Middle East Journal of Digestive Diseases最新文献

Background: The present study aimed to evaluate the endoscopic findings of patients with dyspepsia in Ghaem Hospital, Mashhad, Iran.

Methods: This cross-sectional study collected endoscopic findings in patients with dyspepsia, including epigastric pain or heartburn, postprandial fullness, and early satiety from Ghaem Hospital from 2019 to 2020.

Results: Totally, 743 patients were studied, and 42.3% (n=314) were male. The mean age was 46 years. Among participants, 85.6% (n=636) were included in the functional dyspepsia group, and the rest were included in the organic dyspepsia group. In the organic dyspepsia group, the highest frequency was related to peptic ulcer disease, with 7.2% (n=53). Moreover, the most common complaint was epigastric pain and heartburn. No significant association was found between comorbidities (P=0.083), smoking, and sex (P=0.532) with the risk of organic dyspepsia.

Conclusion: Dyspepsia is not necessarily accompanied by other comorbidities. The most mentioned chief complaint was epigastric pain or heartburn. Functional dyspepsia was the most common diagnosis in patients with dyspepsia, and the peptic ulcer was the leading cause of organic dyspepsia. There was no difference in the underlying cause of dyspepsia in the sexes.

Background: The quality of bowel preparation is one of the key determinants of a successful colonoscopy. Bowel preparation regimens have evolved greatly over the past few decades, with attempts to improve the efficiency and tolerability; still an ideal agent or regimen continues to be oblivious. To compare the efficacy, safety, and tolerance of three bowel preparation regimens for colonoscopy: split dose of oral sulfate solution (OSS), split dose of polyethylene glycol (PEG), and same-day single dose PEG.

Methods: This study was a randomized, single-blind control design with three study groups. Group A received a split dose of OSS, group B received a split dose of PEG, and Group C received a single dose of PEG for bowel preparation. The quality of preparation was assessed using the Boston Bowel Preparation Scale (BBPS), and the adverse effects and tolerance were noted. The data were compared statistically for any significant difference between the regimens.

Results: Mean total BBPS scores were 8.08, 7.52, and 7.92 for groups A, B, and C, respectively (P=0.076). Segmental BBPS scores were statistically similar for the right and transverse colon but differed for the left colon (A: B: C=2.79: 2.54: 2.75; P<0.01). Gastrointestinal side effects and electrolyte disturbances were similar across the three groups. Split-dose preparations were associated with more significant sleep disturbances than single-dose PEG (P<0.001). Patients who received OSS reported more taste intolerance (P<0.01), while those who received single PEG reported more volume intolerance (P<0.001).

Conclusion: Split-dose OSS, split-dose PEG, and single-dose PEG regimens provide adequate and comparable bowel preparation for colonoscopy with good patient tolerance and no significant adverse effects. Overnight PEG and OSS preparations were associated with more substantial sleep disturbances. OSS is associated with more taste intolerance, while single PEG is associated with more volume intolerance.

Background: Gastroesophageal reflux disease (GERD) and bipolar disorder impose substantial global burdens on individuals and healthcare systems. Previous studies suggest a bidirectional association between GERD and bipolar disorder. By searching and reviewing the results of existing studies, this systematic review and meta-analysis aims to review the two-way relationship between GERD and bipolar disorder.

Methods: This study adhered to PRISMA Guidelines, including a comprehensive search of PubMed and Scopus for observational longitudinal studies. Quality (risk of bias) assessment employed the Newcastle-Ottawa Scale, and RevMan version 5.3 facilitated meta-analysis.

Results: Five longitudinal studies (161888 patients) revealed a significant bidirectional link between GERD and bipolar disorder. Patients with GERD had a 2.29-fold higher risk of bipolar disorder (OR=2.29 [1.64, 3.21]; P<0.001), while individuals with bipolar disorder had a 2.80-fold higher risk of GERD (OR=2.80 [1.36, 5.76]; P=0.005). This study also identified independent risk factors, including sex, age under 60 years, and alcohol consumption disorders, influencing the occurrence of bipolar disorder in patients with GERD, as well as there is an influence of the number of psychoactive drugs in the occurrence of GERD in patients with bipolar disorder.

Conclusion: These findings highlight a bidirectional relationship between GERD and bipolar disorder, emphasizing the necessity for integrated care models and personalized treatment plans. The results underscore the importance of considering both gastrointestinal and mental health aspects in managing these interconnected conditions.

Background: The incidence of non-alcoholic fatty liver disease (NAFLD) has increased with the global increase in the outbreak of obesity, type 2 diabetes, and metabolic syndrome, reaching a 25% prevalence. However, there is currently no effective treatment for this disease apart from lifestyle modification. Furthermore, NAFLD commonly presents without symptoms, hence, leading to potentially severe and irreparable consequences.

Methods: This study was based on a systematic review. The search used the keywords "non-alcoholic fatty liver" and "risk factor" across the PubMed, Scopus, and Web of Science databases. First, the articles were evaluated based on their abstract and then on their full text. The risk factors were extracted from the articles and entered into the Excel form, and then a dataset was provided to the expert panel. The risk factors were investigated, and those related to NAFLD were selected.

Results: The results led to the identification of 180 risk factors in 15 categories. First, the risk factors mentioned in fewer than five articles were removed. Then, the remaining 101 risk factors were presented to the expert panel, of which 39 risk factors related to NAFLD were selected.

Conclusion: In summary, this study shows that NAFLD is caused by various factors such as metabolic syndrome, certain diseases, demographic information, specific surgeries, drug consumption, different foods and beverages, occupation, physical activity status, and socioeconomic status. Recognizing these risk factors enables doctors to make earlier diagnoses, potentially preventing disease progression. Additionally, it is possible to develop treatment strategies aimed at reducing the risk factors of the disease, which could result in fewer patients suffering from NAFLD in the future.

Celiac disease (CD) is an immune-mediated enteropathy with varied systemic involvement and association with increased morbidity and mortality. Strong clinical suspicion is the key, and diagnosis is made using histopathology and serology. Though the consumption of a strict gluten-free diet can improve symptoms and limit mucosal damage, curative therapy is still lacking. Significant clinical improvement can be seen after treatment with immunosuppressive therapy; however, there is no definitive role of immunosuppression in preventing complications. Celiac crisis (CC), a serious and life-threatening complication of CD, is characterized by acute onset and rapid progression of gastrointestinal manifestations associated with metabolic and electrolyte disturbances and neurological and renal dysfunction. Management comprises urgent hospitalization, fluid resuscitation, correction of electrolyte imbalance, and albumin infusion. Early identification and diagnosis of CD and timely initiation of a gluten-free diet with proper compliance are of paramount importance in preventing complications, including CC. Regular follow-up after diagnosis is a good approach to assessing adherence to the gluten-free diet, disease activity, and screening for complications. With the advent of improved diagnostic facilities and access to the health care system, timely diagnosis, and efficient management, prognosis has improved significantly in recent years.

Background: Low anterior resection (LAR) is the gold standard for curative cancer treatment in the middle and upper rectum. In radically operated patients, the local recurrence rates with total mesorectal excision (TME) after 5 and 10 years was<10%, with 80% in 5 years survival. Anastomotic leakage (AL) affects 4%-20% of patients who underwent LAR. Based on some studies, there is a risk reduction of symptomatic AL after LAR and the need for reoperation in patients with a defunctioning stoma (DS), also known as diverting stoma. Ileostomy has many complications, such as skin irritation and leakage, dehydration, obstruction, and parastomal hernia. Considering the complications of defunctioning loop-ileostomy (DLI) we designed this study to evaluate noninserting stoma in a particular group of patients.

Methods: This retrospective cohort case series study utilized data of 20 patients with rectal adenocarcinoma with lesion>7 cm from anal verge in rectoscopy who underwent LAR after 28 sessions of chemoradiotherapy (CRT) and 6 weeks of rehabilitation. All of the patients matched our criteria, so DLI was not performed on any of them.

Results: Among our 20 patients, four AL were happened (20%). C-reactive protein (CRP) on post-operation day (POD) six was valuable. Computed tomography (CT) scan was not used as a reliable modality in our study. In all patients with positive AL, magnetic resonance imaging (MRI) was useful and reported correctly, and direct vision of the anastomosis site by rigid rectoscopy was not safe enough to make decisions about it.

Conclusion: The leakage rate was not far from the average leakage rate in other studies. Then it seems it is possible to forget about defunctioning loop stoma (DLS) in safe cases to reduce the stoma complications. Due to our restricted case selection and our close observation protocol, we had no significant complications compared to other studies. According to this study, not inserting stoma in suitable cases with restricted protocol selection is possible, and the leakage rate is not higher in comparison with patients with stoma.

Background: Biological medications have played a significant role in maintenance therapy for Crohn's disease (CD), but some cases become refractory to these agents. Methotrexate (MTX) appears to be a cost-effective and readily available drug for enhancing the effectiveness of maintenance therapy when used in combination with anti-tumor necrosis factor (anti-TNF) therapy in such cases. However, its effectiveness is still to be established. We aimed to assess the efficacy of MTX and anti-TNF combination therapy in patients with refractory CD.

Methods: A retrospective cohort study was conducted on adult patients with CD who were refractory to anti-TNF therapy and were initiated on weekly intravenous MTX in addition to the anti-TNF therapy. These patients were then followed up for over a year. The primary outcome measured was the clinical response to treatment, based on the Harvey-Bradshaw Index. The secondary outcomes included assessing the adverse events and complications of MTX therapy.

Results: Of 70 patients, 44 were included in the final analysis. Among them, 30 patients (68.2%) achieved complete remission, four patients (9.1%) had a partial clinical response, and 10 patients (22.7%) required surgery. The adverse events and complications of MTX therapy were mild and infrequent (9.1%). None of the demographic or clinical factors were significantly associated with response to treatment (P>0.05).

Conclusion: Combining MTX with anti-TNF therapy appears to be an effective and safe treatment for patients with Crohn's disease, particularly those with severe disease who are less responsive to monotherapy. However, further studies are needed to confirm these findings.

Background: Helicobacter pylori is a gram-negative pathogen. The infection caused by this pathogen may result in gastritis and can increase the risk of gastric cancer. This study investigated the relationship between H. pylori infection as the main risk factor for gastritis and changes in serum inflammatory cytokine levels.

Methods: Blood samples from 85 patients with stomach pain, including 46 H. pylori-positive (Hp⁺) and 39 H. pylori-negative (Hp^-) cases, were collected and referred to a gastroenterologist. After isolation and identification of H. pylori, the severity of gastritis was determined for each patient based on the histopathological findings. Finally, the serum levels of cytokines were measured using the multiplex kit and flow cytometry methods.

Results: There were significant differences in the levels of interleukin-2 (IL-2), IL-4, IL-17A, IL-17F, IL-22, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ) between the Hp^- and the Hp⁺ specimens (P≤0.05). The levels of IL-2, IL-17A, IL-17F, IL-22, TNF-α, and IFN-γ were significantly higher in patients with mild and moderate gastritis than Hp^- group (P≤0.05). In addition, IL-4 significantly increased in patients with moderate gastritis compared with Hp^- individuals (P=0.008).

Conclusion: Among the inflammatory cytokines evaluated in this study, IL-17A, IL-17F, and IL-22 may play a crucial role in developing moderate gastritis in infected patients with H. pylori.

Background: Repeated polyserositis, another name for familial Mediterranean fever (FMF), is an autoimmune disorder with an autosomal recessive nature primarily characterized by short-lived repeated periods of peritonitis, pleuritis, and arthritis, generally accompanied by fever.

Methods: Our participants were divided into two groups. Group I (patients): 100 individuals who were diagnosed as patients with FMF and were monitored. Group II (control): matched- healthy individuals (100 controls). They were compared and followed up as regards demographic, clinical, and laboratory data: routine investigations, neutrophil/lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and mean platelet volume (MPV), red cell distribution width (RDW), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).

Results: Group I: MPV mean was 12.03±2.89, whereas group II MPV mean was 7.74±0.57. MPV was significantly statistically greater in group I than in group II. RDW mean in group I was 17.07±1.39 and in group II was 12.92±0.63. RDW was also significantly statistically greater in group I compared with group II. Group I's NLR mean was 3.05±0.71, whereas group II's NLR mean was 1.75±0.2. PLR mean in group I was 164.8±122.8 and in group II was 111.26±29.16.

Conclusion: A statistically significant association was shown between the diagnosis of adult FMF and NLR, PLR, MPV, and RDW.

Background: Among environmental factors, infectious agents, including Helicobacter pylori, can act as triggers for autoimmune thyroid diseases. Therefore, this study aimed to investigate the correlation between autoimmune Hashimoto's thyroiditis with H. pylori infection.

Methods: The participants in this case-control study were 74 individuals 17-62 years who were divided into two groups, including 38 diagnosed Hashimoto's thyroiditis patients from an outpatient clinic of endocrinology and 36 apparently healthy individuals that were selected from family members of cases group age-matched and sex-matched. For individuals in two groups, a questionnaire was completed, including demographic information. Then, they were referred to the laboratory for thyroid stimulating hormone (TSH) and free T4 (FT4) in the control group and anti-thyroid peroxidase antibody (TPO-Ab) levels measurement in case and control groups. Stool samples were obtained from all individuals for H. pylori antigen detection using the ELIZA kit.

Results: There was no significant difference in the mean age of case and control groups (P=0.96), and 81.1% of individuals were female. 58.6% of patients with Hashimoto's thyroiditis and 41.4% of the control group had positive H. pylori, but there was no statistically significant difference between the two groups (P=0.34). Furthermore, there was a significant positive correlation between TPO-Ab levels and H. pylori infection (r=0.2, P=0.03).

Conclusion: TPO-Ab levels were associated with H. pylori infection diagnosed by H. pylori antigen.