Gastroenterology and Hepatology from Bed to Bench

Aim: The aim of this study was to comprehensively analyze histopathologic parameters of Whipple pancreaticoduodenectomy specimens at Taleghani general hospital pathology department.

Background: The Whipple procedure is performed for variety of tumors involving the head of the pancreas, ampulla of Vater, common bile duct, or duodenum.

Patients and methods: Records of all cases of Whipple pancreaticoduodenectomy between 2007 and 2011were retrospectively reviewed and pathological details of diagnosis and staging were extracted.

Results: A total of 51 patients underwent Whipple procedure during a 5-year period, including 37 males and 14 females. The average age was 57 years (18-82 years). The most frequent presenting symptoms were jaundice and weight loss. Forty-four patients (86.3%) had malignant and 7 (13.7%) had benign lesions. Among malignant lesions, 27 (61.4%) were ampullary carcinomas, 12 (27.3%) were pancreatic carcinomas and 5 (11.4%) were cholangiocarcinomas. The pathological stage of most of the tumors was T3 (50%); followed by T2 (29.5%), and T1 (15.9%); only 4.5% were T4. Mean tumor size was 2.8 cm (0.2-7 cm). Duodenal and common bile duct margins were tumor-free in most cases (95.5 %). The pancreatic margin was free in 81.8% of patients; this margin had not been evaluated in 5 patients. Nearly 38.6% of all tumors showed vascular invasion while 68.2% showed perineural invasion. The average number of dissected lymph nodes was 4 (range 1-15); although in 25% of specimens, no lymph nodes had been found. Twelve specimens (35.3%) had lymph node metastases.

Conclusion: The present study demonstrates that most of our patients are diagnosed with malignancy, at advanced stage, and further research is needed to develop practical methods for earlier diagnosis. The fact that 25% of specimens had no lymph nodes needs more consideration.

Aim: The aim of this study was to review cases of non-alcoholic fatty liver disease (NAFLD) cases and to determine the prevalence of non-alcoholic fatty liver disease as a cause of elevated alanine aminotransferase (ALT) in healthy blood donors in the Permian area and also assess risk factors of NAFLD such as body mass index (BMI) and correlation with metabolic syndrome in these subjects.

Background: Non-alcoholic fatty liver disease has been increasingly recognized as the most common pathological conditions affecting the liver. Non-alcoholic fatty liver disease is now recognized as the hepatic component of the metabolic syndrome, which includes hyperlipidemia, glucose intolerance, obesity, and systemic hypertension.

Patients and methods: 2002 randomly selected blood donors inducted hi (participated in) this study. Subjects with more than two times elevated serum ALT level (were) chose for further follow up. subjects with persistently elevated ALT level and negative Laboratory results tor viral hepatitis B and C, autoimmune hepatitis, transferrine saturation <45% and a  negative history of alcohol and medication: who had evidence of liver steatosis on CT-Scan were presumed to have non-alcoholic fatty liver disease.

Results: 378 donors (20.5%) had elevated ALT levels at first measurement. In 35 cases with persistently elevated serum ALT level, in 22(62.9%) non-alcoholic fatty liver disease was the diagnosis. Mean of BMI was 31.18±5.7 (kg/m²) in non-alcoholic fatty liver disease subjects and non-alcoholic fatty liver disease was correlated with metabolic syndrome in these subjects.

Conclusion: Non-alcoholic fatty liver disease is the most common diagnosis for subjects with elevated serum ALT level in healthy blood donors in Kerman, Iran.

Aim: The purpose of the present study was to evaluate the number and proportion of various causes of upper gastrointestinal bleeding and actual numbers of non-NSAID, non-Helicobacter pylori (H.pylori) peptic ulcers seen in endoscopy of these patients.

Background: The number and the proportion of patients with non- H.pylori, non-NSAIDs peptic ulcer disease leading to upper gastrointestinal bleeding is believed to be increasing after eradication therapy for H.pylori.

Patients and methods: Medical records of patients referred to the emergency room of Taleghani hospital from 2010 with a clinical diagnosis of upper gastrointestinal bleeding (hematemesis, coffee ground vomiting and melena) were included in this study. Patients with hematochezia with evidence of a source of bleeding from upper gastrointestinal tract in endoscopy were also included in this study.

Results: In this study, peptic ulcer disease (all kinds of ulcers) was seen in 61 patients which were about 44.85% of abnormalities seen on endoscopy of patients. Among these 61 ulcers, 44 were duodenal ulcer, 22 gastric ulcer (5 patients had the both duodenal and gastric ulcers). Multiple biopsies were taken and be sent to laboratory for Rapid Urease Test and pathological examination. About 65.53% of patients had ulcers associated with H.pylori, 9.83% had peptic ulcer disease associated with NSAIDs and 11.47% of patients had ulcers associated with both H.pylori and consumption of NSAIDs. 13.11% of patients had non-NSAIDs non- H.pylori peptic ulcer disease.

Conclusion: The results of this study supports the results of other studies that suggest the incidence of H.pylori infection related with duodenal ulcer is common, and that non-H pylori and non-NSAIDs duodenal ulcer is also common.

Aim: The aim of this study was to discuss the prevalence of celiac disease (CD) in dyspeptic patients.

Background: Although severe mucosal abnormality with villous atrophy (lesions Marsh III) is at present the gold standard for the diagnosis of CD, presentation with non-specific microenteropathy (Marsh I-II) with positive serology is also common. Patients with dyspepsia, specific CD antibodies and microenteropathy, could have CD.

Patients and methods: From November 2007 to October 2008, 407 patients who randomly underwent diagnostic upper gastrointestinal endoscopy for dyspeptic symptoms (193 male, 214 women; mean age 36.1 years) were studied. Small bowel biopsies were performed in all of them. Histologic characteristics in duodenal biopsy specimens for celiac disease were evaluated according to the modified Marsh Classification. All the patients were also tested for serum total immunoglobulin A and anti-transglutaminase (tTG) antibodies. Those with IgA deficiency were tested for IgG tTG.

Results: Duodenal histology showed Marsh I-IIIc lesions in 6.4% cases. 4 patients (0.98%) were IgA deficient and none of them were positive for IgG tTG. Serology showed a positive result for tTGA in 33/407 (8%) and only 10 of them (2.5%) had abnormal histology (Marsh I-IIIc).

Conclusion: Mildly positive autoantibodies similar to milder enteropathy (Marsh 0-II) have a low specificity for CD. The prevalence of CD among symptomatic dyspeptic individuals was high hence dyspepsia should be considered as a cardinal sign for CD.

Aim: In this study, genetic polymorphism of two tRNA-liked short tandem repeat (STR)-containing loci, R-R and S-Q, was analyzed in order to clarify further the genotypic differences among E. dispar isolates.

Background: Entamoeba dispar is closely related to the human pathogen E. histolytica, the agent of amebic dysentery and amebic liver abscesses. E. dispar is, to some extent, capable of producing variable focal intestinal lesions in animals and of destroying epithelial cell monolayers in vitro, and some have reported it to be capable of producing amoebic liver abscess in hamsters. However no evidence exists at present to link E. dispar with human disease.

Patients and methods: A total of 28 E. dispar samples from gastrointestinal disorder patients were characterized using PCR and sequencing. The sequences obtained were edited manually and aligned.

Results: sequence analysis showed 9 and 6 different patterns of units in the repeat-containing region of R-R and S-Q, respectively. The repeat-containing regions of R-R and S-Q loci were found to be extensively polymorphic, varying in size, number and order of repeat units.

Conclusion: The results demonstrate extensive genetic variability among Iranian E. dispar clinical isolates. The genetic diversity of tRNA gene-linked STR loci shows them to be suitable for epidemiological studies such as the characterization of the routes of transmission of these parasites in Iran.

Coeliac disease (CD) is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease (CD). We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year,  presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy.

A 28-year-old, 32 week pregnant primigravida woman with a past history of increased blood pressure presented with RUQ pain as well as sudden onset of hematemesis. This case illustrates the occurrence of a rare complication (rupture of portal vein pseudoaneurysm inside the biliary system), appearing as upper gastrointestinal bleeding in a pregnant woman. The cause of the rupture is presumably pregnancy-related. We would like to emphasize the presence of pseudoaneurysm of the portal vein as a rare source of gastrointestinal bleeding in pregnancy.