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Abstract Background and Aims Gallstones are one of the most common and costly diseases of the gastrointestinal tract and occur when a combination of deposits consisting of fat or minerals accumulate in the gallbladder or common bile duct (CBD). This paper provides a comprehensive review of gallstone epidemiology, diagnosis, and management, focusing on current clinical guidelines and evidence‐based approaches. Methods A systematic literature review gathered information from various sources, including PubMed, Trip, Google Scholar, Clinical Key, and reputable medical association websites. Keywords related to gallstones, CBD stones, cholelithiasis, choledocholithiasis, and guidelines were used to extract relevant recommendations. Expert consultations and consensus meetings localized the recommendations based on the target population and available resources. Results The paper discusses demographic factors, dietary habits, and lifestyle influences contributing to gallstone formation. Gallstones are categorized into cholesterol and pigment types, with varying prevalences across regions. Many individuals with gallstones remain asymptomatic, but complications can lead to serious and potentially life‐threatening conditions. Diagnosis relies on history, physical examination, laboratory tests, and transabdominal ultrasound. Specific predictive factors help categorize patients into high, moderate, or low probability groups for CBD stones. Conclusion Evidence‐based recommendations for gallstone diagnosis and management are presented, emphasizing individualized treatment plans. Surgical interventions, nonsurgical treatments like oral litholysis with UDCA, and stenting are discussed. The management of gallstones in pregnant women is also addressed, considering the potential risks and appropriate treatment options during pregnancy.

Abstract Severe hyponatremia is life‐threatening in hospitalized patients. We present an elderly female who developed severe hyponatremia, seizure, and loss of consciousness after taking polyethylene glycol (PEG) solution before colonoscopy. The risk of hyponatremia with PEG for colon preparation in elderly susceptible patients is high. We review the relevant literature.

Background: Helicobacter pylori (H. pylori) infection is prevalent in the world. Resistance to antibiotics is the main reason for treatment failure. This clinical trial examined the effect of clarithromycin versus levofloxacin as the content of first line of treatment of the patients with peptic ulcer. Methods: In this double-blind randomized controlled clinical trial study with parallel groups, 148 infected patients by H. pylori who had been proven during endoscopic biopsy were randomly divided into two equal groups. One group was treated with the quadruple therapy of clarithromycin 500 mg BID, amoxicillin 1 g BID, bismuth subcitrate 240 mg BID, and pantazole 40 mg BID. The second group was treated with levofloxacin 500 mg QD, amoxicillin 1 g BID, bismuth subcitrate 240 mg BID, and pantazole 40 mg BID. The duration of treatment was 14 days in both groups and four weeks after treatment, the eradication rate was assessed using the stool antigen test. Findings: The eradication rate was significantly higher using regime containing clarithromycin than that of levofloxacin [81.1%; confidence interval of 95% (95%CI): 72.2%-89.9% vs. 60.3%; 95%CI: 49.3%-72.2%; P = 0.021). The improvement in quality of life in patients treated with clarithromycin was comparable with levofloxacin (7.90 ± 5.79 vs. 9.27 ± 5.89; P = 0.18). Adverse effects were different between the groups in which bad taste was reported more frequently in clarithromycin than levofloxacin (27.0% vs. 4.3%) while epigastric pain was more in levofloxacin (7.1% vs. 2.7%). Conclusion: The effectiveness of clarithromycin on H. pylori eradication rate was significantly higher than levofloxacin.

Background: Irritable Bowel Syndrome (IBS) is a serious syndrome, which damages people’s psychological, communicative, social, and emotional lives. Therefore, the present study was conducted to compare integrative self-knowledge and impulsivity in patients with Irritable IBS and healthy individuals. Methods: This case-control study was conducted on patients with IBS referring to gastroenterologists and healthy individuals in the city of Isfahan in 2018. The sample size included 150 patients with IBS and 150 healthy people in Isfahan selected using non-random convenient sampling method. The integrative self-knowledge and impulsivity questionnaires were applied to collect the information. After collecting the questionnaires and extracting the raw data, SPSS23 software was used and t-test was run to analyze the data. Results: A significant difference was observed between patients with IBS and healthy participants with regard to integrative self-knowledge and impulsivity (P-value < 0.001), so that people with IBS had lower integrative self-knowledge and higher impulsivity in comparison with the healthy individuals. Conclusion: According to the findings, people with IBS had lower integrative self-knowledge and higher impulsivity due to their therapeutic and psychological involvement in the disease. So, third-wave psychological treatments such as mindfulness treatment and positivist psychotherapy are required in this area.

Introdution: Primary biliary cirrhosis is a chronic cholestatic disease of the liver, characterized by the inflammation plus progressive and non-purulent destruction of the small biliary ducts, and the presence of auto antibodies against mitochondrial self-antigens. It seems that the prevalence of PBC in the western world is more than other parts of the world. This study aimed to identify all the patients with PBC in Isfahan and describe their epidemiological and demographic characteristics. Methods: The current study was a historical (retrospective) cohort investigation, which conducted between 2009 and 2017. We conducted this study by filling out questionnaires and obtaining the patients’ records and making telephone calls with previously admitted patients. Sampling was done as a census of all patients according to the study inclusion criteria. To analyze the data. SPSS software Version 16 was used and P-value

Background and Objective: Helicobacter pylori (HP) infection is one of the main risk factors for stomach illness. This study aimed to investigate the relationship between Helicobacter pylori infection and common dietary habits in patients with dyspepsia. Methods: This cross-sectional study was performed on individuals referred for gastrointestinal endoscopy (N: 374) using a one-year food frequency questionnaire and a 24 hour dietary recall for three days. Tissue samples from the antrum, body and fundus were derived and kept in glass containers including formalin buffer for further pathologic examinations. All data were analyzed using SPSS version 13.0. Independent-Sample t test was used to compare the means. P value less than 0.05 was considered significant. Results: The study population was comprised of 214 healthy subjects (57%) and 160 patients (43%). The average daily intake of sausages (p = 0.001), burgers (p = 0.002) was higher in patients compared to the healthy group significantly. The average daily intake of fish (p = 0.001) and weekly intake of tomato (p = 0.001), onions (p = 0.002) and citrus (p = 0.001) was lower among patients in comparison to healthy subjects significantly. Conclusion: The high consumption of fruits and vegetables and low intake of red meat were of dietary habits among healthy individuals. Although, high consumption of processed meat was of dietary habits among patients infected with H. pylori. Therefore, a proper diet can be recommended as a public health policy to the general public.

Background: This study evaluated the clinical efficacy and tolerability of a 14-day course of bismuth-based quadruple therapy including tinidazole and levofloxacin in compare to a 14-day bismuth-based quadruple therapy including clarithromycin as first-line treatment for Helicobacter pylori infection in Iranian adults. Materials and Methods: The study was a prospective, parallel group, randomized controlled, clinical trial that conducted on 150 patients with H. pylori infection. Patients were randomly assigned to the two groups as follows: first group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, and clarithromycin 500 mg (PBAC group), and other group received pantoprazole 40 mg, bismuth subcitrate 240 mg, amoxicillin 1 g, tinidazole 500 mg for 7 days, followed by levofloxacin 500 mg for the second 7 days (PBATL group). Main outcomes were eradication rate, tolerance of treatment, and dyspepsia severity. Results: The eradication rates for PBAC regimen was 81.1% (95% confidence interval [CI]: 71.9–90.2) and for PBATL regimen was 70.8% (95% CI: 60.1–81.6), which was not significantly different (P = 0.147). Tolerance of treatment was similar between groups. The median of severity of dyspeptic after treatment in PBAC group was 10 [9–14.75], which was similar to PBATL group 10 [9–13.5] (P = 0.690). Conclusion: There is no significant difference between PBAC and PBATL regimen, and efficacy was similar in both groups. The overall rate of treatment failure suggests that up to 18%–30% of patients will fail bismuth-based quadruple therapy and require retreatment for the infection.

Background: The aim of the present study was to assess 2- and 4-h postendoscopic retrograde cholangiopancreatography (ERCP) serum amylase and lipase levels for prediction of post-ERCP, pancreatitis (PEP), and their predictive cutoff values. Materials and Methods: In this cross-sectional study, we evaluated serum amylase and lipase levels before the procedure, 2 h and 4 h after the procedure, and in patients with persisting abdominal pain, 24 h afterward. A total of 300 adult patients who underwent ERCP procedures from March 2014 to June 2015 in referral hospital in Isfahan were studied. The receiver operating characteristic analysis was applied to determine the predictive score of amylase and lipase levels for PEP 2 and 4 h after ERCP. Results: The 2-h serum amylase cutoff values of 241 IU/L (normal range: 28–100 IU/L) had a very high negative predictive value (NPV) (98.7%) but a poor positive predictive value (49.2%) for prediction of PEP (area under curve [AUC]: 0.947; 95% confidence interval [CI]: 0.914–0.979). Based on our results, the patients might be considered for supportive therapy of PEP with the 4-h serum amylase above the cut point of 839.5 IU/L with a specificity of 95.1% (AUC: 0.978; 95% CI: 0.964–0.992). In addition, the 2- and 4-h serum lipase levels at cut points of 216 IU/L (AUC: 0.954; 95% CI: 0.931–0.977) and 656.5 IU/L (AUC: 0.966; 95% CI: 0.945–0.986) (normal value

Background: Irritable bowel syndrome (IBS) is assumed as one of the most frequent gastrointestinal disorders, which decreases the patient's quality of life. IBS pathogenesis, however, is not clearly defined. It seems that sleep apnea induces or escalates IBS clinical symptoms. This study aims at evaluating of IBS prevalence in patients, who are afflicted or are not afflicted with sleep apnea. Materials and Methods: This was a case–control study, which was implemented in a sleep laboratory located in Isfahan, Iran. We recruited 200 patients being more than 15 years from 2014 to 2015. Based on the apnea–hypopnea index (AHI), we recruited 100 patients in each of two groups: negative sleep apnea (NSA) (AHI ≤4) and positive sleep apnea (PSA) (AHI >4). IBS was diagnosed through a Rome III diagnostic questionnaire. Results: Overall, the prevalence of IBS among patients referred to sleep laboratory was 17.6%. Indeed, IBS prevalence in NSA and PSA groups were 8.2% and 27.1%, respectively. Furthermore, odds ratio of IBS in PSA group versus NSA was 3.92 (95% confidence interval = 1.58–9.77, P = 0.003). Our results showed that the prevalence of IBS did not differ significantly between various severity of sleep apnea (P = 0.452). Conclusion: This study showed that there was a positive association between sleep apnea and IBS.

Background: This study was done to evaluate the relationship between the time of endoscopy in patients with upper gastrointestinal bleeding with morbidity and mortality rates of patients at the Al Zahra Hospital emergency room. Materials and Methods: In a cohort study, 1152 patients at 2014 and 2015 have been hospitalized due to gastrointestinal bleeding in Al Zahra Hospital, were selected and demographic and clinical information and day and time of endoscopy and hospital mortality and fewer deaths than a month after discharge were studied, and prognosis was analyzed in terms of day and time of endoscopy. Results: Nine hundred and seventy-three cases (84.5%) of endoscopy were performed during the working days and 179 (15.5%) were performed on holidays. Moreover, 801 cases (69.5%) of endoscopy were done in the morning and 351 cases (30.5%) were performed in the evening and night shifts. The day and time of endoscopy had no significant effect on mortality in hospital and less than a month after but hospital death in whom underwent endoscopy by fellowship was significantly higher (P = 0.004). Conclusion: Endoscopy in nonholiday and holiday days and the time of endoscopy has no significant effect on hospital mortality 1 month after discharge. However, other factors such as endoscopy by attendant or fellowship, time between admission to endoscopy, age and sex of the patients, etc., were significantly effective on in-hospital mortality and death 1 months after discharge. Also faster and sooner endoscopy cannot reduce rate of blood transfusions or reduce the length of hospital stay but faster endoscopy of patients can reduce the risk of in-hospital death.

Background: One of the gene expression regulatory mechanisms is mediated by small noncoding RNAs called microRNA (miRNA). They interact with a recognition sequence located mostly in 3'-untranslated regions (3'-UTRs) of mRNAs. Polymorphisms in miRNAs recognition sequences could affect gene expression which in turn may alter disease susceptibility. SET8, a member of the SET domain-containing methyltransferase, acts in a variety of biological processes such as genomic stability. Here, we report correlation of rs16917496 polymorphism, located in the recognition sequence of miR-502 within 3'-UTR of SET8, with colorectal cancer (CRC) in Iranians. Materials and Methods: One hundred and seventy CRC patients and 170 noncancer counterparts were recruited in this case–control study. Genotyping of rs16917496 was performed using polymerase chain reaction-restriction fragment length polymorphism method. Results: There was no significant association of rs16917496 with CRC in population under study (P value for genotype and allele distribution were >0.05). However, stratification analysis based on smoking status revealed that TT+TC genotypes of SET8 rs16917496 are strongly associated with increased risk of CRC (odds ratio: 5.8, 95% confidence interval: 1.37–24.34, P - 0.005) in smoker subgroup. Conclusion: Correlation of rs16917496 T allele with CRC in smokers is emphasizing the importance of individuals' genotype in the recruitment of adverse health hazards of smoking more profoundly for certain people compared to others.

Background: Premedication with orally administered benzodiazepines is effective in reducing anxiety and discomfort related to endoscopic procedures. We evaluated the efficacy and safety of oral midazolam in comparison to sublingual alprazolam as premedication for esophagogastroduodenoscopy (EGD). Materials and Methods: Adult candidates for diagnostic EGD received either oral midazolam (7.5 mg in 15 cc apple juice) or sublingual alprazolam (0.5 mg) 30 min before EGD. Procedural anxiety and pain/discomfort were assessed using 11-point numerical rating scales. Patients' overall tolerance (using a four-point Likert scale) and willingness to repeat the EGD, if necessary, were also assessed. Blood pressure, heart rate, and arterial oxygen saturation were monitored from medication to 30 min after the procedure. Results: Patients experienced a similar reduction in procedural anxiety after medication with oral midazolam and sublingual alprazolam; mean (standard deviation [SD] of 1.86 [1.63] and 2.02 [1.99] points, respectively, P = 0.91). Compared to oral midazolam, pain/discomfort scores were lower with sublingual alprazolam; mean (SD) of 4.80 (3.01) versus 3.68 (3.28), P = 0.024. There was no significant difference between the two groups in patients' tolerance, willingness to repeat the procedure, or hemodynamic events. Conclusion: Oral midazolam and sublingual alprazolam are equally effective in reducing EGD-related anxiety; however, EGD-related pain/discomfort is lower with alprazolam. Both benzodiazepines are equally safe and can be used as premedication for patients undergoing diagnostic EGD.

Background: Acute upper gastrointestinal bleeding is a common and potentially life-threatening emergency with substantial mortality. Fresh frozen plasma (FFP), a good source of coagulation factors, might be an ideal injection agent based on its physiologic properties. Therefore, we evaluated the role of FFP as a hemostatic agent in patients with high-risk bleeding peptic ulcers. Materials and Methods: From August 2015 to April 2016, 108 consecutive patients with high-risk bleeding ulcers were admitted to our university hospital. They were randomly assigned to undergo injection of epinephrine alone (A) or epinephrine plus FFP (B). The primary outcomes assessed were the initial hemostasis, recurrent bleeding, hospital stay, blood transfusion, surgery rate, and 14-day mortality. Results: Initial hemostasis was achieved in 47 of 50 patients (94%) in the Group A and 49 of 50 patients (98%) in the Group B (P = 0.61). There were no significant differences in the rate of recurrent bleeding between Group A (14%) and Group B (8%) (P = 0.52). We found no significant differences between Group A and Group B with respect to the surgery rate, bleeding death, procedure-related death, and duration of hospitalization (P > 0.05). Conclusion: It is concluded the injection of epinephrine alone was equally effective as injection of epinephrine plus FFP to endoscopic hemostasis. Epinephrine alone and epinephrine plus FFP were not different in recurrent bleeding, rate of surgery, blood transfusion, or mortality.

Background: Type II diabetes mellitus (T2DM) is the prevalent type of diabetes in the world. Prediabetic patients are the most probable group to get diabetes. Several studies have mentioned the role of inflammation in the incidence of diabetes. The origin of inflammation can be infection such as Helicobacter pylori (HP) infection. This study was designed to explore the effect of HP eradication on insulin resistance. Materials and Methods: This single-blind randomized controlled clinical trial was conducted in 2014-2015. The sample size consisted of 49 individuals who were in prediabetes stage with HP infection. Patients with positive stool antigen were allocated randomly into two groups. The treatment group took medication to eradicate HP infection by the routine method of four-drug eradication. However, placebo capsules and tablets were given to the patients in the placebo group. Then fasting plasma glucose (FPG), fasting plasma insulin (FPI), and quantitative C-reactive protein (CRP) levels were measured and homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-B), Matsuda index, insulinogenic index, and disposition index were calculated. Results: Results of this study showed that FPI and HOMA-IR increased significantly (P value of FPI = 0.023 and P value of HOMA-IR = 0.019) after HP eradication in the treatment group. On the other hand, comparison of differences at the baseline and after 6 weeks in FPG (P value = 0.045), FPI (P value = 0.013), and HOMA-B (P value = 0.038) revealed significant differences between the placebo group and treatment group. Conclusion: Results showed that HP eradication by a 2-week antibiotic medication did not decrease insulin resistance and even increased FPI and insulin resistance indices. So HP eradication among prediabetic patients is not recommended for the decrease of insulin resistance and postponement of the development of diabetes mellitus.