Introduction: Stomach cancer is among five common malignancies whose prevalence and incidence are considerably associated with our dietary regime. Thus, the present study aims to conduct a systematic ...review and meta-analysis to evaluate the relationship between coffee drinking and the risk of stomach cancer. Materials and Methods: A comprehensive literature search of the databases, including Barakat Knowledge Network System, Cochrane, IranDoc, Web of Science, PubMed, SID, Magiran, Scopus, and Google Scholar web browser was conducted using standard keywords. Data analysis of this meta-analysis was conducted using STATA 14 software and P<0.05 was considered as a significant level for tests. Results: A total of 24 studies with a sample size of 990605 were reviewed which showed drinking coffee prevents stomach cancer OR=0.89, (95% CI: 0.82, 0.98. However, subgroup analysis by gender found no significant statistical relationship between coffee consumption and stomach cancer risk regarding male or female gender. However, the statistically significant relationship between coffee drinking and stomach cancer risk was assessed in several countries, including Korea, Turkey, Uruguay, Venezuela, and Singapore, with the largest effect being reported in Turkey OR=0.51 (95% CI: 0.39,0.67. Conclusion: Coffee consumption prevents and reduces the risk of developing stomach cancer.
Background and purpose: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder worldwide. Fatty liver is more common in patients with metabolic syndrome, obese people, and type 2 ...diabetic individuals. Liver FibroScan is a non-invasive method to evaluate the stiffness and fibrosis of the liver. This study aimed to investigate the findings of FibroScan; the level of liver enzymes, triglycerides, and cholesterol; and demographic characteristics of patients with fatty liver. Materials and methods: In this descriptive cross-sectional study, 300 patients referred to the Gastroenterology and Liver Specialist Clinic in Sari City over a year (2017-18). The patients who were diagnosed with fatty liver according to ultrasound results were included after ruling out Wilson's disease, hemochromatosis, viral hepatitis, and autoimmune diseases. Demographic findings and laboratory profiles were recorded from the patients' files. The severity of liver steatosis and fibrosis was determined from FibroScan results. Data were analyzed in SPSS16 software. Mean and standard deviation were used to express the distribution of quantitative variables of the studied groups, and frequency and percentage were utilized to describe qualitative data. To compare quantitative data, an independent t-test was conducted, while qualitative variables were compared using the Chi-Square test. Results: The mean age of patients was obtained at 48.10±13.01 years (range: 18 to 83) and their mean body mass index (BMI) was 30.88±5.47. Gender and smoking were not related to the severity of liver steatosis and fibrosis. Steatosis grade of S3 and fibrosis stage of F1 were found in 58.33% and 62% of patients, respectively. BMI and triglyceride levels had a significant relationship with the severity of liver steatosis (P<0.01). Moreover, liver fibrosis development showed a significant relationship with increasing age, BMI, AST, ALT, ALP, and Chol (P<0.05). Conclusion: The majority of the studied patients were diagnosed with a steatosis grade of S3 and a fibrosis stage of F1. Triglyceride level had a significant relationship with the severity of hepatic steatosis. BMI was related to the severity of steatosis and liver fibrosis; therefore, weight loss and triglyceride control are recommended to reduce steatosis and liver fibrosis, and periodic liver FibroScan is suggested to monitor the changes in liver fibrosis.
Introduction: Rheumatoid arthritis is a chronic autoimmune disease with numerous side effects. Since long ago, the impact of fish consumption on treating this disease has been of researchers’ ...interest. Hence, this study aims to examine the relationship between fish consumption and the risk of rheumatoid arthritis through a systematic review and a meta-analysis method. Materials and Methods: For this meta-analysis to reach the research related to the case study, the following databases: PubMed, Scopus, Web of Science, Cochrane, and the Google Scholar search engine were conducted. The data were analyzed using the STATA 14, and the significance level of the tests was P<0.05. Results: There were 2166980 people (20218 cases and 2146762 controls) in this case study, and the age range of the patients was between 18 and 89 years. The studies were published between 1991 and 2022 and estimated the odds ratio (OR) of fish consumption and rheumatoid arthritis as (OR=0.83; 95% CI: 0.78, 0.89). This measure was (OR=0.79; 95% CI: 0.72, 0.87) in six case-control studies and (OR=0.86; 95% CI: 0.78, 0.94) in 7 cohort studies. In addition, the effect of fish consumption on reducing the rheumatoid arthritis development was more in people who had consumed fish 2 or less than 2 times a week compared to people who consumed fish more than 2 times every week. Conclusion: Fish consumption reduces the rheumatoid arthritis extension; therefore, these patients are advised to include fish in their diet.
Background: Various digestive symptoms have been frequently reported in a significant portion of patients infected with the virus since the outbreak of Coronavirus Disease 2019 (COVID-19). Most ...patients with COVID-19 have a fever accompanied by respiratory signs and symptoms, such as cough and dyspnea. We present 36 cases with a chief complaint of Gastrointestinal (GI) symptoms along with respiratory symptoms. In this study, we aimed at investigating the prevalence and outcomes of COVID-19 patients with digestive symptoms.
Methods: A variety of observed GI symptoms included nausea and vomiting (72.2%), diarrhea (25%), abdominal pain (19.4%), loss of appetite (14%), and anosmia (14%). The most nonGI symptoms were dyspnea (66.7%), fever (66.7%), dry cough (58.3%), myalgia (52.4%), and others. Six patients (16.6%) were critically ill, 7 (19.4%) were in stable condition, and 23 patients (64%) showed moderate symptoms. Among the patients, 7 (19.5%) needed critical care and were admitted to ICU. Leucopenia, lymphopenia, and elevated acute-phase proteins were other features observed in these patients. The most common antiviral regimen was hydroxychloroquine and oseltamivir. Finally, 32 patients (89%) were discharged, and 4 (11%) died.
Conclusion: This case series study highlights that patients with COVID-19 are prone to GI symptoms along with fever and respiratory symptoms. Patients may even present with digestive symptoms and without any respiratory symptoms. Hence, clinicians should pay more attention to these patients and help diagnose COVID-19 earlier to start prompt treatment before the occurrence of severe disease.
Background: Helicobacter pylori eradication has still remained a challenge, especially in case of failure to novel treatments. Therefore, we designed a study to evaluate the effects of a modified ...bismuth‐containing quadruple therapy including a short course of furazolidone on a group of patients whose sequential therapy had been unsuccessful.
Materials and Methods: Thirty‐six H. pylori‐positive patients who had previously failed a clarithromycin‐containing sequential therapy enrolled the study. They received pantoprazole (40 mg‐bid), amoxicillin (1 g‐bid), and bismuth subcitrate (240 mg‐bid) for 2 weeks and furazolidone (200 mg‐bid) just during the first week. Eight weeks after treatment, H. pylori eradication was reassessed using C14‐urea breath test.
Results: Thirty five patients completed the study. H. pylori eradication rates were 80.6% (95% CI = 67.6–93.5) and 82.9% (95% CI = 70.6–95.2) according to intention‐to‐treat and per‐protocol analyses, respectively. All patients had excellent compliance to treatment, and no one interrupted therapy owing to adverse effects.
Conclusion: Regarding the eradication rate (>80%), low price, and very low adverse effects, a 2‐week bismuth‐containing quadruple regimen including a short course of furazolidone can be an encouraging regimen for second‐line H. pylori eradication in case of sequential therapy failure. Possibly, it can be improved by alterations in dose, dosing intervals, and/or duration.
The prevalence of peptic ulcer disease in hemodialysis dependent patients is higher than the general population. These patients are also more prone to upper gastrointestinal bleeding. The aim of this ...study was to compare the effects of a standard triple therapy with a sequential therapy on Helicobacter pylori eradication in azotemic and hemodialysis patients.
Forty nine hemodialysis and azotemic patients, naïve to H. pylori treatment, were randomized into two groups to receive either standard triple therapy (pantoprazole 40 mg, amoxicillin 500 mg and clarithromycin 250 mg twice a day for 14 days) or a sequential therapy (pantoprazole 40 mg for 10 days, amoxicillin 500 mg twice a day for the first 5 days and clarithromycin 250 mg + tinidazole 500 mg twice a day just during the second 5 days). H. pylori eradication was evaluated by fecal H. pylori antigen assessment 8 weeks after the treatment.
Of 49 patients, 45 patients (21 in triple therapy group and 24 in the sequential group) completed the study. Based on intention to treat analysis, H. pylori eradication rates were 66.7% (95% confidence interval CI: 47.8-85.5%) in standard triple therapy group and 84% (95% CI: 69.6-98.3%) in sequential therapy group (P = 0.34). Per-protocol (PP) eradication rates were (95% CI: 76.2%. 6-89.3%) 54 and 87.5% (95% CI: 68.8-95.5%), respectively (P = 0.32).
According to Maastricht III consensus report, the results of our study showed that sequential therapy might be a better choice compared with the standard triple therapy in azotemic and hemodialysis patients Iran. We propose to assess the effects of shorter-duration sequential therapy (less than 10 days) for H. pylori eradication.
Celiac disease is an autoimmune disorder resulting from gluten consumption in genetically predisposed individuals. The present study investigated the epidemiological, endoscopic, and ...clinicopathological features of patients with celiac disease in the southern littoral of the Caspian Sea.
140 patients with celiac disease were interviewed and examined regarding demographic characteristics, clinical symptoms, and serologic, endoscopic, and pathological findings.
44 (31.4%) of the patients were male and 68.6% were female. The mean age of the patients at diagnosis was 27.13±13.4 years (ranging from 2 to 60 years). The most common gastrointestinal (GI) symptoms were bloating (47.8%), abdominal pain (47.1%) and diarrhea (30.7%), respectively. Also, 17 (12.1%) patients did not complain of any GI symptoms.18 (12.8%) patients had aphthous stomatitis, 10.7% had dermatitis herpetiformis, 3.6% suffered from itching without a rash, two (1.4%) mentioned psoriasis and one (0.7%) had lichen planus. 19 (19.7%) of the female patients complained of menstrual bleeding disorders, 4% mentioned infertility, and 2% experienced primary amenorrhea. The most common comorbid condition was hypothyroidism in 16 (11.4%) patients. The most common endoscopic finding was duodenal scalloping (37.25%). In addition, 7.8% of the patients had a normal endoscopic appearance. 43 (30.7%) patients were classified as Marsh IIIC, 25.7% Marsh IIIB, 17.8% Marsh IIIA, 12.8% Marsh II and 12.8% were classified as Marsh I.
Since celiac disease can present with non-GI manifestations and the majority of our patients had Marsh III classification, it seems that celiac disease must be considered as a routine screening test in GI clinics, and also, it should be kept in mind as a differential diagnosis in other specialty fields.
The combination of sofosbuvir and daclatasvir is a potent, pangenotypic regimen suitable for mass-scale hepatitis C treatment, especially in resource-limited countries where newer, expensive ...combinations are not available. This combination has been widely tested on genotype 4. However, Phase III trials of this combination in other genotypes have been cost prohibitive. With the introduction of generic, low-cost sofosbuvir and daclatasvir, large-scale studies in resource-limited countries are now possible.
Sofosbuvir at 400 mg and daclatasvir at 60 mg were coformulated into a fixed-dose combination (FDC) tablet (Sovodak, Rojan Pharma, Tehran, Iran). Patients from 46 centers were dosed for 12 or 24 weeks with or without ribavirin, in line with existing guidelines. Responses to treatment were evaluated 12 weeks after the end of treatment (for a sustained virological response at Week 12; SVR12).
There were 1361 patients recruited. Overall, the patients were 21% female, with a mean age of 50 years; 39% were cirrhotic; 22% were treatment-experienced; 47% were genotype 1, 41% were genotype 3, and 2% were other genotypes. The genotype was not known in 10% of the patients. The intention-to-treat and per-protocol SVR12 rates were 94.7% and 98.8%, respectively. The safety profile was unremarkable, treatment was well tolerated, and compliance with the single-tablet regimen was excellent.
The treatment with FDC of sofosbuvir and daclatasvir achieved high SVR12 rates, equivalent to those seen in Phase III trials of other pangenotypic options, and has been conducted at a similar scale in a representative, real-world population at a cost of under $100 per patient, which makes this combination suitable for elimination protocols in resource-limited countries.
NCT03200184.
Background: Sequential regimens have been recently reported to be superior to the standard triple therapies in Helicobacter pylori eradication, but most of these studies were performed in Europe and ...data from developing countries are lacking. So we designed a study to compare a sequential regimen with a bismuth‐based quadruple therapy that contains a short course of furazolidone, in Iran.
Methods: Two hundred and ninety‐six patients with duodenal ulcer and naïve H. pylori infection were randomized into two groups: 148 patients received (PAB‐F) pantoprazole (40 mg‐bid), amoxicillin (1 g‐bid), and bismuth subcitrate (240 mg‐bid) for 2 weeks and furazolidone (200 mg‐bid) just during the first week. And 148 patients received (PA‐CT) pantoprazole (40 mg‐bid) for 10 days, amoxicillin (1 g‐bid) for the first 5 days, and clarithromycin (500 mg‐bid) plus tinidazole (500 mg‐bid) just during the second 5 days. C14‐urea breath test was performed 8 weeks after the treatment.
Results: Two hundred and sixty‐one patients completed the study (137 patients in the PA‐CT and 124 in the PAB‐F group). The results were not statistically different between the two groups in the eradication rates and the severity of side effects. The intention to treat eradication rate was 80.4% in the PAB‐F group and 83.7% in the PA‐CT group. Per‐protocol eradication rates were 88.7% and 89.1%, respectively.
Conclusion: Because the two regimens showed acceptable and similar abilities in H. pylori eradication and because of much higher cost of clarithromycin in Iran, the furazolidone containing regimen seems to be superior. Further modifications of sequential therapies are needed to make them ideal regimens in developing countries.
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