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Objective: Nonalcoholic fatty liver disease (NAFLD) is characterized by excessive lipid accumulation in hepatocytes with no consumption of alcohol. Recently, curcumin is a natural polyphenol found in turmeric has been examined for the treatment of NAFLD. This study aimed to assess the efficacy of 160 mg/day nano-micelle curcumin on the amelioration of NAFLD by measuring liver enzymes. Materials and Methods: Patients with NAFLD were randomly divided into curcumin (intervention group n=33) and placebo (n=33) groups and at the end of the study, the data of 56 participants who completed the 2-month intervention were analyzed. Laboratory tests and questionnaires were used to gather information. Both groups received recommendations for lifestyle modification, and were advised to other necessary advices. Patients in the curcumin group received 160 mg/day of nanomicelle curcumin in two divided doses for 60 days. The 2 groups were followed up for two months and clinical and laboratory indices were compared. Results: Our data showed a significant decrease in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the curcumin group (p<0.01) as well as a significant difference between the groups before and after the intervention in curcumin group (p<0.05). Interestingly, a meaningful decrease in AST serum level was observed in the intervention group (p<0.01). Conclusion: Our study demonstrated that short-term supplementation with nano-micelle curcumin results in the reduction of AST and ALT and is beneficial for the treatment of NAFLD. [ABSTRACT FROM AUTHOR]

Some studies have shown that giardia infection is associated with some abdominal symptoms. The aim of this study was to determine the relationship between giardia duodenalis infection and irritable bowel syndrome (IBS). In this clinical trial study, 60 patients with non-constipation predominant IBS based on Rome III criteria were enrolled in the study. 30 patients with giardiasis who were diagnosed with stool Eliza as patients, and 30 other patients who did not have giardiasis as control enrolled to study. All patients were treated with 250 milligrams of metronidazole TDS for 5 days. Abdominal symptoms including abdominal pain, bloating, and diarrhea were determined and compared in both groups before and after treatment. The mean age and sex distribution of the two groups were similar (P>0.5). The pain, bloating, and diarrhea severity before treatment with metronidazole were not significantly different in the two groups. The pain and bloating and diarrhea severity in both groups significantly decreased after the treatment period, but reductions were significantly higher in the case group (P<0.001 and P<0.001 P<0.001, respectively). The mean score of global symptoms before treatment in both case and control groups was similar. (P=0.88), but after treatment it was 4.85±2.18 (P<0.001) and 10.48±2.14 (P<0.001) respectively and the difference between the two groups was significant (P<0.001). The recovery percentage was 0.61±0.16 in the case group and 0.14±0.17 in the control group (P<0.001). Giardia infection in patients with IBS seems to play a significant role in clinical manifestations of non-constipation IBS and treatment with metronidazole can improve these symptoms significantly. [ABSTRACT FROM AUTHOR]

Background: As a common digestive disorder, choledocholithiasis can have serious consequences, including death. Given that opioids have been shown to contribute to the spasm of Oddi's sphincter, which results in biliary stasis in the common bile duct (CBD), it is likely that opioids can also raise the prevalence of choledocholithiasis. In this regard, this study aimed to investigate how common opium addiction was among choledocholithiasis patients in Mashhad, Iran. Methods: The current retrospective observational study was conducted on 599 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP), utilizing information gathered at the Ghaem hospital in Mashhad, Iran, between 2011 and 2015. Patient data were collected from files and records using certain criteria such as gender, opium addiction, hepatic enzymes (AST, ALT, ALP), plasma levels of total bilirubin, and direct bilirubin. The size of the CBD stones as well as the correlation between the gallbladder and CBD stones were calculated. Findings: From among 599 patients included, 345 (57.6%) were female and 254 (42.4%) were male. Moreover, 195 patients (32.2%) had opiate addictions. The size of the CBD stone was correlated with the patient's age (r = 0.17, P = 0.001). The average stone measured 12.22 ± 3.32 mm. There were notable differences in the mean size of the CBD stone (P < 0.001) between addicted and non-addicted cases; specifically, the mean CBD stone size in addicted cases was 12.715.13 mm while it was 12.34.33 mm in non-addicted cases. Conclusion: This study showed patients with CBD stones have a higher rate of opium addiction compared to the general population, indicating a possible link between the two conditions. [ABSTRACT FROM AUTHOR]

Introduction: Based on serological studies, the prevalence of Helicobacter pylori infection in Iranian adults is up to 80%. Gastritis, peptic ulcer, and gastric adenocarcinoma are common clinical outcomes of this infection in Iran. Since antibiotic resistance patterns of Helicobacter pylori are geographically different, local studies are highly required. Methods: Eighty isolates of Helicobacter pylori were obtained from patients referred to the endoscopy unit of Ghaem Hospital in Mashhad. Demographic features including age, gender, and symptoms were recorded before the sampling. The antibiotic susceptibility patterns of isolates were determined for the five common antibiotics used for the treatment of Helicobacter pylori infection. The agar dilution method was used to evaluate the antibiotic resistance patterns. Results: The patterns of antibiotic resistance were determined, and ,%13.7 ,%41.2 %6.6 ,%8.7, and %6.6 of isolates were resistant to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone, respectively. Conclusion: Our study demonstrates that the overall rate of antibiotic resistance of Helicobacter pylori especially in the case of metronidazole has increased over time. The resistance rates are generally higher in the age range of 60-30 years and in females for the case of metronidazole. This reminds us of the need for a continuous monitoring program of antibiotic susceptibility patterns. [ABSTRACT FROM AUTHOR]

Background Common bile duct (CBD) stone is the most common disorder in the biliary tract, which may lead to hospital admission. Opium addiction is one of the most challenging social and health issues in many societies. An important side effect of opium addiction is the Oddi’s sphincter spasm; i.e., it is likely that the prolonged stasis of bile acid increases the risk of gallstone formation in the CBD. Materials and methods: This cross-sectional study was done from April 2019 to November 2019 in Ghaem Hospital in Mashhad, Iran. 400 patients aged 20-80 years were enrolled. All patients had a definite diagnosis of CBD stones and were candidates for endoscopic retrograde cholangiopancreatography (ERCP). Demographic information of patients, history of underlying diseases, liver laboratory disorders, the existence of concomitant gallbladder stones, and opium addiction information were collected. Results The average age of the patients with opium addiction was 65.12 years, and it was significantly higher than the mean age of the patients (61.41 years) without opium addiction (P=0.01). 74.3% were hospitalized, and 25.3% were outpatients. 35.5% of the patients were men, and 64.5% were women. Our study showed that 41.5% of the patients with CBD stones were opiumaddicted. The average CBD stone size in patients with opium addiction (10.15±4.85 mm) was larger than in patients without opium addiction, but a t test showed that this difference was not significant (P = 0.9). Conclusion In this study of patients with CBD stones referred for ERCP, we observed a high prevalence of opium addiction in patients with CBD stones. [ABSTRACT FROM AUTHOR]

Introduction: The present study was conducted to evaluate the prevalence of trend and use of complementary and alternative medicine in patients referring to the Gastroenterology clinics in Mashhad. Methods: The present cross-sectional study was performed at Gastroenterology clinics affiliated with Mashhad University of Medical Sciences. The study began in December 2015 and ended in March 2017. The study subjects (n=751) were randomly selected from patients referring to Gastroenterology clinics in the city of Mashhad. Patients responded to the questions through interviews. The collected data were analyzed by SPSS-16 statistical software. Results: This study was conducted on 751 patients referring to gastroenterologists; of whom, 274 (48.36%) were male and 476 (38.63) were female. According to the results, the most popular complementary and alternative medicine treatments were respectively herbal medicine, cupping therapy and acupuncture. A significant difference was observed in the means at is faction with complementary and alternative medicine between those who believed in it and those who did not (p=0.001); but, no significant difference was detected in mean satisfaction with complementary and alternative medicine between patients with different occupations (p=0.193). There was also a significant difference in the number of patients between the group of patients receiving chemical medication and the group of patients receiving complementary and alternative medicine therapies (p=0.005). No significant difference was found in the level of satisfaction with complementary and alternative medicine between participants referring to the Gastroenterology clinics for different causes (p=0.431); nonetheless, the highest satisfaction was observed in patients with malignancy, and the lowest satisfaction was detected in patients with esophageal disorders. Conclusion: This study indicated the high prevalence of complementary and alternative medicine in Iran. The worldwide popularity of complementary and alternative medicine should not be overlooked, therefore; current medical treatment systems need to be revised and modified. [ABSTRACT FROM AUTHOR]

Non‐alcoholic fatty liver disease (NAFLD) is one of the most common causes of hepatic disorders. It represents a wide range of chronic liver diseases in patients with no history of significant alcohol consumption, starting with simple steatosis and progressing towards non‐alcoholic steatohepatitis, cirrhosis, and ultimately hepatocellular carcinoma. NAFLD is usually associated with type 2 diabetes mellitus, dyslipidemia, metabolic syndrome, and obesity. This disease has mostly been studied in obese individuals; however, it has been widely reported and studied among the lean/non‐obese population in recent years. The pathogenesis of NAFLD in non‐obese patients is associated with various genetic predispositions, particularly a patatin‐like phospholipase domain‐containing protein 3 G allele polymorphism, which results in the accumulation of triglyceride in the liver and resistance to insulin. Additionally, dietary factors such as high fructose consumption seem to play a substantial role in the pathology of non‐obese NAFLD. Although there is not enough evidence on the treatment of NAFLD in non‐obese patients, the standard approach is to advise altering one's lifestyle in order to diminish visceral adiposity. Dietary modification, weight loss, and increased physical activity are highly recommended. We aimed to review and summarize the existing information on the prevalence, pathogenesis, genetic predispositions, diagnosis, and treatment of NAFLD in non‐obese patients according to the latest literature. [ABSTRACT FROM AUTHOR]

There are disagreements about the diagnostic value of the current risk stratification systems in patients with acute upper gastrointestinal bleeding (UGIB). The present study aimed to determine the diagnostic value of the Glasgow-Blatchford score in UGIB patients. This study was conducted on 182 patients with UGIB who underwent endoscopy in the Emergency Department of Imam Reza Hospital, Mashhad, Iran. Glasgow-Blatchford Score (GBS) of each patient was estimated by using the clinical and laboratory parameters. The relationship between Blatchford score and endoscopic findings was assessed. Additionally, the sensitivity and specificity of GBS were measured based on high- and low-risk patients. According to the results, GBS had a high sensitivity (90.9%), specificity (79%), as well as positive (76%), and negative predictive values (92.2%). However, no significant relationship was observed between the Glasgow-Blatchford score and re-bleeding. As the findings of the present study indicated, Glasgow-Blatchford was a good predictive method for the determination of the high-risk and low-risk patients with UGIB. Nevertheless, this method showed poor performance in the prediction of re-bleeding. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is one of the most common cancers among men and women worldwide. Patients who are diagnosed at the early stages of the disease have a significantly better prognosis, lower mortality, and lower burden of the disease. Thus, screening methods, namely colonoscopy, and fecal occult blood test are effective means of a timely diagnosis. However, there are pearls and pitfalls among doctors in the decision to participate and implement these methods. This article aims to evaluate and discuss the attitude and behavior of physicians toward colonoscopy screening. Materials and Methods: This cross-sectional study was performed on 81 physicians working in academic hospitals of Mashhad University of Medical Sciences, Iran, between February and May 2019. Data were gathered using demographic information checklists and a researcher-developed checklist to evaluate the attitude of physicians towards the benefits and necessity of colonoscopy. Data were analyzed using SPSS software version 23, and p < 0.05 was considered statistically significant. Results: 81 physicians with a mean age of 58.9 ± 6.6 years were studied. Most of the participants were male (n = 60, 74.1%), married (n = 79, 97.5%), and had fellowships in their specialty (n = 44, 54.3%). When asked about barriers against colonoscopy, most physicians mentioned unwillingness (n = 24, 29.6%) and lack of time (n = 14, 17.3%). There was no significant association between physicians’ sex and their screening colonoscopy history (p =0.98). Moreover, no significant association was detected between the physicians’ level of education and undertaking colonoscopy (p = 0.15). Conclusion: This study revealed that a large number of physicians are not willing to undergo screening colonoscopy despite the fact that they have a positive attitude towards the method. Although physicians are knowledgeable about the benefits of colonoscopy, it is not sufficient, and creating the right cultural context is also needed. [ABSTRACT FROM AUTHOR]

Primary intestinal lymphangiectasia is a rare congenital disorder leading to edema, hypoproteinemia, lymphocytopenia, and watery diarrhea. We here report a case of primary intestinal lymphangiectasia in a woman with peripheral edema and recurrent diarrhea in whom laparoscopic biopsy confirmed the diagnosis. In this report, a 21-year-old woman was referred to a tertiary hospital because of abdominal pain, lower extremity edema, and a history of chronic watery diarrhea from childhood. The patient was diagnosed as having protein losing enteropathy secondary to intestinal lymphangiectasia. Diagnosis was confirmed by laparoscopy and multiple deep intestinal biopsies were performed. The diagnosis of primary intestinal lymphangiectasia is usually neglected especially in adults. This differential diagnosis should be considered in any patients with a history of chronic diarrhea and hypoproteinemia. The correct clinical suspicion can properly guide physicians to the correct diagnosis. Diet intervention is the cornerstone of the medical management of primary intestinal lymphangiectasia, which is affected strongly with timely diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Irritabale bowel syndrome is one the most common intestinal disease that psychological factors have important role on that. In this study we evaluate the effect of aromatherapy with Rosa damascena on clinical signs of IBS. Methods: In a double blind randomized clinical trial, we chose 60 patients with IBS. The patients filled a two parts questionnaire. In the first part they filled about their bowel habits and in the second part they showed their level of anxiety. The participants were randomly allocated to the aromatherapy and placebo group. The aromatherapy group were treated with inhalation of Rosa Damascena oil and the placebo group inhaled grapeseed oil. Results: The mean age in aromatherapy and control group was 32 and 32.9 years, which was not significantly different. No significant difference in experiencing pain and duration of the abdominal pain was observed between the two groups before or after the intervention. Before and after intervention no significant difference was observed in the stool form and stool frequency and presence of mucus between the two groups. Before and after the intervention no significant difference was observed in the level of hidden anxiety between the two groups. However, after the intervention the level of apparent anxiety was decreased in the aromatherapy group. Conclusion: The findings of our study suggests that except anxiety, Rosa essence was not effective on any other manifestations of IBS. [ABSTRACT FROM AUTHOR]