Saudi Journal of Gastroenterology
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Year : 1999  |  Volume : 5  |  Issue : 2  |  Page : 76-80
Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia


1 Department of Medicine, Gizan, Saudi Arabia
2 Department of Directorate of Health, Gizan, Saudi Arabia
3 Department of General Surgery, Gizan, Saudi Arabia
4 Department of Orthopaedics, Gizan, Saudi Arabia

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Date of Submission16-Dec-1997
Date of Acceptance22-Oct-1998
 

   Abstract 

To determine the relative frequencies of gastrointestinal diseases (GI) in patients admitted to Samtah General Hospital, Gizan, the records of 2,442 adults admitted to the medical and surgical services for gastrointestinal diseases during the period 1413 to 1416 were analyzed retrospectively. 1,028 patients had acute appendicitis. The remaining 1,414 patients were admitted for various other GI diseases. In these 1,414 patients the commonest diseases were gastrointestinal infections (36.4%), peptic ulcer disease (19%), gall bladder disease (18.5%), viral hepatitis and its sequelae (20.7%). Despite the high prevalence of cholelithiasis, acute pancreatitis was uncommon (0.1 %). Inflammatory bowel disease was rare. There was no gender - related difference in the prevalence of gastrointestinal infections, peptic ulcer disease and carcinoma of the stomach. Males were significantly more afflicted than females with viral hepatitis (p<0.0001), cirrhosis of the liver (p<0.0001), hepatocellular carcinoma (p<0.0005), variceal bleeding (p<0.0005), and peptic ulcer bleeding (p<0.005). As a large proportion of our patients had preventable diseases, it is expected that immunization and other public health measures will reduce the frequency of these diseases in the future.

How to cite this article:
Aderoju EA, Ene D, Abutalib H, Aboh I, Okonkwo TN. Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia. Saudi J Gastroenterol 1999;5:76-80

How to cite this URL:
Aderoju EA, Ene D, Abutalib H, Aboh I, Okonkwo TN. Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia. Saudi J Gastroenterol [serial online] 1999 [cited 2019 Nov 19];5:76-80. Available from: http://www.saudijgastro.com/text.asp?1999/5/2/76/33514


Gastrointestinal diseases are common worldwide. Reports on prevalence of gastrointestinal (GI) diseases in the United States indicate that five to ten percent of consultations were due to digestive complaints [1]. In the Netherlands, digestive diseases occur in two million of the country's citizens annually, and make up 13% of the total mortality, 12% of the hospital admissions and 17% of total hospital day [2] . Similar increase in demand for gastroenterological service has been reported from the UK [3] , China [4] and Africa [5]. Saudi Arabia is no exception in this trend. Liver diseases, peptic ulcer disease, gall stones, functional bowel problems, especially irritable bowel syndrome (IBS) and non­-ulcer dyspepsia, are commonly encountered problems [6] . The provision of modem technology and infrastructure has markedly facilitate the diagnosis and therapy of GI diseases in Saudi Arabia within the past two decades [6] . While there are several reports on the prevalence of specific gastrointestinal diseases in the Kingdom of Saudi Arabia such as peptic ulcer disease [7],[8] gall bladder disease [9] , viral hepatitis and chronic liver disease [10],[11],[12] , and gastrointestinal malignancies [13] , reports on the pattern of GI diseases are few. Information of this nature is useful for health care planning strategies. Many patients attending our hospital present with GI symptoms. Most of them are treated as out-patients but a considerable number requires hospitalization. The aim of this study is to describe the pattern of GI diseases in adult patients admitted to Samtah General Hospital over a period of four years (Muharram 1413 - Dhul Hajjah 1416 H, corresponding to July 1992 - May 1996).


   Patients and Methods Top


This study was carried out in Samtah General Hospital (SGH), one of the eight hospitals in Gizan region (population of 1 million). SGH is a 100 beded hospital, and serves a population of 170,000. It is well staffed and equipped in most specialties. The diagnostic facilities in its gastroenterology service include clinical chemistry, immunology, microbiology, endoscopy, contrast radiology and ultrasonography. We reviewed the records of all adult patients admitted with GI diseases to the medical and surgical wards of our hospital during the period 1413 to 1416 H. We also obtained the total number of admissions to these wards during the same period. Data obtained from the records of patients with GI diseases were analyzed according to nationality, gender, the frequency and the distribution of the diagnostic categories. The diagnoses were coded according to the 10 th revision of the International Statistical Classification of Diseases IC-10 [14] . The proportions were compared using Chi squared test and Fisher's exact test as indicated.


   Results Top


The total number of adults admitted to the medical and general surgical wards during the period reviewed was 11,672. There were 10,096 Saudis of whom 5,452 were males. 2,442 patients were admitted for various gastrointestinal diseases. Out of these 2,442 patients, 1.028 were cases of acute appendicitis [Table - 1]. Further analysis of this appendicitis group is being reported elsewhere. The 1,414 non-appendicitis cases were further analyzed in detail. [Table - 2] shows the diseases encountered in the population studied. Gastrointestinal infections accounted for 36.4% of all GI admissions and 4.4% of all adult medical and surgical admissions. Viral hepatitis and its sequelae including cirrhosis of the liver, variceal bleeding and hepatocellular carcinoma were the next most commonly encountered problems. Other diagnostic categories of importance were gall bladder disease, peptic ulcer disease and its complications. Of the 261 cases of cholelithiasis, 219 (83.9%) had multiple medium or large-sized stones, 25 (9.6%) had multiple small stones, while 17 (6.5%) had lone stones. Apart from hepatocellular carcinoma, other neoplasms of the gastrointestinal tract were few. Acute pancreatitis and inflammatory bowel disease were rare. There was no gender- related difference in the prevalence of gastroenteritis, bacillary dysentery, peptic ulcer disease, and carcinoma of the stomach. However, males were significantly more afflicted than females with viral hepatitis (p<0.0001), cirrhosis of the liver (p<0.0001), hepatocellular carcinoma (p<0.0005), variceal bleeding (p<0.0005), and peptic ulcer bleeding (p<0.005). Gallbladder disease was predominantly seen in females (p<0.0001) [Table - 3] and [Figure - 1].


   Discussion Top


Studies based on hospital populations may not accurately reflect the pattern of disease in a community. However, as health care is free and readily available in the Kingdom of Saudi Arabia, most patients utilize the facilities provided in the primary health centers (PHC) and the hospitals for their health needs. SGH receives all the referrals from the 32 PHCs in its area. It is our opinion that our results are valid for health care planning strategies. The high frequency of gastrointestinal infections in our study may be attributed to many factors. These include environmental factors, water supply, level of personal hygiene and public health awareness. Only patients with severe forms of gastrointestinal infections manifesting as dehydration, shock or acute renal failure were admitted to hospital. There was no mortality in this group of patients and there were no cases of the haemolytic uraemic syndrome. Peptic ulcer disease was frequently encountered in our practice. This is consistent with reports from other parts of the Kingdom. This high frequency may be related to infection and re-infection with H. pylori, which is known to be common in many developing countries [15],[16] . GBD is common in our population, especially in females. However, despite this, acute pancreatitis was rare. It has been suggested that patients with acute gall stone pancreatitis tend to have smaller and more numerous stones [17],[18] . The scanty number of patients with small multiple gall stones in our series may account for the low incidence of acute pancreatitis. 20.8% of all GI diseases admitted were due to viral hepatitis, cirrhosis, variceal bleeding or hepatocellular carcinoma. Viral hepatitis alone accounted for 6.9% of this, Infection with hepatitis B & C viruses are common in Saudi Arabia with a prevalence rate of between 5% and 10% for HBV [10] , and up to 6% for HCV in Gizan region [11] . With this background, it is not surprising that cirrhosis of the liver, variceal bleeding and hepatocellular carcinoma are common in the population reviewed. Only one patient was admitted for ulcerative colitis during the period. IBD is relatively rare in Saudi Arabia compared to its prevalence in Europe and North America. However, recent reports indicate that there is an increasing incidence of both ulcerative colitis and Crohn's disease [19],[20] . Irritable bowel syndrome (IBS) is common in Saudi Arabia, and constitutes a major load in GI and medical clinics [6] . However, only seven patients were admitted in our series because of IBS. Our results show that acute appendicitis is very common among young adults. These observations and other findings in relation to patients admitted for acute appendicitis are being reported elsewhere.


   Conclusion Top


A significant proportion of the diseases for which the patients in our study were hospitalized are preventable. It is noted that the Kingdom of Saudi Arabia is concerned with both the preventive and curative arms of medical care. Immunization against hepatitis B virus is currently included in the routine childhood immunization program [21] . This will eventually reduce the prevalence of viral hepatitis and its sequelae. Also, with the improvement in public health facilities, health education and personal hygiene, the infective diseases encountered in our series will be reduced.

 
   References Top

1.Everhart JE. Ed. Digestive diseases in the United States: epidemiology and impact. National Digestive Diseases Data Working Group, United States Department of Health and Human Services, National Institute of Health (NIH) Publication 1994;94:1447.  Back to cited text no. 1    
2.HeneGouwen GPVB. Present position of gastroentrology in the Netherlands. Gut 1994;35:1326-7.  Back to cited text no. 2    
3.Neale G and Williams R. Consultant staffing and career prospects in gastroenterology for England and Wales. Gut 1993;34:284-7.  Back to cited text no. 3    
4.Shao-Ji Jiang. Gastroenterology in China. Gut 1994;35:826.  Back to cited text no. 4    
5.Olubuyide IO, Atoba MA, Ayoola EA. Diseases of the gastrointestinal tract and the pancreas in Africans. Tropical Gastroenterology 1987;8:221-8.  Back to cited text no. 5  [PUBMED]  
6.Al Faleh FZ. Gastroenterology in Saudi Arabia. Saudi J Gastroenterol. 1995;1:1-2.  Back to cited text no. 6    
7.Ayoola EA, Rashed RS, Mofleh IA, Faleh FZ, Laajam MA. Diagnostic yield of upper gastrointestinal endoscopies in relation to age and gender. A study of 10,112 Saudi patients. Hepato-gastroenterology 1996;42:409-15.  Back to cited text no. 7    
8.Laajam MA, Al Mofleh IA, Al Faleh FZ, Al Aska AK, Jessen K, Hossain J, Al Rashed RS. Upper gastrointestinal endoscopy in Saudi Arabia. Analysis of 6,385 procedures. Quarterly J Med, New series 1988;66:249:21-5.  Back to cited text no. 8    
9.Bakhotmah MA. Prevalence of cholelithiasis in a living Saudi adult female population (ultrasonic study). Saudi M Journal. 1977;18:496-8.  Back to cited text no. 9    
10.Al Faleh FZ. Hepatitis B infection in Saudi Arabia. Ann Saudi Med 1988;8:474-80.  Back to cited text no. 10    
11.Bakir TMG. Age - specific prevalence of antibody to hepatitis C virus (HCV) among the Saudi population. Saudi M Journal. 1992;1:321-4.  Back to cited text no. 11    
12.Fashir B, Sivasubramanium V, Al Momen S, Assaf H. Pattern of liver disease in a Saudi patient population. A decade od experience at Security Forces Hospital, Riyadh, KSA. Saudi J Gastroenterol. 1996;2:50-2.  Back to cited text no. 12    
13.Dahish S, Ajarim. Pattern of primary gastrointestinal cancer: King Khalid University Hospital experience and review of published national data. Ann Saudi Med. 1996;16:386-91.  Back to cited text no. 13    
14.International statistical classification of diseases and related health problems. Tenth revision 1992.  Back to cited text no. 14    
15.Louw JA, Lucke W, Jaskiewicz K, Lastovica AJ, Winter TA, Marks IN. Helicobacter eradication in the African setting, with special reference to reinfection and duodenal ulcer recurrence. Gut 1995;36:544-7.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Zaman R, Hussein J, Zawawi TH, Thomas J, Gilpin C, Dibb WL. Diagnosis of Helicobacter pylori infection. A study in the western province of Saudi Arabia. Saudi M Journal. 1995;16:552-5.  Back to cited text no. 16    
17.Acosta JM, Ledesma CL. Gallstone migration as a cause of acute pancreatitis. N Engl J Med. 1974;290:484-7.  Back to cited text no. 17    
18.Armstrong CP, Taylor TU, Jeacock J, Shucast R. The biliary tract in patients with acute gallstone pancreatitis. Br J Surg. 1985;72:551-5.  Back to cited text no. 18    
19.Khan HA, AbdulRahman SM, Khawaja Fl. Ulcerative colitis amongst Saudis: Six year experience in Al Madinah region. Saudi J Gastroenterol. 1996;2:69-73.  Back to cited text no. 19    
20.Al Gindan YM, Satti MB, Al Quorain AA, Al Harridan A. Crohn's disease in Saudi Arabia. A clinico - pathological study of 12 cases. Saudi J Gastroenterol 1996;2:150-5.  Back to cited text no. 20    
21.Al Faleh FZ, Ayoola EA, Jeffry M, Arif M, AI Rashed RS, Ramia S. Intergration of hepatitis B into the expanded program on immunisation. The Saudi Arabian experience. Ann Saudi Med 1993;13:231-6.  Back to cited text no. 21    

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Correspondence Address:
Emmanuel Aderemi Aderoju
Consultant Physician & Gastroenterologist, Samtah General Hospital, Gizan
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864748

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[Pubmed]



 

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