Saudi Journal of Gastroenterology

: 2018  |  Volume : 24  |  Issue : 8  |  Page : 21--37



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. Abstracts.Saudi J Gastroenterol 2018;24:21-37

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. Abstracts. Saudi J Gastroenterol [serial online] 2018 [cited 2021 Dec 6 ];24:21-37
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 SJG2018/01: Efficacy of Stereotactic Body Radiotherapy in the Treatment of Intra-Hepatic Cholangiocarcinoma: A Systemic Review

Hussam Hijazi, Marwan Abulmagd, Joud Almogati, Hind Alhodaly, Lujain Alfattany, Abeer Alzahrani, Wejdan Algamdi

Department of Radiation Oncology, King Abdulaziz University Hospital, Jeddah, KSA

Background: Cholangiocarcinoma is rare malignancy but considered the second common hepatobiliary cancer worldwide, it is classified into intrahepatic and extrahepatic based on the anatomical location. The extrahepatic classically include two subtypes perihilar and distal extra-hepatic. The curative treatment of this cancer is surgical resection but unfortunately most of the patient present with advance stage and other comorbidity so we cannot go to curative resections. Also, some patients after resection still have positive margin despite variety of diagnostic modality, all of these factors will lead to poor outcome. Actually some studies they used sbrt as newly modality radiotherapy for cretin types of cancer such as lung, liver, spinal cord, adrenal glands and recently used for Cholangiocarcinoma and showed improve the outcome for those patients. therefore, We decided to do a systemic review about the effectiveness of SBRT as a treatment modality for cholangiocarcinoma. Methods: We conducted a comprehensive systematic search for studies in various databases, including PubMed, Medline and PMC without specifying a beginning date to the end of March 2017 using a number of keywords to search for the related studies. Results: After applying some criteria for inclusion and exclusion, a total of 414 studies has been minimized to 22 studies included in the table. Conclusion: SBRT provides a reasonable effective modality of treatment for cholangiocarcinoma either as adjunct treatment after incomplete resection or in locally advanced unresectable disease, with a toxicity profile that could be limited with the use of appropriate techniques, dosing and good patient selection.

 SJG2018/02: Clinical Characteristics of Hepatocellular Cancers Referred to Tertiary Care Center in the Western Region of Saudi Arabia

Adnan Al-Zanbagi, Tashkandi Abdulaziz, Almamoom I. Justaniah1, Noha H. Guzaiz1, Ishtiaq Ahmed, M. K. Shariff

Departments of Gastroenterology and Hepatology and 1Radiology, King Abdullah Medical City, Makkah, KSA

Background: Liver cancer is sixth most common cancer in Kingdom of Saudi Arabia (KSA) with few prospective series being reported. We recently started a tertiary referral service in the western region of KSA for Hepatocellular Cancer (HCC) and present the clinical characteristics of the HCC referred to our center. Methods: Information on patient demographics, clinical status, biochemical and radiological results for all the HCC cases referred was prospectively collected and analyzed as below. Results: 27 cases were referred with mean age of 68 years (±9.4 SD) affecting 22 males. All cases were diagnosed radiological and none were diagnosed by surveillance program. Cirrhosis was present in all the patients with hepatitis C virus in 48% (13) being the leading cause of liver disease followed by hepatitis B in 15% (4). 37% (10) had Child-Pugh A, 30% (8) B and C 33% (9) with portal hypertension present in 56% (15). At the time of referral 63% (17) had multinodular HCC. In addition, vascular invasion was present in 15% (4). Due to advance stage of presentation most patients received best supportive care, only 37% (10) were suitable for chemoembolization of which 30% had Transaretrial chemoembolization, 50% had Transaretrial radioembolization, and 20% had Radiofrequency ablation. Conclusion: Our series of HCC characteristics confirms the findings of other regions from this Kingdom, of hepatitis C being the dominant cause of HCC. Diagnosis is usually made at a late stage with few eligible for definitive therapy. For better outcomes early detection of HCC through surveillance maybe needed.

 SJG2018/03: The Impact of Capsule Endoscopy on the Need for Therapeutic Interventions in Hospitalized Patients with Obscure Gastrointestinal Bleeding

Majid Alsahafi1,2, Paula Cramer1, Nazira Chatur1, Fergal Donnellan1

1Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada, 2Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Background: Video capsule endoscopy (VCE) has revolutionized the management of patients with obscure gastrointestinal bleeding (OGIB). There is limited data evaluating the impact of VCE on the need for therapeutic interventions in hospitalized patients with OGIB. Objectives: To determine the impact of inpatient VCE on the need for therapeutic interventions and the need for re-hospitalization for recurrent bleeding. Methods: All hospitalized patients who underwent VCE for OGIB indication at a tertiary academic center were included. Clinical data was collected including therapeutic interventions performed after VCE. Specific therapeutic interventions were defined as medical, endoscopic or surgical treatment directly targeting a specific cause of OGIB. Patients were followed to determine the rate of re-hospitalization. Results: A total of 320 VCE were identified, of which 48 were done in hospitalized patients. The completion rate and the diagnostic yield were 78.5% and 55.8% respectively. Specific therapeutic interventions were performed in 65.2% of patients with positive VCE and 5.8% of patients with negative VCE (p < 0.001). After a median follow up of 30 months (minimum 12, maximum 58), re-hospitalization for recurrent bleeding occurred in 30.4% of patients with positive VCE and 17% of patients with negative VCE. Patients with angiodysplasia on VCE were significantly more likely to be readmitted (p = 0.02). Throughout the course of this study, only 2 (11.7%) patients with negative VCE underwent specific therapeutic interventions. Conclusion: VCE significantly impacted the management of hospitalized patients with OGIB. Inpatient VCE is an effective tool to select patients for therapeutic interventions. Patients with negative VCE studies are unlikely to require specific therapeutic interventions.

 SJG2018/04: Rapid Small Bowel Transit Time Negatively Impacts the Diagnostic Yield of Small Bowel Capsule Endoscopy

Majid Alsahafi1,2, Paula Cramer2, Nazira Chatur2, Fergal Donnellan2

1Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, 2Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

Background: Rapid small bowel transit time (SBTT) is not uncommonly encountered during video capsule endoscopy (CE) examination. We aimed to determine the effect of rapid SBTT on the diagnostic yield. Methods: We retrospectively reviewed all CE procedures performed at a tertiary academic center between February 2015 to October 2017. We collected data on patients' demographics, indication for CE, small bowel transit time and diagnostic yield. SBTT was categorized into 3 categories: category A <60, category B 60-120, and category C >120 minutes. CE studies were excluded if the cecum was not reached or when there is insufficient data. Multiple logistic regression analysis was performed to compare the diagnostic yields between different categories of SBTT. Results: A total of 301 CE were identified, of which 251 CE studies were included in the analysis. The mean patients' age was 58 and 49% were male. The overall diagnostic yield was 32.27% and the mean SBTT was 160 minutes. The diagnostic yield was 18.3% for category A; 33.8% for category B and 36.3% for category C. After adjusting for age, sex and indication for CE, longer SBTT was independently associated with higher diagnostic yield (OR: 2.38; 95% CI 0.95-6.31; P = 0.06) for category B, (OR: 2.73; 95% CI 1.22-6.63; p = 0.01) for category C. Conclusion: Rapid SBTT is associated with lower diagnostic yield. Therefore if clinically concerned , a repeat CE should be considered when the SBTT is less than 60 minutes.

 SJG2018/05: Use of Oral Budesonide in Protein Losing Enteropathy Patients Post Fontan Surgery: A Single Center Experience

Eman Buhamrah, Ahmad Al-Muhaideb1, Majid Al-Fayyadh2, Khalid Al-Saleem, Ali Al-Mehaidib, Wajeeh Al-Dekhail

Departments of Pediatrics and 1Radiology, King Faisal Specialist Hospital and Research Centre, 2Heart Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Background: Protein Losing Enteropathy (PLE) is a well-known complication of Fontan cardiac operation. The exact etiology remains obscure. Most treatment modalities were aimed towards improving cardiac output or reducing inflammation. We describe the effect of Budesonide treatment on serum albumin levels and albumin infusion requirements in patients who developed PLE as a consequence of Fontan operation. Methodology: This is a retrospective chart review of pediatric cardiac patients who underwent Fontan operation and subsequently developed PLE at King Faisal Specialized Hospital & Research Center (KFSH&RC) Riyadh, Saudi Arabia. Results: 9 patients were identified with a median age of 108 months (range 48-192 months). Six were males (66.6%). The median serum albumin value before Budesonide treatment was 16 g/L (range 12-21 g/L). The median serum albumin level after treatment was 39 g/L (range 31-44 g/L). The increase above 30 g/L with treatment was statistically significant (P-value = 0.002). During the 6 months of follow up, the requirement for albumin infusion decreased from 1-2 infusions per week to once every 2 weeks mainly during the first two months of treatment, till complete cessation of albumin infusions thereafter. Two patients relapsed after weaning the dose below 3 mg per day independent of age & weight. Conclusion: Budesonide is effective in improving serum albumin levels and reducing albumin infusion requirements in patients who develop PLE post Fontan surgery. It has shown significant results within the first weeks of starting treatment. Follow up studies are needed to evaluate long-term outcome and potential side effects.

 SJG2018/06: Utility of New Cholangioscopes (SpyGlass DS) in Biliary Diseases: Experience of a Tertiary Care Center

Abed Al Lehibi, Abdullah Al Mtawa, Areej Al Balkhi, Ahmad Al Eid, Adel Al Qutub, Abdullah Al Khathlan, Nawaf Al Otaibi

Gastroenterology Unit, Department of Medicine, King Fahd Medical City, Riyadh, Saudi Arabia

Background: Single-operator cholangioscopy (SOC) was introduced into practice ten years ago to overcome many of the shortcomings of the standard ERCP. Since then, SOC has gained popularity for many diagnostically and therapeutically challenging biliary and pancreatic conditions. Many studies have been published to evaluate its feasibility, usefulness, cost-effectiveness, and safety profile. This paper is a descriptive study in which we aim to share the experience of a single tertiary care center with the newer version of SOC, SpyGlass DS. Methods: We retrospectively reviewed the records of all the patients who went through the procedure in our center from November 2015 - November 2017 to explore the scope of biliary conditions in which SOC was utilized. Technical success was defined by the ability to visualize the lesion and complete the procedure as planned, whereas clinical success was determined by the ability to achieve the desired diagnostic/therapeutic outcome. Results: During the period of interest, 20 patients (9 males) went through 23 cholangioscopy procedures. Sixteen patients failed conventional extraction methods and required the intervention for the treatment of difficult stones, and four patients needed a diagnostic evaluation of biliary strictures. Technical success was achieved in 95.7% (22/23) of the procedures. Regarding clinical success, complete ductal clearance was achieved in 82% of the patients (13/16). Three patients (18%) only had partial removal despite multiple attempts. Holmium laser was the primary modality used to facilitate stone removal during the intervention. Tissue samples were successfully obtained in 100% (4/4) of patients with strictures. Conclusion: The new version of SOC, SpyGlass DS, provides a feasible and an effective option for the management of difficult cholelithiasis, as well as visually evaluating and obtaining histological samples for indeterminate biliary strictures.

 SJG2018/07: Endoscopic Biodegradable Stents for the Management of Leak Post Bariatric Surgery: A Case Series

Abed Al Lehaibi, Areej Al Balkhi, Abdullah AlMtawa, Nawaf Al Otaibi

Gastroenterology Unit, Department of Medicine, King Fahd Medical City, Riyadh, Saudi Arabia

Background and Aims: Postoperative leak is one of the most feared complications after bariatric surgeries. Endoscopic stenting is used to manage leaks by decreasing the GI intraluminal pressure. The main advantage of endoscopic management is providing healing while still allowing for oral nutrition. However, limited literature exists on whether biodegradable stents can be used as an alternative when conventional metallic stents fail. Methods: Our series consists of 4 patients who were found to have a leak as a complication of bariatric surgery. Two patients were initially managed by abdominal/chest drainage and one required TPN. Conventional endoscopic exclusion techniques with fully covered metallic stents were tried and failed in all patients included in this series, thus, biodegradable stents were used as a rescue option. Results: BDS provided immediate improvement for all the patients, and Gastrografin studies were leak-free 2 days after the procedure. All patients were started on oral feeding and discharged home within 5-6 days later. Minimum outpatient follow-up of 8 weeks was achieved with no issues. Follow up endoscopy was done 2-3 months' later in 3 patients and showed completely resorbed stents. The only drawback was the mucosal reaction to the stent in one case, which mandated an attempt for esophageal dilatation. Conclusion: BDSs have the potential to provide a reasonable rescue option to manage post-bariatric surgery leaks in patients who fail conventional endoscopic exclusion methods. However, data from larger studies are needed to collect information on which theoretical advantages/disadvantages of degradable biomaterials apply to real practice.

 SJG2018/08: Utility of Upper GI Endoscopy in the Preoperative Assessment of Patients Going for Bariatric Surgery

AlEid Ahmad, Muhammad Abukhater, Ali Hummedi, Anfal Al Shaie, Areej Al Balkhi, Abdullah AlMtawa, Adel Al Qutub, Mostafa Seleem, Abdullah Khathlan, Khalid Al Sayari, Shameem Ahmad, Tauseef Azhar, Nawaf Al Otaibi, and Abed Al Lehibi

Gastroenterology Unit, Department of Medicine, King Fahd Medical City, Riyadh, Saudi Arabia

Background: Upper GI Endoscopy (UGE) is a routine investigation in the preoperative assessment of bariatric patients at KFMC. The main reason for this step is identifying abnormalities that may change the surgical approach. In this study, we aim to evaluate whether endoscopic findings and H. pylori testing can affect the plan of care in bariatric patients. Methods: We retrospectively reviewed the investigational process of 361 patients planned for bariatric surgery (2014-2016) in our center. The prevalence of H. pylori was then calculated, and patients were categorized in 2 main groups (4 subgroups) based on endoscopic findings. (i) Approach unchanged (A. normal study, and B. abnormal findings that do not change the surgical approach nor postpone surgery). (ii) Approach changed (C. abnormal findings that change the surgical approach, postpone surgery, or D. considered absolute contraindications for surgery). Results: Total of 361 patients, 44% males. (1) Age range: 15-66. (2) Mean age ± SD: 37 years ± 11. (3) Mean BMI ± SD: 48.3 ± 10. The results are summarized in [Table 1] and [Table 2]. Conclusion: UGE can identify a variety of pathological abnormalities prior to bariatric surgery. Since 25% of patients in our study had a change in the surgical approach or a delay in surgery, we suggest that UGE should continue to be the standard of care in all patients undergoing bariatric surgery.{Table 1}{Table 2}

 SJG2018/09: A Multi-country, Cross-sectional Study to Determine Patient-specific and General Beliefs towards Medication and Their Treatment Adherence to Selected Systemic Therapies in Chronic Immune-mediated Inflammatory Diseases: Results of the Lebanese and Saudi Arabian Subpopulation

Abdulaziz Al Quorain, Alfred Ammoury1, Sami M. Bahlas2, Iqbal Bukhari3, Jad Okais4, Ala I. Sharara5, Mireille A. Hobeika6, Ali H. Amer7

Department of Internal Medicine, King Fahd Hospital of the University, Al Khobar, 2Department of Internal Medicine, King Abdulaziz University, Jeddah, 3Department of Dermatology, College of Medicine, Imam Abdul Rahman Bin Faisal University, King Fahd Hospital of University, Dammam, Saudi Arabia, 1Division of Dermatology, St. George Hospital University Hospital Center, 5Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon, 4Division of Rheumatology, St. Joseph University, Philadelphia, Pennsylvania, USA, 6AbbVie Levant, Lebanon, 7AbbVie, Saudi Arabia

 SJG2018/10: Are Saudis Genetically Susceptible to Develop Celiac Disease?

Abdulrahman Al-Hussaini, Hanan Alharthi, Awad Osman, Nezar Eltayeb-Elsheikh, Aziz Chentoufi

Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Objective: To determine the frequency of celiac disease (CD)-predisposing human leukocyte antigen (HLA)-DQ genotypes in the Saudi population, where the prevalence of CD is 1.5% as recently reported in a mass screening study. Methods: In a cross-sectional population-based study, a total of 192 randomly selected healthy school children (97 females, mean age 10.5 ± 2.2 years, all negative for tissue transglutaminase-IgA) were typed for DQA1 and DQB1 genes by polymerase chain reaction sequence specific oligonucleotide probes. Results: Of the 192 children, 52.7% carried the high-risk CD-associated HLA-DQ molecules: homozygous DQ2.5 (2.6%), DQ2.5/DQ2.2 (4.7%), heterozygous DQ2.5 (28.15%), homozygous DQ8 (4.2%), DQ8/DQ2.2 (3.6%), and double dose DQ2.2 (9.4%). Low-risk CD-associated HLA-DQ molecules (single dose DQ2.2 and heterozygous DQ8) constituted 3.6% and 9.4%, respectively. Among the very low risk group, individuals lacking alleles that contribute to DQ2/DQ8 variants (33.5%), 13.5% carried only one of the alleles of the high-risk HLA-DQ2.5 heterodimer called “half-heterodimer” (HLA-DQA1*05 in 12% and HLA-DQB1*02 in 1.5%), and 20.8% lacked all the susceptible alleles (DQX.x). Gender distribution was not significantly different between the CD-risk groups. Conclusion: We are dealing with one of the highest frequencies of CD-predisposing HLA-DQ genotypes among healthy general populations (52.7%) worldwide, which might partly explain the high prevalence of CD in the Saudi community.

 SJG2018/11: Association of Irritable Bowel Syndrome with Overnight Shifts among Physicians and Interns in Jeddah: A Cross-sectional Study

Alanoud Ali Alhamed, Afraa Aljahdali, Halima Saleh1, Nahlah Saati2, Rawan Alsaadi, Salma Abdulsalam3

Ibn Sina National College for Medical Studies, 1Saudi German Hospital, 2Ministry of Health, 3Al Batarji Medical College, Jeddah, Saudi Arabia

Background: Irritable bowel syndrome was found to be influenced by stressful careers. Studies on physicians indicated that working in outpatient clinics, having day shifts, poor quality of sleep, and high level of anxiety and depression were significantly associated with IBS. Objectives: This study aimed to assess the prevalence of IBS among physicians and interns, and its relation to overnight calls in Jeddah, Saudi Arabia. Methods: 260 physicians and interns in Jeddah at king Fahad hospital, maternity and children hospital, king Abdul-Aziz hospital Saudi Arabia were surveyed. Females constituted (60%) of participants. About (83.5%) were Saudis and (47.7%) were married. Participants filled questionnaires anonymously. following an informed consent. Questionnaires included their parts: part 1: contains seven demographic questions: part 2: includes questions about sleeping hours, on-call sleeping hours, over-night shift frequency. Part3: is composed of 11 questions of the Birmingham IBS Symptoms questionnaire, where each question has a range of five answers. Results: There was significant relation between IBS and its subscales and sleep hours during overnight shift (p < 0.001). IBS and its subscales were not statistically significant with usual sleeping hours/day, nor frequency of overnight shift frequency/month. Gender and marital status were no significant related to IBS total score. However, IBS score was significantly higher among Saudis (p = 0.015). Consultant had lower IBS score than intern (p = 0.038), residents (p = 0.015), and specialist (p = 0.031). Also, Non-surgical specialty had lower IBS score sonically than surgical specialty's (p = 0.014). Further, IBS score was found to be significantly different by hospital (p < 0.001). Conclusion: Lack of sleep during overnight shifts seems to increase IBS symptoms for physicians and interns. Surgeons, gynecologists, Saudi physicians were found to be at risk for more IBS symptoms more, whereas consultant were found to be the least affected by IBS symptoms. Score of IBS varies depending on the physician's hospital.

 SJG2018/12: Bile Acid Synthesis Disorders in Arabs: A 10-Year Prospective Screening Study

Abdulrahman Al-Hussaini, Kenneth D. R. Setchell, Bader Al Saleem, James E. Heubi, Khurram Lone, Anne Davit-Spraul, Emmanuel Jacquemin

Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Objectives: Early diagnosis of bile acid synthesis disorders (BASD) is important because, untreated, these conditions can be fatal. Our objectives were to screen children with cholestasis or unexplained liver disease and in those with confirmed BASD to evaluate the effectiveness of cholic acid therapy. Methods: A routine serum total bile acid measurement was performed on children with cholestasis, liver cirrhosis, and liver failure. Patients were screened for BASD by fast atom bombardment ionization-mass spectrometry (FAB-MS) analysis of urine, and molecular analysis confirmed diagnosis. Treatment response to oral cholic acid (10-15 mg/kg bw/day) was assessed from serum liver function tests and fat-soluble vitamin levels. FAB-MS analysis of urine was used to monitor compliance and biochemical response. Results: Between 2007 and 2016, 626 patients were evaluated; 450 with infantile cholestasis. Fifteen cases of BASD were diagnosed: twelve presented with infantile cholestasis (2.7%), an 8-year old boy presented with cirrhosis, and two 18-month old boys presented with hepatomegaly and rickets. Eleven were caused by 3ß-hydroxy-Δ5-C27-steroid oxidoreductase deficiency, three from Δ4-3-oxosteroid 5ß-reductase deficiency, and one had Zellweger syndrome. In all but one, serum total bile acids were normal or low. With cholic acid therapy, 10 are alive and healthy with their native liver. Liver failure developed in 3 infants despite initiation of therapy; 2 died, and one underwent liver transplantation. Conclusion: BASD are rare but treatable causes of metabolic liver disease in Saudi Arabia. Screening for BASD should be considered in all infants with cholestasis and normal/low normal serum total bile acid concentrations.

 SJG2018/13: HLA-DQ Relative Risks for Celiac Disease in the Saudi Population

Abdulrahman Al-Hussaini, Hanan Alharthi, Awad Osman, Nezar Eltayeb-Elsheikh, Maram Alshahrani, Ibrahim Sandogji, Aziz Chentoufi

Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Background: Recently, it has become apparent that the prevalence of celiac disease (CD) in Saudi Arabia (1.5%) is greater than that found in most of the European countries (1%). However, it is not clear what degree of risk is conferred by the HLA-DQ genotypes in the Arab ethnic population of Saudi Arabia as compared to Caucasians. In this study, we sought to establish a CD-risk gradient associated with HLA-DQ genotypes. In addition, the design of our study allowed us to compare HLA-DQ genotypes between symptomatic CD patients and CD children diagnosed during a recent mass screening study. Patients and Methods: We recruited three groups: group I, 46 CD children diagnosed consecutively over the past 10 years; group II, 192 healthy controls matched with group I for sex, age and geographic origin; group III: 55 CD children diagnosed during the mass screening among schoolchildren. All of the participants were typed for DQA1 and DQB1 genes by polymerase chain reaction sequence specific oligonucleotide probes. Results: We have identified 5 groups of CD-risk gradient: 1) very high risk associated with DQ2.5/DQ8 genotype [Odds ratio (OR) = 69, P-value < 0.001]; 2) high risk associated with homozygous DQ2.5 and DQ2.5/DQ2.2 genotypes [OR = 4.56, P-value = 0.012; OR=4.28, P-value = 0.003, respectively]; 3) intermediate-risk associated with DQ8/DQ2.2 (OR = 2.5), heterozygous DQ2.5 (OR = 1.8), and homozygous DQ8 (OR = 1.6); 4) low risk associated with homozygous DQ2.2 (OR = 0.3), heterozygous DQ2.2 (OR = 0.11), and heterozygous DQ8 (OR = 0.11), and 5) very low risk associated with DQX.5 (OR = 0.08) and DQX.x (OR = 0.04). Comparing the groups I and III, we found a significant increase of heterozygous DQ8 in group III (2.2% versus 12.7%, respectively; p-value = 0.045). Only silent celiac case in group III carried DQX.x but none in group I. Conclusion: The highest risk to develop CD in Saudi Arabia is associated with DQ2.5/DQ8 genotype followed by homozygous DQ2.5 and DQ2.5/DQ2.2 genotypes. Heterozygous DQ8 genotype is associated with intermediate risk for development of screening-identified CD but very low risk for development of symptomatic CD.

 SJG2018/14: Cirrhotic Autoimmune Hepatitis, Clinical Features and Outcome of Treatment

Ali Albenmousa, M. Qadri, Khalid Bzeizi, Naser Almasri, A. Madani, Abdulrahman Aljumaah

Division of Hepatology, Department of Gastroenterology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Background: Autoimmune hepatitis (AIH) is a chronic liver disease with wide spectrum of clinical presentation. It is often asymptomatic but may present with non specific symptoms or symptoms related to liver dysfunction. Cirrhosis can be found in 30 to 40% of AIH cases at time of diagnosis and may predict worse prognosis with higher mortality and increased requirement for liver transplantation. Aims: To report the clinical features and outcome of treatment in AIH patients with cirrhosis in a single tertiary centre in Saudi Arabia. Patients and Methods: We retrospectively reviewed the charts of AIH patients who were diagnosed during the period from Jan 1998 till April 2017. The cases were retrieved from hepatology database in Prince Sultan Military Medical city. Diagnosis was made based on revised international AIH scoring system. Cases with definite AIH and probable AIH with good response to treatment were included. Cirrhosis was diagnosed based on liver biopsy, fibroscan or radiological evidence of cirrhosis with clinical features of portal hypertension. Patients with chronic viral hepatitis, metabolic liver disease or hepatic malignancies other than hepatocellular carcinoma were excluded. Analysis was performed with SPSS version 17. Results: Over the study period, 148 patients were diagnosed as AIH and were divided in two groups. Group A included patients with AIH without cirrhosis (N = 74) and group B included AIH patients with cirrhosis (N = 74). Mean age was 35.8 ± 15.3and 41.5 ± 18.5 years in group A and B respectively (p = 0.046). There was no gender difference between groups (57 and 54% in group A and B were females, p = 0.741). Over a median follow up of 57.5 months, 9 patient (12.2%) died in group B compared to 1 patient (1.4%) in group A (p=0.009) while death or liver transplant occurred in 15 patients (20.3%) in group B vs 2 patients (2.7%) in group A (p = 0.001). Fifty one patients (68.9%) in group B presented with symptoms and signs related to complication of cirrhosis while 23 patients (31.1%) presented with abnormal LFT and were found to have cirrhosis histologically or radiologically. Majority of patients had abnormal LFT documented years prior to diagnosis. Group B patients had lower ALT (p = 0.002) lower albumin (p = 0.007), higher IgG (p = 0.036) and lower platelet (p = 0.001) than group A. There was no difference in frequency of positive ANA, ASMA and other less common autoimmune markers. Conclusion: Cirrhosis is a frequent finding in AIH patients at time of diagnosis. It is associated with higher mortality and requirement for liver transplantation. More vigilant assessment of patients with elevated liver enzymes may help in earlier diagnosis and subsequently prevention of cirrhosis and its complication.

 SJG2018/15: Mass Screening for Celiac Disease among School-aged Children: Toward Exploring Celiac Iceberg in Saudi Arabia

Abdulrahman Al-Hussaini, Riccardo Troncone, Musa Khormi, Muath Al Turaiki, Wahid Alkhamis, Mona Alrajhi, Thana Halal, Mosa Fagih, Sahar Alharbi, Muhammed Salman Bashir, Aziz Elchentoufi

Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Objectives: We conducted this mass screening study to determine the prevalence of celiac disease (CD) and characterize the celiac iceberg among Saudi pediatric population in Riyadh, the capital city of Saudi Arabia. Patients and Methods: Over the study period (January 2014 to June 2016), we have conducted a cross-sectional, mass screening, IgA-tissue transglutaminase (TTG-IgA)-based study on 7930 Saudi students from primary and intermediate schools in Riyadh. Students with positive TTG-IgA (> 20 U/L) were called in the hospital to undergo a repeat of TTG-IgA; in those with borderline positive TTG-IgA (20 – 60 U/L) IgA-endomyseal antibody (EMA-IgA) test was performed. Children with TTG-IgA > 60 U/L and children with borderline positive TTG-IgA and positive EMA-IgA were advised to undergo upper endoscopy and intestinal biopsies. Results: We identified 221 students with positive TTG-IgA (2.8%). Celiac disease was diagnosed in 119 cases (1.5%, 1:67 Saudi children) [Mean age 11.5 ± 2.62 years; females 81 (68%)]. Another 51 children had persistently borderline positive TTG-IgA but negative EMA (0.64%) and the remaining 51 had transiently positive TTG-IgA. We have identified three clinical patterns in the screening-identified celiac cases: 1) a silent form (37%), 2) a mild symptomatic form characterized by gastrointestinal symptoms in presence of normal growth or overweight/obesity (48%), and 3) gastrointestinal symptoms associated with impaired growth in 15%. Conclusion: Our study provided evidence of a high prevalence of CD among Saudi children (1.5%); a rate that is at least twice the average prevalence rate in Europe and North America.

 SJG2018/16: Impact of Diabetes Mellitus on Clinical Outcomes in Chronic Hepatitis B Virus Hepatitis Patients

Ali Albenmousa, T. Almutary, M. Qadri, Naser Masri, Khalid Bzeizi

Division of Hepatology, Department of Gastroenterology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Background: Chronic hepatitis B virus (HBV) infection is a common health problem worldwide. It is associated with development of cirrhosis, liver failure and hepatocellular carcinoma (HCC) with subsequent increase in morbidity and mortality. Coexistence of diabetes mellitus (DM) was found in some international studies to increase liver related mortality and morbidity in patients with chronic HBV infection however no similar reports from our region. Aims: To assess the impact of DM on liver related clinical outcomes in patients with chronic hepatitis secondary to HBV infection. Patients and Methods: In this retrospective cohort study we included patients with chronic HBV hepatitis (both eAg positive and eAg negative) based on EASL 2017 criteria. Cases were retrieved from hepatology database in Prince Sultan Military Medical City (PSMMC) during the period between January 1998 and December 2016. Patients were considered diabetic if they were already diagnosed in other medical clinics and started on treatment or otherwise based on American Diabetes Association definition of DM. Cirrhosis was diagnosed histologically, by fibroscan or radiologically in the presence of compatible clinical features of portal hypertension. Hepatocelluar carcimona was diagnosed based on typical radiological features on CT scan or MRI or histologically if the radiological findings were not conclusive. Analysis was performed with SPSS version 17. Results: A total of 667 patients were included in the analysis. The mean age of the whole cohort was 52.4 ± 14.9 years and 72.4% were males. Patient were divided into two groups, group A included patient with DM (N = 189, 28.3%) and group B included patients without DM (N = 478, 71.7%). The Mean age was 49.1 ± 14.8 and 60.5 ± 11.6 years in group A and B respectively (p < 0.000) and there was no gender difference between the groups ( 29.6 vs 26.8%, p = 0.458). Cirrhosis was diagnosed in 33.3% of patients and HCC in 15.5% over a median follow up of 34 months. Overall mortality rate was 9%. Group A patients were more likely to develop cirrhosis (49.7 vs 26.8%, OR = 2.7, p < 0.000), HCC (19.4 vs 13.9%, OR = 1.5, p = 0.082) and to have liver related mortality (15.9% vs 6.7%, OR = 2.8, p < 0.000). On multiple logistic regression, Age (p < 0.000), DM (OR = 2.7, p = 0.017) and high total bilirubin (p = 0.001) were found to be predictors of cirrhosis while HCC was the only statistically significant predictor of mortality (OR = 5.1, p = 0.017). Conclusions: In patients with chronic HBV hepatitis, coexistence of DM increases the risk of cirrhosis and mortality in these patients with a trend toward increase in incidence of HCC. The design of the study could not assess the impact of diabetes control on incidence of these complications and therefore large clinical trials are needed to confirm this effect.

 SJG2018/17: Everloimus Postliver Trasplantation: A Systematic Review

Khalid I. Bzeizi, Richard Smith1, Faisal Aba-Alkhail2, Ali Albenmousa, Rajiv Jalan3, Dieter Broering2

Prince Sultan Medical Military City, 2King Faisal Specialist Hospital, Riyadh, Saudi Arabia, 1Ipswich Hospital Trust, Ipswich, 3UCL Medical School, London, United Kingdom

Background: Calcineurin inhibitors (CnIs) have played a major role in improving both graft and patient survival post liver transplantation. The risk of nephrotoxicity with CnIs has been a concern and Everolimus (EVR) offers alternative immunosuppressive strategies used alone or in combination with reduced dose CnIs post transplantation. Objective: To determine the efficacy and safety of EVR, alone or in combination with reduced dose CnI, as compared to CnI therapy for immunosuppression of de novo liver transplant patients. Methods: We searched MEDLINE, Scopus and the Cochrane Library up to 10th August 2016 for randomized controlled trials (RCTs) comparing EVR and CnI based regimens for immunosuppression of de novo liver transplant patients. Assessment of studies and data extraction was undertaken independently. Results: Eight studies were selected describing 769 patients. Cockcroft-Gault GFR (CG-GFR) was significantly higher at one (p = 0.05), three and five years (p = 0.030) in patients receiving EVR as compared to those receiving CnI therapy. The composite end point of efficacy failure was similar between the two arms after 1, 3 and 5 years of study. A higher number of patients discontinued EVR due to adverse effects in one year, however no difference was noted after 3 and 5 years. A higher rates of proteinuria, peripheral edema and incisional hernia were noted in patients on EVR. The H2304 study compared the efficacy of EVR and reduced tacrolimus (EVR + RTAC) with standard CnI therapy demonstrating non-inferiority of EVR + RTAC after one-year with a favorable response (composite efficacy failure) after 36 months (p = 0.334). Conclusion: The analysis confirms non-inferiority for EVR as primary immunosuppression in de novo liver transplant recipients compared to standard CnI therapy. Everolimus therapy was associated with significantly less renal dysfunction but with a higher rate of discontinuation due to adverse effects.

 SJG2018/18: Status of Vitamins and Minerals in Children with Screening-Identified Celiac Disease: A Case-Control Study

Abdulrahman A. Al-Hussaini, Salman Bashir

Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Background: Malabsorption and micronutrients deficiencies characterize classical “late diagnosed” celiac disease (CD). This study aimed to identify the prevalence of vitamin and mineral deficiencies among children with “early diagnosed” screening-identified CD in comparison to healthy controls to determine whether there is any clinical value in routine testing for deficiencies in those patients. Materials and Methods: A cross-sectional, case-control study was conducted on patients with screening-identified CD diagnosed during a mass screening study [2014 to 2016] (100 patients, 79 females, mean age 11.4 ± 2.7 years) and age and gender-matched healthy controls (100 children, 81 females, mean age 10.8 ± 2.5 years). The controls were randomly selected from those who were negative for CD serological screening. Hemoglobin, serum levels of iron, ferritin, folate, vitamin B12, vitamin A, vitamin E, 25-OH vitamin D, zinc, and selenium were measured. Results: Mean hemoglobin and serum iron level were significantly lower in CD patients as compared to healthy controls [Hemoglobin 12.56 gm/dl versus 13.07 gm/dl (P = 0.024); Iron 10.61 μmol/L versus 13 μmol/L (P = 0.009), respectively]. The serum levels of vitamins and trace elements were similar between the 2 groups. There was significant negative correlation between levels of hemoglobin, iron, and ferritin at diagnosis and serum TTG-IgA titers. There was significant positive correlation between levels of hemoglobin, iron, and ferritin at diagnosis and the degree of villous atrophy. Conclusion: Iron deficiency is the earliest micronutrients deficiency to develop in screening-identified CD cases; the level of serum iron is correlated with the TTG-IgA titer and degree of villous atrophy.

 SJG2018/19: Effect of Bariatric Surgery on Patients with Fatty Liver Disease and Type II Diabetes Mellitus

Mazen Hassanain, Nadia Aljomah, Hisham Alkhaldi1, Fahad Bamehriz, Maram Alkhamash2, Faisal Alsaif, Abdulsalam Alsharbi, Ahmed Madkhali

Departments of Surgery and 1Pathology, 3Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Aim: To study the effect of sleeve gastrectomy in patients with type II diabetes mellitus and fatty liver disease. Methods: We obtained prospectively collected data from participants of two ongoing longitudinal cohort studies at our institution. We included adult patients with a Body mass index of >30 kg/m2, who underwent sleeve gastrectomy for the treatment of morbid obesity. Non-Alcoholic fatty liver disease was diagnosed using ultrasound and tissue biopsy. Diabetes was diagnosed using Hemoglobin A1c and fasting blood glucose levels. Results: Our population included 16 men and 16 women (mean age, 39.5 years; range, 38-46). The preoperative and postoperative median BMIs were 42.1 (range, 37.55-47.5) and 34.2 (range, 29.4-36.7) kg/m2 (P = 0.0003). The macrovascular steatosis percentage pre- and postoperatively was 37.5 and 10, respectively (P = 0.0328). The patients who had complete DM remission postoperatively had a higher median BMI of 42.05 (range, 36.7-45.7) kg/m2 preoperatively and 35.7 (range, 30.6-36.7) kg/m2 postoperatively. Than the patients who did not have remission [38 (range, 35.8-53.9) kg/m2 before surgery and 31.8 (range, 28.5-41.9) kg/m2 after surgery; P = 0.0003]. Regarding the age groups, 12 out of 18 (46.1%) patients were aged <40 years at DM onset, and 9 out of 14 (34.6%) were aged >40 years who had complete diabetes remission postoperatively, which was not statistically significant. Conclusion: DM remission was statistically significant after surgery. Remission occurred more in the higher BMI groups. There was no clear relationship between NAFLD and diabetes remission.

 SJG2018/20: Outcome of Heptitis C Treatments with Variuos Type of New Oral Medications in Different Categories of Saudi Patients, Single Center Experience

A. Al Akwaa, M. El Sadig, A. Al Shoaibi, A. Al Abdullatif

Gastroenterology Division, Department of Medicine, King Abdulaziz Hospital, Al Hasa, Saudi Arabia

The new oral hepatitis C treatments are very effective with responses range from over 90% to 100%. The medications are well tolerated and became readily available nowadays. Aim: To assess the response to various HCV anti-viral therapies in different categories of patients. Methods: We retrospectively looked at the electronic files of all patients treated. Demographic data, comorbid conditions, previous treatments, labs, imaging, type of medications, response at 1 month, end of treatment, 3 months and side effects were recorded. SVR defined as undetected RNA after 3 months. Results: 44 patients were included. Seven patients excluded because of deficient data. Thirty-seven were analyzed DM, hypertension, and chronic kidney disease present in 47%, 52% and 22 % respectively. Cirrhosis 25%. Three patients on hemodialysis. Three failed previous therapy. Females represented 70%. Mean age 60 range 29-78 years. Genotypes 4 in 70%, 1 and 2 were in 14% each. 50% had high viral load. Most patients 70% have been treated with Harvoni or Viekirax with or without Ribavirin. Other medications and combinations have been used where indicated. Two patients treated with generic medications. Undected RNA at 1 month, end of treatment has been 15%, 81% respectively. SVR was 97%. One patient could not tolerate the treatment. SVR was 100% in those completed the courses. Both patients received generic medications had SVR. Conclusion: High response rate in Saudi patients treated with various oral medications. The response was universal regardless of age, comorbidities, previously failed treatment or stages of liver disease.

 SJG2018/21: Prevalance of Helicobacter pylori Resistance among Certain Antibiotics (Amoxicillin, Metronidazole, Clarithromycin, Ciprofloxacin, Levofloxacin, Moxofloxacin and Cefotaxime) at An-Najah National University Hospital

Qusay Abdoh, Lubna Kharraz, Khubaib Ayoub, Aysha Sbeah, Safaa Turman

Faculty of Medicine, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine

Background: The frequency of resistance to antibiotics in H. pylori isolates is increasing and In Palestine, there are limited data regarding the pattern of H. pylori antibiotic resistance. Methods: During 3 months, forty three dyspeptic patients include 22 males and 21 females were subjected to esophageal gastroduodenoscopy and gastric biopsy, the biopsies were taken from Antrum and body while making the endoscopic diagnosis of the patient, The biopsies were applied for microbiological analysis which includes: rapid urease test and histological examination for detecting H. pylori, and bacterial culture using selective media, after culturing for 7 days of incubation, oxidase, urease and catalase tests were done. The positive cultures of H. pylori were applied for studying their susceptibility to various antimicrobial agents which took another 7 days of incubation. Results: The sensitivity test against (7) antibiotic agents, results showed that Ciprofloxacin was the most effective agent, then Levofloxacin then Moxifloxacin then Amoxicillin, were as Metronidazole, Clarithromycin and Cefotaxime were the least effective agents with resistance percentage of (100%) , (50%) and (17%) respectively. Conclusion: Quinolones have the least resistance against H. pylori infection in Iraqi patients.

 SJG2018/22: To Evaluate the Clinical Response of Sofosbuvir (Generic, Searle) Treatment Regime in Pakistani Patients with Chronic Hepatitis C in Real Practice

Tayyab Ghayas Un Nabi, Akhtar Shakil, Malik Sadiq Hussain, Ather Mumtaz, Hassan Nazeer U, Mehmood Tariq, Pasha Burhan, Ikram Yousif, Latif Amir, Sherazi Irfan, Sarfraz Muhammad, Ahmed Shahab, Latif Muhammad, Toor Ul Haq Israr, Nasir Bilal, Mehmood Asif, Baig Mirza Ilyas, Nisar Sajid, Saleem Inamullah, Ahmed Mukhtar, Hafeez Muhammad Shahzad, Mirza Shakeel, Tarmizi Ikram, Naeem Abdul, Salamat Amjad, Adnan Mohammad, Mohammad Riaz, Iltaf Mohammad, Ali Yasir

Clinical Research and Pharmacovigilance, The Searle Company Limited (TSCL), Karachi, Pakistan

Background: In Pakistan, prevalence rate of hepatitis C is the second highest ranging from 4.5% to 8%. Globally, Interferon-free direct-acting antiviral therapy has revolutionized treatment for chronic hepatitis C. However, due to the slow regulatory process of DAAs registration in Pakistan and against the current AASLD/IDSA Hepatitis C Guidance, the Sofosbuvir/Ribavirin combination is the registered treatment therapy. This Post-Marketing Observational Studies (PMOS) conducting across 30 sites at 10 major cities of Pakistan starts from Jan 2017, evaluating the safety and efficacy of Sofosbuvir (Searle, Pakistan) plus ribavirin (generic, Searle, Pakistan) therapy among treatment-naïve Pakistani patients with chronic genotype 3 HCV infection. The study data reflecting the demographic local population safety and effectiveness of Sofosbuvir combination regime. The study abstract sharing the week four (4) interim analysis results. Methods: In the HOME (Hepatitis Observational Management Envision) study as per study inclusion/exclusion criteria, 244 GT-3 HCV infected naïve Pakistani patients, non-cirrhotic received SOF (generic) 400mg with Ribavirin (generic, Searle) daily for 24 weeks. The study assess the overall safety, Raid Virological Response (week 4) and Sustained Virological Response at week 24 (SVR). Results: In the HOME program, out of 244 patients, 121 (49.59%) females while 123(50.40%) were males with Mean Age of 43.16 ± 11.21 (S.D). Province wise RVR data are reported in the [Table 1]. It was observed that treatment was well tolerated among infected patients. Conclusion: In this pooled analysis, the tablet regimen of SOF/RIB for 4 weeks provided high rates of RVR and is a safe, well-tolerated option for HCV patients.{Table 3}

 SJG2018/23: Histological Predictors of Mortality in Patients with Ischemic Colitis

Marwan Albeshri, Rana Bokhari1, Haneen Alabsi, Marwa Alqathmi, Waad Alluhaibi, Yara Fayoumi, Y. Qari2, E. Aljahdli2, M. Alsahafi2, H. Jawa2, Mahmoud Mosli2

College of Medicine, King Abdulaziz University, Departments of 1Pathology and 2Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Background and Aims: Ischemic colitis (IC) is a vascular disease of the large bowel that can lead to death. Diagnosis can be challenging and histopathological examination is often needed for confirmation. The etiology of IC is multifactorial and management varies depending on disease severity. Our aim is to identify histological findings that can predict mortality in patients with IC. Methods: We conducted a retrospective study involving all adult patients identified at King Abdulaziz University Hospitals' (KAUH) electronic medical records to have histolgically confirmed IC. Demographic and clinical data were collected and histology reports were reviewed. Reported histological findings were extracted. Linear and logistic regression analysis were used to examine associations and stepwise model selection to build a model that best predicted mortality due to IC. Results: Our final analysis included 31 patients of which 17 (55%) were males and the mean age was 59 (+-19) years. Both diabetes (p = 0.007) and hypertension (p = 0.002) were significantly associated with mortality. Two patients (6.5%) had previous episodes of IC and 18/31(58%) of patients died. The most commonly involved segment of the colon was the rectosigmoid area (25.8%) followed by the cecum (22.6%). The final model identified by stepwise regression to predict mortality included: transmural infarction (p = 0.118), serosal fibrosis (p = 0.002), pericolic fat necrosis (p = 0.013, mucosal ulceration (p =0.08), mucosal sloughing (p = 0.004), sloughing of the surface epithelium (p= 0.001), chronic inflammation (p = 0.068), congested blood vessels (p=0.030), submucosal fibrosis (p = 0.005), acute inflammatory cells (p = 0.030), and serosal congestion (p = 0.004). Conclusion: IC can lead to mortality in a significant proportion of patients. Multiple histological findings can be used to predict mortality in IC patients but future studies are needed to further validate these findings.

 SJG2018/24: Anxiety and Depression among Patients with Inflammatory Bowel Disease: A Cross-Sectional Comparison with Healthy Individuals

M. H. Mosli, M. Alshamakh, A. Nazzal, O. Idris, M. Zeinelabidin, H. Mohammed, M. Bakhaidar, E. Aljahdli, H. Jawa, Y. Qari

Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Background and Aims: Mood disorders such as depression and anxiety can lead to significant morbidity when associated with chronic illnesses. We aimed to examine the association between anxiety and depression with inflammatory bowel disease (IBD) in comparison to normal healthy individuals and identify clinical and demographic predictors. Patients and Methods: We performed a cross sectional survey involving adult patients diagnosed with IBD (Crohn's disease (CD) or ulcerative colitis (UC)) based on typical clinical criteria. A randomly selected cohort of healthy individuals was recruited to serve as controls. Demographics, clinical and endoscopic data were ascertained. All participants completed an Arabic translated form of the Hospital anxiety and depression (HAD) scale, which is a 14 – item Questionnaire. Depression was defined as a depression subscore >7 and anxiety as an anxiety subscore >7. Mean scores were then compared statistically using student t-test and frequencies using Chi Square. Stepwise model selection through regression analysis was then used to identify predictors of total scores. Results: A total of 244 participants were included (233 controls, 44 CD, and 12 UC). Mean age was 27.8 (+-0.5) and 77% were males. 68% were singles and 74% were Saudi citizens. The mean duration of disease among patients with IBD was 13.3 (+-7.9) months for CD and 15.3 (+-7.9) for UC. Of the patients with IBD, 11/45 (24%) were on steroids, 6/45 (13.3%) underwent bowel surgery and 15/45 (33.3%) reported having perianal disease. Mean depression (6.4+-2.9 vs. 4.9+-3.4, p = 0.003) and mean anxiety scores were higher in cases compared to controls. Model selection identified gender (p < 0.001), disease duration (p = 0.004), duration of symptoms (p=0.009), marital status (p = 0.06), and steroid use (p = 0.05) as predictors of depression scores; and gender (p = 0.021), disease duration (p = 0.002), duration of symptoms (p=0.003), marital status (p < 0.001), and Azathioprine use (p = 0.025) as predictors of anxiety scores. Conclusions: Patients with IBD demonstrate higher depression and anxiety scores compared to healthy individuals. Furthermore, depression and anxiety scores are associated with several demographic and clinical factors.

 SJG2018/25: Predictors of Reduced Bone Density in Children and Adolescent Patients with Crohn's Disease

Omar Saadah, Mahmoud Mosli1

Departments of Paediatrics and 1Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

Background and Aims: There is a clear association between Crohn's disease (CD) and reduced bone density based on recent literature. We aimed to identify clinical predictors of reduced bone density based on bone mineral absorptiometry (DEXA) scans in children and adolescents with CD. Patients and Methods: We performed a retrospective analysis of all patients diagnosed with CD at King Abdulaziz University (KAU) hospital. Demographics, disease characteristics, history of surgical resections, laboratory results and prescribed medications were reviewed. Stepwise model selection regression analysis was used to identify predictors of DEXA scan based T scores. Results: Sixty-four patients were enrolled. Mean age was 17.4 (+-4.9) years. Fifty five percent were males and 15.6% reported family history of inflammatory bowel disease. The commonest pattern of involvement was ileo-colonic disease in 56% and 64% of cases were consistent with inflammatory phenotype. Average body mass index (BMI) was 17.8 (+-7.7) and 27% had history of perianal involvement. Extra-intestinal manifestations (EIMs) of CD were reported in 78% of patients. Eighty eight percent of patients received corticosteroid treatment and 45% biologics during follow up. Model selection identified age (P = 0.001), gender (P = 0.014), presence of fistulas (P = 0.162), and presence of perianal disease (0.073) as the final model to predict T scores on DEXA scanning. Conclusions: age and fistulizing disease appear to significantly predict metabolic bone disease in pediatric CD patients. Careful attention to this subpopulation might help reduce the risk of OP related complications.

 SJG2018/26: Predicting Long-Term Outcome of Ulcerative Colitis Using a Validated Histologic Index of Severity

M. Mosli, R. Bokhari, A. Noor, B. Alnahdi, M. Aldomyati, Y. Qari, E. Aljahdli, M. Alsahafi, H. Jawa

Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Background: Histologic grading of severity has become an important evaluative method for ulcerative colitis (UC) early drug development clinical trials. However, its use to prognosticate patient outcome in clinical practice has not been properly validated. We therefore aimed to validate the recently developed Robarts Histological Index (RHI) of severity as a predictive outcome measure for UC through a retrospective cohort of patients. Methods: A single gastroenterology pathologist examined and scored all baseline histopathology slides of patients with confirmed UC using the Robarts Histopathology Index (RHI) of severity. Colectomy, hospitalization and colorectal cancer (CRC) occurrence within 5 years of diagnosis were considered major outcomes. Results: 97 patients with UC were identified, 24 patients were excluded due to incomplete data or misdiagnosis; 52 patients had the most complete follow up data. Average age was 29.9 (+-15.7) and average duration of follow up was 13.7 months (+-10.4). Sixty percent of patients were males and 23.5% smokers. Mean baseline RHI score was 19.5 (+-7.9) and 11.8% reported a family history of inflammatory bowel disease. 7/52 (13.5%), 27/52 (50%), and 4/52 (7.7%) underwent colectomy, required hospitalization and developed CRC during follow up, respectively. Stepwise model selection, identified baseline RHI score (p = 0.019), gender (p = 0.039), age (p = 0.002), and infliximab use (p = <0.001) as significant predictors of colectomy; smoking (p = 0.002), and age (p = 0.046) as significant predictors of hospitalization; and baseline RHI score (p = <0.001), age (p = <0.001), and infliximab use (p = <0.001) as significant predictors of CRC. Conclusions: While a larger prospectively conducted study is needed to validate the RHI as a prognostic tool for UC; baseline histologic disease activity according to RHI appears to significantly predict colectomy and development of CRC within 5 years of diagnosis with UC.

 SJG2018/27: The Diagnostic Yield of Urgent Colonoscopy in Acute Lower Gastrointestinal Bleeding

M. Mosli, A. Aldabbagh1, H. Aseeri, S. Alqsyer, E. Aljahdali, H. Jawa, M. Alsahafi, Y. Qari

Department of Medicine, King Abdulaziz University, 1Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

Background and Aims: Lower gastrointestinal bleeding (LGIB) can lead to serious morbidity and mortality. However, the majority of patients with LGIB improve without intervention and therefore the benefit of performing early colonoscopy for LGIB is unclear. Accordingly, we aimed to assess the diagnostic yield of urgent versus delayed colonoscopy in detecting colonic sources of acute LGIB. Patients and Methods: We conducted a retrospective study involving all adult patients that underwent inpatient colonoscopy for acute LGIB at King Abdulaziz University Hospital between January 2011 and December 2017. Patients were categorized based on the timing of colonoscopy into urgent (within 24 hours of presentation) and delayed (After 24 hours of presentation). The main primary outcome was success in identifying a source of bleeding. Secondary outcomes included need for a second colonoscopy, emergency colectomy and 30-day mortality. Frequencies were compared using chi-square and predictors of outcomes were studied using logistic regression analysis. Risk ratios (RR), Odds ratio (OR) and 95% confidence intervals (CI) were reported. Results: A total of 183 patients were identified. Mean age was 51.7 years (+-17.9) and 85% of patients presented with fresh blood per rectum. 79% underwent colonoscopy after receiving bowel preparation. 55.4% of procedures were performed within 24 hours of presentation and 16% were aborted due to inability to visualize. A source of LGIB was identified during 55.7% of first attempt colonoscopies. The commonest source of LGIB was internal hemorrhoids in 23.5% followed by a bleeding polyp (18.6%) and bleeding mass (18.6%). A second look colonoscopy was performed for 15/27 (55.6%) of cases where a source was not identified leading to identification of a source in 13/27 (48%). Endoscopic intervention was needed in 20/183 (10.9%) of cases and rebleeding occurred in 45/183 (24.6%) of cases of which 8/123 (6.5%) required hospital re-admission (p < 0.001). 2/183 (1%) presented with severe shock, 123/183 (67%) were discharged immediately following colonoscopy, 5/183 (2.7%) required emergency colectomy and 2/183 (1%) died during admission. The RRs comparing early to delayed colonoscopy for source of LGIB identification, colectomy and mortality were 1.01 (95% CI = 0.73–1.40, p = 0.94), 4.8 (95% CI = 0.55–42.3, p = 0.11) and 1.2 (95% CI=0.08 – 18.9, p = 0.89), respectively. Timing of colonoscopy (OR = 0.28, 95% CI = 0.08–0.94, p = 0.04) appeared to be predictive of colectomy on multiple logistic regression analysis; otherwise no significant predictors of outcomes were identified. Conclusions: In this cohort of patients that underwent colonoscopy to investigate LGIB, the majority of procedures were performed within 24 hours of presentation where a bleeding source was identified in less than half of patients and interventions rarely performed. Urgent colonoscopy for LGIB led to expedite discharge and timing of colonoscopy appears to be predictive of the need for emergency colectomy.

Keywords: Urgent, colonoscopy, acute, lower gastrointestinal bleeding.

 SJG2018/28: First Phase Validation of Self-Screening Malnutrition Risk Using an Arabic Translated Malnutrition Universal Assessment Tool

M. Mosli, M. Albishri1, A. Alsolami1, F. Addas1, A. Qazli1, E. Aljahdli, M. Alsahafi, H. Jawa, Y. AlQari

Department of Medicine, King Abdulaziz University, 1College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Background: Patients with inflammatory bowel disease (IBD) are susceptible to malnutrition. Assessment of nutrition largely depends on physical examination and laboratory investigations. The malnutrition universal assessment tool (MUST) is a simple tool that has been validated in English for nutritional self-assessment by patients with IBD. We aim to test the agreement between patient and health care administered assessments of an Arabic translated version of the MUST score. Methods: After translating the MUST score into Arabic using the Brislin back-translation method, we performed a cross sectional study including all outpatients diagnosed with IBD at King Abdulaziz University based on conventional criteria. Prior to their encounter with their health care physician (HCP), patients completed the Arabic translated version of the MUST score. Patients were then assessed by HCPs who then completed the Arabic version of the MUST score followed by their usual clinical assessment. Low, medium, and high nutrition risk will be defined as a MUST score of 0, 1, and >1, respectively. To evaluate chance corrected agreement between patient self-administered Arabic MUST scores and HCP scores we used the benchmarks set by Landis and Kock, which designate weighted kappa values <0 as no agreement, 0–0.20 as slight agreement, 0.21–0.40 as fair agreement, 0.41–0.60 as moderate agreement, 0.61–0.80 as substantial agreement, and 0.81–1 as almost perfect agreement. Results: A total of 98 patients with IBD were surveyed (57% Crohn's disease and 42.9% ulcerative colitis) and 83.7% were Saudi's. Mean age was 30.3 (+-12). Overall agreement between patient self-completed Arabic MUST and HCP completed MUST score was substantial (agreement = 71.3%, expected agreement = 19.7%, kappa = 0.64, p < 0.0001). Upon categorizing scores according nutrition risk, agreement was almost perfect (agreement = 100%, expected agreement = 61.2%, kappa = 1, p < 0.0001). 53% of patients categorized the MUST score as easy to perform and 46.9% very easy. Conclusions: Agreement between the patient self-administered and HCP administered MUST score is substantial when an Arabic translated version is used. The self-administered MUST score is an easy and valid tool that can be used to assess the nutritional status of outpatients with IBD. Further studies completing the validation of this tool in Arabic is needed.

 SJG2018/29: Baseline Risk Assessment of Patients with Ulcerative Colitis: Does Initial Treatment Selections Influence Outcomes?

M. H. Mosli, S. Aljehani, B. Alshmrani, Z. Habib, E. Aljahdli, H. Jawa, Y. Qari, S. Alfaer, T. Almalaki, A. Albeshry

Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Background and Aims: Treatment of ulcerative colitis (UC) seldom follows a step-up approach and targets colonic mucosal healing. Although mucosal healing reduces the risk of colectomy, whether or not early treatment of patients with high-risk features using TNF antagonists reduces the risk of colectomy is not clear. Accordingly, we aim to evaluate the effect of baseline treatment selection according to risk profile on 5-year outcomes and identify predictors of poor outcomes. Patients and Methods: Adult patients with confirmed UC were retrospectively identified. Baseline clinical and endoscopic data were collected. Patients were assigned a risk profile based on the presence or absence of “high risk” features within the first 6 months of diagnosis including moderate to severe endoscopic disease, frequent need of steroids, steroid dependency, and disease involving the entire colon according to endoscopy. Treatment discordance was defined as treating “high-risk” patients with medications other than anti-TNF therapy during the first 6 months after diagnosis or treating “low risk” patients with anti-TNF therapy within 6 months of diagnosis. Association between discordance and 5-year colectomy and hospitalization rates, were statistically calculated through regression analysis, as were predictors of outcomes. Results: 108 patients were identified and studied. Median age was 36 (interquartile range = 27-50) and average duration of disease was 6.6 (+-3.1). Females comprised 62% of the cohort and 72% were Saudi citizens. Thirty percent of patients reported cigarette smoking and 53% of patients were placed in the high-risk category. Discordance between baseline risk and treatment selection did not significantly predict outcomes. While the 5-year risk of colectomy was not statistically significantly higher in patients identified as high-risk when compared to those that were low-risk (Risk ratio (RR) = 1.34, 95% confidence interval (CI) = 0.40-4.49, p = 0.63), 5-year risk of hospitalization was higher in high-risk patients (RR = 2.19, 95% CI = 1.22-3.96, p = 0.009). On regression analysis, male gender was a significant predictor of colectomy (OR = 13.46, 95% CI = 1.41–128.35, p = 0.024); and hospitalization was predicted by baseline albumen concentrations (OR = 1.08, 95% CI = 1.02–1.15, p = 0.012), steroid dependence (OR = 4.56, 95% CI = 1.05 – 19.74, p = 0.043) and endoscopic severity (OR = 2.27, 95% CI = 1.00-5.16, p = 0.049). Conclusions: Unlike CD, discordance between baseline risk and treatment selection does not appear to predict outcomes. UC patients with high-risk features are at risk for hospitalization within 5 years of diagnosis. Furthermore, the 5-year risk of colectomy is higher in males and risk of hospitalization is higher in patients with moderate to severe endoscopic disease, low albumen concentrations, and elevated CRP at baseline.

 SJG2018/30: Prevalence and Clinical Predictors of Upper GI Crohn's Disease

Mahmoud Mosli, Kholoud Fallatah, Abdulrhman Baradei, Fatimah Howladar, Motaz Daiwali, Omar Alshuaibi, Hani Jawa, Emad Aljahdali, Yousif Qari, Omar Saada1

Departments of Medicine and 1Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia

Background and Aims: Crohn's' disease (CD) can rarely involve any part of the gastrointestinal (GI) tract including the esophagus, stomach and duodenum. However, clinical features of upper GI Crohn's (UGIC) are not clearly characterized. We therefore aimed calculate the prevalence and study clinical characteristics of patients diagnosed with UGIC. Patients and Methods: We performed a retrospective analysis of all patients diagnosed with CD who underwent upper gastrointestinal endoscopy between 2012 and 2017 at King Abdulaziz University (KAU) hospital, irrespective of age. Patients with documented ulcerations involving the upper GI tract i.e. esophagus, stomach and duodenum seen endoscopically and confirmed histologically were labeled as UGIC. Data on demographics, disease characteristics, extra-intestinal manifestations, and symptomatology were reviewed. Frequencies and means were reported for categorical and continuous variables, respectively. Prevalence of UGIC was calculated and stepwise model selection was used to statistically identify clinical predictors. Results: We identified 80 CD patients who underwent upper GI endoscopy from our medical records. Of the total, 5/80 (6.3%) had confirmed UGIC (1 esophageal, 3 gastric, and 1 duodenal). Mean age was 21 (+-9.4) years and 50% were males. Family history and ancestral consanguinity was reported in 7.5% and 41.3%, respectively. Disease distribution was ileo-colonic 38%, colonic 34%, and ileal in 20%. Non-stricturing non-penetrating phenotype was reported in 75%, stricturing in 15.4%, and fistulizing in 2.6%. 7.8% reported history of perianal disease. Extra-intestinal manifestations (EIMs) of CD were reported in 20% of patients. Model selection identified age (p = 0.03) as the only significant predictor of UGIC. Conclusions: The prevalence of UGIC is relatively low. Upper GI symptoms and malnutrition do not seem to predict the presence of UGIC.

 SJG2018/31: Prevalence of Helicobacter pylori Infection in Patients with Dyspepsia in Central Rural Region of Saudi Arabia

Bader Ghanem Alanazi, Faisal Hameed Alanazi, Abdulilah Zaid Albriek, Nasser Abdullah Alaqil, Omar Arahmane1, Georgios Zacharakis

Department of Internal Medicine, Endoscopy Unit, Prince Sattam Bin Abdulaziz University Hospital, 1Endoscopy Unit, King Khaled Hospital, Al Kharj, Saudi Arabia

Background: Limited studies have been conducted to study the helicobacter pylori infection prevalence in patients associated with the cause of the referral in Saudi Arabia. The aim of the currents study was to investigate the frequency of H. Pylori infection in patients with dyspepsia in central rural region of Saudi Arabia, in Al Kharj. Methods: The prospective study enrolled only patients with dyspeptic symptoms following the ROME IV criteria during the period of May 2016 to November 2017. All data was collected from Outpatient Gastroenterology Clinic of Prince Sattam bin Abdulaziz University (PSAUH) and King Khaled Hospital (KKH), an affiliated hospital with PSAU, serving over 600,000 population of Al Kharj region. The patients referred to private sector for Urea Breath Test (UBT). Results: Out of 800 patents with dyspepsia 686 (86%) underwent UBT (mean age 41.3 years old (range 17-770)). The frequency of H. Pylori infection for females in Al Kharj region was estimated as 38.5 (117/304) among Saudi: 62.2% (102/164) and non-Saudi: 65.2% (15/23) comparing to males of 40.5% (154/382) among Saudi: 62.5% (80/128) and non-Saudi: 74% (74/100), respectively (always p > 0.05). The majority of the H. Pylori infected patients were in the age group 21-30 years old (40.3%). Conclusion: More than 1/3 of females and males with dyspeptic symptoms are affected by H. Pylori infection in Al kharj with no significant difference among Saudi and non-Saudi populations, Patients requiring eradication of H. Pylori was similar in A lKharj region compare to the other Saudi Arabian areas.

 SJG2018/32: Prevalence of Functional Dyspepsia Symptoms in Saudi Arabia: The Role of Rome IV Criteria

Georgios Zacharakis, Moaz Hassan Alharbi, Manal Mahmood Alsalmi1, Sultan Bander Alotibi2, Yasameen Abdullah Algaradi, Fatimah Nassir Alsadiq2, Pavlos Nikolaidis3

Department of Internal Medicine, Endoscopy Unit, University Hospital, Prince Sattam bin Abdulaziz University, Al-Kharj, 1Ibn Sina National College for Medical Studies, Jeddah, 2Almaarefa Medical College, 3Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

Background: The aim of this population based study was to estimate the frequency of self-reported symptoms consistent with recently developed ROME IV criteria for functional dyspepsia (FD) among adults of KSA. Methods: A nationwide study of 3120 individuals aged 18 years old and above of the Saudi general population involved in the study. A web-based ROME IV questionnaire survey program was used for this study. The Arabian language questionnaire included sociodemographic factors and FD symptoms according to ROME IV criteria for FD. Results: Among 3120 adult individuals visited the site, 1760 (56.4%) agreed to participate. The average respondent age was 20 (18-67) years. Almost half of the respondents were females (50.5%), married (36.2%), 29% overweight and 28% obese. About 21.8% of respondents reported symptoms consistent with Postprandial Distress Syndrome (PDS) such as bothersome early satiation 15.7% and/or postprandial fullness 35.5% and 21.1% reported consistent with Epigastric Pain Syndrome (EPS) such as bothersome epigastric pain 16.3% and/or epigastric burning 32%. Abdominal distension/swelling/bloating symptoms of FD that may overlap with IBS but not predominant also reported by the survey participants (44.2%). Belching, nausea/retching and vomiting (8.7% and 3.1%, respectively) reported less frequently. Excess overlap among PDS and EPS 19.1% and among Irritable Bowel Syndrome (IBS) and PDS 11.5% were reported. There is no significant difference in frequencies of the above categories for women vs men reported (p < 0.05, x2 = 5.1574). Conclusion: Symptoms consistent with ROME IV criteria for FD were found to have high prevalence in KSA and there is excess overlap among PDS and EPS.

 SJG2018/33: Prevalence and Clinical Associations of Upper and Lower Endoscopic Findings in Al Kharj Saudi Arabian Population: Is the Local Practice Up to Date?

Omar Mohd, Mohammed Nasser Aldojayn, Abdulaziz Salman Almuaythir, Othman Mohammed Almousa, Naif Theeb Alqahtani, Saad Mohammed Alhaqbani, Fawaz Nawaf Alshaalan, Omar Arahmane1, Pavlos Nikolaidis2, Georgios Zacharakis

Department of Internal Medicine, Endoscopy Unit, Prince Sattam bin Abdulaziz University Hospital, Al Kharj, 1Endoscopy Unit, King Khalid Hospital, Najran, 2Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

Introduction: The aims of this study are to identify the common indications for gasatrointestinal tract (GI) endoscopy and to determine the prevalence, location and clinical associations of endoscopic findings in Al Kharj. Methods: Endoscopy reports at Endoscopy Unit of King Khaled Hospital (KKH), which is a major teaching hospital in Al Kharj Governate, affiliated with the Prince Sattam Bin Abdulaziz University, providing endoscopy services for the population of more than 650,000 people were collected for the period 2016 to 2017 inclusive. Results: A total of 315 patients, 59.31% Saudi, 50% males, underwent GI endoscopy the last two years with mean age 43.1 (range, 15-65). Of the 100 (32%) patients with dyspepsia symptoms the majority had gastritis 64 (64%), of whom 3 (3%) had gastritis with peptic ulcer, the rest had normal endoscopic findings. Moreover, 55 patients (17.4%) had gastroesophageal reflux disease (GERD) symptoms, with esophagitis 9 (16.3%) or hiatal hernia 8 (14.5%). Also, a total of 138 (44%) patients had GI bleeding with heamorroids 49 (35.5 %), peptic ulcer 15 (10.9%), colon cancer 18 (13%) and gastric cancer 4 (2.9%), inflammatory bowel disease 12 (8.7%), oesophageal varices 7 (5.1%), diverticula 3 (2.2%) and angiodysplasia 2 (1.4%). Of the 116 patients underwent colonoscopy 46 (40%) detected with polyps. Only 6 patients (5.2%) had an indication of colon screening. Conclusions: Preventive measures such as screening colonoscopy should be implemented in Al Kharj area. Also, a substantial rate of inappropriate endoscopy indications such as GERD and dyspepsia has been demonstrated.

 SJG2018/34: The Clinical Utility of Thiopurine Metabolite Levels in IBD: Experience from a University Hospital

R. K. Felwick, F. G. Ewbank, D. Akarca, I. Ahmed

Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK

Background: Thiopurines are the mainstay of treatment in IBD. Measurement of thioguanine nucleotide levels has been shown to guide the optimisation of therapy with better clinical outcomes.{1} It is less clear which patient groups benefit most from metabolite measurement. The aim of this study was therefore to determine the clinical utility of thiopurine metabolite measurement in a cohort of IBD patients from a University hospital. Methods: IBD patients who had thiopurine metabolites measured between 2014 and 2016 were identified. Demographic data, reason for testing, metabolite measurements and outcome were recorded by retrospective clinical notes review. Results: 141 patients were identified (44 UC, 97 CD). A total of 210 Metabolite measurements were made, active disease 103/210 (49%), inactive disease 44/210 (21%) or other indications in 64/210 (30%). Patients with active disease had their treatment optimised in 63/103 (61.2%). Metabolite measurement had the least clinical utility in those with inactive disease. From 43 measurements, 71% resulted in no change to treatment. Overall 50% of these resulted in no change in clinical management. Measurement for dose optimisation, side effects or consideration of stopping a biologic resulted in changes to treatment in 51.4, 50 and 0% respectively. Conclusion: Metabolite measurements in patients with active IBD show the greatest clinical utility in term of treatment optimisation and better clinical outcome, and should be restricted to these groups.


Smith M, Blaker P, Patel C, Marinaki A, Arenas M, Escuredo E, et al. The impact of introducing thioguanine nucleotide monitoring into an inflammatory bowel disease clinic. Int J Clin Pract 2013;67:161-9.

 SJG2018/35: Analysis of Faecal Volatile Organic Compounds in Healthy Population Across the Countries

I. Ahmed, V. De Pretor, K. Rioux, N. Ratcliffe, C. Probert

Clinical Science at South Bristol, University of Bristol, Bristol Royal Infirmary, Bristol, UK

Background: Faecal volatile organic compounds (VOCs) are emerging non-invasive tools for diagnosing gastrointestinal disorders. Pattern of faecal VOCs in healthy population may be different across the countries due to differences in the dietary habits and environmental conditions, and can provide basis for understanding its changes in disease conditions.1 Methods: We aim to study the faecal VOCs of the healthy population from England, Belgium and Canada. A total of 159 health volunteers (British = 109, F = 69), (Belgium = 20, F = 14), (Canada = 30, F = 17) donated faecal samples. Fresh samples were aliquoted in 18 mls sealed vials. VOCs were extracted using solid phase micro extraction and were analysed using gas chromatography–mass spectrometery. VOCs were identified using NIST library search comparing their fragment pattern. Results: A total of 232 VOCs were identified. Using binary data, univariate analysis was used to identify statistically significant (p < 0.05) VOCs in discerning differences between the three groups. Alcohols, ketones and esters were predominantly associated with British volunteers compared while aldehyde and alkene were predominantly detected VOCs in Canadian and Belgium groups respectively. A multivariate discriminant function analysis was able to differentiate three groups with a sensitivity of 96% and specificity of 90%. Conclusion: Faecal VOCs analysis in the healthy population of different countries may provide important basis in the clinical utility of faecal biomarkers in studying the differences in disease prevalence and behaviour.


Probert CS, Ahmed I, Khalid T, Johnson E, Smith S, Ratcliffe N, et al. Volatile organic compounds as diagnostic biomarkers in gastrointestinal and liver diseases. J Gastrointestin Liver Dis 2009;18:337-43.

 SJG2018/36: The Frequency of Giardiasis and Amoebiasis among Patients Misdiagnosed with Irritable Bowel Syndrome and/or Functional Dyspepsia

Sana M. Kamal, Maher Mualla Alotaibi, Abdulmajeed Mualla Alotaibi, Abdulaziz Mohammed H. Hammudah, Ibrahim Abdulrahman Alrubayan, Rami Mohammed Alfaifi, Abdulaziz Tariq A. Etaiwi, Ahmed Hamza Mohammed Alhadi, Khalid Abdulaziz ALasous

Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia

Background: Abdominal colic and dyspepsia are frequent presentation in many cases. Such symptoms are mistaken for irritable bowel syndrome, due to improper investigations. Thus, the current study determined the frequency of Giardia lamblia and Entamoeba histolytica among patient pre-diagnosed with irritable bowel syndrome. Methods: Patients present with symptoms suggestive of irritable bowel syndrome such as dyspepsia, abdominal colic, distention, or altered bowel habits are enrolled and followed up. They all underwent stool and urine analysis, complete blood count liver and renal functions, abdominal ultrasound, and serology for giardiasis and amoebiasis. Results: One hundred ninety-eight patients fulfilled inclusion criteria. Dyspepsia was the most common followed by abdominal colic and nausea. Acute Amoebiasis was detected in 48/198 patients and giardiasis was detected in 21/198 cases. Patients with Amoebiasis had episodes of diarrhea and tenesmus, abdominal colic and diarrhea. Giardiasis was manifested as nausea and occasional vomiting. Conclusion: Thorough investigations are imperative for all patients presenting with dyspepsia and abdominal discomfort to exclude infective parasite.

 SJG2018/37: Rassf1a Gene Promoter Methylation as a Biomarker for Hepatocellular Carcinoma in Patients with Chronic Viral Hepatitis C

A. A. Abou Zeid, E. T. El-Sayed, M. R. Tawfik1, J. K. Ahdy2

Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, 1Department of Internal Medicine, Faculty of Medicine, Hepatobiliary Unit, Alexandria University, 2Department of Clinical and Chemical Pathology, Al Ramel Pediatrics Hospital, Ministry of Health, Alexandria, Egypt

Background and Aims: Aberrant DNA methylation is among the commonest aberrant epigenetics alterations studied in hepatocellular carcinoma (HCC). The aim of our study was evaluating serum RASSF1A gene promoter methylation in patients with HCV- associated liver cirrhosis with and without HCC as a potential new biomarker for early detection of HCC. Methods: The study was conducted on 60 individuals divided into 3 groups: Twenty patients with newly diagnosed primary HCC on top of HCV- related liver cirrhosis, Twenty patients with HCV- related liver cirrhosis, Twenty age and sex matched healthy individuals as a control group. They were subjected to measurement of methylated promoter of RASSF1A gene serum level using methylation specific PCR (MSP). Results: Methylated RASSF1A was detected in 65% of patients with HCC, 30% of patients with HCV- related liver cirrhosis, but it was not detected in any of the controls. The serum methylated RASSF1A was found to differentiate patients with HCC from healthy controls with an AUC of 0.825, and an accuracy of 82.50%. It was able to differentiate patients with HCC from those with patients with HCV- related liver cirrhosis with an AUC of 0.675 and an accuracy of 67.50%. Also, there were no significant statistical difference between RASSF1A methylation status and the size of HCC mass (p= 0.449. Conclusion: Detection of serum methylated RASSF1A could be of value for early diagnosis of HCC especially in high risk patients such as HCV patients.

 SJG2018/38: Acute Pancreatitis: A Cross-sectional, Longitudinal, Period Prevalence Study on the Local Etiologies and the Severity of the Disease in the Saudi Population

Abed Al Lehibi, Mohammad Abdullah Wani, Abdullah Almtawa, Khalid Al Sayari, Adel Al Qutub, Shameem Ahmed, Tauseef Azhar

Gastroenterology Unit, Department of Medicine, King Fahd Medical City, Riyadh, Saudi Arabia

Background and Aims: Prospective and population-based studies on the etiologies and outcomes of acute pancreatitis (AP) are lacking. In this paper, we aimed to determine the different etiologies, severity, and complications of AP in a single center in Saudi Arabia. Methods: prospective population-based study of patients diagnosed with AP at the King Fahad Medical City Riyadh during years (2013-2015). Information on symptoms, etiology, and complications were registered. Bedside index for severity in acute pancreatitis (BISAP) score was calculated within 24 hours of admission to assess the severity. Results: During the study period a total of 90 patients (37 males) diagnosed with acute pancreatitis were enrolled. The age ranged between 13 and 97 years with a mean of 42.6 ± 2.4 (mean ± SEM). The etiological groups were as follows, biliary pancreatitis 42 (46.7%), post ERCP pancreatitis 8 (8.9%), idiopathic 10 (14.5%), hypertriglyceridemia 4 (5.8%), alcohol induced 4 (4.4%), pancreatic devism 3 (4.3%), papillary stenosis 4 (4.4%), drug induced 2 (2.2%), IPMN 1 (1.4%), trauma 1 (1.1%), primary pancreatic cancer 1 (1.1%), postoperative acute pancreatitis 5 (5.6%), MIAP (metastasis induced acute pancreatitis) 1 (1.4%). BISAP score of 3 or more was seen in 6 (8.6%). During the study two patients died, mortality 2.8%, one had BISAP score of 4 the other 5. Conclusion: The results of our study indicate that some variations exist between local and international statistics in terms of etiologies and mortality of acute pancreatitis. Thus, data from more extensive, local studies are encouraged to gather more information on this topic.

 SJG2018/39: The Diagnostic Accuracy of Cytology for the Diagnosis of Hepatobiliary and Pancreatic Cancers

M. Al-Hajeili, M. Alqassas1, A. Alomran1, B. Batarfi1, B. Basunaid1, R. Alshail1, S. Alaydarous1, R. Bokhary2, M. Mosli

Department of Medicine and 1Faculty of Medicine, King Abdulaziz University, 2Department of Pathology, King Abdulaziz University, Jeddah, Saudi Arabia

Background and Objectives: Although cytology testing is considered a valuable method to diagnose tumors that are difficult to access such as hepato-biliary-pancreatic (HBP) malignancies, its diagnostic accuracy remains unclear. We therefore aimed to investigate the diagnostic accuracy of cytology testing for HBP cancers. Patients and Methods: We performed a retrospective study of all cytology samples that were used confirm radiologically detected HBP tumors. Sensitivity, specificity, positive and negative likelihood ratios and positive and negative predictive values were calculated in comparison to histological confirmation. Results: A total of 133 medical records were reviewed, for which we calculated an overall sensitivity 76%, specificity 74%, negative likelihood ratio 0.30 and a positive likelihood ratio 2.9. Cytology was more accurate in diagnosing hepatic lesions (sensitivity = 79%, specificity = 57%) compared to pancreatic (sensitivity = 60%, specificity = 83%) and gall bladder lesions (sensitivity = 50% and specificity = 85%). Accuracy of cytology was higher for detection of primary cancers (sensitivity = 77% , specificity = 73%) compared to metastatic cancers (sensitivity = 73%, specificity = 100%). FNA was found to be the most frequently used cytological technique to diagnose HBP lesions with a sensitivity 78.8%. Conclusion: Cytological testing is an accurate method for the diagnosis of HBP cancers, especially for lesions of the liver and pancreas. Given its relative simplicity, cost effectiveness, and paucity of alternative diagnostic methods, cytological testing should still be considered as a first line tool for diagnosis of HBP malignancies.

 SJG2018/40: Eosinophilic Eosophagitis in Patients Presenting with Dysphagia: A Retrospective Study from a Single Tertiary Care Centre

H. Jawa, R. Bahurmuz, D. Alhazmi, A. Saeed, L. Halawani, R. Bokhari, M. Mosli, Y. Qari

Department of Medicine, Gastroenterology Division, King Abdulaziz University, Jeddah, Saudi Arabia

Background and Aims: Eosinophilic esophagitis (EoE) is an increasingly prevalent cause of dysphagia in many Western countries, especially in young adults, yet the prevalence of EoE in Middle-Eastern countries remains unknown. We aimed to estimate the prevalence of EoE in Saudi patients presenting with dysphagia. In addition, we aimed to assess the pattern of practice of physicians with regards to patients presenting with dysphagia. Patients and Methods: We performed a retrospective review of all adolescent and adult patients who underwent upper gastrointestinal (GI) endoscopy for the assessment of dysphagia. Demographics, endoscopic and histologic findings were reviewed. The primary outcome was the prevalence of biopsy proven EoE (defined as >15 eosinophils per high power field (eos/hpf)) in patients presenting with dysphagia. Secondary outcomes included the frequency of endoscopic features suggestive of EoE and appropriateness in performing esophageal biopsies to diagnose EoE. Results: 138 patients were identified and reviewed. Mean age was 50.7 years and 43.5% were males. Endoscopy revealed normal esophageal mucosa in 52.9%. White plaques were reported in 4.3%, linear furrows in 2.9% and multiple rings (trachealization) in 2.2%. Esophageal biopsies were obtained in 20.3% of all patients and in 7.1% of patients with normally appearing esophageal mucosa to rule out EoE. Only 2 patients (1.4%) with biopsy proved EoE were identified from this cohort, both were young adults. Conclusions: Failure to acquire esophageal biopsies from patients presenting with dysphagia, as per international guidelines, may explain the low prevalence of EoE observed in this population. Alternatively, prevalence of EoE might be lower than expected in Middle-Eastern countries. Large prospective studies are needed to accurately assess the prevalence of EoE in Middle-Eastern countries.