Faramarz Derakhshan

Shahid Beheshti University of Medical Sciences, Teheran, Tehrān, Iran

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Publications (33)42.18 Total impact

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    ABSTRACT: Hepatitis C is a major reason of morbidity and mortality among hemophilia patients. Although combination therapy with peginterferon (peg-INF) and ribavirin is considered as standard treatment for chronic hepatitis C (CHC), but more evidence of the efficacy and safety is needed. In this study, efficacy and tolerability of combination therapy with peginterferon α-2a-ribavirin was investigated among hemophilia HCV infected patients. In a quasi-experimental, 45 naive hemophilia patients with chronic HCV received 180 mg of pegylated interferon (Pegasys) by subcutaneous injection weekly plus an oral dose of 800-1200 µg ribavirin daily according to body weight. The treatment continued 48 weeks in patients with genotype one and 24 weeks in those with genotype 3. Sustained virological response (SVR) was considered as efficacy of treatment. Forty three patients (95.6%) reached to end of treatment response (ETR); only two (4.4%) patients did not respond and were discontinued from treatment. None of 43 patients relapsed. SVR obtained in 43 of 45 patients (95.6%), in multivariate logistic regression model, third month's treatment WBC (WBC > 2000) remained the only significant predictor of SVR. Regimen dose reduced in three patients; two of those because of ALT increasing and other one for his retinal bleeding. In repeated measurement analysis, alanine aminotransferase (ALT) and hemoglobin (Hb) decreased significantly during treatment, but reduction of platelet (PLT) was not significant. CONCLUSONS: Results show high efficacy and safety of combination therapy of Peg-IFN-α 2a plus ribavirin among hemophiliacs with chronic hepatitis C.
    Iranian Red Crescent medical journal. 08/2012; 14(8):466-9.
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    ABSTRACT: Noroviruses are one of important agents that cause acute viral gastroenteritis worldwide. These viruses are belonging to Caliciviridae family and are genetically diverse. To date, there is no valuable data about prevalence of norovirus infection and the dominant genogroup/genotype among Iranian population. The objective of this study was to determine the frequency of norovirus infection in Iranian patients with gastroenteritis referred to three hospitals of Tehran and to specify the dominant genogroup/genotype of this virus among our study population. A total of 293 patients with acute gastroenteritis were included in the study. Detection of norovirus was performed using RT-PCR method and confirmed by direct sequencing with specific designed primers for capsid region of norovirus genome. Phylogenetic analysis was performed using the neighbor-joining method. Norovirus strains identified in our study were subsequently categorized according to previously defined genogroup/genotypes. Of these, norovirus GII was dominant genogroup. Sixty-five percent (17 of 26) of positive samples were determined as GII and 35% (9 of 26) were determined as GI, respectively, in 2008-2009. And among 8 sequenced strains of genogroup II the most frequent genotype was GII.3. The results of this study indicated that norovirus must be considered as one of the infectious causes of acute gastroenteritis among Iranian population. We also found that GII.3 is more prevalent in our study population. To the best of our knowledge there is limited data about the role of noroviruses in children and adults' acute gastroenteritis among Iranian patients and this prevalence and genotyping report of norovirus infection could be remarkable for further studies.
    Food and Environmental Virology 03/2012; 4(1):1-5. · 2.51 Impact Factor
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    ABSTRACT: Hepatitis B virus (HBV) isolates from Iranian patients around the country were characterized. Eighty-one complete genomes from HBV isolates were sequenced and analyzed. The studied population was grouped into three categories including inactive carriers, patients with chronic hepatitis, and patients with liver cirrhosis. Molecular and phylogenetic analyses revealed that Iranian patients were infected with HBV genotype D and subgenotype D1. The most common subtype was ayw2, followed by ayw3 and ayw4. Several deletions and insertions that had no correlation with disease outcome were observed in the HBV genomes. The most frequent mutation in the major hydrophilic region (MHR) of HBV surface antigen (HBsAg) was sP120S. Almost half of the patients studied carried precore (PC) mutant variants and one-third of the studied population was infected with variants carrying basal core promoter (BCP) mutations. PC and BCP mutations were observed in older patients, especially in those with chronic liver disease. Sixty-seven patients (82.7%) were HBeAg negative, and the prevalence of precore mutant isolates (G1896A) was higher in this group than in HBeAg-positive patients. Lamivudine drug resistance mutations were detected after 1 year of treatment in about 30% of lamivudine-treated patients. In conclusion, these results demonstrate that HBV subgenotype D1 is the only subgenotype circulating in Iran, and there is no evidence of any exotic genotype in the region. The HBV PC (G1896A) mutation may play an important role in the clinical outcome of the disease by increasing the risk of progressive liver disease among Iranian patients infected with HBV.
    Journal of Medical Virology 03/2012; 84(3):414-23. · 2.37 Impact Factor
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    ABSTRACT: This study evaluated the association between serum endothelin- 1 level and symptoms, clinical examination, laboratory and cardio-respiratory parameters, in patients with cirrhosis compared to controls. Cirrhosis is associated with significant portal, pulmonary and systemic vascular abnormities. Recent studies have suggested that endothelin -1 may have a significant role in the regulation of vascular tone. In this case - control study, subjects that had been evaluated and diagnosed with biopsy-proven cirrhosis and age-matched controls with no evidence of cardio-vascular or liver disease were recruited. Review of medical records, routine laboratory investigations and cardio-respiratory investigations including echocardiography to look for evidence of hepato-pulmonary syndrome were performed. 50 patients were subjects were recruited. The most common aetiology of the cirrhosis was chronic hepatitis B viral infection. 7/50 cases had evidence of the hepatopulmonary syndrome. Among the patients with evidence of the hepatopulmonary syndrome, dyspnoea (100%) and cyanosis (90%) were the most common of the symptoms and signs recorded. Pao2 and arterial - alveolar oxygen gradients were the most sensitive tests in the diagnosis of hepatopulmonary syndrome. Orthodoxy specificity was 100%. The median concentration of serum endothelin-1 in cases with hepatopulmonary syndrome was 1.06+/- 0.015 pg/ml (range 0.92 - 1.21), in cases of sub-clinical hepatopulmonary syndrome, 2.49+/- 0.08 (4.05- 0.93) in patients with cirrhosis but no evidence of hepatopulmonary syndrome criteria 0.85+/-0.74(1.06-0.64) in controls. There was a significant difference in serum endothelin- 1 levels between patients with cirrhosis and controls, but not between patients with cirrhosis complicated by hepatopulmonary syndrome and controls.
    Gastroenterology and hepatology from bed to bench. 01/2012; 5(Suppl 1):S13-9.
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    ABSTRACT: The aim of this study was to assess the prevalence of celiac disease (CD) in dyspeptic patients. Although severe mucosal abnormality with villous atrophy (lesions Marsh III) is the histology gold standard for the diagnosis of CD, non-specific microenteropathy (Marsh I-II) with positive serology is also common Patients with dyspepsia, specific CD antibodies and microenteropathy, could have CD. From November 2007 to October 2008, 407 randomly chosen patients who underwent diagnostic upper gastrointestinal endoscopy for dyspeptic symptoms (193 male, 214 women; mean age 36.1 years) were studied. Small bowel biopsies were performed in all of them. Histologic characteristics in duodenal biopsy specimens for CD were evaluated according to the modified Marsh Classification. All the patients were also tested for serum total immunoglobulin A and anti-transglutaminase (tTG) antibodies. Those with IgA deficiency were tested for IgG tTG. Duodenal histology showed Marsh I-IIIc lesions in 6.4% cases. 4 patients (0.98%) were IgA deficient and none of them were positive for IgG tTG. Serology showed positive results for tTGA in 8% of the patients and 2.5% of them had abnormal histology (Marsh I-IIIc) compatible with CD. The results of this study showed that milder enteropathy (Marsh 0-II) have a low specificity for CD. The prevalence of CD among dyspeptic individuals is significantly (2.5%) higher than in the general population (1%) and CD should be investigated in these patients.
    Gastroenterology and hepatology from bed to bench. 01/2012; 5(4):197-201.
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    ABSTRACT: Co-infection with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) in patients with chronic hepatitis B virus (HBV) infection can alter the course of the disease. In this study, we investigated the frequency of HIV and/or HCV co-infection in chronic HBV patients and related risk factors in acquiring the HCV and or HIV co-infectionit. We studied 264 chronic HBV patients who visited the Gastrointestinal and Liver Ward of the Taleghani Hospital, Tehran, Iran between 2006 and 2010. Demographic information and records of possible risky behavior were obtained. Antibodies against HBV, HCV, and HIV, levels of alanine transaminase (ALT) and aspartate transaminase (AST), and conversion from hepatitis B e antigen (HBeAg) to hepatitis B e antibody (HBeAb) were evaluated. Of 264 patients with chronic HBV in this study, 184 patients (70%) were men and 78 patients (30%) were women. Only 1 patient (0.37%) was positive for anti-HIV antibody, whereas 12 patients (4.54%) were positive for anti-HCV antibody. None of the patients had co-infection with all 3 viruses (HBV, HIV, and HCV). This study demonstrated that the prevalence of HCV is higher than that of HIV in chronic HBV patients. Since HCV or HIV co-infection affects the therapeutic outcome in chronic HBV patients, testing for HIV and HCV is recommended, especially for patients with a history of risky behavior.
    Hepatitis Monthly 12/2011; 11(12):993-6. · 1.25 Impact Factor
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    ABSTRACT: Wilson disease (WD) is an autosomal recessive disorder. The WD gene, ATP7B, encodes a copper-transporting ATPase involved in the transport of copper into the plasma protein ceruloplasmin and in excretion of copper from the liver. ATP7B mutations cause copper to accumulate in the liver and brain. We examined the ATP7B mutation spectrum in Wilson disease patients in Iran. Genomic DNA was extracted from patients with Wilson disease. The entire coding region of the ATP7B gene was amplified using PCR and analyzed using direct sequencing. We identified five novel mutations in 5 Iranian patients with Wilson disease. The first was a transversion, c.2363C > T, which led to an amino acid change from threonine to isoleucine. The second mutation was a deletion, c.2532delA (Val845Ser), which occurred in exon 10. The third mutation was a transition mutation, c.2311C > G (Leu770Leu), which occurred in the TM4 domain of the ATP7B protein. The fourth mutation was a transversion, (c.3061G > A) (Lys1020Lys), in exon 14. Lastly, we identified a transversion, c.3206C > A (His1069Asn) in exon 14 which led to a change in function of the ATP loop domain of the ATP7B protein. The H1069Q mutation was identified as the most common mutation in our study population. Based on our findings, the H1069Q may be a biomarker that can be used in a rapid detection assay for diagnosing WD patients.
    Hepatitis Monthly 11/2011; 11(11):890-4. · 1.25 Impact Factor
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    ABSTRACT: Chronic hepatitis C infection is caused by the hepatitis C virus (HCV), and its clinical complications include liver cirrhosis, liver failure, and hepatocellular carcinoma.Transforming growth factor-β1 (TGF-β1) is an important cytokine in cell growthand differentiation, angiogenesis, extracellular matrix formation, immune responseregulation, and cancer development and progression. The aim of this study was to investigate the relationship between single nucleotide polymorphisms (SNPs) in TGF-β1 and chronic HCV infection among patients referred to the Taleghani Hospital, Tehran, Iran between 2008 and 2010. In this case-control study, samples were collected using a convenience sampling method. We genotyped 164 HCV patients and 169 healthy controls for 3 SNPs in the TGF-β1 gene (-509 promoter, codon 10, and codon 25). We determined the SNP genotypes by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. To confirm the PCR-RFLP genotyping results, 10% of the samples were re-genotyped using a direct sequencing method. There were no significant differences in the allelic frequency distribution of SNPs at -509 C/T, +869 C/T, or +915 G/C between HCV patients and the healthy controls. Genotyping results for all three polymorphic sites were similar with no statistically significant differences between the groups. Most of the Iranian patients (over 85%), both healthy controls and HCV patients, had the GG genotype at the +915 G/C position, resulting in a high level of TGF-β1 production. Therefore, we concluded that the SNPs investigated by us cannot be considered as prognostic factors for HCV infection in our population, despite being reported as prognostic markers in other populations. Moreover, there is a possibility that most of the population is susceptible to HCV infection.
    Hepatitis Monthly 11/2011; 11(11):901-6. · 1.25 Impact Factor
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    ABSTRACT: Background: IL-22 is recognized a key player in the chronic inflammatory disorders. IL-22 signals through a class II cytokine receptor composed of an IL-22-binding chain, IL-22Rα1and the IL-10Rβ subunit, which is shared with the IL-10R. Chronic inflammation is a risk factor for colorectal cancer and polymorphisms in the inflammatory genes could modulate the levels of inflammation. We have investigated 4 single nucleotide polymorphisms (SNPs) in genes of the IL-22 (rs1179251 & rs1179246) and IL-22Rα (rs4648936 & rs10794665) in Iranian population. Methods: Genomic DNA is isolated from peripheral blood leukocytes by salting out method. Two hundred eight patients with colorectal cancer and 253 healthy control subjects were genotyped using polymerase chain reaction-restriction fragment length polymorphism. PCR-RFLP was confirmed using the sequencing. Result: The rs1179246 G/T (3’ UTR) polymorphism of the IL-22 gene was significantly associated with CRC (p=0.01). Nevertheless, the others studied polymorphisms in IL-22 and IL-22 R α did not show any significant associated with CRC risk. Conclusion: Our data suggest that IL-22 polymorphism in 3’-UTR region (rs1179246) may contribute to CRC susceptibility
    European Human Genetics Conference 2011; 05/2011
  • Sci J Hamadan Univ Med Sci. 01/2011; 17(4):17-24.
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    ABSTRACT: BACKGROUND AND OBJECTIVE: Transforming growth factor beta (TGF-β) has an inhibitory role in homeostasis of T-cell response and regulatory T cells and regulation of immune response against viral infections. Codon 10 of protein is located in the signal peptide and involved in secretion of cytokine. The aim of this study was to investigate the association of leu-pro polymorphism of codon 10 and hepatitis C susceptibility in patients. METHODS: This case-control study was performed on 112 chronic hepatitis C patients and 122 healthy control subjects. TGF-β1 gene was amplified with PCR method and genotypes were determined using Restriction Fragment Length Polymorphism (RFLP) with MspA1I restriction enzyme. FINDINGS: The frequency of CT genotype in both groups was higher than CC and TT. Genotyping results for CC, CT and TT states in patients was 50%, 19.6% and 30.4% and in healthy controls was 59%, 13.9% and 27.1% respectively. We found no significant difference between patients and healthy controls according to codon 10 polymorphism. CONCLUSION: According to the results of this study, no relationship was found between this protein’s genetic variations and chronic hepatitis C infection susceptibility.
    JBUMS. 01/2011; 13.
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    ABSTRACT: The NOD2 gene is known to have a strong association with Crohn's disease, but different trends were reported in occurrence of NOD2 variants in distinct ethnicities. The aim of this study was to assess all exonic sequences of the NOD2 gene in Iranian Crohn's disease patients and healthy controls to identify any existing variation and evaluate their association with Crohn's disease. A total of 90 non-related Crohn's disease patients and 120 sex- and age-matched healthy controls of Iranian origin were enrolled in this study. The participants were referred to a tertiary center in a 2-year period (2006-2008). The exonic regions of the NOD2 gene were amplified by polymerase chain reaction and evaluated by direct sequencing. A total of 21 sequence variations were identified among all exonic regions of the NOD2 gene, of which eight had an allele frequency of more than 5%. Eight new mutations (one in exon 2 and seven in exon 4) were observed. The three main variants (R702W, G908R, and 1007fs) showed allele frequencies of 13.3%, 2.2%, and 1.7%, respectively. Three new variations (P371T, A794P, and Q908H) and R702W mutation were significantly more frequent in Crohn's disease patients compared to controls. Eight novel mutations were identified in the NOD2 exons, but the pathophysiological importance of these variants remains unclear. Iranian patients with their different genetic reservoirs may demonstrate some novel characteristics for disease susceptibility.
    International Journal of Colorectal Disease 01/2011; 26(6):775-81. · 2.24 Impact Factor
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    ABSTRACT: ABSTRACT Background and Aim: Production of unusual cytokine levels in hepatitis C infection appears to be associated with progression of the disease, persistence of the virus in host, and establishment of chronic disease. Interleukin-12 as a heterodimeric immunoregulating cytokine is important in the generation of a Th1-based immune response. In this study we investigated the role of IL-12B 3′UTR polymorphism in susceptibility to chronic hepatitis C infection. Material and Methods: A total of 126 chronic hepatitis C patients and 136 healthy blood donors were genotyped for IL12-p 40- 3′ UTR polymorphism. Genotyping was carried out by PCR-RFLP method. The results were confirmed by analyzing 10 % of the samples by direct sequencing. Results: We found no significant differences in genotype and allele frequencies of the 3’UTR polymorphism between chronic hepatitis C patients and healthy controls. Conclusion: There was no association between IL12B-3’UTR polymorphism and chronic hepatitis C infection.Our study can be useful in regard to the factors regulating IL-12 production, and its consequent impact on chronic hepatitis C infection susceptibility in Iranian population. Key words: Chronic hepatitis C, Polymorphism, IL12-p40, 3′UTR Conflict of Interest: Nill Received: Aug 16, 2010 Accepted: Dec 28, 2010
    Scientific Journal of Kurdistan University of Medical Sciences 01/2011; 16(1):10-19.
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    ABSTRACT: Ulcerative colitis (UC) is a disabling disease with increasing incidence in Iran. In spite of combined medical therapy, some patients eventually undergo total colectomy. Infliximab has proved itself as a rescue therapy and even as an early aggressive therapy for severe extensive UC. Meantime, there are concerns about its complications. The aim of this study was to evaluate the efficacy of infliximab in Iranian refractory UC patients. This multi centric case-series study included 29 UC patients receiving two to three of the drugs prednisolone, AZT/6MP and 5ASA but yet having flare-ups. At first, the extent of colon involvement was determined by colonoscopy; then the drug was administered at baseline, 2nd week and 6th week and colonoscopy repeated afterwards. Clinical and laboratory data were also recorded. In first endoscopy 18 patients (62%) out of 29 suffered from pancolitis and none had normal results. In second examination (done on 19 patients), one was normal and only 8 of 18 (27.6%) had pancolitis. Considering missing cases, at least in 33.3% of patients the drug has reduced the extreme extent of colon involvement. Also a wilcoxon signed ranks test revealed significant reduction of the disease extension after this treatment (p = 0.008). There were only one leucopenic and one hypotensive reactions in short term. The drug showed effectiveness in the term of disease modifying, too. These data show the usefulness of the drug in refractory UC. Longer follow ups and controlled trials are needed.
    Journal of research in medical sciences 01/2011; 16(1):6-15. · 0.68 Impact Factor
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    ABSTRACT: Background: As a result of chronic hepatitis C virus (HCV) infection hepatitis C occurs, this type of viral infection can lead to clinical complications such as chronic hepatitis, liver cirrhosis, liver failure and hepatocellular carcinoma (HCC). Transforming Growth Factor-β1 (TGF-β1) protein is one of the important cytokines that regulate cell growth and differentiation, angiogenesis, extracellular matrix formation, regulating immune responses and plays a role in cancer development and progression. Objectives: The aim of this study was to investigate the relationship between single nucleotide polymorphisms of this gene and chronic hepatitis C infection among patients referred to Taleghani hospital, Tehran, IR Iran, from 2008 to 2010. Patients and Methods: In this Case-control study we collected samples using convenience sampling method and examined 164 patients with hepatitis C and 169 healthy controls for three polymorphisms (-509 promoter, codon 10 and codon 25) of TGF-β1 gene. Determination of single nucleotide polymorphism (SNP) genotypes was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and to confirm the RFLP genotyping results, 10 % of samples were re-evaluated by direct sequencing method. Results: No significant differences were observed in the allelic frequency distribution at position - 509 C/T, + 869 C/T and + 915 G/C. Genotyping results for all three polymorphic sites were closely similar with no statistically significant difference. Conclusions: Majority (over 85%) of Iranian sample donors including hepatitis C infection patients and healthy controls showed the GG genotype in + 915 G/C position and consequently they have had High TGF-β1 production. So we can conclude that these SNPs could not considered as prognostic factors for hepatitis C infection in our population athwart some other studied populations. In addition we can consider this possibility that this majority group is assorted to group, more susceptible to hepatitis C infection.
    Journal of Hepatitis Monthly. 01/2011; 11:901-906.
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    ABSTRACT: Background: Hepatitis B virus (HBV) is one of the most important causative agents of chronic liver diseases worldwide. However, the etiology of chronic hepatitis is not well recognized, but cytokines which are crucial regulatory agents of immune system play an important role in determination of natural course of viral infection. Host genetic background and single nucleotide polymorphisms have an effective role on cytokines productivity and function. So this study is aimed to investigate the relation between single nucleotide polymorphism in the 3’-untranslated region (3’ UTR) of interleukin 12 p40 gene on position +1188 and susceptibility to chronic hepatitis B infection. Materials and Method: A case-control study was performed on 140 chronic HBV patients and 150 healthy controls. Genotyping was done by PCR-RFLP method. Sequences of 10% of samples were analyzed by direct sequencing to confirm the genotyping results. Results: Frequencies of AA, AC and CC genotypes of IL-12B on +1188 position were 56.4%, 36.4% and 7.1% in patient group and 59.3%, 33.3% and 7.3% in control group, respectively. No statistically significant difference was found between two groups (p= 0.487). Conclusion: Genotype frequencies of this gene in the studied population are in line with results of most researches from different countries. Results of this study suggest that there is no association between IL-12B polymorphism on +1188 positions and susceptibility to chronic hepatitis B in Iranian population.
    zjrms. 01/2011;
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    ABSTRACT: Background: The co-infection of Hepatitis C virus and/or Human immunodeficiency virus in HBV chronic patients can alter the course of the disease. Objective: In this study, we investigated the frequency of HIV and/or HCV co-infection in chronic HBV patients and related risk factors in acquiring it. Materials/patients and Methods: we studied 264 chronic HBV patients who attended the Gastrointestinal and liver ward of Taleghani Hospital, Tehran, Iran from 2006 to 2010. Demographic information and records of possible risky behavior was taken. Antibody against HBV, HCV, HIV and levels of ALT & AST and also switching from HBeAg to HBeAb status were evaluated. Results: Of 264 patients with chronic hepatitis B in this study 184 (70%) of patients were men and 79 (30%) were women. Only one patient (0.37%) was positive for Anti-HIV antibody, whereas twelve patients (4.54%) were positive for Anti-HCV antibody. None of the patients had the co-infection of all these three viruses. Conclusion: This study showed that the prevalence of HCV is higher than HIV in chronic HBV patients. Since the HCV or HIV co-infection is effective in therapy in chronic hepatitis B patients, testing for HIV and HCV is recommended especially for patients with the history of risky behaviors.
    Journal of Hepatitis Monthly. 01/2011; 11.
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    ABSTRACT: Background and study aimsSelection of the best drug regimens for effective eradication of Helicobacter pylori (H. pylori) infection, especially in patients at risk of peptic ulcer relapses and development of complications of peptic ulcer disease, is challenging. This study assessed and compared the efficacy of the two common proton pump inhibitor (PPI)-based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population.
    Arab Journal of Gastroenterology 01/2010; 11(4):187-191.
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    ABSTRACT: Vitamin C in gastric juice and in vitro has been shown to inhibit the growth of Helicobacter pylori (H. pylori). The purpose of this study was to investigate the effect of addition of vitamin C to eradication regimen on H. pylori eradication rate. This randomised controlled clinical trial was conducted on 312 patients with H. pylori infection who had referred to the Taleghani Research Center of Gastroenterology and Liver Disease. Patients were randomly divided into two groups. Group A patients (162 patients) received amoxicillin 1g and metronidazole 500 mg b.i.d., bismuth 240 mg b.i.d. and omeprazole 40 mg q.i.d. in two divided doses. Patients in group B (150 patients) received the same regimen plus 500 mg vitamin C per day. All patients received therapy for 2 weeks. Four weeks later all patients underwent urea breath test and results were compared. A total of 140 patients in group A and 141 in group B completed the study. On intention-to-treat analysis 48.8% of patients in group A in comparison to 78% in group B responded to eradication therapy and had negative urea breath test (p<0.0001). Addition of vitamin C to H. pylori treatment regimen of amoxicillin, metronidazole and bismuth can significantly increases H. pylori eradication rate.
    Digestive and Liver Disease 07/2009; 41(9):644-7. · 3.16 Impact Factor
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    ABSTRACT: Eosinophilic esophagitis is among the causes of refractory reflux disease. Biopsy of esophagus is the gold standard for diagnosis. In this study we determined the frequency of eosinophilic esophagitis (EE) in refractory reflux cases referred to Motility Department of Shahid Beheshti Research Center of Gastroenterology and Liver Disease, Tehran, Iran. In this cross-sectional study, 68 cases with refractory reflux disease underwent endoscopy and had biopsies taken. Specimens were stained by hematoxylin and eosin and two independent pathologists confirmed the diagnosis of eosinophilic esophagitis. Mean (standard deviation, SD) age at diagnosis was 41.8 (10.94) years. All had allergy or atopy, and unknown dysphagia was noted for 66%. Endoscopic findings were as follows: esophagitis (33.3%), rings (33.3%), and whitish plaques (33.3%). Prevalence of eosinophilic esophagitis was 8.8% (N = 6; one man and five women). No statistical difference in demographic variables was found between eosinophilic esophagitis cases and others, except for history of atopy, food impaction, and endoscopic features (P value <0.005). Eosinophilic esophagitis should be considered in the differential diagnosis of any cases with refractory reflux who complain of chronic unexplained dysphagia, with history of recurrent food impaction, and atopy or abnormal endoscopic features.
    Digestive Diseases and Sciences 03/2009; 55(1):28-31. · 2.26 Impact Factor