Geographic trends and risk of gastrointestinal cancer among patients with celiac disease in Europe and Asian-Pacific region

Mohammad Rostami Nejad, David Aldulaimi, Sauid Ishaq, Mohammad Javad Ehsani-Ardakani, Mohammad Reza Zali, Reza Malekzadeh, Kamran Rostami

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):167-169

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.

Original Article

Programmed death-1 gene polymorphism (PD-1.5 C/T) is associated with gastric cancer

Sanaz Savabkar, Pedram Azimzadeh, Vahid Chaleshi, Ehsan Nazemalhosseini Mojarad, Hamid Asadzadeh Aghdaei

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):178-182

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.

Living related donor liver transplantation in Iranian children: a 12- year experience

Najmeh Haseli, Jafar Hassanzade, Seyed Mohsen Dehghani, Ali Bahador, Seyed Ali Malek-Hosseini

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):183-189

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.

NMR based metabonomics study on celiac disease in the blood serum

Fariba Fathi, Fatemeh Ektefa, Afsaneh Arefi Oskouie, Kamran Rostami, Mostafa Rezaei-Tavirani, Amir Houshang Mohammad-Alizadeh, Mohsen Tafazzoli, Mohammad Rostami Nejad

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):190-194

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.

Erythromycin decreases the time and improves the quality of EGD in patients with acute upper GI bleeding

Mohammad Javad Ehsani Ardakani, Ehsan Zare, Maryam Basiri, Hamid Mohaghegh Shalmani

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):195-201

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.

Application of semi-parametric single-index two-part regression and parametric two-part regression in estimation of the cost of functional gastrointestinal disorders

Mohadese shojai, Anoshirvan Kazemnejad, Farid Zayeri, Mohsen Vahedi

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):202-209

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.

Case Report

Jejunal intussusception caused by a huge Vanek’s tumor: a case report

Hassan Neishaboori, Iradj Maleki, Omid Emadian

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):210-213

Case Presentation

Cholangiocarcinoma or Caroli disease: a case presentation

Mahmud Baghbanian, Hassan Salmanroghani, Ali Baghbanian

Gastroenterology and Hepatology from Bed to Bench, Vol. 6 No. 4 (2013), 22 September 2013, Page Gastroenterol Hepatol Bed Bench 2013;6(4):214-216

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.

Short Cuts