Middle East Journal of Digestive Diseases最新文献

Esophageal squamous cell papilloma (ESP) is a benign tumor that is rarely found in the esophagus. Human papillomavirus (HPV) has been known to play a role in the development of ESP. In most cases, ESP is asymptomatic but may also manifest with dysphagia, heartburn, and epigastric pain. Although rare, ESP has the potential to become malignant; thus, early detection and removal of the tumor is essential. Here, we report a rare case of ESP in a 29-year-old woman.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that can affect various organs. This report describes a 65-year-old woman who presented with abdominal pain, weight loss, and elevated liver enzymes. After the diagnostic workup, a percutaneous biopsy of the liver lesions showed histological changes in EHE. What stands out in this case is that imaging studies revealed multiple cystic lesions with fluid-fluid levels, even though such manifestation is not typically seen in this disease. This case emphasizes the importance of considering EHE in the differential diagnosis of hepatic lesions, even in atypical presentations.

Background: According to the high prevalence of anal fistulas and the recurrence of the disease following surgery, different methods have been suggested for appropriate treatment of this disease; however, there is no consensus on the most effective method. This study aimed to compare the healing time, recurrence rate, fecal incontinence, and quality of life associated with endorectal advancement flap versus cutting Seton insertion for high-type anal fistulas.

Methods: In this retrospective cohort study, 81 patients with trans-sphincteric high-type perianal fistula, including 53 men and 28 women, were studied for 5 years (2019-2024). The Patients included in this study were divided into two categories. One of them underwent an endorectal advancement flap, and the other one underwent cutting Seton insertion. SPSS software was used for statistical analysis.

Results: 37 (45.7%) patients underwent endorectal advancement flap, and 44 (54.3%) patients had cutting Seton insertion. There was no significant difference in recurrence rate, incontinence, and quality of life between the two groups, while the healing time in the group that underwent endorectal advancement flap was significantly different and shorter in comparison with the patients who underwent cutting Seton insertion (30 versus 60 days, respectively, P=0.016).

Conclusion: Our study results showed a more significant reduction in the healing time with endorectal advancement flap surgery than the cutting Seton insertion procedure in patients who suffered from trans-sphincteric high-type anal fistula without any significant difference regarding the recurrence rate, incontinence, and quality of life.

Background: First-degree relatives (FDRs) of patients with colorectal cancer (CRC) possess a higher risk of developing CRC. Colonoscopy is among the most effective screening methods for preventing CRC. This study aimed to assess screening rates among FDRs of patients with CRC and determine obstacles to screening in this population.

Methods: This cross-sectional study was conducted in Isfahan, Iran. A total of 160 asymptomatic FDRs were identified and considered eligible for inclusion in the analysis.

Results: The mean age of FDRs was 50 years, and 65.6% were at high risk for CRC. Only 32.4% underwent screening according to guidelines, and all of them were classified as high-risk. Index patients (IPs) aged under 50 and receiving a recommendation for screening were identified as two main factors associated with guideline-based CRC screening. Among FDRs who did not undergo colonoscopy, 64.4% were unaware of the risk of CRC, and 56.3% lacked knowledge about the procedure.

Conclusion: Urgent implementation of effective interventions and improved education for both healthcare providers and patients on risk-based CRC screening for FDRs is crucial. Further descriptive investigations are needed to identify barriers to CRC screening in this population.

Background: Fatty liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD) have recently been recognized as a major global health issue, and there is much evidence linking MASLD with a range of extrahepatic comorbidities. The current study evaluated extrahepatic comorbidities in patients with MASLD and highlighted the necessity of a multidisciplinary approach to its management.

Methods: A cross-sectional study was conducted at a tertiary center in Tehran. Fatty liver was diagnosed via ultrasonography findings. Exclusion criteria included those with other liver diseases, such as chronic viral hepatitis. Participants underwent liver stiffness measurement using Fibroscan, and clinical data and liver function tests were collected, and questionnaires for DASS-21 and the Pittsburg Sleep Quality Index (PSQI) were completed. We conducted a chi-square test and ANOVA test to evaluate and explore the extrahepatic comorbidities and manifestations associated with fatty liver disease.

Results: Of the 385 study participants, 50.6% had severe steatosis, and 29.1% had severe fibrosis. Several comorbidities, such as hypertension (fibrosis: P=0.033, steatosis: P=0.011), diabetes (fibrosis: P=0.006, steatosis: P=0.002), and poor sleep quality (fibrosis: P=0.015), were significantly associated with the severity of non-alcoholic fatty liver disease (NAFLD). There were statistically significant differences in mean scores of depression and anxiety across different levels of fibrosis and steatosis (P<0.05).

Conclusion: MASLD is a multisystem disorder with widespread extrahepatic manifestations impacting many organs and systems. Patients with MASLD should be screened for comorbidities such as diabetes, cardiovascular disease, and mental health conditions to improve overall health outcomes and prevent disease advancement.

[This corrects the article DOI: 10.34172/mejdd.2022.289.].

Background: Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disease in which the patients may be asymptomatic or complain of heartburn and regurgitation or pulmonary symptoms. Aim of the study: Examine the serum level of soluble HLA-G (sHLA-G) in patients with GERD, which can be used as a biomarker for early detection of GERD.

Methods: The study was a case-control prospective study that enrolled 40 patients who consulted the Gastroenterology Unit-Al-Kindy Teaching Hospital and were diagnosed with GERD by their physician. They were compared with 40 control healthy individuals from January 2023 to May 2024. Serum samples were used for quantitative assessment of sHLA-G using a sandwich enzyme-linked immunosorbent assay.

Results: A higher proportion of females were observed in the GERD group compared with the control group (72.5% vs. 42.6%). This difference was statistically significant (P=0.006). A statistically non-significant difference was observed in sHLA-G levels between patients with GERD and healthy controls (P=0.158). The median sHLA-G level was non-significantly higher in patients with GERD (0.529 ng/mL) compared with the controls (0.523 ng/mL).

Conclusion: The present study provides early evidence for an association between elevated sHLA-G levels and GERD with limited diagnostic value. It revealed a significant negative correlation between sHLA-G levels and sex. Further studies are needed to elucidate the mechanisms underlying this relationship and explore the potential of sHLA-G as a diagnostic or therapeutic target for GERD.

Background: IThis study aimed to investigate the concordance of endoscopic ultrasonography (EUS) results and biochemical analysis of cyst fluid obtained through fine needle aspiration (FNA) in diagnosing mucinous pancreatic cysts.

Methods: In this retrospective study, the medical records of 81 patients with pancreatic cystic lesions were examined. EUS results and cyst fluid analysis (carcinoembryonic antigen [CEA] and amylase) concordance rate was evaluated, and the agreement between the two methods was assessed through Cohen's kappa coefficient.

Results: The concordance rate of EUS and cyst fluid analysis with CEA cutoff point>192 ng/mL was 52.5% and 69.2%, respectively, for mucinous cystic neoplasm (MCN) and Intraductal papillary mucinous neoplasm (IPMN) diagnosis. The sensitivity and specificity of cyst fluid analysis for MCN and IPMN (taking EUS as the reference) were 59.1% and 93.33%, respectively. The positive predictive value was equal to 97.5%, and its negative predictive value was 34.14. Using the CEA<5 ng/mL cutoff point for detecting serous cystic neoplasm (SCN) cysts was associated with the sensitivity, specificity, and positive and negative predictive values of 73.3%, 78.8%, 44%, and 92.8%, respectively. The concordance rate of EUS and pancreatic cyst fluid analysis was 65.43%, with a kappa correlation coefficient of 0.326.

Conclusion: The specificity and positive predictive value of CEA>192 for the diagnosis of mucinous pancreatic cysts is high, but it is associated with moderate sensitivity and a low negative predictive value. Altogether, there is a moderate agreement between the results of EUS and biochemical analysis of FNA cyst fluid in diagnosing mucinous pancreatic cysts.

[This corrects the article DOI: 10.34172/mejdd.2021.231.].