Saudi Journal of Gastroenterology
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   2009| April-June  | Volume 15 | Issue 2  
    Online since March 26, 2009

 
 
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ORIGINAL ARTICLES
Helicobacter Pylori: Prevalence and relationship with abdominal pain in school children in makkah city, western Saudi Arabia
Abdulwahab MA Telmesani
April-June 2009, 15(2):100-103
DOI:10.4103/1319-3767.45359  PMID:19568573
Background/Aim: The published data on Helicobacter pylori ( H. pylori ) prevalence and its relationship with abdominal pain in Saudi Arabia is scarce. This study was carried out to determine the prevalence of H. pylori and its relationship with chronic recurrent abdominal pain (RAP) among school students in Makkah City, Saudi Arabia. Materials and Methods: Three hundred and fourteen school students, 103 at the intermediate level (grades 7-9) aged 12-15 years and 211 at the secondary level (grades 10-12) aged 15-18 years were tested for H. pylori. Urea breath test (UBT) was used for this purpose. Children with chronic RAP were identified as per the Apley criteria. Results: Overall, the UBT was positive in 86/314 (27.4%) students. It was positive in 45/103 (43.7%) intermediate school students and 41/211 (19.4%) secondary students. Out of the 55 students with chronic RAP, 40 (73%) were positive for H. pylori . Further, 62.9% and 82.1% were positive among the intermediate and secondary school students with RAP, respectively. The overall and specific odds ratios of RAP were 12.35 [95% confidence interval (C.I.) 6.30-24.22] and 10.40 (95% C.I. 1.75-11.73) for the intermediate school students and 22.69 (95% C.I. 7.99-64.44) for the secondary school students. Conclusion: The prevalence of H. pylori among the school children in Makkah, Saudi Arabia, is relatively low compared with developing countries. The prevalence was found to be higher among the younger age group. Further, there was a significant relation between H. pylori infection and RAP among the school students.
  14 5,401 724
Crohn's disease in a Saudi outpatient population: Is it still rare?
Mohammad A Al-Mofarreh, Ibrahim A Al Mofleh, Ibrahim N Al-Teimi, Abdulrahman M Al-Jebreen
April-June 2009, 15(2):111-116
DOI:10.4103/1319-3767.45357  PMID:19568575
Background/Aim: To determine the epidemiology of Crohn's disease (CD) in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. Materials and Methods: The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. Results: Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance (2.3:1). The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain (88%), diarrhea (70%), bloating (61%), rectal bleeding (50%), weight loss (33%), constipation (24%) and perianal disease (23%). The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. Conclusion: From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years.
  10 3,304 478
Role of vitamin-E on rat liver-amiodarone: An ultrastructural study
Mohamed Samir A Zaki, Refaat A Eid
April-June 2009, 15(2):104-110
DOI:10.4103/1319-3767.48967  PMID:19568574
Background/Aim: Amiodarone, a class III antiarrhythmic drug, has been found to be effective in the management of patients with life-threatening ventricular arrhythmias. The aim of this study was to test whether the co administration of vitamin-E with amiodarone can reduce amiodarone-induced liver damage. Materials and Methods: Twelve male albino rats were divided into three groups (ml vegetable oil/day by oral gavages daily for 2 weeks and were used as control group. The rats of the second group received 5.4 mg amiodarone/100 gm rat dissolved in vegetable oil daily by oral gavages for 2 weeks. In the third group, the rats received 5.4 mg amiodarone and 5 mg vitamin-E/100 gram rat dissolved in 2 ml vegetable oil by oral gavages daily for 2 weeks. Two weeks after treatment, the rats were sacrificed and liver specimens were immediately taken and processed for transmission electron microscopic examinations. Results : Sections from the rat liver receiving amiodarone examined by electron microscopy showed disrupted hepatocytes with increased vacuolations. Degenerated organelles and disrupted nuclei were observed. The microvilli of bile canaliculi were disrupted and the hepatocytes showed increased lipid contents. Both endothelial cells and Kupffer cells were damaged. Phospholipids inside the mitochondria showed a loss of cristae. Sections from the liver of rats received amiodarone and vitamin-E showed lesser effects, especially in depositions of phospholipids in the mitochondria and the whole organelles and the nucleus showed minor damage in comparison to the previous group. Conclusion: Milder hepatotoxic effects are seen in rats administered amiodarone and vitamin E simultaneously suggesting that vitamin-E may play a role in amelioration of the effects of amiodarone.
  8 3,688 524
A study of Helicobacter pylori -associated gastritis patterns in Iraq and their association with strain virulence
Nawfal R Hussein, Sarbar M Napaki, John C Atherton
April-June 2009, 15(2):125-127
DOI:10.4103/1319-3767.48971  PMID:19568578
Background/Aim: Helicobacter pylori ( H. pylori ) infection causes peptic ulceration and gastric adenocarcinoma. In Iraq, gastric cancer is rare. We investigated whether infected adults had the antral-predominant pattern of H. pylori -associated gastritis, which does not predispose to cancer. Materials and Methods: We evaluated histopathological changes by the Sydney scoring system in gastric biopsies taken from 30 H. pylori -infected adults and studied the correlation of these changes with the virulence factors. The Mann-Whitney test was used for the comparison of histopathological data. The presence or absence of each pathological index was evaluated with respect to the possession of virulence factors by the infecting H. pylori strain using the χ2 test. Results: Gastric lymphocyte infiltration was more prominent in the antrum ( P = 0.01). Neutrophil infiltration was mild and gastric mucosal atrophy was rare. No relationship was found between virulence factors and histopathological changes. Conclusions: The mild pathology and antral-predominant gastritis help explain the low cancer rate in Iraq.
  8 3,986 670
REVIEW ARTICLES
Helicobacter pylori infection in children
Shaman Rajindrajith, Niranga M Devanarayana, Hithanadura Janaka de Silva
April-June 2009, 15(2):86-94
DOI:10.4103/1319-3767.48964  PMID:19568571
Helicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. Although the organism is thought to be responsible for many diseases, only a handful of them have a direct causal relationship. At present, only a small number of children with well-defined clinical syndromes are benefited from testing and treatment. The treatment should include at least two antibiotics with a proton pump inhibitor.
  8 5,625 1,041
ORIGINAL ARTICLES
Biliary ascariasis in the Indian subcontinent: A study of 42 cases
Madhumita Mukhopadhyay
April-June 2009, 15(2):121-124
DOI:10.4103/1319-3767.48970  PMID:19568577
Background/Aim: History of ascariasis is known to stretch back many centuries. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Materials and Methods: Forty-two cases of hepatobiliary ascariasis were studied over a period of 3 years. All the patients were adults aged between 20 and 50 years and all but two were admitted with acute upper abdominal pain. Results: In this study, biliary ascariasis was found to be more common in females, 73.8% (31 patients). The most common presentation was upper abdominal pain in 95.2% of the patients (40 patients). Complications observed were obstructive jaundice in 28.56% (12 patients), cholangitis in 16.7% (seven patients), acute pancreatitis in 2.4% (one patient) and hepatic abscess in 2.4% (one patient). History of worm emesis was present in 38.1% (16 patients). History of previous cholecystectomy was present in 16.7% (seven patients) and endoscopic sphincterotomy in 4.8% (two patients). Ultrasound was the diagnostic tool of choice with 100% results. Conservative management was successful in 83.3% (35 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients). Conclusion: In endemic countries, ascariasis should be suspected in patients with biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Most of the patients respond to conservative management.
  7 3,319 595
Total leucocyte count, C-reactive protein and neutrophil count: Diagnostic Aid in acute appendicitis
Sheikh Muzamil Shafi, Misbha Afsheen, Farooq A Reshi
April-June 2009, 15(2):117-120
DOI:10.4103/1319-3767.48969  PMID:19568576
Background/Aim: Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time. Otherwise, delay in diagnosis and treatment can lead to diffuse peritonitis. Materials and Methods: A study was conducted on 110 patients who were operated for acute appendicitis to determine the role and predictive value of the total leucocyte count (TLC), C-reactive protein (CRP) and percentage of neutrophil count in the diagnosis of acute appendicitis. Preoperative TLC, CRP and percentage of neutrophil count were determined and were compared with the results of the histopathology of the removed appendix. Results: Of all the patients studied, 92 had histopathologically positive appendicitis. The TLC was found to be significantly high in 90 patients who proved to have acute appendicitis, whereas CRP was high in only 88 patients and neutrophil percentage was raised in 91; four had a normal CRP level. Thus, TLC had a sensitivity, specificity and positive predictive value of 97.82%, 55.55% and 91.8%, respectively. CRP had a sensitivity, specificity and positive predictive value of 95.6%, 77.77% and 95.6% respectively. Percentage of neutrophil count had a sensitivity, specificity and positive predictive value of 98.9%, 38.88% and 89.21%, respectively. When used in combination, there was a marked improvement in the specificity and the positive predictive value to 88.04% and 98.7%, respectively. Conclusion: The inflammatory markers, i.e., TLC, CRP and neutrophil count can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.
  6 6,864 794
IN FOCUS
Distinguishing tuberculosis and Crohn's disease in developing countries: How certain can you be of the diagnosis?
Udayakumar Navaneethan, Jijo V Cherian, Rajesh Prabhu, Jayanthi Venkataraman
April-June 2009, 15(2):142-144
DOI:10.4103/1319-3767.49012  PMID:19568588
Distinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohn's disease are initially misclassified as having Intestinal tuberculosis in places where tuberculosis is endemic before they are treated for Crohn's disease. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. Future prospective studies are required in patients with granulomatous colitis to prevent unnecessary inappropriate anti tuberculous therapy for patients with Crohn's disease and appropriate early treatment for a patient with tuberculosis.
  5 7,684 1,039
REVIEW ARTICLES
Gastrointestinal opportunistic infections in human immunodeficiency virus disease
Awadh R Al Anazi
April-June 2009, 15(2):95-99
DOI:10.4103/1319-3767.48965  PMID:19568572
Gastrointestinal (GI) opportunistic infections (OIs) are commonly encountered at various stages of human immunodeficiency virus (HIV) disease. In view of the suppressive nature of the virus and the direct contact with the environment, the GI tract is readily accessible and is a common site for clinical expression of HIV. The subject is presented based on information obtained by electronic searches of peer-reviewed articles in medical journals, Cochrane reviews and PubMed sources. The spectrum of GI OIs ranges from oral lesions of Candidiasis, various lesions of viral infections, hepatobiliary lesions, pancreatitis and anorectal lesions. The manifestations of the disease depend on the level of immunosuppression, as determined by the CD4 counts. The advent of highly active antiretroviral therapy has altered the pattern of presentation, resorting mainly to features of antimicrobial-associated colitis and side effects of antiretroviral drugs. The diagnosis of GI OIs in HIV/ acquired immunodeficiency syndrome patients is usually straightforward. However, subtle presentations require that the physicians should have a high index of suspicion when given the setting of HIV infection.
  5 4,697 921
CASE REPORTS
Case of unusual foreign body in the rectum
Murtaza A Akhtar, Pooja K Arora
April-June 2009, 15(2):131-132
DOI:10.4103/1319-3767.48973  PMID:19568580
A 44-year-old male patient with a foreign body in rectum (beverage bottle), introduced as sexual perversion, is presented with literature review. The management emphasis is on transanal retrieval and ruling out of the rectal and colonic perforation and the requirement for postremoval psychiatric treatment.
  3 4,214 535
BRIEF COMMUNICATION
Prevention of bile leak after liver surgery: A fool-proof method
Aswini K Pujahari
April-June 2009, 15(2):128-130
DOI:10.4103/1319-3767.48972  PMID:19568579
Background/Aim: Bile leak is not uncommon after liver surgeries. There is no adequate method described to prevent this morbid complication. Materials and Methods: At the end of the liver procedure, transcystic normal saline was injected under pressure with distal clamping. Leaking saline on the cut surface of the liver was sutured. The process was repeated till no leaking was observed. A suction drain was kept for any bile leak. Results: Open liver resection and hydatid cyst surgery cases were included. There were 24 cases, with 13 males and 11 females. The age range was from 4 to 80 years, with a mean of 48 years (SD 17.7). The number of leak sites that could be sutured were 0-4 (mean of 2.3 0.5). None had bile leak postoperatively. Conclusion: Transcystic injection under pressure with distal clamping demonstrates the leak sites. Suturing them prevents the postoperative bile leak.
  2 4,326 463
LETTERS TO THE EDITOR
Bony metastasis of gastric adenocarcinoma
Bhavesh Devkaran, R Jhobta, DK Verma
April-June 2009, 15(2):137-138
DOI:10.4103/1319-3767.49009  PMID:19568584
  2 2,226 366
CASE REPORTS
Uncomplicated spontaneous rupture of the pancreatic pseudocyst into the Gut - CT documentation: A series of two cases
Mohammed F Mir, Feroze Shaheen, Tariq A Gojwari, Manjeet Singh, Pervez Nazir, Shafeeq Ahmad
April-June 2009, 15(2):135-136
DOI:10.4103/1319-3767.48975  PMID:19568582
Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present herein two cases of uncomplicated spontaneous rupture of a pancreatic pseudocyst into the stomach with complete resolution.
  1 4,083 473
EDITORIAL
Glimpse of the epidemiological research on Helicobacter Pylori in Saudi Arabia
Abdulaziz A BinSaeed
April-June 2009, 15(2):85-85
DOI:10.4103/1319-3767.48963  PMID:19568570
  1 1,973 508
CASE REPORTS
Wind sock deformity in rectal atresia
Seyed M V Hosseini, Farhad Ghahramani, Alireza Shamsaeefar, Tannaz Razmi, Mohammad Zarenezhad
April-June 2009, 15(2):133-134
DOI:10.4103/1319-3767.48974  PMID:19568581
Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age.
  - 3,102 423
LETTERS TO THE EDITOR
Male gender and laparoscopic cholecystectomy
Iqbal Saleem Mir
April-June 2009, 15(2):137-137
DOI:10.4103/1319-3767.49008  PMID:19568583
  - 1,665 303
Hairdye-induced hepatitis: An unusal cause of acute hepatitis
Varadaraj P Gokak, Sasikala Mitnala, Ramji Cheemalkonda, Rupa Banarjee, Nagaraj Rao Padaki, D Nageshwar Reddy
April-June 2009, 15(2):138-139
DOI:10.4103/1319-3767.48999  PMID:19568585
  - 1,968 351
Intestinal spirochetosis: Do we always treat it or is it a self-limiting disease?
Apurva Sinha, Tony Mak, Shabina Petkar, Arthur Allan
April-June 2009, 15(2):139-141
DOI:10.4103/1319-3767.49010  PMID:19568586
  - 8,889 431
Obstructive jaundice due to primary choroidal malignant melanoma metastasis: An unusual presentation
Gaurav Maheshwari, Nairuthya Shivathirthan, Premashish J Haldar, Dinesh Kamath
April-June 2009, 15(2):141-141
DOI:10.4103/1319-3767.49011  PMID:19568587
  - 2,049 303
RADIOLOGY QUIZ
Twelve-years old girl with retro-rectal mass
Mounir Arroud, Chater Lamiae, Samir Atmani, Said Boujraf, My Abderrahmane Afifi, Moustapha Hida, Youssef Bouabdallah
April-June 2009, 15(2):145-146
DOI:10.4103/1319-3767.49013  PMID:19568589
  - 2,642 345
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