Systematic Review and Meta-Analysis

Survival of Gastric Cancer Patients in Iran: A Systematic Review and Meta-Analysis

Fargol Farahmandi, Mohammad-Mahdi Salarabedi, Parynaz Parhizgar, Swetha Variyath, Nabeel Al-Yateem, Syed Azizur Rahman, Amina Al-Marzouqi, Saeed Hashemi Nazari, Alireza Mosavi Jarrahi

Gastroenterology and Hepatology from Bed to Bench, ,

Objective: Gastric cancer is one of the most common cancers in Iran with high mortality. The aim of this study was to estimate the survival rates among Iranian gastric cancer patients and to evaluate if the survival has improved during last three decades.

Materials and Methods: A PRISMA-based systematic review of all published studies addressing gastric cancer survival in Iran was performed. International databases of Scopus, Web of Science, PubMed, and Iranian databases were included in the study. The study included databases from their inception till February 2022. Due to the inherent heterogeneity, we use a random effect model to pool the survivals in three categories of one, three, and five-year survivals.

Results: Thirty-three studies with total cases of 17,207 were included into the study.  The overall (pooled) one, three, and five-year survivals were estimated as 58.9% (95% CI: 0.52, 0.66), 29.9% (95% CI: 0.25, 0.35), and 18.2% (95% CI: 0.15, 0.23), respectively. Results of subgroup analysis for the calendar years of study showed that the one, three and five-year survival rates increased during the last three decades but the results were not statistically significant.  There was disparity in survival based on geographic distribution.

Conclusion: The results of our study clearly showed improvement in survival in last three decades indicating better access to treatment in recent years.

Review Article

PSC is a chronic cholestatic liver disease which is associated with IBD in 70% of cases. It seems PSC/IBD is a distinct phenotype that is different from PSC and IBD alone. Herein, we review the epidemiology, pathogenesis, natural course and management of PSC/IBD before and after LT for PSC. Extensive colitis, rectal sparing, backwash ileitis and mild symptoms   are characteristics of IBD coexisting with PSC. Moreover, PSC patients with concurrent IBD have higher risk of cholangiocarcinoma and colorectal neoplasia predominantly in right colon and at younger age. Hence, lifelong surveillance of these patients is crucial. Interestingly, the course of IBD (ulcerative colitis) following LT for PSC is very variable and a portion of patients may experience colitis worsening after LT despite immunosuppressive regimens. As well, management of these patients has been discussed in this review.

The possible role of viral infections in pancreatitis: A narrative review

Behrang Sarshari, Raziyeh Zareh-Khoshchehreh, Mohsen Keshavarz, Seyed Ali Dehghan Manshadi, SeyedAhmad SeyedAlinaghi, Hamid Asadzadeh Aghdaei, Seyed Reza Mohebbi

Gastroenterology and Hepatology from Bed to Bench, ,

Acute pancreatitis, a potentially fatal disease, with symptoms including nausea and/or vomiting, indigestion, abdominal pain, is known range from a mild self-limiting form up to a more severe and lethal form. Today, various causative agents are recognized in the development of acute pancreatitis as one of the most frequent gastrointestinal diseases, such as gallstones, alcoholism, and hypertriglyceridemia. Microbial pathogens with about 10% of the acute pancreatitis cases, mainly viruses, are among the other factors that thought to play a role in this regard. After the pancreatitis diagnosis has been made, depending on the causative agent, management approach and requiring specific intervention affect the final outcome. The purpose of this review is to provide a clearer picture to help us for better understand the role of viral agents in the development of acute pancreatitis, which will lead to timely diagnosis, treatment and better management of acute pancreatitis.

Original Article

The effects of acupressure on intestinal function in patients with coronary artery bypass graft surgery

Fatemeh Khan-Mohammadi, Hedayat Jafari, Masoumeh Bagheri-Nesami, Mahmood Moosazadeh, Mahsa Kamali, Nadali Esmaeili-Ahangarkelai, Kamran Qods

Gastroenterology and Hepatology from Bed to Bench, ,

Aim: The present study aimed to determine the effects of acupressure on intestinal function of patients undergoing Coronary Artery Bypass Graft (CABG) surgery.

Background: The constipation leads to complications such as bradycardia in heart. Studies indicated that cardiovascular patients are prone to constipation. Acupressure is one of the therapeutic and palliative approaches that can be used by doctors, nurses and even patients themselves.

Material and methods: The present three-groups randomized clinical trial study was conducted on 90 patients (30 patients in each group) undergoing CABG surgery. In the intervention group, the patients received acupressure points LI4 and ST25 from 48 hours after surgery twice a day (10 am and 6 pm) for three sequential days. In the sham group, the patients received acupressure at 1.5 cm distance from the LI4-ST25 points and the patients in the control group received only the usual care. In this research, demographic and medical information questionnaire, Rome IV scale, Bristol stool scale, symptom registration checklist and daily excretion assessment checklist (intestinal function) were used. The intestinal function indices were completed 24 hours after surgery (before intervention), 48, 72, 96 and 120 hours after surgery. Data analysis was done using SPSS.V24 software.

Results: All of the three intervention, sham and control groups were without defecation in 24 hours (before intervention) and 48 hours after surgery. There was a significant difference between the three intervention, sham and control groups in the number of stools after 72 hours, 96 hours and 120 hours after the intervention (p<0.001). Also, a significant difference was observed among the three groups in terms of the stool consistency 96 hours after the start of the intervention (p=0.032) and 120 hours after the start of the intervention (p<0.001).

Conclusion: The results of the present study showed that patients had a significant improvement in terms of the number of bowel movements and stool consistency in the intervention group. In acute conditions, when patients are hospitalized in the intensive care unit, who have complete bed rest, the use of acupressure on LI4-ST25 points can induce positive effects on intestinal function.

Aims: The current study purposed to evaluate the autologous platelet-rich plasma (PRP) and platelet-rich fibrin glue (PRFG) effect on the treatment of complex and recalcitrant anal fistula (AF) which had not been cured by several surgeries.

Background: AF has remained one of the difficult challenges for centuries. Surgery is the common treatment method for it, but the risk of fecal incontinence and recurrence is still a distressing complication for both patients and surgeons. The scientific literature reported new techniques that each one has its pros and cons. It was reported that the autologous platelets-rich fibrin glue is a promising treatment modality.

Methods: Autologous PRP and PRFG were prepared from 10 patients’ own blood. The surgeon curetted the tract of the anal fistula for the deepithelialisation till hemorrhage occurred; PRP was injected around the fistula into the tissue and PRFG was interpositioned in the tract. The data including age, number of past surgeries, complications, number of PRP and PRFG applications, and the time of stopping the leakage were collected. Patients were followed up between 10 months to 84 months after treatment.

Results: No complications were observed during and after the injection. During the period of follow-up, AF leakage was stopped for 6 patients but not for 4 patients.

Conclusion: Since autologous PRP injection and PRFG interposition is a safe, effective, and minimally invasive procedure for resistant AF to surgeries; it can be used along with surgery to increase the healing rate of complex anal fistula.

Long non-coding RNAs as potential biomarkers for diagnosis of gastric cancer and virtual screening on the web for drug repurposing

Nahid Askari, Behnaz Salek Esfahani, Sepideh Parvizpour, Sara Shafieipour, Morteza Hadizadeh

Gastroenterology and Hepatology from Bed to Bench, ,

Aim: The goal of this study was to find lncRNAs and mRNAs that were expressed differently by combining microarray datasets from different studies. This was done to find the important target genes for anti-cancer therapy. 

 Background: Gastric cancer (GC) is the fourth most frequent and second-most deadly malignancy worldwide. Thus, genetic diagnosis and treatment should focus on genetic and epigenetic variables. According to several studies, disordered non-coding RNAs (ncRNAs), such as lncRNA expression, regulate gastric cancer invasion and metastasis. Several studies suggest that lncRNAs cooperatively regulate gene expression and GC progression.

Methods: We obtained differentially expressed mRNAs (DEmRNAs) and lncRNAs (DElncRNAs) from three GC tissue microarray datasets by meta-analysis and screened the genes using the "Limma" package. Then by RNAInter database, we assigned DEmRNAs for each DElncRNA. Function enrichment pathway and gene ontology analysis was performed by clusterProfiler and GOplot packages for final DEmRNAs.

Results: A total of 9 DElncRNAs (5 up-regulated and 4 down-regulated) and 856 DEmRNAs (451 up-regulated and 405 down-regulated) between tumor and normal samples were found. Finally, 117 differentially expressed mRNAs were predicted as interactors for six DElncRNAs (H19, WT1-AS, EMX2OS, HOTAIR, ZEB1-AS1, and LINC00261).

Conclusion: Our study illustrated the suitable potential biomarker for the prognosis of patients with gastric cancer and predicted the drug-gene interaction network for detected genes to enable advances in cancer therapeutic development and provide information on the mechanism of carcinogenesis.

Aim: The aim of this study to examine environmental factors associated in Iranian patients with IBD.

Background: The role of environmental factors in development of inflammatory bowel disease (IBD) remains uncertain.

Materials and Methods:  In this case-control study, patients with IBD referred to the Taleghani Hospital, Tehran, Iran, were recruited between 2017 and 2019. Controls were matched by sex. Data were collected using the designed questionnaire. Conditional logistic regression models were used to estimate adjusted odds ratios (ORs).

Results: On the univariate analysis, predictive variables for IBD included age under 50 years, married status, sleep disturbances, vitamin D deficiency, stress, dietary fiber deficiency, post-menopausal hormone therapy, oral contraceptive and antibiotics (P< 0.005). In multivariate analysis, the risk of IBD was significantly increased with under 50 years (OR: 6.699, 95%CI: 3.271-8.662, P=0.017), abnormal sleep status (OR: 6.383, 95%CI: 3.389-7.19, P=0.001), and using oral contraceptive (OR: 7.426, 95%CI: 5.327-9.865, P=0.001). However, the risk of IBD was significantly decreased with older age (OR: 0.795, 95%CI: 0.697-0.907, P=0.001) and married status (OR: 0.008, 95%CI: 0.001-0.438, P=0.018).

Conclusion: Data suggest that environmental factors play a significant role in the etiology of IBD and probably on the disease course. While the evidence for some factors is strong, many factors require further supportive data.

Network Analysis of Liver Cancer: A System Biology Approach

Babak Arjmand , Somayeh Jahani Sherafat, Mostafa Rezaei –Tavirani, Maryam Hamzeloo Moghadam, Mohammad Amin Abbasi

Gastroenterology and Hepatology from Bed to Bench, ,

Background: Liver cancer as a common health problem is characterized by difficulties in early diagnosis and rapid progression. Due to lack of targeted drugs and the other features of disease the survival rate for patients is extremely low

Aim: Determining critical dysregulated proteins in liver cancer is the main aim of this study.

Methods: The related dysregulated proteins for liver cancer were retrieved from STRING database. The queried proteins were included in a network by cytoscape software and the central nodes of the network were enriched via gene ontology.  

Results: Among 11 introduced central nodes (GAPDH, TP53, EGFR, MYC, INS, ALB, IL6, AKT1, VEGFA, CDH1, and HRAS), HRAS and AKT1 were highlighted as critical dysregulated proteins which can be considered as possible biomarkers.

Conclusion: Analysis revealed that AKT1 and HRAS and the related biochemical pathways (specially “HIF-1 signaling pathway”) are the possible diagnostic and therapeutic agents of liver cancer. 

Psychometric Properties of Iranian version of Irritable Bowel Syndrome- Behavioral Responses Questionnaire (IBS-BRQ)

Amrollah Ebrahimi, mohammad forghani, Masoodeh Bababkhanian, Peyman adibi Sedeh

Gastroenterology and Hepatology from Bed to Bench, ,


Introduction: In addition to somatic symptoms and complaints, patients with irritable bowel syndrome have specific dysfunctional behaviors that lead to disease persistence and avoid useful function. The aim of this study was determine Psychometric Properties of Iranian version of Irritable Bowel Syndrome- Behavioral Responses Questionnaire (IBS-BRQ).

Method: Participants included 170 patients with irritable bowel syndrome who were diagnosed based on ROM-IV criteria  and selected from patients referred to the Gastrointestinal Disorders Clinic, as well as 100 persons from the general population in Isfahan in2020 . Both groups completed  the 28-item Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). Also Questionnaires including The Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), Irritable bowel syndrome-quality of life IBS-QOL, illness perception questionnaire (IPQ-R),Irritable Bowel Syndrome-Patient satisfaction (IBS-SAT), Hope scale, Interpersonal forgiveness scale, and Dysfunctional Attitude Scale- 26-item (DAS-26) were completed  to determine the validity of IBS-BRQ. Tests  of Internal consistency, principal components analyses(PCAs), differentiation analysis and correlation were used to determine its reliability,  criterion and construct validity.


Findings: The IBS-BRQ was found to be valid and  reliable in both group with a high degree of internal consistency. In  IBS patients (Cronbach's α=.94) and controls (Cronbach's α=.87). The scale differentiated significantly between IBS patients and controls (p<.001). The PCA supported a two-factor solution in IBS patients and one-factor in  general papulatin sets of data. The criterion validity was high as evidenced by a high correlation with DAS-26 (r=0.53, Pb.001), IBS-QOL  (r=0.76, Pb.001),IBS-SSS(r=0.44, Pb.001), IPQ-R(r=0.56, Pb.001), and revesed corrolation with IPF(r=-.031, Pb.001), IBS-SAT(r=-0.23, Pb.001),HOPE(r=-0.49, Pb.001)

Conclusion: The Persian version of the IBS-BRQ offered a well-defined behavioral response measure in IBS patients with high validity and reliability, making it a suitable measure to employ in future IBS clinical research in Iran.

Case Report

Gastric Cavernous Hemangioma in 48-Years Male Patient : An Unusual Case Presenting Upper Gastrointestinal Bleeding Manifestations

Coana Sukmagautama, Aiman Hilmi Asaduddin, Ulya A'malia, Desy Puspa Putri

Gastroenterology and Hepatology from Bed to Bench, ,

Background: Gastric hemangioma (GH) is a rare benign tumor that may cause to upper gastrointestinal bleeding. Further, this condition could lead life-threatening conditions thus should be recognized sooner in order to minimize unnecessary invasive surgical intervention and accident.

Case: We reported a 48 years old man which came to the emergency room (ER) with the chief complaint of hematemesis and black stool accompanied by abdominal pain, cold sweat, body weakness and enlarger stomach. Physical examination showed slightly icteric eye and conjunctival pallor. There was epigastric and right upper quadrant tenderness at the palpation and occult blood of feces was positive. Laboratory test resulted slight microcytic hypochromic anemia, absolute neutrophilia, hypoalbuminemia, and elevation of urea and creatinine. Further, the esophagogastroduodenoscopy was performed and showed broad mass with dilated blood vessels. The histopathological examination result revealed gastric mass with the histological erythrocyte extravasation. The diagnosis was hematemesis melena owing to cavernous GH with differential diagnosis of hematoma and other gastric mass, with anemia gravis. For the treatment, patient received fluid resuscitation, omeprazole, tranexamic acid, somatostatin, and antibiotics. He also received two kolfs transfusion of packed red cell.

Discussion : Gastric hemangiomas are benign vascular tumors that can lead to severe gastrointestinal bleeding. These benign tumors are lesions that develop as a result of endothelial cell proliferation and concomitant pericytic hyperplasia, which leads to a collection of dilated vessels. The cavernous subtype of GH often consists of larger diameter blood arteries with accompanying wider blood-filled spaces. The cavernous GH are more prone to rupture, which resulting in significant bleeding. Endoscopic assessment is importance in patients with upper GI bleeding, and GH appear as well-circumscribed vascular submucosal mass. Although this disease is benign with a lower recurrence, we suggest for further surgical treatment and the requirement for long-term follow-up to assess the outcome.

A novel stop codon mutation in STK11gene is associated with Peutz-Jeghers Syndrome and elevated cancer risk: Case study

Binazir Khanabadi, Diba Najafgholizadeh Seyfi, Leili Rejali, Mohammad Yaghoob taleghani, Shabnam Shahrokh, Mehdi Tavallaei, Elahe Daskar Abkenar, Fatemeh Naderi Noukabadi, Hamid Asadzadeh Aghdaei, Ehsan Nazemalhosseini mojarad

Gastroenterology and Hepatology from Bed to Bench, ,

Based on the analysis of patients with Peutz-Jeghers syndrome(PJS), STK11 is known as a tumor suppressor gene, which is involved in cell polarization, regulation of apoptosis and DNA damage response.

 In this case report study, we examined STK11 gene sequencing in a 42-year-old woman with mucocuta neous pigmentation and positive family history.

Endoscopy and colonoscopy showed >1000 polyps throughout the stomach/colon (PJ-type hamartomas); the larger polyp in stomach was resected and the small bowel imaging detected multiple jejunum/ileum  small polyps.

The released data from the sequencing results showed five alteration in exons 1 to 5. The major mutation in stop codon is reported as converted to the amino acid Tryptophan(TRP) to Tyrosine (TER); The TGG codon is converted to TAG by mutation. Finally, another novel mutation in STK11 stop codon as a‘de novo’ variant is seen.

It is predicted that stop codon mutations make the affected person susceptible to developing colorectal cancer.

Medical Education

A step-by-step guide to approaching colon polyps

Amir Sadeghi, Naghmeh Salarieh, Pardis Ketabi Moghadam

Gastroenterology and Hepatology from Bed to Bench, ,

Colorectal cancer (CRC) is introduced to be one of the most prevalent cancers among Iranian men and women.(1)  Colorectal polyps as known precursors of CRCs are of great importance. Surveillance, locating and removal of colorectal polyps make them the most modifiable factor outside of other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation.(2)  In keeping with this significance, the present study is intended to have a brief review on classification, probability of endoscopic resection, complications of endoscopic polypectomy as well as proper surveillance after polypectomy.

Photo Quiz

An unusual cause of failure to thrive

Saeed Abdi, Naghmeh Salarieh , Pardis Ketabi Moghadam

Gastroenterology and Hepatology from Bed to Bench, ,

The presented case id a 16-year-old boy admitted to the gastrointestinal clinic with complaint of dysphagia, fatigue and delayed growth. He has been complaining about dysphagia to liquids and solids simultaneously from approximately 10 years ago being progressively deteriorated during the last year.