Hafez Fakheri

Background: Inflammatory bowel disease (IBD), encompassing Crohn′s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition affecting the gastrointestinal tract. While significant progress has been made in managing IBD, the long‐term outcomes remain heterogeneous, prompting this cohort study. Methods: A retrospective analysis was performed on patients with IBD registered between 2000 and 2023. Clinical data, including demographics, disease activity, remission rates, therapeutic approaches, and complications, were collected. Results: Among 600 enrolled patients, 72.8% were diagnosed with UC. Both patients with UC and those with CD showed improvements in endoscopic severity by the end of follow‐up ( p < 0.001). Clinical remission was achieved by 96.3% of patients with UC and 91.2% of those with CD during the last 6 months of follow‐up ( p = 0.046). Disease progression occurred in 22.1% of patients with CD and 18% of those with UC ( p = 0.100). Gastrointestinal complications were more prevalent in patients with CD (25.6% vs. 1.6%, p < 0.001). Relapse remained high, with 86.7% of patients with UC and 92.6% of those with CD experiencing relapses at least once during follow‐up, particularly those with severe baseline disease ( p < 0.01). Biologic therapies were used more frequently ( p < 0.01) and initiated earlier in patients with CD ( p = 0.031). Conclusion: The study showed significant clinical improvement, yet many patients, particularly those with severe initial disease, had incomplete remission and frequent relapses, necessitating more effective long‐term management strategies. The distinction between CD and UC highlights the need for specialized treatments.

Background: While celiac disease (CD) ordinarily presents with gastrointestinal manifestations, extraintestinal appearances may also happen. Although cutaneous manifestations are one of the most common extraintestinal manifestations of CD, little is known about their prevalence and associated factors. This study aims to determine the prevalence of cutaneous manifestations and related factors in CD patients. Methods: This cross-sectional study enrolled CD patients referred to the National Celiac Registry, for whom a diagnosis of CD was confirmed through clinical examination, serological testing, and intestinal biopsy. Data on demographic characteristics, CD staging, clinical manifestations, underlying comorbidities, and family history (FH) of diseases were collected. Data were analyzed using SPSS version 25.0. A p -value less than 0.05 was considered significant. Results: Of the 4357 enrolled CD patients (male 65.7%), 18.20% had cutaneous manifestations, with eczema (3.73%), dermatitis herpetiformis (3.46%), and psoriasis (0.71%) being the most common disorders. The FH of skin disorders (Odds ratio (OR)=7.99, 95% confidence interval (CI) 2.44-26.13, p =0.00), osteoarthritis (OR=6.15, 95% CI 1.15-32.78, p =0.03), Sjögren syndrome (OR=4.82, 95% CI 1.98-11.73, p =0.00), mouth aphthae (OR=3.10, 95% CI 1.80-5.32, p =0.00), thalassemia (OR=2.78, 95% CI 1.19-6.50, p =0.01), constipation (OR =1.62, 95% CI 1.10-2.38, p =0.01), and iron deficiency anemia (IDA) (OR=1.54, 95% CI 1.05-2.24, p =0.02) were independent predictors, and type I diabetes mellitus (OR=0.20, 95% CI 0.05-0.81, p =0.02) was a protective factor for skin diseases. Conclusion: Considering the higher probability of cutaneous manifestations in CD patients, regular clinical evaluation of these patients is recommended for timely diagnosis and management of underlying skin diseases.

Background: Helicobacter pylori, the most prevalent infection in the world, has great importance due to being related to peptic ulcer disease, gastric metaplasia, dysplasia, and even gastric adenocarcinoma or mucosa-associated lymphoid tissue (MALT) lymphoma. The standard H. pylori eradication regimen is based on antibiotic susceptibility testing. If susceptibility testing is not available, a standard treatment regimen will be recommended based on records of H. pylori resistance rates to antibiotics in a region or locally proven highly effective regimens (equal to or higher than 90% eradication rate). The aim of this review was to define suitable recommendations for local treatment in different cities of Iran. Methods: This review article consists of randomized controlled trials related to H. pylori eradication in Iran. Data including the kind of therapy, number of patients and per-protocol H. pylori eradication rates were recorded in data gathering forms. Data search was conducted in PubMed and Google Scholar databases from 2018 to December 2023. Results: According to our review of Iranian articles regarding first-line H. pylori eradication regimens, these treatment protocols could be recommended: Bismuth-clarithromycin quadruple therapy in Ardabil, bismuth-clarithromycin quadruple therapy with probiotics in Birjand, standard triple therapy in Ilam, bismuth quadruple therapy or bismuth triple therapy or concomitant regimen in Sari, sequential therapy in Tehran and bismuth quadruple therapy in Yazd. These regimes can be extended to other regions that have a similar situation. According to the reports of Iranian researchers, a quinolone-containing regimen (levofloxacin preferred) is recommended for second-line eradication therapy. Conclusion: Various H. pylori eradication regimens can be used as first-line therapy; however, choices for second-line therapy are limited. We recommend the quinolone-containing regimens as the preferred second-line therapy.

Background: Despite the rising prevalence of Inflammatory Bowel Disease (IBD), age and sex differences in its outcomes remain understudied. We investigated age and sex differences in IBD patients using a nationwide study in Iran, the Iranian Registry of Crohn’s and Colitis (IRCC). Methods: The IRCC is a national registry that gathered information on adult IBD patients since 2017. The collected data included demographic information, medication history, disease activity, comorbidities, diagnosis age, prognosis, the extent of ulcerative colitis (UC), Crohn’s disease (CD) location, and extraintestinal manifestations. The statistical methods included the independent Student’s t-test, Chi-square test, and binary logistic regression, using R version 4.2.2. Results: Among the 9,392 IBD patients, 7,496 (3,600 females) and 1,896 (808 females) had UC and CD, respectively. Sex difference showed higher odds of active disease in the past six months in male CD patients (OR 1.24 [95%CI 1.03, 1.49]) vs. females, but in male UC patients, the OR was 0.85 [0.78, 0.93]. Severe disease was less likely in CD patients aged 19–59 and >60 vs. <18. Similarly, UC patients 60. Conclusions: This study emphasizes the importance of understanding age and sex differences in IBD outcomes. These findings contribute to the ongoing global discussion on IBD management and facilitate the development of targeted interventions and personalized care.

Background: Celiac disease is an autoimmune disorder resulting from gluten consumption in genetically predisposed individuals. The present study investigated the epidemiological, endoscopic, and clinicopathological features of patients with celiac disease in the southern littoral of the Caspian Sea. Methods: 140 patients with celiac disease were interviewed and examined regarding demographic characteristics, clinical symptoms, and serologic, endoscopic, and pathological findings. Results: 44 (31.4%) of the patients were male and 68.6% were female. The mean age of the patients at diagnosis was 27.13±13.4 years (ranging from 2 to 60 years). The most common gastrointestinal (GI) symptoms were bloating (47.8%), abdominal pain (47.1%) and diarrhea (30.7%), respectively. Also, 17 (12.1%) patients did not complain of any GI symptoms.18 (12.8%) patients had aphthous stomatitis, 10.7% had dermatitis herpetiformis, 3.6% suffered from itching without a rash, two (1.4%) mentioned psoriasis and one (0.7%) had lichen planus. 19 (19.7%) of the female patients complained of menstrual bleeding disorders, 4% mentioned infertility, and 2% experienced primary amenorrhea. The most common comorbid condition was hypothyroidism in 16 (11.4%) patients. The most common endoscopic finding was duodenal scalloping (37.25%). In addition, 7.8% of the patients had a normal endoscopic appearance. 43 (30.7%) patients were classified as Marsh IIIC, 25.7% Marsh IIIB, 17.8% Marsh IIIA, 12.8% Marsh II and 12.8% were classified as Marsh I. Conclusion: Since celiac disease can present with non-GI manifestations and the majority of our patients had Marsh III classification, it seems that celiac disease must be considered as a routine screening test in GI clinics, and also, it should be kept in mind as a differential diagnosis in other specialty fields.

Introduction: Rheumatoid arthritis is a chronic autoimmune disease with numerous side effects. Since long ago, the impact of fish consumption on treating this disease has been of researchers’ interest. Hence, this study aims to examine the relationship between fish consumption and the risk of rheumatoid arthritis through a systematic review and a meta-analysis method. Materials and Methods: For this meta-analysis to reach the research related to the case study, the following databases: PubMed, Scopus, Web of Science, Cochrane, and the Google Scholar search engine were conducted. The data were analyzed using the STATA 14, and the significance level of the tests was P<0.05. Results: There were 2166980 people (20218 cases and 2146762 controls) in this case study, and the age range of the patients was between 18 and 89 years. The studies were published between 1991 and 2022 and estimated the odds ratio (OR) of fish consumption and rheumatoid arthritis as (OR=0.83; 95% CI: 0.78, 0.89). This measure was (OR=0.79; 95% CI: 0.72, 0.87) in six case-control studies and (OR=0.86; 95% CI: 0.78, 0.94) in 7 cohort studies. In addition, the effect of fish consumption on reducing the rheumatoid arthritis development was more in people who had consumed fish 2 or less than 2 times a week compared to people who consumed fish more than 2 times every week. Conclusion: Fish consumption reduces the rheumatoid arthritis extension; therefore, these patients are advised to include fish in their diet.

Introduction: Stomach cancer is among five common malignancies whose prevalence and incidence are considerably associated with our dietary regime. Thus, the present study aims to conduct a systematic review and meta-analysis to evaluate the relationship between coffee drinking and the risk of stomach cancer. Materials and Methods: A comprehensive literature search of the databases, including Barakat Knowledge Network System, Cochrane, IranDoc, Web of Science, PubMed, SID, Magiran, Scopus, and Google Scholar web browser was conducted using standard keywords. Data analysis of this meta-analysis was conducted using STATA 14 software and P<0.05 was considered as a significant level for tests. Results: A total of 24 studies with a sample size of 990605 were reviewed which showed drinking coffee prevents stomach cancer [OR=0.89, (95% CI: 0.82, 0.98]. However, subgroup analysis by gender found no significant statistical relationship between coffee consumption and stomach cancer risk regarding male or female gender. However, the statistically significant relationship between coffee drinking and stomach cancer risk was assessed in several countries, including Korea, Turkey, Uruguay, Venezuela, and Singapore, with the largest effect being reported in Turkey [OR=0.51 (95% CI: 0.39,0.67]. Conclusion: Coffee consumption prevents and reduces the risk of developing stomach cancer.

Introduction: Green tea drinking is one of the traditional methods to prevent colorectal cancer (CRC). The present study proposes a systematic review and meta-analysis approach to investigate the relationship between green tea drinking and CRC risk. Materials and Methods: The literature survey has been carried out using the previously published studies in the Google Scholar search engine and various electronic databases, including Scopus, Cochrane, Web of Science, Embase, and PubMed. The review process has continued until July 13, 2021. Besides, the Q test and I2 index were employed to evaluate the heterogeneity of the studies. STATA 14 software has been conducted to analyze the gathered dataset. It is essential to note that the significance level for statistical tests was set to 5% (P value < 0.05). Results: The results of 18 studies accomplished on 44,992 patients aged 19-80 years have been used to compute the relative risk of green tea consumption in CRC (OR [odds ratio] = 0.99; 95% CI: 0.83-1.18), colon (OR=0.97; 95% CI: 0.85-1.10), and rectum (OR=1; 95% CI: 0.86-1.16). Although green tea consumption was a protective factor in Asia and the United States, it was considered a risk factor in Australia. The general population studies classified green tea as a risk factor for CRC, while hospital studies considered this product as a protective factor. Conclusion: The findings showed that green tea had the most significant effect on reducing the colon cancer risk, while it had the minimum influence on CRC. Additionally, it did not affect rectal cancer. It is essential to note that these relationships were not statistically significant. Registration: The current protocol was also registered on PROSPERO (#CRD42021276257, https://www.crd.york. ac.uk/prospero/display_record.php?ID=CRD42021276257).

Aim: Celiac disease (CD) is an immune-mediated disorder with various manifestations. The aim of this study was to evaluate the prevalence of gastrointestinal (GI) and extra-intestinal symptoms of celiac patients, especially migraine, and compare it with healthy individuals.Methods: We compared 1000 celiac subjects (CS) registered at our celiac center with the control group for headache-based on International Classification of Headache Disorders, third edition criteria and their GI symptoms. Besides, CS with migraine and non-migrainous headache were compared in terms of GI symptoms and accompanied conditions.Results: Headache was more common in CS than controls (34% vs 27% respectively, P value<0.001) and more prevalent in females (71.9% in females vs 28% in males, P value = 0.004). Moreover, the prevalence of migraine in CS was higher than controls (20.7 vs 11.9% respectively, P value<0.001). Furthermore, migraine was more prevalent in females with CD (80% in females vs 19% in males, P value = 0.033), and often without aura (76%). Abdominal pain (76.9%, P value = 0.025), diarrhea (54.9%, P value = 0.002), and constipation (42.9%, P value = 0.011) were the most common GI symptoms in CS with headache and more prevalent in CS with migraine. Conversely, type 1 diabetes mellitus was less common in CS with migraine than in CS with non-migrainous headache. (P value = 0.001). On multivariate logistic regression analysis, female sex (OR 1.50, 95%CI 1.22–1.83, P value < 0.001), and CD (OR 1.36, 95%CI 1.12–1.65, P value = 0.002) were independent predictors of headache, whereas age more than 60 years (OR 0.70, 95%CI 0.50–0.97, P value = 0.032) had a protective effect.Conclusion: Headache especially migraine is more prevalent in CS than healthy controls. In addition, abdominal pain, diarrhea, and constipation are more common in CS with migraine than in CS with non-migrainous headaches. Therefore, evaluation of CD in patients with migraine and these simultaneous GI symptoms seems reasonable.

Background: New therapeutic options are urgently needed to tackle the novel coronavirus disease 2019 (COVID-19). Repurposing existing pharmaceuticals provides an immediate treatment opportunity. We assessed the efficacy of sofosbuvir and daclatasvir with ribavirin for treating patients with COVID-19.Methods: This was a single-centre, randomized controlled trial in adults with moderate COVID-19 admitted to the Ghaem Shahr Razi Hospital in Mazandaran Province, Iran. Patients were randomly assigned to 400 mg sofosbuvir, 60 mg daclatasvir and 1200 mg ribavirin (intervention group) or to standard care (control group). The primary endpoint of this study was length of hospital stay. This study is registered by IRCT.ir under the ID: IRCT20200328046886N1.Results: Between 20 March 2020 and 8 April 2020, 48 patients were recruited; 24 patients were randomly assigned to the intervention group and 24 to the control group. The median duration of hospital stay was 6 days in both groups (P = 0.398). The number of ICU admissions in the sofosbuvir/daclatasvir/ribavirin group was not significantly lower than the control group (0 versus 4, P = 0.109). There was no difference in the number of deaths between the groups (0 versus 3, P = 0.234). The cumulative incidence of recovery was higher in the sofosbuvir/daclatasvir/ribavirin arm (Gray’s P = 0.033).Conclusions: This randomized trial was too small to make definitive conclusions. There were trends in favour of the sofosbuvir/daclatasvir/ribavirin arm for recovery and lower death rates. However, there was an imbalance in the baseline characteristics between the arms. Larger randomized trials should be conducted to investigate this treatment further.