-Background -Celiac disease is an immune-mediated enteropathy due to a permanent sensitivity to gluten in genetically susceptible people. Iron-deficiency anemia is the most widely experienced anemia in humans. Iron-deficiency anemia additionally is a common extra intestinal manifestation of celiac disease. Objective -To investigate correlation between tTg levels and histological alterations and then to determine the prevalence of celiac disease in Center and South area patients of Iran with iron deficiency anemia. Methods -A total of 402 patients aged 12-78 years who presented with iron-deficiency anemia were included in this study. Hemoglobin, mean corpuscular volume and serum ferritin were determined. Venous blood samples for anti-tissue transglutaminase antibody immunoglobuline A and G were obtained from these patients. Upper gastrointestinal endoscopy was recommended to patients who had positive serology.

AimTo evaluate the efficacy and tolerability of tetracycline vs. high-dose amoxicillin in bismuth-based quadruple therapy for Helicobacter pylori(H. pylori) eradication.MethodsThis randomized, open-label clinical trial included 228 patients with H.pylori infection and duodenal ulcer without a history of H.pylori treatment. Patients were randomly divided into two groups. The amoxicillin group received metronidazole 500mg, bismuth subcitrate 240mg, and amoxicillin 1000mg, all three times a day, plus omeprazole 20 mg twice a day, for 14 days. The tetracycline group received metronidazole 500mg three times a day; bismuth subcitrate240mg and tetracycline HCl 500mg, both four times a day; and omeprazole 20 mg twice a day, for 14 days. Evaluation for compliance and drug-relatedadverse effects were evaluated at the end of two weeks. Eight weeks after the end of treatment, the rate of H.pylori eradication was assessed by the C13urease breath test.ResultsThere were no significant demographic differences between the two groups. Eradication rate was higher with the amoxicillin-containing regimen than the tetracycline-containing regimen: 105/110 (95.51%; 95% confidence interval, 91.5%–99.3%) vs. 88/105 (83.8%; 95%CI, 76.7%–90.8%) by per-protocol analysis (p = 0.005) and 92.9% (95%CI, 88.1%–97.6%) vs. 76.5% (95%CI, 68.7%–84.2%) by intention-to-treat analysis (ITT, p = 0.001). Adverse effects were significant higher in the tetracycline groupthan in the amoxicillin group (65.2% vs. 43.4%; p = 0.001).ConclusionBismuth-based quadruple therapy including high-dose amoxicillin and metronidazole achieved an acceptable rate of H.pylori infection eradication with good tolerance in patients with duodenal ulcer. This regimen can overcome treatment resistance in areas with high prevalence of metronidazole and clarithromycin resistance.Trial registrationThe Thai Clinical Trial Registry (TCTR) 20170623004

No abstract

Background/Aim:Endosonography is a distinct method for evaluating the structural lesions of the gastrointestinal (GI) tract, particularly the pancreatobilliary region. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesion through providing fine needle aspiration. This study aims at evaluating the results and efficacy of endoscopic ultrasound fine needle aspiration (EUS-FNA) in patients with pancreatic solid mass.Patients and Methods:The present study is an observational, prospective case series nature, evaluated patients with pancreatic solid mass referred to Imam Khomeini educational hospital in Tehran for a duration of one year since November 2010. In order to determine the false negative cases, the patients were followed-up from 6 to 12 months.Results:EUS-FNA was conducted on all 53 patients without any complication. The majority of patients included in the study were males (68%) and 81% of patients had a mass in the head of pancreas. The result of cytopathology revealed 36 adenocarcinomas (68%), 7 other malignancies (13%), benign lesions (6%) and 7 non-diagnostic cases (13%). The frequency of non-diagnostic results was significantly high in masses smaller than 3 cm (6 vs. 1, P < 0.002). Patients with non-diagnostic result were younger than those with malignant cytopathology (52 ± 7.5 vs. 66 ± 7.5 years, P < 0.001).. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this procedure concerning Adenocarcinoma were 88%, 100%, 100%, 70% and 90%, respectively.Conclusion:EUS – FNA is an effective and safe procedure in histopathologic diagnosis of pancreatic tumors. This procedure is useful in all pancreatic mass cases including resectable and non-resectable ones.

Background Occult hepatitis B infection is characterized by negative hepatitis B surface antigen (HBsAg) and also detectable hepatitis B virus (HBV) -DNA, with or without hepatitis B core antibody (anti-HBc). HBV reactivation in individuals under immunosuppressive therapy is critical, occurring in occult HBV. Objective In this study, we aimed to determine the prevalence of occult HBV infection among hepatitis B surface antigen negative in cancer patients before receiving chemotherapy. Methods Sera from 204 cancer patients who were negative for HBsAg, were tested for anti-HBc antibodies. The samples that were negative for HBsAg but positive for anti-HBc also examined for HBV-DNA by polymerase chain reaction (PCR). Results Of the 204 HBsAg negative blood samples, 11 (5.4%) samples were positive for anti-HBc antibodies. HBV-DNA was detected in 9/11 (81%) of anti-HBc positive samples. Occult HBV infection in hematological cancers was more than solid cancers, 4.8% and 4.3% respectively. There was no significant difference in HBc antibody positivity based on vaccination, previous blood transfusions, history of familial hepatitis or biochemical parameters (ALT, AST, total and direct bilirubin levels) (P>0.05). Conclusion Screening of occult HBV infection by HBsAg, HBV DNA and anti HB core antibody should be suggested as a routine investigation in cancer patients before receiving chemotherapy.

We report a 36-year-old female with longstanding oily diarrhea and new-onset dysphagia that was diagnosed as celiac disease and esophagus adenocarcinoma. Celiac is a multisystemic autoimmune disease associated with a longstanding inflammatory process, especially in the gastrointestinal tract. This chronic inflammation may lead to a modest increase in neoplasia risk. There is a modest increased risk of malignancy in celiac disease, particularly adenocarcinoma and T-cell lymphoma of the small intestine and squamous cell carcinoma (SCC) of the esophagus, mouth, and pharynx. Although there is an association between SCC of the esophagus and celiac disease, there are no reports in the English literature about a relationship between celiac disease and esophageal adenocarcinoma. This case shows that as well as SCC, adenocarcinoma of the esophagus may also occur in patients with longstanding celiac disease.

Background: The conventional method for testing Hepatitis B (HBsAg) can be not detected  occult Hepatitis B in patients. No diagnosis of hepatitis B in patients with lupus nephritis and glomerulopathy treated with Immunosuppressive drugs, can be clear Hepatitis B. Also, due to the possible role of occult Hepatitis B in the lack of a complete response to treatment and continue proteinuria Assess the prevalence of occult Hepatitis B in these patients is important.in this study we decided to the survey Prevalence of occult hepatitis B in patients with lupus nephritis and glomerulopathy referred to SHAHID SADOUGHI Hospital in Yazd.Methods: This study was a descriptive-cross sectional study. A total of 112 patients with lupus nephritis and glomerulopathy referred to internal department, nephrology and rheumatology clinic of SHAHID SADOUGHI Hospital in five-year period studied. HBsAg, HBsAb was measured in patients and those with HBsAg positive and HBsAg negative HBV-DNA was measured. Demographic was collected in the questionnaire that already provided. The collected data were entered into SPSS version 20, using statistical tests were analyzed.Result: The results showed that the mean age of participants was 40.84 ± 15.11 years. From 112 patients participated in the study,49 patients (43.8%) were men and63 patients (56.2%) were female. Also from 112 patients,97 patients (86.6%) had primary glomerulopathy and 15 patients (13.4%) had lupus nephritis. The prevalence of occult hepatitis B was 3.0% in patients with primary glomerulopathy and 13.3% in lupus nephritis patients. There was a significant relationship between the frequency of HBc-Ab and the mean age of patients with type of disease (P-value <0.05).Conclusion: The prevalence of occult hepatitis B in patients with lupus nephritis was greater than the prevalence in pateints with gleumeronephritis.

Purpose: To evaluate the efficacy and safety of low dose versus usual dose of Hyoscine during endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods: This randomized, open-label clinical trial included 282 patients undergoing ERCP who had duodenal peristalsis interfering with cannulation. Patients were randomly divided into two groups: Group one and two received low (5 mg) and usual (10 mg) dose of Hyoscine, respectively. Cardiovascular service consultation was performed for all patients before entering the study and performing ERCP. Hyoscine was injected intravenously, and the spasmolytic effect of the drug was assessed while the papilla was in a completely enface view. The time interval between cessation of peristalsis and its further onset was recorded by the chronometer. Also, patient's heart rate and blood pressure were monitored during ERCP by digital monitoring. Results: The results showed no statistically significant differences in the mean duration of peristalsis, the duration of the antispasmodic activity and the time required to increase the heart rate between two groups (P=0.38, P=0.48, P=0.32, respectively). No significant differences were observed regarding the average of heart rate and mean arterial blood pressure (MAP) before drug administration between the two groups (P=0.182 and P=0.29, respectively), but after the drug administration, tachycardia and hypotension were significantly higher in the second group (P=0.007 and P=0.001, respectively). There was no statistically significant difference in the frequency of arrhythmia between two groups (P=0.08). The results also showed that tachycardia and hypotension occurred more frequently in men and elderly patients (P <0.05). Conclusion: A low dose of Hyoscine is as effective as the usual dose and its side effects such as alteration in blood pressure and heart rate are much fewer, especially in men and elderly patients.