Middle East Journal of Digestive Diseases最新文献

{"title":"A Case of Massive Gastrointestinal Bleeding Due to Abdominal Tuberculosis","authors":"Sai Krishna Reddy Bana, Suja Lakshmanan, Vaasanthi Rajendran, Senthil N, Archa Anna Anil, Nanthakumar L","doi":"10.34172/mejdd.2023.346","DOIUrl":"https://doi.org/10.34172/mejdd.2023.346","url":null,"abstract":"This case is about a complication of abdominal tuberculosis in the form of a massive lower gastrointestinal (GI) bleed, which was timely intervened by angioembolization. A young man in his mid-20s on empirical anti-tubercular therapy (ATT) for abdominal tuberculosis, presented with severe abdominal pain. The patient then developed frank per rectal bleeding, leading to a significant drop in hemoglobin level, requiring multiple blood transfusions. Upper GI endoscopy and colonoscopy findings were inconclusive. Contrast-enhanced computed tomography (CECT) of the abdomen was performed, which revealed a contrast extravasation into the jejunum due to a leak in the jejunal branch of the superior mesenteric artery (SMA), followed by selective SMA angiography (digital subtraction angiography), which was arrested by angioembolization. The patient had multiple abdominal lymphadenopathies with omental nodules. Histopathological examination of the omental nodules revealed epithelioid granuloma with Langerhans-type cells. The patient is currently receiving ATT and is doing well.","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135397900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Albumin Levels Relation to Tumor Aggressiveness in Patients with Hepatocellular Carcinoma from a Tertiary Care Hospital in Pakistan","authors":"Mahrukh Ali, Om Parkash","doi":"10.34172/mejdd.2023.345","DOIUrl":"https://doi.org/10.34172/mejdd.2023.345","url":null,"abstract":"Background: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality in patients with chronic liver diseases (CLDs). Studies have shown a correlation between low serum albumin levels and the aggressiveness of liver cancer. We aimed to determine the prevalence of hypoalbuminemia and its relationship with HCC aggressiveness in our patients. Methods: This study was conducted retrospectively, and data were gathered from the gastroenterology unit of the Department of Medicine at the Aga Khan University Hospital in Karachi, Pakistan. The study included all patients who had been diagnosed with HCC between February 2015 and February 2019. Results: In total, 380 patients with HCC were included in this study. The mean serum albumin level was 2.79 g/dL (SD±0.655) and 318 (83.7%) had serum albumin levels of≤3.5 g/dL. No statistically significant association was identified between albumin levels and parameters of tumor aggressiveness (tumor size, number of tumor nodules, portal vein thrombosis [PVT], and alpha-fetoprotein [AFP] levels) in our patients. Conclusion: We found no association between low albumin levels and parameters of HCC progression in our patients. This highlights the need for additional markers to determine the severity of HCC in underdeveloped populations.","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135399432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interesting Case of Pseudomelanosis Duodeni with Brunner’s Gland Hyperplasia","authors":"Shiraz Salim Khan, Hamid Ullah Wani, Mohammed Zohaib","doi":"10.34172/mejdd.2023.349","DOIUrl":"https://doi.org/10.34172/mejdd.2023.349","url":null,"abstract":"Pseudomelanosis (PM) is a rare disorder characterized by scattered black pigmentation of the intestinal mucosa. PM has uncertain etiology and pathogenesis. It has been linked to several drugs and systemic illnesses. Upper gastrointestinal (GI) pseudomelanosis is an uncommon condition that may be brought on by oral iron consumption, upper GI hemorrhage, end-stage renal failure, or antihypertensive drug use. The duodenal involvement is well described in literature. The lesion is passive but can mimic more alarming entities like malignant melanoma. We describe a 33-year-old woman who had nonspecific dyspepsia, thrombocytopenia, systemic lupus erythematosus, chronic kidney disease, hypertension, and arthritis. Upper GI endoscopy revealed patches of speckled black spots in the duodenum, which were identified as duodenal pseudomelanosis.","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135399431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Syndrome in Celiac Disease: What Does Following a One-Year Gluten-Free Diet Bring?","authors":"Nasrin Motazedian, Mehrab Sayadi, Amirali Mashhadiagha, Seyed Ali Moosavi, Fatemeh Khademian, Ramin Niknam","doi":"10.34172/mejdd.2023.342","DOIUrl":"https://doi.org/10.34172/mejdd.2023.342","url":null,"abstract":"Background: Metabolic syndrome (MetS) is a set of conditions that occur together and increase the risk of cardiovascular disease. Previous studies have linked a gluten-free diet (GFD) to obesity and MetS in some populations. However, others have suggested that weight gain is usually regulated only in underweight individuals with celiac disease (CD). Owing to the lack of sufficient data and the importance of GFD in controlling cardiovascular disease, we surveyed the prevalence of MetS and its components before and after a year of GFD in patients referred to the main celiac clinic in southern Iran. Methods: This was a repeated cross-sectional study conducted on 69 patients with a definite diagnosis of cardiovascular disease who were on follow-up and registered at the Shiraz Celiac Clinic. Demographic, anthropometric, and laboratory measurements at the time of diagnosis and one year after the GFD were extracted from their medical records. Results: The participants’ mean age was 35.53, and 68.1% were women. The prevalence of MetS increased from 5.8% to 11.6% after a year of the GFD; however, this increase was not statistically significant. Waist circumference (WC) and serum triglyceride levels were significantly elevated during the study period. Conclusion: A GFD may contribute to the development of MetS in patients with cardiovascular disease; however, the rate of MetS is still lower than that in the general population. It is critical to educate patients about these potential risks and encourage them to have a healthy lifestyle that includes a balanced diet and physical activity.","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135399435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Liver-Derived Vascular Lesion: Hepatic Hemangioma or Hepatic Epithelioid Hemangioendothelioma?","authors":"Roham Gholami, Moslem Soltani, Naghmeh Salarieh, Pardis Ketabi Moghadam","doi":"10.34172/mejdd.2023.347","DOIUrl":"https://doi.org/10.34172/mejdd.2023.347","url":null,"abstract":"Hepatic epithelioid hemangioendothelioma (EHE) is an uncommon vascular endothelial cell tumor of the liver with numerous symptoms and features. The median affected age is 41, and females are more frequently affected than men. In the following article, a 37-year-old nurse is presented who was referred to the hospital with severe right upper quadrant pain. She had been misdiagnosed with hepatic hemangioma for years, which finally turned out to be hepatic EHE. Liver transplantation has been recognized as the therapeutic method of choice due to the considerable extent of liver involvement and nonresponse to medications.","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"168 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135397898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper and Lower Gastrointestinal Bleeding: A Retrospective Study on 10 Years Experiences in Southeastern Iran.","authors":"Alireza Bakhshipour,&nbsp;Raheleh Rafaiee","doi":"10.34172/mejdd.2023.329","DOIUrl":"https://doi.org/10.34172/mejdd.2023.329","url":null,"abstract":"<p><p><b>Background:</b> Gastrointestinal bleeding (GIB) is an emergency medical situation that is very common, although often benign but can cause considerable morbidity and mortality and health care costs. The aim of this study was to analyze the endoscopic evaluation of upper GIB (UGIB) and lower GIB (LGIB) in Sistan and Balouchestan, southeast Iran. <b>Methods:</b> Data from patients with GIB in a referral university-affiliated hospital in Zahedan, Southeastern Iran during a 10-year period, were obtained. A total of 21884 reports of adult patients' endoscopy and colonoscopy from 2011 to 2020 who were admitted to Ali-Ibn-Abitaleb hospital were studied of which 5862 reports were related to GIB. Incomplete files were excluded. Information on age, sex, and endoscopic diagnosis of the 5053 reports was analyzed and compared using chi-square statistical test. <b>Results:</b> There were 3310 men (65.6%) and 1743 women (34.4%) with a mean (±SD) of age 48.4 (±19.83) years. 3079 patients had UGIB (60.8%) and 1974 patients had LGIB (39.2%). Peptic ulcer (72.8% duodenal ulcer and 27.2% gastric ulcer) was seen as the main reason for UGIB (29.7%) and hemorrhoids were the main reason for LGIB (44.2%). Mallory-Weiss syndrome was significantly common in the age<40 years old, and the incidence rate of malignancy was significantly higher in those aged>40 years old than in the younger age group (<i>P</i><0.001). <b>Conclusion:</b> Peptic ulcer was the most common etiological factor and it was more common in men than in women. Gastroesophageal varices were the second most common cause of UGIB. Hemorrhoids and anal fissures were observed as the most common colonoscopic findings of LGIB. The prevalences of UGIB and LGIB are more common in men than women and increase with age. It is important for physicians to constantly update their information about the spectrum of diseases in their region and their changing over time to provide accurate diagnosis and management timely.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"15 2","pages":"116-120"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/3c/mejdd-15-116.PMC10404084.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9953302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability, Validity, and Transcultural Adaptation of New Persian Version of Celiac Disease Quality of Life Questionnaire.","authors":"Ramin Niknam,&nbsp;Peyman Jafari,&nbsp;Ali Reza Safarpour,&nbsp;Sara Shojaei-Zarghani,&nbsp;Mohammad Reza Fattahi","doi":"10.34172/mejdd.2023.331","DOIUrl":"https://doi.org/10.34172/mejdd.2023.331","url":null,"abstract":"<p><p><b>Background:</b> Health-related quality of life (HRQOL) assessment in patients with celiac disease (CD) leads to understanding the impact of the CD and interventions on the individual and society. The aim of this study was transcultural adaptation and evaluation of the reliability and validity of the standardized questionnaire of celiac disease quality of life (CD-QOL) in the Persian language in southwest Iran. <b>Methods:</b>150 adults with CD were randomly selected from the celiac clinic and Fars Celiac Registry to complete the New Persian version of the CD-QOL questionnaire. Transcultural adaptation of the questionnaire was conducted by a four-step procedure. The internal consistency of the CD-QOL subscales and convergent and discriminant validity were assessed using Cronbach's alpha coefficient and Spearman's correlation, respectively. Construct validity was evaluated by exploratory and confirmatory factor analysis. <b>Results:</b> All domains of the CD-QOL questionnaire had acceptable internal consistency, showing excellent reliability. The scaling success rates for convergent and discriminant validity were also within an acceptable range (87-100%). In the factor analysis model, similar to the original English version, four factors were extracted characterizing the patients' answers (limitations, dysphoria, health concerns, and inadequate treatment). <b>Conclusion:</b> Our Persian version of the CD-QOL questionnaire had high reliability and validity and could be used in clinical practice assessing the CD-specific HRQOL in the Iranian population.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"15 2","pages":"126-132"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/8c/mejdd-15-126.PMC10404082.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9955334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Presentation of Adult-Onset Still's Disease.","authors":"Elham Sobhrakhshankhah,&nbsp;Farhad Zamani,&nbsp;Behdad Behnam,&nbsp;Hossein Ajdarkosh,&nbsp;Amirhossein Faraji,&nbsp;Mahmoodreza Khonsari,&nbsp;Mehdi Nikkhah","doi":"10.34172/mejdd.2023.332","DOIUrl":"https://doi.org/10.34172/mejdd.2023.332","url":null,"abstract":"<p><p>Adult-onset Still's disease (AOSD) is a rare rheumatic disorder with various presentations. It is diagnosed based on the Yamaguchi criteria, besides the exclusion of infectious diseases and other rheumatic disorders and malignancies. Here, we describe a case of a young man, presenting with remittent fever, abdominal pain, and persistent nausea. Further evaluations showed elevated acute phase reactants, abnormal levels of liver transaminase, multiple lymphadenopathies, and pleural effusion. He was finally diagnosed with AOSD and responded well to corticosteroids and methotrexate. We describe the present case to alert gastroenterologists to AOSD as a rare differential diagnosis in patients with persistent gastrointestinal symptoms.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"15 2","pages":"133-135"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/bb/mejdd-15-133.PMC10404086.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9955338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases.","authors":"Niloofar Khoshnam-Rad,&nbsp;Homayoon Vahedi,&nbsp;Anahita Sadeghi,&nbsp;Mansoor Rastegarpanah,&nbsp;Soha Namazi,&nbsp;Amir Anushiravani,&nbsp;Ali Reza Sima,&nbsp;Shabnam Shahrokh,&nbsp;Sudabeh Alatab,&nbsp;Reza Malekzadeh","doi":"10.34172/mejdd.2023.327","DOIUrl":"https://doi.org/10.34172/mejdd.2023.327","url":null,"abstract":"<p><p><b>Background:</b> Pharmacotherapy with biologics and small molecules, as the more effective therapies for moderate to severe ulcerative colitis (UC) and Crohn's disease (CD), is complex. Choosing the best methods for their utilization in order to induce and maintain remission are critical for practicing gastroenterologists. We aimed to develop an Iranian consensus on the management of inflammatory bowel disease (IBD) patients with biologics and small molecules. <b>Methods:</b> A Delphi consensus was undertaken by experts who performed a literature summary and voting process. Quality of evidence was assessed using the Grading and Recommendations Assessment, Development, and Evaluation; and an additional risk of bias-protocol. <b>Results:</b> Following an extensive search of the literature, 219 studies were used to determine the quality of the evidence. After three rounds of voting, consensus (defined as≥80% agreement) was reached for 87 statements. <b>Conclusion:</b> We considered different aspects of pharmacotherapy in this consensus. This guideline, along with clinical judgment, can be used to optimize management of IBD patients.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"15 2","pages":"83-106"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/d2/mejdd-15-83.PMC10404092.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9955340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whipple's Disease; An Overlooked Diagnosis.","authors":"Kerollos Motwade N Kerollos,&nbsp;Bahaa Osman Taha","doi":"10.34172/mejdd.2023.333","DOIUrl":"https://doi.org/10.34172/mejdd.2023.333","url":null,"abstract":"<p><p>Whipple disease is a rare multisystem inflammatory disease. Because fewer than 1000 reported cases have been described, clinical experience with this disorder is sparse. We are reporting a case of a 46-year-old man who presented with fever, weight loss, and polyarthralgia for 2 months, and 1 month of diarrhea. The patient was thoroughly investigated for collagen diseases and COVID-19, with no definite diagnosis. A therapeutic trial by immunosuppressive drugs provided partial remission followed by a marked rebound of the symptoms. His occult blood in stool was positive and subsequent upper endoscopy with proximal small intestinal biopsies showed the pathological features of Whipple's disease. The patient showed a dramatic improvement following treatment with ceftriaxone and trimethoprim-sulfamethoxazole. Despite the rarity of Whipple's disease, its course mimics many rheumatological diseases, inflammatory bowel disease, and COVID-19 disease. It should always be a part of the differential diagnosis of obscure polyarthralgia and chronic diarrhea.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"15 2","pages":"136-138"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/21/mejdd-15-136.PMC10404087.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9953299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}