Gastroenterology and Hepatology from Bed to Bench

Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for considering a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support adjusting the terminologies to treatable clinicopathological conditions.

Chronic constipation is still considered a functional or idiopathic disorder. However, in recent years there is
evidence that its pathopysiological grounds may be actually due to a complex system of abnormalities of the
enteric nervous system of these patients. In particular, as reported in this review, the enteric glial cells seem
to be constantly involved in constipated patients, suggesting that (at least some forms of) constipation should
be considered as true neuro-gliopathies.

Gagne's model of instructional design is based on the information processing model of the mental events that occur when adults are presented with various stimuli and focuses on the learning outcomes and how to arrange specific instructional events to achieve those outcomes. Applying Gagne's nine-step model is an excellent way to ensure an effective and systematic learning program as it gives structure to the lesson plans and a holistic view to the teaching. In this paper, we have chosen a routine practical procedure that junior doctors need to learn: insertion of a peritoneal (ascitic) drain and we use Gagne's "events of instruction" to design a lesson plan for this subject.

Aim: In this retrospective survey women with and without self-reported postpartum depression (PPD) were compared in regards to consumption-frequency of foods and supplements rich in nutrients beneficial to nervous system (NS) health, in regards to consumption-frequency of compounds which may counteract the effect of the above and in regards to nutritional support provided to them during a pregnancy between 2003 and 2008.

Background: Postpartum depression (PPD) is defined as a major depressive episode that begins within 1 month of delivery and is experienced by roughly 13% of mothers.

Patients and methods: Four Hundred participants were recruited through the internet. Data gathered via multiple choice questionnaires was statistically analyzed using SPSS and Statistical software; statistical procedures included discriminant analysis, Pearson's product moment correlation, independent t-test and cross-tabulations.

Results: Out of 400 participants 83 (20.8%) were affected by self-reported depression after a pregnancy between 2003 and 2008. Depressed subjects consumed oily fish and offal significantly more often than non depressed subjects. Depression was more prevalent among women with vegetarian diets. No significant difference concerning food group intake or the ratios between foods rich in nutrients beneficial to NS health and foods rich in compounds antagonising their effect were found between depressed and non depressed subjects. Iron supplementation correlated positively with zinc supplementation in both groups. Roughly 70% of women reported to have received no information about n-3 fatty acid fish oils during pregnancy; informed subjects consumed fish oils more often. The majority of subjects with self-reported depression described nutritional support during pregnancy as inadequate.

Conclusion: Within this Austrian sample, the prevalence rate of postpartum depression was high; while the consumption of oily fish and vegetarian diets negatively correlated with depression, Patient information positively correlated with the consumption of fish oil supplements. These results indicate that further studies will be required in order to establish the exact relationship between nutrition and mental health during and after pregnancy.

Colorectal cancer (CRC) is the second leading cause of cancer death. Progress has been made in the development of chemotherapy for advanced CRC. Targeted therapies against VEGF or EGFR are now commonly used. However, many cases show that tolerance develops to such treatments; therefore, new strategies are required to replace or complement current therapies. Nuclear factor-?B (NF-?B) transcription factors play a key role in many physiological processes such as innate and adaptive immune responses, cell proliferation, cell death, and inflammation. It has become clear that aberrant regulation of NF-?B and the signaling pathways that control its activity are involved in cancer development and progression, as well as in resistance to chemo- and radio- therapies. Hence, anti-NF-?B therapy may rescue many cases of CRC and should be considered as a therapeutic target.

Aim: The aim of this study was to analyze clinical findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography complications.

Background: Endoscopic retrograde cholangiopancreatography has become a very common procedure for the evaluation and treatment of biliary and pancreatic diseases.

Patients and methods: A retrospective review of 2447 endoscopic retrograde cholangiopancreatography procedures and their complications since Apr 2006 till Dec 2010 was conducted to identify their incidence, optimal management, and clinical outcomes.

Results: 2447 endoscopic retrograde cholangiopancreatography procedures were performed. Overall, complications developed in 168 (6.9%) cases: perforation in 10 (0.4%), hemorrhage in 4 (0.16%) and mild to severe pancreatitis in 154 (6.3%). The patients mean age was 66± 6 yrs with females/ males of 1432(58.5%)/ 1015(41.5%).  Abdominal pain, nausea, leukocytosis and hyperamylasemia were most common findings in these patients. Surgery was performed for 6 patients (0.24%). The most hospital station was 20 days: surgical group 7±2 days, pancreatitis 11± 4 days and average 6 days for others.

Conclusion: Endoscopic retrograde cholangiopancreatography remains the endoscopic procedure that carries a high risk for morbidity and or mortality. The majority of events are of mild-to-moderate severity and when surgery should be done, it depends upon the clinicopathological condition and we don't advise pyloric exclusion, gastrojejunostomy and duodenal diversion for these patients.

Aim: The aim of this study was to assess the incidence of irritable bowel syndrome in women undergoing hysterectomy and tubular ligation.

Background: The results of previous studies have shown an increased incidence of irritable bowel syndrome after gynecological surgeries.

Patients and methods: Participants were patients of Alzahra and Taleghani University hospitals in Tabriz. One hundred and seventy two women without gastrointestinal symptoms or a diagnosis of the irritable bowel syndrome underwent tubular ligation and 164 women underwent hysterectomy. Patients were assessed every 3 month after hysterectomy and tubular ligation for 12 months. Irritable bowel syndrome was diagnosed by a questionnaire based on Rome II criteria.

Results: During 12 months after surgeries, 19 (11%) patients in tubular ligation group and 19 (11%) in hysterectomy group had abdominal pain with at least two symptoms of irritable bowel syndrome. Irritable bowel syndrome was diagnosed in 9 (5%) patients in the tubular ligation and 13 (8%) patients in hysterectomy groups (P>0.05). In both studied groups, the most prevalent symptoms along with abdominal pain were chronic constipation and abnormal bowel movement and the least prevalent were diarrhea and passage of mucus.

Conclusion: These results suggest that gynecological surgeries (tubular ligation and hysterectomy) may predispose to the development of the irritable bowel syndrome.

Aim: This study reports the prevalence observed in Minimal Standard Terminology (MST) writing in three hospital endoscopy centers in Tehran.

Background: In 1991 European association decided to recognize the minimal essential terms for preparing the endoscopy reports using computer software. These activities have led to the arrangement of MST.

Patients and methods: The cross - sectional study in 2070 endoscopy and colonoscopy reports from three hospital endoscopy centers in Tehran to review their information by using a check list that includes all the items available in MST, were collected. Main variables were including indication, describing findings, anatomy, diagnosis, diagnostic procedures, treatment procedures and examination limitations. Based on MST our collected data were divided to three main groups, the standards group, close to the standard and non-standard groups.

Results: Of total reports in the three hospitals surveyed, 19% of indications, 25.9% of finding descriptions, 58.4% of digestive system anatomy, 41.6% of diagnosis, and 15.5% of examination limits were recorded as standard. Of all diagnostic and therapeutic procedures performed, 26.3% of diagnostic procedures and 2.3% of treatment processes were recorded as non-standard form.

Conclusion: Considering the existence of multiple headlines in MST criteria, accurate and complete application in handwritten reports is a widespread problem and it is recommended to use the computer software that includes all the headlines of the MST for endoscopy and colonoscopy reporting.

Aim: The purpose of this study was to characterize phenotypically and genotypically the serotypes of the E. coli O111 associated with diarrheal disease and assess the variation among serotypes in terms of specific virulence factors and HeLa cells adherence patterns.

Background: Escherichia coli O111 serogroups are prevalent in endemic or sporadic cases of diarrhea, especially in developing areas.

Patients and methods: A total of 54 strains of E. coli O111 isolated from diarrheal and healthy cases were included in this study. Flagella antigens of motile and non-motile strains were identified by fliC-RFLP method (H types) and confirmed with agglutination test using H-specific antisera. All strains were tested for the presence of 5 different gene regions associated with virulence (eaeA, eaeB, bfpA, sxt and EAF plasmid) by PCR and the patterns of bacterial attachment to HeLa cells was assayed in cell culture.

Results: Of 54 E. coli O111 strains, 89% were typeable with standard H antisera and the remaining 11% of strains were non-motile (H -). Twenty-three different H type were distinguished among the O111 strains by PCR-RFLP. The most common serotypes included H21, H9, H2, H6 and H12 (48%). Serotypes O111:H9 were represented by strains with 2 patterns of virulence genes (eaeA⁺/bfpA⁺/EAE⁺, and eaeA⁺/bfpA^-/EAE^-) and serotype H14 was represented by strains with the single eaeA⁺/bfpA⁺/EAE^- combination. Four distinct patterns of adherence were distinguished: LA, LLA, AA and DA. All of serotypes with the eaeA⁺/bfpA⁺/EAE⁺, or eaeA⁺/bfpA⁺/EAE^-, combination isolated from children with diarrhea exhibited the LA pattern, and serotypes with eaeA⁺/bfpA^-/EAF^- showed the LLA, while the majority of the strains isolated from healthy cases exhibited the DA, AA and NA patterns.

Conclusion: Strains of this O serogroup represented a diverse of serotypes with a variety of virulence factors and mechanisms of pathogenesis.

Aim: The aim of current study is to investigate whether tonsillar and/or adenoid tissue of patients with chronic adenotonsillitis plays a reservoir role for Helicobacter pylori (H. pylori) or Helicobacter hepaticus (H. hepaticus).

Background: Recently, there have been arguments ragarding Helicobacter pylori (H. pylori) being reserved in adenotonsillar tissue.

Patients and methods: This study was performed with 90 patients with the diagnosis of chronic tonsillitis and adenoid hypertrophy, mean age 36 ± 22, 32 (36%) female and 58(64%) male. Presence of H. pylori and H.hepaticus were detected by glmM gene and 16S rRNA specific primers respectively.

Results: Of all patients 58 (65%) were found seropositive for H. pylori IgG while only 7(8%) patients had gentile gastrointestinal (GI) symptom, all gastritis. H. pylori and H.hepaticus was not detected in any of the patients by PCR.

Conclusion: There was no correlation between GI symptom and/or seropositivity of H. pylori with presence of H. pylori and H. hepaticus in adenotonsillar tissues. Our results did not support the role of adenotonsills as a reservoir for H. pylori or H. hepaticus.

Aim: The aim of present study was to screen two categories of psychiatric disorders in chronic functional constipation.

Background: It has been established that the prevalence of mood and anxiety disorders among patients with functional gastrointestinal disorders is higher than in the general population.

Patients and methods: Fifty four constipated patients were recruited from patients referred to the motility disorder department of Research Center for Gastroentrology and Liver Diseases, and screened for psychiatric disorders using HADS (Hospital Anxiety and Depression Scale) and MINI (Mini International Neuropsychiatric Interview).

Results: The results showed a relatively high prevalence of anxiety and depression both in HADS (33.3% and 22.2% respectively) and MINI (33.3% and 31.5% respectively).

Conclusion: Based on our results the prevalence of mood and anxiety disorders in constipated patients is much higher than general population and in order to reduce health care costs for constipated patients, we need to have an intervention program for comorbid psychological dysfunctions which affect the course of gastrointestinal disorders.

Elevated serum level of bilirubin is a common manifestation which is occurred in several diseases. Hyperbilirubinemia can manifest either conjugated or unconjugated. Conjugated or direct hyperbilirubinemia usually are caused by hepatocellular diseases or cholestatic liver diseases. Merely conjugated hyperbilirubinemia is the main manifestation of two congenital syndromes, including Dubin-Johnson and rotor syndrome; however it can be seen in some patients with recurrent benign intrahepatic cholestasis. This article reports a patient with Dubin- Johuson syndrome as a benign and rare condition.