Middle East Journal of Digestive Diseases最新文献

Background: Patients with inflammatory bowel disease (IBD) require lifelong treatment, which significantly impacts their quality of life. Self-management of this disease is an effective factor in managing chronic conditions and improving patients' quality of life. The use of mobile applications is a novel approach to providing self-management models and healthcare services for patients with IBD. The present systematic review aimed to identify the features and technologies used in the development of IBD disease management applications.

Methods: This systematic review was conducted according to PRISMA guidelines in PubMed, Scopus, and Web of Sciences databases up to August 8, 2023, which included initial searches, screening studies, assessing eligibility and risk of bias, and study selection. The data extraction form was based on the study objectives, including bibliographic information from articles, such as the first author's name, year of publication, country of origin, and details related to mobile health applications, such as the name of the application, features and technologies used, advantages and disadvantages, main outcomes, and other results. The content of the research was analyzed according to the research objectives.

Results: In the initial review of four databases, a total of 160 articles were retrieved and subsequently entered into EndNote. After removing duplicates and irrelevant studies based on title, abstract, and full-text assessments, 12 articles were finally selected. The studies were conducted between the years 2015 and 2024. 100% of the applications designed for patients with IBD were aimed at treatment, 83% were for self-management of the disease, and 33% of the applications were intended for disease diagnosis. The features of IBD management applications were categorized into four groups: education, monitoring, counseling, and diagnosis and treatment.

Conclusion: Various mobile applications have been developed for the management of IBD, each differing in features and technologies used. While current IBD applications have limited capabilities in diagnosing disease severity, they still hold significant potential in empowering patients through education, counseling, and monitoring. The integration of artificial intelligence and decision support systems may enhance the effectiveness and reliability of these applications.

Fournier gangrene is a rare but severe complication of ulcerative colitis, characterized by necrotizing fasciitis affecting the genital and perineal regions. We present a case of a 53-year-old man with a history of ulcerative colitis and cytomegalovirus (CMV) colitis who developed Fournier gangrene, an exceptionally uncommon occurrence in this patient population. The patient initially presented with intense pain, swelling, and skin discoloration in the genital area, accompanied by systemic symptoms, including fever. Prompt recognition and intervention are critical due to the aggressive nature of Fournier gangrene, which often results in significant morbidity and mortality. This case underscores the importance of vigilance for unusual presentations of necrotizing infections in patients with inflammatory bowel disease (IBD), particularly those with complicating factors such as immunosuppression and concurrent infections.

Granular cell tumors (GCTs) of the gastrointestinal tract are rare neoplasms often detected incidentally as subepithelial lesions during endoscopic examination. The occurrence of GCTs in the gastric cavity is even rarer. So far, there have been only four reports of multifocal gastric GCTs. Our study presents the fifth case involving a middle-aged lady with incidental multifocal gastric GCT. It is the first such case reported in West Asia.

Background: The current research examines the molecular terrain of celiac disease (CD) through microRNA (miRNA) and cytokines as potential new diagnostic and therapeutic markers. Gluten-appropriate immune response is a key feature of an autoimmune clinical entity known as CD that leads to inflammation and degeneration of small intestine mucosa. However, the mechanisms responsible for this remain unclear.

Methods: Quantitative reverse transcription polymerase chain reaction (RT-qPCR ) was carried out on serum samples obtained from patients with CD and control groups to unravel their pathogenesis. Assessing miR-155, miR-15b, interleukin (IL)-2, IL-7, IL-35and IL-37 levels in expression might be useful in diagnosing or treating the disorder.

Results: A significant dysregulation of these molecular players in patients with CD compared with healthy controls has been evidenced by results from this study. For instance, miR-155 was up-regulated, whereas miR-15b was significantly down-regulated in CD, illustrating their roles in immune responses and inflammation-mediated processes. Besides, there was an over-expression of IL-2 and an under-expression of IL-37 in patients with CD, indicating these biomolecules' role in immuno-dysregulation and inflammatory process underlying CD. In addition, a positive correlation between IL-2 and miRNA 155 expression levels was observed in patients with CD, suggesting that they could be involved together with other cytokines, showing the interplay between immune response pathways and inflammatory cascades during CD pathogenesis.

Conclusion: These molecular signature discoveries might result in new and revolutionary diagnostic modalities and molecular-targeted therapies for CD pathogenesis. When used with the scientific understanding of miRNAs and cytokines associated with CD pathophysiology, it creates a basis for personalized medicine based on the individualized molecular profile of all patients. This will undoubtedly increase the efficacy of CD treatment strategies. In brief, more research on molecular pathways' workings should be done to harness their potential in CD diagnosis and treatment.

Pancreatic cancer (PC) is a lethal cancer with poor prognoses. Identifying and characterizing pancreatic cystic lesions (PCLs) in the early detection and follow-up plans is thought to help detect pancreatic malignancy. Besides, the molecular features of PCLs are thought to unravel potentials for targeted therapies. We present a narrative review of the existing literature on the role of PCLs in the early detection, risk stratification, and medical management of PC. High-grade intraductal papillary mucinous neoplasms (IPMN) and pancreatic intraepithelial neoplasia (PanIN) stage III are high-risk lesions for developing PC. These lesions often require thorough histomolecular characterization using endoscopic ultrasound (EUS), before a surgical decision is made. EUS is also useful in the risk assessment of PCLs with tentative plans-for instance, in branch-duct IPMNs (BD-IPMN)- where the final decision might change. Besides the operative decisions, recent improvements in the application of targeted therapies are expected to improve survival measures. Knowledge of molecular features has helped develop targeted therapies. In summary, the histomolecular characterization of PCLs is helpful in optimizing management plans in PC. Further improvements are still needed for the broad application of this knowledge in the clinical setting.

Background: The possibility of pelvic floor dysfunction (PFD) occurrence seems to be higher in patients with inflammatory bowel disease (IBD) due to the presence of functional gastrointestinal disorders in these patients. Hence, this study aimed to evaluate the association of ulcerative colitis (UC) in women with PFD and its comparison with the healthy (without IBD) population.

Methods: The present study was conducted on 150 women with UC and 150 without-IBD individuals. Pelvic Floor Distress Inventory (PFDI-20) was used to evaluate the pelvic floor function.

Results: The results of this study revealed that UC had a significant role in increasing not only the PFD score (Beta=3.04; P<0.001) but also the score of each sub-scale of Pelvic Organ Prolapse Distress Inventory (POPDI) (Beta=6.61; P<0.001), Colo-Rectal-Anal Distress Inventory (CRADI) (Beta=9.37; P<0.001), and Urinary Distress Inventory (UDI) (Beta=5.56; P=0.015). In addition, aging, increased body mass index (BMI) and menopause had significant role in increasing POPDI, UDI, and PFDI scores, respectively (P<0.05).

Conclusion: The percentage of PFD in women with UC was significantly higher than its percentage in women without IBD. This dysfunction was more visible in the two sub-scales of POPDI and CRADI. In addition to having UC, aging, BMI, and menopause played a significant role in increasing PFD.

Background: Fissure-in-Ano is a common condition of the anorectal region. Most of the time, it is managed non-surgically. There are various drugs used for the treatment of anal fissures. Calcium channel blockers are one of them that reduce the tone of sphincter muscles. The present study compares the efficacy of oral diltiazem and topical 2% diltiazem ointment in patients with chronic anal fissures.

Methods: Patients were randomized into two groups. Group A (n=25) received treatment in the form of oral diltiazem, while group B (n=25) received treatment in the form of 2% (weight/volume) diltiazem ointment for local application in addition to other conservative methods like sitz bath and stool softeners. Outcomes in the form of success of treatment and complications were assessed. Statistical analysis was done using MedCalc software version 14.0. P value of<0.05 was considered significant.

Results: The mean age of patients was 32.00±10.67 years in group A and 30.64±9.53 years in group B. Pain relief was significantly better in group B than in group A at the end of the first week (P=0.00018), but at the end of 6th week, no significant difference was observed. Fissure healing was more significant in group B than in group A after 6 weeks (P=0.0152).

Conclusion: Local diltiazem ointment is a better option than oral diltiazem for anal fissures with respect to better outcomes and lesser complications.

Background: Pancreatic duct (PD) dilation could be presented in both benign and malignant diseases. Endoscopic ultrasonography (EUS) is a sensitive modality that provides both structural assessment and tissue sampling. This study aims to explore the importance of PD dilation as a potential indicator related to various pancreatobiliary pathologies identified via EUS.

Methods: Among 3109 subjects who underwent EUS, 599 had evidence of dilated PD and met the inclusion criteria of this retrospective study. Also, the patients underwent EUS fine needle aspiration (EUS-FNA) to evaluate the etiology when required. All data were extracted from patients' medical records to perform statistical analysis.

Results: The study sample revealed 64% being male with a median age was 65-years. Pancreatic adenocarcinoma was the most common etiology diagnosed in 236 patients (39.4%), followed by sphincter of Oddi dysfunction (SOD) in 13% of subjects. Ampullary carcinoma, common bile duct stone, and cholangiocarcinoma were found at 9.5%, 8.8%, and 6.8%, respectively. Abdominal pain was the most common symptom seen in 440 (73.4%) patients. Opium consumption was reported in 170 (28.4%) subjects. Opium consumption was significantly more prevalent in patients with SOD (P<0.05).

Conclusion: We suggest that PD dilation could be associated with a wide range of pancreaticobiliary pathologies, especially pancreatic neoplasms. In this regard, PD dilation should be considered as a crucial indicator of pancreatic neoplasm despite it may be associated with no clear etiologies.

Background: Iatrogenic bile duct injury (BDI) is one of the most common complications that challenge surgeons performing laparoscopic cholecystectomy (LC). As the number of LC surgeries increases, a pattern of BDI is emerging, but little is known about this matter. The purpose of this study was to assess the pattern of post-LC BDIs directed in a referral center in Iran.

Methods: Post-BDI patients referred to a hepatobiliary center were studied. Demographic data, clinical status, diagnostic examinations, referral time, post-referral management, and morbidity were analyzed.

Results: Nine out of 68 patients had Charcot's cholangitis triad featuring right upper quadrant abdominal pain, fever, and icter. Fever, icter, and itching were the most frequent symptoms. Increased bilirubin, leukocytosis, and abnormal liver function test (LFT) were the most common laboratory abnormalities. 30 patients experienced hepatic artery injury. Out of them, six patients experienced hepatectomy due to hepatic ischemia. Two patients were re-admitted and re-operated, and four patients died.

Conclusion: Early and correct treatment by a hepatobiliary surgeon experienced in the management of these types of injuries prevents further complications in patients suffering from iatrogenic BDI. Postoperative complications of bile duct repair, such as anastomosis stricture, are possible; thus, patients need long-term and thorough postoperative observation.

Background: Helicobacter pylori, the most prevalent infection in the world, has great importance due to being related to peptic ulcer disease, gastric metaplasia, dysplasia, and even gastric adenocarcinoma or mucosa-associated lymphoid tissue (MALT) lymphoma. The standard H. pylori eradication regimen is based on antibiotic susceptibility testing. If susceptibility testing is not available, a standard treatment regimen will be recommended based on records of H. pylori resistance rates to antibiotics in a region or locally proven highly effective regimens (equal to or higher than 90% eradication rate). The aim of this review was to define suitable recommendations for local treatment in different cities of Iran.

Methods: This review article consists of randomized controlled trials related to H. pylori eradication in Iran. Data including the kind of therapy, number of patients and per-protocol H. pylori eradication rates were recorded in data gathering forms. Data search was conducted in PubMed and Google Scholar databases from 2018 to December 2023.

Results: According to our review of Iranian articles regarding first-line H. pylori eradication regimens, these treatment protocols could be recommended: Bismuth-clarithromycin quadruple therapy in Ardabil, bismuth-clarithromycin quadruple therapy with probiotics in Birjand, standard triple therapy in Ilam, bismuth quadruple therapy or bismuth triple therapy or concomitant regimen in Sari, sequential therapy in Tehran and bismuth quadruple therapy in Yazd. These regimes can be extended to other regions that have a similar situation. According to the reports of Iranian researchers, a quinolone-containing regimen (levofloxacin preferred) is recommended for second-line eradication therapy.

Conclusion: Various H. pylori eradication regimens can be used as first-line therapy; however, choices for second-line therapy are limited. We recommend the quinolone-containing regimens as the preferred second-line therapy.