Middle East Journal of Digestive Diseases 

About: Middle East Journal of Digestive Diseases is an academic journal published by Shiraz University of Medical Sciences. The journal publishes majorly in the area(s): Medicine & Internal medicine. It has an ISSN identifier of 2008-5230. It is also open access. Over the lifetime, 504 publications have been published receiving 6990 citations.

Epidemiology of celiac disease in iran: a review.

Abstract: Celiac disease (CD) was traditionally believed to be a chronic enteropathy, almost exclusively affecting people of European origin. Celiac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. The availability of new, simple, very sensitive and specific serological tests has shown that CD is as common in Middle Eastern countries as in Europe, Australia and New Zealand where the major dietary staple is wheat. A high prevalence of CD has been found in Iran, in both the general population and the at-risk groups, i.e. patients with type 1 diabetes or irritable bowel syndrome (IBS). In developing countries, serological testing in at risk groups is necessary for early identification of celiac patients. Clinical studies show that presentation with non-specific symptoms or a lack of symptoms is as common in the Middle East as in Europe. Wheat is a major component of the Iranian diet and exposure to wheat proteins induces some degree of immune tolerance, leading to milder symptoms that may be mistaken with other GI disorders. The implementation of gluten free diet (GFD) is a major challenge for both patients and clinicians in Iran, especially since commercial gluten-free products are not available in this area.

Hepatocellular Carcinoma in the World and the Middle East

Abstract: Hepatocellular carcinoma (HCC) is a major worldwide public health concern. Despite recent advances, there has been little success in improving the survival of HCC patients. Due to advances in diagnostic modalities and the increasing incidence of chronic viral hepatitis and nonalcoholic fatty liver disease (NAFLD), both of which are well known risk factors of HCC, the prevalence of HCC is increasing in developed countries and it is expected that this trend will continue in the future. In Middle Eastern countries the prevalence of this cancer is lower compared to sub-Saharan Africa and some Far East countries; however it is documented that the prevalence of this cancer in some parts of the Middle East is also increasing. In the current review, the prevalence and burden of this disease worldwide, particularly in Middle Eastern countries, and risk factors for HCC are discussed.

Probiotics and Nonalcoholic Fatty liver Disease.

Abstract: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, both in adults and in children. NAFLD represents a spectrum of liver diseases that range from hepatic steatosis to steatohepatitis and cirrhosis. However, NAFLD is more prevalent in overweight and obese individuals. Evidence thus far suggests that hepatic triglyceride accumula­tion is not always derived from obesity; gut microbiota can also play a role in the development of insulin resistance, hepatic steatosis, necroinflammation and fibrosis. On the other hand, probiotics can strengthen the intestinal wall, reducing its permeability, bacterial translocation, and endotoxemia according to animal and human studies. They can also reduce oxidative and inflamma­tory liver damage, while improving the histological state in certain situations. This review article focuses on research that has been conducted on probiotics and NAFLD, highlighting their efficacy as a novel therapeutic option for the treatment of this condition.

Malnutrition in Liver Cirrhosis: The Influence of Protein and Sodium

Abstract: Protein calorie malnutrition (PCM) is associated with an increased risk of morbidity and mortality in patients with cirrhosis and occurs in 50%-90% of these patients. Although the pathogenesis of PCM is multifactorial, alterations in protein metabolism play an important role. This article is based on a selective literature review of protein and sodium recommendations. Daily protein and sodium requirements of patients with cirrhosis have been the subject of many research studies since inadequate amounts of both can contribute to the development of malnutrition. Previous recommendations that limited protein intake should no longer be practiced as protein requirements of patients with cirrhosis are higher than those of healthy individuals. Higher intakes of branched-chain amino acids as well as vegetable proteins have shown benefits in patients with cirrhosis, but more research is needed on both topics. Sodium restrictions are necessary to prevent ascites development, but very strict limitations, which may lead to PCM should be avoided.

Prevalence of Nonalcoholic Steatohepatitis in Iran: A Population based Study

Abstract: BACKGROUND Non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) is the most common form of chronic liver disease worldwide and is no longer considered a benign disease. Its prevalence has not been determined in a large-scale population-based study in Iran. METHODS A total of 6583 individuals aged 18 to 65 were randomly selected from three geographically distinct provinces in Iran. Blood samples were obtained from each subject and a questionnaire was completed exploring data including self-admitted regular alcohol use. Serums were tested for anti-HCV antibody (anti-HCV), hepatitis B surface antigen and anti-hepatitis B core antibody. Positive samples for anti-HCV antibody were re-tested and those positive in a repeat ELISA were confirmed by a recombinant immunoblot assay (RIBA) test. Serums were also tested for ALT levels. Subjects with elevated ALT defined as serum ALT ≥40 IU/L with no history of alcohol consumption and negative HBV and HCV infection were considered as "presumed NASH". RESULTS In this study 5589 subjects were analyzed. Two hundred and forty two individuals (4.3%) were diagnosed with elevated ALT levels. Among individuals with elevated ALT, 15 (6.2%) were diagnosed with either hepatitis B or hepatitis C. The overall weighted prevalence of presumed NASH was 2.9%. According to multivariate analysis, male sex, urban lifestyle, and being overweight or obese were significantly associated with "presumed NASH". CONCLUSION Obesity and metabolic syndrome, the most predictive factors of fatty liver disease, are increasing in Iran, therefore the prevalence of NAFLD/NASH and related complications are expected to increase in the future. This population based study gives a crude estimate of the prevalence of NASH around the country. Studies with more accurate surrogates of NASH need to be done. The disparity among different provinces merits special consideration.