Gastric Precancerous Lesions in First Degree Relatives of Patients with Known Gastric Cancer: a Cross-Sectional Prospective Study in Guilan Province, North of Iran

Mansour-Ghanaei, Fariborz,Joukar, Farahnaz,Baghaei, Seyed Mohammad,Yousefi-Mashhoor, Mahmood,Naghipour, Mohammad Reza,Sanaei, Omid,Naghdipour, Misa,Shafighnia, Shora,Atrkar-Roushan, Zahra Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.5

Background & Objectives: In patients with gastric cancer, the most frequently reported family history of cancer also involves the stomach. The aim of this study was to assess the presence of gastric precancerous lesions in first-degree relatives of patients with gastric cancer and to compare the obtained results with those of individuals with no such family history. Methods: Between 2007 and 2009, 503 consecutive persons more than 30 years old were enrolled in the study covering siblings, parents or children of patients with confirmed adenocarcinoma of stomach. The control group was made up of 592 patients who were synchronously undergoing upper gastrointestinal endoscopy for evaluation of dyspepsia without gastric cancer or any family history. All subjects were endoscopically examined. Results: The overall prevalence of Helicobacter pylori was 77.7% in the cancer relatives and in 75.7% in the control group. Chronic gastritis was found in 90.4% vs. 81.1% (P<0.001). Regarding histological findings, 37(7.4%) of the study group had atrophy vs. 12(1.7%) in the control group (P<0.001), while no difference was observed for intestinal metaplasia (20.3%vs. 21.6%, P=0.58). Dysplasia were shown in 4% of cancer relatives but only 0.4% of the control group (P<0.001). There was no gender specificity. Conclusions: Findings of our study point to great importance of screening in relatives of gastric cancer patients in Iran.

Does treatment of Helicobacter Pylori Infection Reduce Gastric Precancerous Lesions?

Mansour-Ghanaei, Fariborz,Joukar, Farahnaz,Mojtahedi, Kourosh,Sokhanvar, Homayoon,Askari, Kourosh,Shafaeizadeh, Ahmad Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.4

Background: Treatment of Helicobacter pylori (H. pylori) decreases the prevalence of gastric cancer, and may inhibit gastric precancerous lesions progression into gastric cancer. The aim of this study was to determine the effect of treatment on subsequent gastric precancerous lesion development. Materials and Methods: We prospectively studied 27 patients who had low grade dysplasia at the time of enrollment, in addition to dysplasia atrophic gastritis and intestinal metaplasia observed in all patients. All were prescribed quadruple therapy to treat H. Pylori infection for 10 days. Patients underwent endoscopy with biopsy at enrollment and then at follow up two years later. Biopsy samples included five biopsies from the antrum of lesser curvature, antrum of greater curvature, angularis, body of stomach and fundus. Results of these biopsies were compared before and after treatment. Results: Overall, the successful eradication rate after two years was 15/27 (55.6%). After antibiotic therapy, the number of patients with low grade dysplasia decreased significantly (p=0.03), also with reduction of the atrophic lesions (p=0.01), but not metaplasia. Conclusions: Treatment of H. pylori likely is an effective therapy in preventing the development of subsequent gastric premalignant lesions.

Screening of Precancerous Gastric Lesions by Serum Pepsinogen, Gastrin-17, Anti-Helicobacter Pylori and Anti-Caga Antibodies in Dyspeptic Patients over 50 years Old in Guilan Province, North of Iran

Mansour-Ghanaei, Fariborz,Joukar, Farahnaz,Rajpout, Yaghoub,Hasandokht, Tolou Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.18

Background: The aim of this study was to investigate the value of serum gastric markers to differentiate between patients with precancerous lesions and nonatrophic chronic gastritis. Materials and Methods: Serum samples of 128 patients with dyspepsia who were candidates for endoscopic examination were tested for pepsinogen (PG I and PG II), PG I/II ratio, gastrin 17(G-17), anti-Helicobacter pylori (anti-H pylori ) and anti-CagA antibodies. Two sample t-tests, chi-square tests and Pearson's correlation analyses were used for analysis using SPSS (version 20). Results: PGI, PG I/II ratio values were decreased significantly in the precancerous lesion group (0.05, 0.001 respectively). The frequency of H pylori infection was significantly (p=0.03) different between the two groups ofthe study. Conclusions: We suggest PGI and the PG I/II ratio as valuable markers for screening of premalignant gastric lesions.

Endoscopic Findings in a Mass Screening Program for Gastric Cancer in a High Risk Region - Guilan Province of Iran

Mansour-Ghanaei, Fariborz,Sokhanvar, Homayoon,Joukar, Farahnaz,Shafaghi, Afshin,Yousefi-Mashhour, Mahmud,Valeshabad, Ali Kord,Fakhrieh, Saba,Aminian, Keyvan,Ghorbani, Kambiz,Taherzadeh, Zahra,Sheykhia Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.4

Background & Objectives: Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. This study was designed to assess upper GI endoscopic findings among people > 50 years targeted in a mass screening program in a hot-point region. Methods: Based on the pilot results in Guilan Cancer Registry study (GCRS), one of the high point regions for GC-Lashtenesha- was selected. The target population was called mainly using two methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GI endoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT) from the antrum and also further biopsies from five defined points of stomach for detection of precancerous lesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologic evaluation. Results: Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of $61.7{\pm}9.0$ years (range: 50-87 years) underwent upper GI endoscopy. H. pylori infection based on the RUT was positive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven (0.5%) and one (0.07%) persons, respectively. A remarkable proportion of studied participants were found to have esophageal hiatal hernia (38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which were mostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcers were found in 5.9% (82) and 6.9% (96) of the screened population. Conclusion: Upper endoscopy screening is an effective technique for early detection of GC especially in high risk populations. Further studies are required to evaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderate risk population before recommending this method for the GC surveillance program at the national level.

A 10-year Study of Esophageal Cancer in Guilan Province, Iran: The Guilan Cancer Registry Study (GCRS)

Mansour-Ghanaei, Fariborz,Heidarzadeh, Abtin,Naghipour, Mohammad Reza,Joukar, Farahnaz,Valeshabad, Ali Kord,Fallah, Mohammad-Sadegh,Rezvani, Seyed Mahmoud,Sedigh-Rahimabadi, Massih,Rokhshad, Hasan,Dad Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.12

Background: Northern Iran counts as one of the highest prevalence regions for esophageal cancer (EC) worldwide. This study was designed to assess the epidemiologic aspects of EC in north central and northwest Iran over a 10 year period. Materials and Methods: The Guilan cancer registry study (GCRS) is a population-based cancer registry study featuring retrospective (1996-2003) and prospective (2004-2005) phases. A detailed questionnaire based on WHO standards for cancer registratration was applied to gather the required information. Two trained physicians coded information using ICD-O-3 in close coordination with an expert pathologist. Results: A total of 19,936 cases of malignancy (mean age $55.4{\pm}18.0$ years, range: 1-98 years) were registered, including 1,147 cases (670 males, 447 female; mean age: $64.0{\pm}11.5$ years) of EC. In 1996 the male/female ratio among patients with EC was 1.25 which increased to 1.53 in 2005. The lower third of the esophagus still remained the most common site of tumors. The average age-standardized rate (ASR) was 6.9 and 4.1 per $10^5$ men and women, respectively. In 1996, the ASRs were 7.2 and 5.2 per $10^5$ men and women which decreased to 6.9 and 4.1 per $10^5$ in 2004-2005. Squamous cell carcinoma (SCC) was the most prevalent histological subtype of EC accounting over 80% of cases. Conclusions: However the prevalence of adenocarcinoma (ADC) showed an increase to 18.4%. Guilan province may be considered a relatively low incidence region for EC.

Knowledge about Gastric Carcinoma in North of Iran, A High Prevalent Region for Gastric Carcinoma: A Population-Based Telephone Survey

Mansour-Ghanaei, Fariborz,Joukar, Farahnaz,Soati, Fatemeh,Mansour-Ghanaei, Alireza,Naserani, Sara Bakhshizadeh Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.7

Background & Objectives: The most northern and northwestern regions of Iran are at a high risk for gastric cancer. The aim of this study was to assess the general population's awareness about risk factors, symptoms and signs, preventive methods and management of gastric carcinoma in a high prevalence city in the North of Iran. Methods: A cross-sectional population-based telephone survey which was conducted on 3,457 residents of Rasht, the capital city of Guilan Province, to assess their awareness regarding gastric carcinoma. The questionnaires contained demographic data and statements on respondents' knowledge about risk factors, symptoms and signs, prevention and management of gastric cancer which were filled by general practitioners after asking the subjects. Data were analyzed in SPSS14. P<0.05 was considered significant. Results: The mean knowledge score of the respondents was $5.05{\pm}1.37$ regarding risk factors of gastric carcinoma, $4.39{\pm}1.99$ regarding symptoms and signs, $6.0{\pm}1.22$ regarding preventive strategies, and $1.6{\pm}1.16$ regarding management. Totally the mean knowledge level of the respondents toward gastric carcinoma would be $17.1{\pm}3.97$ from the maximum grade of 29. The age group of 45-55 y/o, bachelor degree and higher, physicians and nurses, those who had cancer history in friends or had the history of gastrointestinal diseases showed significantly higher knowledge scores (P=0.001). Conclusion: There is a general lack of awareness of cancer risk factors, symptoms and signs, methods of prevention, and importance of early diagnosis and treatment. Educational programs should be developed to promote adherence to recommended screening guidelines.

Knowledge about Colorectal Cancer in Northern Iran: a Population-Based Telephone Survey

Mansour-Ghanaei, Alireza,Joukar, Farahnaz,Mansour-Ghanaei, Fariborz,Rasoulian, Javid,Naghipour, Mohammad Reza,Fani, Arezoo,Kazemnejad, Ehsan Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.17

Background: Colorectal cancer (CRC) is one of the most common malignancies of the gastrointestinal tract. The aim of this study was to assess the general knowledge of CRC in individuals living in Rasht, Iran, using a population-based cross-sectional telephone survey. Materials and Methods: A total of 1557 participants between 18 and 80 years of age were interviewed using random sampling from the telephone directory. Knowledge of risk factors, symptoms, diagnosis, and prevention of CRC was assessed using a validated questionnaire. Results: The mean knowledge level of the 1,557 respondents (average age 46 y) was $13.5{\pm}4.29$ (maximum possible score = 26), and 46.4% (722/1,557) of the subjects achieved grades lower than the mean score. The mean scores for knowledge of symptoms and risk factors were $3.97{\pm}1.83$ (range: 0-7) and $5.17{\pm}1.65$ (range: 0-9), respectively. Older age, higher education, and employment were significantly associated with better scores for recognition of risk factors and warning symptoms. The majority of subjects correctly identified weight loss (70.2%; 1,093/1,557) and rectal bleeding (63.3%; 986/1,557) as symptoms of CRC, and that smoking (85.9%; 1,337/1,557) and a low-fiber diet (73.4%; 1,143/1,557) were risk factors. Approximately half of the subjects noted increasing age, genetic background and fried food as other risk factors. A considerable number (54.8%; 853/1,557) identified colonoscopy as a screening method for detecting CRC in asymptomatic patients. However, a third of the subjects in the target group for screening (${\geq}50y$) were not interested in undergoing screening, primarily due to a lack of symptoms. Conclusions: Our results suggest that the knowledge of CRC is poor among the public, and therefore greater attempts should be made to increase awareness. Public education emphasizing the risk factors and symptoms of CRC, as well as the importance of regular screening regardless of the presence of symptoms, may help to reduce CRC morbidity and mortality.

Outcome of Intestinal Metaplasia in Gastric Biopsy of Patients with Dyspepsia in Guilan Province, North Iran

Mansour-Ghanaei, Fariborz,Joukar, Farahnaz,Soati, Fatemeh,Mansour-Ghanaei, Alireza,Atrkar-Roushan, Zahra Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.6

Background: It is generally accepted that gastric carcinomas are preceded by a sequential multistage process that includes chronic gastritis, gastric atrophy, usually with intestinal metaplasia (IM), and dysplasia. This series of changes in gastric carcinogenesis is often initiated by Helicobacter pylori (H pylori) infection. The aim of the present study was determination of gastric histopathologic changes in IM patients after at least one year in Guilan province, Iran. Materials and Methods: This case-series study was conducted in Guilan Gastrointestinal and Liver Disease Research Center (GLDRC) during 2010 to 2011. Gastric biopsy was performed for all 71 known cases of IM and precanceric lesions including gastric atrophy, IM, dysplasia and H pylori infection were determined after at least one year. Results: Of the total of 71 patients with established IM who were enrolled, 50 had complete-type IM and 21 had incomplete-type IM. Fifty two people had H pylori infection. H pylori eradication was achieved in 39 patients (75%). Secondary pathology findings of patients with IM were complete metaplasia (39.4%), incomplete metaplasia (32.4%), dysplasia (23.9%) and other precanceric lesions (4.2%). Dysplasia (20%vs 33%) occurred in patients who had complete and incomplete IM at baseline respectively (p>0.05). Age, gender, family history of gastric cancer(GC); smoking habits and NSAIDs use were not associated with gastric premalignant lesions in initial and secondary pathologies (p>0.05). The difference became statistically significant between H pylori infection in patients with more than 3 years diagnostic intervals (p<0.05). Statistical difference between eradicators and non-eradicators was not significant. Conclusions: We found that incomplete IM increased the risk of subsequent dysplasia in this study.

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

Fariborz Mansour-Ghanaei,Farahnaz Joukar,Ali Akbar Khalesi,Mohammadreza Naghipour,Masood Sepehrimanesh,Kourosh Mojtahedi,Sara Yeganeh,Hamid Saeidi Saedi,Saba Fakhrieh Asl 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.3

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.

Efficacy of curcumin/turmeric on liver enzymes in patients with non-alcoholic fatty liver disease: A systematic review of randomized controlled trials

Fariborz Mansour-Ghanaei,Makan Pourmasoumi,Amir Hadi,Farahnaz Joukar 한국한의학연구원 2019 Integrative Medicine Research Vol.8 No.1

Background: Several studies reported that curcumin supplementation could improve non-alcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the efficacy of curcumin/turmeric supplementation on liver enzymes in patients with NAFLD. Methods: PubMed, Scopus, Web of Science and Google Scholar were systematically searched until December 2017. We included randomized controlled trials (RCTs) which examined effect of curcumin/turmeric supplementation on NAFLD in adult participants. Main outcome was alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Potential risks of bias (ROB) were assessed by using Cochrane ROB tool. Results: All included studies showed low ROB in most of item of Cochrane ROB tool. Meta-analysis of 4 randomized controlled trials including 228 subjects showed a trend toward significant reduction of ALT blood concentrations in subgroup with ≥1000 mg/day curcumin supplementation (–11.36 IU/L, 95% CI: –22.75 to 0.02; I2:51%). Meta-analysis showed a significant reduction of AST in studies with 8-weeks administration (–9.22 IU/L, 95% CI: –12.77 to –5.67; I2: 49%). Conclusion: This review suggests that curcumin/turmeric might have a favorable effect on NAFLD in higher dosage. Further high-quality studies with large-scale and higher dosage are warranted.