ISSN: 2008-2258

Review Article

Cholestasis and Behavioral Disorders

Delaram Eslimi Esfahani, Mohammad Reza Zarrindast

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021



Background: Memory and learning processes occur in different areas of the brain, especially the hippocampus and amygdala. Considering the expanded use of nanoparticles in recent years, it is important to understand the biological interactions of these materials. Alumina Nanoparticles are used in the provision of some vaccines, drug delivery, water purification and welding industry. Consequently, the potential effects of this substance on the cells and biochemical molecules should be investigated. Materials and Methods: Wistar male rats were divided into three groups; The control group, the sham group (received deionized water) and the test group (received Alumina Nanoparticles in the CA1 region at the dose of 0.37 mg / kg. The shuttle box was used to test the memory. Then the hippocampus of the rats was removed and used for histological examination with the method Haematoxylin & Eosin and tunel tests. Results: The results of the behavioral test showed a significant increase in latency of the experimental group in the dark room compared to the other two groups. Histological examination indicated a reduction in neuronal density, tissue necrosis (hematoxylin-eosin test) and apoptosis (tunel test) in CA1 region in the test group. Conclusion: The results show that Alumina Nanoparticles can be effective in neuronal degeneration and decrease memory and learning ability.

Original Article

Association of MALAT1 expression in gastric carcinoma and its clinicopathological features significances in an Iranian patient

Vahid Chaleshi, Hamid Asadzadeh Aghdaei, Mahyar Nourian, Shahrokh Iravani, Hasan Jalaeikhoo; Mohsen Rajaeinejad; Ali Reza Khoshdel, Hamed Naghoosi

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021


The aim of this study was to evaluate the expression of MALAT1 and the relationship between their expressions with clinical characteristics in an Iranian gastric cancer patient.


Long non-coding RNAs (LncRNAs) play critical roles in the initiation and development of gastric cancer. Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) is a highly conserved lncRNA and plays important roles in various types of human cancer. However, our understanding about the role of lncRNAs in the occurrence and development of gastric cancer are not fully clear.

Materials and Methods

This cross-sectional study was performed on 41 gastric tumor tissue samples with matched normal adjacent tumor tissues. The RNA level of lncRNA MALAT1 gene were assessed using the quantitative Real-time polymerase chain reaction. B2M was used as an internal control. The 2 -ΔΔCq method was used to determine the expression fold changes.


A significant association was observed between the levels of MALAT1, gene in gastric tumor tissues comparing normal adjacent tissues (Mean = 1.558, p= 0.014). In addition, clinicopathologic data comparing with MALAT1 RNA expression levels in gastric cancer tissues was evaluated. However, no significant association were observed between the relative expression of MALAT1 and the stage, grad, H. pylori infection and tumor size groups among gastric cancer patients (P= 0.82, p= 0.904, p=0.407 and p= 0.701, respectively).


Our results showed that MALAT1 have a significant association in gastric cancer. The expression of MALAT1 may be used as a diagnostic biomarker for monitoring gastric cancer patients.

Keywords: Gastric Cancer, MALAT1, LncRNA, Clinicopathological Feature


Short-term and long-term survival of patients with gastric cancer

Ali Karamoozian, Mohammad Reza Baneshi, Abbas Bahrampour

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Background: Bayesian mixture cure rate model is commonly used to analyze dataset with long-term survival rates by controlling the frailty effect so that the heterogeneity between observations can be also controlled through this model. On the other hand, determining the risk factors and protective factors of gastric cancer is currently considered very important due to the fact that the disease has become one of the most dangerous types of mortal cancers. Therefore, it is possible to determine the effective risk factors of short-term and long-term survival in patients through utilizing from this model.

Methods: Present study was conducted on 339 patients with gastric cancer whose data have been recorded in hospitals of Kerman province of Iran during 2001-2015. In the study, Bayesian mixture cure rate model was used to determine the effective factors of short-term and long-term survivals in patients. The frailty effect was also taken into account in the model to control heterogeneity between patients.

Results: In present study, the event of interest was occurred for 57.5% of patients. Over time, the survival rate of cancer patients was reached to its lowest approximately 0.3 at the end of study. According to the results of present study, variables of chemotherapy, morphology and metastasis were identified as effective factors of short-term and long-term survivals of patients.

Conclusion: The effective factors of long-term survivor can be identified in addition identifying the effective factor of their short-term survival by utilizing from Bayesian mixture cure rate model with taking into account the frailty effect, while this matter is impossible through conventional models of survival analysis. On the other hand, the chemotherapy, morphology and metastasis are the most important effective factors of short-term and long-term survival in patients with gastric cancer.

Gene expression data analysis leads to better characterization of pathways which are involved in colorectal

Samira Shabani, Nasibeh Khayer, Jamshid Motalebzadeh, Tayebeh Majidi zadeh, Frouzandeh Mahjoubi

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

The fourth common malignancy in the world is colorectal cancer and the over-all burden is estimated to rise by 2030 and efforts are needed to improve alternative treatments to surgical resection.In this research bioinformatics analysis was applied based on previously transcriptomic data in order to better characterization of pathways and gene sets which are involved in colorectal cancer. Then by using two statically methods (gene regulatory network (GRN) and Gene set enrichment analysis (GSEA)).we found that the pair of genes: {IL2R, CYFIP2}, {FOXM1, PPARA}, {MCTP1, CTSC} and {PYROXD1, CYF1P2} are functionally related. In addition the pair of genes {IL2R, CYFIP2} and {FOXM1, PPARA} simultaneously were involved respectively in "vascular endothelial growth factor signaling pathway” and “ribonucleotide diphosphate metabolic process” .These two pathways are considered as important biological processes in Colorectal cancer. Therefore, this research shows that the combination of bioinformatics analysis and functional investigates provided the opportunity to discover the feasible pathways and gene sets related to tumorigenicity.

Aim: To understand the mutual interaction of gastric motility and autonomic functions, the present study was aimed to explore the effect of sympathetic activation by ‘cold pressor test’ (CPT) on gastric motility assessed by electrogastrography (EGG); and, evaluate the association of heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) with gastric motility during rest and during CPT.

Background: Autonomic nervous system has significant influence on gastrointestinal motility. HRV is commonly employed to assess the functions of autonomic nervous system. BPV and BRS are relatively newer technique and give more holistic picture of autonomic functions along with the short term regulation of blood pressure (BP).

Materials and Methods: In fourteen young, healthy subjects, gastric motility was assessed by EGG. Beat-to-beat BP and lead II ECG were recorded to assess HRV, BPV and BRS. BPV and BRS parameters were calculated for systolic, mean and diastolic BP. Parameters of HRV and BPV were calculated for time and frequency domains. BRS were calculated by sequence and spectral methods.

Results: Significant increase in diastolic BP (p = <0.0001) and EGG-frequency (p = 0.0229) were observed during CPT. Significant correlations were observed between EEG-frequencies and many of the HRV, BPV and BRS parameters. Correlation coefficient found to be highest between total power of HRV and EEG-frequencies during baseline (p = 0.0107, r = -0.6571) and during CPT (p = 0.0059, r = -0.6935).

Conclusion: EEG-frequency can be decreased by acute increase in sympathetic activity, induced by CPT. The novel findings are the significant correlations between many of the HRV, BPV and BRS parameters with EGG-frequency.

RNA Language in Colorectal Cancer Using an Integrative Bioinformatics Approach

Sepideh Kadkhoda, Farzaneh Darbeheshti, Nima Rezaei, Ghasem Azizi-Tabesh, Faezeh Zolfaghari, Sadollah Tavakolibazaz, Reza Taslimi, Javad Tavakkoly-Bazzaz

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Background: Identification of competing endogenous RNAs (ceRNAs), especially circRNAs, have become new hotspots in cancer researches. Although, their roles and underlying mechanisms in colorectal cancer (CRC) development remain mostly unknown. The aim of this study was to integrate both coding and non-coding available microarray data in development of CRC coupled with bioinformatics analyses to understand a more inclusive pathobiologic map regarding their molecular interactions and functions.

Methods: The microarray data were retrieved from the Gene Expression Omnibus (GEO) database and analyzed. Several bioinformatics tools and databases including CircInteractome, CSCD, miRTarbBase, TargetScan, miRmap, GEPIA, STRING, Enrichr, DAVID, and MCODE were applied for further elucidation. Principal component analysis (PCA) has seperatly run for four datasets. The dysregulated circRNA-miRNA-mRNA network in CRC was constructed by Cytoscape. In addition, co-expression and protein-protein interaction (PPI) networks were established based on differentially expressed (DE) protein coding genes in CRC.

Results: PCA discloses colorectal tumor and normal tissuses could be distinguished not only by mRNAs expression profile, but also by both circRNAs and miRNAs expression profiles. We identified 14 DE mRNAs (commonly between two datasets), 85 DE miRNAs and 36 DE circRNAs in CRC tissues compared with normal tissues. Taking their potential interactions into account, a circRNA-miRNA-mRNA network was constructed. Then, according to ceRNA hypothesis, the axes with expression in the desired direction were extracted. Our results disclosed some DE circRNAs with potential oncogenic (circ_0014879) or tumor suppressive (circ_0001666 and circ_0000977) effects. Finally, PPI network suggests pivotal roles for DOCK2 and PTPRC dysregulation in progression of CRC, possibly by facilitating of tumor escape from immune surveillance.

Conclusion: Current study proposes a novel regulatory network consisting of DE circRNAs, miRNAs and mRNAs in CRC development that in turn highlights the roles of DE circRNAs at the upstream of oncotranscriptomic cascade in CRC development, suggesting their potentiality to be utilized as both prognostic and therapeutic biomarker.

Tenofovir in the treatment of hepatitis B virus infection after liver transplantation, a single center large population study

Fardad Ejtehadi, Mohammad Reza Pashaei, Alireza Shamsaeefar, Nasrin Motazedian, Ramin Niknam, Seyed Ali Malekhosseini, Kamran B Lankarni

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Aim: Although the rate of recurrence of hepatitis B virus after liver transplantation is now very uncommon with both nucleosides and nucleotides analogues represented with lamivudine   and Tenofovir disoproxil fumarate respectively, there are few studies comparing the two classes.  As there are concerns with resistance with the former and with renal dysfunction in the latter, comparison of the two drugs in long term is of utmost importance in finding the best practice for HBV prophylaxis after LT.

Material and methods:

A total of 302 HBV-related post-transplant patients who received liver transplantation from deceased donors were enrolled in this retrospective study from 2011 to 2015 in Shiraz Organ Transplant Center, Iran. The demographic data, kidney function, recurrence, resistance rate, and acute rejections at 1, 6, 12 months’ interval and after 12 months were compared on TDF (n=209) and Lamivudine (n=93) groups.


During a median follow-up period of 42.9 months, the mean creatinine level was not significantly different between two groups. Hepatitis B virus recurrence rate as well as acute graft rejection episode had no statistical difference in both groups over study period.


Kidney function, creatinine level, disease recurrence and acute graft rejection were comparable between Tenofovir disoproxil fumarate and Lamivudine in patients who received follow up periods.

Risk factors, endoscopic findings and treatments in upper gastrointestinal bezoars: Multi-center experience

Gholamreza Hemmasi, Elena Zanganeh, Seyed Ashkan Hosseini, Mehdi Alimadadi, Anahita Ahmadi, Shahin Hajiebrahimi, Mohammadreza Seyyedmajidi

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Background and study aim: Bezoars are compact masses that formed by accumulation of high-fiber diet, undigested food, hair or medications. The majority of bezoars are asymptomatic but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction or perforation. We aimed to investigate the risk factors, endoscopic findings and treatments in upper gastrointestinal bezoars.

Patients and methods: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019.  Bezoars were detected in 109 of 15830 endoscopy records (0.68%).

Results: 103 patients (52.4% male) were enrolled in this study. The mean age of the patients was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2%), diabetes mellitus (21.3%), hypothyroidism (15.5%), trichophagia (5.8%) and anxiety disorders (2.9%), respectively. The most common endoscopic findings were peptic ulcers (34.9%), erosive gastritis/duodenitis (12.6%) and reflux esophagitis (10.6%). While bezoars were most commonly observed in the stomach (84.4%), the majority of them were phytobezoars (92.2%). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4%.

Conclusion: These findings indicated that bezoars are more common among patients with history of gastrointestinal surgery, diabetes mellitus or psychiatric disorders. They are closely related to peptic ulcer and reflux esophagitis and they can be successfully treated with endoscopic interventions.

Frequency of Toxin Genes and Antibiotic Resistance Pattern of Clostridioides difficile Isolates in Diarheal Samples among Hospitalized Patients in Hamadan, Iran

Leili Shokoohizadeh, Fatemeh Alvandi, Abbas Yadegar, Masoumeh Azimirad, Seyed Hamid Hashemi, Mohammad Yousef Alikhani

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Aims: This study was designed to investigate the prevalence of Clostridioides difficile, toxin-producing strains and antibiotic resistance patterns in diarrheal samples from hospitalized patients in Hamadan, West of Iran.

Background: Today, concerns on Clostridioides difficile infection have increased significantly due to improper use of antibiotics, as well as due to its toxins, spore form and antibiotic resistance, and has become a progressive health concern.

Material and Methods: In this case-sectional study, a total of 130 diarrhea samples of patients admitted to different wards of three hospitals in Hamadan from November 2018 to September 2019 were collected. After confirmation of Clostridioides difficile colonies by culturing on CCFA medium and PCR, the presence of toxin encoding genes (tcdA, tcdB), and Binary toxin genes (cdtA and cdtB) was detected by PCR. The antibiotic resistance of the isolates to metronidazole, vancomycin and clindamycin was determined using agar dilution method.

Results: Out of 130 diarrhea samples collected from hospitalized patients, 16 (12.3%) C. difficile was isolated. PCR results were positive for two toxin-producing genes; tcdA and tcdB, in all (100%) C. difficile isolates and binary toxins include cdtB and cdtA was detected in 8 (50%) and 6 (37.5%) isolates, respectively. The results of antibiotic susceptibility testing showed, resistance to metronidazole and clindamycin antibiotics in 3 (18.75%) and 2 (12.5%) isolates, respectively, and 3(18.75%) of isolates showed intermediated resistance to vancomycin.

Conclusion: The results of this study showed toxigenic C. difficile with tcdA+/ tcdB+ profile is the cause of a number of nosocomial diarrheas in our area and clinical laboratories should routinely perform C. difficile diagnostic tests on diarrhea specimens of hospitalized patients. Resistance to metronidazole and clindamycin should be considering as a warning to prevent the irrational administration of these antibiotics and thus prevent the spreading of C. difficile in hospitalized patients.

Case Report

Congenital intestinal volvulus with episodes of pain for long period of time: Case report

Hamid Talebzadeh, Shahrzad Andalib, Mohammad Masoud Andalib

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

The prevalence of Intestinal volvulus as a cause of abdominal pain is rare in adults and normally presents during infancy. Approximately 90% of patients with volvulus are diagnosed within the first year of life, 80% of whom are diagnosed within the first month of life.

The case was a 34-year-old pregnant woman whom was admitted to the hospital due to self-limited episodes of epigastric pain from young ages. The patient complained that the pains have worsened recently. Further clinical investigation lead us to invasive intervention due to signs of obstruction and the patient was transferred to operating room. The case represents the rare times of  intestinal volvulus  in adults and its complication through pregnancy.

Dysphagia – A Rare Presentation of Multiple Myeloma

Sami Ghazaleh, Anay Hindupur, Christian Nehme, Yasmin Khader, Marcel Ghanim, Taha Sheikh, Tarik Alhmoud

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Introduction: Dysphagia is a symptom with a broad differential diagnosis. Usually, the etiology of dysphagia is benign, but it is essential to rule out serious causes. It is also critical to think outside the box when the etiology is not obvious. We describe a case of multiple myeloma that initially presented with dysphagia.Case presentation: An 81-year-old male patient presented with dysphagia to solid food associated with anorexia and weight loss of 22 kg over the last 6 months. The patient looked chronically ill and cachectic. Upper endoscopy showed patchy erythema in the gastric antrum. Gastric biopsy was consistent with gastric amyloidosis. Although serum and urine protein electrophoresis did not show a monoclonal (M) band, immunofixation did show elevated free kappa light chains and elevated free Kappa/Lambda ratio. Bone marrow biopsy was consistent with multiple myeloma.Discussion: Although gastrointestinal involvement is common in amyloidosis, it is unusual for amyloidosis to initially present in the gastrointestinal tract. Identification and treatment of the underlying condition, e.g. multiple myeloma, can lead to regression of gastrointestinal amyloidosis.

Symptomatic giant gastric hyperplastic polyp: a case report

Nicholas Dalkie, Andrew Lane, Bruce Lockett, Kamran Rostami

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021


Here we describe a rare case of a 59-year-old male who was diagnosed with giant hyperplastic polyps, after he was referred in with the symptoms of abdominal pain and vomiting, and associated red-flag symptoms of unintentional weight loss and early satiety.

Primary follicular lymphoma of the duodenum: A case report and review of literatures

Cheep Charoenlap, Keerati Akarapatima, Komsai Suwanno, Attapon Rattanasupa, Arunchai Chang

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Follicular lymphoma (FL) is one of the most common types of non-Hodgkin lymphoma (NHL). The gastrointestinal tract is the most involved extra-nodal site of NHL. However, primary duodenal FL (DFL), is a rare entity, with only a few reported cases, mainly involve second part of the duodenum and have an excellent prognosis. We report the case of a 74-year-old man underwent esophagogastroduodenoscopy. Endoscopic finding revealed multiple small whitish mucosal nodules were detected around the major duodenal papilla. Biopsy of these lesions compatible with grade I FL. Further investigation failed to demonstrate any evidence of nodal or systemic involvement, thus, the clinical staging was stage I, according to the Lugano staging system. A “watch and wait” policy was chosen. Neither lesion aggregation nor lymphadenopathy was noted during the 5-year follow-up period. In conclusion, this was an uncommon case of DFL, which behave indolent nature and excellent prognosis. However, further studies are needed to clarify characteristics, prognosis, and therapeutic approach.

Letter to Editor

Photo Quiz

An unusual cause of intermittent obstruction of colon

Elena Zanganeh, Seyed Ashkan Hosseini, Mehdi Alimadadi, Mohammadreza Seyyedmajidi

Gastroenterology and Hepatology from Bed to Bench, , 8 March 2021

Here we report a case of a 61-year-old otherwise healthy man presented to our hospital complaining of intermittent colicky pain of left-sided abdomen, bloating and constipation lasting for last month.   He had no previous abdominal surgeries or significant problems in his past medical history. Physical examination revealed mild anemia and abdominal tenderness. The patient’s hemoglobin level was 11.8 g/dL and his carcinoembryonic antigen level (CEA) was normal; Erythrocyte sedimentation rate (ESR) was 28 mm/hr and C-reactive protein (CRP) was 0.7 mg/dL.

Contrast-enhanced abdominal computed tomography (CT) revealed the presence of a concentric mass in the descending colon with a density of approximately -100 Hounsfield units (Fig. 1,2). A colonoscopy was performed for a better assessment which revealed a giant submucosal mass on the descending colon that encompassed more than 75% of the bowel lumen (Fig. 3). Biopsy was performed and histopathologic examination of the specimens showed reactive changes without evidence of dysplasia or malignancy but definite diagnosis could not be made. The patient underwent a segmental colonic resection by laparotomy because of the mass size and the inability to rule out a malignancy. Pathological examination of the surgical specimen showed mature adipocytes in the submucosa with mucosal ulceration without signs of malignancy. Four days after surgery, the patient was asymptomatic and discharged.