Saudi Journal of Gastroenterology
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Year : 1996  |  Volume : 2  |  Issue : 1  |  Page : 50-52
Pattern of liver disease in a Saudi patient population: A decade of experience at security forces hospital, Riyadh, KSA


1 Department of Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
2 Department of Pathology, Security Forces Hospital, Riyadh, Saudi Arabia

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   Abstract 

We report the pattern of liver disease revealed by a study of liver biopsies of 277 adults aged 16-85 years old from January 1983 - December 1993.
The most common histological diagnoses were: cirrhosis in 22.3%, chronic active hepatitis (CAH) 16.6%, hepatocellular carcinoma (HCC) in 7.2%, fatty changes in 12% of patients. Less common diag­noses included: Cholestasis in 8 (2.8%), Hemochromatosis in 7 (2.5%), periportal fibrosis in 4 (1.4%), Wilson's disease in 3 (1%), Alcoholic hepatitis in one patient and lymphoma in one patient. Inadequate specimens were encountered in 7 (2.5%). The commonest causes of liver cirrhosis were: Hepatitis C virus (HCV) in 73.3% of patients tested for it and hepatitis B virus (HBV) in 23.2%.
Complications related to the procedures were exceedingly low. One patient, with Budd-Chiari Syn­drome required emergency laparotomy to control bleeding.
In conclusion, liver cirrhosis, CAH and HCC were common patterns of chronic liver disease in this series. HCV was the most common cause of CAH and liver cirrhosis.

How to cite this article:
Fashir B, Sivasubramaniam V, Al Momen S, Assaf H. Pattern of liver disease in a Saudi patient population: A decade of experience at security forces hospital, Riyadh, KSA. Saudi J Gastroenterol 1996;2:50-2

How to cite this URL:
Fashir B, Sivasubramaniam V, Al Momen S, Assaf H. Pattern of liver disease in a Saudi patient population: A decade of experience at security forces hospital, Riyadh, KSA. Saudi J Gastroenterol [serial online] 1996 [cited 2019 Sep 17];2:50-2. Available from: http://www.saudijgastro.com/text.asp?1996/2/1/50/34041


Liver cirrhosis is the leading cause of death in Asia [1],[2] . Chronic liver disease (CLD) constitutes a major health problem in the Kingdom of Saudi Arabia (KSA) [3],[4] . Ten percent of population are HBsAg carriers [3] . The prevalence of HCV ranges from 1.2-2.5 among Saudis [6],[7] . In this study we respectively have investigated the pat­tern of liver disease among 277 patients who have had liver biopsy for various reasons from January 1983 to December 1993.

The objectives of this retrospective study were a) To study the pattern of CLD among adult Saudi population seen at Security Forces Hospital. b) Tc define the clinical features of a group of patients with hepatitis, cirrhosis and hepatocellular car­cinoma (HCC) in whom diagnosis was made upon histologicaly criteria. c) To highlight some epidemiological basis for future studies.


   Patients and Method Top


We reviewed case notes of 277 patients aged 16­85 years who underwent either percutaneous biopsy by Menghini needle or wedge biopsy dur­ing laparotomy from January 1983 - December 1993. All patients were Saudis. The indications for liver biopsy were: Abnormal LFT, chronic viral hepatitis, hepatomegaly or a liver mass. From the case notes, the following information were obtained: Age, sex, nationality, HBV & HCV markers, alpha feto protein (AFP), liver function tests (LFT), and histological diagnosis.


   Result Top


Over the 400 case notes reviewed, only 277 were eligible and qualified for inclusion in this study. Non-Saudi nationals were not included. One hundred sixty nine (61%) were males.

The histological diagnosis of 277 liver biopsies is shown in [Table - 1] & [Table - 2]. Liver cirrhosis, CAH, chronic persistent hepatitis (CPH) and HCC were the most frequent causes of chronic liver disease.

Liver cirrhosis was found in 22.3% of patients with age range of 40-60 (median. 50) years. HCV was present in 73.3% of patients tested. HBsAg was present in 23.2%.

CAH was found in 16.6% of cases. With age range of 20-40, (median 35) years, HCV-antibody was present in 65% of cases tested and HBsAg was positive in 22.7%. Autoimmune CAH was found in 8.6%. However, HBsAg was predomin­antly found in patients with CPH 47.3% Anti­HCV was present in 35.7%.

HCC was found in 7.2 % of the cases. 80 were males. HBsAg was positive in 50 %. Mean age was 50 years, median AFP was 902 ng/ml. The overall prevalence of HBeAg among patients with CLD was 18.7 %. The prevalence of HDV antibody among patients with CLD was 26.6 %.

Metastatic carcinoma of the liver was found in 12 patients (4.3 %). In majority of cases, the pri­mary was unknown. Fatty infiltration of the liver was a frequent cause of abnormal LFTs and hepatomegaly in our study (11.5 %).

Other less common conditions are summarized in [Table - 2].


   Discussion Top


Our study clearly demonstrated that liver cir­rhosis, CAH, CPH and HCC constituted the major causes of CLD diagnosed by liver biopsy. This was comparable with reports from Western and Eastern regions and from Riyadh [1],[2],[5] . Despite the fact that HBsAg carrier rate is higher 10 % compared to HCV 1.2-2.5 % among Saudis [7],[8],[9] , the frequency of hepatitis C virus among patients with liver cirrhosis and CAH was much higher 73.2 % to 65 %, respectively. This clearly demonstrated the role of HCV in the pathogenesis of CLD which was the leading cause of CAH, cir­rhosis and HCC in this series. Similar results were reported from Abha by Jamjoom, et al [5] . HBV was the second leading cause of chronic liver dis­ease and HCC in our patients. This emphasizes the importance of preventive measures against HBV and HCV in the form of public education, vaccination at an early age, careful screening of blood donors and the use of disposable needles.

Metastatic carcinoma of the liver was found in 12 patients. The primary was in the pancreas in one, in the stomach in two patients and the colon in two cases. In seven cases, the origin of the pri­mary was unknown. Fatty infiltration of the liver (11.5 %) was found to be a common cause of abnormal LFT or hepatomegaly. Diabetes mel­litus and obesity were among the possible causes. In our series, hepatic granuloma and periportal fibrosis were surprisingly rare 1 % and 1.3 respectively, compared with studies done else­where in the K.S.A [1] . This was not explained. In our study, we have found only seven patients with primary hemochromatosis and two with Wilson's disease. This indicates, these two conditions are uncommon in this region. This was supported by other similar studies from different regions in the K.S.A [2]. Alcoholic liver disease was exceed­ingly rare in our study; only one case was reported. This was explained by the religious, social and cultural background of this Muslim society. Eighteen patients (6.4 %) had normal liver biopsy and 15 (5.4 %) had mild specific hepatitis. The prevalence of HBV and HCV among these patients was low.

The mortality and morbidity related to the pro­cedure was exceedingly low. Only one patient developed severe bleeding, that required laparotomy. It was a case of Budd-Chiari syn­drome.


   Conclusion Top


Although the data represents only that from a single hospital, the spectrum of liver disease cor­relates well with the previous published data from other hospitals in the Kingdom. It will also pro­vide valuable information for a metaanalysis at a future date. These significant mortality and mor­bidity related to HCV and HBV should stimulate more attention towards preventive measures[15].

 
   References Top

1.Al-Mofleh,I. The pattern of chronic liver disease in a hospital population in Riyadh. E Afr Med J 1988:65:514­9.  Back to cited text no. 1    
2.Al Quorain A, Satti MB, Al Hamdan A. et al. Patterns of chronic liver disease in Eastern province of Saudi Arabia, Trop Geog Med 1994;46:358-60.  Back to cited text no. 2    
3.Al Faleh F. Hepatitis B infection in Saudi Arabia. Ann Saudi Med 1988;8:474-98.  Back to cited text no. 3    
4.Atiyah M and Ali MA. Primary hepatocellular car­cinoma in Saudi Arabia. Amer J Gastroenterol 1980:74­9.  Back to cited text no. 4    
5.Jamjoom GA and Quli SR. Seriodiagnosis of hepatitis C virus in acute and chronic liver disease in Southwestern Saudi Arabia. J Trop Med Hyg 1992;95:428-31.  Back to cited text no. 5    
6.Fakunte YM. Mohammed A, Wafaa F, et al. Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh. Ann Saudi Med 1991;11:504-6.  Back to cited text no. 6    
7.Mofareh M, Yisa M, Wafaa M, et al. Prevalence of anti­bodies to hepatitis C virus in blood donors in Riyadh. Ann Saudi Med 1991;11:501-3.  Back to cited text no. 7    
8.Yisa M, Mohammed A, Abdullah Z, et al. Prevelance of antibodies to hepatitis C virus in Saudi patients with chronic liver disease. Ann Saudi Med 1991;1 1:5.  Back to cited text no. 8    
9.Yisa M, Mohammed A, Al Ghreimil M, et al. Preva­lence of antibodies to hepatitis C virus in Saudi and expatriate women in Riyadh, Saudi Arabia. Ann Saudi Med 1991:11:494-6.  Back to cited text no. 9    
10.Padmanabhan P. Hepatitis C virus infection in hemodialysis patients in Saudi Arabia. J Kidney Disease -Transplant 1994;5(2):157-8.  Back to cited text no. 10    
11.Ramhish B, Anand D. Kirubakaran C. Raghupathy P. The pattern of liver disease in Indian children. A review article of 128 biopsied cases. Ann Trop Pediatr 1993;13:159-63.  Back to cited text no. 11    
12.Al Faleh F, Ayoola EA. Arif M, et al. Seroepidemiology of hepatitis B virus infection in Saudi Arabian children. J Infect 1992;24:197-206.  Back to cited text no. 12    
13.Massoud M, Helmy O, Saleh AW. Hepatitis Delta anti­bodies in some HBsAg positive patients in Saudis in Riyadh. J Egypt Soc Parasitol 1991;21:561-5.  Back to cited text no. 13    
14.Shoboksi OA, Serebour FE. The etiology of active viral hepatitis in Western region of Saudi Arabia. Trans R Soc Trop Med Hyg 1987;81:219-21.  Back to cited text no. 14    
15.Zakim and Boyer. Hepatology: a text book of liver dis­ease. (Second edition) Philadelphia, W.B. Saunders Company, 1990;p1222.  Back to cited text no. 15    

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Correspondence Address:
B Fashir
Liver Transplant Unit, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864842

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