Naproxen, isosorbide dinitrate and co-administration cannot prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial.

BACKGROUNDS/AIMS: Acute pancreatitis is the most widespread complication of endoscopic retrograde cholangiopancreatography. Here, we investigated the efficacy of rectal suppository naproxen, sublingual isosorbide dinitrate and their co-administration in the prevention of post-ERCP pancreatitis. METHODS: This double-blind randomized clinical trial carried out from June 2015 to February 2016 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 585 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients divided into three groups. Group A received 500 mg naproxen, group B took 5 mg isosorbide dinitrate, and group C was co-administrated both agents before ERCP. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and increase of serum amylase activity more than 3 times over the upper normal limit (60-100 IU/L) within first the 24 h post-ERCP. RESULTS: Totally, 80 patients developed PEP included 29 (4.9%), 24 (4.1%), and 27 (4.6%) patients in groups A, B, and C, respectively (p=0.845). Longer ERCP time (p=0.041), using diazepam (p=0.033), a higher number of pancreatic ducts cannulation (p＜0.001), pancreatic duct injection (p=0.013), and using pancreatic stent (p=0.004) were the predisposing factors for PEP. CONCLUSIONS: Our findings indicated that prophylactic naproxen suppository or isosorbide dinitrate sublingually or co-administration had no significant difference in the prevention and severity of PEP, however, enhancing the endoscopist's skills can be effective. Departments and educational hospitals should develop their assessment and quality assurance measures for the training of fellows' not only technical training but also an understanding of the diagnostic and therapeutic roles of the procedure.

Analysis of babA, cagE and cagA Genes in Helicobacter pylori from Upper Gastric Patients in the North of Iran.

OBJECTIVE: Helicobacter pylori is a Gram-negative bacterium which has a serious effect on up to half of the world's population and has been related to different gastric diseases. The goal of this study was to assess the frequency of babA, cagE and cagA genotypes among H. pylori strains isolated from gastric biopsies of endoscopic patients in the north of Iran. METHODS: The present study was performed on 90 strains of H. pylori isolated from patients with gastric diseases (Gastric ulcer (GU), Duodenal ulcer (DU), Gastritis (G), Non-ulcer dyspepsia (NUD) and Gastric adenocarcinoma (GC)). DNA was extracted from all isolated strains and PCR method was performed to detect the prevalence of babA2, cagE and cagA genes using specific primers. RESULTS: Among 90 samples of H. pylori, babA2, cagE, and cagA genes were detected in 42.2%, 30% and 82.2% of strains respectively. The statistical analysis showed that the prevalence of cagA gene in GU, G, DU, and NUD was significantly higher than other genes. Moreover, cagA, and babA2 genes were significantly more prevalent in GC patients compared to cagE gene. Our isolates exhibited 8 distinct arrangements of virulence patterns. The occurrence of cagA (35.6%) was the most prevalent pattern followed by cagA/babA2 (20%) and cagA/babA2/cagE (14.4%). CONCLUSION: In summary, as first report from Guilan province in the north of Iran, we showed significant association between the presence of babA2, cagE, and cagA genes in different types of gastric disorders.

Evaluations of life style factors and the severity of Gastroesophageal reflux disease; a case-control study.

The incidence of Gastroesophageal reflux disease (GERD) has increased remarkably worldwide. This study focuses on the background features of these patients and evaluates the two GERD sub types; none erosive (NERD) and erosive (ERD). In a case-control study, patients with reflux symptoms who had obtained a total score of 8-18 of the GERD questionnaire were included. Control group consisted of their families with lower scores and no reflux presentations. All demographic features were recorded. Then upper GI endoscopy performed and the cases divided into two sub groups: NERD and ERD. In the next step, all demographic data analyzed for these two subgroups. The data were analyzed using the SPSS software version 21. A number of 210 subjects included in each group (210 patients with GERD and 210 control group) with normal statistical distribution of age and gender. There was a significant relationship between GERD and BMI (P=0.001), eating fatty foods (P=0.0001), lying after meal (P=0.0001), drinking beverages with meal (0.0001), eating spicy food (0.006) and NSAIDs use (P=0.0001). Then the cases divided into two subgroups; NERD (n=146) and ERD (n=64). There were a significant relationship with eating salty-smoky food (P=0.005) and eating spicy food (P=0.011). The difference of BMI between NERD and ERD was remarkable but was not statistically significant. Our results showed that obesity is an important risk factor for GERD. Other possible risk factors such as NSAIDs use and certain foods and wrong habits like lying after meal should be addressed in future longitudinal surveys.

Helicobacter pylori infection and MDM2 SNP309 association with gastric cancer susceptibility.

AIMS: MDM2 is a negative regulator of p53, and has also been implicated in carcinogenesis. The aim of this study was to define the causal association of Helicobacter pylori infection and the MDM2 SNP309 among northern Iranian patients with gastric cancer (GC). Two hundred and eight patients with GC and 200 cancer-free controls were genotyped for MDM2 SNP309 using the polymerase chain reaction-restriction fragment length polymorphism method. The ureC (glmM) gene was used for detection of H. pylori in this study. RESULTS: The G allele was found more frequently among patients with GC (55%) than among controls (37%). The risk of GC for MDM2 309G/G genotypes was considerably increased when compared with TT genotypes (odds ratio [OR]=15.93, 95% confidence interval [CI]=4.17-60.84). Among H. pylori-infected subjects, a significantly increased risk of GC associated with the GG genotype was quite clear (OR=14.66, 95% CI=3.54-60). CONCLUSIONS: The GG genotype was associated with an increased risk of gastric carcinoma. We also found that there is a joint effect of MDM2 SNP309G/G genotype and H. pylori infection for the development of gastric carcinoma. However, the findings need to be verified in large population-based prospective studies for more rigorous analyses of subgroups and gene-environment and gene-gene interactions.