Middle East Journal of Digestive Diseases最新文献

Lymphangiomas are benign lymphatic system abnormalities that can appear anywhere on the skin and mucous membranes. Lymphangiomas are caused by congenital or acquired lymphatic system disorders. In the congenital form, although the cause is unknown it is said that it is formed by the incorrect attachment of lymphatic channels to the main lymphatic drainage duct before the age of 5 years. lymphangiectasia as a subgroup of lymphangioma occurs seldom in the small bowel, especially in adults. If that happens, protein-losing enteropathy will be the most common presenting sign. In the present study, we introduce a case of a 40-year-old man without a history of any congenital or acquired diseases who was admitted to the emergency room due to long-lasting obscure overt gastrointestinal (GI) bleeding. Normal upper and lower GI endoscopies were suggestive of GI bleeding originating from the small intestine. Despite receiving iron supplements, he continued to have melena and remained anemic. Further evaluation of the small intestine by deep enteroscopy revealed multiple white spots histologically consistent with dilated lymphatics. Intestinal lymphangiectasia was eventually introduced to be the final diagnosis of the patient.

Background: Liver biopsy remain as the gold standard for diagnosing hepatic fibrosis; however, it has some limitations, such as life-threatening complications, low acceptance by the patients, and variations in the related sample. Therefore, there is a need for the development of non-invasive investigations for diagnosing hepatic fibrosis. Vibration-controlled transient elastography (VCTE) is one of these non-invasive methods. Methods: This study included 73 patients suffering from non-alcoholic fatty liver disease (NAFLD) who were older than 18 years. The patients underwent VCTE at the Baqiatallah and Firoozgar hospitals. Then, they underwent a liver biopsy by an experienced radiologist in the same hospital. A receiver operating characteristic (ROC) curve of different fibrosis stages was used to evaluate the VCTE verification. Results: VCTE could detect any fibrosis levels (stage 1 and higher) with an area under the ROC curve (AUROC) of 0.381. Moreover, it detected stage 2-4 fibrosis with an AUROC of 0.400, stage 3-4 fibrosis with an AUROC of 0.687, and stage 4 fibrosis with an AUROC of 0.984. Conclusion: The VCTE has high clinical validity in diagnosing the advanced stages of fibrosis (stages 3, 4) and can be a suitable alternative to the invasive method of liver biopsy with high reliability.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor originating from the gastrointestinal tract and have a broad spectrum of clinicopathological features affecting disease management regarding the treatment modalities. Methods: A retrospective study of 49 patients who underwent surgery for gastrointestinal tumors between 2008 and 2016 was conducted. Clinical, pathological, and immunohistochemical features of patients with and without recurrence were statistically analyzed. Results: Twenty-nine (59.1%) patients had gastric; 16 (32.6%) had small intestinal; 3 (6.1%) had mesenteric; and 1 (2.2%) had rectal GISTs. Microscopic tumor necrosis and tumor ulceration were also significant for disease recurrence (P = 0.005, P = 0.049). High-risk patients according to Miettinen's risk classification were more likely to develop a recurrence (P < 0.001). Additionally, high-grade tumors were also a risk factor for recurrence (P < 0.001). Ki-67 levels were available in 40 patients and the mean Ki-67 level was 16.8 in patients with recurrence, which was a significant risk factor in regression analysis (HR: 1.24, 95%, CI: 1.08-1-43). Five-year disease-free survival rates of non-gastric and gastric GISTs were 62.3% and 90%, respectively (P = 0.044). Conclusion: Larger tumors and higher mitotic rates are more likely to develop recurrence. High Ki-67 levels were also associated with recurrence.

In the worldwide medical literature, only one case of inlet patch shows a kissing pattern on endoscopy. This article describes a 69-year-old female patient who came to the gastroenterology clinic, Rohani hospital, Babol University of Medical Sciences (Iran) for an examination for indigestion. Endoscopy showed two polyps in the background of a maroon patch just below the upper esophageal sphincter, oppositely positioned in view of the kissing pattern, and extending into muscular mucosa and regional lymph nodes. There was no A polyp biopsy was performed and, on histological evaluation, there was heterotopic cardiac gastric mucosa. Since heterotopic gastric mucosa can be found anywhere in the gastrointestinal tract, careful examination of the proximal esophagus increases the likelihood of detecting an inlet patch.

Cytomegalovirus (CMV) colitis occurs commonly in immunocompromised patients with high mortality. CMV infection has also been reported in immunocompetent individuals and it has a varied clinical presentation. When HIV-infected patients are started on antiretroviral therapy (ART) there is a reconstitution of the immune system which results in the paradoxical worsening of existing conditions or development of new disease conditions known as immune reconstitution inflammatory syndrome (IRIS). In the setting of IRIS one of the most common infections to occur is non-tubercular mycobacteria (NTM). The infection generally develops when the CD4 count is < 50 cells/µL. Here we present a rare case of CMV colitis followed by NTM infection in the setting of IRIS, its management, and treatment outcomes.

Background: The ideal combination regimen for Helicobacter pylori (HP) eradication has not yet been determined and the success rate of HP eradication has been extensively reduced worldwide due to increasing antibiotic resistance. So this multinational multi-center randomized controlled trial was designed to evaluate the efficacy of tetracycline +levofloxacin for HP eradication. Methods: During a 6-month period, all of the cases with HP infection in eight referral tertiary centers of three countries were included and randomly allocated to receive either tetracycline + levofloxacin or clarithromycin plus amoxicillin quadruple regimen for two weeks. For all of the participants, pantoprazole was continued for 4 more weeks and after one to two weeks of off-therapy, they underwent urea breath test C13 to prove eradication. Results: Overall 788 patients were included (358 male (45.4%), average age 44.2 years). They were diagnosed as having non-ulcer dyspepsia (516 cases, 65.5%), peptic ulcer disease (PUD) (234 cases, 29.69%), and intestinal metaplasia (38 cases, 4.8%). Racially 63.1% were Caucasian, 14.5% Arab, 15.6% African, and 6.1% Asian. The participants were randomly allocated to groups A and B to receive either tetracycline + levofloxacin or clarithromycin. Among groups A and B in intention to treat (ITT) and per protocol (PP) analysis, 75.2% & 82.1% (285 cases) and 67.5% & 70.1% (276 cases) of participants achieved eradication, respectively (P = 0.0001). The complete compliance rate in groups A and B were 84.4% and 83.6%, respectively. During the study, 33.5% of the participants in group A (127 cases) reported side effects while the complication rate among group B was 27.9% (114 cases, P = 0.041). The most common complaints among groups A and B were nausea and vomiting (12.6% & 9.3%) and abdominal pain (4.48% & 2.68%), respectively. The rate of severe complications that caused discontinuation of medication in groups A and B were 2.1% and 1.46%, respectively (P = 679). In subgroup analysis, the eradication rates of tetracycline+levofloxacin among patients with non-ulcer dyspepsia, PUD, and intestinal metaplasia were 79.4%, 88.1%, and 73.9%, respectively. These figures in group B (clarithromycin base) were 71.3%, 67.6%, and 61.5% respectively (P = 0.0001, 0.0001, and 0.043). Conclusion: Overall, the combination of tetracycline+levofloxacin is more efficient for HP eradication in comparison with clarithromycin+amoxicillin despite more complication rate. In areas with a high rate of resistance to clarithromycin, this therapeutic regimen could be an ideal choice for HP eradication, especially among those who were diagnosed with PUD.

Leptospirosis is an emerging zoonosis of worldwide importance. Its distribution is closely linked to hydrometric conditions. It is characterized by a wide clinical range, from the subclinical form, or one with few symptoms; which resolves spontaneously, to the multi-visceral form, known as icterrohemorrhagic disease or Weil's disease, with a lethal risk. All organs can be affected but with variable frequency. Pancreatic involvement is not well documented. We describe a 45-year-old man with Weil's disease associated with acute necrotizing pancreatitis. The evolution was favorable but required a three-week stay in the intensive care unit.

Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.

Background: Routine bowel preparation instructions are usually given to patients in the form of oral explanations with written instructions. The purpose of this study was to evaluate the effectiveness of multimedia training in the form of video CDs on the quality of colon preparation and other related indicators. Methods: 201 outpatients in three referral academic colonoscopy centers were randomly assigned to two groups. The first group (n=100) received supplementary video CD education besides the routine instructions (VCD group). The second group (n=101) received only routine instruction, which included oral and printed instructions (non-VCD group). Results: Complete use of colon cleansing medication was statistically and significantly better in the VCD group (P=0.038). Duration of colonoscopy was shorter in the VCD group (P=0.001), demand for conscious sedation was lesser in the VCD group (P=0.049), and the quality of colon preparation was better in the VCD group (P<0.00). There was no statistically significant difference in pain sensation (P=0.1), cecal intubation rate (P=0.3), and technical difficulty of the colonoscopy (P=0.1) in both groups. Conclusion: Supplementary education in the form of multimedia CD increases the patients' compliance to cleansing mediation consumption, improves the quality of bowel preparation, and decreases the duration of colonoscopy with lesser demands for conscious sedation.