Gastroenterology and Hepatology from Bed to Bench

Gluten associated disorders and the question around these associations has recently attracted attentions of many health professionals. This is because of high prevalence of undiagnosed gluten related disorders presenting with a multitude of symptoms and complications inside and outside small bowel. While the environmental factors associated with a complex genetics are leading to destructions of the small intestinal villi resulting in malabsorption syndrome in CD, GS is characterised by negative antibodies and grossly normal histology. The association between celiac disease and other disorders has been clearly established and there have been many reports of numerous intestinal and extra intestinal coexistent disorders with CD. But there is little information available regarding the clinical behavior of gluten sensitivity. In this review we discuss the clinical presentation of non-celiac GS and the prospect of current and the future diagnostic pathway.

Aim: The aim of this study is to estimate oral cavity cancer mortality for Iranian population, using Bayesian approach in order to revise this misclassification.

Background: Mortality is a familiar projection to address the burden of cancers, but according to Iranian death registry, about 20% death statistics were still recorded in misclassified categories.

Patients and methods: We analyzed national death statistic reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004 stratified by age group, sex, and cause of death are included in this analysis. Oral cavity cancer [ICD-10; C00-08] were expressed as the annual mortality rates/100,000, overall, by sex and by age group (<50 and ?50 years of age) and age standardized rate (ASR). The Bayesian approach to correct and account for misclassification effects in Poisson count regression with a beta prior employed to estimate the mortality rate of EC in age and sex group.

Results: According to the Bayesian re-estimate there were between 20 to 30 percent underreported mortality records in death due to oral cavity cancer. The age standardized mortality rate of oral cavity cancer increased dramatically during these years, Age specific rate for oral cavity cancer indicated higher mortality rate for older age.

Conclusion: Our findings suggested a substantial undercount of oral cavity cancer mortality in Iranian population. So policy makers who determine research and treatment priorities on death rates should notice to this underreported data.

Aim: This study evaluated the association between serum endothelin- 1 level and symptoms, clinical examination, laboratory and cardio-respiratory parameters, in patients with cirrhosis compared to controls.

Background: Cirrhosis is associated with significant portal, pulmonary and systemic vascular abnormities. Recent studies have suggested that endothelin -1 may have a significant role in the regulation of vascular tone.

Patients and methods: In this case – control study, subjects that had been evaluated and diagnosed with biopsy-proven cirrhosis and age-matched controls with no evidence of cardio-vascular or liver disease were recruited. Review of medical records, routine laboratory investigations and cardio-respiratory investigations including echocardiography to look for evidence of hepato-pulmonary syndrome were performed.

Results: 50 patients were subjects were recruited. The most common aetiology of the cirrhosis was chronic hepatitis B viral infection. 7/50 cases had evidence of the hepatopulmonary syndrome. Among the patients with evidence of the hepatopulmonary syndrome, dyspnoea (100%) and cyanosis (90%) were the most common of the symptoms and signs recorded. Pao₂ and arterial – alveolar oxygen gradients were the most sensitive tests in the diagnosis of hepatopulmonary syndrome. Orthodoxy specificity was 100%. The median concentration of serum endothelin-1 in cases with hepatopulmonary syndrome was 1.06+/- 0.015 pg/ml (range 0.92 – 1.21), in cases of sub-clinical hepatopulmonary syndrome, 2.49+/- 0.08 (4.05- 0.93) in patients with cirrhosis but no evidence of hepatopulmonary syndrome criteria 0.85+/-0.74(1.06-0.64) in controls.

Conclusion: There was a significant difference in serum endothelin- 1 levels between patients with cirrhosis and controls, but not between patients with cirrhosis complicated by hepatopulmonary syndrome and controls.

Aim: To compare the conventional GI endoscopy and using general anesthesia during the procedure regarding the satisfaction and acceptance among Iranian patients.

Background: Ability to measure and assess the patients’ satisfaction with colonoscopy and upper endoscopy will improve the quality of health care provided by gastroenterologists and thus resulting in better acceptability of endoscopy.

Patients and methods: In a prospective, multicenter, non-randomized clinical trial 756 patients were included between 2009 and 2010. A satisfaction developed questionnaire was answered by the patients who were candidate for elective upper and/or lower GI endoscopy within 72 hours after the procedure. Total satisfaction score was measured and compared between endoscopy patients with and without anesthesia. Different variables analyzed in order to find the influencing factors in patient satisfaction during the endoscopic procedures.

Results: The mean age of patients was 40.7 ± 15.1 years and 59% of them were female. Overall, 50.5% of patients underwent general anesthesia during the endoscopic procedure. There was a significant correlation between education level and satisfaction with the endoscopy. Also, anesthesia during endoscopy significantly increased the total satisfaction score of the patients (OR= 2.07, 95% CI: 1.24-2.9, P<0.0001).

Conclusion: The level of patient’s education and using anesthesia during GI endoscopy were two factors influencing the total patient satisfaction with the endoscopic procedures. Thus, we suggest using anesthesia for GI endoscopic procedures.

Aim: The aim of this was to investigate some clinical profiles and lifestyle changes in stoma patients.

Background: Stoma patients experienced multiple complications due to their ostomy formation.

Patients and methods: A cross-sectional study performed on 102 random samples of stoma patients. Any patient with adequate physical and mental capability to participate and having had an ostomy in place for at least 3 months was eligible to enter the study. Participants asked to answer study questions concerning age, sex, type of stoma, having permanent or temporary ostomy, underlying cause of stoma formation, type of cancers cause of stoma. Patient also questioned about some lifestyle changes because of stoma including: changing diet, sexual satisfaction (if sexually active after stoma formation), sense of depression, changing job, change clothing style.

Results: Colostomy was the most common type of stoma followed by ileostomy and urostomy. In 80.4% of patients under study the stoma was permanent. Most patients had a stoma because of cancer (77.5%), with colon cancer (41.2%) being the most common malignant diagnosis. The mean age of cancer patients (56.1±10.9) with stoma was significantly higher than non-cancer patients (44.7±12.9) (p<0.05). A significant differences were found regarding to sexual satisfaction after stoma formation between the two groups (p<0.05) and the cancer group was less sexually satisfied post-ostomy.

Conclusion: In conclusion, stoma formation can caused multiple problems for both cancer and non-cancer patients. Counseling of patient is an important component of care that could help stoma patients to adjust with new situations. 

Aim: This study compared PR and NB in predicting HCV patient costs. The objective of this study was to predict the direct cost of the HCV patient in Iran.

Background: Hepatitis C virus (HCV) is a common and expensive infectious disease in Iran.

Cost associated with HCV and its complications has not been well characterized. Analysis of cost data is important in providing consistent information to aid budgeting decisions and certain statistical regression models need for prediction mean costs. Poisson regression (PR) and negative binomial regression (NB) are more common in cost prediction study.

Patients and methods: This study designed as a cross-sectional clinic base from 2001 to 2010. First treatment period of each patient bring in study. We evaluated the doctor visiting, drugs, and hospitalization and laboratory tests of patients. Cost per person per one treatment period estimated in purchasing power parity dollars (PPP$). The PR is one of the models from general linear models (GLM) for describing count outcomes. The NB is another model from (GLM) as an alternative to the PR model.

Results: According to Likelihood ratio test NB was found to be more appropriate than PR (P<0.001). Genotype, marriage, medication, and SVR were being significant. Genotype 3 versus 1 decreasing cost while marriage, consuming pegasys and SVR increasing.

Conclusion: choosing best model in cost data is important because of specific feature of this data. After fitting the best model, analyzing and predicting future cost for patient in different situation is possible.