Gastroenterology and Hepatology from Bed to Bench

Celiac disease is an autoimmune disorder that affects genetically predisposed individuals upon the ingestion of gluten. It is now considered one of the most common genetic disorders in Europe and Asian Pacific region with a prevalence of up to 2.67% of the population. The true prevalence of celiac disease may still be underestimated. Studies remain limited by sample size and selection bias. Celiac disease predisposes to the development of gastrointestinal malignancies, especially lymphomas and small bowel adenocarcinoma. The risk of developing a celiac disease associated malignancies remains uncertain, despite numerous studies. In Middle Eastern countries, the literature regarding celiac disease has expanded significantly in recent years. These studies reported have largely concentrated on the epidemiology of Celiac disease and there is an absolute and relative paucity of published research regarding celiac disease associated malignancy. The aim of this article is to review the current literature and evaluate the risk of gastrointestinal malignancies among patients with celiac disease and then review studies from the Asian Pacific region of the world.

Aim: This study aimed to determine the association between PD-1.5C/T (rs2227981, +7785) and the risk of gastric cancer (GC) in an Iranian population.

Background: Gastric cancer is the fourth most common cancer in the world. The programmed death 1 (PD-1) is a member of the CD28 super family. PD-1 is a negative regulator of T-cell effector mechanisms which decrease immune responses against cancer.

Patients and methods: we conducted case- control study to investigate the association of PD-1.5 C/T polymorphism in 122 GC patients and 166 control individuals. DNA was extracted from blood specimens. Genotypes were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay.

Results: The frequency of CC, CT and TT genotypes was 53.6%, 42.2% and 4.2% in control group and 41%, 54.1% and 4.9% in gastric cancer patients respectively. CC genotype was more frequent in control individuals than in patients but we found no statically significant association. The frequencies of PD-1.5CT genotypes were significantly higher in GC patient compared with control individuals (OR= 1.77, 95% CI= 1.077-2.931; P=0.026). Allele distribution was similar in patients and healthy individuals (p=0.061).Frequency of C and T alleles was 74.7%, 25.3% in control individuals and 68.03% and 31.97% in gastric cancer patients respectively.

Conclusion: These results suggest that PD-1.5 C/T polymorphism may affect the GC risk and prognosis in an Iranian population.

Aim: The aim of this study was to describe our results and investigate the survival of below-18-year-old patients undergoing LRDLT and the factors affecting this.

Background: Living Related Donor Liver Transplantation (LRDLT) has become a good option to provide suitable grafts for children with liver diseases. Using this method, children who have no chance for life can live a much longer life.

Patients and methods: The present study is a historical cohort study carried on 191 patients below-18-year-sold who had undergone LRDLT for the first time in the Namazi hospital liver transplantation center. Survival rate of the patients was assessed using Kaplan-Meier method. The effect of factors related to the recipients, donors, and the transplantation process on the patients’ survival was also investigated.

Results: 1, 3, 5 and 11-year survival of patients was 71%, 66%, 65%, and 65%, respectively. In the univariate analysis, age, weight at transplantation, PELD/MELD score, existence of post-transplant complications were found to be effective factors on the patients’ survival. In the multivariate analysis, weight at transplantation, PELD/MELD score, and existence of post-transplant complications were the prognostic variables.

Conclusion: LRDLT is now well established with satisfactory results in our center. Although the survival rate of the patients is lower than the survival rate reported in other studies, but the survival of the patients who had survived 1 month after the transplantation was comparable to other studies.

Aim: The aim of this study is to look for the proper methods that would be a major step towards untreated CD diagnosis and seek the metabolic biomarkers causes of CD and compare them to control group.

Background: Celiac disease (CD) is a common autoimmune disorder that is not easily diagnosed using the clinical tests.

Patients and methods: Thirty cases and 30 controls were entered into this study. Metabolic profiling was obtained using proton nuclear magnetic resonance spectroscopy (¹HNMR) to seek metabolites that are helpful for the detection of CD. Classification of CD and healthy subject was done using random forest (RF).

Results: The obtained classification model showed an 89% correct classification of CD and healthy subject for the external test set. The metabolites that caused changes in people with CD were identified using RF; these metabolites include lactate, valine and lipid.

Conclusion: The findings of the present study reveal serum lactate, valin and lipid levels in CD patient are lower than healthy cohorts. This metabolite may provide diagnostic tools as well as insight into potential targets for disease therapy.

Aim: To evaluate the efficacy of erythromycin to decrease the time and improves the quality of EGD in patients with acute upper GI bleeding.

Background: The diagnostic and therapeutic value of esophagogastroduodenoscopy (EGD) in patients with upper GI bleeding is often limited by the presence of residual blood or clots. Infused erythromycin (3 mg/kg) before EGD, a potent gastro kinetic drug, might improve the quality of EGD in patients with upper GI bleeding and decrease the time of EGD and second- look EGD.

Patients and Methods: In a prospective, randomized, double-blind controlled trial, 40 patients with acute upper gastrointestinal bleeding in Taleghani hospital, Tehran, Iran were studied. The patients were randomized into 2 groups: 1) nasogastric tube placement receiving placebo, and 2) intravenous erythromycin infusion (3mg/kg at 30 min) combined with nasogastric tube placement. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, blood units transfused, and length of hospital stay and mortality.

Results: A clear stomach was found more often in the erythromycin group (100% vs. 25%; P< 0.001). Erythromycin shortened the endoscopic duration (14 vs. 32 minutes in the placebo group; P< 0.001) and reduced the need for second-look endoscopy (1 vs. 3; P< 0.001), admission duration (2 vs 5; P< 0.001) and reduced the blood units transfused (2 vs 4; P< 0.001).

Conclusion: In patients with acute upper GI bleeding, infusion of erythromycin before endoscopy significantly decreases the time and improves the quality of EGD.

Aim: For the purpose of cost modeling, the semi-parametric single-index two-part model was utilized in the paper. Furthermore, as functional gastrointestinal diseases which are well-known as common causes of illness among the society people in terms of both the number of patients and prevalence in a specific time interval, this research estimated the average cost of functional gastrointestinal diseases.

Background: Health care policy-makers seek for real and accurate estimations of society’s future medical costs. However, data dealt with in hygienic studies have characteristics which make their analysis complicated; distribution of cost data is highly skewed since many patients pay great costs. In addition, medical costs of many persons are zero in a specific time interval. Indeed, medical costs data are often right skewed, including remarkable number of zeros, and may be distributed non-homogeneously.

Patients and methods: In modeling these costs by the semi-parametric single-index two-part model, parameters were determined by method of least squares; a result of this method was compared with the results yielded from two-part parametric model.

Results: Average costs of functional gastrointestinal diseases and their standard deviation in semi-parametric and parametric methods were yielded as $72.69±108.96 (R²=0.38) and $75.93±122.29 (R²=0.33) respectively.

Conclusion: Based on R­² index, the semi-parametric model is recognized as the best model. Totally, the two-part parametric regression model is a simple and available model which can be easily interpreted; on the other hand, though the single-index two-part semi-parametric model cannot be easily interpreted, it has considerable flexibility. The study goals can be indeed used as the main factor for choosing one of these two models.

Inflammatory fibroid polyp (known also as Vanek’s tumor) is a type of localized, non-neoplastic inflammatory pseudotumor or inflammatory myofibroblastic tumor that occurs most commonly in the stomach but also in the small and large bowel. It is a documented cause of intussusception in adults. We report a case of a 40-year-old woman who presented with severe, postprandial abdominal pain followed by projectile vomiting over a period of three days. Ultrasonography demonstrated a solid and echogenic mass surrounded by the typical mural layers of an invaginated jejunum. She underwent urgent laparotomy and resection of an 18 cm tumor from the distal jejunum. The immuno-histopathological diagnosis after segmental jejunal resection was a jejunal inflammatory fibroid polyp. Although inflammatory fibroid polyps are seen very rarely in adults, they are among the probable diagnoses that should be considered in obstructive tumors of the small bowel causing intussusceptions.

Early diagnosis and appropriate treatment of cholangiocarcinoma is problematic. Cross sectional imaging and tumor marker CA _19-9 are not absolutely reliable and tissue sampling is difficult. We present a patient with cholangitis and cystic dilation of intra-hepatic bile ducts that primarily diagnosed as Caroli's disease in imaging and needle biopsy but laparotomy and surgical biopsy revealed cholangiocarcinoma.