Gastroenterology and Hepatology from Bed to Bench

Hepatitis C is an emerging disease in the world and Iran. In this review the situation in Iran will be more clarified and the strategies for better control will be discussed.

Aim: The aim of this study is to estimate gastric cancer (GC) mortality rate for Iranian population, using Bayesian approach in order to revise the existing classification which is thought to be a misclassification.

Background: Gastric cancer (GC) is an important cause of mortality among many other types of cancer. Data on cancer mortality can be used to guide policy makers in order to setup cancer prevention programs. According to Iranian death registry, about 20% death statistics are still recorded in misclassified categories.

Patients and methods: National Death Statistics Reported by the Ministry of Health and Medical Education (MOH&ME) from 1995 to 2004 is included in this analysis. The Bayesian approach to correct and account for misclassification effects in Poisson count regression with a beta prior is employed to estimate the mortality rate of GC in age and sex group.

Results: According to the Bayesian analysis there were between 30 to 40 percent underreported mortality records in death due to GC and the mortality rate is increased through recent years.

Conclusion: Our findings suggest a substantial undercount of GC mortality in Iranian population. So healthcare policy makers who determine research and treatment priorities on death rates as an indicator of public health priorities should notice this underreported data.

Aim: This study aimed to design a model and to compare the prognostic impact of concurrent using of tobacco and alcohol in colon and rectal cancers via a competing risks approach.

Background: Many authors have confirmed both alcohol and tobacco smoking as the risk factors of CRC. The effect of concurrent using has been explored for an association with CRC and a comparison between sub-sites found in few studies.

Patients and methods: 1219 patients with CRC diagnosis according to the pathology report of Research Institute For Gastroenterology And Liver Diseases (RIGLD) cancer registry, from 1 January 2002 to 1 October 2007, were entered into the study. Separately and concurrently, tobacco smoking and alcohol drinking were analyzed using competing risk parametric survival analysis with frailty parameter adjustment utilizing STATA statistical software.

Results: In separate evaluations, tobacco smoking and alcohol use were significantly related to the survival only in patients with colon cancer (Hazard Ratio (HR) =1.61 and 95% Confidence Interval (CI) = (1.16-2.23) for tobacco and HR=1.93 and 95% CI= (1.22-3.06) for alcohol). In addition, these factors were significantly different between two sub-sites of colon and rectum (HR=1.78, (95% CI= (1.12-2.83) for tobacco and HR=4.44, 95% CI= (1.74-11.37) for alcohol). Also, results of concurrent analysis showed that only "current or past tobacco- current or past alcohol" category had significant relationship to the survival in patients with colon cancer (HR=2.17 and 95% CI= (1.27-3.71)) and this was significantly different between two sub-sites (HR(C/R) =5.16 and 95% CI= (1.65-16.12)). In total, survival probability of colonic patients was lower than that of rectum cancer patients.

Conclusion: Concurrent using of tobacco and alcohol might be a prognostic factor of survival in patients with colon cancer. These results could be beneficial for prognosis and treatment application planning screening programs and its possible modifications.

Aim: To investigate if hepatic iron content influences the response to therapy in patients with chronic hepatitis C or B.

Background: It seems that the presence of elevated body iron stores and, in particular, elevated hepatic iron levels, is one of the strongest predictors of resistance to interferon treatment for chronic hepatitis C or B.

Patients and methods: Two hundred and one patients with chronic hepatitis C or B who were referred to Tehran Hepatitis Center were enrolled in this study. Histological quantification of hepatic iron was carried out by scoring iron separately within hepatocytes, sinusoidal cells, and portal triads. To estimate a cut off point for iron deposit as a predictor of response to treatment, Odd´s ratio with 95% confidence interval was calculated for each level of iron deposit.

Results: Iron scores were divided into two levels of high and low at several cut-off points, but the most significant differences were found when score 2 was considered as the cut-off point.  Odd's ratios were not significant in any of the hepatic zones. The lowest P-values were related to zone II sinusoidal cells and the total of sinusoidal cells and portal iron score (P= 0.08) in which the Odd's ratios were 6 (95% CI, 0.77 to 46.6) and 3.9 (95% CI, 0.88 to 17.4) respectively.

Conclusion: In our society, liver iron content cannot be considered as an important risk factor of resistance to treatment in chronic hepatitis patients because of the very small prevalence. So, hepatic iron measurement and scoring do not seem cost-effective and valuable for all patients with chronic hepatitis in our population.

Aim: The aim of this study was to identify and compare the pattern of acute viral hepatitis in two regions of Iran.

Background: The epidemiological pattern of acute hepatitis varies across the Globe depending on geographic region, health status, socioeconomic conditions and differences in exposure to etiological factors.

Patients and methods: A cross-sectional study was carried out among 357 cases of acute viral hepatitis referring to the hepatitis centers in Tehran (n = 109) and Zahedan (n = 248) during 2003-2004. All patients were tested against Anti-HAV IgM, HBsAg, HCV and HDV antibody by enzyme linked immunosorbent assay (ELISA). Specific viral cause of hepatitis and demographic characteristics of patients were compared between the two populations.

Results: Study participants in Zahedan were significantly younger than those in Tehran (11.4±9.63 years vs. 31.0±10.76; P< 0.05). The proportion of male participants in Tehran was considerably higher compared to Zahedan (86.2% vs. 52%; P< 0.05). In Tehran, HBV (62%) and HCV (15%) were the most frequent type of hepatitis, while in Zahedan, HAV (72%) and HBV (18%) were the most common type of hepatitis.

Aim: The aim of this study was to differentiate Entamoeba dispar from Entamoeba histolytica by PCR directly from fresh stool.

Background: Microscopy does not allow for the differentiation of Entamoeba dispar from Entamoeba histolytica. Several PCR-based methods have been described and used successfully for this purpose, but the methods for DNA extraction from stool samples are usually time-consuming and problematic due to inhibitory factors in feces.  

Patients and methods: From a total of 1700 stool samples collected and examined by microscopy, 22 samples (1.3%) were microscopically positive for the E. histolytica /E. dispar complex. The DNA of these samples was extracted directly from fresh stool and PCR was carried out using two sets of species-specific primers from a short tandem repeat (STR) in the D-A locus.

Results: Of these, 21 samples (95.45%) were diagnosed as E. dispar and only one sample (4.55 %) was found to be E. histolytica. In this study, by improving the DNA extraction from fresh stool, we were able to efficiently differentiate E. histolytica and E. dispar.

Conclusion: To avoid unnecessary treatment of patients not infected with E. histolytica, the development of effective techniques, such as direct DNA extraction from stool, is recommended.

Aim: The aim of this study was to describe the frequency of non- specific symptoms of gastro esophageal reflux and association of these symptoms with Gastro esophageal Reflux Disease (GERD) in Iranian population.

Background: GERD is a common gastrointestinal disorder, worldwide. Some patients with GERD have no symptoms while others may have non-specific symptoms.

Patients and methods: This study was designed as a cross-sectional and population based evaluation that was conducted on 782 cases that selected by random sampling in northeast region of Tehran province. Relation between non-specific symptoms and GERD was assessed using ?2 test. The odds ratios (OR) and 95% CI were calculated for each symptom.

Results: Most common non-specific symptom in subjects under study, was abdominal pain with a female preponderance. Abdominal pain, globus sensation, cough & dyspnea, and halitosis were statistically associated to GERD. There was no relationship between age and non-specific symptoms.