Gastroenterology and Hepatology from Bed to Bench

Over the last five decades the association between coeliac disease and other autoimmune disorders such as autoimmune thyroid disease or diabetes mellitus type 1 has been well established through many studies and to this day is subject to on-going clinical and scientific investigation worldwide. While no link has been established between coeliac disease and type 2 diabetes mellitus, coeliac disease is common in patients with type 1 diabetes. The improvement of symptoms in patients with both conditions through dietary intervention, in the form of a gluten free diet, has been widely described within the literature.

Aim:

The purpose of this study was to evaluate the influence of intronic polymorphism of the SMAD7 (Mothers Against Decantaplegic Homolog 7) gene (rs2337104) on the risk of colorectal cancer (CRC) and clinicopathological features in an Iranian population

Background: SMAD7 has been identified as an antagonist of transforming growth factor beta (TGF-b)-mediating fibrosis, carcinogenesis, and inflammation. Regarding to the recent genome-wide scan, a risk locus for colorectal cancer at 18q21 has been found, which maps to the SMAD7 gene.

Methods: This case-control study was performed on 109 CRC patients and 109 healthy controls recruited in Taleghani hospital. The genotyping of all samples were done by TaqMan assay via an ABI 7500 Real Time PCR System (Applied Biosystems) with DNA from peripheral blood. The association of this polymorphism with the risk of CRC and clinicopathological features was investigated.

Results: our results indicated that there were no any significant association between genotypic and allelic frequencies of SMAD7 polymorphism (rs2337104) and CRC risk in our population.  Although the T allele is the most frequent one in this population and its frequency was 86.7% in patients compared with 91.7% in controls (OR=1.705, 95% CI= 0.916 -3.172). Also the SMAD7 genotypes were not associated with any clinicopathological characteristics in CRC patients (P_value>0.05).

Conclusion: For the first time, this study results revealed that this SMAD7 polymorphism couldn’t be a potential risk factor for CRC or a prognostic biomarker for prediction of clinicopathological features in an Iranian population. A large-scale case-control study is needed to validate our results.

Introduction:

Treatment of Familial adenomatous polyposis (FAP) is centered on early recognition and curative surgery with either restorative proctocolectomy with ileal-pouch-anal-anastomosis (IPAA) or colectomy with ileorectal anastomosis (IRA). In this study we describe the presentation, treatment, and complications of 27 FAP patients.

Method:

All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure.

Results:

Overall 27 patients were included, 12 (44.44%) index patients, and 15 (55.55%) relatives diagnosed by screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to diffuse desmoid tumors. Daytime stool frequency was the most common side effect (70.37%), followed by bowel discomfort episodes (55.56%), requiring dietary restrictions (37.4%), passive incontinence (25.93%), soiling (22.22%), nighttime stool frequency (18.52%), Flatus incontinence (16.0%), and anastomosis leakage (3.70%). On average patients treated by IPAA experienced less complication than those treated by IRA.

Conclusion:

Compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience, and if supported by future studies, will cement IPAA as the treatment of choice in FAP.

ABSTRACT

Background and Purposes: Gastrointestinal cancers including stomach adenocarcinoma are very prevalent and one the main causes of death due to cancer. Mazandaran has a high mortality rate of stomach adenocarcinoma. This study was proposed for estimation of survival time in patients with stomach adenocarcinoma.

Materials and Methods: The study was historical cohort. The samples were the patients with stomach adenocarcinoma referred to Tooba clinic among 3 years (2007-2010). A parametric model was fitted on data. Kaplan Mayer and life table method were used for estimation of survival probability.  The effects of covariates on survival time were assessed by Cox Regression model.

Results: 68.3% of the patients were men and 31.7% were women. The mean of patients' age was 64 years. 48.4% of patients were in the most advanced stage i.e.: stage 4. The more than 2 years survival probability of patients was calculated 27.7% by using Kaplan Mayer method. The stage, metastasis, surgery, and age were the variables which affect the survival probability of patients, by using Cox hazard proportional model.

Conclusion:  The survival time of our patients is much lower than the developed countries which are related to latency in diagnosis and therapeutic limitations.

Key words: stomach adenocarcinoma, parametric model, life table, Cox hazard proportional model.

1) Corresponded Author  ,Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran

2) Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran

3) Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

4)Tehran university,Tehran ,Iran

5) Department of Occupational health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran

Background & objectives: Shigellosis is caused by different species of Shigella and one of the most common causes of diarrhea in children. This disease is endemic in many developing countries including Iran.  The aim of this study was to determine the incidence of Shigella species and their antimicrobial suceptibility patterns in hospitalized children with shigellosis .

Methods: This prospective cross sectional study was conducted in a teaching hospital in Abadan , Iran during June 2011 to may 2013. Stool specimens were collected from paediatric age group. All isolates were confirmed as Shigella species by biochemical and serologic tests. Antibiotic sensitivity pattern of these isolates was studied by  disk diffusion Method.

Results : Among all 705 stool samples, 36(5.1%) yielded Shigella.  Of cases, 392 (55.6%) of  were female and 313 (44.4%) of them were male. The most common Shigella isolates were S.flexneri (n=19, 52.7%) followed by S.sonnei(n=11, 30.5%), S.boydii (n=4, 11.1%) and S.dysenteriae 2(5.5%). Of the Shigella isolates, (47.2%) showed resistance to tow or more antimicrobial agents. Resistance pattern against various antimicrobials were as follows: trimethoprim-sulphamethoxazole (80.5%), ampicillin (63.8%), tetracycline(58.3%), Chloramphenicol(33.3%), nalidixic acid(27.7%), cefixime(16.6%) and. Additionally, there was no resistance against ciprofloxacin and ceftriaxone.

Conclusion : The most common isolates was S.flexeneri followed by S.Sonei. There was no antibiotic resistance against ciprofloxacin and ceftriaxone. TMP-SMZ showed highest resistancy.

Aim: Thereby we aimed to detection of bacterial DNA (bactDNA) in SBP by polymerase chain reaction (PCR) and its prognostic relevance in cirrhotic patients with culture-negative non-neutrocytic ascites(CNNNA).  Background: approximately 60% of patients with spontaneous bacterial peritonitis (SBP) are ascites culture negative. Methods: Of each 77 patients with cirrhosis and ascites, two samples including blood & ascitic fluid (AF) were taken. Blood samples were obtained for routine biochemical study and PMN count. AF samples were used for biochemical analysis and aerobic and anaerobic culture. BactDNA was detected by PCR using bacterial universal 16srRNA gene primer. Results: Hepatitis B, 41(45%), was the most frequent cause of cirrhosis. Of all AF samples, 3 (3.9%) were positive for bacterial culture (one streptococcus ? hemolytic and two E.coli). The mean number of PMN in AF was 63. BactDNA was detected in 33 (42.9%) of 77 of samples (group A) and bactDNA was absent in 41(53.2%) of samples (group B). Blood WBC, prothrombin time, LDH, serum total protein, AF WBC, serum albumin, AF albumin, AF total protein, serum total bilirubin, AST, ALT and BUN were not differ statically different among group A and B. Conclusions: Hepatitis B is the common cause of cirrhosis in Iranian cirrhotic patients. Also current study showed that the high number of Iranian cirrhotic patients with CNNNA carries bactDNA in their AF. The clinical findings as well as clinical laboratory data in patients with CNNNA are independent to bactDNA status in their ascitic fluid.

Esophageal lymphoma is a rare condition, accounting for less than 1% of all gastrointestinal lymphomas. Primary extra nodal esophageal lymphoma constitutes less than 0.2% cases of the total esophageal lymphomas. The definition of primary GI lymphoma has differed among authors. The etiology of the disease is unknown, with the role of Epstein-Barr virus being controversial. The common symptoms of patients with esophageal lymphoma include dysphasia, odynophagia, weight loss, chest pain or present as a result of complications. Burkitt’s lymphoma is one of the fastest growing human malignancies, with a 100% replication rate. Endemic, sporadic (non-endemic) and immunodeficient variants have been recognized. The diagnosis of Burkitt’s lymphoma relies on morphologic findings, immunophenotyping results, and cytogenetic features. Burkitt’s lymphoma is usually treated with LMB-96 protocol depending on the risk stratification. We present a case of primary esophageal Burkitt’s lymphoma, which has been successfully treated with LMB-96 protocol. An extensive review of literature did not reveal a single case of esophageal Burkitt’s lymphoma. To the best of our knowledge this is the first case report in the world literature with diagnosis of primary esophageal Burkitt’s lymphoma.