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A letter to the editor is presented in response to the article by physician S. Merat, on study regarding hepatitis B in Iran.

Background: The emerging goals of journal clubs are now considered to be teaching critical appraisal skills and how to use evidence based medicine in practice. Although journal clubs are well accredited, designing the right format to keep members stimulated and educated remains a great challenge. Methods: We conducted journal club structure modifications in internal medicine residency program of a university affiliated hospital. Initially, group-based sessions identified feasible changes and baseline data concerning residents" knowledge of evidence based medicine (EBM) was collected using a questionnaire. Modifications were implemented and a second set of group discussions and data collection took place after 12 months. Results: A total of 78 (86.7%) internal medicine residents participated. The most important identified changes were schedule adjustments and setting new goals regarding EBM, medical statistics and critical appraisal teaching. Group discussion showed increased satisfaction and questionnaire assessments showed significant improvement in residents' knowledge of EBM. Conclusions: Redesigning journal clubs with emphasis on regularity and setting new horizons basically improves their effectiveness. Assigning entire sessions to augment participants" skills in new areas of knowledge is a unique way to fit journal clubs as a novel and innovative teaching practice. [ABSTRACT FROM AUTHOR]

Background: The Sydney system offers a standard biopsy protocol for detection and follow-up of gastric preneoplastic lesions such as intestinal metaplasia (IM). The highest frequency of cardia-type gastric adenocarcinoma (GA) in Iran has been documented in the north-western part of the country. This study aims to investigate the effect of the addition of mucosal biopsies of gastric cardia to the standard Sydney protocol on the rate of detection of IM in the asymptomatic residents of this high-risk region for proximal gastric cancer. Methods: A retrospective new analysis was performed on the previous data obtained in cross-sectional endoscopic screening in 2000 as well as a biopsy study of 508 asymptomatic volunteer residents in Meshkinshahr district, Ardabil province. The screening study was conducted in a group of residents aged 40 years and older who did not have any previous GI or hemodynamic problems. Results: Intestinal metaplasia at the Sydney protocol sampling sites was detected in 107 samples belonging to 76 of the 508 (14.99%) volunteers. Twenty-one patients had IM at the cardia. Of these, five patients had IM-cardia (IM only at the cardia). Therefore, adding a cardia biopsy to the set of biopsies diagnosed five more IM cases which were not diagnosed on the standard Sydney protocol (P = 0.062). Conclusion: The addition of a biopsy from the cardia to the Sydney protocol biopsy set does not seem to improve the frequency of detection of IM in the residents of this high-risk geographic area for proximal gastric carcinoma. [ABSTRACT FROM AUTHOR]

Although foreign body (FB) ingestion is relatively common, ingestion of a toothbrush is rare. We are reporting on a 26-year old female who had accidentally swallowed a toothbrush which was successfully removed via endoscopy using a polypectomy snare. [ABSTRACT FROM AUTHOR]

Background and Aims: The duration of protection provided by hepatitis B (HB) vaccine is still unknown but can be estimated indirectly by measuring the anamnestic immune response to booster doses of the vaccine. Methods: We searched electronic databases and conference databases up to December 2008. We also screened reference lists of articles and contacted the authors and vaccine manufacturers for additional references. We included randomized and nonrandomized studies assessing the anamnestic immune response to the booster of HB vaccine in healthy participants 5 years or more after initial vaccination. Results: The meta-analysis included 34 studies with 53 intervention groups and 4,479 individuals. The protective antibodies induced by initial vaccination waned over time; however, nonprotected vaccinees who had lost their antibodies to hepatitis B surface antigen (anti-HBs) over time responded strongly to the booster dose. The seroprotection rate of HB vaccine after the primary vaccination was 98.00% [95% confidence interval (CI): 95.32%, 99.52%] after 5 years, 96.88% [95% CI: 94.61%, 98.50%] after 6-10 years, 88.80% [95% CI: 79.84%, 95.08%J after 11-15 years, and 85.12% [95% CI: 82.18%, 88.20%] after 16-20 years. Conclusions: According to these findings, the protection provided by HB vaccine is dependent on immune memory rather than anti-HBs titer; therefore, recommendations for booster doses should be based on immune memory instead of the persistence of antibody. In addition, a full course of MB vaccination can induce a long-term and strong serologic immunity against hepatitis B virus infection. Nonetheless, the decreasing trend of seroprotection during the first and second decades after immunization indicates that the long-term immunity induced by HB vaccine may diminish over time. This issue raises the possibility of the need for a booster dose, although universal revaccination does not seem necessary during the first and second decades after primary vaccination in healthy individuals with normal immune status who had fully responded to a complete course of the vaccine. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) marked by rectal and colon inflammation, leading to relapsing symptoms. Its prevalence is increasing, particularly in developed nations, impacting patients' health. While its exact cause remains unclear, genetic and environmental factors are implicated, elevating the risk of colorectal cancer (CRC). Colectomy, though declining, is still performed in select UC cases, necessitating further study., Methods: We analyzed data from the Iranian Registry of Crohn's and Colitis (IRCC) to examine UC patients undergoing colectomy. We collected demographic and clinical data from 91 patients, focusing on dysplasia. Statistical analyses assessed dysplasia risk factors., Results: Patients with dysplasia were older at diagnosis and surgery compared to those without dysplasia. Age emerged as a significant risk factor for dysplasia in UC patients undergoing colectomy. No significant associations were found between dysplasia and other factors., Conclusion: Age plays a crucial role in dysplasia risk among UC patients undergoing colectomy. Older age at diagnosis and surgery may indicate a higher risk of dysplasia and CRC. Clinicians should consider age when managing UC patients and implementing screening protocols. Further research with larger samples is needed to confirm these findings., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

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., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients., Methods: This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes., Results: From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients ( P <0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P =0.001), immunomodulators (44.9% vs 25.2%, P <0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P =0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P =0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P <0.001), immunomodulators (58.7% vs 41.8%, P =0.005) and anti-TNF (49.6% vs 35.4%, P =0.006)., Conclusion: Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background & Aims: The prevalence of clinically significant endoscopic findings in people with dyspepsia and understanding how symptoms can predict endoscopic pathology can help inform dyspepsia guidelines. We evaluated this in an updated systematic review and meta-analysis., Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews from 2010 through to January 2022 to identify relevant articles. Eligible studies enrolled adults from the community, workplace, blood donation or screening clinics, family physician offices, or internal medicine clinics. Studies were required to report prevalence of dyspepsia and perform esophagogastroduodenoscopy (EGD). Prevalence of clinically significant endoscopic findings in subjects with and without dyspepsia was pooled for all studies and compared using odds ratios and 95% confidence intervals (CIs). The data were pooled with those of the 9 studies included in the prior review., Results: Of 511 papers evaluated, 184 reported prevalence of dyspepsia. Fifteen reported prevalence of endoscopic findings among 41,763 participants (40.4% with dyspepsia). Erosive esophagitis was the most common abnormality (pooled prevalence, 11.0%; 95% CI, 8.9%-13.2%) followed by peptic ulcer (pooled prevalence, 4.4%; 95% CI, 2.5%-6.7%). The only finding encountered more frequently in individuals with dyspepsia, compared with those without, was peptic ulcer (odds ratio, 1.61; 95% CI, 1.08-2.39). More than 85% of EGDs were completely normal. Gastroesophageal cancer was rare (<0.4%) and equally prevalent among those with and without dyspepsia., Conclusions: Erosive esophagitis was the most common clinically significant finding at EGD, whereas gastroesophageal cancers were rare. Most pathology, including esophagitis and cancer, were found in similar proportions in both groups. These findings support noninvasive approaches to managing dyspepsia in the community, with EGD reserved for those at high risk of malignancy., (Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: The epidemiological evidence regarding the carcinogenicity of nitrate and sodium in drinking water is limited, partly because measuring the exposure at the individual level is complex. Most studies have used nitrate in water supplies as a proxy for individual exposure, but dietary intakes and other factors may contribute to the exposure. The present study investigates the factors associated with urinary nitrate and sodium in a high-risk area for esophageal and gastric cancers., Methods: For this cross-sectional study, we used data and samples collected in 2004-2008 during the enrollment phase of the Golestan Cohort Study from a random sample of 349 participants (300 individuals from 24 rural villages and 49 from the city of Gonbad), stratified by average water nitrate in their district, the source of drinking water, and the usual dietary intake of nitrate and sodium. Nitrate, sodium, and creatinine were measured in a spot urine sample collected at the time of interview. We used the provincial cancer registry data to calculate the cumulative incidence rates of esophageal and gastric cancers for each location through June 1, 2020, and used weighted partial Pearson correlation to compare the incidence rates with median urinary nitrate and sodium in each village or the city., Results: Among 349 participants (mean age±SD: 50.7 ± 8.6 years), about half (n = 170) used groundwater for drinking, and the use of groundwater was significantly more common in high-elevation locations (75.8%). The geometric mean of the creatinine-corrected urinary nitrate concentration was 68.3 mg/g cr (95%CI: 64.6,72.3), and the corresponding geometric mean for urinary sodium was 150.0 mmoL/g cr (95%CI: 139.6,161.1). After adjusting for confounders, urinary nitrate was associated with being a woman, drinking groundwater, and living in high-elevation locations, but not with estimated dietary intake. Urinary sodium concentration was significantly associated with monthly precipitation at the time of sampling but not with elevation or drinking water source. There were significant positive correlations between both median urinary nitrate and sodium in each location and esophageal cancer incidence rates adjusted for sex and age (r = 0.65 and r = 0.58, respectively, p < 0.01), but not with gastric cancer incidence., Conclusion: In a rural population at high risk for esophageal and gastric cancers, nitrate excretion was associated with living at a higher elevation and using groundwater for drinking. The associations between nitrate and sodium excretion with esophageal cancer incidence warrant future investigation., (Published by Elsevier Inc.)

Background: The role of genetic and environmental factors in inflammatory bowel disease's (IBD) clinical course is not fully clear. We aimed to assess the clinical phenotype, disease course, and prognosis of familial IBD in comparison with sporadic cases., Methods: We conducted a prospective national matched case-control study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) recruited from 2017 until 2020. Sporadic and familial IBD patients were matched based on age, sex, and disease duration. Data on demographics, past medical disease, family history of IBD, disease type, clinical phenotype, extraintestinal manifestations, IBD medications, IBD activity using the IBD-control-8 questionnaire and the Manitoba IBD index, emergency visits in the past 12 months, admissions in the past 3 months, history of colon cancer, IBD-related surgeries, and aggressive phenotype were gathered. Variable distributions were compared between sporadic and familial cases., Results: Overall, 5231 patients with ulcerative colitis (UC, 18.3% familial) and 1438 patients with Crohn's disease (CD, 16.7% familial) were registered in the IRCC. Age at diagnosis was similar between familial and sporadic cases. After matching, 3523 UC patients and 908 CD patients were enrolled in the study. Extraintestinal manifestations, UC extent, CD location and behavior, anti-TNF use, disease activity, colon cancer, IBD-related surgeries and the aggressive phenotype were similar between these sporadic and familial cases., Conclusions: The prevalence of familial UC and CD cases in Iran was more similar to western countries, and family history did not show a predictive value for disease phenotype, course, and outcomes in our study., (© 2021 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

BACKGROUND : Immunosuppressive agents used in the treatment of inflammatory bowel diseases (IBDs) could potentially increase the risk of coronavirus disease 2019 (COVID-19). We aimed to compare COVID-19 frequency in patients with IBD with their households and identify the related risk factors. METHODS : Firstly, a multi-centered, observational study on 2110 patients with IBD and 2110 age-matched household members was conducted to compare COVID-19 frequency. Secondly, the data of patients with IBD and COVID-19 who had called the COVID-19 hotline were added. Multivariable logistic regression was used to evaluate the effect of age, type and severity of IBD, the number of comorbidities, and medications on the frequency of COVID-19 among the patients with IBD. RESULTS : The prevalence of COVID-19 in patients with IBD and household groups was similar (34 [1.61%] versus 35 [1.65%]; P = 0.995). The prevalence of COVID-19 increased from 2.1% to 7.1% in those with three or more comorbidities ( P = 0.015) and it was significantly higher in those with severe IBD ( P = 0.026). The multivariable analysis only showed a significant association with anti-TNF monotherapy (OR: 2.5, CI: 0.97-6.71, P = 0.05), and other medications were not associated with COVID-19. CONCLUSION : The prevalence of COVID-19 in patients with IBD was similar to the household members. Only patients with IBD receiving anti-TNF monotherapy had a higher risk of COVID-19 susceptibility. This finding could be attributed to the higher exposure to the virus during administration in health care facilities., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest related to this work., (© 2022 Middle East Journal of Digestive Diseases.)

BACKGROUND The COVID-19 pandemic has affected the health care infrastructure dramatically, with abundant resources necessarily being redirected to COVID-19 patients and their care. Also, patients with chronic diseases like inflammatory bowel disease (IBD) may be affected in several ways during this pandemic. METHODS We used the Iranian registry of Crohn's and colitis (IRCC) infrastructure. We called and sent messages to follow-up and support the care of all registered patients. Besides, we prepared and distributed educational materials for these patients and physicians to reduce the risk of COVID-19 infection. We risk-stratified them and prepared outpatient clinics and hospitalization guidance for IBD patients. RESULTS Of 13165 Iranian patients with IBD, 51 have been diagnosed as having COVID-19. IBD patients made 1920 hotline calls. Among the patients with suspicious presentations, 14 COVID-19 infections were diagnosed. Additionally, 1782 patients with IBD from five provinces actively phone-called among whom 28 definite cases were diagnosed. CONCLUSION IBD patients' follow-up could help in diagnosing the affected IBD patients with COVID-19. Additionally, the performance of protective actions and preparing the patients and physicians for decisive proceedings are the principles of protection of IBD patients., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest related to this work., (© 2020 Middle East Journal of Digestive Diseases.)

Background: The burden of inflammatory bowel disease (IBD) hasn't been reported in Iran. We aimed to estimate the prevalence and incidence of IBD and its trend in Iran at national and subnational level from 1990 to 2012., Methods: We conducted a systematic review of English and Persian databases about the epidemiology of IBD. We also collected outpatient data from 17 provinces of Iran using almost all public and private referral gastroenterology clinics. Prevalence and incidence rate was calculated at national and subnational levels. The Kriging method was used to extrapolate provinces with missing data and GPR model to calculate time trends of rates at subnational level., Results: We found 16 case series, two population-based studies, and two review articles. We collected 11,000 IBD cases from outpatient databases. Among them, 9,269 (84.26%) had ulcerative colitis (UC), 1,646 (14.96%) had Crohn's disease (CD), and 85 had intermediate colitis (IC). A total of 5,452 (49.56%) patients were male. Mean age at diagnosis was 32.80 years (CI: 13 - 61) for UC and 29.98 years (CI: 11 - 58) for CD. Annual incidences of IBD, UC, and CD in 2012 were 3.11, 2.70, and 0.41 per 100,000 subjects respectively. Prevalence of IBD, UC, and CD in 2012 were 40.67, 35.52, and 5.03 per 100,000 subjects respectively. The incidence of UC and CD showed a significant increase during the study period (P for trend < 0.05)., Conclusions: The incidence and prevalence of IBD are increasing in Iran. Establishing a national IBD registry seems necessary for comprehensive care of IBD patients in Iran.

BACKGROUND Early diagnosis and endoscopic resection of adenomatous polyps is the main approach for screening and prevention of colorectal cancer (CRC). We aimed to assess polyp detection rate (PDR) and to characterize demographic, clinical, and pathological features of colorectal polyps in an Iranian population. METHODS We retrospectively analyzed the data from 5427 colonoscopies performed during 2007-2012 at Masoud Clinic, the main endoscopy center associated with Sasan Alborz Biomedical Research Center, in Tehran, Iran. RESULTS Our sample included 2928 (54%) women and 2499 (46%) men, with the mean age of 48.3 years (SD=16.1). The most common reasons for colonoscopy included screening in 25.0%, and gastrointestinal bleeding in 15.2%. Cecal intubation was successful in 86% of patients. The quality of bowel preparation was fair to excellent in 78.1% (n=4235) of colonoscopies. Overall PDR was 42.0% (95% CI: 40.6-43.3). The PDR in men (51.1%, 95% CI: 49.1-53.1) was significantly higher than women (34.2%, 95% CI: 32.4-35.9, p<0.001). Polyps were more frequently observed in patients after the 6(th) decade of life (F=3.2; p=0.004). CRC was detected in 2.9% (73/2499) of men and 1.9% (57/2928) of women (p=0.02). The mean age for patients with cancer was significantly higher than that for individuals with polyps, 60.9 (SD=13.4) year vs. 56.9 (SD=13.7) year, respectively (p=0.001). Almost 82.8% of the lesions were precancerous with tubular type predominance (62.3%) followed by tubulo-villous (10.3%), villous (6.6%), and serrated (3.6%). Hyperplastic/inflammatory polyps comprised 17.2% of lesions. CONCLUSION Distal colon was more prone to develop polyps and cancer than proximal colon in our series. These findings provide a great infrastructure for next preventive programs and have implications for colorectal cancer screening at population-level.

Background: This study assesses the potential effect of Lactobacillus reuteri as a single strain probiotic preparation (Biogaia®) on irritable bowel syndrome (IBS)., Methods: Patients diagnosed with IBS who fulfilled Rome III criteria and consented to participate in this study were randomized to receive either the probiotic or an identical placebo once daily for four weeks. Patients used a questionnaire to record any symptoms and adverse reactions over a one-week run-in period and during the final two weeks of intervention. For each group, we calculated the differences between mean scores of the variables and compared the results between groups., Results: Frequency of defecation increased in the Biogaia® group and decreased in the placebo group meaningfully. But There were no significant difference in the two groups in other terms of bloating, sense of urgency for defecation, abdominal pain, stool shape, quality of defecation, sense of incomplete evacuation, and treatment satisfaction., Conclusion: The frequency of defecation increased in the Biogaia® group and decreased in the placebo group, however this study did not classify patients according to diarrhea or constipated subgroups, the efficacy of this drug is not clear. Hence Lactobacillus reuteri was not better than placebo in controlling IBS symptoms in this study. However, considering the significant placebo effect in IBS patients, it may be necessary to conduct studies with larger numbers of participants to better assess the possible beneficial effects of Biogaia.

Objectives: To investigate the association between opium use and subsequent risk of death., Design: Prospective cohort study., Setting: The Golestan Cohort Study in north-eastern Iran collected detailed validated data on opium use and other exposures at baseline. Participants were enrolled between January 2004 and June 2008 and were followed to May 2011, with a follow-up success rate of over 99%., Participants: 50,045 participants aged 40-75 at baseline., Main Outcomes: Mortality, all cause and major subcategories., Results: 17% (n = 8487) of the participants reported opium use, with a mean duration of 12.7 years. During the follow-up period 2145 deaths were reported. The adjusted hazard ratio for all cause mortality associated with ever use of opium was 1.86 (95% confidence interval 1.68 to 2.06). Opium consumption was significantly associated with increased risks of deaths from several causes including circulatory diseases (hazard ratio 1.81) and cancer (1.61). The strongest associations were seen with deaths from asthma, tuberculosis, and chronic obstructive pulmonary disease (11.0, 6.22, and 5.44, respectively). After exclusion of people who self prescribed opium after the onset of major chronic illnesses, the associations remained strong with a dose-response relation., Conclusion: Opium users have an increased risk of death from multiple causes compared with non-users. Increased risks were also seen in people who used low amounts of opium for a long period and those who had no major illness before use.

Aim: To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both., Methods: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4 +/- 11.5 years) met Rome II or Rome III criteria (depending on the year of diagnosis) for IBS. 2658 patients were diagnosed with GERD based on clinical presentation and endoscopic findings. We assessed other functional symptoms (epigastric pain, nausea, vomiting, belching, constipation and diarrhea) in patients suffering from GERD, IBS or both., Results: Among IBS subjects, 63.6% (69.0% women, 31.0% men; mean age: 36.4 +/- 10.3 years) also had GERD, whereas 34.7% of the non-IBS patients had GERD [odds ratio (OR) = 3.2, 95% confidence interval (CI): 2.9-3.7, P < 0.0001]. Among patients with GERD, 33.9% of subjects met Rome criteria compared to 13.5% of non-GERD patients (OR = 3.6, 95% CI: 3.1-4.3, P < 0.0001). Prevalence of all functional symptoms was higher in overlapping GERD and IBS subjects, when compared with their prevalence in the IBS subjects without GERD or GERD only subjects (P < 0.05)., Conclusion: This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.

Background: Publication bias is an important factor that may result in selection bias and lead to overestimation of the intervention effect. In this study, the focus was on using capture-recapture method as a statistical procedure which may possibly be a practical means for measuring the amount of publication bias., Methods: A systematic review was conducted to estimate the duration of protection provided by hepatitis B vaccine by measuring the anamnestic immune response to booster doses of vaccine and retrieved studies from three separate sources of electronic databases, reference lists of the studies, and conference databases as well as contact with experts and manufacturers. Capture-recapture and some conventional methods such as funnel plot, Begg test, Egger test, and trim and fill method were employed for assessing publication bias., Results: Based on capture-recapture method, completeness of the overall search results was 87.2% [95% CI: 84.6% to 89.0%] and log-linear model suggested 5 [95% CI: 4.2 to 6.2] missing studies. The funnel plot was asymmetric while Begg and Egger tests results were statistically insignificant and trill and fill approach made no change in pooled effect., Conclusions: Capture-recapture method may be a useful practical approach for estimating the number of missing studies which are not usually detected by search strategy. As a result, use of capture-recapture method as an alternative approach could be suggested for estimating the extent of publication bias based on overlapping information rather than mirror image of extreme values on funnel plot.

Background: Osteoporosis has been frequently reported in patients with inflammatory bowel diseases, especially Crohn's disease., Methods: All consecutive Crohn's disease patients who attended the GI Clinics at Shariati Hospital, Tehran, Iran, from 2004 to 2007 were evaluated. A BMD-DEXA assessment was performed for all patients. Among those patients diagnosed with osteoporosis (T score

In a recently published paper in the "British Medical Journal", a joint collaboration of well-known international scientists represented by Islami et al. has tackled this issue.1 In a well-designed, laborious case-control study in Golestan, Iran, they looked at 300 cases of esophageal SCC and 571 age and sex matched neighborhood controls, assessed the temperature of the commonly used drink "tea" among them and compared it between the two groups. After adjusting for several confounders including ethnicity, daily vegetable intake, alcohol consumption, tobacco or opium use, duration of residence in rural areas, education level and car ownership (the latter two as indices of socio-economic status), they found that consuming hot tea is associated with significantly increased chance of developing esophageal SCC. The adjusted odds ratio(OR) for developing esophageal SCC in those who reported drinking "very hot tea" was 8.16 (95% CI: 3.93 to 16.91) as compared to those taking warm or lukewarm tea (P<0.001) and for those drinking "hot" tea the adjusted OR was 2.07 (95% CI: 1.28 to 3.35). According to Islami et al., 21.1% and 36.2% of the cases drank their tea "very hot" or "hot", respectively. Self-claim of "hot", "very hot", and "warm or "lukewarm" tea drinking correlated with the claimed time from pouring tea to its drinking by the individual (weighted kappa statistics: 0.69). They did not find any correlation between amount of tea consumed and development of esophageal SCC. They have also reported limited data of tea temperature measurement in addition to the self claims of tea drinking habits (as mentioned for the case-control study) from a large on-going cohort study in the same region. The authors conclude that it is probably the "hotness" rather than the "tea" which is responsible for this increased chance of SCC of esophagus. In an accompanying editorial, Whiteman suggests that people drink their tea at least 5 minutes after pouring it in their cups.

Background: Increased duodenal intraepithelial lymphocytes is a key histological finding in celiac disease. Available studies suggest a wide normal range (10 - 40 intraepithelial lymphocytes /100 epithelial cells, EC). We assessed the normal range of distal duodenal intraepithelial lymphocytes., Methods: Biopsies from the normal-looking distal duodenum from individuals referring for endoscopy for reasons other than intestinal pathologies were stained with hematoxylin-eosin and immuno-histochemistry (immunohistochemistry, CD45). At least 1000 cells from the tip and body of the villi were assessed. Villous height to crypt depth ratio was calculated., Results: Fifty individuals were enrolled. Four were excluded (inadequate biopsies). Mean intraepithelial lymphocyte count was similar in villous tip and body. In the whole villous, upper limit of normal (mean+2SD) was 35 intraepithelial lymphocytes/100EC (95% CI: 31 - 39) in immunohistochemistry and 34 intraepithelial lymphocytes/100EC (95%CI: 29 - 37) in H&E staining. The villous height to crypt depth ratio was 3.9. Hematoxylin-eosin and immunohistochemistry had excellent agreement., Conclusion: Intraepithelial lymphocyte counts less than 35/100EC in IHC and 34/100EC in hematoxylin-eosin staining can be considered normal. Counts between 36-39 (immunohistochemistry) and 35 - 37 (hematoxylin-eosin) are borderline and more than 39 (immunohistochemistry) and 37 (hematoxylin-eosin) are increased. The hematoxylin-eosin staining method seems adequate for clinical purposes. Regional differences in the normal upper limit for intraepithelial lymphocytes as well as changes over time should be considered when interpreting duodenal biopsies.

Background: The prevalence of gastroesophageal reflux disease (GERD) in Asian populations is reported to be lower than that in the West. Population-based data on the prevalence and symptom profile of GERD in developing Caucasian countries is lacking. Our objective was to determine the prevalence of gastrointestinal symptoms and clinical spectrum of GERD in Tehran, northern Iran and their association with patient characteristics., Methods: One thousand seven hundred telephone numbers were randomly selected from Tehran telephone directory using a simple random method. A two-step screening telephone survey was then performed. In each answered call a second rapid survey was done to select a subject 18-65 years old from that household. A validated questionnaire was then filled out for that individual. Patient characteristics (age, education, and gender) and history of acid regurgitation and heartburn during the last week, as well as the previous three months were inquired about., Results: Of the 1,700 selected numbers, 278 either did not answer or did not have an eligible case; 220 refused to participate. A total of 1,202 subjects (42% males, mean age: 36 years, range: 18-65 yr) were surveyed. The prevalence of heartburn occurring monthly, weekly, and daily was 4.7% (CI95%: 3.5-6.0%), 1.6% (CI95%: 1.0-2.5%), and 0.6% (CI95%: 0.3-1.3%), respectively. The corresponding figures for acid regurgitation were 15.6% (CI95%: 13.6-17.7%), 5.7% (CI95%: 4.4-7.1%) and 1.5% (CI95%: 0.9-2.4%), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced daily, weekly and monthly was 1.9% (CI95%: 1.2-2.9%), 6.8% (CI95%: 5.4-8.3%), and 18.4% (CI95%: 16.2-20.6%). There was no relationship between the prevalence of GERD and either gender, age, or education., Conclusion: Monthly GERD symptoms occur in 18.4% of the general population in Tehran. Acid regurgitation is more common (4 - 5 times) than heartburn. Gender, age, and level of education do not affect the prevalence of GERD symptoms in the community studied.

Background: Los Angeles classification is widely adopted for reporting endoscopic gastroesophageal reflux disease. We assessed the inter- and intra-observer variability of the Los Angeles classification., Methods: Still images (n = 254) of the lower esophagus were presented to 9 gastroenterologists (6 experts and 3 trainees) and they were asked to report the images according to the Los Angeles classification. After 2 weeks the images were reordered and they were asked to report them again. Kappa statistic was calculated for intra- and inter-observer variability., Results: The kappa for intra-observer agreement was 0.54 (attendings: 0.54; trainees; 0.55; P = not significant) and the inter-observer agreement was 0.22 (attendings: 0.20; trainees: 0.31; P = 0.027). The inter- and intra-observer kappa values in differentiating nonerosive from erosive cases were 0.22 (attendings: 0.21; trainees: 0.31, P = not significant) and 0.57 (attendings: 0.58; trainees: 0.55, P = not significant), respectively., Conclusion: According to our data, the Los Angeles classification has acceptable intra-observer variability, both for detecting presence or absence of erosions and for differentiating between different degrees of esophagitis, while its inter-observer performance seems to be less acceptable. It may be reasonable and timely to have another look at the Los Angeles classification to see whether its performance can be improved even further.

Objective: To estimate the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in a young population and evaluate the risk factors., Methods: This cross-sectional study using a reliable and valid questionnaire was performed during June and July 2005, on randomized selection of 620 students form Azad University of Tabriz. Gastroesophageal reflux disease was defined as at least weekly heartburn and/or acid regurgitation., Results: Mean age (+/- SD) of the responders was 22.48 +/- 1.98 years. The prevalence of heartburn and/or acid regurgitation experienced at least weekly was 6.3% and monthly was 13%. The severity of symptoms was mainly of a mild to moderate degree. There was no difference in prevalence of any GERD symptom between 2 genders and it was not associated with age of the study population. A frequent symptom of GERD was reported more among subjects with atypical symptoms. There was no relation between marriage status and prevalence of GERD. On the other hand, GERD was less common among subjects with no family history of upper gastrointestinal disease and students in higher rank fields. Increased body mass index (but no recent weight gain or lose) and drinking coffee and tea was associated with higher prevalence of GERD symptoms., Conclusion: This study as the first study using a valid questionnaire reveals a high prevalence of frequent GERD symptoms in a young population of Tabriz. Atypical symptoms should be considered in this area.