Tehran University Medical Journal

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Background: Helicobacter pylori (Hp) infection often occurs in childhood and adolescence, with the frequency increasing with age. Hp infection is associated with insufficient hygiene, overcrowding and low socioeconomic status. Although declining in developed countries, children in the developing countries continue to have a high prevalence of Hp infection. As the association of Hp infection with chronic abdominal pain is not ubiquitously accepted, in this study we investigate the significance of endoscopic finding associated with Hp infection in children with abdominal tenderness.

Methods: This cross-sectional study included 1,665 healthy children, aged 6 to 12 years, in whom Hp infection was evaluated using the IgG anti-H. pylori test. Hp-positive children with epigastric tenderness underwent upper gastrointestinal (GI) endoscopy. Urease activity of gastric mucosal biopsies was measured. The presence and density of Hp organisms, the presence of follicular gastritis, and the nature of inflammation and gastritis activity were assessed by histologic examination.

Results: Of 1665 children, 429 (26%) subjects (51% girls, 49% boys) were seropositive for H. pylori. There was a significant association between Hp infection and older age (p<0.001) and male/female ratio (p<0.05). Epigastric tenderness was detected in 39 children (1%), 29 of whom underwent upper GI endoscopy. Nodular gastritis with antral erythema was the most common endoscopic finding (26/29 89.7%). Histological findings revealed that, in all cases with endoscopic nodularity, lymphoid follicles were present. Bacterial density was low in 13 (44.8%), moderate in 14 (48.2%) and high in 2 (7%) subjects.

Conclusion: The findings of the present study demonstrated that antral nodularity is the most common feature in children with Hp infection and epigastric tenderness was significantly associated with histological findings of lymphoid follicles.

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Background: Laryngotracheal stenosis is one of the most challenging problems for otolaryngologists. Several methods were developed to treat this problem. However, in many cases, this symptom could be recurred and the patients would suffer from operations for treatment. In this survey, the effect of topical mitomycin-C after laser therapy and dilatation for preventing laryngotracheal stenosis is considered. Methods: Twenty three cases suffered from laryngotracheal stenosis were studied in a clinical trial between years 2006-2007 in Amir-alam educational Hospital in Tehran, Iran. The patients were divided into two groups. In 12 patients (case group), we used topical mitomycin-C (1mg/ml for 4 min) after dilatation and laser therapy, and in 11 of them (control group), this solution was not used. All patients were controlled by endoscopy one and three months later, and then followed up. The results of this study were compared statistically. Results: In the control group after treatment (dilatation and laser), the average changed- vertical and horizontal lengths of stenosis were 0.47±0.77mm and 0.50±0.60mm respectively. However in the control group these changed averages were 2.28±1.15mm and 2.23±1.03mm, respectively after treatment (p<0.0001). The average changed cross section between the two groups were different significantly (p<0.0001), too. Conclusions: In the laryngotracheal stenosis, the use of topical mitomycin-C could reduce the recurrence of the stenosis after dilatation and after the laser procedures. In addition, the need for repeated therapy will be reduced.

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Background: Percutaneous endoscopic gastrostomy (PEG) is one of the ways to non-oral feeding in patients with dysphagia caused by conditions such as stroke, oropharyngeal malignancy and motor neuron disease. The aim of study was assessment of early outcome of PEG in hospitalized patients according to clinical situation and underlying disease.
Methods: This study was cross- sectional and prospective. Sixty five patients were included with PEG from April 2011 to July 2012, at Sina University Hospital, Tehran, Iran. Tube function, feeding, and patients' symptoms were assessed and patients were followed six month at least to one year after procedure .The follow up of patients were stopped if the patient died or removal of tube.
Results: Sixty five patients (33 men, 32 women) enrolled in this study. The mean age of patients was 57.45±16.83 years (19-94 years). Head trauma and postoperative thoracic surgery were in 15 (23.1%) and 4 (6.2%) cases. 36 of patients (55.39%) had no symptoms. The complications include lickage (11 cases), stenosis (9 cases), cellulitis (7 cases), and PEG separation (2 cases). A total of 29 patients were complicated and 21 patients (72%) of them complicated 2 -5 months after PEG. No statistical significant differences between two sexes in PEG complication. 27 patients (41%) died that have no relation to complications of PEG.
Conclusion: Finally, the study showed the PEG is a safe method to enteral nutrition. The advantages of this method include its simplicity, no need to general anesthesia and low rate of complications especially in inpatient under the supervision of medical staff. Therefore it can be used as a favorable method.

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Background: Lack of precise diagnostic criteria and sufficient findings in support of biopsy sampling during upper gastrointestinal endoscopy is one of the special challenge in endoscopy assessment in Barrett's esophagus. The aim of this study was to evaluate the mucosa in the distal esophagus tissues through a biopsy during upper gastrointesti- nal endoscopy in gastroesophogeal reflux disease patients whose symptoms don't im- prove or only partially resolve with treatment. Methods: A cross-sectional study was done in patients with gastroesophogeal reflux disease medically resistant to treatment. The patients were assessed by gastroenterology department in Sina Hospital, Tehran, Iran, since September 2012 to September 2013. Patients with coagulopathy, esophageal varicose, esophageal cancer, earlier detection of developing Barrett's esophagus, history of irritable bowel syndrome, psychological dis- orders and using of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, were excluded. Esophageal squamous epithelium and cylindrical tissue of stomach was carefully checked by endoscope. Then 2 to 4 biopsy of the Z-line above the gastroe- sophageal mucosa were obtained. Results: One hundred and fifty three patients included 78 men (51%) and 75 females (49%) with a mean age of 47.92±17.57 years participated in the study. The mean of body mass index of patients was 25.05±4.17 kg/m2 and body mass index in 45.8 % of the patients more than 230 kg/m2. Biopsy specimens were taken in 31 cases were not enough for histological examination. In other patients, 25 cases (20.5%) were normal and 97 cases (79.5%) had the following pathological diagnosis: mild esophagitis (49 cases 40.2%), moderate esophagitis (24 cases 19.7%), severe esophagitis (14 cases 11.5%), Barrett's esophagus (8 cases, 6.5%), fungal esophagitis (1 cases, 0.8%), and eosinophilic esophagitis (1 cases 0.8%). 117 patients (76.5%) had H. pylori infection. Sensitivity and specifity of endoscopy for detection of Barrett's esophagus during upper gastrointestinal endoscopy were 100% and 84.13% (CI 95%:78.53-89.09%), respec- tively. Conclusion: Our data showed that doing of accurate and adequate biopsy samples from lesions in upper GI endoscopy can be helpful in the diagnosis of Barrett's esophagus

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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.

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