Prevalence of Different Types of Primary Esophageal Motility Disorders and Their Associated Factors in Patients Referring to Shariati Hospital during 2018-2019.

BACKGROUND: Esophageal motility disorders (EMDs) are common in patients with dysphagia and are effectively diagnosed with high-resolution manometry (HREM). In this study, we aimed to evaluate the prevalence of different types of primary EMDs in patients referred for HREM and to further investigate the factors associated with EMDs. METHODS: In this cross-sectional study, all patients referred to the endoscopy section of Shariati Hospital during 2018-2019 (279 patients) were subjected to HREM and were evaluated according to their diagnosis, and the effect of each factor and each symptom on motility disorders was investigated. RESULTS: 84.5% (235) of the participants were diagnosed with at least one esophageal motility disorder; of them, achalasia was the most common form (52.6%). None of the predictive factors showed a statistically significant correlation with EMDs. However, regarding the symptoms, regurgitation and nocturnal cough were significantly more common in patients with EMD (P=0.001 and 0.009, respectively). CONCLUSION: This study demonstrates the high prevalence of EMDs in patients undergoing manometry. None of the factors studied, such as age, sex, diabetes, hypothyroidism, smoking, and alcohol and opium consumption, had a statistically significant correlation with EMDs.

Cross-cultural adaptation, validity, and reliability of the Wexner questionnaire in patients with functional constipation in an Iranian population.

AIM: The present study aimed to cross-culturally adapt and assess the validity and reliability of the English version of the Wexner questionnaire translated into the Persian language in Iranian patients. BACKGROUND: Constipation is one of the most common gastrointestinal disorders; therefore, it is necessary to utilize an index for both the clinic and research studies. METHODS: In the first phase, the English version of the Wexner questionnaire was translated into the Persian language. In the second phase, the Persian version was assessed to evaluate the psychometric properties in 136 patients with functional constipation who referred to gastrointestinal and physical medicine clinics. Content validity was assessed by face validity. Construct validity was tested based on hypothesis testing and structural validity. The correlation of the total scores of the Wexner questionnaire and the Patient Assessment Constipation Quality Of Life (PAC-QOL) questionnaire was used for concurrent criterion validity. Internal consistency and test-retest reliability were calculated using Cronbach's α and intraclass correlation coefficient (ICC).The floor/ceiling effect of the questionnaire was also evaluated. RESULTS: The content validity of the Persian version of Wexner's questionnaire was acceptable. The construct and concurrent criteria validity showed moderate correlation. The internal consistency and intrarater reliability were moderate (0.51) and excellent (rp = 0.97, p-value <0.001), respectively. No floor/ceiling effect was seen. CONCLUSION: The Persian version of the Wexner questionnaire showed good validity and reliability in Iranian patients and can therefore be applied in clinics as well as in research for Persian-speaking countries.

Safety and Efficacy of Graded Gradual Pneumatic Balloon Dilation in Idiopathic Achalasia Patients: A 24-Year Single-Center Experience.

BACKGROUND: Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up. METHODS: We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. 216 patients did not undergo PBD due to comorbid diseases. Ultimately, 1092 achalasia patients were enrolled. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Response to treatment was evaluated by Vantrappen scoring system. RESULTS: Of 1092 achalasia patients, 937 patients were treated by PBD and 155 patients were treated by combined therapy (PBD 1 month after Botulinum toxin injection). In short-term follow-up, 728 of 1092 patients underwent one PBD and 77.3% of them had excellent or good response (responders), 163 patients (58.6%) who underwent two PBDs were responders, and 44 (51.2%) patients who underwent three PBDs were responders. Overall, 2193 balloon dilations were performed on 1092 patients (mean 2 PBDs/patient). Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. The responders with two, three, and four or more dilations were 149, 67, and 67, respectively. The overall response rate was 69%. No any serious complications were noted by using the graded gradual method. CONCLUSION: Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.

Comparison of Treatment Response in Different Types of Achalasia: A Long-Term Study.

BACKGROUND Three manometric patterns are seen in high-resolution manometry (HRM). Response to treatment has been reported to be different in these subtypes. We aimed to investigate the frequency and response to treatment in subtypes of achalasia. METHODS 306 patients between 15 to 60 years old, naïve to treatment with idiopathic achalasia (IA) were evaluated prospectively in a cohort study for 8 years. The patients were treated with pneumatic balloon dilation (PBD), and evaluated before and one month after PBD with Achalasia Symptom Score (ASS) and timed barium esophagogram (TBE) and then every 6 months with ASS. The primary study outcome was defined as a reduction in ASS (equal to or less than 4) and a reduction greater than 80% in the volume of barium in TBE at 1 month after PBD compared with baseline values. RESULTS According to HRM, 57 were classified as type I (18.62%), 223 as type II (72.9%), and 26 as type III (8.5%). The mean lower esophageal sphincter (LES) residual pressures before treatment were 34.05 ± 31.55, 32.99 ± 17.90, and 37.47 ± 14.07 mmHg in types I, II, and III, respectively (p = 0.18). The mean ASS values before treatment were 12.23, 11.50, and 11.50, for types I, II, and III, respectively (p = 0.29). The ASS dropped to 2.50 in type I, 2.40 in type II, and 2.12 in type III at 1 month after treatment (p = 0.83). Eventually, at the end of follow-up, 24 patients with type I (83%), 82 patients with type II (67%), and five patients with type III (83%) showed sustained good responses (p = 0.528). CONCLUSION Manometric subtypes of achalasia did not have an important role in clinical success in the long term. Achalasia has no definite cure, but with current treatment modalities, palliation of symptoms is possible in over 90% of patients.

Common Digestive and Liver Diseases among 5880 Patients Admitted to Shariati Hospital,Tehran,Iran during 2000-2009.

BACKGROUND Digestive and liver diseases (LD) are among the most common causes of mortality and morbidity in Iran and throughout the world. We have aimed to report the etiology and outcome of gastrointestinal and LD that needed admission in a typical tertiary referral hospital in Tehran during the last decade. METHODS Shariati Hospital Gastroenterology and Liver Disease Department (GI & LD) was established in 1974. Information on admitted patients in this department, such as age, gender, clinical, laboratory and imaging results, fi nal diagnosis (according to ICD-10), and hospital outcome have been regularly collected by a special summary form since 1999. For this study, the results were analyzed and compared for two, 5-year time periods, 2000-2004 and 2005-2009. RESULTS There were 5880 patients (64.60% male) with a mean age of 51.8 years (range: 12 to 90 years) who were admitted. The hospital mortalityrate was 6.80%, of which 71.53% were male. The most common cause of hospital admission (39.25%) and mortality (38.55%) was chronic LD. The most common etiologies for admission in both genders were HBV and cryptogenic or non-alcoholic fatty LD(NAFLD) induced cirrhosis of the liver. Other common etiologies were gastrointestinal bleeding, HCV-induced cirrhosis, and CBD stones in male patients;CBD stones, gastrointestinal bleeding and autoimmune hepatitis in female patients. The rate of admission due to HBV-related LD decreased from 21.73% to 11.15%, while admission due to NAFLD-related liver (cryptogenic) disease remained unchanged (11.60% to 10.49%). The rate of admission for pancreatic cancer increased from 1.71% to 4.56%, CBD stones from 6.96% to 10.22%, cholangitis from 3.37% to 6.93%, acute pancreatitis from 2.54% to 4.65%, and Crohn's disease from 1.93% to 2.72%. CONCLUSION End-stage LD secondary to viral, autoimmune and NAFLD constitute the etiology of up to 50% of admissions and mortalities in Shariati Hospital for both genders. While the admission rate of HBV-related LD is declining, the rate of NAFLD-related LD remains stable. The rates of admission for pancreatic cancer, CBD stone, cholangitis, acute pancreatitis and crohn disease increased over the decade.