Gastroenterology and Hepatology from Bed to Bench

(Please cite as: Weissman S, Saleem S, Aldulaimi D. Landmark studies and emerging strategies for the management of acute severe ulcerative colitis. Gastroenterol Hepatol Bed Bench 2019;12(3):179-82).

As the incidence of inflammatory bowel diseases (IBD) increases in the newly industrialized countries, the health and financial burden of disease also increase. These changes make the role of IBD biomarkers further crucial. Serum calprotectin, as a novel blood-based biomarker of IBD, has been investigated in several investigations. Yet, there is no consensus regarding its clinical utility. We searched the electronic database, including PubMed, EMBASE, Scopus, and Web of Science up to the end of 2018 to find how serum calprotectin associates with the disease characteristics in IBD. The search terms included: inflammatory bowel diseases, IBD, Crohn Diseases (CD), Ulcerative Colitis (UC), calprotectin, serum, and blood. Based on our review, a biomarker role has been suggested for serum calprotectin in IBD, as significant associations were found between serum calprotectin and disease burden, prognosis, and relapse. A complementary role to fecal calprotectin has also been suggested for serum calprotectin. On the other hand, considering a significant correlation between serum calprotectin and serum CRP, but not fecal calprotectin, serum calprotectin could be more representative of systemic inflammation than an intestinal inflammation. Consequently, further researches are needed to unwrap the potential of serum calprotectin as a blood-based biomarker in IBD.

Keywords: Inflammatory bowel diseases, Serum calprotectin, Biomarker.

(Please cite as: Azramezani Kopi T, Shahrokh SH, Mirzaei A, Asadzadeh Aghdaei H, Amini Kadijani A. The role of serum calprotectin as a novel biomarker in inflammatory bowel diseases: a review study. Gastroenterol Hepatol Bed Bench 2019;12(3):183-89).

Aim: The aim of this study was to investigate the effects of eight weeks aerobic and resistance exercise on blood lipid profile in elderly with non-alcoholic fatty liver disease (NAFLD).

Background: Increased sedentary have a potential role in the development of NAFLD. Exercise training as an effective strategy to reduce NAFLD is presented.

Methods: In a randomized clinical trial study, thirty nine elderly patients with NAFLD were enrolled and were randomly divided in three groups. Aerobic groups (AG, n=13), resistance group (RG, n=13) and control group (CG, n=13). AG participated in an 8-week aerobic training (three 45-min sessions per week at 55-75% of HRR (heart rate reserve)). RG participated in an 8-week resistance exercises (three 45-min sessions per week at 50-70% of 1RM (one-repetition measure). Blood lipid profile of patients were evaluated baseline and after eight weeks.

Results: At baseline, there were no differences between the two groups. In two group, cholesterol and low density lipoprotein (LDL) of blood of elderly follow eight weeks aerobic training with p=0.02 and p=0.02 were decreased, respectively. Also, High density lipoprotein (HDL) was improved follow aerobic training (p=0.008). However, the aerobic and resistance training were not effective on triglyceride (TG).

Conclusion: aerobic training was more effective than resistance training in improving the blood lipid profile in elderly with NAFLD and can role in management of this condition.

Keywords: Aerobic training, Aging, Resistance training, Non-alcoholic fatty liver disease, Lipid profile.

(Please cite as: Ghamarchehreh ME, Shamsoddini AR, Alavian SM. Investigating the impact of eight weeks of aerobic and resistance training on blood lipid profile in elderly with non-alcoholic fatty liver disease: a randomized clinical trial. Gastroenterol Hepatol Bed Bench 2019;12(3):190-96).

Aim: We designed this study to evaluate the effectiveness of the combination of topical rectal therapy with biofeedback in treatment of solitary rectal ulcer compared to single biofeedback therapy.

Background: Biofeedback therapy is an appropriate treatment for patients with solitary rectal ulcer syndrome (SRUS) but it seems that it is not effective alone. Topical medical therapies are supposed to have an additive role to biofeedback.

Methods: This randomized, controlled trial was conducted on 63 patients with SRUS. Patients were randomly enrolled into two groups of combination and single therapy. The patients in combination group (n=31) received biofeedback plus a topical therapy (an enema contained dexamethasone, sulfasalazine and bismuth) and the patients in single therapy group (n=32) were treated with biofeedback alone.

Results: Endoscopic responses to treatment in the combination and single groups were 80% and 50%, respectively (P<0.05).  Clinical improvement in symptoms such as difficulty to evacuate, digitation to evacuate, feeling of incomplete evacuation, time to need to evacuation and life style alternation were significantly better in treated group by combination therapy than single therapy. Regarding to the mean total score based on all subjective parameters, the results were also significantly better in the treated group by combination therapy.

Conclusion: Topical anti-inflammatory therapies in combination with biofeedback is an efficient treatment for patients with SRUS.

Keywords: Biofeedback, SRUS, Endoscopic responses.

(Please cite as: Abdi S, Tavakolikia N, Yamini M, Bagheri M, Sadeghi A, Pourhoseingholi MA, et al. Solitary rectal ulcer syndrome: addition of rectal therapies to biofeedback is more effective than biofeedback alone. Gastroenterol Hepatol Bed Bench 2019;12(3):197-202).

Aim: We assessed the knowledge of physicians regarding diagnosis and treatment of celiac disease (CD).

Background: Specialists as the main therapist group of CD patients may play crucial role in the diagnosis and treatment of CD. Therefore, training and ensuring their capabilities is important.

Methods: The population was specialists including Gastroenterologist, GI fellow, consultants, residents and general practitioners graduated in Medical Sciences Universities in Iran. The examination was the experts made and aimed to assess the educational needs of physicians and explore their failures in the diagnosis and treatment of CD with the key feature approach. Data was collected using a questionnaire that its validity and reliability was confirmed by experts (r = 91.6%). The total score was 150 with the classification of participants to the following categories: good (112- 150), intermediate (39-112) and weak ( ?38).

Results: Out of 300 participants, 197 questionnaires were returned (Response rate = 66%). The mean age of the participants was 42.67 years (SD = 7.9 years) with majority were male (63.6%). Average score of participates who had less than three year’s experience was significantly higher than others (P?0.05). Only 12.1% and 9.8% of specialists have got the excellent score for diagnosis and treatment, respectively.

Conclusion: It may conclude that specialists have had performance gap and around 90% needed training based on the principles of instructional design in order to improve their knowledge and skills to do and practice their assigned tasks. Therefore, development of training packages according to the principles of instructional design is suggested.

Keywords: Instructional design, Celiac Disease, specialists, need assessment.

(Please cite as: Barzegar F, Rostami-Nejad M, Rostami K, Ahmadi S, Mohaghegh-Shalmani H, Sadeghi A, et al. Lack of health care professional’s awareness for management of celiac disease may contribute to the under diagnosis of celiac disease Gastroenterol Hepatol Bed Bench 2019;12(3):203-208).

Aim: This study compares the effects of two drug regimens for Helicobacter pylori (H. pylori) infection resistant to the first line drug regimen among patients referred to Ilam clinics, Iran.

Background: Single drug regimen is not effective for H. pylori infection and therefore, application of triple or quadruple drug regimens are currently applied.

Methods: This study was performed by a before-after comparative method and patients were randomly selected among those consecutively referred to Ilam gastrointestinal clinics. Patients with failure in the first line treatment, were randomly divided into two equal groups and each group was treated by one of the PPI+Amoxicillin+Rifampicin or PPI+Amoxicillin+Levofloxacin drug regimens for 14 days. Six weeks after treatment, patients were tested for H. pylori stool antigen and the results were compared between two groups.

Results: In this study, 100 patients including 49 (49%) men and 51 (51%) women were examined. There was no statistical difference between the two groups for gender, age and living location at the start of study (p = 0.068). The mean age of the patients was 44.55 ±15.1 years old ranging from 17 to 85 years. Response to treatment among the levofloxacin group, was 90% and in rifampicin group 72% with a significant difference (p<0.04).

Conclusion: The response rate of H. pylori infection to the Levofloxacin based regimen was 90%; however, the application of rifampicin in combination with other drugs against H. pylori infection (72% response rate), should be limited to reduce the possibility of drug resistance in case of tuberculosis infection.

Keywords: Helicobacter pylori, Levofloxacin, Rifampicin, PPI, Drug resistance.

(Please cite as: Abangah GH, Raughani A, Asadollahi P, Asadollahi KH. Comparison between the two drug regimens of PPI+Amoxicillin+Rifampicin and PPI+Amoxicillin+ Levofloxacin for the treatment of H. pylori infections resistant to the first line drug regimen among patients referred to Ilam clinics Gastroenterol Hepatol Bed Bench 2019;12(3):209-216).

Aim: The aim of this study is to examine the relationship between dietary patterns and the risk of Colorectal Cancer (CRC) and adenomas.

Background: Dietary patterns have been shown to be associated with risk of CRC, but there are a few data on this context and its relationship with risk of colorectal adenomas as the precursors of the CRC.

Methods: This hospital-based case-control study was conducted in three major general hospitals in Tehran province, Iran. Data was collected (October 2016 to May 2018) from 129 colorectal cancer and 130 colorectal adenoma patients that confirmed by pathology and colonoscopy findings and 240 controls with non-neoplastic conditions and not afflicted with diet related chronic diseases. Dietary data were evaluated by 147-items semi-quantitative food frequency questionnaire. Multivariate logistic regression was used to estimate the relationship between dietary patterns and risk of colorectal cancer and colorectal adenoma.

Results: Three dietary patterns (healthy, western and traditional) were derived. After adjusting for confounders, the Healthy dietary pattern was associated with a decreased risk of Colorectal Cancer (OR=0.22, 95% CI=0.14-0.37) and Colorectal Adenoma (OR=0.43, 95% CI=0.27-0.69). Higher intake of the Westernized pattern was positively associated with risk of Colorectal Cancer (OR=3.5, 95% CI=2.13-5.19) and Colorectal Adenoma (OR=2.47, 95% CI=1.49-4.08). There was no significant association between traditional pattern and the Colorectal Cancer (OR=99, 95% CI=0.61-1.59) and Colorectal Adenoma (OR=0.85, 95% CI=0.54-1.35) risk.

Conclusion: Our study suggested that the “Healthy” dietary pattern reduces the risk of Colorectal Cancer and Colorectal Adenoma, while the “Western” dietary pattern increases the risk of both Colorectal Cancer and Colorectal Adenoma.

Keywords: Dietary pattern, Colorectal cancer, Colorectal adenoma, Healthy dietary pattern, Western dietary pattern.

(Please cite as: Bahrami A, Houshyari M, Jafari S, Rafiei P, Mazandaranian MR, Hekmatdoost A, et al. Dietary patterns and the risk of colorectal cancer and adenoma: a case control study in Iran Gastroenterol Hepatol Bed Bench 2019;12(3):217-225).

Aim: The aim of this study was to determine the relation between different food groups intake, nutritional status of cirrhotic patient and the stage of the disease.

Background: Protein-energy malnutrition (PEM) is a common problem in cirrhotic patients. Food intake assessment is highly important in the investigation regarding the health-disease process.

Methods: In this cross-sectional study, sixty eight ambulatory cirrhotic patients, with a mean age of 54 years, were included. In order to assess the stage of the disease and malnutrition status, Child-Pugh score and Subjective Global Assessment index were used respectively. Dietary intakes were assessed using a 168-item semi-quantitative validated food frequency questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were computed, using logistic regression models.

Results: After adjustment for confounders, we found significant inverse relations between intakes of nuts (OR=0.140, CI=0.031-0.625) and olive (OR=0.212, CI=0.049-0.917) with severity of disease and boiled potatoes (OR=0.154, CI=0.040-0.592) and legumes (OR=0.090, CI=0.020-0.406) with malnutrition status. Inversely, solid fats (OR=3.324, CI=1.080-10.238) and mayonnaise (OR=5.215, CI=1.203-22.612) were positively associated with disease severity and malnutrition, respectively.

Conclusion: These findings suggest that selection of healthy foods was negatively associated with severity of hepatic cirrhosis whereas unhealthy food groups had a positive relation with disease severity and malnutrition.

Keywords: food groups, hepatic cirrhosis, malnutrition, Child-Pugh score.

(Please cite as: Pashayee-khamene F, Saber-firoozi M, Hatami B, Hekmatdoost A, Rashidkhani B, Aghamohammadi V, et al. Food groups intake of cirrhotic patients, comparison with the nutritional status and disease stage. Gastroenterol Hepatol Bed Bench 2019;12(3):226-232).

Aim: This study aims to investigate the morbidity, mortality, and health care utilization of infection in patients with cirrhosis, with the hope of making clinical recommendations.

Background: The pathophysiology of liver cirrhosis makes patients susceptible to a variety of complications including infection. It contributes to a staggering rate of death and places a tremendous financial burden on the health care system.

Methods: The pathophysiology of liver cirrhosis makes patients susceptible to a variety of complications including infection. It contributes to a staggering rate of death and places a tremendous financial burden on the health care system.

Results: In this cross-sectional study, we queried the National Inpatient Sample (NIS) database for patients discharged from United States (US) hospitals with International classification of diseases (ICD) diagnostic codes consistent with liver cirrhosis, between January 2011 and December 2014. The patients were classified based upon the presence or absence of an infection, as well as their demographics and comorbidities. The data was then analyzed using the IBM SPSS version 25 statistical software.

Conclusion: From 2011 to 2014, 660,727 cirrhotic patients were identified. Of these, 20.6% were found to have an infection. The mortality rate during hospitalization was 4.7% of all cirrhotic patients. The hospital length of stay was significantly longer for the study group than the control group (8.22 days versus 5.11 days) (P <0.0001). Similarly, the mean hospital cost was higher in the study group compared to the control group ($74,729.53 ± $125,963.75 vs. $46,413.32 ± $71,936.50 P< 0.0001).

Keywords: Liver Cirrhosis, infection, morbidity, mortality, hospital costs.

(Please cite as: Saleem S, Katragadda R, Weissman S, Bleibel W. Comparison of ISG15, IL28B and USP18 mRNA levels in peripheral blood mononuclear cells of chronic hepatitis B virus infected patients and healthy individuals Morbidity and mortality of infections in the cirrhotic patients: a US population-based study. Gastroenterol Hepatol Bed Bench 2019;12(3):233-238).

Aim: Screening differentially expressed genes (DEGs) related to Eosinophilic gastroenteritis (EG) to introduce possible biomarkers.

Background: EG as a rare gastrointestinal disorder is characterized with gastrointestinal bleeding, crampy generalized abdominal pain, diarrhea, nausea, vomiting, and weight loss. In this study gene expression profile of patients is analysis via protein-protein interaction (PPI) analysis to reveal new prospective of disease.

Methods: Top significant genes of gene expression profiles of 5 gastric antrum EG patients and 5gastric antrum control from GEO which were matched via boxplot analysis were screened via PPI network by using Cytoscape software and STRING database. Numbers of 20 top nodes of query DEGs based on degree value were introduced as central nodes which 7 critical central genes among them were identified. Gene ontology enrichment for the 20 central genes was done by using CluGO. Action map for the central genes was performed by applying CluePedia.

Results: Among 20 central nodes, TXN, PRDX2, NR3C1, GRB2, PIK3C3, AP2B1 and REPS1 were recognized as critical central genes. Nine biological terms were determined that most of them were involved in the transport processes.

Conclusion: The introduced possible biomarkers can be used in the differential diagnosis of the disease and also in treatment of disorder.

Keywords: Eosinophilic gastroenteritis, gene, protein-protein interaction network.

(Please cite as: Zadeh-Esmaeel MM, Rezaei-Tavirani M, Ahmadi NA, Vafaee R. Evaluation of gene expression change in eosinophilic gastroenteritis. Gastroenterol Hepatol Bed Bench 2019;12(3):239-245).

Aim: To better understand the anticancer properties of coffee, bioinformatics analysis of gene expression profile of HT-29, human colon cell line in the exposure of caffeic acid (CA) is proposed in this study.

Background: Coffee as a popular beverage has been shown to be a potential health promoter as well as being effective on different kinds of diseases including cancer.

Methods: The differentially expressed genes (DEGs) across the comparison of groups of samples including none-treated HT-29 and HT-29 tread with CA were applied for the protein-protein interaction mapping. Cytoscape v.3.7.1 constructed a network and analyzed the topological features of the most noteworthy DEGs.

Results: The genes of CTSZ, AFF4, DHRS2, and HMGCS1 known as active agents in cancer progression, were identified as the central DEGs in the constructed PPI network in this study. Especially, HMGCS1 is the most central gene is also linked to one of the important colon cancer altered processes, cholesterol metabolism.

Conclusion: Lowering the risk of colon cancer could be perhaps through nominated DEGs and therefore, regulation of serum cholesterol as well as protection against cancer development.

Keywords: Coffee consumption, Colon cancer, Transcriptome, Protein-protein interaction network analysis, Biological process analysis.

(Please cite as: Rezaei-Tavirani M, Rezaei Tavirani M, Zamanian Azodi M. The bioinformatics aspects of gene screening of HT-29, human colon cell line treated with caffeic acid Gastroenterol Hepatol Bed Bench 2019;12(3):246-253).

Aim: Evolution of gene expression change of intestine tissue in celiac patients to find a new molecular prospective of disease is the aim of this study.

Background: Celiac disease (CD) as an autoimmune disease is known as an immune reaction response to the gluten in patients. It is reported that genetic and environmental conditions are important in onset and progress of CD.

Methods: gene expression profiles of intestinal tissue in 12 celiac patients and 12 healthy controls from gene expression omnibus (GEO) were downloaded and verified by boxplot analysis. The significant and selected differentially expressed genes (DEGs) were included protein-protein interaction (PPI) network analysis. The central nodes were identified by network analyzer.

Results: The network was constructed from 161 query DEGs and 50 additional neighbors. GTF2H1, VEGFA, SUMO1, RAD51, MED21, BBP4, LEP, and MAP2K7 as potent hub nodes LRP5, RABGEF1, BCAS2, DYRK1B, AOC3, RABL2A, CRTAP, VEGFA, and SPOPL as potent bottlenecks are introduced as crucial nodes.

Conclusion: Among the crucial DEGs, Vascular endothelial growth factor A (VEGFA) was highlighted as an important biomarker candidate for follow up of celiac patients.

Keywords: Celiac disease, Biomarker, VEGFA, Follow up, Gene.

(Please cite as: Rezaei-Tavirani S, Rostami-Nejad M, Montazar F. Highlighted role of VEGFA in follow up of celiac disease. Gastroenterol Hepatol Bed Bench 2019;12(3):254-259).

The spleen cyst is a rare and often incidental finding that can be primary or secondary, parasitic or non-parasitic. Based on the size of the cyst, the patient may experience symptoms and plan of treatment based on size and symptoms will be done. Our patient was a 14 years old girl who had two years of vague abdominal pain and was referred to our hospital with severe abdominal pain. In the CT scan, three large cysts were observed in the spleen; another surgical consultation was done and recommendation for splenectomy was made. The patient became hydrated and treated with ceftriaxone and metronidazole.

Keywords: Children, Splenic cyst, Pain, Case report.

(Please cite as: Tajik P, Goudarzian AH, Pourzahabi Z. A 14-year girl with abdominal pain: case report of splenic cyst. Gastroenterol Hepatol Bed Bench 2019;12(3):260-262).

Pancreatitis and pseudo-pancreatic cysts are frequently encountered entities; however, intrahepatic pseudocysts presenting as large number of liver cysts with absence of overt signs of pancreatitis has never been reported in literature. Here, we report an interesting case of multiple intrahepatic pancreatic pseudocysts (MIHPPs), a challenging diagnosis to be kept in mind while dealing with complex cystic lesions of liver. Pseudocysts are common complication of pancreatitis, often these are located within the vicinity of the pancreas in the lesser sac and the retroperitoneum. Extra pancreatic location of these cysts within the liver is a diagnosis often missed, with only 50 odd cases reported in literature till date. Most of these reported cases are either subcapsular in location or limited in number to one or two lesions. Although rare, possibility of MIHPPs is an important diagnosis that should be kept in mind while considering list of differentials for complex cystic lesions of the liver even in the absence of overt signs of pancreatitis.

Keywords: pancreatitis, pseudocysts, hepatic cyst, intrahepatic pseudocysts, multidetector computed tomography.

(Please cite as: Tomar S, Ghasi RG, Agarwal J. Multiple intrahepatic pancreatic pseudocyst (MIHPPs): an overlooked and misdiagnosed entity. Gastroenterol Hepatol Bed Bench 2019;12(3):263-266).