Arch Iranian Med 2009; 12 (5): 516 – 525 History of Contemporary Medicine Development of Gastroenterology and Hepatology in Iran: Part II-Advances in Research and Therapeutic Modalities Mehdi Saberifiroozi MD•*,**, Seid-Hossein Mir-Madjlessi MD*,*** Abstract The first attempts to start research activities and try Following the establishment of Gastroenterology to publish papers in this field were started in Shiraz and Hepatology Fellowship Programs in 1987, and Tehran after 1960.2,3 According to published significant developments in research and health articles, the major diseases during 1970’s were care delivery have been achieved. The number of published articles has increased significantly and upper GI cancers, liver cirrhosis of liver, now more than 10 approved research centers are immunoprolifertive small intestinal disease involved in several longitudinal and population (IPSID), and peritoneal tuberculosis. According to based studies in GI epidemiology, viral hepatitis and K. Nasr important factors which promoted the GI oncology around the country. research activities in Shiraz University in the Before 1987 less than 50 gastroenterologists were working in the country, but now more than 300 1960s and 1970s were: requirement of publication gastroenterologists are involved in public and in good journals for academic promotion, full time private health care delivery systems. Advanced system for academic staff, good medical charts in diagnostic and therapeutic endoscopic procedures hospitals, good laboratory, pathology and and complex surgical procedures such as liver transplantation are a routine now. radiology services, and very high rates of autopsy, These achievements are indicative of hard work which were available in a few academic centers at and determination of dedicated physicians after the that time.4 It should be emphasized that in the 90s Islamic Revolution, and the support of governmental and after 2000, significant improvements have and non-governmental sectors. The future prospect been done in the quantity and quality of research in of development in the discipline of gastroenterology and hepatology in Iran seems to be very all universities of Iran, which can be related to encouraging. increasing number of academic staff and research centers, more longitudinal and population based Keywords: Gastroenterology • history of studies and positive attitude of the government to medicine • Iran research for development of the country.5 The list of scientists who have published more than 20 Introduction papers and their corresponding h-factor are shown efore the establishment of subspecialty in Table 1 and the list of highly cited papers in training program in gastroenterology gastroenterology and digestive oncology are shown and hepatology in 1976, which was a in Tables 2 and 3. In Table 4 the research centers B with at least 5 years of age are shown with their major step in the progress of this subspecialty in Iran, there were few published articles in scientific output and the corresponding h-factor. international peer reviewed journals in this field.1 The accomplishments in the field of research can be summarized as follows: Authors’ affiliations: *Digestive Disease Research Center, Viral hepatitis and cirrhosis Shariati Hospital, Tehran University of Medical Sciences, Tehran, **Gastroenterohepatology Research Center, Nemazee Hospital, Cirrhosis and its complications have been the Shiraz University of Medical Sciences, Shiraz, ***Iranian Medical most common diagnosis among patients admitted Institute, Tehran, Iran. 2,3 6 •Corresponding author and reprints: Mehdi Saberi-Firoozi MD, in GI wards from 1960s to the present time Gastroenterohepatology Research Center, Nemazee Hospital, (Table 1). Dr. Borhanmanesh in Shiraz was among Shiraz University of Medical Sciences, Shiraz, Iran. the first scientists who did clinical research on E-mail: [email protected] Accepted for publication: 29 April 2009 cirrhosis and published papers about viral etiology 516 Archives of Iranian Medicine, Volume 12, Number 5, September 2009 M. Saberifiroozi, S. H. Mir-Madjlessi Table 1. Scientists in the field of clinical gastroenterology with their corresponding h-factor (2000 – 2009) from Scopus July 2009. Rank Name of scientist Affiliation All documents h-factor 1 Reza Malekzadeh DDRC/TUMS 162 19 2 Mohammad Reza Zali GLRC/SBUMS 100 8 3 Sadegh Massarrat GLRC/SBUMS 88 9 4 Kamran Bagheri Lankarani GERC/SUMS 43 6 5 Seyed Moid Alavain BRCG/BUMS 40 9 6 Shahin Merat DDRC/TUMS 30 12 7 Mehdi Mohamadnejad DDRC/TUMS 37 9 8 Siavosh Nasseri-Moghaddam DDRC/TUMS 28 9 9 Mehdi Saberifiroozi GERC/SUMS 27 7 10 Pourshams Akram DDRC/TUMS 23 10 11 Nasser Ebrahimi Daryani DDRC/TUMS 22 5 RC=research center; DDRC=digestive disease research center; TUMS=Tehran University of Medical Sciences; GLRC=gastroenterology and liver disease research center; SBUMS=Shaheed Beheshti University of Medical Sciences; GEHRC=gastroenterology and hepatology research center; SUMS=Shiraz University of Medical Sciences; RCGL=research center for gastroenterology and liver disease; BUMS=Baghiatallah University of Medical Sciences and complications of cirrhosis.7–8 No major journal is published by the “Research Center for progress happened before 1980 when following Gastroenterology and Liver Diseases” of availability of serologic tests for diagnosis of viral Baqiyatallah University of Medical Sciences, in hepatitis it was recognized that HBV is the Tehran. It is the official journal of the “Iranian etiology of nearly 70% of cirrhosis with its Hepatitis Network” and is indexed in the web of complications in Iran.9,10 science (http://hepmon.com). During the last 30 years after revolution a major Liver transplantation was established for the progress5 happened in the field of viral hepatitis first time in Nemazee Hospital, Shiraz,13 by Ali and cirrhosis with more than 100 papers published Malekhosseini and his team. This center is doing about viral hepatitis and cirrhosis in international more than 150 transplants each year. The second journals reporting advances in diagnosis and center for Liver Transplant has already been treatment of HBV.11,12 A new journal in the field of started in Imam Khomeini Hospital in Tehran.83 viral hepatitis named “Hepatitis Monthly” was Iranian scientists were among the first group of founded in 2002 by S.M. Alavian. This clinical researchers who started Stem cell transplant for Table 2. Top Ten highly cited gastroenterology or hepatology papers from Iran during 1995 – 2009. Source: Scopus July 2009. Numbers Type of Rank Title of manuscript First and CC authors Affiliation Journal/year of research citations Omeprazole in reducing Kaviani, Hashemi Alim Pharm Ther 1 re-bleeding in peptic RCT SUMS/DDRC 63 SUMS/DDRC 2003 ulcer Probucol in treatment of J Hepatol 2 RCT Merat, Malekzadeh DDRC/TUMS 50 Nash 2003 Prevalence APD and IBS Eur J Gastro Hep 3 Observational Massarrat, Saberfirozi SUMS 47 In Iran 1995 Alim Pharm Ther 4 Botax/ PD in Achalasia RCT Mikaeli, Malekzadeh DDRC/TUMS 46 2001 Clarith vs. furazol in HP Alim Pharm Ther 5 RCT Fakheri, Malekzadeh DDRC/TUMS 43 eradication 2001 6 Celiac in IBS CCS Shahbazkhani, Malekzadeh DDRC/TUMS Alim Pharm Ther 43 Prevalence of celiac in Eur J Gastro Hep 7 observational Shahbazkhani, Malekzadeh DDRC/TUMS 42 Iranian blood donors 2003 Effect of triple therapy Am J 8 ….eradication of RCT Saberi-Firoozi, Massarrat SUMS Gastroenterol 41 Helicobacter pylori 1995 Cyclosporin A in Malekzadeh, Naserri- Dig Dis Sci 9 RCT DDRC/TUMS 35 autoimmune hepatitis Moghaddam 2001 HCV risk factors in blood J Gastro 10 CCS Alavian, Massarrat RCGL/DDRC 35 donors Hep2002 RC=research center; DDRC=digestive disease research center; TUMS=Tehran University of Medical Sciences; GLRC= gastroenterology and liver disease research center; SBUMS=Shaheed Beheshti University of Medical Sciences; GEHRC= gastroenterology and hepatology research center; SUMS=Shiraz University of Medical Sciences; RCGL=research center for gastroenterology and liver disease; BUMS=Baghiatallah University of Medical Sciences Archives of Iranian Medicine, Volume 12, Number 5, September 2009 517 Development of gastroenterology and hepatology in Iran Table 3. Top ten highly cited digestive oncology papers from Iran during 1970 – 2008. Source: Scopus January 2009 Number of Rank Title of Manuscript Type of Research First &CC authors Affiliation Journal/year citations 1 Esoph. cancer in the Kmet, IPHR/ Caspian littoral initial Observational Science 1972 130 Mahboubi TUMS/IARC studies 2 Esophageal cancer in the Observational Mahboubi IPHR /TUMS JNCI 1977 52 Caspian littoral 3 IPSID Review Khojasteh, New Eng J Med Review article SUMS 43 Haghshenas, 1983 4 Ardabil Cancer registry Sadjadi, Int J Cancer Observational DDRC/TUMS 42 Malekzadeh 2003 5 Precancerous lesions in JCP Interventional Malekzadeh DDRC/TUMS 33 Ardabil 2004 6 Caspian Cancer Registry IPHR/ BJC Observational Mahboubi, Kemet 32 TUMS/IARC 1973 7 Esophageal cancer in NE Saidi, BJC Interventional SBUMS 30 Iran Sepehr 2000 8 Epidem. of upper GI Islami, BJC Observational DDRC/TUMS 26 Cancer Malekzadeh 2004 9 Golestan cohort Pilot Phase Pourshams, BJC Observational DDRC/TUMS 21 study Malekzadeh 2005 10 Cancer occurrence in Iran Sadjadi, APCP Observational DDRC/TUMS 21 in 2002 Malekzadeh 2005 11 Colorectal in cancer Ansari, Cancer Letter Observational DDRC/TUMS 16 Malekzadeh 2006 RC=research center; DDRC=digestive disease research center; TUMS: Tehran University of Medical Sciences; GLRC=gastroenterology and liver disease research