Tehran University Medical Journal

---

Background: Helicobacter pylori is a gram negative microaerophilic spiral bacilli, which causes duodenal and gastric ulceration. Also this organism cause distal gastric adenocarcinoma and primary gastric lymphoma. The most important Helicobacter pylorus virulence factor is cytotoxin associated gene A (cagA) Pathogenicity Island that cause secretion of antibody by stimulation of immune system. Measurement of the serum antibody can be used to diagnosis strain of Helicobacter pylorus that causes peptic ulcer disease (PUD). Serological discrimination between strain types would reduce the need to emergent endoscopic studies. The aim of this study was comparison of serum anti-CagA antibodies of patients with peptic ulcer disease and patients with Non-ulcer dyspepsia. Methods: This case-control study was carried out from october 2011 to october 2012, in 130 patients who complained of dyspepsia more than six months and referred to gastroenterology and endoscopic ward of Firoozgar Hospital, Iran University of Medical Sciences, Tehran. Serum sample obtained from all patients. Anti-CagA antibodies levels were measured in serum samples using ELISA technique. Patients with peptic ulcers as cases and patients without peptic ulcer in endoscopy study were considered as controls. Results: One hundred thirty patients were enrolled in the study and equally two groups (65 patients in case group and 65 patients in control group). Fifty nine subjects of case group (90.76%) and 37 subjects of control group (56.92%) had positive serum anti-CagA antibody (P= 0.003). Sixty one percent of anti-CagA antibodies positive patients and 17.6% of anti-CagA antibodies negative patients had peptic ulcer (P= 0.003). (Odds ratio= 7.4 95%CI: 2.8-19.7 P= 0.003). Conclusion: The detection of CagA antibodies as an additional and noninvasive test in association with determination of serum anti-CagA antibodies, could help better detection of risk factors of peptic ulcer disease. Also it can reduce the emergency endoscopy process. We can use this technique in patients with dyspepsia who had no warning signs or malignant disease and not taking a nonsteroidal anti-inflammatory drugs in primary care of clinical practices.

---

Background: High-resolution manometer (HRM) of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4). It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification.

Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma) and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4) ≤ 15 mmHg were studied.

Results: Our finding showed that the non-achalasia esophageal motility disorders (58%) was more common than the achalasia (18.2%). Heartburn (68.5%), regurgitation (65.4%) and non-cardiac chest pain (60.6%) were the most common clinical symptoms. Although, vomiting (91.7%) and weight loss (63%) were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2%) was the most common, absent peristalsis (97%) and the hyper-contractile esophagus were rarest in the non- achalasia esophageal motility disorders.

Conclusion: However, achalasia is a treatable esophageal motility disorder but non-achalasia esophageal motility disorders were more common. Thus, manometrial study is an imperative tool for proper diagnosis and treatment of these patients, especially in gastro-esophageal reflux disease. Clinical finding could not accurately diagnosis between different types of non-achalasia esophageal motility disorders from each other’s.