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Background: The present study was conducted with the aim of comparing the effects of cognitive-behavioral therapy (CBT) and emotion-focused therapy (EFT) on distress tolerance in patients with irritable bowel syndrome (IBS}. Methods: The present study was conducted using a quasi-experimental method with a pretest-posttest design, follow-up, and a control group. The statistical population of the present study included 185 patients referred to Masoud Gastroenterology and Liver Clinic in Tehran, Iran. From among these patients, 35 patients were randomly selected and were assigned to 3 groups (2 experimental groups and 1 control group). The experimental groups took part in 8 weekly sessions of CBT or EFT and the control group did not receive any psychological intervention. The Distress Tolerance Scale (DTS} (Simons & Gaher, 2005) was used as the measurement instrument in this study. Two-factor repeated measures analysis of variance (mixed ANOVA} and one-way analysis of covariance (ANCOVA} were used to analyze the data. Results: The results revealed that CBT and EFT were effective on the distress tolerance of IBS patients and both therapies had a lasting effect over time. There was no significant difference between the effects of the two methods on distress tolerance. Conclusion: CBT and EFT are effective interventions in enhancing the distress tolerance of IBS patients and these interventions can be used in programs designed to manage the symptoms of this disease. [ABSTRACT FROM AUTHOR]

Background: Lead is a widely distributed metal in the environment and can be toxic to the human body. Lead poisoning has different clinical features. Recently, there have been increasing reports about lead poisoning following oral opium use. We report on a series of patients presented with abdominal pain attributable to lead-contaminated opium. Materials and Methods: We recruited all patients presented with abdominal pain and opium addiction, referring to the emergency room of a universityaffiliated hospital. Demographic, clinical, and laboratory data, as well as abdominal imaging and blood lead level, were collected for all patients. Results: Of 208 patients enrolled, 183 were male (88%), and the mean age was 51.2 ± 14.1 years. They all had a minimum of one-year history of oral opium consumption. 112 (53.8%) patients had a blood lead level of more than 20 μg/dL, and 22 patients (10.5%) had a blood lead level of more than 100 μg/dL. Half of the patients had a history of several hospital admissions for abdominal pain. Among patients with a lead level of more than 20 μg/dL, 87 (78%) had anemia with a hemoglobin level of less than 13 g/dL (mean hemoglobin 11.1 ± 2.5 g/dL). Conclusion: Our case series highlights the role of opium administration as a possible emerging cause of acute abdominal pain of unknown cause. [ABSTRACT FROM AUTHOR]

Abstract Background Gastroesophageal reflux disease is a common and chronic disorder but long term, prospective studies of the fate of patients seeking medical advice are scarce. This is especially prominent when looking at non-erosive reflux disease (NERD) patients. Methods We designed a prospective cohort to assess the long term outcome of GERD patients referring to gastroenterologists. Consecutive consenting patients, 15 years of age and older, presenting with symptoms suggestive of GERD referring to our outpatient clinics undergo a 30 minute interview. Upper gastrointestinal endoscopy is performed for them with protocol biopsies and blood samples are drawn. Patients are then treated according to a set protocol and followed regularly either in person or by telephone for at least 10 years. Discussion Our data show that such a study is feasible and follow-ups, which are the main concern, can be done in a fairly reliable way to collect data. The results of this study will help to clarify the course of various subgroups of GERD patients after coming to medical attention and their response to treatment considering different variables. In addition, the basic symptoms and biological database will fuel further molecular epidemiologic studies.

Previous studies have reported an association between hot tea drinking and risk of esophageal cancer, but no study has examined this association using prospectively and objectively measured tea drinking temperature. We examined the association of tea drinking temperature, measured both objectively and subjectively at study baseline, with future risk of esophageal squamous cell carcinoma (ESCC) in a prospective study. We measured tea drinking temperature using validated methods and collected data on several other tea drinking habits and potential confounders of interest at baseline in the Golestan Cohort Study, a population‐based prospective study of 50,045 individuals aged 40–75 years, established in 2004–2008 in northeastern Iran. Study participants were followed‐up for a median duration of 10.1 years (505,865 person‐years). During 2004–2017, 317 new cases of ESCC were identified. The objectively measured tea temperature (HR 1.41, 95% CI 1.10–1.81; for ≥60°C vs. <60°C), reported preference for very hot tea drinking (HR 2.41, 95% CI 1.27–4.56; for "very hot" vs. "cold/lukewarm"), and reported shorter time from pouring tea to drinking (HR 1.51, 95% CI 1.01–2.26; for <2 vs. ≥6 min) were all associated with ESCC risk. In analysis of the combined effects of measured temperature and amount, compared to those who drank less than 700 ml of tea/day at <60°C, drinking 700 mL/day or more at a higher‐temperature (≥60°C) was consistently associated with an about 90% increase in ESCC risk. Our results substantially strengthen the existing evidence supporting an association between hot beverage drinking and ESCC. What's new? Previous studies have indicated that hot tea may increase the risk of esophageal cancer. In this large, prospective study, the authors found that drinking hot tea is indeed associated with an increased risk of esophageal squamous cell carcinoma (ESCC). Furthermore, a preference for "very hot" tea more than doubled this risk. It may thus be a reasonable public‐health measure to extrapolate these results to all types of beverages, and to advise the public to wait for beverages to cool to <60°C before consumption. [ABSTRACT FROM AUTHOR]

BACKGROUND The incidence of colorectal cancer is rising in several developing countries. In the absence of integrated endoscopy and pathology databases, adenoma detection rate (ADR), as a validated quality indicator of screening colonoscopy, is generally difficult to obtain in practice. We aimed to measure the correlation of polyp-related indicators with ADR in order to identify the most accurate surrogate(s) of ADR in routine practice. METHODS We retrospectively reviewed the endoscopic and histopathological findings of patients who underwent colonoscopy at a tertiary gastrointestinal clinic. The overall ADR and advanced-ADR were calculated using patient-level data. The Pearson's correlation coefficient (r) was applied to measure the strength of the correlation between the quality metrics obtained by endoscopists. RESULTS A total of 713 asymptomatic adults aged 50 and older who underwent their first-time screening colonoscopy were included in this study. The ADR and advanced-ADR were 33.00% (95% CI: 29.52-36.54) and 13.18% (95% CI: 10.79-15.90), respectively. We observed good correlations between polyp detection rate (PDR) and ADR (r=0.93), and mean number of polyp per patient (MPP) and ADR (r=0.88) throughout the colon. There was a positive, yet insignificant correlation between advanced ADRs and non-advanced ADRs (r=0.42, p=0.35). CONCLUSION MPP is strongly correlated with ADR, and can be considered as a reliable and readily obtainable proxy for ADR in opportunistic screening colonoscopy programs. [ABSTRACT FROM AUTHOR]

Introduction: Esophagogastroduodenoscopy (EGD) is commonly used for assessment of dyspepsia in the general population. Gastroenterology societies recommend different ages for doing EGD. We developed a decision tree model and performed a utility assessment to determine the optimal age at which to conduct EGD for assessing dyspepsia in the general population Methods: We developed a decision tree with two main strategies: “prompt endoscopy, PE”, and “test and treat with managed endoscopy, T&T” with three main outcomes of “no cancer”, “early cancer” (amenable to cure), and “advanced cancer”. We delineated the paths to the outcomes with each strategy and conducted a utility assessment involving gastroenterology physicians and patients referring to a referral gastroenterology clinic. Using the mean utilities obtained for each path and the highest prevalence of gastric cancer among the general dyspeptic population in Iran as a high prevalence area for gastric cancer, we calculated the expected utilities for each strategy. We included a sensitivity analyses testing the performance of the decision tree under various assumptions. Results: The expected values for PE and T&T, the main strategy nodes, were 0.721 and 0.980 respectively under the base case assumptions, clearly favoring T&T. On sensitivity analysis, when utilities were kept constant and prevalence increased stepwise, the preferred strategy changed at a prevalence of 69.0% for upper GI cancers. When the prevalence of cancer was kept fixed at 1.2% and the utility of EGD was increased stepwise, a utility of 98.0% or more was required for the PE to become the preferred strategy. A third sensitivity analysis in which both prevalence and utility of EGD were increased stepwise revealed that if the prevalence of cancer in the given dyspeptic population is at least 3.0% and the utility of PE is 97.0% or more, then prompt endoscopy has a higher utility. Conclusion: According to our data, utility of EGD is the most important factor in determining the method of assessing dyspeptic patients in the general population. The T&T strategy is the preferred method in most cases with PE better reserved for those with a very low disutility for EGD. [ABSTRACT FROM AUTHOR]