A Case Report: An Unusual Variation in the Facial Artery.

The facial artery is the main artery supplying the face occasionally. It gives three branches on the face, the inferior labial, the superior labial, and the lateral nasal, and terminates as the angular artery. Due to congenital vascular variations in the facial artery, it has been considered in the dissection of the head and neck region. During the dissection of a 65-year-old woman to expose this region, we discovered that the left facial artery is terminated by the superior labial artery after giving off the submental and inferior labial branches. At the level of the left oral commissure, the facial artery was attached to the buccinator muscle as connective tissue, with a noticeable decrease in diameter. The purpose of this study is to report a new variation of the facial artery that is particularly important for cadaver dissection, and head and neck surgeries, as well as for facial artery angiography.

Pomegranate seed extract enhances the inhibitory effect of adipose-derived mesenchymal stem cells on breast cancer cell line in co-culture conditions.

Background and purpose: Pomegranate seed extract (PSE) possesses anticancer activities and healing effects. Adipose-derived stem cells (ADSCs) are being considered a new candidate for cancer treatment. The purpose of this study was to investigate the effect of PSE on the cell cycle and apoptosis of the MCF-7 cell line in the co-culture condition with ADSCs. Experimental approach: MCF-7 and ADSC cells (ratio 1/1) were cultured in a transwell plate with and without PSE (PSE-co-culture and co-culture groups). MCF-7 cells were cultured in monolayer without and with PSE (mono-culture and PSE-mono-culture groups). MCF-7 cell line was harvested on day 5 and cell viability, apoptotic activity, cell cycle, and gene expression were evaluated. Findings / Results: The results of the MTT assay indicated that PSE at 100 µg/mL has the highest cytotoxicity on the MCF-7 in the PSE-co-culture group. The cell cycle analysis revealed that ADSCs in combination with PSE significantly increased the population of MCF-7 cells in the G1 phase, resulting in the arrest of MCF-7 cells cycle in the G0/G1 transition. In addition, the most apoptotic MCF-7 cells (41.5%) were detected in the same group. Expression of BAX and caspase3 genes were upregulated while anti-apoptotic (BCL-2) and angiogenesis inducer (VEGF) genes were downregulated in the PSE-co-culture group compared with the other groups. Conclusion and implications: ADSCs reduced cell viability and proliferation of MCF-7 cells in co-culture conditions and adding PSE to the medium increased the apoptosis of cancer cells. This study suggests that ADSCs with PSE can suppress tumor cells.

Therapeutic effects of human adipose mesenchymal stem cells and their paracrine agents on sodium iodate induced retinal degeneration in rats.

AIMS: The degeneration of retinal neurons which occurs in many neurodegenerative diseases of retina such as retinitis pigmentosa and aged-related macular degeneration, is a progressive phenomenon and leads to permanent visual disability. Aside from their economic and social impact, those who suffer from these diseases have a poor quality of life due to the lack of cures. Researchers have turned to stem cell therapies as a potential solution to this global health crisis. Mesenchymal stem cells (MSCs) and their paracrine agents such as conditioned medium (CM) and exosomes (Exo) have been applied to treat different retinal disorders. This study compared the therapeutic effects of human adipose mesenchymal stem cells (hADSCs) and their secretome on an in vivo model of sodium iodate retinal neurodegeneration. MAIN METHODS: We analyzed the expression of retinal cells' specific mRNAs by RT-PCR and proteins by immunostaining as well as performing visual cliff avoidance test as a functional evaluation technique. There were four therapeutic groups in this study: hADSC, hADSC-CM, hADSC-Exo and hADSC-Exo + CM. KEY FINDINGS: Although all groups showed different therapeutic effects on various retinal cells, the results of hADSC-CM were most striking, especially in terms of photoreceptor regeneration and retinal function. SIGNIFICANCE: The findings of present study demonstrated the different effects of MSC-based therapies on various retinal cells which could be helpful in designing more precise treatments that suit to each neurodegenerative disease mechanism and the cells involved. It also suggests that CM might be a better choice due to its multifactorial characteristic.

Therapeutic effects of mesenchymal stem cells-derived extracellular vesicles' miRNAs on retinal regeneration: a review.

Extracellular vesicles (EVs), which consist of microvesicles and exosomes, are secreted from all cells to transform vital information in the form of lipids, proteins, mRNAs and small RNAs such as microRNAs (miRNAs). Many studies demonstrated that EVs' miRNAs have effects on target cells. Numerous people suffer from the blindness caused by retinal degenerations. The death of retinal neurons is irreversible and creates permanent damage to the retina. In the absence of acceptable cures for retinal degenerative diseases, stem cells and their paracrine agents including EVs have become a promising therapeutic approach. Several studies showed that the therapeutic effects of stem cells are due to the miRNAs of their EVs. Considering the effects of microRNAs in retinal cells development and function and studies which provide the possible roles of mesenchymal stem cells-derived EVs miRNA content on retinal diseases, we focused on the similarities between these two groups of miRNAs that could be helpful for promoting new therapeutic techniques for retinal degenerative diseases.

Evaluation of endoscopic characteristics of upper gastrointestinal polyps in patients with familial adenomatous polyposis.

BACKGROUND: Familial adenomatous polyposis (FAP) is a disease inherited in an autosomal dominant fashion. Most FAP patients develop upper gastrointestinal polyps; especially those in the antrum and duodenum are usually neoplastic. The aim of this study was to evaluate the prevalence of gastroduodenal polyps in Iranian FAP patients. MATERIALS AND METHODS: 28 patients affected by FAP underwent front-view and side-view endoscopy. Papillary biopsies were performed in all patients. Location of polyps, their number and size, pathology study, patient general information (gender, age, family history of FAP or colorectal cancer and gastroduodenal polyps) were analyzed. RESULTS: Gastric polyps were seen in 39.3 % of patients. Some 72.7% of the affected individuals had fundic gland polyps and 36.36% had hyperplastic polyps. Duodenal adenoma was observed in 25% of patients. While 57% of patients had tubular adenoma with low grade dysplasia, 42.8% showed tubulovillous adenoma with low grade dysplasia. CONCLUSIONS: Findings of this study indicated that the prevalence of gastroduodenal polyps in FAP patients is high and dysplasia may be evident in duodenal polyps. Therefore, it appears that routine gastroduodenal endoscopy in FAP patients is necessary.

Direct medical care costs associated with patients diagnosed with chronic HCV.

BACKGROUND: HCV virus (HCV) is a significant global problem with wide-ranging socio-economic impacts. Because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and hepatocellular carcinoma (HCC), the economic burden of HCV infection is substantial. OBJECTIVES: This study aimed to estimate the direct medical care costs of chronic HCV infection. PATIENTS AND METHODS: For this cross-sectional study, 365 courses of HCV treatment were extracted from medical records of 284 patients being referred to Tehran HCV clinic, a clinical clinic of Baqiyatallah Research Center for Gastroenterology and Liver diseases, from 2005 to 2010. All the patients had been diagnosed with HCV. Direct medical care costs for each course of HCV treatment have been calculated based on Purchasing Power Parity Dollar (PPP$). RESULTS: Average direct medical costs for the courses treated with conventional interferon plus ribavirin (INF-RBV) were 4,403 PPP$, and 20,010 PPP$ for peg-interferon plus ribavirin (PEG-RBV) courses. There was an increase of the direct costs in both courses of treatment to achieve Sustain Viral Response (SVR). The costs amounted to 10,072 PPP$ in (INF-RBV) treatment and 34,035 PPP$ in (PEG-RBV). The significant difference between the costs of these two courses of treatment is attributable to high cost of Peg-interferon. This indicates that the medication costs are the dominant costs. CONCLUSIONS: According to the results, total direct medical costs for HCV patients in Iran exceeded 12 billion PPP$ in (INF-RBV) treatment and 55 billion PPP$ in (PEG-RBV).

Epidemiological features of hepatitis B and C infection in a high risk population: results of screening programs.

AIM: The aim of this study was to report the epidemiological features of HBV & HCV infection in an Iranian high risk population. BACKGROUND: Hepatitis B and hepatitis C infections are worldwide serious public health problems. Iran has an intermediate prevalence of infection and a screening program was started in 2010 among high risk individuals. PATIENTS AND METHODS: This cross-sectional study was conducted on 4455 new patients during two past years. Demographic information, age, gender, occupational status, medical history, history of vaccination against HBV, high risk exposure and laboratory findings were collected for each patient. Then distribution of demographic and risk factors was evaluated in each type of hepatitis. RESULTS: The mean age of patients was 45.6±17.3 years. More than two-thirds of the diagnosed cases were infected with HBV. 74% of patients were carriers of hepatitis virus. 60% of patients had no symptoms at diagnosis. Illicit intravenous drug use was most common high risk exposure in patients under study (n=366, 8.2%). High risk behaviors including illicit intravenous drug use and unprotected sex were relatively higher in patients infected with hepatitis C compared to patients with hepatitis B infection. CONCLUSION: Findings of this study suggest that illicit intravenous drug use, contact with an infected household member and unprotected sex are the most common high risk exposure in Iranian patients infected with viral hepatitis. Therefore, preventive strategies such as health education, vaccination and screening programs should be directed to these groups. The results also show that a majority of patients have no symptoms at the time of diagnosis, therefore periodic screening tests in high risk groups is required.

Specific count model for investing the related factors of cost of GERD and functional dyspepsia.

AIM: The purpose of this study is to analyze the cost of GERD and functional dyspepsia for investing its related factors. BACKGROUND: Gastro-oesophageal reflux disease GERD and dyspepsia are the most common symptoms of gastrointestinal disorders. Recent studies showed high prevalence and variety of clinical presentation of these two symptoms imposed enormous economic burden to the society. Cost data that related to economics burden have specific characteristics. So this kind of data needs to specific models. Poisson regression (PR) and negative binomial regression (NB) are the models that were used for analyzing cost data in this paper. PATIENTS AND METHODS: This study designed as a cross-sectional household survey from May 2006 to December 2007 on a random sample of individual in the Tehran province, Iran to find the prevalence of gastrointestinal symptoms and disorders and its related factors. The Cost in each item was counted. PR and NB were carried out to the data respectively. Likelihood ratio test was performed for comparison between models. Also Log likelihood, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare performance of the models. RESULTS: According to Likelihood ratio test and all three criterions that we used to compare performance of the models, NB was the best model for analyzing this cost data. Sex, age and insurance statues were being significant. CONCLUSION: PR and NB models were carried out for this data and according the results improved fit of the NB model over PR, it clearly indicates that over-dispersion is involved due to unobserved heterogeneity and/or clustering. NB model in cost data more appropriate fit than PR.

Increased oesophageal cancer mortality rate in Iran.

BACKGROUND AND STUDY AIMS: The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer. PATIENTS AND METHODS: We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardised rate (ASR). RESULTS: The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age. CONCLUSION: This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade.

Four years incidence rate of colorectal cancer in Iran: a survey of national cancer registry data - implications for screening.

INTRODUCTION: Design and implementation of screening programs in each country must be based on epidemiological data. Despite the relatively high incidence of CRC, there is no nationwide comprehensive program for screening in Iran. This study was designed to investigate national CRC data and help to determine guidelines for screening. METHODS: Incidence data used in this study were obtained from Iranian annual of National Cancer Registration report. Age standardized rates (ASR)were calculated using world standard population and were categorized by age, sex, anatomic subsite and morphology of tumor. Data were analyzed using SPSS.V.13 and Open Source Epidemiologic Statistics for Public Health software (OpenEpi v.2.3.1). RESULTS: A quarter of cases were less than 50 years of age. The majority of tumors were detected in the colon. The overall ASR in the four years period was 38.0 per 100000 and was higher for men compared women (P<0.05). Incidence rate of colorectal cancer increased with age. CONCLUSION: Results of present study indicated that incidence of colorectal cancer is relatively high in Iran. Incidence of CRC in people under 50 years and in rectum were reported higher than other countries that related etiologic factors should be investigate in further studies. According to the increasing of ASR after age 50 years, it seems that onset of screening at age 50 would be appropriate.

Irritable bowel syndrome, gastro-oesophageal reflux disease and dyspepsia: overlap analysis using loglinear models.

BACKGROUND AND STUDY AIMS: Irritable bowel syndrome (IBS), gastro-oesophageal reflux disease (GERD) and dyspepsia are three most important gastrointestinal disorders which occur frequently together in patients. This study aims to assess the association between IBS, GERD and dyspepsia by using loglinear model analysis. PATIENTS AND METHODS: This cross-sectional household survey, the purpose of which was to find the prevalence of gastrointestinal symptoms, disorders and the related factors, has been done from May 2006 to December 2007 in Tehran province, Iran. Subjects were interviewed by trained personnel. GERD was diagnosed as the experience of heartburn and/or acid regurgitation at least once a week for the last 3 months. IBS and dyspepsia were diagnosed according to the Rome III criteria. Loglinear models were applied to investigate the simultaneous association between IBS, GERD and dyspepsia. RESULTS: 77.9% of IBS patients had dyspepsia symptoms and 74.7% had GERD symptoms as well at the same time. As for the other two symptoms, 66% of GERD patients were also suffering from dyspepsia. CONCLUSIONS: These three symptoms frequently overlap; the overlap is systematic and not by chance or random.

An overview of colorectal cancer survival rates and prognosis in Asia.

Colorectal cancer is a rapidly rising trend in Asia. The incidence in many Asian countries is on par with the West. Several studies have provided data regarding the survival of patients with colorectal cancer. In Asia, the overall cure rate of colorectal cancer has not improved dramatically in the last decade, 5-year survival remaining at approximately 60%. Colorectal cancer survival time has increased in recent years, but mortality rate remains high. Although studies have determined a number of factors that can predict survival of patients after diagnosis, life expectancy has not been increased dramatically. It seems that among the prognostic factors explored so far, the most important are those that relate to early diagnosis of cancer. Primary detection is feasible since efficient screening modalities are available. Colonoscopic surveillance is needed, especially in subjects at higher risk.

Quality of life outcomes in patients living with stoma.

BACKGROUND: Despite efforts to maintain the intestinal tissue and treat gastrointestinal disease, a large number of patients undergo ostomy surgery each year. Using stoma reduces the patient's quality of life (QOL) greatly. Although there are approximately 3000 patients in Iran; there is little information about the impact of stoma on their QOL. AIMS: The study aims to evaluate QOL of stoma patients using a special measurement tool. SETTINGS AND DESIGN: This survey was a cross-sectional study that was conducted on 102 random samples of stoma patients. MATERIALS AND METHODS: The City of Hope Quality of Life-Ostomy Questionnaire was used for collecting demographic and clinical information and evaluating QOL. STATISTICAL ANALYSIS USED: Univariate and multiple regression analyses were performed to identify predictors of QOL. RESULTS: The mean score for the overall QOL for stoma patients was 7.48 ± 0.9. 70% of patients were dissatisfied with sexual activities. More than half of them reported feelings of depression following stoma surgery. Univariate analysis indicated that factors such as the type of ostomy (temporary/permanent), the underlying disease that had led to the stoma, depression, problem with location of ostomy, and change in clothing style had significant effects on overall QOL and its subscales (P < 0.05). The results of the regression analyses showed that only depression and problem with the location of ostomy were statistically significant in predicting patients' QOL and its subscales (P < 0.05). CONCLUSIONS: The findings demonstrated that living with stoma influences the overall aspect of QOL. Education for the patients and their families is important for improving the stoma patients' QOL. Sexual and psychological consultation may also improve patients' QOL.

Epidemiological features of gastro-esophageal reflux disease in Iran based on general population.

AIM: The aim of this study was to evaluate the epidemiology of GERD base on population study in Tehran providence. BACKGROUND: Gastro-esophageal reflux disease (GERD) is a common and chronic problem. Recent reports from developing countries indicate increment in the incidence and prevalence of the disease over the past. PATIENTS AND METHODS: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran. Participants completed a valid gastro-esophageal reflux Questionnaire. The questionnaire included personal and family characteristics such as age, gender, and educational status. In addition, interviewers asked them regarding 10 GI symptoms. RESULTS: Altogether 18180 individuals participated in this cross-sectional study. The mean ± SD age of participant was 38.7±17.1 and 9072 (49.9%) were women. The prevalence of GERD was 8.85 (8.43-9.26). There was significant relationship between age, sex, marital and educational status with GERD. GERD symptoms were more common in women, older people, individuals with low education and married people. There was overlap between GERD, irritable bowel syndrome (IBS) and uninvestigated dyspepsia (UD). CONCLUSION: According to our finding although the prevalence of GERD in our population is less than other studies, this prevalence is increasing in recent years.

History of upper gastrointestinal cancers in relatives: a community-based estimate.

AIM: The present study aimed to evaluate the prevalence of positive family history of these cancers in a large population-based sample of Tehran province, capital of Iran. BACKGROUND: Upper gastrointestinal (UGI) cancers (gastric and esophagus cancer) constitute a major health problem worldwide. A family history of cancer can increase the risk for developing cancer and recognized as one of the most important risk factors in predicting personal cancer risk. PATIENTS AND METHODS: This study designed as a cross-sectional survey in general population (2006-2007) of Tehran province. Totally 7,300 persons (age > = 20 years) sampled by random sampling on the basis of the list of postal, of whom 6,700 persons agreed to participate (response rate 92%). Respondents were asked if any first-degree (FDR) or second-degree (SDR) relatives had gastric or esophageal cancer. RESULTS: Totally, 6,453 respondents (48% male) entered to the study. The mean age of responders with positive FH was significantly higher than those with negative FH (P < 0.05). In total, 341 respondents (5.3%) reporting a history of UGI cancers in their relatives, 134(2.1%) in FDRs, and 207(3.2%) in SDRs. CONCLUSION: Our findings showed that the reported prevalence of FH of UGI cancers was relatively low and varied by specific respondent characteristics such as age and sex. However, the estimates of prevalence presented here are likely to be conservative compared with actual prevalence because of self-reported data gathering.

Estimation of average diagnosis and treatment costs of hepatitis C.

AIM: The objective of this study was to estimate the average cost of diagnosis and treatment of hepatitis C among patients based on their treatment regime, during the one course of treatment and six-month after stopping that. BACKGROUND: Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide and a major public health problem. PATIENTS AND METHODS: All data for this cross-sectional study were collected from medical records of 200 patients with hepatitis C, who referred to a private gastroenterology clinic between years 2005 through 2009. Information related to the 200 patients was extracted from their medical records and finally, 77 patients of them, who their treatment was not interfering with any other disease entered in this study. Therefore diagnosis and treatment costs of these patients were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$). RESULTS: Mean costs of diagnosis and treatment in one course of treatment and six month after that with standard interferon plus ribavirin (INF-RBV) exceeds 3,850 PPP$ and for patients who treated with peg-interferon plus ribavirin (PEG-RIBV) was 16,494 PPP$. Also in both types of treatment, medication cost was found to be a dominant cost component. CONCLUSION: Hepatitis C represents a very important and potentially costly disease to managed care organizations. Patients with this disease require expensive drug therapies and consume significant health care resources.

Using statistical models to assess medical cost of hepatitis C virus.

AIM: This study compared PR and NB in predicting HCV patient costs. The objective of this study was to predict the direct cost of the HCV patient in Iran. BACKGROUND: Hepatitis C virus (HCV) is a common and expensive infectious disease in Iran. Cost associated with HCV and its complications has not been well characterized. Analysis of cost data is important in providing consistent information to aid budgeting decisions and certain statistical regression models need for prediction mean costs. Poisson regression (PR) and negative binomial regression (NB) are more common in cost prediction study. PATIENTS AND METHODS: This study designed as a cross-sectional clinic base from 2001 to 2010. First treatment period of each patient bring in study. We evaluated the doctor visiting, drugs, and hospitalization and laboratory tests of patients. Cost per person per one treatment period estimated in purchasing power parity dollars (PPP$). The PR is one of the models from general linear models (GLM) for describing count outcomes. The NB is another model from (GLM) as an alternative to the PR model. RESULTS: According to Likelihood ratio test NB was found to be more appropriate than PR (P < 0.001). Genotype, marriage, medication, and SVR were being significant. Genotype 3 versus 1 decreasing cost while marriage, consuming pegasys and SVR increasing. CONCLUSION: Choosing best model in cost data is important because of specific feature of this data. After fitting the best model, analyzing and predicting future cost for patient in different situation is possible.

Clinical profile and post-operative lifestyle changes in cancer and non-cancer patients with ostomy.

AIM: The aim of this was to investigate some clinical profiles and lifestyle changes in stoma patients. BACKGROUND: Stoma patients experienced multiple complications due to their ostomy formation. PATIENTS AND METHODS: A cross-sectional study performed on 102 random samples of stoma patients. Any patient with adequate physical and mental capability to participate and having had an ostomy in place for at least 3 months was eligible to enter the study. Participants asked to answer study questions concerning age, sex, type of stoma, having permanent or temporary ostomy, underlying cause of stoma formation, type of cancers cause of stoma. Patient also questioned about some lifestyle changes because of stoma including: changing diet, sexual satisfaction (if sexually active after stoma formation), sense of depression, changing job, change clothing style. RESULTS: Colostomy was the most common type of stoma followed by ileostomy and urostomy. In 80.4% of patients under study the stoma was permanent. Most patients had a stoma because of cancer (77.5%), with colon cancer (41.2%) being the most common malignant diagnosis. The mean age of cancer patients (56.1±10.9) with stoma was significantly higher than non-cancer patients (44.7±12.9) (p < 0.05). A significant differences were found regarding to sexual satisfaction after stoma formation between the two groups (p < 0.05) and the cancer group was less sexually satisfied post-ostomy. CONCLUSION: In conclusion, stoma formation can caused multiple problems for both cancer and non-cancer patients. Counseling of patient is an important component of care that could help stoma patients to adjust with new situations.

Economic burden attributable to functional bowel disorders in Iran: a cross-sectional population-based study.

OBJECTIVE: While few population-based studies on the economic burden of functional bowel disorders (FBD) have been published from developing countries like Iran, this study aimed to estimate their direct and indirect costs for five groups of patients: irritable bowel syndrome (IBS), functional constipation (FC), unspecified-FBD (U-FBD), functional abdominal bloating (FAB) and functional diarrhea (FD). METHODS: Up to 18,180 adults randomly sampled from Tehran, Iran (2006-2007) were interviewed using two questionnaires based on the Rome III criteria to detect FBD patients and to estimate their medical expenses (such as visiting the doctor, drugs, hospitalization and laboratory tests) and productivity loss in the previous 6 months. All costs were converted to dollar purchasing power parity (PPP$) to facilitate cross-country comparisons. RESULTS: The mean total 6-month costs were approximately: 160, 147, 103, 96 and 42 PPP$ for IBS, FC, U-FBD, FAB and FD, respectively. The highest proportion of drug consumption was found in IBS patients. The highest mean duration of absence from work was seen in IBS patients (2.26 days). Overall, doctor visit costs accounted for approximately 1/3 of the total costs for FBD, followed by hospitalization. A higher indirect cost of illness was found in IBS (54 PPP$), whereas it was zero in FD. CONCLUSION: The economic burden of FBD seems to be moderately high in Iran and it imposes a relatively heavy financial burden on the Iranian national health system because of its high prevalence and its impact on quality of life, productivity and waste of resources.

Economic burden of gastro-oesophageal reflux disease and dyspepsia: A community-based study.

BACKGROUND AND STUDY AIMS: Gastro-oesophageal reflux disease (GERD) and dyspepsia are common digestive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran. PATIENTS AND METHODS: The study was performed on a total of 18,180 adult subjects (age>18 years) taken as a random sample in Tehran province, Iran (2006-2007). A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months. RESULTS: GERD was found in 518 (41.9% males) patients and dyspepsia in 404 patients (38.9% males). Further 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively (PPP, purchasing power parity dollars). The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively. CONCLUSION: According to our results, hospitalisation and physician visits were the main cost of disease that could be minimised by revision of the insurance business in Iran.