Gastroenterology and Hepatology from Bed to Bench

Hepatitis viruses are infectious agents that can infect liver and cause inflammation. The infection triggers immune response against infected cells that leads to the destruction of hepatic cells. This destruction has two consequences: leaking ALT and AST liver enzymes which increases during the course of disease and accumulation of bilirubin- a red pigmented compound released from dead red cells- which causes the yellow coloration of eyes and skin. These viruses transmit through diverse routes i.e. blood transfusion, sexual contacts and consuming water or food contaminated by feces. Enteric hepatitis viruses use the latter route for transmission; hence their outbreaks are more common in underdeveloped countries. There are currently two distinguished enteric hepatitis viruses, hepatitis A and hepatitis E. These viruses belong to different family of viruses and their epidemiological characteristics are different. These infections can be diagnosed by an ELISA for IgM antibody. A vaccine has been developed in last decade of twentieth century for hepatitis A virus, which is administered mostly in the developed world i.e. U.S and Japan. Treatment for these infections is mostly supportive; however, in the case of fulminant hepatitis the liver transplantation might be necessary.

Sulphites are widely used as preservative and antioxidant additives in the food and pharmaceutical industries. Exposure to sulphites has been reported to induce a range of adverse clinical effects in sensitive individuals, ranging from dermatitis, urticaria, flushing, hypotension, abdominal pain and diarrhoea to life-threatening anaphylactic and asthmatic reactions. Exposure to the sulphites arises mainly from the consumption of foods and drinks that contain these additives; however exposure may also occur through the use of pharmaceutical products, as well as in occupational settings. Most studies report a prevalence of sulphite sensitivity of 3 to 10% among asthmatic subjects who ingest these additives. However, the severity of these reactions varies, and steroid-dependent asthmatics, those with marked airway hyperresponsiveness, and children with chronic asthma, appear to be at greater risk. Although a number of potential mechanisms have been proposed, the precise mechanisms underlying sulphite sensitivity remain unclear.

Recent trends in medical education are moving rapidly away from gaining a certain number of marks in high-stakes examinations and towards gathering evidence of clinical competence and professional behavior observed in clinical environments (workplace-based learning). In the Miller’s framework for assessing clinical competence, workplace-based methods of assessment target the highest level of the pyramid and collect information about doctors' performance in their everyday practice. Direct Observation of Procedural Skills (DOPS), Mini-Clinical Evaluation Exercise (mini-CEX) and Case-based discussion (CbD) are some of the most commonly used methods of workplace-based assessments. I explain these three methods of assessment and their advantages and discuss that if incorporated in a structured program of teaching for doctors in training, they can promote active, learner-centered learning and facilitate provision of developmental verbal feedback to the trainee immediately afterwards.

Aim: The purpose of this study was to investigate the possible influence of age and gender on association between -765G > C COX-2 genetic polymorphism and gastric adenocarcinoma risk in Iranian patients.

Background: The promoter polymorphism of COX-2 gene -765G>C has been described to play an important role in many cancers such as gastric cancer.

Patients and methods: We carried out single-nucleotide polymorphism analysis in Iranian samples including 91 patients and 91 control normal using PCR- RFLP technique.

Results: Statistical analysis revealed no significant association between GG, GC and CC genotypes and risk of gastric adenocarcinoma. However differences were considered significant (P=0.043) for female subjects with C carrier genotypes (GC and CC) and gastric adenocarcinoma when compared with male patients (P=0.645) and control groups (P=0.653). Also, there was a statistically significant difference between increasing of age and susceptibility for gastric adenocarcinoma (Odd Ratio = 1.125, 95% CI=1.089-1.162).

Conclusion: These results suggested that Iranian C carrier females can be more susceptible for gastric adenocarcinoma in comparison with control group. Also increasing of age should be considered as a risk factor for this disease.

Aim: In this study the anticancer activity of Lavender aqueous extract against MKN45 cell line was evaluated.

Background: Plant-based drugs are regarded as promising therapies. Lavender is a plant that has been cultivated from ancient times. An aqueous extract of Lavender has shown therapeutic effects on the nervous system in the high doses based on in-vivo studies. Gastric cancer is one of the frequent cancers in Iranian population. We therefore assessed the effect of Lavender upon a gastric cancer cell line.

Patients and methods: The MKN45 cancer cell line was selected for treatment with aqueous extract of Lavender. Survival of MKN45 cell line was studied in the presence of various concentrations of Lavender extract by MTT assay method. Morphological studies were performed via microscopic analyses. Flow cytometry and proteomics techniques were applied to determining pharmaceutical mechanism of lavender cytotoxic effects.

Results: The survival and morphological studies revealed anticancer characteristics of extract. Flow cytometry findings indicate that Lavender extract had a cytotoxic effect upon the cell line.  Proteomics analysis identified a significant alternation in gastric cellular proteome expression after treating with the extract. Among 1000 spots, more than 700 spots showed changes in protein expression levels by informatics analysis. Of these proteins, expression of three cancer biomarkers, Annexin1, Anolase1 and HSP70 were suppressed by extract.

Conclusion: This study suggests that Lavender extract is cytotoxic and alter protein expression in a gastric cancer cell line.

Aim: This study investigated the prevalence of sapovirus infections in patient with acute gastroenteritis in Tehran, Iran.

Background: Sapovirus, a member of the family Caliciviridae is one of the major causative agents of viral gastroenteritis affecting both children and adult individuals. There isn't enough data about prevalence and genotypes of sapovirus infection in Tehran, the capital city of Iran.

Patients and methods: A total of 42 fecal samples were collected from patients with acute gastroenteritis from May to July 2009. RT nested- PCR was performed for screening. To genotype the sapovirus isolates, some positive samples were subjected to phylogenetic analysis by sequencing of fragments of viral capsid gene region.

Results: Sapovirus was detected in 5 of 42 stool specimens from patients with acute gastroenteritis. Sapovirus detected in this study was clustered into only one distinct genogroup I/2. Sapovirus GI/2 was predominant.

Conclusion: Our results show that among the studied viruses responsible for this disease, sapovirus was a major viral isolate virus.

Aim: In this study, we determined the relationship between the serum level of IL-23 and the severity of ulcerative colitis (UC) among our population.

Background: A recent major breakthrough for describing the pathogenesis of intestinal tissue injury in inflammatory bowel disease (IBD) is the pathway related to interleukin-23 (IL-23).

Patients and methods: We performed a prospective case-control study on a total of 85 new patients with ulcerative colitis, recruited from a general referral hospital. Forty ethnically matched healthy controls were also enrolled among hospital staffs and analyzed. Serum IL-23 level was quantified using an electrochemiluminescence immunoassay (ECLIA) method with an immunoassay analyzer.

Results: The mean serum IL-23 level in the group with ulcerative colitis was significantly higher than the healthy individuals (347.5±130.8 pg/ml versus 233.5±86.3 pg/ml; p< 0.001). There was a positive correlation between the serum level of IL-23 and disease duration (r = 0.27, p = 0.04). Also, a direct relationship was found between the serum level of IL-23 and the severity of disease (mean IL-23 in mild UC = 296.2±51.2 pg/ml; in moderate UC= 356.1±142.9 pg/ml; and in severe UC= 399.3±163.8 pg/ml, p=0.04).

Conclusion: Serum level of IL-23 is directly correlated with the duration and severity of ulcerative colitis.

Aim: The aim of this study was to evaluate the epidemiology of GERD base on population study in Tehran providence.

Background: Gastro-esophageal reflux disease (GERD) is a common and chronic problem. Recent reports from developing countries indicate increment in the incidence and prevalence of the disease over the past.

Patients and methods: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran. Participants completed a valid gastro-esophageal reflux Questionnaire. The questionnaire included personal and family characteristics such as age, gender, and educational status. In addition, interviewers asked them regarding 10 GI symptoms.

Results: Altogether 18180 individuals participated in this cross-sectional study. The mean ± SD age of participant was 38.7±17.1 and 9072 (49.9%) were women. The prevalence of GERD was 8.85 (8.43-9.26). There was significant relationship between age, sex, marital and educational status with GERD. GERD symptoms were more common in women, older people, individuals with low education and married people. There was overlap between GERD, irritable bowel syndrome (IBS) and uninvestigated dyspepsia (UD).

Conclusion: According to our finding although the prevalence of GERD in our population is less than other studies, this prevalence is increasing in recent years.

Gastric lipoma is a rare tumor, accounting for only 5% of gastrointestinal tract lipomas and less than 1% of all gastric tumors. Histological diagnosis is usually easy. However, the tumor may sometimes undergo significant inflammatory changes leading to a difficult differential diagnosis with well-differentiated liposarcoma. Authors report the case of a 51-year-old man, presenting with epigastralgia of recent onset. Physical exam was unremarkable. Endoscopy revealed a large, ulcerated, submucosal, and antral tumor. CT scan showed an antral mass with fat attenuation. The patient underwent a total gastrectomy. Macroscopic examination identified in the antral wall a 9-cm, well-circumscribed, nodular lesion, with a greasy cut surface. On histological examination, the tumor was composed of a mature adipocytes proliferation, showing significant variation in cell size, associated to some lipoblasts. Nuclei were sometimes large, irregular, neither with hyperchromasia nor mitosis. Diagnosis of a well-differentiated liposarcoma was suspected and molecular cytogenetic analyses showed neither MDM2 nor CDK4 gene amplification on fluorescent in situ hybridization. The diagnosis of lipoma was made. Twelve months after surgery, the patient is doing well. In conclusion, Differentiating benign from malignant fatty tumors is sometimes difficult in morphologic features. In these cases, cytogenetic procedures are the only means for an accurate diagnosis.