Hepatitis B virus YMDD-motif mutations with emergence of lamivudine-resistant mutants: a threat to recovery

Muhammad Idrees, Zunaira Awan, Shazia Rafique, Irshad-ur Rehman, Haji Akbar, Sadia Butt, Sobia Manzoor, Liaqat Ali Khan, Saira Munir, Samia Afzal, Zareen Fatima, Bisma Rauff, Mahrukh Naudhani, Mohammad Ali, Sana saleem, Sadaf Badar

Gastroenterology and Hepatology from Bed to Bench, Vol. 3 No. 3 (2010), 20 June 2010,

Hepatitis B virus (HBV) is a crucial public health problem with approximately 350 million affected people and a death rate of 0.5 to 1.2 million per year worldwide. It proceeds to end-stage liver diseases including cirrhosis with hepatic decompensation and hepatocellular carcinoma (HCC). Pakistan lies in the endemic region with 3% HBV carrier rate in the country. The differences in disease outcome and antiviral treatment response among HBV infected patients are variable in different regions of the world due to marked differences in HBV genotypes. These variants are different in their serological reactivity patterns, virus replication, liver disease severity and antiviral treatment responsiveness. The highly mutating nature of HBV is the major cause of its ever increasing antiviral resistance. Importantly the tyrosine-methionine-aspartate-aspartate (YMDD)-motif mutants emerge during prolonged lamivudine treatments that elicit immune clearance. This review deals with the HBV nature, mutation appearance and particularly emphasizes on lamivudine induced mutations in a conserved region (YMDD motif) which is further worsening the antiviral therapies with passage of time.

16-bp insertion polymorphism of p53 gene in gastritis lesion

Rouhallah Najjar Sadeghi, Pedram Azimzadeh, Mohsen Vahedi, Mahsa Molaei, Seyed Reza Mohebbi, Homayon Zojaji, Seyed Reza Fatemi, Mohammad Reza Zali

Gastroenterology and Hepatology from Bed to Bench, Vol. 3 No. 3 (2010), 20 June 2010,

Aim: The purpose of this study was to assess the incidence of 16bp insertion of intron 3 p53 in gastritis lesion and its correlation with clinicopathological aspects.

Background: p53 alterations have been implicated in the development of gastric malignancies.

Patients and methods: 97 gastritis and normal adjacent tissues were investigated for p53 gene analysis using PCR-sequencing of intron3 and immunohisthochemistry technique.

Results: All of samples express p53 protein. In addition 64.9% of patients had no insertion and 7.2% had homozygous insertion while the others were heterozygous. This alteration has no association with clinicopathological findings.

Conclusion: Most of our patients had no insertion but an insertion frequency obtained here was found to be higher than those reports in a previous work on colorectal and esophageal cancer. It is possible that the polymorphism has correlation with gastritis and maybe with gastric cancer development. If so, this alteration associates with as yet unknown molecular and /or clinical factors which are involved in the (dys) regulation of p53 expression and function, and exerts its effects during gastritis development through them.

Current situation of Cryptosporidium and other enteroparasites among patients with gastroenteritis from western cities of Mazandaran province, Iran, during 2007-2008

Hossein Nahrevanian, Seyedeh Atena Azarinoosh, Behzad Esfandiari, Seyed Peyman Ziapoor, Mohammad Shadifar, Galia Amirbozorgy, Effat Hayati, Javad Davoodi

Gastroenterology and Hepatology from Bed to Bench, Vol. 3 No. 3 (2010), 20 June 2010,

Aim: The aim of this study was to evaluate the prevalence rate of Cryptosporidium and other enteropathogen parasites among patients with gastroenteritis in western cities of Mazandaran province, northern Iran, during one year.

Background: As specific characterization, high humidity, ecological conditions, superficial water sources, municipal water supplies, domestic and industrial animal husbandry and the rate of raining made Mazandaran as a favorable province for transmission of parasitic diseases.

Patients and methods: This investigation was conducted between June 2007 to June 2008 in western cities of Mazandaran province, Northern Iran. Overall, 420 stool samples of gastroenteritis patients were collected from Chalous (194 sample), Tonekabon (187 sample) and Ramsar (39 sample), fixed and examined by Direct Method (DM) for diagnosis of enteropathogen parasites, Acid-Fast Staining (AFS) and Auramin Phenol Fluorescence (APF) for detection of Cryptosporidium and other sporozoan protozoa.

Results: The results confirmed the overall prevalence rate of parasitic infections to be 2.14% (9 patients) among those cities, and the highest rate of infection was observed to be among Giardia lamblia (1.19%, 5 patients), Blastocystis hominis (0.71%, 3 patients) and Entamoeba coli (0.24%, 1 patient) respectively. There was no Cryptospordium and other sporozoan infection among the test samples. Comparative prevalence rates of parasitic infections in Chalous, Tonekabon and Ramsar were 1.55% (3 patients), 2.14% (4 patients) and 2.56% (1 patient) respectively. The relative frequencies of parasitic infections among infected individuals were associated with seasons, therefore the highest and the lowest rates were observed in autumn (40%) and spring (10%), respectively.

Conclusion: Although, the current results showed a decline in the rate of parasitic infections in Mazandaran province recently in comparison with the past previous studies, the situation is always under caution for emerging and re-emerging enteropathogen parasites with the emphasize on opportunistic parasites.

The role of hiatal hernia in patients with endoscopic erosive esophagitis

Yousef Bafandehtiz, Jafar Shadi

Gastroenterology and Hepatology from Bed to Bench, Vol. 3 No. 3 (2010), 20 June 2010,

Aim: This study aimed at determining the prevalence of hiatal hernia (HH) in patients with endoscopic erosive esophagitis (EE).

Background: Gastro-esophageal reflux disease (GERD) is one of the most common problems all over the world. This may lead to erosive esophagitis. Previous studies have demonstrated that HH has an important role in the pathogenesis of reflux disease. The rising prevalence of GERD among Iranians necessitates more comprehensive studies about the underlying etiologies. This study aimed at determining the prevalence of HH in patients with endoscopic erosive esophagitis (EE).

Patients and methods: In a case-control setting, 454 patients with gastrointestinal problems referred to the endoscopy unit of Tabriz Imam Hospital were evaluated during a 24-month period. Two hundred and twenty seven patients determined to have EE and 227 patient with non-ulcer dyspepsia (NUD) enrolled as the control group. The presence of HH was assessed during the endoscopic procedure. The possible risk factors for EE also elucidated.

Results: HH was confirmed in 94.3% of the case group comparing with the rate of 30% in the controls (OR=38.49, 95%CI: 20.55-72.11; p<0.001). The male patients were significantly dominant in the case group (130 patients vs. 92 patients; p<0.001). The presence of HH was an independent risk factor for the EE. The age of patients with EE and concurrent HH was significantly lower than that in the patients without it (42.13 years vs. 55.08 years; p=0.001). There was no significant relation between the presence of HH and the gender of patients with EE.

Conclusion: This study showed that HH is a common concomitant finding in patients suffering from heartburn due to EE. Thus considering this pathological entity is necessary, especially in younger patients.

The role of endoscopic ultrasonography in detection of gall bladder microlithiasis, sludge and stone in patients with biliary pain

Amir Houshang Mohammad Alizadeh, Farahnaz Fallahian, Mahsa Khodadoostan, Hamid Mohaghegh Shalmani, Mohammad Reza Zali

Gastroenterology and Hepatology from Bed to Bench, Vol. 3 No. 3 (2010), 20 June 2010,

Aim: To evaluate the role of  endoscopic ultrasonography (EUS) in the diagnosis of gallbladder microlithiasis, sludge, and stone  in patients with clinical suspicion of cholecystitis, but with normal transabdominal ultrasonography (TUS) during six months follow-up after laparosopic cholecystectomy (LCT).

Background: Endosonography has been shown to be highly sensitive in the detection of choledocholithiasis, especially in patients with small stones and nondilated bile ducts, and gallbladder microlithiasis.

Patients and methods: A prospective study was performed on patients with biliary pain and normal transabdominal ultrasonography, for presence of microlithiasis, sludge, and stone in gallbladder at Arad hospital, Tehran, Iran from January 2004 to January 2007. EUS examination was performed with a mechanical radial scanning UM-20 echo-endoscope (Olympus Optical, Tokyo, Japan). Patients in whom EUS demonstrated gallbladder sludge, microlithisis, and stone were offered laparoscopic cholecystectomy within one week.

Results: A total of 245 patients (176 female and 69 male) were included in this study from January 2005 to January 2007. 88 out of 245 (36%) patients had gallbladder abnormalities which were diagnosed by EUS including: 43 gallbladder microlithiasis (48.3%), 23 gallbladder sludge (26%), 22 gallbladder stone (24.7%). Surgery performed for all these cases. Episodes of biliary pain during six months after LC reported in eight cases with gallbladder stone, but in no cases of microlithiasis or sludge.

Conclusion: EUS seems to be a choice imaging method for detection of microlithiasis, sludge and stone of gallbladder in patients with biliary colic but normal transabdominal ultrasonography. In subjects with biliary pain and negative EUS, it is not reasonable to offer cholecystectomy.

Preoperative abdominal ultrasonography: validity and it's diagnostic errors in suspected appendicitis

Vahid Amini, Fereshteh Kamani

Gastroenterology and Hepatology from Bed to Bench, Vol. 3 No. 3 (2010), 20 June 2010,

Aim: The aim of this study is to evaluate the accuracy of preoperative abdominal ultrasonography in suspected appendicitis, and equivocal exam.

Background: Acute appendicitis is a common problem and occasional challenging diagnosis in emergency department of every general hospital.

Patients and methods: Within a period of one year from march 2007 through March 2008, all patient with suspected appendicitis and equivocal physical exam admitted in emergency department of Taleghani hospital undergone preoperative sonography and then results compared with intra operative finding and final pathologic report.

Results: Among totally 106 urgent appendectomies performed in this period of time, 65 (61.3%) of patients had highly suspicious physical finding and underwent appendectomy directly without delay. Of the remainder, 41 (38.7%) with equivocal exam, preoperative ultra sonography were performed and then underwent appendectomy and entered in this study. Of totally 41 patients, 25 (61%) were male and 16 (39%) were female. Preoperative ultra sonography were highly suggestive appendicitis in 15 (36.59%) of patients, that correlate with intra operative finding and final pathologic results of appendicitis in 14 (93.3%), eight (19.51%) patients with final operative finding of appendicitis had also preoperative sonography suggestive of appendicitis. Among 18 (43.9%) patients with preoperative ultra sonography of normal appendix or inability for visualization appendix, 14 (77.7%) had final pathologic diagnosis of appendicitis. Sensitivity, specificity, positive and negative predictive values of preoperative sonography were 73.3%, 75%, 95.6% and 27.3%, respectively.

Conclusion: Preoperative ultra sonography as a tool in evaluation of patients with equivocal physical findings, suspicious of appendicitis, has a moderate accuracy in this setting, considering ultra sonography as operator- dependent measure.

Case Report

Celiac disease (also known as gluten-sensitive enteropathy or nontropical disease) is a common autoimmune disorder that caused by sensitivity to dietary gluten and related proteins in genetically sensitive individuals. The disorder may be diagnosed atany age and that affects many organ systems. Celiac disease occurs in adults and children at rates approaching 0.5 to   1% of the population. We report a case of celiac disease (CD) in a young adult female patient with watery diarrhea, weight loss, ascites, arthropathy and evidence of vitamin K deficiency.