An Overview of the Current Hepatitis B Treatment Strategies after Liver Transplantation.

Currently, liver transplantation (LT) is considered as the only option for the treatment of patients with various causes of liver failure, including patients with chronic hepatitis B virus (HBV) infections. Overall, patients with HBV who undergo LT are at increased risk of hepatitis B infection recurrence. Although the current knowledge regarding the pathophysiology of this infection has been dramatically increased over the past few decades, it is still considered a complex disease process with varying degrees of clinical characteristics and changing patterns over time. There are various treatment strategies for preventing HBV recurrence in the LT setting. Generally, these regimens include oral nucleoside/ nucleotide analogues (NAs), hepatitis B immune globulin (HBIG), and vaccines or the combination of these drugs. The treatment strategy of choice should be based on cost-effectiveness, along with other patients underlying conditions. In this case, studies indicate that potent NAs are more cost-effective than HBIG in most case scenarios. In this article, we aimed to review the general medications used in the prophylaxis of the recurrence of HBV infection after LT.

The Role of Melatonin in Colorectal Cancer.

The prevalence and mortality rate of colorectal cancer have been dramatically rising globally. Currently, colorectal cancer is emerging as the fourth leading cause of death and the third most common malignancy worldwide. The major drawback in colorectal cancer treatment is related to severe adverse events of both chemotherapy and radiation therapy that lead to toxicity and inflammation. Recently, melatonin as an antioxidant, immune-stimulant, and antimutagenic agent has been noticed. Different studies worked on the molecular role of melatonin on carcinogenesis progression. Overall, the anticancer activity of melatonin, combined with its actions via multiple signaling pathways, is considered hugely exciting to use this drug as a possible treatment strategy to cure cancer. Apart from its anticancer potential, this drug has shown to induce modulation of chemotherapy toxicity and improving its therapeutic efficacy. The present review aimed to discuss the possible role of melatonin usage in management of colorectal cancer.

Successful Removal of a Biliary Stent in the Jejunum Using Double-Balloon Enteroscopy.

BACKGROUND: Plastic biliary stent placement has been widely used as a safe approach for the management of hilar neoplasms or the dilation of benign biliary obstruction. Despite the complexity of this procedure, this approach is followed by a few complications. The incidence rate of stent migration is about 10%. In a majority of cases, the migrated stents are retained within the gastrointestinal tract and pass through the intestine with no complication or need for medical intervention. CASE REPORT: In this paper, we described the case of the migrated biliary stent with prolonged abdominal pain, which was removed successfully by using double-balloon. CONCLUSION: In the case of patient with prolonged abdominal pain and previous history of biliary stent placement, migration of stent should be considered as differential diagnosis and Double-Balloon Enteroscopy can be a safe approach in those cases.

Association of interleukin-1 gene polymorphism with risk of gastric and colorectal cancers in an Iranian population.

BACKGROUND: Chronic inflammation is associated with neoplasms and several types of cancer. Therefore, polymorphisms in the inflammation-related genes could modify the cancer susceptibility. OBJECTIVE: To investigate the associations between IL-1RN VNTR and rs419598 polymorphisms in IL-1 receptor antagonist (IL-1ra) and colorectal cancer (CRC) and gastric cancer (GC) in an Iranian population. METHODS: In this study, 126 cancer cases (91 CRC and 35 GC) and 97 healthy controls were included. Genotyping of IL-1RN VNTR and rs419598 was performed by PCR amplification and PCR-RFLP, respectively. Logistic regression was applied to identify the independent risk factors for colorectal and gastric cancers by computing the odds ratio (OR) and 95% confidence intervals (95% CI). All statistical analyses were performed using the SPSS statistical software. RESULTS: There were significant differences between cancer groups and control group concerning the frequency of A1/A2 genotypes in IL-1RN VNTR polymorphism. The carrier status of IL-1RN* 2 allele was associated with increased risk of CRC (p = 0.0003; OR = 0.02; 95% CI: 0.491-0.85) and GC (p = 0.0006; OR = 0.106; 95% CI: 0.321-0.035). Also, the homozygous ILRN *2/*2 genotype was associated with increased risk of gastric cancer (p = 0.04; OR = 0.133; 95% CI: 0.020-0.908). There was no association between different alleles of rs419598 and CRC and GC. CONCLUSION: This study demonstrates an association between the carrier status of IL-1RN* 2 and CRC and GC in an Iranian population.

Effect of general anesthesia during GI endoscopic procedures on patient satisfaction.

AIM: To compare the conventional GI endoscopy and using general anesthesia during the procedure regarding the satisfaction and acceptance among Iranian patients. BACKGROUND: Ability to measure and assess the patients' satisfaction with colonoscopy and upper endoscopy will improve the quality of health care provided by gastroenterologists and thus resulting in better acceptability of endoscopy. PATIENTS AND METHODS: In a prospective, multicenter, non-randomized clinical trial 756 patients were included between 2009 and 2010. A satisfaction developed questionnaire was answered by the patients who were candidate for elective upper and/or lower GI endoscopy within 72 hours after the procedure. Total satisfaction score was measured and compared between endoscopy patients with and without anesthesia. Different variables analyzed in order to find the influencing factors in patient satisfaction during the endoscopic procedures. RESULTS: The mean age of patients was 40.7 ± 15.1 years and 59% of them were female. Overall, 50.5% of patients underwent general anesthesia during the endoscopic procedure. There was a significant correlation between education level and satisfaction with the endoscopy. Also, anesthesia during endoscopy significantly increased the total satisfaction score of the patients (OR= 2.07, 95% CI: 1.24-2.9, P < 0.0001). CONCLUSION: The level of patient's education and using anesthesia during GI endoscopy were two factors influencing the total patient satisfaction with the endoscopic procedures. Thus, we suggest using anesthesia for GI endoscopic procedures.

Evaluation of patients' satisfaction with anesthesia in gastrointestinal endoscopic procedures in Iran.

AIM: The purpose of this study was to assess satisfaction level and related factors among patients who had an anesthesia during endoscopic procedures; and also validate a questionnaire for evaluating satisfaction with anesthesia. BACKGROUND: The level of patient satisfaction with GI endoscopic procedure is an important criterion to indicate the level of expertise in endoscopy. PATIENTS AND METHODS: We performed a prospective descriptive study at Resalat Hospital, Tehran, Iran. Three hundred seventy nine elective patients undergoing anesthesia for GI endoscopy procedure in 2010 were recruited. A 20-item questionnaire was used to evaluate the satisfaction with the anesthesia. The questionnaire was answered within 72 hours after the procedure. The satisfaction was graded into four major groups: anesthesia delivery, procedural recall, side effects and global satisfaction. RESULTS: The level of satisfaction with anesthesia and its related factors were determined. The mean score of satisfaction with anesthesia delivery, procedural recall, side effects, global satisfaction, and total satisfaction (question 1-16) were 6.15 ± 1.23, 5.65± 1.48, 5.24± 1.16, 5.01± 1.29, and 5.46± 1.14, respectively. There was a significant difference in patients' satisfaction level between different jobs (p=0.02) as well as different levels of education (p=0.01). CONCLUSION: Higher educational level was accompanied with greater satisfaction. The highest satisfaction score was seen among retired patients and the lowest level was found in housekeepers.

H pylori infection among 1000 southern Iranian dyspeptic patients.

AIM: To describe the frequency of H pylori infection among 1000 southern Iranian dyspeptic patients. METHODS: A prospective study was performed in a referral hospital in south of Iran from 1999 to 2005. One thousand dyspeptic patients (518 males, mean +/- SD age of 49.12 +/- 12.82 years) consecutively underwent upper gastrointestinal endoscopy. Multiple gastric antral biopsy samples were taken from all patients for rapid urease test and histopathologic examination (96.9% satisfactory samples). Patients were considered H pylori-infected if one or both tests were positive. RESULTS: Six hundred and seventy-one patients (67.1%, 95% confidence interval [CI]: 64.2%-70.0%) were H pylori-infected. H pylori positivity was significantly more frequent in patients with peptic ulcer disease (PUD) than in those with non-ulcer dyspepsia (P < 0.001). Male-to-female ratio for duodenal and gastric ulcers was 2.7:1 and 1.5:1, respectively. Moreover, the duodenal-to-gastric ulcer ratio was 1.95:1. The frequency of H pylori infection among those with endoscopic diagnosis of gastritis, duodenal ulcer, gastric ulcer, and normal mucosa was 70.1% (398/568), 86.2% (150/174), 71.9% (64/89), and 33.5% (54/161), respectively. H pylori infection, male sex, and older age were independently associated with PUD in multivariate analysis. H pylori positivity was associated with chronic gastritis, and chronic active gastritis with odds ratios of 34.21 (95% CI: 12.19%-96.03%) and 81.21 (95% CI: 28.85%-228.55%), respectively. CONCLUSION: H pylori and PUD are highly frequent in dyspeptic patients from south of Iran. H pylori is a cardinal risk factor for chronic active or inactive gastritis.