[Show abstract][Hide abstract] ABSTRACT: Hepatitis A virus (HAV) and hepatitis E virus (HEV) are enteric hepatotropic viruses and their prevalence is related to the sanitary conditions of the region under investigation. There are only a few studies on the seroepidemiology of these two viruses in the general Iranian population. The purpose of this investigation was to measure the prevalence of hepatitis A and E infections in the general population. Between 2006 and 2007, a cross sectional study was performed in Tehran, Iran. Blood specimens were collected and questionnaires were filled in for 551 persons. Patient sera were tested by ELISA for anti-HEV and anti-HAV IgGs. The χ(2) test and independent t-test were used for statistical analysis and p<0.05 was considered significant. The overall seroprevalence rates of anti-HEV IgG and anti-HAV IgG were 9.3% and 90%, respectively. The prevalence of antibodies to HAV and HEV was greater among men than women and increased with age. However, there was no significant relationship between age and gender with the existence of anti- HAV and HEV IgG antibodies. Our results show the seroprevalence of HAV and HEV antibodies are high and both viruses are endemic in this region. These findings are in accordance with results obtained from previous studies. We recommend that foreign travelers to Iran are vaccinated against HAV.
Transactions of the Royal Society of Tropical Medicine and Hygiene 07/2012; 106(9):528-31. · 1.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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).
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$) to facilitate cross-country comparisons.
The mean total 6-month costs were approximately: 160, 147, 103, 96 and 42 PPP$ 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.
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.
Journal of Digestive Diseases 10/2011; 12(5):384-92. · 1.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
Arab Journal of Gastroenterology 06/2011; 12(2):86-9.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to describe the occurrence of self report bloating and related factors in patients with irritable bowel syndrome (IBS).
Bloating symptoms are common in patients with IBS and have significant impact on normal daily function.
This study was a community-based cross-sectional survey that conducted using a valid questionnaire base on Rome III criteria. Univariate analysis was used for investigation about distribution of self reported bloating according to demographic and psychological factors in irritable bowel syndrome patients.
Out of 18180 subjects under study, 198 cases met criteria for the diagnosis of the irritable bowel syndrome according to criteria ROME III and 61.6% reported bloating symptoms. Bloating symptoms were more prevalent among patients with intermittent symptoms and diarrhea than in patients with constipation. Catastrophic events and depression were independent risk factors for bloating.
Findings of this study support the clinical impression regarding the high prevalence of bloating symptoms in patients with irritable bowel syndrome. Further studies are needed to understand the role of physiological and psychological factors and their interaction in development of bloating in irritable bowel syndrome patients.
Gastroenterology and hepatology from bed to bench. 01/2011; 4(2):86-90.
[Show abstract][Hide abstract] ABSTRACT: Having a family history (FH) of cancer is recognized as one of the most important factors in predicting personal cancer risk. Since reports on cancer FH from developing countries are limited, the present study was conducted to provide a first report on the prevalence of familial cancers in Iran.
Cross-sectional analysis performed on self-reported FH of cancers based on data from a large population based study in Tehran, the capital of Iran. Each participant was shown a list of site-specific cancers and asked if a relative had been diagnosed with any cancer on the list, completing the question by specifying the age of diagnosis.
Stomach cancer (4.6%) was the most common condition noted for family members, followed by the cancers of the breast (4.2%), lung (3.5%), liver (3.1%), leukemia (3.0) and colorectum (2.8%). The most frequent cancer reported by the responders was breast (1.8%) in first degree relatives (FDR) and stomach (1.8%) and stomach (2.8%) in second degree relatives (SDR). A FH of cancer was more commonly reported by younger persons and females. Of all respondents with a positive FH, 28.2% had at least one affected person diagnosed at age under 50 years in their FDRs.
A substantial proportion of individuals in the Iran report having a family member affected by cancer, and thus may be recommended for early cancer screening services.
Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(1):289-95. · 1.50 Impact Factor
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: Recent studies have shown inconsistent results about the association between body mass index and symptoms of gastrointestinal disorders. The aim of this study was to assess the association between body mass index (BMI) and symptoms of uninvestigated dyspepsia in patients with gastrointestinal symptoms and their relations with age.
This study was designed as a cross-sectional and population based evaluation that was conducted in Iran. The patients were interviewed by using questionnaire which was arranged on the basis of Rome III criteria for functional dyspepsia. The association between body mass index, age and dyspepsia symptoms was determined.
A total of 790 patients with gastrointestinal symptoms (249 men, mean +/- SD of age, 49.9 +/- 19 years; mean +/- SD of BMI, 25.4 +/- 4.7) were included and among them 681 (86.2%) had symptoms of dyspepsia. The prevalence of dyspepsia symptoms among females younger and older than 50 years were 83% and 93.8% ,respectively, but these percentages among males younger and older than 50 years were 84.5% and 81.5%.In males younger and older than 50 years 42.9% and 37.6% had BMI over than 25, but these percentages were 51.3% and 54.8% for females. Among overweight and obese patients the prevalence of dyspepsia symptoms were 82.7% and 78%, respectively, compared with normal weight (90.7%).
After the age of 50, the prevalence of dyspepsia symptoms and high body mass index were increased in females, but were decreased in males. No relation between symptoms of dyspepsia and body mass index in both genders was found.
East African journal of public health 12/2010; 7(4):318-22.
[Show abstract][Hide abstract] ABSTRACT: Heartburn is a highly prevalent disorder and is one of the most common gastrointestinal (GI) symptoms encountered in clinical practice. Despite the increasing importance of the early diagnosis of heartburn, there are few studies available on the prevalence of the disease and its Symptoms. The aim of this study was to estimate the frequency of heartburn in the Iranian adult population and analyze its associations with possible confounding factors.
This study was designed as an epidemiological, cross-sectional and population based study that was conducted during May to December 2006 in Firoozkou city of Iran. Participants were interviewed by using a questionnaire which included sociodemographic, health relevant life style and clinical factors and GI symptoms. Statistical analysis was performed by using chi-square test and logistic regression model.
The frequency of heartburn was 28% and is different between men and women (P < 0.05). Also there was a relationship between self report tension and anxiety, BMI and depression with heartburn in univariate analysis (p < 0.05), but in multivariate analysis only age, self report tension and anxiety had a significant relationship with heartburn.
Heartburn is very frequent in Iranian population and has a considerable impact on everyday life. Many factors that may affect the prevalence of heartburn should be considered for prevention and control of this disease.
East African journal of public health 06/2010; 7(2):196-8.
[Show abstract][Hide abstract] ABSTRACT: A case-control study was conducted to investigate the epidemiology and clinical features of Blastocystis hominis among Iranian patients with and without GI symptoms.
Six hundred and seventy patients with GI and Six hundred and seventy patients without GI symptoms were enrolled as cases and controls respectively during 2006-07. Standard microscopic examinations following in vitro culture were used to examine the stool samples for presence of trophozoites and cysts of B. hominis.
Infection with B. hominis occurred most commonly in those with GI symptoms (5.67 %) compared with those patients without GI symptoms (3.43 %). The most common symptom in case group was abdominal pain (86.84 %). B. hominis was mostly found with Giardia lamblia in case group and with Entamoeba coli in control group. In addition, there was no significant relation between the presence of GI symptoms and the incidence of B. hominis.
B. hominis has long been described as a non-pathogenic protozoan parasite until recently, when claims have been made that it could result in pathogenic conditions. Thus, to confirm the complication is needed to additional study especially on molecular pathogenesis of this organism.
East African journal of public health 03/2010; 7(1):101-4.
[Show abstract][Hide abstract] ABSTRACT: The prevalence of irritable bowel syndrome (IBS) is relatively high, but up to now, no population based study in Iran has used the ROME III criteria. The aim of the present study was to determine the prevalence of IBS by using the ROME III criteria in the adult population of Iran.
A face to face survey was conducted in a large area of the Tehran province. IBS was diagnosed by using a validated questionnaire based on the ROME III criteria.
The study population comprised 18,180 participants, with a female to male ratio of 1. 15.3% of participants complained of gastrointestinal (GI) symptoms, while the prevalence of IBS was estimated to be 1.1% (139 women, 59 men, p=0.000). IBS patients were more likely to be married, and older. The most common presenting symptoms of IBS were abdominal pain that was relieved by defecation (94%), change in fecal consistency (78%), and change in bowel frequency (70%). Constipation was predominant in 52% of IBS cases, diarrhea was predominant in 18%, and 8% experienced intermittent diarrhea and constipation.
The prevalence of IBS is relatively low in the Iranian adult population according to the ROME III criteria. The most probable reasons are the specificity of ROME III criteria and the characteristic low prevalence of GI symptoms in the study population.
Journal of gastrointestinal and liver diseases: JGLD 12/2009; 18(4):413-8. · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Atypical presentation is the most prevalent form of coeliac disease (CD) and mostly clinically indistinguishable from other gastrointestinal (GI) disorders. The first objective of this study was to determine the prevalence of CD in patients with GI symptoms and the second objective was to characterize the typical manifestations of the atypical forms of CD.
This was a cross sectional study comprising 5,176 individuals by random sampling of self-referred people from the Tehran province, during the years 2006-2007 in a primary care setting. From 5,176 individuals, 670 with GI symptoms were selected for coeliac serology including total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) antibodies. Those with IgA deficiency were tested with IgG tTG.
This study shows that 13% (670/5176) of self-referred patients to a general practice suffer from GI symptoms. Dyspepsia was the most common symptom in 25 seropositive cases similar to the rest of the study group. A positive anti-tTG test was found in 22 from 670 investigated subjects (17 women, 5 men) (95% CI: 1.70-4.30) and 8/670 were IgA deficient. A positive IgG tTG was detected in 3/8 IgA deficient individuals. The prevalence of CD antibodies in serologically screened samples excluding IgA-deficient was 3.3% and 3.7% when including those IgA-deficient with positive tTG-IgG.
Non-specific GI symptoms seem to be the typical presentation of atypical CD. This study indicated that there is a high prevalence of CD antibodies among patients with GI symptoms (3.7%). More awareness regarding the atypical presentation of CD could be the key step in identifying asymptomatic patients.
Journal of gastrointestinal and liver diseases: JGLD 09/2009; 18(3):285-91. · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many factors have been linked to the occurrence of constipation, but few studies exist regarding the link between obesity and constipation. The aim of this study was to assess the association between body mass index (BMI) and functional constipation in the Iranian community.
From May 2006 to December 2007, a cross sectional study was conducted in the Tehran province and a total of 18,180 adult persons were drawn up randomly. One questionnaire was filled in two stages through interviews. In the first part, personal characteristics and 11 gastrointestinal symptoms were listed. Those who reported at least one of these 11 symptoms were referred for the second interview. The second part of the questionnaire consisted of questions about different gastrointestinal disorders based on the Rome III criteria including functional constipation.
459 adult persons were found to have functional constipation. The mean +/- SD of BMI was 26.5 +/- 4.7 and 60% of the patients had a BMI more than 25. Age and education were significantly associated factors with obesity, showing that older patients and less educated patients were more overweight and obese. Smoking, marital status and sex were not significantly associated with obesity but, up to 60% of low educated women who had functional constipation, had a BMI more than 25.
Our study showed that about 60% of patients with functional constipation were overweight, which was more than the mean of our community. In addition there may be an association between higher BMI level and the low education level with constipation in Iranian women.
Journal of gastrointestinal and liver diseases: JGLD 07/2009; 18(2):151-5. · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence and determinants of uninvestigated dyspepsia in the Iranian population.
A cross-sectional study conducted in Tehran province from May 2006 to December 2007, included 18,180 adult persons selected randomly. The study took place at Shahid Beheshti University, MC, Tehran, Iran. A questionnaire was completed in 2 steps. In the first part, personal characteristics and 11 gastrointestinal symptoms were inserted. Those who reported at least one of these 11 symptoms were referred for the second interview, which consisted of questions on different gastrointestinal disorders based on Rome III criteria, including uninvestigated dyspepsia.
The prevalence rate of uninvestigated dyspepsia was 8.5% (10.9% in women and 6.4% in men). Among the subjects diagnosed with dyspepsia, bothersome postprandial fullness was the most common symptom (41.5%). Uninvestigated dyspepsia was more common in low educated and widowed participants. Approximately 41.4% of patients had a history of depression, and 66.1% had self report of stress. The prevalence of functional irritable bowel syndrome in patients with uninvestigated dyspepsia was 8.3% and gastroesophageal reflux disease was 64.9%.
Uninvestigated dyspepsia has a less common prevalence in the general Iranian population than developed countries. Women, older, obese, widowed, and low education subjects are more likely to suffer from dyspepsia.
Saudi medical journal 04/2009; 30(3):397-402. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: Gastro esophageal reflux disease (GERD) is a common gastrointestinal disorder all over the world. Some patients with GERD have no symptoms while others may have non-specific symptoms. The aim of this study was to define the frequency of non- specific symptoms of gastro esophageal reflux and to determine the association of these symptoms with GERD in a population- based study. Methods: This cross-sectional and population- based study was conducted on 782 subjects who were randomly selected from 2 cities of Firoozkooh and Damavand in the northeast of Tehran province. The relationship between non-specific symptoms and GERD was assessed through Chi-square and the odds ratios (OR) with 95% of certainty levels were calculated for each symptom. Results: In this study, 228 persons (29.2%) with GERD were diagnosed. The most common non-specific symptom in the subjects was abdominal pain with a distinct female preponderance. Globus sensation, cough and dyspnea, and halitosis were among the other symptoms having a direct relationship with GERD. No significant relationship was observed between age and non-specific symptoms of GERD. Conclusion: In sum, this study showed the prevalence of non-specific symptoms which are strongly related to gastro esophageal reflux disease. Therefore, considering these symptoms in diagnosis course of the disease seems necessary.
[Show abstract][Hide abstract] ABSTRACT: Gastro-oesophageal reflux disease and irritable bowel syndrome are common diseases, which may be related.
To assess the association between gastro-oesophageal reflux disease and irritable bowel syndrome in a country with high prevalence of Helicobacter pylori.
This study was designed as cross-sectional and population-based in Tehran province, Iran. The participants were interviewed by using a valid and reliable questionnaire. Gastro-oesophageal reflux disease was defined by weekly or more frequent heartburn and/or acid regurgitation. Irritable bowel syndrome was diagnosed according to the Rome III. The association between these two disorders was calculated using a statistical model that allows the odds ratio (OR) to be measured.
A total of 6526 individuals were selected randomly, the response rate was 87.8%. Among the respondents, 178 (3.1%) participants reported both the diseases. The OR of having gastro-oesophageal reflux disease and irritable bowel syndrome together was estimated to be 16.55 (95% confidence interval: 12.85-21.33) indicating significant association between the two diseases. Thirty-four percent of patients with gastro-oesophageal reflux disease and 61.5% with irritable bowel syndrome suffered from both diseases. Sex did not have a significant effect on the OR of coexistence. Older participants were statistically more prone to the coexistence of two diseases.
The association between gastro-oesophageal reflux disease and irritable bowel syndrome was significantly higher in our community compared with others. Their association occurs predominantly in older participants. Further studies for understanding of the pathophysiological mechanisms behind these two diseases are required.
European Journal of Gastroenterology & Hepatology 09/2008; 20(8):719-25. · 1.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The vitamin D receptor (VDR) gene maps to a region on chromosome 12 shown to be linked to inflammatory bowel disease (IBD). Many studies have recognized the relation of VDR gene polymorphisms with inflammatory and autoimmune disorders. Determining the frequency of these polymorphisms and their possible relation with IBD can improve understandings about the genetic background of these diseases. The objective of this study was to assess the association of VDR gene polymorphisms (Apa I, Taq I, Bsm I, Fok I) with IBD in Iran.
In this case control designed study 150 patients with ulcerative colitis, 80 patients with Crohn's disease and 150 Age and Sex matched healthy controls from Iranian origin were enrolled. These patients were referred to a tertiary center during a two-year period (2004-2006). Assessment of VDR gene polymorphisms was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The genotype-phenotype association for these polymorphisms was analyzed.
Only the frequency of the Fok I polymorphism was significantly higher in ulcerative colitis and Crohn's groups. The frequency of the polymorphic allele f was higher in ulcerative colitis and Crohn's patients comparing with controls (P = 0.011 and P < 0.001, respectively). The f/f genotype was also significantly more frequent (P < 0.001), while the F/F genotype was less presented in Crohn's patients compared to controls (P < 0.001). No genotype-phenotype association was observed with any mutations.
This study suggests a probable association of the Fok I polymorphism in VDR receptor gene and Crohn's susceptibility in Iranian population.
Journal of Gastroenterology and Hepatology 09/2008; 23(12):1816-22. · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An association between obesity and gastro-esophageal reflux disease (GERD) has been frequently reported in western communities. 1,2,3 A recent study conducted by Corley et al in the United States of America showed that the association between body mass index (BMI) and reflux-type symptoms was partially mediated through abdominal diameter and there was a consistent association between abdominal diameter and reflux-type symptoms in the white population, but no consistent association was found in the black population or Asians. 4 It is not known whether an association exists among people of the Asian origin after adjusting for other known risk factors of GERD. This study aimed to determine whether there is any relationship be-tween BMI and symptoms of GERD in our community and compare our results with those reported from western countries. Methods We designed this as a cross-sectional and population-based interview study which was conducted from May through December 2006 in Firoozkouh city and Damavand city, located in the northeast region of Tehran province, Iran. Out of a population of 1,00,000, we randomly select-ed a total of 6325 subjects on the basis of the number of their health dossiers. Following the postal codes and ad-dresses recorded in the dossiers, trained health personnel went to their houses, door-to-door and face-to-face and asked them to participate in the first interview. This inter-view was designed on the basis of the first part of our questionnaire which consisted of 22 questions dealing mainly with personal and family characteristics. In addi-tion, health personnel asked about 11 gastrointestinal (GI) symptoms including acid regurgitation and heartburn.
Indian Journal of Gastroenterology 07/2008; 27:153-155.
[Show abstract][Hide abstract] ABSTRACT: Aim: To determine the associated factors of reflux duration, using quantile regression model. Background: Reflux is one of the most prevalent gastrointestinal disorders. Statistical tools are widely used to assess the associated factors on reflux severity and frequency. Patients and methods: A door to door questionnaire has been used to evaluate gastrointestinal symptoms including reflux and heartburn between May and December 2006 in Tehran. A total of 790 adult patients with gastrointestinal problems were selected using random sampling method. Among them 208 persons were found to have heartburn. A quantile regression was employed to assess the associated factors and the results were compared to linear regression and Cox semi parametric model. Results: Heartburn duration had dramatically high negative skewness. Quantile regression analysis indicated significant increase in the given decile of heartburn duration associated with a unit increase in given patient characteristic containing sex, pain severity and pain after having some specific food. The results from linear regression and Cox model showed poor reliability in comparison to Quantile regression. Conclusion: The results have demonstrated that using quantile regression leads to better interpretation and richer inference about association between heartburn duration and patient characteristics.
[Show abstract][Hide abstract] ABSTRACT: The CARD15/NOD2 gene, located on the pericentromeric region of chromosome 16 (IBD1) has been reported to have an association with IBD, especially Crohn's disease. Three common mutations of CARD15 are variably associated with Crohn's disease in different ethnic groups. We evaluated the frequency of these mutations (R702W, G908R and 1007fsinsC) in Iranian IBD patients and compared it with the healthy control population.
One hundred patients with ulcerative colitis, 40 patients with Crohn's disease, and 100 sex- and age-matched controls were enrolled from a tertiary center during a one-year period (2005-2006). The three mutations were assessed in DNA of leukocytes by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).
The frequency of R702W mutation was significantly higher in Iranian patients with Crohn's disease (p< 0.001; OR 19.21; 95% CI 4.23-87.32) compared to healthy controls. No association was observed between the other mutations and Crohn's disease and none of these mutations was associated with ulcerative colitis.
The R702W mutation of CARD15 gene was associated with Crohn's disease in the Iranian population.
Indian Journal of Gastroenterology 01/2005; 27(1):8-11.