Annals of Colorectal Research Annals of Colorectal Research Ann Colorectal Res http://www.colorectalresearch.com 2322-5262 2322-5289 10.5812/acr. en jalali 2017 6 25 gregorian 2017 6 25 4 1
en 10.17795/acr-32942 The Changing Face of Inflammatory Bowel Disease: Etiology, Physiopathology, Epidemiology The Changing Face of Inflammatory Bowel Disease: Etiology, Physiopathology, Epidemiology review-article review-article Results

Once almost unknown, the prevalence of IBD, in the Eastern World and China, is now increasing by manifold, therefore arousing warning signals.

Conclusions

A multidisciplinary approach will soon be necessary, to face the tenacious behavior of IBD, on a global perspective.

Evidence Acquisition

While these phenomena may well be labeled as genetic factors, the environment has its role as well. Drugs (chiefly, antibiotics and non-steroidal anti-inflammatory molecules, with proton pump inhibitors recently joining the list) and smoking habits are all being scrutinized as IBD causative factors.

Context

The term inflammatory bowel disease (IBD) classically includes ulcerative colitis (UC) and Crohn’s disease (CD). An abnormally increased mucosal permeability seems to underlie UC, whereas CD is thought to be the result of an immune deficiency state.

Results

Once almost unknown, the prevalence of IBD, in the Eastern World and China, is now increasing by manifold, therefore arousing warning signals.

Conclusions

A multidisciplinary approach will soon be necessary, to face the tenacious behavior of IBD, on a global perspective.

Evidence Acquisition

While these phenomena may well be labeled as genetic factors, the environment has its role as well. Drugs (chiefly, antibiotics and non-steroidal anti-inflammatory molecules, with proton pump inhibitors recently joining the list) and smoking habits are all being scrutinized as IBD causative factors.

Context

The term inflammatory bowel disease (IBD) classically includes ulcerative colitis (UC) and Crohn’s disease (CD). An abnormally increased mucosal permeability seems to underlie UC, whereas CD is thought to be the result of an immune deficiency state.

Inflammatory Bowel Disease;Physiopathology;Microbiome;Epidemiology;Genetics Inflammatory Bowel Disease;Physiopathology;Microbiome;Epidemiology;Genetics http://www.colorectalresearch.com/index.php?page=article&article_id=32942 Giovanni Clemente Actis Giovanni Clemente Actis Department of Gastro-Hepatology, Gradenigo Hospital, Ospedale Gradenigo, Italy; Department of Gastro-Hepatology, Gradenigo Hospital, Ospedale Gradenigo, P. O. Box: 10153, Torino, Italy. Department of Gastro-Hepatology, Gradenigo Hospital, Ospedale Gradenigo, Italy; Department of Gastro-Hepatology, Gradenigo Hospital, Ospedale Gradenigo, P. O. Box: 10153, Torino, Italy.
en 10.17795/acr-33450 Use of General Surgery and Urology Online Modules in Medical Education Use of General Surgery and Urology Online Modules in Medical Education research-article research-article Results

In urology, the mean pre-module score was 22.4 (SD 4.3) and the mean post-module score was 33.0 (SD 2.1) (P < 0.001). Students who completed all the pre-module and post-module questions had a mean increase of 12.8 score points (SD 3.9). In general surgery, significantly more students completed all of the pre-module (42.7% vs. 27.5%) and post-module (23.2% vs. 7.3%) questions for the general surgical modules in 2010 compared to the urology modules in 2009 (P ≤ 0.001).

Conclusions

The introduction of web-based general surgery and urologic learning modules as an adjunct to traditional teaching improved student knowledge, and their usage improved over time.

Materials and Methods

Four general surgical and urologic web-based learning modules were delivered as an adjunct to traditional teaching via an online learning management system to fourth year medical students in 2009 and 2010. Each module contained 40 identical pre-module and post-module questions which allow analysis of change in student performance after delivery of these modules. The student t-test and Fisher’s exact test were used for statistical analysis.

Objectives

To determine if online learning modules improve student performance in general surgery and urology. To determine if previous use of online learning modules promote future utilization of such modules among students.

Background

Web-based learning is increasingly used as an adjunct to, and a replacement for, traditional learning methods. We investigated the impact of web-based learning modules in improving the delivery of undergraduate medical education in general surgery and urology.

Results

In urology, the mean pre-module score was 22.4 (SD 4.3) and the mean post-module score was 33.0 (SD 2.1) (P < 0.001). Students who completed all the pre-module and post-module questions had a mean increase of 12.8 score points (SD 3.9). In general surgery, significantly more students completed all of the pre-module (42.7% vs. 27.5%) and post-module (23.2% vs. 7.3%) questions for the general surgical modules in 2010 compared to the urology modules in 2009 (P ≤ 0.001).

Conclusions

The introduction of web-based general surgery and urologic learning modules as an adjunct to traditional teaching improved student knowledge, and their usage improved over time.

Materials and Methods

Four general surgical and urologic web-based learning modules were delivered as an adjunct to traditional teaching via an online learning management system to fourth year medical students in 2009 and 2010. Each module contained 40 identical pre-module and post-module questions which allow analysis of change in student performance after delivery of these modules. The student t-test and Fisher’s exact test were used for statistical analysis.

Objectives

To determine if online learning modules improve student performance in general surgery and urology. To determine if previous use of online learning modules promote future utilization of such modules among students.

Background

Web-based learning is increasingly used as an adjunct to, and a replacement for, traditional learning methods. We investigated the impact of web-based learning modules in improving the delivery of undergraduate medical education in general surgery and urology.

Education;General Surgery;Online Systems;Urology Education;General Surgery;Online Systems;Urology http://www.colorectalresearch.com/index.php?page=article&article_id=33450 Dwayne Chang Dwayne Chang Royal Perth Hospital, Perth, Western Australia; Royal Perth Hospital, Perth, Western Australia. Tel: +618-92242244, Fax: +618-92243577 Royal Perth Hospital, Perth, Western Australia; Royal Perth Hospital, Perth, Western Australia. Tel: +618-92242244, Fax: +618-92243577 Steve McCombie Steve McCombie Fiona Stanley Hospital Urology, Murdoch, Western Australia Fiona Stanley Hospital Urology, Murdoch, Western Australia Callum Logan Callum Logan Repatriation General Hospital, Daw Park, South Australia Repatriation General Hospital, Daw Park, South Australia Astrid Davine Astrid Davine University of Western Australia, Crawley, Western Australia University of Western Australia, Crawley, Western Australia Fiona Leece Fiona Leece University of Western Australia, Crawley, Western Australia University of Western Australia, Crawley, Western Australia Diana Jonas-Dwyer Diana Jonas-Dwyer University of Western Australia, Crawley, Western Australia University of Western Australia, Crawley, Western Australia Dickon Hayne Dickon Hayne Fiona Stanley Hospital Urology, Murdoch, Western Australia; University of Western Australia, Crawley, Western Australia Fiona Stanley Hospital Urology, Murdoch, Western Australia; University of Western Australia, Crawley, Western Australia
en 10.17795/acr-36133 Problems in Colorectal Stapler Use Problems in Colorectal Stapler Use letter letter Colorectal Surgery;Surgical Staplers;Minimally Invasive Surgical Procedures Colorectal Surgery;Surgical Staplers;Minimally Invasive Surgical Procedures http://www.colorectalresearch.com/index.php?page=article&article_id=36133 Abbas Abdollahi Abbas Abdollahi Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran; Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118022677, Fax: +98-5118525255 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran; Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118022677, Fax: +98-5118525255 Ghodratollah Maddah Ghodratollah Maddah Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Hosein Shabahang Hosein Shabahang Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Hamed Golmohammadzadeh Hamed Golmohammadzadeh Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
en 10.17795/acr-34404 Clinical and Pathological Characteristics of Mucinous Colorectal Adenocarcinoma: A Comparative Study Clinical and Pathological Characteristics of Mucinous Colorectal Adenocarcinoma: A Comparative Study research-article research-article Conclusions

This study indicates that most clinicopathological characteristics of MCC are different from those of NMCC. In addition, there was an association between the mucinous subtype and adverse pathological features in the patients with colorectal cancer.

Patients and Methods

This retrospective study was carried out by reviewing the medical records of 70 mucinous colorectal cancer (MCC) patients who were diagnosed and treated at a tertiary academic hospital between 2005 and 2010. For the comparative analysis, 491 patients with non-mucinous colorectal cancer (NMCC) were included.

Results

Of 561 patients with colorectal adenocarcinoma, 70 patients (12.5%) had the mucinous type. There were 42 (60%) men and 28 (40%) women, with a median age of 55 years old (range 24 - 81 years) included in the study. We did not find any differences regarding the patients’ mean age (P = 0.408) and male/female ratio (P = 0.700) between the MCC and NMCC; however, there was a predilection for the right colon and sigmoid colon in the MCC, when compared to the NMCC (P = 0.012). In addition, the MCC tended to have a larger tumor size (P = 0.004), higher histological grade (P < 0.001), higher node stage (P < 0.001), higher number of dissected nodes (P = 0.013), higher number of positive nodes (P < 0.001), and a higher rate of perineural invasion (P = 0.013) compared to the NMCC.

Background

Mucinous adenocarcinoma accounts for approximately 5% - 15% of all colorectal cancers.

Objectives

The aim of this study was to investigate the clinicopathological characteristics of patients with mucinous colorectal adenocarcinoma.

Conclusions

This study indicates that most clinicopathological characteristics of MCC are different from those of NMCC. In addition, there was an association between the mucinous subtype and adverse pathological features in the patients with colorectal cancer.

Patients and Methods

This retrospective study was carried out by reviewing the medical records of 70 mucinous colorectal cancer (MCC) patients who were diagnosed and treated at a tertiary academic hospital between 2005 and 2010. For the comparative analysis, 491 patients with non-mucinous colorectal cancer (NMCC) were included.

Results

Of 561 patients with colorectal adenocarcinoma, 70 patients (12.5%) had the mucinous type. There were 42 (60%) men and 28 (40%) women, with a median age of 55 years old (range 24 - 81 years) included in the study. We did not find any differences regarding the patients’ mean age (P = 0.408) and male/female ratio (P = 0.700) between the MCC and NMCC; however, there was a predilection for the right colon and sigmoid colon in the MCC, when compared to the NMCC (P = 0.012). In addition, the MCC tended to have a larger tumor size (P = 0.004), higher histological grade (P < 0.001), higher node stage (P < 0.001), higher number of dissected nodes (P = 0.013), higher number of positive nodes (P < 0.001), and a higher rate of perineural invasion (P = 0.013) compared to the NMCC.

Background

Mucinous adenocarcinoma accounts for approximately 5% - 15% of all colorectal cancers.

Objectives

The aim of this study was to investigate the clinicopathological characteristics of patients with mucinous colorectal adenocarcinoma.

Colorectal Cancer;Mucinous Adenocarcinoma;Pathology;Characteristics Colorectal Cancer;Mucinous Adenocarcinoma;Pathology;Characteristics http://www.colorectalresearch.com/index.php?page=article&article_id=34404 Sare Hosseini Sare Hosseini Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Shadi Zohourinia Shadi Zohourinia Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran Mohammad Zare-Bandamiri Mohammad Zare-Bandamiri Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, IR Iran Maral Mokhtari Maral Mokhtari Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Soudabeh Pourhashemi Soudabeh Pourhashemi Department of Biostatistics, Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Biostatistics, Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran Massood Hosseinzadeh Massood Hosseinzadeh Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Mohammad Mohammadianpanah Mohammad Mohammadianpanah Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, P. O. Box: 71936, Shiraz, IR Iran. Tel: +98-7136125168, Fax: +98-7136474320 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, P. O. Box: 71936, Shiraz, IR Iran. Tel: +98-7136125168, Fax: +98-7136474320
en 10.17795/acr-34627 Pneumatosis Coli Secondary to Eosinophilic Colitis: Report of a Refractory Case Pneumatosis Coli Secondary to Eosinophilic Colitis: Report of a Refractory Case case-report case-report Conclusions

Eosinophilic colitis usually has a good prognosis, however its association with pneumatosis coli could reflect a serious damage to the colonic mucosa. Although eosinophilic colitis responds well to medical treatment, yet in certain cases where clinical signs are evident and pneumatosis coli is present, surgical intervention is the treatment of choice.

Case Presentation

A 48-year-old female patient with a history of recurrent attacks of abdominal pain and distention that did not respond to conservative treatment, was hospitalized and investigated thoroughly. The result of abdominal computed tomography (CT) scan indicated the presence of pneumatosis coli. Based on the findings of the CT scan, colonoscopy was done revealing hyperemic and hypertrophied mucosa at the hepatic flexure, from which multiple punch biopsies were taken for histopathological assessment. The pathological examination of these biopsies detected a diffuse active colitis of moderate severity with excess eosinophils (10 - 15/HPF), which is consistent with the diagnosis of EC. The patient improved dramatically on fluid therapy and antibiotics with complete resolution of pneumatosis coli in the follow up CT scan. However, the patient developed a severe relapse of symptoms once oral intake was resumed and this time the conservative treatment failed to improve the condition. Surgery was indicated and laparoscopic right hemicolectomy with primary anastomosis and covering ileostomy was done. The patient was free of symptoms after the operation and her postoperative course was uneventful with no complications encountered.

Introduction

Pneumatosis intestinalis (PI) is a broad term that describes the presence of gas in the bowel walls. The colon is affected in 36% of cases. Eosinophilic colitis (EC) is a rare form of colitis that is characterized mainly by eosinophilia in blood and affected tissues. Although eosinophilic colitis responds well to conservative treatment, yet the association of PI could be an indication of emergent surgery.

Conclusions

Eosinophilic colitis usually has a good prognosis, however its association with pneumatosis coli could reflect a serious damage to the colonic mucosa. Although eosinophilic colitis responds well to medical treatment, yet in certain cases where clinical signs are evident and pneumatosis coli is present, surgical intervention is the treatment of choice.

Case Presentation

A 48-year-old female patient with a history of recurrent attacks of abdominal pain and distention that did not respond to conservative treatment, was hospitalized and investigated thoroughly. The result of abdominal computed tomography (CT) scan indicated the presence of pneumatosis coli. Based on the findings of the CT scan, colonoscopy was done revealing hyperemic and hypertrophied mucosa at the hepatic flexure, from which multiple punch biopsies were taken for histopathological assessment. The pathological examination of these biopsies detected a diffuse active colitis of moderate severity with excess eosinophils (10 - 15/HPF), which is consistent with the diagnosis of EC. The patient improved dramatically on fluid therapy and antibiotics with complete resolution of pneumatosis coli in the follow up CT scan. However, the patient developed a severe relapse of symptoms once oral intake was resumed and this time the conservative treatment failed to improve the condition. Surgery was indicated and laparoscopic right hemicolectomy with primary anastomosis and covering ileostomy was done. The patient was free of symptoms after the operation and her postoperative course was uneventful with no complications encountered.

Introduction

Pneumatosis intestinalis (PI) is a broad term that describes the presence of gas in the bowel walls. The colon is affected in 36% of cases. Eosinophilic colitis (EC) is a rare form of colitis that is characterized mainly by eosinophilia in blood and affected tissues. Although eosinophilic colitis responds well to conservative treatment, yet the association of PI could be an indication of emergent surgery.

Pneumatosis;Coli;Eosinophilic;Colitis Pneumatosis;Coli;Eosinophilic;Colitis http://www.colorectalresearch.com/index.php?page=article&article_id=34627 Sameh Hany Emile Sameh Hany Emile Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt; Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt. Tel: +20-1006267150, Fax: +20-50239733 Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt; Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt. Tel: +20-1006267150, Fax: +20-50239733 Hosam Ghazy Elbanna Hosam Ghazy Elbanna Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt Hossam Ayman Elfeki Hossam Ayman Elfeki Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
en 10.17795/acr-34565 Incidence of Ulcerative Colitis Relapse: A Prospective Cohort Study in Southern Iran Incidence of Ulcerative Colitis Relapse: A Prospective Cohort Study in Southern Iran research-article research-article Conclusions

Although, the reported incidence was almost equal to previous reports from other regions of the world, relapsed and non-relapsed UC patients received mesalazin as treatment without any significant differences.

Results

Among the 1273 registered patients with UC, 157 patients were enrolled in the survey by systematic sampling. Among patients, 48.7% were female and no significant difference was observed between the mean age of two gender groups (P = 0.70). Seventy-four patients, 48.1% (33 males and 41 females), relapsed during the 12-month follow-up period and the main medication of the 64 non-relapsing (80%) and 62 relapsing (83.8%) patients was mesalazin (P = 0.65).

Objectives

The current study aimed to find out the incidence of relapses in patients with UC in Southern Iran.

Patients and Methods

In a prospective cohort study in a period of one year (from October 2012 to October 2013) 157 patients with UC who were in clinical remission for at least three months and were registered in the IBD registry of Shiraz University of Medical Sciences, Shiraz, Iran were enrolled. The sample size was calculated according to the formula to determine a ratio. Clinical relapse was described as deterioration of bowel movements, lower intestinal bleeding or worsening of abdominal pain and diarrhea leading to changes in previous treatment. Age and gender distribution and the frequency of relapse in a one-year follow-up were recorded.

Background

The epidemiology of inflammatory bowel disease (IBD) is changing globally and there is disagreement between studies about the prevalence of relapse of ulcerative colitis (UC) as a type of IBD.

Conclusions

Although, the reported incidence was almost equal to previous reports from other regions of the world, relapsed and non-relapsed UC patients received mesalazin as treatment without any significant differences.

Results

Among the 1273 registered patients with UC, 157 patients were enrolled in the survey by systematic sampling. Among patients, 48.7% were female and no significant difference was observed between the mean age of two gender groups (P = 0.70). Seventy-four patients, 48.1% (33 males and 41 females), relapsed during the 12-month follow-up period and the main medication of the 64 non-relapsing (80%) and 62 relapsing (83.8%) patients was mesalazin (P = 0.65).

Objectives

The current study aimed to find out the incidence of relapses in patients with UC in Southern Iran.

Patients and Methods

In a prospective cohort study in a period of one year (from October 2012 to October 2013) 157 patients with UC who were in clinical remission for at least three months and were registered in the IBD registry of Shiraz University of Medical Sciences, Shiraz, Iran were enrolled. The sample size was calculated according to the formula to determine a ratio. Clinical relapse was described as deterioration of bowel movements, lower intestinal bleeding or worsening of abdominal pain and diarrhea leading to changes in previous treatment. Age and gender distribution and the frequency of relapse in a one-year follow-up were recorded.

Background

The epidemiology of inflammatory bowel disease (IBD) is changing globally and there is disagreement between studies about the prevalence of relapse of ulcerative colitis (UC) as a type of IBD.

Ulcerative Colitis;Relapse;Mesalazin;Incidence Ulcerative Colitis;Relapse;Mesalazin;Incidence http://www.colorectalresearch.com/index.php?page=article&article_id=34565 Seyed Vahid Hosseini Seyed Vahid Hosseini Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Seyed Alireza Taghavi Seyed Alireza Taghavi Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Peyman Jafari Peyman Jafari Biostatistics Ward, Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran Biostatistics Ward, Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran Abbas Rezaianzadeh Abbas Rezaianzadeh Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Maryam Moini Maryam Moini Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Manoosh Mehrabi Manoosh Mehrabi Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Masood Sepehrimanesh Masood Sepehrimanesh Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Ali Reza Safarpour Ali Reza Safarpour Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, P. O. Box: 719351311, Shiraz, IR Iran. Tel: +98-7132357282, Fax: +98-7132307594 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, P. O. Box: 719351311, Shiraz, IR Iran. Tel: +98-7132357282, Fax: +98-7132307594
en 10.17795/acr-36233 Letter to Editor Concerning the Article: The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure During Pregnancy Letter to Editor Concerning the Article: The Effect of Oral Psyllium Herbal Laxative Powder in Prevention of Hemorrhoids and Anal Fissure During Pregnancy letter letter Anal Fissure;Pregnancy;Psyllium;Hemorrhoids Anal Fissure;Pregnancy;Psyllium;Hemorrhoids http://www.colorectalresearch.com/index.php?page=article&article_id=36233 Masood Sepehrimanesh Masood Sepehrimanesh Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7136481441 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7136481441 Manoosh Mehrabi Manoosh Mehrabi Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.17795/acr-37372 Response to Letter to Editor: the Effect of Oral Psyllium Herbal Laxative Powder on Prevention of Hemorrhoids and Anal Fissure During Pregnancy: A Randomized Double Blind Clinical Trial Response to Letter to Editor: the Effect of Oral Psyllium Herbal Laxative Powder on Prevention of Hemorrhoids and Anal Fissure During Pregnancy: A Randomized Double Blind Clinical Trial letter letter Response;Hemorrhoid;Fissure Response;Hemorrhoid;Fissure http://www.colorectalresearch.com/index.php?page=article&article_id=37372 Ali Reza Safarpour Ali Reza Safarpour Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132357282, Fax: +98-7132307594 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132357282, Fax: +98-7132307594