[Comparing clinical manifestations and endoscopic findings between elderly and non- elderly patients with dyspepsia reffered to Rasoul-e-Akram Hospital in 2014]

Background: Frequency of H.pylori infection in the elderly with dyspepsia is unknown in Iran. The aim of this study was to compare manifestations and endoscopic/pathologic findings in elderly and non- elderly population in a teaching hospital

Materials and methods: In this cross sectional study, all patients over 18 years with dyspepsia admitted to our hospital over a period 6 months were studied. All adult patients [below 60 years] and elderly patients [over 60 years] diagnosed with dyspepsia were examined and underwent upper gastrointestinal endoscopy. Analysis was performed using chi square, in order to find correlation between symptoms and endoscopic and pathologic findings of patients with dyspepsia and age

Results: Totally, 500 patients [250 elderly] were studied. The mean [ +/- SD] age of elderly and others were 76 +/- 2.8 years and 41 +/- 3.3 years, respectively. Our results showed that the frequency of H.pylori infection in elderly was 66% in comparison of 34.8% in adults [p<0.005]. In endoscopic findings, frequency of erosive duodonitis [p=0.031] and duodenal deformity [p=0.025] increased with age. In pathologic findings, frequency of dysplasia and metaplasia in the elderly was more than others [p<0.05]

Conclusion: Upper endoscopy screening may be an effective technique for early detection of H.pylori infection and its complications, such as metaplasia and dysplasia, in the elderly

Clarithromycin vs. gemifloxacin in quadruple therapy regimens for empiric primary treatment of Helicobacter pylori infection: a randomized clinical trial

Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer. Clarithromycin resistance is a major cause of treatment failure. This randomized clinical trial aimed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H.pylori infection. In this randomized double blind clinical trial [RCT 2012102011054N2], a total of 120 patients were randomized to two groups of 60 patients each. Patients with proven H.pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e-Akram General Hospital in Tehran, Iran. The patients in the OBAG group received omeprazole [20 mg] twice daily, bismuth subcitrate [240 mg] twice daily, amoxicillin [1 gr] twice daily, and gemifloxacin [320 mg] once daily, and those in the OBAC group received omeprazole [20 mg] twice daily, 240 mg of bismuth subcitrate twice daily, amoxicillin [1 gr] twice daily, and clarithromycin [500 mg] twice daily for 10 days. Five patients from each group were excluded from the study because of poor compliance, so 110 patients completed the study. The intention-to-treat eradication rate was 61.6% and 66.6% for the OBAC and OBAG groups, respectively. According to the per protocol analysis, the success rates of eradication of H.pylori infection were 67.2% and 72.7% for OBAC and OBAG groups, respectively [p=0.568]. The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen; hence, this new treatment could be considered as an alternative for the patients who cannot tolerate clarithromycin

[Prevalence of colorectal polyps among women with ovarian and endometrial cancers admitted in Firoozgar, Akbarabadi and Rasol Akram Hospitals during 2010- 2011: a brief report]

Patients with endometrial or ovarian cancer have an increased risk for breast or colon cancer. The aim of this study was to assess the individual and age-related characteristics of patients with a combination of these malignancies. In this retrospective descriptive study, we reviewed the medical records of 100 patients admitted for endometrial or ovarian cancer in Rasol Akram, Akbarabadi and Firozgar educational Hospitals in Tehran, Iran, during 2010- 2011. Colon polyps were evaluated by immunohistochemistry assay. The mean age, weight and BMI of the patients were 50.21, 65.9 and 26.07, respectively. Among 100 cases participating in this study, five [5%] patients had colon polyps. All the five cases with colon polyp had positive familial histories of ovarian cancer. With considering the low prevalence of colorectal polyps among women with ovarian and endometrial cancers, patient's follow-up for screening test is not recommended

comparison between Pegylated interferon alpha-2a and standard interferon in combination with ribavirin in treating patients with bleeding disorders and chronic hepatitis C

Patients with bleeding disorders are frequently infected with hepatitis C virus [HCV]. There are few reports on the effect of standard interferon in these patients and no published report on pegylated interferon. The aim of this study was to compare pegylated interferon alpha-2a and standard interferon alpha with ribavirin in patients with bleeding disorders and chronic HCV infection. Consecutive patients referring to a specialized clinic in Tehran were included in the study. The first 37 patients received pegylated interferon [PEGASYS, Hoffmann-La Roche Inc., Basel, Switzerland], 180 microg weekly and the next 38 patients received standard interferon, 3 million units 3 times a week. Both groups also received ribavirin 800 mg daily. Patients were treated for 48 weeks and were followed for 24 weeks. Liver biopsy was not performed due to the potential risks involved in patients with bleeding disorders. 34 patients in each group completed the study. The intention-to-treat sustained viral response was 34% and 62% in the standard interferon and pegylated interferon group, respectively [p=0.02]. Pegylated interferon alpha-2a and ribavirin is almost twice as effective as standard interferon and ribavirin in treating HCV infection in patients with bleeding disorders and is an acceptable treatment option even when histologic data is not available

Oral omeprazole in patients undergoing combination endoscopic therapy for bleeding peptic ulcers A: prospective double-blind randomized study

Endoscopic therapies can decrease the morbidity of patients with high risk peptic ulcer. The aim of this study was to evaluate the beneficial effects of oral omeprazole therapy in patients with bleeding peptic ulcer who received combined endoscopic treatment [epinephrine injection and Argon Plasma Coagulation]. Eighty six patients with bleeding from gastric, duodenal or stomal ulcers and endoscopic stigmata of recent bleeding were enrolled in our study. All patients received injection of epinephrine [1:10,000] and also their ulcers were treated with Argon Plasma Coagulator. The patients then randomly assigned to receive oral omeprazole [40 mg every 12 hours] or placebo. Five [11.6%] of 43 patients in the placebo group had rebleeding; but no rebleeding was detected among 43 patients in omeprazole group [p= 0.05]. One patient in the Placebo group underwent surgery for control of his rebleeding; but none of the patients in omeprazole group needed surgery. One patient in the placebo group and none of the patients in the omeprazole group died. The average hospital stay was 5 days in the omeprazole group and 5.8 days in the placebo group. Addition of oral omeprazole to combined endoscopic therapy significantly reduces recurrent bleeding rates

comparison between pegylated interferon alpha-2a and standard interferon in combination with ribavirin in treating patients with bleeding disorders and chronic hepatitis C

Patients with bleeding disorders are frequently infected with hepatitis C virus [HCV]. There are few reports on the effect of standard interferon in these patients and no published report on pegylated interferon. The aim of this study was to compare pegylated interferon alpha-2a and standard interferon alpha with ribavirin in patients with bleeding disorders and chronic HCV infection. Consecutive patients referring to a specialized clinic in Tehran were included in the study. The first 37 patients received pegylated interferon [PEGASYS, Hoffmann-La Roche Inc., Basel, Switzerland], 180 microg weekly and the next 38 patients received standard interferon, 3 million units 3 times a week. Both groups also received ribavirin 800 mg daily. Patients were treated for 48 weeks and were followed for 24 weeks. Liver biopsy was not performed due to the potential risks involved in patients with bleeding disorders. 34 patients in each group completed the study. The intention-to-treat sustained viral response was 34% and 62% in the standard interferon and pegylated interferon group, respectively [p=0.02]. Pegylated interferon alpha-2a and ribavirin is almost twice as effective as standard interferon and ribavirin in treating HCV infection in patients with bleeding disorders and is an acceptable treatment option even when histologic data is not available

Peginterferon alfa-2a and ribavirin in patients with chronic hepatitis C and inherited bleeding disorders

Background: patients with inherited bleeding disorders who regularly receive clotting factors are frequently infected with hepatitis C virus [HCV]. Liver biopsy in these patients is high-risk and not always performed. There is no report on pegylated interferon [PEG-IFN] and ribavirin in patients with bleeding disorders in whom no histologic data is available

Aim: to assess the safety and efficacy of combined PEG-IFN alfa-2a and ribavirin in patients with inherited bleeding disorders and hepatitis C. Methods: We studied 37 patients with inherited bleeding disorders and HCV infection. Patients where planned to receive pegylated interferon alfa 2a [PEG-IFN alfa-2a] 180 micg weekly and ribavirin 800mg daily for 48 weeks. They were then followed for 24 weeks after the end of treatment

Results: early virologic response at week 12 of treatment was achieved in 3 1/34 patients [91%] and end-of-treatment response was achieved in 30/3 1 patients [97%]. Sustained virologic response was 26/32 [81%] and 26/35 [74%] on per-protocol and intention-to-treat analysis respectively. Dose reduction due to adverse effects was necessary in 11 patients

Conclusion: the combination of PEG-IFN alpha 2a and ribavirin is safe and highly effective in patients with inherited bleeding disorders and HCV infection, even when histologic data is absent