Saudi Journal of Gastroenterology
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REVIEW ARTICLE
Diseases of the appendix recognized during colonoscopy
Fazal Imtiaz Khawaja
May-August 2002, 8(2):43-52
PMID:19861790
  86,154 0 -
Asymptomatic gallstones: Should we operate?
Khalid R Murshid
April-June 2007, 13(2):57-69
DOI:10.4103/1319-3767.32179  PMID:19858615
Symptomatic gallstones are easy to treat, unfortunately however asymptomatic gallstones are as easy to treat. This creates a problem for health care planners in the form of the financial implications involved, since asymptomatic gallstones are even more common than gallstones associated with symptoms and require no surgical intervention, while the funds diverted towards dealing with them drains the health care establishment of much needed funds in an era of costly health care. In this review we attempt to clarify the fact that asymptomatic gallstones need no intervention in most cases, thereby saving the patient unnecessary surgery and the health care establishment costs, both in the financial form and in manpower.
  59,335 2,229 4
The role of ultrasonography in portal hypertension
Nizar A Al-Nakshabandi
September-December 2006, 12(3):111-117
DOI:10.4103/1319-3767.29750  PMID:19858596
Portal hypertension is a commonly encountered clinical condition with multiple causes and several squeal. Ultrasound is an accurate non-invasive means of assessing its aetiology, severity and complications. I will review the role of ultrasonography in portal hypertension. The ultrasonic features that help identify its aetiology will be discussed as will the criteria that allow an assessment of disease severity and its complications.
  49,539 3,576 7
ARTICLES
Parasitic disease of the liver and biliary tree
Abdulrahman E Mohamed, Mohamed A Al Karawi, Zuhul Ghandour
January-April 1997, 3(1):22-28
PMID:19864809
Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. Bile iry tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliary tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobiliary parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography (ERCP) is safe and effective in diagnosis and management of biliary tree parasites.
  43,793 1 -
REVIEW ARTICLES
Ascites and spontaneous bacterial peritonitis: Recommendations from two United States centers
Vinay Sundaram, Vignan Manne, Abdullah MS Al-Osaimi
September-October 2014, 20(5):279-287
DOI:10.4103/1319-3767.141686  PMID:25253362
Cirrhosis affects millions of people throughout the world. Two of the most serious complications of liver cirrhosis are ascites and spontaneous bacterial peritonitis (SBP). The development of ascites is related to the severity of portal hypertension and is an indicator of increased mortality. Although sodium restriction and diuretic therapy have proven effective, some patients may not respond appropriately or develop adverse reactions to diuretic therapy. In such cases, interventions such as transjugular intrahepatic portosystemic shunt (TIPS) placement are warranted. SBP is a complication of ascites that confers a very high mortality rate. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. Initiation of prophylaxis in SBP remains controversial. Given the burden of liver cirrhosis on the health care system, ascites and SBP will continue to provide challenges for the primary care provider, hospitalist, internist, and gastroenterologist alike.
  42,806 836 -
CASE REPORT
Colonoscopic removal of an appendiceal polyp
Fazal Imtiaz Khawaja
September-December 2002, 8(3):93-95
PMID:19861799
  31,389 0 -
ARTICLES
Doxycline-induced esophageal ulcerations
Mohammad Abdullah Al Mofarreh, Ibrahim Abdulkarim Al Mofleh
January-April 1998, 4(1):20-24
PMID:19864782
Over a period of six years 16 patients presented to Dr. Al Mofarreh's polyclinic with drug­-induced esophageal ulcerations. One patient had esophagitis without ulcerations and two patients, who declined endoscopy were not included in this analyzis. The mean age of the remaining 13 patients was 28.92 ± 10.39 years. The mean ulcers number was 3.69 ± 2.76. The ulcers were located at the mid-esophagus, 29.23 ± 3.94 cm from the incisors teeth. Odynophagea, retrosternal pain and dysphagea in 13 (100%), 12 (92%) and 9 (69%) patients, respectively, were the most frequent presenting symptoms. All patients took a doxycycline preparation at bed time with little water. The mean elapse between the drug intake and endoscopy was 7.85 ± 9.96 days. The symptoms resolved within a maximum of one week of antireflux treatment despite the continuation of doxycycline therapy in three patients with brucellosis. The current data confirmed the role of oral doxycycline intake, the timing and the amount of concurrent fluid in the etiology of esophageal ulcerations.
  31,321 0 -
Gastroenterological manifestations of sickle cell disease
Abdul-Wahed Nasir Meshikhes
January-April 1997, 3(1):29-33
PMID:19864810
Sickle cell hemoglobinopathy is a common genetic disorder which is prevalent in certain areas of the Kingdom of Saudi Arabia. It is characterized by repeated hemolytic and vasoocclusive crises which lead to widespread vascular occlusion and subsequent multiple organ infarctions. Affected individuals present with a wide variety of gastrointestinal disorders mimicking vasoocclusive episodes causing diagnostic confusion and delays that may catch the unwary clinician. This article briefly reviews the gastroenterological manifestations of sickle cell disease.
  30,296 4 -
IN FOCUS
Fibroscan® : A noninvasive test of liver fibrosis assessment
Abdullah S Al-Ghamdi
July-September 2007, 13(3):147-149
DOI:10.4103/1319-3767.33470  PMID:19858635
Determination of the extent of progress of hepatic fibrosis is important in clinical practice, where it may reflect the severity of liver disease and predict response to treatment. Percutaneous liver biopsy is the gold standard for grading and staging of liver disease. However, liver biopsy is an invasive procedure with certain unavoidable risks and complications. Several methods have been studied in an attempt to reach a diagnosis of cirrhosis by noninvasive means. Fibroscan® has been designed to quantify liver fibrosis by means of elastography and found to have reasonably good sensitivity and specificity patterns, especially in patients with advanced fibrosis and can be used as an alternative to liver biopsy.
  25,722 1,512 1
REVIEW ARTICLE
Acute biliary pancreatitis: Diagnosis and treatment
Zakaria M Hazem
July-September 2009, 15(3):147-155
DOI:10.4103/1319-3767.54740  PMID:19636174
Gallstones are the commonest cause of acute pancreatitis (AP), a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP) is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis
  22,724 3,589 6
The physiology of the biliary tree. Motility of the gallbladder - part 2
Mansour Abdul Gadir Ballal, Paul Anthony Sanford
January-April 2000, 6(1):3-17
PMID:19864723
  25,284 1 -
ARTICLES
Chronic diarrhea in children : Part I. physiology, pathophysiology, etiology
Mohamed I El Mouzan
January-April 1995, 1(1):37-42
PMID:19864866
Chronic diarrhea is an important cause of morbidity and mortality in children. Although the pattern of the problem is well established in Western countries. limited data are available from Saudi Arabia. The purpose of this review is to provide an updated overview of the physiology of digestion, pathophysiology and etiology of diarrhea with particular emphasis on patterns prevalent in Saudi Arabia
  23,829 1 -
EDITORIAL
Perspective on the Saudi council for health specialities
Hussein Al-Freihi
January-April 2003, 9(1):1-5
PMID:19861802
  23,692 0 -
REVIEW ARTICLE
Physiology of the Sphincter of Oddi - the present and the future? - part 1
Mansour A Ballal, Paul A Sanford
September-December 2000, 6(3):129-146
PMID:19864708
The mechanisms controlling the sphincter of Oddi (SO) have received considerable attention over the past two decades. Progress towards their elucidation has been slow, perhaps because of the sphincter's relative inaccessibility and the different responses of the human "resistor" as compared to the "pumper" observed in several animal models. The list of agents affecting the sphincter grows alarmingly. In this review, divided into two parts, substances have been classified as neurotransmitters, hormones, local factors and pharmacological agents. The first part considers the roles of neurotransmitters. These include (a) vasoactive intestinal polypeptide (VIP) and nitric oxide (NO). Both cause relaxation. A recent model of their complex interrelationships in smooth muscle is described. (b) Substance P (SP) and enkephalins. These produce contractions. The former can act directly. An indirect effect via cholinergic neurones may be the result of SP release from vagal afferents. (c) Catecholamines, which cause contraction or relaxation via activation of α- or β-adrenoreceptors, respectively. In the second part attention is focussed on cholecystokinin (CCK) which normally relaxes the SO via neuronal mechanisms. A CCK-sensitive pathway from sensory duodenal neurones to SO ganglia has been described. Reactive oxygen species are among the local factors discussed. Their description as being "the good, the bad and the ugly" seems merited. Pharmacological agents include NO donors, octreotide and botulinum toxin (BTX). Octreotide induces tachyoddia and may impair biliary flow. BTX has exciting potential in the diagnosis of SO abnormalities and as a therapeutic alternative to sphincterotomy. In both parts of the review current concepts of different aspects of smooth muscle control are presented. In several instances data regarding the SO is lacking. We discuss (a) the role of interstitial cell of Cajal in the control of slow waves, (b) different pathways contributing to tonic and phasic contractions, (c) the 4 levels of neural control, (d) interrelationships of immune and nervous systems, and (e) links between emotional states and gut functions.
  23,672 2 -
ARTICLES
The postcholecystectomy syndrome: A review
Khalid R Murshid
September-December 1996, 2(3):124-137
PMID:19864820
The objective is to study the Postcholecystectomy Syndrome (PCS); its causes, different methods of diagnosis and different treatment options and their results in order to deduce from the above data the best method of prevention of its occurrence and the best method of treatment once it has occurred. Data sources include a medline search of articles covering this topic in the English literature and the abstracts of non-English articles from 1966-1994. The total number of articles of interest to the study being approximately 120. There are many causes of PCS, some related to improper preoperative diagnosis and some related to avoidable and unavoidable consequences of cholecystectomy. The different diagnostic modalities are dependent on the cause as are the different treatment options. The best treatment of this condition remains prevention whenever possible. Proper diagnosis of those patients who truly require cholecystectomy and care in performing the cholecystectomy will minimize the incidence of this syndrome.
  23,087 2 -
CASE REPORT
Biliary ascariasis: Report of a complicated case and literature review
FM Sanai, MA Al-Karawi
January-March 2007, 13(1):25-32
DOI:10.4103/1319-3767.30462  PMID:19858609
Invasion of the Ascaris worm into the biliary system leads to a wide variety of clinical syndromes. Most of the descriptions of the disease have originated from the developing world, where due to the environmental factors there is a high level of parasitism. An increased incidence of biliary ascariasis borne out of population migration and increased facilities for diagnosis has led to a renewal of interest in this disease in the developed world. Significant morbidity and mortality is associated with the concomitant complications, and early diagnosis and management is of utmost importance. Common disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, and cholangitis. Although with a potential for serious mortality, pancreatitis, and cholangiocarcinoma constitute relatively less common threats. Recent advances in endoscopy have shifted the attention of this disease from the surgeon to the gastroenterologist and a consensus of opinion is arising for early intervention. We present here a patient with biliary ascariasis managed endoscopically and review the epidemiology, prevalence, clinical presentation, diagnosis, and management of this disease.
  20,125 1,328 11
ARTICLES
Chronic diarrhea in children : Part II. Clinical Approach and Management
Mohamed I El Mouzan
May-August 1995, 1(2):81-86
PMID:19864855
Chronic diarrhea is a complex symptom. The clinical approach and management should be based on pathophvsiologic considerations and stepwise laboratory investigations. In infants with severe malnutrition, nutritional support is a priority in the management of this condi­tion.
  21,142 0 -
Formol-ether concentration method in the diagnosis of active schistosoma mansoni in patients with detectable IHA
Mohammad A Al Mofarreh, Ahmad M Al Akwaa, Sayed W Hasan, Ibrahim A Al Mofleh
September-December 2000, 6(3):157-160
PMID:19864711
Schistosomiasis is a world wide human infection. In Saudi Arabia there are multiple endemic foci. Various methods have been used to diagnose Schistosoma mansoni. We studied 1410 patients coming from S. mansoni endemic areas with detectable antibodies by indirect hemagglutination (IHA). Stool specimens were tested for S. mansoni ova by direct smear and formol-ether concentration (FEC) methods. The objective of the study was to identify patients with active schistosomiasis using FEC method and a single direct smear. Twenty percent of IHA positive patients had active infection detected by FEC, while a single direct stool smear diagnosed only 2.4% (P<0.0001). The percentage of positive FEC was significantly increasing in linear trend with IHA level. This trend wasn't observed with direct smear examination. The current data suggest that FEC is helpful to diagnose active schistosomiasis, therefore it is recommended in IRA positive individuals.
  21,013 0 -
REVIEW ARTICLE
The importance of interstitial cells of cajal in the gastrointestinal tract
Othman A Al-Shboul
January-February 2013, 19(1):3-15
DOI:10.4103/1319-3767.105909  PMID:23319032
Gastrointestinal (GI) motility function and its regulation is a complex process involving collaboration and communication of multiple cell types such as enteric neurons, interstitial cells of Cajal (ICC), and smooth muscle cells. Recent advances in GI research made a better understanding of ICC function and their role in the GI tract, and studies based on different types of techniques have shown that ICC, as an integral part of the GI neuromuscular apparatus, transduce inputs from enteric motor neurons, generate intrinsic electrical rhythmicity in phasic smooth muscles, and have a mechanical sensation ability. Absence or improper function of these cells has been linked to some GI tract disorders. This paper provides a general overview of ICC; their discovery, subtypes, function, locations in the GI tract, and some disorders associated with their loss or disease, and highlights some controversial issues with regard to the importance of ICC in the GI tract.
  18,142 2,401 1
Enterocutaneous fistula
Oluwole Gholagunte Ajao, Mohammed Yahya Shehri
May-August 2001, 7(2):51-54
PMID:19861768
Based on the modality of treatment, historically the management of enterocutaneous fistula has been grouped into three periods. The era of antibiotics (1945-1960), the era of intensive nurse care (1960-1970) and the era of intravenous hyperalimentation (1970-1975). Schein's modification of Sitges-Serra classification of enterocutaneous fistula is now preferred to the old classification of high-output type and low output type. A major cause of enterocutaneous fistula is technical failure. Serum level of short-turn over proteins such as albumin retinal-binding protein, thyroxin binding pre-albumin as serum transferring are predictors of mortality and spontaneous fistula closure. Immediate surgical correction of the fistula is not a priority of treatment. The control of sepsis and adequate nutrition are the two most important aspects of management. The use of somatostatin and octreotide has been shown to shorten the period of spontaneous closure of the fistula.
  20,418 1 -
ARTICLES
Endoscopic features of Helicobacter pylori induced gastritis
Mohammed Qaseem Khan, Zuhair Alhomsi, Sami Al-Momen, Mahmuda Ahmad
January-April 1999, 5(1):9-14
PMID:19864753
It's still controversial whether certain macroscopic endoscopic features can be used to diagnose Helicobacter pylori (HP) related gastritis. The literature dealing with this subject is confusing, because of the lack of precise terminology, no large control trials, major discrepancies in interpretations of macroscopic changes and poor correlation of the macroscopic appearance and histological finding of gastritis. We conducted a prospective study of 208 dyspeptic patients, who underwent upper gastrointestinal endoscopies from February 1997 to June 1997. Only those patients who had either normal looking gastric mucosa or macroscopic gastritis were included in the study. Endoscopically normal looking mucosa was seen in 67 patients (65.6%), erythematous gastritis in 51 (74%), mosaic appearance in 18 (88%), erosive gastritis in 14 (85%), nodular gastritis in 17 (94%), atrophic gastritis in 12 (75%), and fundal rugae hypertrophies in 5 (80%). We suggest that the antral nodularity, raised erosions, mosaic appearance and mixed findings, are the reliable indicators of the underlying HP induced gastritis. However, these endoscopic findings are very specific, though not sensitive, for HP gastritis.
  19,779 1 -
REVIEW ARTICLE
Herbal medicine in the treatment of ulcerative colitis
Fei Ke, Praveen Kumar Yadav, Liu Zhan Ju
January-February 2012, 18(1):3-10
DOI:10.4103/1319-3767.91726  PMID:22249085
Ulcerative colitis (UC) is a refractory, chronic, and nonspecific disease occurred usually in the rectum and the entire colon. The etiopathology is probably related to dysregulation of the mucosal immune response toward the resident bacterial flora together with genetic and environmental factors. Several types of medications are used to control the inflammation or reduce symptoms. Herbal medicine includes a wide range of practices and therapies outside the realms of conventional Western medicine. However, there are limited controlled evidences indicating the efficacy of traditional Chinese medicines, such as aloe vera gel, wheat grass juice, Boswellia serrata, and bovine colostrum enemas in the treatment of UC. Although herbal medicines are not devoid of risk, they could still be safer than synthetic drugs. The potential benefits of herbal medicine could lie in their high acceptance by patients, efficacy, relative safety, and relatively low cost. Patients worldwide seem to have adopted herbal medicine in a major way, and the efficacy of herbal medicine has been tested in hundreds of clinical trials in the management of UC. The evidences on herbal medicine are incomplete, complex, and confusing, and certainly associated with both risks and benefits. There is a need for further controlled clinical trials of the potential efficacy of herbal medicine approaches in the treatment of UC, together with enhanced legislation to maximize their quality and safety.
  16,082 3,066 8
Sphincter of Oddi and its dysfunction
Prasad Seetharam, Gabriel Rodrigues
January-March 2008, 14(1):1-6
DOI:10.4103/1319-3767.37793  PMID:19568485
Sphincter of Oddi though mostly heard about in 'anatomy textbooks' is making its way into surgical practice due to various disease states affecting it and its dysfunction seems to be an important condition to be observed while treating patients with abdominal pain. In this review, we have attempted to discuss all the relevant conditions affecting it, particularly the dysfunction with a detailed literature review.
  17,935 1,156 3
ARTICLES
Ascites: Tips on diagnosis and management
Ibrahim A Al Mofleh, Rashed S Al Rashed
May-August 1996, 2(2):80-86
PMID:19864832
Clinical evaluation and diagnostic paracentesis with estimation of the serum-ascitic albumin gradient (SAAG) is the most important step in identifying the etiology of ascites. At a level of 1.1 g/dl, SAAG, accurately (96.7%) differentiate portal hypertension from nonportal hypertension-associated ascites. The majority of patients with ascites (>80%) have portal hypertension associated etiology mainly, liver cirrhosis. Approximately 90% of patients with ascites complicating cirrhosis respond to salt restriction and diuretics. The remainder (10%),have refractory ascites which commonly respond well to large volume paracentesis (LVP). Asymptomatic complications occurring in patients treated with LVP may not necessitate treatment. Other alternative methods for treatment of refractory ascites include: ascitic fluid recirculation (AR), peritoneovenous shunting (PVS),transjugular intrahepatic portosystemic stent-shunting (TIPS) and orthotopic liver transplantation (OLT).
  19,027 2 -
Swallowed foreign body: Is interventional management always required?
Gharamah Yahya Al Shehri, Talal Abdullah Al Malki, Mohammed Yahya Al Shehri, Oluwole Gbolagunte Ajao, Suleiman Abdulaziz Jastaniah, Kamal Sidiq Haroon, Mohammed Makram Mahfouz, Mubarak Mohammed Al Shraim
May-August 2000, 6(2):84-86
PMID:19864717
A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.
  19,009 1 -
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