Distribution pattern of colorectal diseases based on 2300 total colonoscopies.

AIM: We conducted a cross-sectional study to estimate the prevalence of CRD in our area in East Azerbaijan, Iran. BACKGROUND: Colorectal diseases (CRD) include a broad spectrum that varies from benign lesions to malignant and cancerous masses. CRD can be investigated by colonoscopy. Some of these diseases are highly preventable with timely screening and appropriate planning by the healthcare system. METHODS: This is a hospital-based, cross-sectional study by the Gastroenterology Department on patients who underwent colonoscopy between June 2013 and March 2015 in outpatient clinics at private Shahriyar medical center and Imam Reza University Hospital in Tabriz, East Azerbaijan province, Iran. Chi-square analysis and bivariate Pearson correlation coefficient were applied in this study using SPSS 20. RESULTS: During the study period, we recruited 2300 patients (1230 men, 1070 women) with the mean and median (Standard Deviation=SD) age at presentation of 47.10 (0.338) and 47 (16.195) years. The duration of patients' symptoms ranged from 1 to 480 months, with mean and median (SD) values of 26.99 (0.902) and 12 (40.76) months, respectively. Despite at least 20 types of pathologies seen on colonoscopy, normal cases constituted the majority (32.7%).The most serious diseases in the study were IBD (10.9%), polyps (14.4%) and cancers (4.9%). Colonoscopic findings had a significant correlation with patients' age and gender; also, we detected a significant correlation between patients' chief complaint and colonoscopic findings as well as colonoscopic pathology samples. CONCLUSION: Despite the ongoing westernization of lifestyle in our country, the distribution of colorectal diseases in Iran is different from Western population. It is important to recognize the prevalence of these diseases in our area to determine exposure factors for management and planning correctly in health system policies.

The role of Helicobacter pylori and CagA in response to treatment in Iranian Gastroesophageal Reflux Diseases patients.

AIM: This study was conducted to evaluate the influence H. pylori infection and anti-CagA status on the efficacy of Omeperazole 20 m.g. b.d. for patients with endoscopic oesophagitis. BACKGROUND: The influence of Helicobacter pylori (H. pylori) infection and its virulent strain (cytotoxin-associated gene A: CagA) has not been evaluated on efficacy of treatment for patients with erosive oesophagitis in Iran. PATIENTS AND METHODS: One hundred and ten patients (55 H. Pylori positive and 55 H. Pylori negative) with endoscopic evidence of oeosphagitis were enrolled in this interventional study and treated with Omeprazole 20 m.g. b.d. Healing was assessed at repeat endoscopy after 8 weeks of treatment. H. Pylori infection and anti-CagA-IgG (immunoglobulin G) antibodies were determined for each subject by the rapid urease test, pathological assessment and ELISA. RESULTS: At repeat endoscopy, following 8 weeks of Omeprazole 20 m.g. b.d. therapy, endoscopic healing of oesophagitis had occurred in 32 % of the HP +ve patients and 23 % of the HP -ve patients (chi square p < 0.01). Among the HP +ve endoscopic healing occurred resolved in 11 (32.4 %) of the CagA +ve patients and 19 (90.5 %) of the CagA -ve patients. This difference was significant (chi-square p <0.001). CONCLUSION: H. pylori infection and the CagA virulence factor are associated with an increased rate of healing amongst patients with endoscopic oesophagitis treated with Omperazole 20 m.g. b.d. compared to patients without H. pylori infection.

Nitrate Determination of Vegetables in Varzeghan City, North-western Iran.

Background Vegetables play an important role in human nutrition. Nitrate content is a signifi-cant quality criterion to determine characteristic of vegetables. About 80% of nitrate intake in human is from vegetables and fruits. High dietary intake of nitrate is seen as an undesirable be-cause of its association with gastric cancer and infantile methemoglobinemia. Varzeghan, North¬western Iran is one of the cities with high Age-standardized incidence rates (ASR) of gastric can¬cer in Iran. Currently, in Varzeghan there is no available and accurate information describing ni¬trate concentration as one of the important risk factors of vegetables for human consumption. Methods In this cross sectional study totally 11 types of vegetables (cabbage, lettuce, spinach, parsley, coriander, dill, leek, fenugreek, tarragon, fumitory and mint) from several different green¬grocery of Varzeghan were collected in spring (April) and autumn (November and December) 2011 and their nitrate contents were analyzed. Results Mean nitrate contents at the above noted fresh vegetables were 161, 781, 83, 707, 441, 501, 1702, 684, 805, 772 and 191 mg NO3-kg-1 respectively. In none of the 11 fresh vegetables nitrate content were not more than established limitations. Conclusion Nitrate concentrations were below of others reported at different countries. The mean concentration of nitrate at all vegetables in autumn was higher than in spring significantly.

Subsite distribution of gastric cancer in an area of high prevalence--northwest Iran.

BACKGROUND: The aim of the present study was to determine subsites of gastric cancer in East Azerbaijan, Iran-a high incidence region for gastric cancer and Helicobacter pylori infection. METHODS: Data were collected from 2002 through 2007 from patients who sought treatment for gastrointestinal symptoms or signs at a university clinic and subsequently underwent upper gastrointestinal endoscopy. RESULTS: Cancer was diagnosed and histologically confirmed in 362 patients (352 adenocarcinomas). The mean age of the patients was 64.57 +/- 11.32 (range, 16-94 years) and the male-to-female ratio was 2.8:1. The gastric cardia was involved in 40.3% of patients with gastric adenocarcinoma, while the gastric fundus was involved in 3.7%, the gastric body in 49.1%, and the gastric antrum in 24.1% of patients. Complete evaluation for metastasis was possible in 144 patients; 61 were free of metastasis, and most of these patients underwent surgical therapy. Cardia involvement was not associated with the sex or age of patients. CONCLUSIONS: Noncardia gastric cancer is still more frequent in East Azerbaijan, which is likely due to the very high prevalence of infection with Helicobacter pylori. The low rate of cancer involving the fundus is a target for further research on the etiology of gastric cancer.

Clinical predictors of colorectal polyps and carcinoma in a low prevalence region: results of a colonoscopy based study.

AIM: To estimate the prevalence of colorectal cancer (CRC) in patients with long lasting colonic symptoms undergoing total colonoscopy; and to establish clinical features predicting its occurrence. METHODS: This prospective study was carried out in Imam Hospital, Tabriz University of medical sciences, Iran. Continuous patients with long lasting lower gastrointestinal tract symptoms who had the criteria of a colonoscopy were included. The endoscopist visualized the caecum documented by a photo and/or a specimen from terminal ileum. RESULTS: Four hundred and eighty consecutive symptomatic patients [mean age (SD): 42.73 (16.21)] were included. The prevalence of colorectal neoplasia was 15.3% (34 subjects) and 37.7% (181 subjects) had a completely normal colon. Adenomatous polyps were detected in 56 (11.7%) patients, in 12.3% of men and 10.9% of women. The mean age of the patients with a polyp was significantly higher than the others (49.53 +/- 14.16 vs 41.85 +/- 16.26, P = 0.001). Most of the adenomatous polyps were left sided and tubular; only 22.5% of polyps were more than 10 mm. Cancer was detected in 16 (3.6%) of our study population, which was mostly right sided (57.2%). The mean age of patients with cancer was significantly higher than the others (60.25 +/- 8.26 vs 42.13 +/- 16.08, P < 0.005) and higher than patients with polyps [60.25 (8.26) vs 49.53 (1.91) (P < 0.0005)]. None of the symptoms (diarrhea, abdominal pain, rectal bleeding, constipation, altering diarrhea and constipation, history of cancer, known irritable bowel disease, history of polyp and fissure or family history of cancer) were predictors for cancer or polyps, but the age of the patient and unexplained anemia independently predicted cancer. CONCLUSION: Less advanced patterns and smaller sizes of adenomas in Iran is compatible with other data from Asia and the Middle East, but in contrast to western countries. Prevalence of colonic neoplasia in our community seems to be lower than that in western population. Colonic symptoms are not predictors for polyps or cancer but unexplained anemia and elder age can predict CRC.

Colorectal neoplasms in symptomatic patients without evidence of bleeding: a prospective study in an Iranian population.

BACKGROUND: Colorectal cancer (CRC) is a preventable disease with a high mortality and morbidity. Data on its prevalence are lacking in Iran, as well as for adenomatous polyps. This study was conducted to estimate prevalence of CRC in patients with long lasting colonic symptoms (except for known risk factors for cancer and those with rectal bleeding) who underwent total colonoscopy. METHODS: This prospective study was carried out in Imam Hospital, Tabriz University of Medical Sciences, Iran. The recruitment procedure involved 228 individuals aged more than 30 who visited a gastroenterologist because of lower gastrointestinal tract symptoms and had criteria for a colonoscopy. The endoscopist visualized the caecum in all, documented by a photo of caecum and/or specimen of the terminal ileum. The Chi square test and multiple logistic regression analysis were used to determine the significance of associations between different symptoms and colonoscopic findings. RESULTS: Thirty four subjects (14.9%) were found to have colorectal neoplasia and 112 (49.1%) had a completely normal colon. Adenomatous polyps were detected in 27 patients, which included 15.6% of men and 7.0% of women. Most of them were tubular (58.3%) and severe dysplasia was reported in only 3 cases (11.1%). Mean age of patients with a polyp (51.1+/-12.5 years) was not significantly different compared to others (p=0.381) nor mean duration of symptoms (21.1 months, p=0.435). Cancer was detected in 7 (3.1%) of our study population, the mean age of 65.7+/-6.0 years in this case being significantly elevated (p<0.0005). None of the symptoms were predictors of cancer or polyps. This result was the same by a multivariate analysis including age, gender and duration of the symptoms. CONCLUSION: The low prevalence of colorectal neoplasms as well as the less advanced pattern of adenomas in Iran are compatible with other data from Asia and the Middle East, contrasting with western countries.

Clinicopathologic characteristics of esophageal cancer patients in northwest Iran--very low incidence of adenocarcinomas.

AIMS: Iran is one of the known countries with a high incidence of esophageal cancer in Asia . We have recently shown that the incidence of Barrett's esophagus, a precancerous lesion for esophageal adenocarcinoma (AC) is very low in the northwest of the country. Therefore, we hypothesized that esophageal AC would also be lower than in the Western world. The aim of this study was to assess the clinicopathologic characteristics of esophageal cancer in comparison the data from western populations. METHODS: This mixed (prospective-retrospective) study enrolled 350 consecutive patients with esophageal cancers (216 endoscopically and pathologically documented, including 134 surgically proven cases) from May 2000 to May 2006, in our referral center in Tabriz, in the northwest of Iran. We localized the tumors in esophagus and esophago-gastric junction. Type III gastric cardial cancers were excluded. RESULTS: The mean age of the patients was 61+/-12.36 (min 16, max 83). The male to female ratio was almost equal (51.7% vs 48.3%). The lower third of the esophagus was involved in 62% of the patients and esophageal ACs accounted for 18.9% of the cases. However, distinct esophageal adenocarcinomas was only seen in two and in the remainder gastric cardia was also involved. SCC was more frequent in females, and adenocarcinoma in males (x 2=8.89, df=2, p=0.012. Among 134 operated cases, resection was feasible in 74.6%. CONCLUSION: In this Iranian population, the incidence of esophageal adenocarcinoma is very much lower than in Western countries.

Distribution of cancer and adenomatous polyps in the colorectum: study in an Iranian population.

OBJECTIVE: There is consensus that the majority of colorectal carcinomas (CRCs) arise from adenomatous polyps. Therefore, for management of colorectal cancer, diagnosis and endoscopic resection of adenomas is advised. If the same etiologic factors are operating for polyps and cancers their anatomical distributions should be the same. The present study was conducted to determine whether the distribution of adenomas is consistent with that of CRCs and for comparison with other studies, especially in Western populations. MATERIALS AND METHODS: We reviewed, retrospectively , endoscopically reported anatomic sites of all adenomatous polyps and CRCs which were histologically confirmed from Jan 1992 to Dec 2005 in Tabriz, the North-west of Iran. One hundred and forty-three CRC's and 180 adenomatous polyps (in 145 patients) were found. Patients with polyposis syndromes were excluded the analysis. Age and sex of patients, size and anatomic sites of polyps and cancers were studied. RESULTS: The average ages of patients with adenomas and cancers were 46.3(SD 14.7) and 53.9(SD 13.3)years, with 55.5% and 62.2% in males, respectively. In both cancer and adenoma cases the most common presenting symptoms were rectal bleeding and bloody diarrhea ( 52.4% , 16.9% and 39.2% , 15.8% for cancers and adenomas, respectively) without any significant difference(0>05). The vast majority of adenomas (85%) and cancers (81.7%) were left sided (p>0.05). The propensity for polyps to be found in the descending colon was of borderline significance (p=0.07). The cecal segment uniquely demonstrated cancers(p=0.01) without any polyps. CONCLUSION: A similar anatomic distribution pattern and left shift of colorectal adenomas and cancers in this Iranian population is compatible with most other Asian countries. However, because of the occurrence of the neoplasms in the right colon total colonoscopy should still be considered for screening purposes.

Endoscopic and histologic findings in Iranian patients with heartburn.

BACKGROUND: Heartburn is a common manifestation of gastroesophageal reflux disease. Barrett's esophagus and esophageal adenocarcinoma, known complications of this disease, appear to be less prevalent in Asia than in Western countries. We looked for endoscopic and histologic evidence of Barrett's esophagus in Iranian patients with heartburn. METHODS: During September 2001 to September 2003, endoscopy was done in all patients with heartburn, either lasting longer than 3 months (n=1182) or for 1-3 months but resistant to 4 weeks of omeprazole therapy (n=66). Biopsy was taken from columnar-lined mucosa above the GE junction, at 5 cm above the Z line in normal- appearing mucosa, and from any abnormal areas. RESULTS: Of the 1248 patients (mean age 45 [SD 15.5] years, 750 men; duration of heartburn 68 [SD 87.5] months), 960 (66.5%) had erosive esophagitis and 30 (2.4%) had Barrett's esophagus, including 10 and 20 with long- and short-segment involvement, respectively. Of 134 patients with normal-appearing mucosa, 122 had histologic evidence of esophagitis. CONCLUSION: Barrett's esophagus may be less common in Iran than in Western countries, despite presence of severe heartburn and erosive esophagitis.

Demographic and anatomical survey of colorectal polyps in an Iranian population.

OBJECTIVE: Asian countries generally have low incidences of colorectal cancers (CRCs). One approach to prevention is based on recognition and removal of polyps. The aim of this study was to determine basic demographic features, anatomic distribution and characteristics of colorectal polyps in a local Asian population for comparison with western data. METHODS: We here performed a retrospective chart review of 194 patients with colorectal polyps detected by endoscopy [total colonoscopy in 136 cases (73.1%), and flexible sigmoidoscopy in the remainder] during 1992-2005, focusing on descriptive statistics for categorical variables, including distribution pattern and histology. Cold biopsy in 14 cases, piecemeal endoscopic resection in 5 patients, and usual snare polypectomy in the remainder were performed. Patients with polyposis syndromes were excluded from the analysis. RESULTS: The average age of patients was 43.2 yr (range 2-80) with 71% being males. Most of the polyps were presented in 5th decade (p=0.029). A total of 32 (17.2%) had synchronous proximal polyps (15% adenomas), and 154 cases had solitary polyps. The vast majority of the polyps were left sided and the most frequent type was adenoma (63%), with a villous component in 37.1%. Coexistent cancer was seen in 10.9% of cases. CONCLUSION: In this Iranian population, the majority of polyps are left sided. The incidence of adenomas and their histology appear comparable to data for western patients, but with a significantly lower rate for synchronous neoplastic lesions.