Profile and frequency of p53 gene alterations in gastritis lesions from Iran.

BACKGROUND: It has been frequently shown that p53 alterations have an important role in the development of gastric cancers but there is no data on p53 alteration in gastric cancer and its precancerous lesions from Iran although this country experiences one of the highest gastric cancer incidence and mortality rates in the world. The purpose of this study was to do a comprehensive assessment of p53 alterations in the Iranian population of gastritis patients and to evaluate the association between p53 alterations, microsatellite status and clinicopathological aspects. METHODS: After DNA extraction, PCR sequencing was done for exons 2-7. Also microsatellite status was evaluated using five microsatellite markers: NR-27, NR-21, NR-24, BAT-25 and BAT-26. RESULTS: The highest rate of alteration was seen in codons 72 (85.6%, SNP) and 248 (30.9%, mutation). Also, we found 2 new mutations in codons 9 and 146. In contrast with previous work, transition at the CpG codons was relatively rare. Nucleotide alterations were more prevalent in the Helicobacter pylori-positive group but not significantly. Neither nuclear staining for p53 protein nor microsatellite instability was seen in gastritis lesions. CONCLUSION: p53 alterations might contribute to the pathogenesis of gastritis and perhaps gastric cancer in Iran. However, the different spectrum seen here implies other mechanism(s) in gastritis and gastric cancer development in the Iranian population.

Evaluation of global genome methylation in gastritis lesion and its correlation with clinicopatological findings.

Global genome hypomethylation as an epigenetic phenomenon may induce (pre)neoplastic transformation through inducing chromosomal and genomic instability and activating oncogenes. Global genome hypomethylation has a fundamental role in early stages of tumorigenesis but little is known about this epigenetic event in gastric precancerous lesions such as gastritis. Therefore, we decided to evaluate this issue in gastritis lesion for obtaining new insight toward molecular biology of gastric cancer. Here we used a technique composed of restriction enzyme digestion and pyrosequencing known as luminometric methylation assay to evaluate this issue. DNA obtained from normal and gastritis lesions was digested with HpaII (sensitive to methylation in its cut site) and MspI (insensitive). Overhangs resulting from these enzymes then fill in by polymerase extension assay using pyrosequencing instrument. Nucleotide incorporation during polymerase extension generates light, which expresses as pick in the pyrogram. By comparing the height of picks obtained form both enzymes it can be possible to evaluate and compare global genome methylation level of gastritis and normal tissues. If the target site is fully methylated, the HpaII/MspI (their pick height) will approach zero. If not, this ratio will be around 1. In the other conditions this ratio varies between 0 and 1. Comparing the ratio of normal and gastritis sample, it can be inferred whether or not gastritis is hypomethylated. This study was performed on 83 gastritis and normal adjacent tissues. The patients included 34 male and 49 female and were 15 to 83 years old. According to our study, gastritis tissue was hypomethylated more than the normal tissue (p = 0.028). Global genome methylation has no significant correlation with MSI, pathological findings, age, and gender. We conclude that global genome hypomethylation occurs in the gastritis level. This reduction probably continues in the next steps toward gastric cancer and may induce other epigenetic and/or genetic changes (such as MSI) that promote carcinogenesis.

Gastric atrophy: use of OLGA staging system in practice.

AIM: This study used the OLGA system to characterize the histology pattern of gastritis in dyspeptic outpatients with a mean age of 45 years from regions with different gastric cancer risks. BACKGROUND: Several classification systems have been purposed for understanding the status of the gastric mucosa. Currently, the Sydney system is the most widely employed. Nevertheless, the applicability of the Sydney system in therapeutic and prognostic areas is a matter of debate. Given this shortcoming an international group of gastroenterologists and pathologists developed a new system named Operative Link on Gastritis Assessment (OLGA). PATIENTS AND METHODS: In this cross-sectional comparative study the OLGA system was used to characterize the histology pattern of gastritis in 685 dyspeptic patients referring to the department of gastroenterology of a training hospital. RESULTS: No significant correlation was found between active inflammation and total OLGA score (P > 0.05). Also, no statistically significant correlation was found between activity and intestinal metaplasia, dysplasia, atrophy, and cancer (P > 0.05). Even though, there is a positive correlation between mild chronic inflammation and total OLGA score, no correlation has been identified between chronicity and dysplasia or cancer (P > 0.05). Nearly, In all cases with no dysplasia OLGA score was zero but all patients with gastric cancer OLGA score was more than two. CONCLUSION: Generally, the activity is not a useful factor in predicting prognosis and its loss of relation with total OLGA score does not make OLGA score any less predictable.

Is ESR Important for Predicting Post-ERCP Pancreatitis?

BACKGROUND: Pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), resulting in substantial morbidity and occasional mortality. There are notable controversies and conflicting reports about risk factors of post-ERCP pancreatitis (PEP). AIM: To evaluate the potential risk factors for PEP at a referral tertiary center, as a sample of the Iranian population. MATERIALS AND METHODS: Baseline characteristics and clinical as well as paraclinical information of 780 patients undergoing diagnostic and therapeutic ERCP at Taleghani hospital in Tehran between 2008 and 2012 were reviewed. Data were collected prior to the ERCP, at the time of the procedure, and 24-72 hours after discharge. PEP was diagnosed according to consensus criteria. RESULTS: Of the 780 patients who underwent diagnostic ERCP, pancreatitis developed in 26 patients (3.3%). In the multivariable risk model, significant risk factors with adjusted odds ratios (ORs) were age <65 years (OR = 10.647, P = 0.023) and erythrocyte sedimentation rate (ESR) >30 (OR = 6.414, P < 0.001). Female gender, history of recurrent pancreatitis, pre-ERCP hyperamylasemia, and difficult or failed cannulation could not predict PEP. There was no significant difference in the rate of PEP in wire-guided cannulation versus biliary cannulation using a sphincterotome and contrast injection as the conventional method. CONCLUSIONS: Performing ERCP may be safer in the elderly. Patients with high ESR may be at greater risk of PEP, which warrants close observation of these patients for signs of pancreatitis after ERCP.

Penbactam for Helicobacter pylori eradication: a randomised comparison of quadruple and triple treatment schedules in an Iranian population.

BACKGROUND & STUDY AIMS: Selection of the best drug regimens for eradication of Helicobacter pylori infection especially in patients at risk of peptic ulcer relapses and the development of complications is challenging. This study assessed and compared the efficacy of the two common PPI based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. PATIENTS & METHODS: Three hundred and thirty patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols all given twice daily: (a) A 14-day quadruple therapy (OMAB group) comprising omeprazole 20mg, metronicazole 500 mg, amoxicillin 1g, and bismuth subcitrate 240 mg; (b) A 14-day triple regimen (OCP group) comprising omeprazole 20mg plus clarithromycine 500 mg and penbactam 750 mg and (c) A 14-day triple regimen (OCA group) comprising omeprazole 20mg plus clarithromycine 500 mg and amoxicillin 1g. Cure was defined as a negative urea breath test at least six weeks after treatment. RESULTS: The per-protocol eradication rates achieved with both OCP regimen (87.0%) and OCA treatment (90.8%) were significantly higher than the OMAB treatment protocol (56.0%); however, no significant difference emerged in eradication rates between the two triple treatment schedules. No significant differences between the groups were found in most side-effects. CONCLUSION: Two-week quadruple therapy showed a lower eradication rate compared to common triple treatment schedules when used as first-line eradication treatment for H. pylori infection in Iranian population.

Evaluation of the benefit of addition of clidinium C to a Helicobacter pylori eradication regimen.

AIM: This study aimed to evaluate the success of H.pylori eradication therapy in patients with dyspepsia by therapeutics regimes with and without clidinium C. BACKGROUND: Helicobacter pylori infections are reported in all parts of the world. Appropriate antibiotic therapy can treat infection. The ideal treatment regimen has not been specified. PATIENTS AND METHODS: In a randomized, double blind clinical trials study, 250 patients with dyspepsia were enrolled. All patients were treated by Omeprazole, Metronidazole, Amoxicillin and Bismuth (OMAB) for two weeks. One tablet clidinium C before each meal was added to this regimen in the intervention group (A). Urea Breath Test (UBT) was carried out after 8-12 weeks after treatment for evaluation of H.pylori eradication. RESULTS: 132 patients in the intervention group (A) and 118 patients in the control group (B) were enrolled to the study. The rate of eradication in group A was significantly higher than group B (62.1% vs. 50%, p=0.04). CONCLUSION: The results supported the effect of clidinium C for increasing of helicobacter pylori eradication, but further studies need to be performed.

ERCP features and outcome in patients with periampullary duodenal diverticulum.

Background. Although periampullary diverticulum is usually asymptomatic and discovered incidentally in patients during endoscopic retrograde cholangiopancreatography (ERCP), it may lead to post-ERCP morbidity. We compared baseline characteristics and clinical data as well as ERCP results in patients with and without periampullary diverticulum. Methods. Clinical, laboratory, and ERCP data of 780 patients referred to the Taleghani Hospital, as a great referral endoscopy center, in Iran were prospectively analyzed. Results. The periampullary diverticulum was identified in 44 patients (5.6%). Cannulation of common bile duct was more failed in patients with diverticulum compared to others (35.5% versus 11.5, P < 0.001). Patients with diverticulum had eight times more often common bile duct stone compared to patients without diverticulum (54.5% versus 12.2%, P < 0.001). Post-ERCP complications were observed in 2.3% and 4.2% of patients with and without diverticulum, respectively, which did not significantly differ in both groups. Conclusion. Because of more failure cannulation in the presence of periampullary diverticulum, ERCP requires more skills in these patients. Prevalence of common bile duct stone was notably higher in patients with diverticulum; therefore, more assessment of bile stone and its complications in these patients is persistently recommended.

Cholangiographic features in opium-addicted patients at a tertiary hospital in iran.

Background/Aims. Destructive and metabolic changes in hepatobiliary system have been demonstrated following opium use; however, cholangiographic features of bile ducts in opium-addicted patients with sphincter of Oddi dysfunction are not clearly determined. We described these differences and assessed the effects of opium use on postendoscopic retrograde cholangiopancreatography complications. Methodology. One hundred and nineteen patients with the diagnosis of sphinctre of Oddi dysfunction according to the Geenen-Hogan classification were studied. Eight patients were confirmed opium-addicted and others were nonaddicted. Change of serum amylase concentrations after endoscopic retrograde cholangiopancreatography and clinical diagnosis of addicted and non-addicted patients were compared. Results. Serum concentrations of liver aminotransferases and alkaline phosphatase were similar between the two groups. Serum concentration of amylase before endoscopic retrograde cholangiopancreatography was similar between them, whereas concentration of this enzyme was higher in nonaddicted ones after endoscopic retrograde cholangiopancreatography. Regarding pathologic changes in papilla, opium addiction group in comparison with control group statistically showed more tumoral features (25.0% versus 5.4%) and ulcerated changes (12.5% versus 0.0%). Conclusions. Opium use can increase probability of papilla ulcerative and tumoral changes in patients with sphinctre of Oddi dysfunction. Postendoscopic retrograde cholangiopancreatography serum amylase level may be reduced following opium addiction.

The relation between the level of interleukin-23 with duration and severity of ulcerative colitis.

AIM: In this study, we determined the relationship between the serum level of IL-23 and the severity of ulcerative colitis (UC) among our population. BACKGROUND: A recent major breakthrough for describing the pathogenesis of intestinal tissue injury in inflammatory bowel disease (IBD) is the pathway related to interleukin-23 (IL-23). PATIENTS AND METHODS: We performed a prospective case-control study on a total of 85 new patients with ulcerative colitis, recruited from a general referral hospital. Forty ethnically matched healthy controls were also enrolled among hospital staffs and analyzed. Serum IL-23 level was quantified using an electrochemiluminescence immunoassay (ECLIA) method with an immunoassay analyzer. RESULTS: The mean serum IL-23 level in the group with ulcerative colitis was significantly higher than the healthy individuals (347.5±130.8 pg/ml versus 233.5±86.3 pg/ml; p< 0.001). There was a positive correlation between the serum level of IL-23 and disease duration (r = 0.27, p = 0.04). Also, a direct relationship was found between the serum level of IL-23 and the severity of disease (mean IL-23 in mild UC = 296.2±51.2 pg/ml; in moderate UC= 356.1±142.9 pg/ml; and in severe UC= 399.3±163.8 pg/ml, p = 0.04). CONCLUSION: Serum level of IL-23 is directly correlated with the duration and severity of ulcerative colitis.

Evaluation of antibody frequency against HBV, HCV and HTLV-1.

AIM: This study was designed to evaluate the frequency of antibody against these viruses in individuals attending the endoscopy ward of Taleghani hospital Tehran, Iran. BACKGROUND: Blood-borne viruses such as hepatitis B and hepatitis C virus and HTLV-1 virus are among the world's public health problems. Hepatitis viruses cause liver problems and HTLV-1 infection can lead to adult T-Cell lymphoma (ATL). PATIENTS AND METHODS: Blood samples of 219 individuals attending the endoscopy ward of Taleghani hospital between years 2009-2011 were collected. A questionnaire containing demographic data was completed for each subject. Blood samples were tested for antibody against HTLV-1, HCV and HBc by ELISA (Dia.pro Italy). In case of positive results for anti-HBc, samples were also tested for HBs Ag antigen. RESULTS: Ninety two subjects were male and 127 were female. Mean age of the population was 39.87 ± 16.47. None of the subjects had anti-HCV antibody, while 4 of them had anti-HTLV-1 antibody and 26 anti-HBc antibody; which only two of these individuals had HBs Antibody. CONCLUSION: The results of this study show that frequency of anti-HCV and anti-HTLV-1 antibodies are very low, while the frequency of anti-HBc was higher in the population. Since HTLV-1 is the causative agent of a type of blood cancer, it seems that screening of donated bloods in this region should be considered.

Preventive role of wire-guided cannulation to reduce hyperamylasemia and pancreatitis following endoscopic retrograde cholangiopancreatography.

Background and Study Aims. The usefulness of wire-guided cannulation for avoiding hyperamylasemia and pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is conflicting, and therefore we designed this study to determine whether wire-guided cannulation reduces the rate of post-ERCP hyperamylasemia and pancreatitis and compare its efficacy to conventional method. Patients and Methods. Seven hundred and forty-eight patients with hepatobiliary diseases consecutively underwent diagnostic or therapeutic ERCP at the unit of Taleghani referral hospital in Tehran. Among them, 546 patients were eligible for wire-guided cannulation and underwent this procedure and others underwent sphincterotome biliary cannulation using contrast injection as the conventional method. Results. Patients in the two groups were comparable in terms of gender and age. Successful biliary cannulation was achieved similary in the guidewire and conventional group (89.2% versus 86.4%) that in 5.4% and 14.1% of them it was difficultly performed, respectively (P = 0.003). The main pancreatic duct was more visualized in 99.0% of patients in conventional group in comparison with 79.0% in another group (P < 0.001). Multivariate regression analysis showed that wire-guided cannulation had a protective role for post-ERCP hyperamylasemia (OR: 0.336, 95% CI: 0.181-0.623, P < 0.001). However, there were no significant differences between the two groups in rates of other procedure-related complications, such as, pancreatitis, bleeding, and perforation. Conclusion. The use of guidewire cannulation in comparison with conventional method can be accompanied with lower post-ERCP hyperamylasemia, and therefore selection of this cannulation technique especially in high-risk group is recommended.

Utility and safety of ERCP in the elderly: a comparative study in iran.

Background. The present study sought and compared the utility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the elderly and younger people in a great sample of Iranian population. Methods. Our study involved 780 patients undergoing diagnostic and therapeutic ERCP at the Taleghani hospital in Tehran between 2010 and 2011; among them, 558 patients were less than 70 years old and others were 70 years old or older. The patients were prospectively identified and data including clinical and biochemical features, ERCP procedures, ERCP diagnosis, and ERCP complications were gathered on them prospectively. Results. Clinical manifestations were comparable in young and older groups except for hepatosplenomegaly and constipation that were more prevalent in the elderly. Laboratory findings were similar in both groups other than mean levels of alkaline phosphatase, hemoglobin and albumin levels, which were higher in the elderly group. Selective biliary cannulation was technically more successful in the younger than in others (89.0% versus 81.8%). Common bile duct stone was the most frequent diagnosis in both young and older groups (36.6% and 45.9%, resp.), whereas ERCP was reported to be normal in 13.4% of the younger and 5.0% of the elderly patients. Post-ERCP complications were observed in 4.8% of patients aged less than 70 years in comparison with 2.3% of patients aged over 70 years. The most frequent complication was pancreatitis that was significantly more developed in young than older patients (3.6% versus 1.5%; OR: 8.216, P = 0.015). Conclusion. Diagnostic ERCP is safe and well tolerated in the elderly and even associated with significantly less risk than the younger.

Risk factors for post-ERCP cholangitis in patients with pancreatic cancer from a single referral center in Iran.

Cholangitis is relatively uncommon but associated mortality is high due to the predisposition in people with underlying disease. For this recognition of contributing risk factors is necessary. Therefore, the present descriptive- analytical cross-sectional survey was designed to determine contributing risk factors for post-ERCP cholangitis in patients with pancreatic cancer. From 2005 to 2010, 110 consecutive cases of pancreatic cancer attending to a tertiary referral centre (Taleghani Hospital), Tehran, Iran were recruited. The patients all underwent stenting via endoscopic retrograde cholangiopancreatography (ERCP). On univariate analysis, a metallic stent type (95% confidence interval (CI) 1.025-11.34, P=0.037), having no jaundice (1.44-2.22, P=0.009), having no pain (1.32-1.91, P=0.026), a history of prior ERCP (1.16-10.37, P=0.020), and having a proximal biliary stone (1.002- 5.93, P=0.046) were related to cholangitis. However on multivariate analysis, none of these factors were found to be contributing risk factors. Cholangitis is avoidable with adequate biliary drainage. Because success rates are higher and complication rates lower for endoscopists performing large volumes of ERCP, performance of the procedure should be concentrated as much as possible in institutions with endoscopists having adequate experience. Patients with a high risk for complications may be best served by referral to an advanced center.

Proinflammatory cytokines and thrombomodulin in patients with peptic ulcer disease and gastric cancer, infected with Helicobacter pylori.

BACKGROUNDS: Helicobacter pylori infect more than half of the global population. It is suggested to be related with gastritis, peptic ulcer disease (PUD), and gastric cancer. AIMS: The aim of this present study was to evaluate proinflammatory cytokines including interleukin 1, 6, 8, 10, and thrombomodulin in H. pylori-infected patients with PUD and gastric cancer. PATIENTS: This cross-sectional study was conducted in Taleghani Hospital on 111 patients with H. pylori infection. MATERIALS AND METHODS: Patients were divided into three groups of PUD, cancer, and control (normal on endoscopy), according to the results of endoscopy. The serum levels of interleukins 1, 6, 8, and 10 and thrombomodulin was determined using enzyme-linked immunosorbent assay (ELISA) technique. H. pylori infection was diagnosed by histological examination of the endoscopic biopsy. RESULTS: One hundred eleven patients were included in the study; 30 as PUD group, 30 as gastric cancer group, and 51 as controls. There was no significant difference between the means of IL-1 and IL-10 levels among the three groups (P = 0.744 and 0.383, respectively). IL-6, IL-8, and thrombomodulin levels were found to be statically different among the three groups (P < 0.05). The level of IL-6, IL-8, and thrombomodulin in cancer group was significantly higher than PUD and control groups (P < 0.05). CONCLUSION: There is a significant association between H. pylori infection and serum IL-6, IL-8, and thrombomodulin but such relation is not present between H. pylori and IL-1 and IL-10. Immunity response (IL-6, IL-8 and thrombomodulin) is more severe in cancer patient than PUD.

Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: A randomised clinical trial.

BACKGROUND AND STUDY AIMS: Uraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori (HP). Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance (CrCl) and eradication of HP infection with new sequential and standard triple therapeutic regimens. PATIENTS AND METHODS: A total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens: A 14-day standard triple therapy with 20mg omeprazole bid, 1000mg amoxicillin bid and 500mg clarithromycin bid and a new sequential regimen with 20mg omeprazole bid and 1000mg amoxicillin bid both for 14 days, 500mg ciprofloxacin bid for the first 7 days and 200mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30mgdl(-1). RESULTS: One hundred and sixty two out of 180 HP-positive patients (54.3% male, 51.6±12.1 years) completed treatment in the four groups and were studied. According to renal function they were classified into group A (n=39), haemodialysis (HD) patients; group B (n=37), CrCl <30mgdl(-1) without HD; group C (n=36), CrCl between 30 and 60mgdl(-1); and group D (n=50), control subjects with CrCl >90mgdl(-1). HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens. CONCLUSION: HP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported.

Clinical and histological presentation of Helicobacter pylori and gluten related gastroenteropathy.

BACKGROUND: Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. METHODS: Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. RESULTS: Among 250 patients, 232 (93%) had histological evidence of Helicobacter pylori infection. Histological abnormalities (Marsh I to IIIc) were present in 24 (10%). Of 24 patients, 20 (83%) with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 (10%) had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 (3.6%) had microscopic and macroscopic enteritis (Marsh I to IIIc). CONCLUSIONS: Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations.

Biliary brush cytology in the assessment of biliary strictures at a tertiary center in Iran.

BACKGROUND: Confirmation of cholangiocarcinoma and other malignant bile duct stenosis is challenging. The aim of the current study was to assess the accuracy of brush cytology for diagnosis of malignant biliary strictures. METHODS: 105 patients with hepatic biliary strictures undergoing ERCP were included in this study. Prospectively collected data included symptoms, results of biochemical testing and imaging procedures, as well as details of ERCP. Exclusion criteria were: 1) strictures that would not permit passage of guidewire and brush accession; and 2) post-operative strictures. Brushings of the bile duct strictures were performed. All patients were followed for at least 6 months. The final diagnosis was confirmed following surgery, histopathological diagnosis of the lesion, radiological infiltration of adjacent organs or metastases, or after at least a 6-month follow-up. RESULTS: 88 brush samples from 88 patients were of appropriate quality. The overall diagnostic sensitivity and specificity for malignant nature of biliary strictures were 40.7% and 100%, respectively. The sensitivity was 66.6 % for ampullary carcinomas, 36.3% for pancreatic cancer and 32.5% for cholangiocarcinomas. CONCLUSIONS: Despite the low sensitivity, due to the relative ease and safety, brush cytology should remain the first choice for diagnosis of causes of biliary strictures.

Low frequency of human T-cell lymphotropic virus 1 antibodies in Iranian gastric cancer patients in comparison to controls.

There is some evidence that human T-cell lymphotropic virus (HTLV-1) infection has a reverse association with gastric cancer (GC). Data about this association in the Iranian population are scarce. In this study we therefore assessed the frequency of anti-HTLV-1 antibody in GC patients and compare it to antibody presence in healthy individuals in Iranian population. This case control study was performed between 2008-2011 on 201 GC patients and 219 control subjects. HTLV-1 antibodies were assessed by ELISA and the positive results were confirmed by western blotting. Totals of 201 gastric cancer patients and 219 controls were enrolled in this study. The tumors in the majority of patients (45.3%) were in the distal (non-cardia) area. Mean age of patients at the time of diagnosis was 59.2±12.5 and mean age of controls was 57.7±11.3. While only one GC patient (0.5%) was positive for HTLV-1 antibody, there were four individuals (1.89%) from the control group with antibodies. In addition, smoking had statistically significant relationship with cancer (P=0.001). Our study showed that the frequency of HTLV-1 antibody in patients was lower than in controls, similar to the results obtained in Japan. Further investigations with a larger sample size are needed in order to determine the association between GC and HTLV-1 infection in Iran.

Effect of addition of vitamin C to clarithromycin-amoxicillin-omeprazol triple regimen on Helicobacter pylori eradication.

BACKGROUND: The use of vitamin C as a supplement with the common regimen for eradication of Helicobacter pylori infection is the subject of ongoing controversy. We conducted a prospective controlled study with the aim of testing whether the vitamin C supplement to the therapy includes lower dosage of clarithromycin could have an acceptable influence on Helicobacter pylori eradication in comparison with routine anti-Helicobacter pylori regimen. MATERIALS AND METHODS: Two hundred and fourteen consecutive patients with the verification of Helicobacter pylori infection via positive Rapid Urease Test (RUT) and histology results were included and divided into two therapy groups: 1) a group without vitamin C (n = 100) that were administered 20 mg omeprazol, 1 g amoxicillin, and 500 mg clarithromycin twice daily for 2 weeks and 2) a triple-plus-vitamin C group (n = 114) that was administered 20 mg omeprazol, 1 g amoxicillin, 250 mg clarithromycin plus 250 mg vitamin C twice daily for 2 weeks. Four weeks after the completion of therapy, each patient was scheduled for urea breath test to assess the success of Helicobacter pylori eradication. RESULTS: Similar eradication of Helicobacter pylori was found between the triple-only group with 500 mg of clarithromycin and the triple with 250 mg of clarithromycin-plus vitamin C group (89% versus 86.8%, P = 0.623). CONCLUSIONS: Adding vitamin C might reduce the needed dosage of clarithromycin for eradication of Helicobacter pylori.