Search

Background: Helicobacter pylori (H. pylori) has infected about 50% of the world's population and it is the main cause for peptic ulcer, gastric adenocarcinoma and even a major cause for gastric MALT lymphoma. Methods: This study was performed in Mazandaran, Sari, situated in North of Iran. Three-hundred and twenty-eight adult patients with endoscopically approved gastric or duodenal ulcers or erosions and H. pylori infection were randomly divided into 2 groups to receive either 14 days PABT (Pantoprazole 40 mg, Amoxicillin 1 g, Bismuth 425 mg (all twice daily) and Tetracycline 500 mg four times a day) and PACM (Pantoprazole 40 mg, Amoxicillin 1g, Clarithromycin 500 mg, and Metronidazole 500 mg, all twice daily). To evaluate H. pylori eradication, fecal H. pylori antigen test was performed 8 weeks after treatment. Results: The eradication rates were 94.51% in the PABT and 91.46% in PACM group based on the intention to treat analysis. Moreover, the eradication rates were 95.58% and 92.72% according to per-protocol analysis, respectively. Also, both groups had very low rates of severe side effects. Conclusion: Regarding the ideal eradication rates achieved by both treatment groups and the low rates of severe side effects, both treatment protocols can be prescribed for H. pylori eradication in North of Iran. [ABSTRACT FROM AUTHOR]

Background: Celiac disease is an autoimmune disorder resulting from gluten consumption in genetically predisposed individuals. The present study investigated the epidemiological, endoscopic, and clinicopathological features of patients with celiac disease in the southern littoral of the Caspian Sea. Methods: 140 patients with celiac disease were interviewed and examined regarding demographic characteristics, clinical symptoms, and serologic, endoscopic, and pathological findings. Results: 44 (31.4%) of the patients were male and 68.6% were female. The mean age of the patients at diagnosis was 27.13 ± 13.4 years (ranging from 2 to 60 years). The most common gastrointestinal (GI) symptoms were bloating (47.8%), abdominal pain (47.1%) and diarrhea (30.7%), respectively. Also, 17 (12.1%) patients did not complain of any GI symptoms.18 (12.8%) patients had aphthous stomatitis, 10.7% had dermatitis herpetiformis, 3.6% suffered from itching without a rash, two (1.4%) mentioned psoriasis and one (0.7%) had lichen planus. 19 (19.7%) of the female patients complained of menstrual bleeding disorders, 4% mentioned infertility, and 2% experienced primary amenorrhea. The most common comorbid condition was hypothyroidism in 16 (11.4%) patients. The most common endoscopic finding was duodenal scalloping (37.25%). In addition, 7.8% of the patients had a normal endoscopic appearance. 43 (30.7%) patients were classified as Marsh IIIC, 25.7% Marsh IIIB, 17.8% Marsh IIIA, 12.8% Marsh II and 12.8% were classified as Marsh I. Conclusion: Since celiac disease can present with non-GI manifestations and the majority of our patients had Marsh III classification, it seems that celiac disease must be considered as a routine screening test in GI clinics, and also, it should be kept in mind as a differential diagnosis in other specialty fields. [ABSTRACT FROM AUTHOR]

Aim: We compared the efficacy of two different regimens for H. pylori eradication in areas with high antibiotic resistance. Background: Helicobacter pylori (H. pylori) is a gram-negative bacillus that has a strong association with chronic gastritis and peptic ulcer disease. Different regimens with varying degrees of effectiveness have been used for H. pylori eradication. Methods: The current randomized controlled trial (RCT) randomly assigned 217 patients who had indications for H. pylori eradication therapy to two groups. One group were administered concomitant quadruple therapy (pantoprazole 40 mg, amoxicillin 1 gr, clarithromycin 500 mg, and metronidazole 500 mg every 12 hours) for 14 days, and the second group received 14 days of high-dose dual therapy, consisting of esomeprazole 40 mg BID and amoxicillin 1g TDS. H. pylori eradication was assessed eight weeks after the end of treatment. Results H. pylori eradication rates by PP analysis for 14 days concomitant quadruple therapy and high-dose dual therapy were 88.6% (95% CI, 80.3-92.8) and 82.2% (95% CI, 74.8-89.5), respectively (p = 0.19). According to intention-to-treat (ITT) analysis, the eradication rates were 81.6% (95% CI, 74.5-88.6) and 80.6% (95% CI, 73-88.1), respectively (p = 0.58). Overall drug side effects were 20.8% in high-dose dual therapy and 49.6% in concomitant quadruple therapy (p < 0.001). Conclusion: Fourteen days concomitant quadruple therapy can be considered as a relatively acceptable regimen for H. pylori eradication in areas with high clarithromycin and metronidazole resistance. It seems that high-dose dual therapy could be a promising alternative regimen in these areas. [ABSTRACT FROM AUTHOR]

BACKGROUND Gastroesophageal reflux disease (GERD) is a common problem with annoying symptoms. It is associated with negative impact on quality of life. Prokinetic agents may be used in combination with acid suppression agents as an adjunctive in patients with GERD refractory to proton pump inhibitors (PPI) therapy, rather than as sole treatment. This study aimed to evaluate the efficacy of combination of PPI with domperidone (a prokinetic agent) compared with PPI alone in the treatment of patients with refractory GERD. METHODS This study was a double blind clinical trial on 29 patients with GERD refractory to PPI during the period of one month. By randomization, the patients were divided into two groups. Group A was treated by pantoprazole 40 mg twice daily and domperidone three times a day for a month, while group B was treated by pantoprazole 40 mg twice daily and placebo three times a day. In this study endoscopy was performed to evaluate the prevalence of erosive esophagitis, non-erosive reflux, and hiatal hernia. Manometry was conducted to study the prevalence of dysmotility. GERD symptom questionnaires including the Gastrointestinal Symptom Rating Scale (GSRS), Carlson Dennett, and the Medical Outcomes Study Short Form-36 health survey (SF36) were used before and after treatment for screening GERD and assessing treatment response. RESULTS There were 17 (58.62%) women and 12 (41.37%) men. The prevalence of erosive esophagitis and non-erosive reflux, was 10.34% and 89.66%, respectively. There was a significant difference comparing reflux symptoms before and after treatment between the two groups according to reflux and Carlson Dennett questionnaires. At the end of the study, symptoms of reflux significantly improved by treatment. Although, the quality of life questionnaire scores improved by treatment, there was no statistically significant difference in response to treatment between the two groups. CONCLUSION In this research, we showed that adding domperidone to PPI could not make any improvement in patients with refractory reflux regarding the quality of life and improving the symptoms. [ABSTRACT FROM AUTHOR]

Background: Clinical trials and meta-analyses have reported about 20% failure rates in first-line Helicobacter pylori (H. pylori) eradication. This reflects the need for effective second-line eradication regimens. Materials and Methods: 61 patients with H. pylori infection who had failed previous non-bismuth clarithromycin-containing first line therapies entered the study. They were given a 14-day levofloxacin-containing triple regimen consisted of pantoprazole 40 mg, amoxicillin 1gr, and levofloxacin 500mg, each given twice daily. Eight weeks after the treatment, H. pylori eradication was assessed by 14C-urea breath test. Results: All patients completed the study. The eradication rate was 91.8% (95% confidence interval = 84.9% - 98.6%) by both intention to treat and per-protocol analyses. Side effects of therapy were reported by eight patients (13.1%), but they were severe in only two patients (3.2%). Conclusion: According to the high H. pylori eradication rate and the very low rate of severe adverse effects, levofloxacin-containing triple therapy seems to be a suitable second-line option in case of previous failure by clarithromycin-containing therapies. We suggest further studies with shorter duration of treatment or lower dose of levofloxacin. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anemia has been considered as an alarming sign of the possible presence of malignancy in the digestive tract. Inadequate assessment of such affected patients can lead to delay in the diagnosis of gastrointestinal (GI) tumors especially colorectal cancers. Therefore the present study examined the upper and lower GI tract of postmenopausal women with iron deficiency anemia by GI endoscopy. Materials and Methods: Women aged over 45 years referred to Gastroenterology Clinic of Imam Khomeini Hospital were asked about their menstruation. Postmenopausal women with the anemia were enrolled. A list of laboratory studies were performed for all included patients. These laboratory studies included complete blood count (CBC), iron profile and stool examination for occult blood. 103 postmenopausal women with iron deficiency anemia according to laboratory tests were interviewed and their clinical and biochemical variables were recorded. All of the study patients underwent esophagogastroduodenoscopy and colonoscopy. The endoscopic findings were recorded regarding the presence of GI lesions causing iron deficiency anemia or the lack of them. Results: A total of 103 patients participated in this study. Endoscopy revealed a source of iron deficiency anemia in 90.3% of the study population. Upper and lower GI tract lesions were found in 73.8% and 51.5% of the patients, respectively. The most frequent lesions in the upper GI endoscopy were severe gastroesophageal reflux disease involving 34 patients (33%) followed by gastric erosions in 31 cases (30.1%) and duodenal ulcer in 15 cases (14.6%). Conclusion: In postmenopausal women with iron deficiency anemia as in men, it is necessary to examine the GI tract [ABSTRACT FROM AUTHOR]

To clarify the effect of γδ T cells and invariant Natural Killer T (iNKT) cells in pathophysiology of dyspeptic disorders, number of these two cells in patients with non-ulcer dyspepsia (NUD), peptic ulcer disease (PUD), and gastric cancer (GC) were compared.Patients with dyspepsia were divided into three groups of NUD, PUD, and GC according to their endoscopic and histopathological examinations. Helicobacter pylori infection was diagnosed by rapid urease test and histopathology. The number of peripheral blood CD3+TCRγδ(+) T cells and CD3+Va24Ja18+ iNKT cells were determined by flow cytometry. Immunohistochemistry (IHC) was also used for identifying the TCRγδ+ cells.Forty two patients with NUD (31.6%), 44 with PUD (33.1%), and 47 with GC (35.3%) were included in the study. The frequency of CD3+TCRγδ(+) T cells in peripheral blood of patients with GC (2.71±0.25) was significantly lower than that in NUD (3.97±0.32, p<0.05) and PUD groups (3.87±0.32, p<0.05). However, there was no significant difference in CD3+TCRγδ(+) T cell percentage between the NUD and PUD groups. The frequency of TCRγδ(+) lymphocytes was significantly lower in tissue samples from patients with GC (4.81±0.53) than in NUD (11.09±1.09, p<0.0001) and PUD groups (11.11±1.01, p<0.0001). Also, we could not find any significant difference in the percentage of mucosal TCRγδ+ cells between the NUD and PUD groups. The results showed no significant difference in iNKT cells percentage among the three groups of patients.The results suggest that decreasing number of γδ T cells may be related to development and progression of gastric cancer. [ABSTRACT FROM AUTHOR]

Ramadan fasting is the implementation of a full and regular body and mental health care, which is considered both. It is scientifically proven that Ramadan fasting not only causes Mental Relaxation, But also Causes Increase in Endorphin hormones, which Helps Recovery Mental condition. These events Cause Relief and increase consciousness in fasting person. The question is fasting is good for health or not. Which patient is able to fast? To answer these questions we decided to review Gastro -intestinal diseases and effect of fasting with them. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of classic standard triple therapy regimen of helicobacter pylori (H. pylori) eradication has decreased to unacceptably low levels, largely related to development of resistance to metronidazole and clarithromycin. Thus successful eradication of H. pylori infections remains challenging. Therefore alternative treatments with superior effectiveness and safety should be designed and appropriately tested in all areas depending on the native resistance patterns. Furazolidone has been used successfully in eradication regimens previously and regimens containing furazolidone may be an ideal regimen. Methods: H. pylori infected patients with proven gastric or duodenal ulcers and/or gastric or duodenal erosions at Imam Khomeini Hospital in Sari/Northern Iran, were randomly allocated into three groups: group A (OABF) with furazolidone (F) (200 mg bid.), group B (OABM-F) metronidazole (M) (500 mg bid.) for the first five days, followed by furazolidone (F) (200 mg bid.) for the second five days and group C (OAF) with furazolidone (F) (200 mg tid.). Omeprazole (O) (20 mg bid.) and amoxicillin (A) (1000 mg bid.) were given in all groups; bismuth (B) (240 mg bid.) was prescribed in groups A & B. Duration of all eradication regimens were ten days. Eight weeks after treatment, a 14C-urea breath test was performed for evaluation of H. pylori eradication. Results: A total of 372 patients were enrolled in three groups randomly (124 patients in each group); 120 (97%) patients in group A (OABF), 120 (97%) in group B (OABM-F) and 116 (93%) in group C (OAF) completed the study. The intention-to-treat eradication rates were 83.7% (95% CI= 77.3-90.4), 79.8% (95% CI= 72.6-87), and 84.6% (95% CI= 78.2-91.1) and per-protocol eradication rates were 86.6% (95% CI= 80.5-92.8), 82.5% (95% CI= 75.6-89.4), and 90.5% (95% CI= 85.1-95.9) for groups OABF, OABM-F, and OAF, respectively. No statistical significant differences were found in case of severe drug adverse effects between the above mentioned three groups (p> 0.05). The most common side effects, namely nausea and fever, occurred in all groups, but more frequently in group C (OAF) (p< 0.05). Conclusion: In developing countries such as Iran, furazolidone-based regimens can substitute clarithromycinbased regimens for H. pylori eradication because of a very low level of resistance, low cost and high effectiveness. Considering per-protocol eradication rate of ten days OAF regimen, and the acceptable limit of ninety percent, we recommend this regimen in developing countries such as Iran to be substituted of classic standard triple therapy. In order to minimize rare serious adverse effects, one week high dose OAF regimen should be taken into consideration in other studies. [ABSTRACT FROM AUTHOR]

BACKGROUND Furazolidone has been used as an alternative for clarithromycin or metronidazole in Helicobacter pylori (H.pylori) eradication regimens. In Iran, 14-day Furazolidone-containing quadruple regimens have shown promising eradication rates, but short-course, low dose therapies are always attractive. Therefore, we designed a study to compare the efficacy of two 10-day triple regimens containing moderate and high dose furazolidone for H.pylori eradication. METHODS Two hundred and ten patients with peptic ulcer disease who were naïve to H.pylori treatment were included. They were randomized into 2 groups: 105 patients received omeprazole 20mg, amoxicillin 1000mg, and furazolidone 200mg(OAF-400), all twice a day for ten days. And the remaining 105 patients received omeprazole 20mg twice a day, amoxicillin 1000mg twice a day and furazolidone 200mg three times a day for ten days(OAF-600). Urease breath test was performed 8 weeks after the treatment to confirm H. pylori eradication. RESULTS The intention-to-treat eradication rate was 76.19% in group OAF-400 and 80.95% in group OAF-600 (p=0.38). Per protocol eradication rates were 81.63% and 89.47%, respectively (p= 0.11).Severe adverse effects were reported by 8.6% of the patients in group OAF-400 and 5.7% of the patient in group OAF-600 (p=0.1). However, the total side effects (including mild, moderate, and severe ones) were significantly more prevalent in the OAF-600 group (p=0.001). CONCLUSION None of our triple furazolidone-based regimens (moderate- and high-dose) could achieve the standard eradication rate, and therefore, cannot be considered as a suitable option for first-line treatment. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori is a major human gastric for various gastro duodenal diseases. A number of putative virulence factors such as dupA, homB, tnpA have been described. To date, none were found to be significantly associated with specific H. pylori-related diseases (e.g. gastric cancer and duodenal ulcer). Methods: the primary aim of this study was to test the H. pylori hrgA genotype isolated from 253 Iranian symptomatic patients to investigate possible association with clinical outcomes. The positive culture results were confirmed by glmM (genetic control for H. pylori) PCR assay. Results: The results showed hrgA gene was detected in 44/253 strains (17.3%). Prevalence of the hrgA gene was relatively high in strains isolated from duodenal ulcer patients (P=0.0063; Odd ratio: 3.54; CI 95%: 1.42-8.77). Conclusions: In contrast our findings showed that the prevalence of hrgA in our control group (gastritis patients) was 22.7% (P>0.05). Conclusively, hrgA gene is a good candidate as a discriminatory biomarker for patients with duodenal ulcer. [ABSTRACT FROM AUTHOR]

Background and purpose: Ulcerative colitis (UC), a subtype of inflammatory bowel diseases (IBD), is an immune-mediated chronic intestinal condition. Changes in the copper (Cu) and zinc (Zn) concentrations have been reported previously in IBD. Due to controversial results, the aim of this study was to evaluate and compare serum and urine levels of Zn and Cu in patients with UC and control group. Materials and methods: This case-control study was conducted on 50 patients with UC and 49 healthy volunteers. Urine and venous blood samples were collected from patients and healthy volunteers and separated serum and urine samples were kept at -20oC. Levels of Zn and Cu were measured in blood serum and urine using atomic absorption spectrophotometry. Data were analyzed then. Results: Mean serum levels of Zn and Cu in patients with UC were 72.6 ± 15.2 and 138.3 ± 42.6 µg/dl, respectively; the values in normal individuals were 104.0 ± 37.9 and 110.0 ± 38.5 µg/dl, respectively. Mean urine levels of Zn and Cu in UC patients were 128.7 ± 37.5 and 8.7 ± 2.3 µg/dl, respectively; in normal individuals, the values were 109.0 ± 34.0 and 4.1 ± 1.5 µg/dl, respectively. The differences between the two groups were significant (P < 0.01). In patients, the overall mean Zn concentration in serum was lower and in urine was greater than the controls. The serum and urine Cu concentrations were higher in those with UC. Conclusion: According to the results, trace element levels such as Zn and Cu in patients with UC are subjects to change. As UC is an inflammatory disease and Cu levels are increased during inflammation, serum and urinary Cu levels were higher. The decrease in serum and increase urinary Zn in patients with UC is debatable. So, for future studies, Zn supplementation and examining mucosal healing process is suggested. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) is a Gram-negative bacterium that is well known in the involvement of chronic inflammation in the gastric mucosa of the human stomach. Several studies have investigated the possible role of H. pylori presence in different gastroduodenal disorders with conflicting results. This study aimed to further investigate such a field. Helicobacter pylori strains were cultured from 160 patients (mean age of 42 years; range 15-75; 90 were male, and 70 were female) [40 gastric cancer (GC), 55 duodenal ulcer (DU) and 65 non-ulcer dyspepsia (NUD)]. In this study, allelic variants of iceA, iceA and babA were identified by polymerase chain reaction. The overall prevalence of babA gene was 40.6% (65/160). The prevalence of babA gene was 95% with gastric cancer, 18.1% with duodenal ulcer and 26.1% with non ulcer dyspepsia, respectively. The prevalence of babA in GC patients was significantly higher as compared to either NUD or UD patients ( P = 0.0004), while no statistical significance was found between the latter two patient groups. Our study finds that babA and iceA genes are more prevalent in GC compared to either NUD or DU patients in Iran. [ABSTRACT FROM AUTHOR]

Background and purpose: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of increased liver enzymes. The world population are suffering from NAFLD (30% in IRAN, 20% - 40% in western countries, and 5% - 30% in Asia-Pacific). The prevalence of NAFLD is higher in hyperlipidemic, diabetic and obese people. This study assessed the preventive effect of sylmarin on the progression of NAFLD/NASH. Materials and methods: This clinical trial was performed in 41 patients with NAFLD referring to gastrointestinal clinics in Sari. The patients were randomly divided into case and control groups. The case group was treated with a tablet containing 140 mg silymarin twice a day for six months and the control group was given placebo for the same period. The data was analyzed using independent t-test, paired t-test and Chi-Square in SPSS. Results: At the end of the treatment period the improvement of steatosis in sonography was more significant in case group (P= 0.03). Liver enzymes reduced significantly in silymarin group compared to other group (P= 0.002 for ALT and P= 0.01 for AST). Conclusion: In this study sylmarin reduced the liver enzymes in the intervention group. Therefore, it could be of great benefit in the treatment of NAFLD. [ABSTRACT FROM AUTHOR]