Iranian Registry of Crohn's and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East

BACKGROUND/AIMS: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn's and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. METHODS: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach's α. RESULTS: All sections of questionnaire had Cronbach's α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). CONCLUSIONS: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.

comprehensive look at irritable bowel syndrome and its associated factors considering the rome IV criteria: a penalized smoothly clipped absolute deviation regression approach in the pars cohort study

Background:After the introduction of the Rome IV criteria for the diagnosis of irritable bowel syndrome [IBS], studies on the clinical significance of the new criteria in the settings of a large study has been scarce

Objective: Herein we used the infrastructures provided by one the largest cohort studies in Iran to evaluate the epidemiological features related to IBS

Methods:A total of 9264 participants, were enrolled in the initial registry. Diagnosis of IBS was done using the Rome IV criteria. Individuals with IBS were compared with a control group. Since the study included a large sample size of patients, we used the penalized smoothly clipped absolute deviation [SCAD] regression analysis to construct a model for the evaluation of factors associated with IBS

Results:Overall, data of 9163 participants entered the final analysis. In total, 1067 [11.6%] individuals were diagnosed with IBS, among which 57 [5.3%] were diarrhea dominant [IBS-D], 380 [35.6%] were constipation dominant [IBS-C], and 630 [59%] did not mention having any of the two [IBS-U]. In the regression model, back pain/arthralgia [OR: 1.98, 95% CI: 1.65 - 2.40], insomnia [OR: 1.65, 95% CI: 1.40 - 1.93], depression [OR: 1.64, 95% CI: 1.38 - 1.95], female sex [OR: 1.58, 95% CI: 1.27 - 1.96], anxiety [OR: 1.43, 95% CI: 1.21 - 1.69], and being married [OR: 1.23, 95% CI: 1.03 - 1.48], were associated with higher rates of IBS. We found that IBS prevalence displays a peak at the age of 41 years for both men and women

Conclusion:The present study provides a background for follow-up studies to be conducted in order to evaluate causality between IBS and some major diseases such as liver disease. We also found that opium use, although not statistically significant, in addition to sex, education, back/joint pain, depression, insomnia, anxiety, and marital status might be a contributing factor in IBS

Complications of colonoscopy and its management: a single gastroenterologist experience

Background: Colonoscopy is a widely used procedure and although is generally safe, it could have both gastrointestinal and non-gastrointestinal complications. The aim of this report is to assess the major complications of colonoscopies performed by one expert gastroenterologist and their management in Tehran Iran

Methods: We have recoded the rates of adverse events and their management in all the colonoscopies performed by a single expert gastroenterologist during 23 years [1994-2017]. Demographic factors including age, race, and sex, and colonoscopy findings and patients' comorbidities were recorded

Results: During 23 years, 9012 colonoscopies and about 1700 polypectomies were performed. The number of serious complications was six [0.07%]. Colonic perforation occurred in five patients [0.06%]; three of whom had undergone polypectomies. All cases of colonic perforation were managed by surgery and all were discharged with no complications. One patient suffered from cardiac arrest just after colonoscopy in the recovery room and died 20 days after colonoscopy [0.01%]

Conclusion: Although the rate of adverse events after colonoscopy was low, it is still an important concern in developing screening recommendations in low and middle-income countries

Current challenges of liver transplantation in Iran

Liver transplantation [LT] is a lifesaving procedure and the treatment of choice for patients suffering from end-stage liver disease [ESLD]. There is increasing number of patients with ESLD in Iran. There is a need to expand and develop new centers to provide better access to LT for patients with ESLD in Iran. This review will address current and future challenges for LT in Iran

Prevalence of chronic constipation and its associated factors in pars cohort study: a study of 9000 adults in Southern Iran

Background: Chronic constipation is one of the most common gastrointestinal disorders. It has negative effects on the patients' quality of life, and their productivity, and results in a high economic burden on the healthcare services. The aim of the present study was to estimate the prevalence of chronic constipation and its associated factors in pars cohort study [PCS]

Methods: A cross-sectional study was conducted on the baseline data of the PCS. Data gathering was done by structured questionnaire and physical examination. A total of 9264 subjects aged between 40 and 75 years were enrolled in the PCS. Diagnosis of chronic constipation was done using Rome IV criteria. Multivariable binary logistic regression was applied for data analysis

Results: A total of 752 [8.1%] participants were diagnosed as having chronic constipation [9.3% of female and 6.7% of male participants]. Older age [OR: 1.55, 95% CI:1.31-1.83], physical activity [OR: 0.56, 95% CI: 0.46-0.68], opium consumption [OR: 2.06, 95% CI: 1.63-2.60] , anxiety [OR: 1.38, 95% CI: 1.15-1.65], depression [OR: 1.22, 95% CI: 1.01-1.48], back pain or arthralgia [OR: 1.38, 95% CI: 1.14-1.67], insomnia [OR: 1.62, 95% CI: 1.36-1.93] and gastroesophageal reflux disease [OR: 1.51, 95% CI :1.28-1.78] were associated with the prevalence of constipation in the multivariable analysis

Conclusion: Chronic constipation was a common problem in the PCS population. Decreasing modifiable risk factors associated with constipation such as opium consumption and physical inactivity can reduce its prevalence and decrease burden of the disease.

[ association between dietary fat intake and pancreatic cancer risk: a large prospective study]

Pancreatic cancer [PC] is classified as one of the most deadly cancers. Since the role of diet in modifying the effects of known risk factors of PC has been well established, exploring the dietary intakes in relation to the etiology of PC can be useful for elucidating the mechanisms of the disease progression

Materials and Methods: This study was conducted within the Golestan prospective cohort study. The estimated intake of total fat and various dietary fat sources was calculated using a validated semi-quantitative food frequency questionnaire. The relationship between these dietary intakes and risk of PC was examined using Cox Regression and hazard ratio [HR] with 95% confidence interval [CI 95%] was reported

Results: During 383,630 person-years follow-up and after excluding subjects with incomplete baseline information, a total of 48,676 adults were studied. Until October 30, 2014, 54 cases of PC were confirmed by medical professionals, based on the medical records and the exact cause of death using the criteria of the International Statistical Classification of Diseases and Related Health Problems 10 [ICD10]. After adjusting for potential confounders we did not observe any statistically significant relationship between the intake of total fat and various dietary fat sources and risk of PC. There was only a significant positive association between the risk of PC and daily intake of butter, cream, and solid vegetable oil in the age-adjusted regression models [HR=2.10; 95% CI=1.04-4.21; P for trend=0.03]. However, this relationship was not remained significant anymore in the fully adjusted models

Conclusion: Based on the results of the current research, after taking into account all of the potential confounding factors, dietary intake of total fat as well as various dietary fat sources had no significant association with the risk of PC. However, it is likely that consuming substantially less saturated and trans fat sources such as dairy fats as well as solid vegetable oils may be beneficial to reduce the risk of this cancer

[Higher intake of dietary fiber, but not fruits or vegetables is associated with lower risk of pancreatic cancer: a large prospective study]

Background: pancreatic cancer [PC] is classed as the 7th leading cause of cancer-related death in the world. Previous evidence indicates that hyperglycemia, insulin resistance, diabetes, and obesity are implicated in pancreatic carcinogenesis. Thus, evaluation of the dietary intakes in the etiology of PC can be useful to identify the risk factors of the disease

Materials and Methods: we examined the association between total intake of fruits, vegetables, and dietary fiber and the risk of PC in 50,045 participants aged 40-75 years within the Golestan Cohort Study. Dietary data were collected using a validated semi-quantitative food-frequency questionnaire, which was administered at baseline. Cox proportional hazards models were used to estimate multivariate hazard ratio with 95% confidence interval

Results: during 383,630 person-years of follow-up and after excluding the participants with incomplete baseline information, a total of 48,676 adults were evaluated. Until October 30, 2014, 54 cases of PC were confirmed based on the exact cause of death using ICD10 criteria. After considering all potential confounding factors, there was only a statistically significant inverse association between the risk of PC for the highest tertile of daily fiber intake compared with the lowest tertile [HR=0.41; 95% CI= 0.15-1.05; P for trend= 0.05]. However, the relationship between fruits and vegetables and PC risk was not statistically significant

Conclusion: in summary, based on the findings of this study, increased dietary fiber may reduce the risk of PC. This result highlights the importance of a diet rich in fiber in order to prevent PC progression. Finally, given the limited number of studies in this field and inconclusive results, there is still a need for new prospective studies with long follow-up

Prevalence and correlates of gastroesophageal reflux disease in Southern Iran: pars cohort study

Background: Prevalence of gastroesophageal reflux disease [GERD] is increasing worldwide. We aimed to estimate the prevalence of GERD in Pars Cohort Study [PCS] and to find its correlates

Methods: We used the baseline data from PCS. PCS was conducted in the district of Valashahr in Fars province in southern Iran from 2012 to 2014. 9264 inhabitants who were 40-75 years old, and agreed to participate were enrolled. Data were collected by a structured questionnaire and simple physical examination of all participants

Results: Generally, 58.50% [95% CI 57.49 - 59.51] of the participants had GERD and 25.10% [95% CI 24.22 - 25.99] experienced it at least weekly. Approximately, 32.0%, 52.0%, and 24.4% of the participants reported heart burn sensation, regurgitation, and both symptoms, respectively. Being female [OR: 1.45, 95% CI 1.27 - 1.65], being older [OR: 1.20, 95% CI 1.06 - 1.36], being divorced/ widowed/separated [OR: 1.38, 95% CI 1.01 - 1.91], and lower education [OR: 1.43, 95% CI 1.02 - 2.03] were associated with frequent GERD

Conclusion: GERD is common in PCS and its prevalence is close to that in western countries. Being female, higher age, being divorced/widowed/separated, lower education, history of hypertension, anxiety, insomnia, and non-cigarette tobacco smoking were associated with frequent GERD. We are going to investigate the causal relationship between these risk factors and GERD in the next stages of PCS

Epidemiological profile of hepatitis B virus infection in Iran in the past 25 years; a systematic review and meta-analysis of general population studies

Background: Chronic hepatitis B virus [HBV] infection is one of the most important health problems worldwide with a high rate of morbidity and mortality. It is a major risk factor for cirrhosis and liver cancer. Currently, Iran is located in the intermediate HBV zone; however, recent studies have provided some evidence indicating an epidemiological change in the country. The aim of this study was to estimate the prevalence of HBV in Iran

Methods: A systematic review was conducted to evaluate the studies performed in the past 25 years that have reported the prevalence of HBV infection and its associated factors in the Iranian general population [1990-2014]. Any study assessing and reporting serum Hbs Ag levels was included in this review

Results: After excluding all impertinent studies, 19 eligible studies were included in the analysis. The overall prevalence of HBV was 3% [95% CI 2% to 3%]. Its distribution showed that the prevalence of HBV varies in different provinces from 0.87% to 8.86%. The HBV rate was highest in the Golestan [8.86%] and lowest in the Kurdistan [0.87%] provinces

Conclusion: This study provides some evidence about the prevalence of HBV in Iran. However, the collected data was very heterogenic, even within a single province, which made it hard to estimate a single-point prevalence. High quality studies are needed to find reliable information about HBV prevalence and to decrease the heterogeneity of results in the country

nail as a biomonitor of trace element status in Golestan cohort study

Background: In the Golestan Cohort Study that was launched to investigate the causes of esophageal cancer, a complete biospecimen bank was established for storage of collected blood, urine, hair, and nail samples. The objective of this study was to evaluate the feasibility of nail samples as a biomarker of selected trace elements status

Methods: Thirty toenail samples were selected randomly from the participants of Golestan Cohort Study [GCS]. The samples were cleaned and analyzed for selenium, mercury, chromium, iron, zinc, and scandium by instrumental neutron activation analysis at the University of Missouri Research Reactor Center. Pearson correlation coefficients were computed for selected trace elements concentration versus scandium concentration to assess terrestrial contamination

Results: The selenium, zinc, and mercury were not correlated with scandium, suggesting they were free from substantial contamination. The high correlations of scandium with iron and chromium suggest that the iron and chromium levels may be compromised by terrestrial contamination. The coefficients of variation for duplicate samples for selenium and zinc were 2.6% and 7.2%, respectively

Conclusion: The nail samples from Golestan Cohort Study appears to be useable as a biomarker of selenium, zinc, and mercury and could be considered for use in future studies

Assessment of pneumatic balloon dilation in patients with symptomatic relapse after failed Heller myotomy: a single center experience

Background: Although Heller myotomy is one of the most effective treatments for achalasia, it may be associated with early or late symptom relapse in some patients. Therefore, additional treatment is required to achieve better control of symptoms. Aim: To evaluate the safety and efficacy of pneumatic balloon dilation [PBD] in patients with symptom relapse after Heller myotomy

Methods: Thirty six post-myotomy patients were evaluated from 1993 to 2013. Six patients were excluded from the analysis because of comorbid diseases or epiphrenic diverticula. Thirty patients were treated with PBD. Primary outcome was defined as a decrease in symptom score to 4 or less and a reduction greater than 80% from the baseline in the volume of barium in timed barium esophagogram in 6 weeks. Achalasia symptom score [ASS] was assessed at 1.5, 3, 6, and 12 months after treatment and then every six months in all patients and PBD was repeated in case of symptom relapse [ASS>4]

Results: The mean age of the patients was 45.5 +/- 13.9 years [range: 21-73]. Primary outcome was observed in 25 patients [83%]. The mean ASS of the patients dropped from 7.8 before treatment to 1.3 +/- 2.0 at 1.5 months after treatment [p=0.0001]. The mean volume and height of barium decreased from 43.1 +/- 33.4 and 7.1 +/- 4.7 to 6.0 +/- 17.1 and 1.1 +/- 2.2, respectively [p=0.003, p=0.003]. The mean duration of follow-up was 11.8 +/- 6.3 years. At the end of the study, 21 patients [70%] reported sustained good response. No major complications such as perforation or gross bleeding were seen

Conclusion: PBD is an effective and safe treatment option for achalasia in patients with symptom relapse after Heller myotomy

Manganese intake and risk of esophageal cancer in golestan cohort study

Background: Infections attributed to Helicobacter pylori [H. pylori] involve almost half of the world's population. One of the effects is auto-antibody induction and cross-reaction with numerous proteins in the body. As a result of its widespread prevalence and importance, this study evaluates the associations between H. pylori and thyroid auto-antibodies

Materials and Methods: This study enrolled 100 patients who were candidates for gastroesophageal endoscopy that referred to the Yazd Gastrointestinal Clinic. Patients underwent the following laboratory analyses: urease test, anti-H. pylori [IgG], TSH, T4, T3 and thyroid auto-antibodies [anti-thyroglobulin, anti-thyroid peroxides] Patients were divided into two groups of H. pylori positive and negative according to the results of the anti-H. pylori IgG and urease tests. The level of thyroid auto-antibodies and thyroid function tests were compared between groups. Data were analyzed with chi-square and t-tests. SPSS software version 17 was used for data analysis

Results: Overall, 61 % of patients were H. pylori positive. The mean anti-Thyroid peroxidase level in the H. pylori positive group was significantly more than the negative group [p<0.01]. In addition, 19.7% of H, pylori positive patients and 5.1% of H. pylori negative patients had positive anti-TPO levels, which the difference between both groups was significant [p<0.04]. There was no significant difference in thyroid fimction between the two groups

Conclusion: Although no significant difference in thyroid function was seen in the two groups more patients tested positive for anti-TPO levels in the H. pylori positive group, which was suggestive of thyroid auto-antibody induction by H. pylori

Solid pseudopapillary neoplasm of pancreas; a case series and review literature

Background: Information regarding solid pseudopapillary neoplasm [SPN] of the pancreas is limited in Iran. We aimed to review the clinicocytopathological features and follow-up of patients with SPN of pancreas who were diagnosed in a single center in Iran

Method: Seven patients with SPN of the pancreas were diagnosed during January 2010 to March 2015 at the Digestive Disease Research Institute of Tehran University of Medical Sciences. The patients were reviewed prospectively

Results: Six out of the 7 patients were female and the mean age of all the patients was 29.4 years ranging from 15 to 61 years. The most common clinical presentation was nonspecific abdominal pain [N=6]. The tumors were located mostly in head and neck of the pancreas. SPN was diagnosed in all patients by fine needle aspiration through endosonography [EUS-FNA]. All patients underwent surgery. Histological findings of surgical tissues were consistent with EUS-FNA. The postoperative follow-up period of about 14 months was uneventful

Conclusion: SPN of the pancreas is a rare pancreatic tumor which affects primarily young women. EUS-guided FNA could play an important role in preoperative diagnosis of SPN of the pancreas

Nonadherence to medication in inflammatory bowel disease: rate and reasons

Background: This study is the first study to evaluate the nonadherence rate and reasons of same patient with inflammatory bowel disease [IBD] in Iran

Method: During 9 months, 500 patients with IBD were enrolled in the study. Patients were interviewed about their nonadherence behaviors. Factor analysis was used to analyze the collected answers

Results: The overall rate of nonadherence was 33.3% [27.6% intentional nonadherence and 5.7% unintentional nonadherence]. 33.6% of the patients had at least one relapse after discontinuing treatment. The most frequent reason for intentional nonadherence was discontinuing the treatment after recovering from symptoms [42.7%]. The most frequent reason for unintentional nonadherence was forgetfulness [5.2%]. 19.8% of the patients did not visit their gastroenterologist on time and they purchased drugs from the drugstore. These patients reported that their clinics were too far and difficult to access. There was no significant relationship between nonadherence and demographic variables

Conclusion: Multiple reasons are suggested as factors of medication nonadherence and they seem to be different among different populations. Determining these possible reasons, could lead to finding suitable strategies to overcome or reduce them

association between dietary carbohydrate intake and pancreatic cancer risk: a large prospective study

Background: Pancreatic cancer [PC] is ranked as the 7th leading cause of cancer death worldwide and is one of the most deadly cancers. Several lines of evidence indicate that insulin resistance, diabetes, and obesity are implicated in its carcinogenesis

Materials and Methods: We examined the association between the consumption of carbohydrate foods and risk of PC in 50,045 participants [21241 men and 28804 women aged 40 to 75 years] of the Golestan Cohort Study in northeastern Iran. Dietary data were collected using a validated semi-quantitative food-frequency questionnaire. Cox proportional hazards models were used to estimate multivariate hazard ratio with 95% confidence interval

Results: During 8.5 years [383,630 person-years] of follow-up and after excluding participants with incomplete data, a total of 48,676 adults [20,683 men and 27,993 women] were studied. Until October 30, 2014, 54 cases of pancreatic cancer were confirmed by a medical team, based on the medical records and the exact cause of death according to ICD10 criteria. After adjusting for age, total energy intake, history of diabetes, smoking status, education, opium consumption, body mass index, waist to hip ratio, ethnicity, sex, the metabolic equivalent of task [MET], residential area, and socioeconomic status, we did not observe any statistically significant relationship between consumption of total carbohydrate and carbohydrate foods including whole grains, refined grains, sugars, and potatoes and risk of PC

Conclusion: Based on the results of the present study, dietary intake of total carbohydrate as well as various carbohydrate food sources had no significant association with the risk of PC. Finally, given the limited number of studies in this field and their inconclusive results, there is still a need for new prospective studies with long follow-up

Esophageal cancer in golestan province, Iran: a review of genetic susceptibility and environmental risk factors

Esophageal squamousi cell carcinoma [ESCC] is an aggressive tumor that is typically diagnosed only when the tumor has gained remarkable size, extended to peripheral tissues, and led to dysphagia. Five-year survival of advanced cancer is still very poor [19%], even with improved surgical techniques and adjuvant chemoradiation therapy

Therefore, early detection and prevention are the most important strategies to reduce the burden of ESCC

Our review will focus on the studies conducted in Golestan province, an area with a high prevalence of ESCC in northern Iran. We review three aspects of the research literature on ESCC: epidemiological features, environmental factors [including substance abuse, environmental contaminants, dietary factors, and human papilloma virus [HPV], and molecular factors [including oncogenes, tumor suppressor genes, cell cycle regulatory proteins, and other relevant biomarkers]

Epidemiological and experimental data suggest that some chemicals and lifestyle factors, including polycyclic aromatic hydrocarbons [PAHs], cigarette smoking, opium use, and hot tea drinking are associated with the development of ESCC in Golestan

HPV infects the esophageal epithelium, but so far, no firm evidence of its involvement in esophageal carcinogenesis has been provided. Some of these factors, notably hot tea drinking, may render the esophageal mucosa more susceptible to injury by other carcinogens

There are few studies at molecular level on ESCC in Golestan

Increasing awareness about the known risk factors of ESCC could potentially reduce the burden of ESCC in the region. Further studies on risk factors, identifying high risk populations, and early detection are needed

Magnetic resonance enterography in 300 known cases of crohn's disease: an initial report from a referral center in Iran

Background: Magnetic resonance enterography [MRE] has become the modality of choice in assessment of patients with Crohn's disease [CD]

We aimed to present our experience on 300 patients with CD who underwent MRE during the first 30 months after setting up MRE for the first time in a referral center in Iran

Methods: Patients with a definite diagnosis of CD based on either ileocolonoscopy or histopathological studies were included in the final report and categorized into four phenotypes of inactive, active, stricturing, and penetrating disease

Results: This was a case series study on 300 patients with known CD out of 594 referred subjects. The most prevalent phenotype was inactive observed in 162 [54.0%] patients followed by stricturing in 44 [14.7%], active in 40 [13.3%], penetrating in 27[9%], and active on chronic in 27 [9%] cases. The number of referred patients increased from 51 cases in the first 6 months to 165 in the last 6 months

Conclusion: This study presents the first report on the application of MRE in Iran as superb modality for management of CD. The growing number of referred patients indicates that MRE has been successful in addressing the most critical concerns of clinicians on determining the dominant disease phenotype

A randomized, double blinded, placebo-controlled clinical trial of silymarin in ulcerative colitis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of silymarin in ulcerative colitis (UC) patients.</p><p><b>METHODS</b>A randomized double blinded placebo-controlled clinical trial was conducted in 80 UC patients whose disease had been documented and were in remission state between September 2009 and October 2010. Patients were assigned to silymarin group (42 cases) and placebo group (38 cases) using a random number table. Either silymarin (140 mg) or placebo (lactose mono-hydrate, corn starch magnesium stearate) tablets were given once daily for 6 months along with their standard therapy. The efficacies were assessed by disease activity index (DAI), frequency difference of the disease flare-up, and paraclinical data.</p><p><b>RESULTS</b>Ten patients (4 in the silymarin group due to nausea and 6 in the placebo group due to disease flare-up and abdominal pain) discontinued the study. An improvement in hemoglobin level (11.8±1.6 g/dL vs. 13.4±1.2 g/dL,P<0.05) and erythrocyte sedimentation rate (23.7±11.5 mm/h vs.10.8±3.2 mm/h,P<0.05) was observed in the silymarin group but not in the placebo group. DAI significantly decreased in the silymarin group and reached from 11.3±3.5 to 10.7±2.8 (P<0.05). Thirty-five out of 38 patients in the silymarin group were in complete remission with no flare-up after 6 months as compared to 21 out of 32 patients in the placebo group (P=0.5000).</p><p><b>CONCLUSION</b>Silymarin as a natural supplement may be used in UC patients to maintain remission.</p>

Is it necessary to screen for celiac disease in adult idiopathic osteoporosis?

The aim of this study was to investigate the necessity of screening for celiac disease in idiopathic osteoporotic patients. Osteopenia and osteoporosis are well-known and prevalent complications of celiac disease. However, the relative prevalence of celiac disease among osteoporotic populations is not known, and the benefit of screening for celiac disease among the osteoporotic population remains controversial. We evaluated a total of 560 individuals, 460 with osteoporosis and 100 healthy subjects, from the rheumatology clinic in Imam Khomeini and Shariati hospital by IgA anti-tissue transglutaminase [anti-tTG] for celiac disease. Then individuals with positive serologic test underwent upper GI Endoscopy and 2nd part duodenum biopsies. The clinical findings were evaluated in both groups and were compared with each other. Five [1.08%] of 460 patients with osteoporosis and 1 [1%] of 100 subjects without osteoporosis had celiac disease by positive serologic and pathology results. Three patients with positive serology and pathology results were female. All patients in osteoporotic group had at least one other symptom of celiac disease. Two of them had anemia and others had chronic abdominal pain, recurrent oral aphtous lesion and chronic bloating. In the present study, the prevalence of celiac disease in osteoporotic patients is not high enough to justify recommendation for serologic screening of celiac disease in all patients with idiopathic osteoporosis; but in osteoporotic patients with other celiac or gastrointestinal symptoms and signs, for example iron deficiency anemia, chronic dyspepsia and bloating, constipation or diarrhea and recurrent aphtous lesions, it is necessary to evaluate for celiac disease

Verification of ALDH activity as a biomarker in colon cancer stem cells-derived HT-29 cell line

Background: Recent evidence has suggested that epithelial cancers including colorectal cancer [CRC] have driven by a small population of self-renewing, multi-potent cells termed cancer stem cells [CSCs] which could be responsible for recurrence of cancer. Aldehyde dehydrogenase 1 [ALDH1] activity has used as a functional stem cell biomarker to isolate CSCs in different cancers such as colorectal cancer

Objectives: The main aim of this research was to determine the utility of ALDH1 activity along with CD44 and EPCAM in identifying stem cell-like cells in human HT-29 colonic adenocarcinoma cell line

Materials and Methods: In this experimental study, colon CSCs biomarkers including CD44, EPCAM and ALDH1 in colonospheres and parent cells have analyzed by flow cytometry. The expression levels of stemness genes in spheroid and parental cells have investigated using SYBR Green real-time PCR. In addition, in vivo xenografts assay has performed to determine tumorigenic potential of tumor spheroid cells in nude mice

Results: According to results, over 92% of spheroids were CD44+/EpCAM+, while parent cells only have expressed 38% of CD44/EpCAM biomarkers [P < 0.001]. Controversially, ALDH activity was about 2-fold higher in the parent cells than spheroid cells [P < 0.05]. In comparison with the parental cells, expression levels of ''stemness'' genes, like Sox2, Oct4, Nanog, C-myc, and Klf4 have significantly increased in colonosphere cells [P < 0.05]. Further, administration of 2500 spheroids could be sufficient to initiate tumor growth in nude mice, while 1x106 of parental cells has needed to form tumor

Conclusions: For the first time, we have shown that colonospheres with low ALDH1 activity has indicated increased tumorigenic potential and stemness properties. So, it hasn't seemed that ALDH1 could become a useful biomarker to identify CSCs population in HT-29 cell line