three (42%) patients were males. Thirty-four (22.6%) patients had precancerous lesions. Ninety (60%) patients had positive PCR results for H. pylori. H. pylori infection test was positive in 24 (70.6%) patients with precancerous lesion. Sixty-six (57%) patients without the precancerous lesions (116 cases) were positive for H. pylori. Conclusion: There was no a significant difference in the rate of H. pylori infection and its genotype distribution was between patients with and without the precancerous lesions. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of low dose versus usual dose of Hyoscine during endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods: This randomized, open-label clinical trial included 282 patients undergoing ERCP who had duodenal peristalsis interfering with cannulation. Patients were randomly divided into two groups: Group one and two received low (5 mg) and usual (10 mg) dose of Hyoscine, respectively. Cardiovascular service consultation was performed for all patients before entering the study and performing ERCP. Hyoscine was injected intravenously, and the spasmolytic effect of the drug was assessed while the papilla was in a completely enface view. The time interval between cessation of peristalsis and its further onset was recorded by the chronometer. Also, patient's heart rate and blood pressure were monitored during ERCP by digital monitoring. Results: The results showed no statistically significant differences in the mean duration of peristalsis, the duration of the antispasmodic activity and the time required to increase the heart rate between two groups (P=0.38, P=0.48, P=0.32, respectively). No significant differences were observed regarding the average of heart rate and mean arterial blood pressure (MAP) before drug administration between the two groups (P=0.182 and P=0.29, respectively), but after the drug administration, tachycardia and hypotension were significantly higher in the second group (P=0.007 and P=0.001, respectively). There was no statistically significant difference in the frequency of arrhythmia between two groups (P=0.08). The results also showed that tachycardia and hypotension occurred more frequently in men and elderly patients (P < 0.05). Conclusion: A low dose of Hyoscine is as effective as the usual dose and its side effects such as alteration in blood pressure and heart rate are much fewer, especially in men and elderly patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy and tolerability of tetracycline vs. high-dose amoxicillin in bismuth-based quadruple therapy for Helicobacter pylori(H. pylori) eradication. Methods: This randomized, open-label clinical trial included 228 patients with H.pylori infection and duodenal ulcer without a history of H.pylori treatment. Patients were randomly divided into two groups. The amoxicillin group received metronidazole 500mg, bismuth subcitrate 240mg, and amoxicillin 1000mg, all three times a day, plus omeprazole 20 mg twice a day, for 14 days. The tetracycline group received metronidazole 500mg three times a day; bismuth subcitrate240mg and tetracycline HCl 500mg, both four times a day; and omeprazole 20 mg twice a day, for 14 days. Evaluation for compliance and drug-relatedadverse effects were evaluated at the end of two weeks. Eight weeks after the end of treatment, the rate of H.pylori eradication was assessed by the C13urease breath test. Results: There were no significant demographic differences between the two groups. Eradication rate was higher with the amoxicillin-containing regimen than the tetracycline-containing regimen: 105/110 (95.51%; 95% confidence interval, 91.5%–99.3%) vs. 88/105 (83.8%; 95%CI, 76.7%–90.8%) by per-protocol analysis (p = 0.005) and 92.9% (95%CI, 88.1%–97.6%) vs. 76.5% (95%CI, 68.7%–84.2%) by intention-to-treat analysis (ITT, p = 0.001). Adverse effects were significant higher in the tetracycline groupthan in the amoxicillin group (65.2% vs. 43.4%; p = 0.001). Conclusion: Bismuth-based quadruple therapy including high-dose amoxicillin and metronidazole achieved an acceptable rate of H.pylori infection eradication with good tolerance in patients with duodenal ulcer. This regimen can overcome treatment resistance in areas with high prevalence of metronidazole and clarithromycin resistance. Trial registration: The Thai Clinical Trial Registry (TCTR) [ABSTRACT FROM AUTHOR]

Introduction: Fatty liver is the most common cause of chronic liver disease, and is the second cause for liver transplantation in the United States, and seems to be the leading cause by 2025. It's high and increasing prevalence, as well as lack of symptom in most patients, highlights the importance of finding an easy, sensitive and affordable tool for screening of None-alcoholic fatty liver disease (NAFLD) in large population. Therefore, the aim of present study was to investigate the relationship between NAFLD and neck circumference (NC) and compare its predictive value with other anthropometric factors and also finding a NC cut-off point for predicting NAFLD in Iranian population. Methods: It was a cross-sectional study which was performed in Tehran, Iran from November 2016 to March 2017. Eligible persons were selected among patients who referred for routine checkup.Finally, 593 individuals were enrolled and anthropometric indices and blood pressure were measured. Abdominal ultrasonography and Biochemical Blood tests were also taken after12 hours of fasting. Results: The prevalence of NAFLD and MetS in our study was respectively 51.1% and 48.1%. NC was significantly associated with NAFLD, MetS, FBS, triglyceride, AST, ALT, systolic and diastolic blood pressure, and other anthropometric indices in both genders (P value < 0.0001), which was remained significant even after adjusting for possible confounding factors. There was a significant negative correlation between HDL levels and NC in both sexes (P value < 0.001), but LDL level was significantly correlated with NC just in women (P value = 0.04 in women and 0.977 in men). Receiver operating characteristic (ROC) curve analysis shows the highest area under the curve for NC in predicting NAFLD and MetS, which was followed by waist circumference, neck to height ratio,and waist to hip ratio respectively. The best NC cutoff point for NAFLD were 39.25cm (sensitivity 79% - specificity 69%) in men and 34.85cm (sensitivity 84% - specificity 64%) in women. Conclusion: Neck circumference is an independent predictor for NAFLD and MetS which has a highest Predictive value among other anthropometric indices. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of inflammatory bowel disease may be associated with the disruption in interactions between the immune system and gut flora. Epigenetic mechanisms especially, DNA methylation appear to be significant regarding the interaction between the environment and genome. ABCB1 is the encoding gene for multi-drug resistance protein 1 (MDR1) (P-glycoprotein), which is an important transmembrane protein responsible for the efflux of cellular molecules from the intestinal wall to the lumen. Method: In this study, we compared the methylation status of the promoter of ABCB1 in rectal mucosa of patients with ulcerative colitis (UC) and healthy controls by using the bisulfite conversion system and real-time quantitative multiplex methylation-specific PCR (QM-MSP). Results: We demonstrated that the mucosal specimen of 26 UC patients had significantly higher levels of promoter methylation in comparison to 26 controls. Conclusion: As the first investigation of Iranian patients with UC, we showed that patients had higher levels of ABCB1 promoter methylation in their inflammatory rectal mucosa compared to controls. However, this altered state of methylation did not associate with the characteristics of the patients such as age and sex. Our findings are a basis for further studies on concurrent assessment of promoter methylation and expression of ABCB1 in UC. [ABSTRACT FROM AUTHOR]