Gastroenterology and Hepatology from Bed to Bench

Cancer starts with a change in one single cell. This change may be initiated by external agents and genetic factors. Cancer is a leading cause of death worldwide and accounts for 7.6 million deaths (around 13% of all deaths) in 2008. Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year. In this review, different aspects of gastric cancer; including clinical, pathological characteristic of gastric cancer, etiology, incidence, risk factors, prevention and treatment are studied.

Obesity with an increasing prevalence rate worldwide is correlated with multiple comorbidities. Unfortunately, the currently available therapies such as the pharmacotherapy, bariatric surgery or gene-transfer technology are associated with a number of disadvantages including undesirable side effects, poor compliance or transient effectiveness. Therefore, modifications of the lifestyle factors might be of great importance. Recently, neurotrophic factors and their metabotrophic potential in targeted pharmacology against obesity has been the focus of intense research. Meanwhile, because of the complexity and multi-factorial nature of obesity, it will still remain as a challenging medical problem.

Aim: Leptin is a 16 kDa polypeptide hormone which secreted by adipose tissue and has an important role in energy balance, insulin pathway and inflammation, because of that it may play an important role in colorectal cancer (CRC). Leptin exerts its effect through the leptin receptor (LEPR) a member of the class I cytokine receptor family.

Background: We have investigated whether glutamine to arginine substitution (Gln223Arg) in exon 6 of the leptin receptor gene, has implications for susceptibility to CRC.

Patients and methods: Polymerase chain reaction (PCR) and restriction enzyme digestion (RFLP) was performed to evaluate the association between the Gln223Arg polymorphism of the LEPR and CRC risk in a case-control study in 346 subjects involving 173 cases with CRC and 173 controls.

Results: There was no statistically evidence of significant difference in genotype and allele frequencies between the cases with CRC and controls for the Gln223Arg polymorphism of LEPR, before or after adjusting for confounders (age, BMI, sex, and smoking status). Furthermore, no significant difference was observed between the CRC cases and controls by BMI, sex and smoking status.

Conclusion: Our findings suggest that the LEPR Gln223Arg polymorphism is not associated with the risk of CRC in Iranian population.

Aim: The aim of this study was to compare prognostic factors between colon and rectal cancers.

Background: Prognosis of Colorectal Cancer (CRC) may depend on the anatomical site.

Patients and methods: A total of 1219 patients with CRC diagnosis according to the pathology report of RCGLD cancer registry, from 1 January 2002 to 1 October 2007, were entered into the study. Demographic and clinico-pathological factors were analyzed using survival analysis.

Results: From age at diagnosis, colon cancer had significantly better survival than rectal cancer (Multivariate Hazard Ratio (MVHR)=0.24; 95% Confidence Interval (CI) =(0.074-0.77)). Other factors, including marital status (MVHR =1.78; 95% CI =(0.33-9.62)), body mass index (BMI) (MVHR =1.21 and 1.54;  95% CI =(.30-4.85) and (.44-5.4) respectively for < 18.5 and >30 BMI groups), pathologic stage (MVHR =.64; 95% CI =(.21-1.98)) and alcohol history (MVHR =4.86; 95% CI =(.67-35.14)) were not significantly different between the two patient group but suggested a possible effect upon prognosis. Overall survival in rectum was better than that of colon.

Conclusion: Our findings support this hypothesis that prognosis of CRC varies with tumor site.

Aim: In this study, the prevalence of C. difficile, from patients with gastrointestinal complaints and its association with other enteropathogen microbes were investigated.

Background: Clostridium difficile is an important pathogen associated with outbreaks of pseudomembranous colitis and other intestinal disorders, such as diarrhea.

Patients and methods: Enterotoxin and cytotoxin (toxin A and toxin B) of C. difficile on the patient's stool samples were detected by a double sandwich enzyme-linked Immunosorbant assay technique using a commercial kit (Premier toxins A & B; Generic Assays, Inc., Germany). The microbial isolation and examination was done, according to the standard identification methods.

Results: Out of 356 individuals (57.6 % male and 42.4 % female) the results of C. difficile were positive for 19 patients (5.3 %) and negative for 337 patients (94.6 %) according to the results of C. difficile antigen kit. There was no association between the existence of C. difficile toxin and microbial population or antibiotic usage.

Conclusion: This prevalence study clearly supports the hypothesis of a probable role of C.difficile in developing gastrointestinal complaints in patients with diarrhea. More studies are needed to evaluate the role of C. difficile in these diseases.

Aim: The purpose of this study was to assess satisfaction level and related factors among patients who had an anesthesia during endoscopic procedures; and also validate a questionnaire for evaluating satisfaction with anesthesia.

Background: The level of patient satisfaction with GI endoscopic procedure is an important criterion to indicate the level of expertise in endoscopy.

Patients and methods: We performed a prospective descriptive study at Resalat Hospital, Tehran, Iran. Three hundred seventy nine elective patients undergoing anesthesia for GI endoscopy procedure in 2010 were recruited. A 20-item questionnaire was used to evaluate the satisfaction with the anesthesia. The questionnaire was answered within 72 hours after the procedure. The satisfaction was graded into four major groups: anesthesia delivery, procedural recall, side effects and global satisfaction.

Results: The level of satisfaction with anesthesia and its related factors were determined. The mean score of satisfaction with anesthesia delivery, procedural recall, side effects, global satisfaction, and total satisfaction (question 1-16) were 6.15 ± 1.23, 5.65± 1.48, 5.24± 1.16, 5.01± 1.29, and 5.46± 1.14, respectively. There was a significant difference in patients' satisfaction level between different jobs (p=0.02) as well as different levels of education (p=0.01).

Conclusion: Higher educational level was accompanied with greater satisfaction. The highest satisfaction score was seen among retired patients and the lowest level was found in housekeepers.

Aim: To determine the prevalence of gastrointestinal symptoms and signs among persons with diabetes mellitus in a specialist hospital.

Background: Gastrointestinal symptoms and signs are common among patients with diabetes mellitus. Morbidity from

Patients and methods: In this descriptive, cross-sectional study, subjects from the general population with diabetes (n=200) were recruited for this study. Subjects were randomly chosen from patients known to have diabetes,

(type I&II), attending the diabetes clinic at Sina University Hospital, in Tabriz during 2003. The questionnaire recorded gastrointestinal symptoms among the subject population.

Results: 91% and 9% of patients had Type II and I diabetes, respectively. Sixty seven percent of them had poor controlled diabetes and only 3% had well controlled diabetes. Gastrointestinal symptoms and signs were reported in 92% of patients. The common GI symptoms were constipation (59.5 %), followed by bloating (44 %), abdominal pain (31%), dyspepsia (30%), and mass protruding through anus (22.5%). Abdominal tenderness on deep palpation was the commonest clinical sign (54%). GI symptoms were more prevalent in subjects aged 60-69 years (97.2%). Seventy four percent of patients with GI signs and symptoms had complications such as neuropathy 61.5% and retinopathy associated with neuropathy 38.5%.

Conclusion: The prevalence of GI symptoms and signs in the population studies was higher than that reported from other populations, and there is a relationship between glycaemic control and complications of diabetes in diabetic subjects.

Inflammatory bowel disease (IBD) frequently affects young patients of childbearing age. Treatments for inflammatory bowel disease include immunosuppressive, cytotoxic and surgical therapies. Azathioprine is frequently used to treat patients with steroid dependent IBD. We report the case of a patient with ulcerative colitis, treated with azathioprine prior to conception and during the subsequent pregnancy with the subsequent successful delivery of healthy twins. Although some potential risks indeed exist, the use of AZA may not be harmful to the mother or the fetus in many instances.