Saudi Journal of Gastroenterology
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   2017| July-August  | Volume 23 | Issue 4  
    Online since July 17, 2017

 
 
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SYSTEMATIC REVIEW/META ANALYSIS
Effect of long-term proton pump inhibitor administration on gastric mucosal atrophy: A meta-analysis
Zhong Li, Cong Wu, Ling Li, Zhaoming Wang, Haibin Xie, Xiaozhou He, Jin Feng
July-August 2017, 23(4):222-228
DOI:10.4103/sjg.SJG_573_16  PMID:28721975
Background/Aims: Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related gastrointestinal diseases. Recently, some studies have reported that PPIs can alter the gastric mucosal architecture; however, the relationship remains controversial. This meta-analysis study was designed to quantify the association between long-term PPI administration and gastric atrophy. Materials and Methods: A PubMed search was conducted to identify studies using the keywords proton pump inhibitors or PPI and gastric atrophy or atrophic gastritis; the timeframe of publication searched was up to May 2016. Heterogeneity among studies was tested with the Q test; odds ratios (OR) and 95% confidence intervals (CI) were calculated. P values were calculated by I2 tests and regarded as statistically significant when <0.05. Results: We identified 13 studies that included 1465 patients under long-term PPI therapy and 1603 controls, with a total gastric atrophy rate of 14.50%. There was a higher presence of gastric atrophy (15.84%; statistically significant) in PPI group compared to the control group (13.29%) (OR: 1.55, 95% CI: 1.00–2.41). Conclusions: The pooled data suggest that long-term PPI use is associated with increased rates of gastric atrophy. Large-scale multicenter studies should be conducted to further investigate the relationship between acid suppressants and precancerous diseases.
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EDITORIAL
Inflammatory bowel disease: Clinical screening and transition of care
Badr Al-Bawardy
July-August 2017, 23(4):213-215
DOI:10.4103/sjg.SJG_294_17  PMID:28721973
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ORIGINAL ARTICLES
Detection of clostridium difficile antigen and toxin in stool specimens: Comparison of the C. difficile quik chek complete enzyme immunoassay and GeneXpert C. difficile polymerase chain reaction assay
Abiola C Senok, Kamel M Aldosari, Rayan A Alowaisheq, Othman A Abid, Khalid A Alsuhaibani, Mohammad A Khan, Ali M Somily
July-August 2017, 23(4):259-262
DOI:10.4103/sjg.SJG_80_17  PMID:28721981
Background/Aims: Accurate and rapid laboratory diagnosis of Clostridium difficile infections (CDI) remains a significant challenge. A two-step algorithm for detection of toxigenic C. difficile in stool based on initial screening for glutamate dehydrogenase assay followed by confirmation by toxin A+B detection using an enzyme immunoassay (EIA) or molecular assay has been proposed. We aimed to evaluate the C. difficile Quik Chek Complete® (QCC-EIA) versus the GeneXpert® C. difficile polymerase chain reaction (PCR) assay in this two-step algorithm. Materials and Methods: Two hundred and ten liquid stool samples obtained between June 2014 and June 2015 from patients suspected of CDI were tested by the QCC-EIA and GeneXpert PCR assay. The GeneXpert assay was used as the reference standard to calculate the QCC-EIA sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Of the 210 stool samples tested, 43 (20.5%) were positive by QCC-EIA, while 31 (14.8%) were positive by GeneXpert assay. The sensitivity and specificity of the QCC-EIA were found to be 100 and 93%, respectively; the PPV and NPV were 72 and 100%, respectively. The binary toxin was detected in 12 (38.7%) and tcdC gene deletion in 3 (9.6%). Conclusions: The low specificity of QCC-EIA makes it less reliable as a confirmatory test for CDI diagnosis. This test may be used as a screening test in a two-step algorithm when combined with a molecular assay or another confirmatory test.
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Histological outcomes between hot and cold snare polypectomy for small colorectal polyps
Toshiki Yamamoto, Sho Suzuki, Chika Kusano, Kyoko Yakabe, Maho Iwamoto, Hisatomo Ikehara, Takuji Gotoda, Mitsuhiko Moriyama
July-August 2017, 23(4):246-252
DOI:10.4103/sjg.SJG_598_16  PMID:28721979
Background/Aim: To compare the complete resection rate of hot and cold snare polypectomy for small colorectal polyps. Patients and Methods: We retrospectively reviewed the medical records of 233 consecutive patients with 461 colorectal polyps up to 10 mm in diameter that were treated by hot or cold snare polypectomy between April 2014 and August 2016. Lesions treated by hot snare polypectomy (n = 137) and cold snare polypectomy (n = 324) were compared. The histological complete resection rates were evaluated between the two groups. We analyzed the relationship between factors for complete resection and clinical factors using multivariate analysis. Results: There was a significantly higher complete resection rate in hot snare polypectomy than in cold snare polypectomy (70.5% vs. 47.3%; P < 0.001). In the analysis of subgroups categorized according to polyp size, the complete resection rate for hot snare polypectomy was significantly higher than that for cold snare polypectomy among polyps ≥6 mm (69.0% vs. 43.5%; P < 0.001). Among polyps ≤5 mm, no significant difference regarding the complete resection rate was observed between the methods (81.3% vs. 53.4%; P = 0.057). There was no significant difference in the incidence of adverse events between the two groups. Multivariate analysis revealed that using hot snare polypectomy (odds ratio 3.03; P < 0.001), small lesion size (odds ratio 1.57; P = 0.049), and lesion location in the left colon (odds ratio 1.73; P = 0.007) were independent factors for complete resection. Conclusion: Hot snare polypectomy provides a higher complete resection rate than does cold snare polypectomy for larger (6–10 mm) subcentimeter colorectal polyps.
  1,853 284 -
Screening irritable bowel syndrome patients for symptoms predictive of crohn's disease using the red flag score
Mahmoud Mosli, Mutaz Bamarhul, Abdulrahman Alharbi, Sohaib Shafei, Ahmad Alharbi, Khalid Bamahfouth, Hani Jawa, Emad Aljahdali, Salim Bazaraa, Yousif Qari
July-August 2017, 23(4):229-232
DOI:10.4103/sjg.SJG_601_16  PMID:28721976
Background/Aims: The diagnosis of inflammatory bowel disease (IBD) is often delayed due to misdiagnosing patients with irritable bowel syndrome (IBS), mostly because of the under-recognition of high-risk features. The red flag score (RFS) has been recently developed to identify patients with higher risk of IBD rather than IBS. The aim of this study is to estimate the prevalence of high-risk features, according to the RFS, among patients diagnosed with IBS who would consequently be candidates for ileocolonoscopic evaluation. Patients and Methods: Adult patients with IBS seen at the general medicine clinic were recruited and surveyed using the RFS. Clinical and demographic data were collected. The prevalence of high-risk features, defined as a RFS >5, was calculated. Logistic regression analysis was used to identify predictors of RFS >5. Results: A total of 255 patients with IBS were recruited. The mean age was 30.6 years (±9.9 years); 71.4% of patients were women (182/255), and 90.2% were from Saudi Arabia (230/255). More than half of the patients we surveyed (51.4%) had not visited a gastroenterologist previously. The mean RFS was 6.6 (±3.6) and 54.9% of patients (140/255) scored more than 5 and accordingly were selected for further investigations. Statistical analysis identified no previous visits to a gastroenterologist as the only significant predictor of RFS >5 (OR = 2.2, 95% CI = 1.3–3.7, P = 0.003). Conclusions: More than half of the patients known to have IBS are candidates for further investigations to eliminate the possibility of IBD as a diagnosis according to the validated RFS. Patients who did not seek a specialized consultation with a gastroenterologist might be at a higher risk of being misdiagnosed as having IBS.
  1,812 220 -
SYSTEMATIC REVIEW/META ANALYSIS
Hepatitis C virus infection and risk of osteoporosis: A meta-analysis
Karn Wijarnpreecha, Charat Thongprayoon, Panadeekarn Panjawatanan, Parkpoom Phatharacharukul, Patompong Ungprasert
July-August 2017, 23(4):216-221
DOI:10.4103/sjg.SJG_452_16  PMID:28721974
Background/Aims: Hepatitis C virus (HCV) infection is one of the most common infections worldwide. Several epidemiologic studies have suggested that patients with HCV infection might be at an increased risk of osteoporosis. However, the data on this relationship remains inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence. Materials and Methods: A literature search was performed using MEDLINE and EMBASE databases from inception to June 2016. Studies that reported relative risks, odd ratios (OR), or hazard ratios comparing the risk of osteoporosis among HCV-infected patients versus those without HCV infection were included. Pooled OR and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Four studies met our eligibility criteria and were included in the analysis. We found a higher risk of osteoporosis among patients with chronic HCV with OR of 1.65 (95% CI: 0.98–2.77). Sensitivity analysis including only studies with higher quality yielded a higher OR, and the result was statistically significant (OR: 2.47; 95% CI: 1.03–5.93). Conclusions: Our study demonstrated a higher risk of osteoporosis among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.
  1,692 299 -
ORIGINAL ARTICLES
Noninvasive biomarkers as surrogate predictors of clinical and endoscopic remission after infliximab induction in patients with refractory ulcerative colitis
Elham A Hassan, Haidi K Ramadan, Ali A Ismael, Khaled F Mohamed, Madiha M El-Attar, Ihab Alhelali
July-August 2017, 23(4):238-245
DOI:10.4103/sjg.SJG_599_16  PMID:28721978
Background/Aims: Treatment of refractory ulcerative colitis (UC) is a clinical challenge, and after biological therapy, monitoring clinical and endoscopic responses is fundamental. We aimed to investigate and compare the predictive power of different noninvasive parameters for clinical remission and mucosal healing after infliximab induction therapy in refractory UC patients. Patients and Methods: Serum and fecal biomarkers, including hemoglobin, white blood cells, erythrocyte sedimentation rate, C-reactive protein (CRP), and fecal calprotectin (FC), and colonoscopy were assessed in 44 patients with refractory UC before and after (week 12) infliximab induction. Clinical and endoscopic responses were measured by clinical Mayo score and endoscopic Mayo subscore, respectively. Results: After infliximab induction, 54.5% and 65.9% had clinical remission and mucosal healing, respectively. Post-induction CRP and FC were significantly lower in clinical responders versus nonresponders (P = 0.01 and 0.001, respectively) and in patients with mucosal healing than without (P < 0.001). Among all the parameters tested, FC had the best predictive value of clinical remission [Area under the curve (AUC = 0.826)] and mucosal healing (AUC = 0.949). Post-induction FC had 87.5% sensitivity and 89% specificity (cut-off <100 μg/g) for predicting clinical remission and 89.7% sensitivity and 93.3% specificity (cut-off <58 μg/g) for predicting mucosal healing. Conclusions: Post-infliximab induction FC can be used as a surrogate marker for predicting clinical remission and mucosal healing in refractory UC patients.
  1,440 202 -
Risk of coronary artery disease in celiac disease population
Rama D Gajulapalli, Deepak J Pattanshetty
July-August 2017, 23(4):253-258
DOI:10.4103/sjg.SJG_616_16  PMID:28721980
Background/Aims: Celiac disease (CD), a chronic autoimmune condition, is associated with systemic inflammation capable of causing extra intestinal manifestations. Chronic inflammatory process has been implicated in the pathogenesis of accelerated atherosclerosis. Studies examining the burden of coronary artery disease (CAD) in patients with CD are lacking. We evaluated the prevalence of CAD in patients with CD. Patients and Methods: Electronic health records from different health care systems were obtained utilizing a Health Insurance Portability and Accountability Act-compliant, patient de-identified web application. Among the 48,642,290 patients, 59,010 were diagnosed with CD. The remaining 48,583,280 patients without CD served as comparison controls. Results: The prevalence of CAD was significantly higher in patients with CD than in the controls [5140 (8.7%) vs. 2119060 (4.4%), P < 0.001], with the odds ratio (OR) being 2.09 (95% confidence interval [CI]: 2.03–2.15, P < 0.0001). There was a similarly higher prevalence among younger patients (age, <65 years) with CD compared with those without CD (3.72% vs 1.98% [OR: 1.85, 95% CI: 1.7488–1.9417, P < 0.0001). Conclusions: The prevalence of CAD increased nearly two-fold in patients with CD.
  1,298 146 -
A cross-sectional survey of Saudi gastroenterologists: Transition strategies for adolescents with inflammatory bowel disease
Elaf Al-Jahdali, Mahmoud Mosli, Omar Saadah
July-August 2017, 23(4):233-237
DOI:10.4103/sjg.SJG_77_17  PMID:28721977
Background/Aims: The transition of adolescents with inflammatory bowel disease (IBD) from pediatric to adult care requires a well-structured standardized protocol to ensure the delivery of optimal healthcare and decrease the risk of nonadherence, hospitalizations, and complications. The aims of this survey are to evaluate current IBD transition practices adopted by gastroenterology services across the Kingdom of Saudi Arabia (KSA) and to identify the major challenges standing in the way of implementing effective transition strategies from the perspectives of pediatric and adult gastroenterologists. Patients and Methods: An online survey was distributed to KSA pediatric and adult gastroenterologists through the Kingdom's national gastroenterology association. The questionnaire included closed-ended questions regarding existing institutional transition strategies and perspectives regarding the impact of different factors on their ability to effectively transition adolescents from pediatric to adult care. Results: A total of 80 adult and pediatric gastroenterologists responded to the survey invitation. Most of the participating gastroenterologists worked at a tertiary care center (82.5%). The majority of gastroenterologist (73.8%) reported that they do not follow a defined protocol for transitioning in their current practices. However, a structured transition program was noted to be “very important” by 78.8% of gastroenterologists. The most favored method of transitioning was joint outpatient clinic attended by patient, caregiver, pediatric gastroenterologist, and adult gastroenterologist (35.9%) and the most commonly reported barrier to transitioning was “lack of proper preparation” for transitioning (53.2%). Conclusions: Although acknowledged by the majority of participants as being “very important,” no standardized IBD transition protocol is followed in the majority of practices across KSA. A well-structured national protocol for transitioning adolescents with IBD is needed.
  1,249 163 -
LETTER TO EDITOR
Towards supporting greater and lower cost access to direct acting antiviral treatment for hepatitis C for all patients
Said A Al-Busafi, Heba Omar
July-August 2017, 23(4):263-264
DOI:10.4103/sjg.SJG_136_17  PMID:28721982
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