Background:Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and may cause significant morbidity and even death. There is no effective prophylactic intervention for patients with average risk yet. This study aims to investigate preventive effect of aggressive hydration for post-ERCP pancreatitis.Materials and Methods:In a double-blind controlled setting, 150 patient were randomly assigned to receive either aggressive hydration with lactated Ringer's solution (3 mL/kg/h during ERCP, followed by a 20 mL/kg bolus and 3 mL/kg/h for 8 h after the procedure, n = 75) or standard amount of hydration (1.5 mL/kg/h during and for 8 h after ERCP, n = 75). Patients were observed for volume overload as well as pancreatic pain and serum levels of amylase at baseline and 2, 8, and 24 h after ERCP. Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up. Hyperamylasemia and pancreatic pain were the secondary end points.Results:Mean age of the patients was 50.8 ± 13.5 years. Most of the patients were female (66%). Pancreatitis developed in 21 patients, including 22.7% of patients receiving standard hydration and 5.3% patients receiving aggressive hydration (P = 0.002). Hyperamylasemia was detected in 44.0% of patients receiving standard hydration and 22.7% of patients aggressive hydration (P = 0.006). The pancreatic pain was reported by 5.3% of patients receiving aggressive hydration and 37.3% of patients receiving standard hydration (P ≤ 0.005).Conclusion:Aggressive hydration with lactated Ringer's solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

BACKGROUND Considering the importance of Helicobacter pylori (H. pylori) eradication, this clinical trial was designed to prospectively evaluate the efficacy of levofloxacin-based, sequential therapy in comparison with quadruple therapy for eradicating H. pylori. METHODS Overall 156 patients with dyspepsia and H. pylori infection were included in this study and were randomly allocated to either 10-day sequential therapy group (group A) to receive pantoprazole (40 mg twice daily), amoxicillin (1 gr twice daily), levofloxacin (500 mg twice daily), and tinidazole (500 mg twice daily) (PALT) or 14-day quadruple therapy group (group B) to receive pantoprazole, clarithromycin, bismuth subcitrate, and amoxicillin (PABC). At the end of the study the eradication rate in each group was assessed by urea breath test (UBT). RESULTS Age range of the participants was 18-65 years (average 36.9 years) and 50% of them (78 patients) were men. 78 patients were allocated to group A and 78 patients to groupe B. After antibiotic therapy, all the patients received acid suppression therapy with Proton Pump Inhibitor (PPI) for 4 weeks and then the eradication rate was confirmed by UBT (Heli FAN plus 13C, Germany). Before performing UBT, all the participants were requested to halt consumption of PPI for at least 1 week. During the treatment there was not any major complication but in group A (sequential therapy), two patients complained of minor complications including musculoskeletal pain. None of the patients in group B had any complaint or side effect. The rate of H. pylori eradication in group A was 78.2% (61 patients) while this rate in group B was 83.3% (65 patients) with no significant difference between the two groups (p = 0.42). In subgroup analysis, the rate of eradication among men in group A and B were 76.9% and 89.7%, respectively (p = 0.22) while the eradication rate among women were 79.4% and 76.9%, respectively (p = 1.00). CONCLUSION It seems that levofloxacin base sequential therapy does not have any advantage in comparison with quadruple regimen and until finding any more effective short course therapy for H. Pylori eradication; we encourage quadruple regimen to be used as the first line therapy.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD)is an important health problem worldwide and despite the rising prevalence, there is currently no satisfying therapeutic strategy. Dark chocolate (DC) is a food rich in phenolic antioxidants, which may exert favorable and modifying effects on lipid profile, insulin resistance, oxidative stress, and metabolic effects. This study aims to investigate the possible effects of DC consumption on the lipid profile, fasting blood sugar (FBS), liver transaminases (ALT, and AST), inflammatory, and antioxidant status among NAFLD patients. METHODS: In this double-blind, placebo-controlled trial, 42 patients with NAFLD were randomly allocated to 2 groups: the treatment group (n=21) whom received 30 gr dark chocolate (83%) daily and the control group (n=21), for a 12 weeks period. RESULTS: During the intervention period, taking 30 gr DC (83%) daily resulted in a significant decrease in AST (P=0.012), body weight (P=0.027), and BMI (P=0.042) in the treatment group. In addition, patients who received DC had considerable changes in serum HDL (P=0.044). However, no significant changes occurred in serum levels of ALT, hs-CRP, anthropometric measures (WC, HC, and WHR), and grades of NAFLD in both groups (P>0.05). CONCLUSION: DC consumption can decrease the level of AST in patients with NAFLD and could be a potential therapeutic approach. We recommend more investigation about potential therapeutic effects of dark chocolate to be further clarified.

A 52-year old man with recurrent vomiting was referred for upper gastrointestinal endoscopy. During endoscopy, superficial erosions were found on the upper part and obstruction in the middle part of the stomach (• " Fig. 1 and• " Fig. 2). The stomach was rotated around an axis connecting the gastroesophageal junction and the pylorus. The antrum was rotated in the opposite direction toward the fundus. The organoaxial type of gastric volvulus that was seen in our patient is associated with sliding hiatal hernia (• " Fig. 3). In patients with acute gastric volvulus, endoscopic reduction and de-rotation should be attempted. During the procedure, the suction of trapped air and placement of a nasogastric tube after devolvulization are obligatory [1]. In this case, endoscopic reduction of the volvulus was unsuccessful (• " Video 1), and the patient was referred for surgical devolvulization. During laparotomy, the stomach was decompressed and fixed to the abdominal wall (gastropexy) to prevent recurrence. Gastric necrosis was not detected during the surgery, and the patient was discharged from the hospital 3 days later. Gastric volvulus is characterized by abnormal rotation of the stomach along its horizontal or vertical axis. It is classified as primary (idiopathic) or secondary based on the etiology, as organoaxial or

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