Saudi Journal of Gastroenterology
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   2007| April-June  | Volume 13 | Issue 2  
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Clinico-pathological patterns of colorectal cancer in Saudi Arabia: Younger with an advanced stage presentation
Abdulrahman M Aljebreen
April-June 2007, 13(2):84-87
DOI:10.4103/1319-3767.32183  PMID:19858619
Aim: Colorectal cancer (CRC) is the third most common cancer in the world. The aim of this study was to identify the clinical and pathological features of CRC in a tertiary care hospital in Saudi Arabia. Materials and Methods: This is a retrospective study of all patients diagnosed to have CRC at King Khalid University Hospital in Riyadh, Saudi Arabia over a 10 year period (1995-2005). The data collected from medical files, endoscopy and imaging reports included age, gender, clinical presentation, smoking, relevant past or family history, site and size of the tumor, stage, carcinoembryonic antigen level and tumor grade. Results: A total of 113 patients were included over the 10 year period. The average age at diagnosis was 55 years (S.D.=15), 58% of the patients were males and 42% were females. Thirty-seven percent of the patients were 50 years of age or younger. The most common clinical presentation was abdominal pain (68%) followed by rectal bleeding (62%) and weight loss (55%). Left-sided lesions and rectal cancer constituted 76% and 48% of all CRC tumors respectively. Sixty-eight percent of lesions were stage C and above. Forty-five percent of patients presented with complete large bowel obstruction. Conclusion: In this analysis, we found that Saudi patients were more likely to present with colorectal cancer at a more advanced stage of the disease and at younger ages compared to Western populations. This data suggests the need for a mass screening program to be implemented for this common and preventable cancer in Saudi Arabia.
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Prevalence of hepatitis B virus infection in the Gezira State of Central Sudan
HMY Mudawi, HM Smith, SA Rahoud, IA Fletcher, OK Saeed, SS Fedail
April-June 2007, 13(2):81-83
DOI:10.4103/1319-3767.32182  PMID:19858618
Aim: This is a cross-sectional study to determine the prevalence and risk factors for transmission of hepatitis B virus (HBV) infection in the Gezira state of central Sudan prior to the introduction of blood screening and vaccination against HBV. Materials and Methods: The study was carried out on the population of Um Zukra village in Gezira state of Central Sudan. The village was surveyed on five consecutive days in Dec 2000. Epidemiological characteristics were recorded and participants were interviewed for risk factors of viral hepatitis. Blood samples were then collected and tested for HBsAg and HBcAb. Results: A total of 404 subjects were screened with a mean age of 35 years; 54.9% were females, HBsAg and HBcAb were reactive in 6.9% and 47.5% of the studied population, respectively. Exposure to HBV increased with increasing age. The only significant risk factor for transmission of infection was a history of parenteral antischistosomal therapy. Conclusion: This study shows that prevalence of HBV infection is high in the studied population and it is hoped that introduction of blood screening and vaccination against HBV would decrease the carrier pool in the next few years.
  7 5,602 747
Endoscopic ultrasound and hisopathologic correlates in eosinophilic gastroenteritis
Sami Alnaser, Abdulrahman M Aljebreen
April-June 2007, 13(2):91-94
DOI:10.4103/1319-3767.32185  PMID:19858621
Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic infiltration into any layer of stomach and intestine (mucosa, muscularis mucosa and serosa), usually in association with peripheral eosinophilia. In this case report, we present a patient with eosinophilic gastroenterocolitis who had a history of bronchial asthma and presented with abdominal pain. He was found to have peripheral eosinophilia, perforation and gangrenous bowel on performing surgery and tissue eosinophilia on histopathology examination. His endoscopic ultrasound (EUS) showed significant thickening of his antral and duodenal mucosal and submucosal layers which correlated well with the gross and microscopic pathology of the resected surgical specimen. This is the first case to demonstrate EUS abnormalities in this very rare disorder.
  5 7,392 694
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.
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Does Helicobacter pylori affect portal hypertensive gastropathy?
Ibrahim A Al Mofleh
April-June 2007, 13(2):95-97
DOI:10.4103/1319-3767.32186  PMID:19858622
Helicobacter pylori (H. pylori) is a major etiological factor of peptic ulcer disease (PUD). It is supposed to be a risk factor for the more frequently encountered PUD in patients with liver cirrhosis. Several investigators have evaluated the effect of H. pylori on liver cirrhosis, portal hypertensive gastropathy (PHG) and encephalopathy with controversial results. Some reports have shown a higher seroprevalence and suggested a synergistic effect of H. pylori on liver cirrhosis and PHG. However, this increased prevalence is associated with a negative histology and is not influenced by the cause of cirrhosis, PHG, Child class or gender. Most studies have not found any correlation between H. pylori and PHG. In contrast, other studies have reported a markedly lower prevalence of H. pylori in cirrhotics with duodenal ulcer compared to controls. The aim of this article is to review the relationship between H. pylori infection and portal hypertensive gastropathy and the role of H. pylori eradication in cirrhotic patients.
  2 5,747 860
Hepatitis C virus-associated thrombocytopenia is not related to serum thrombopoietin levels
Ola A Afifi, Eman M Sewify, Madiha M El-Attar, Amal O Taie, Ahmad K Mostafa
April-June 2007, 13(2):76-80
DOI:10.4103/1319-3767.32181  PMID:19858617
Objective: Hepatitis C virus (HCV) infection is one of the most important health problems in Egypt. Thrombocytopenia is a common finding in subjects with chronic hepatitis. The precise etiology of this thrombocytopenia is still obscure. There is increasing interest in the potential role of thrombopoietin (TPO) as a cause of this thrombocytopenia. The aim of this work was to determine serum TPO levels in HCV-positive patients and to test the assumption that HCV-associated thrombocytopenia could be due to low TPO levels. Materials and Methods: Forty patients with HCV infection were included in this study and classified into three groups according to the degree of thrombocytopenia (IA-mild, IB-moderate, II-none). Twenty five healthy volunteers served as control (Group III). All patients and controls had undergone full clinical assessment and the following laboratory investigations: complete blood count, liver function tests, prothrombin time and concentration and serum TPO level. Results: TPO levels were significantly elevated in Group IA as compared to the control group ( P <0.05). No significant difference was found between groups IA and II. TPO in Group IB was slightly, but insignificantly reduced compared to Group IA but did not differ statistically from the control or Group II. Significant negative correlation was found between serum TPO levels and platelet counts in Groups IA, IB and II (r=-0.421, P <0.05). No correlations were found between serum TPO levels and liver function tests or hematological parameters. Conclusion: An impaired TPO production did not explain the development of thrombocytopenia in HCV and other mechanisms must be involved.
  2 5,151 627
Candida esophagitis in achalasia cardia: Case report and review of literature
Praveen Kumar, Suyash Mohan, Ashish Verma, Sanjay S Baijal
April-June 2007, 13(2):88-90
DOI:10.4103/1319-3767.32184  PMID:19858620
Candida albicans is by far the most common cause of infectious esophagitis. In most patients, this infection is secondary to an immuno-compromised state. In nearly 25% of the cases, underlying causes of esophageal stasis, e.g., achalasia and scleroderma, facilitate fungal colonization of the esophagus. Double contrast esophagography is a highly sensitive tool for diagnosing candida esophagitis. This report discusses the uncommon association of Candida esophagitis with achalasia cardia, their radiographic features and a short review of the available literature.
  1 8,921 764
Adalimumab: A new tumor necrosis factor antagonist and the treatment of Crohn's disease
Ahmed Helmy, Khalid Al Kahtani
April-June 2007, 13(2):98-100
DOI:10.4103/1319-3767.32187  PMID:19858623
Antibody-neutralization studies have implicated tumor necrosis factor-α (TNF-α) and IL-12 p40 in the pathogenesis of Crohn's disease (CD). Many randomized controlled trials (RCTs) have demonstrated the efficacy of infliximab, a chimeric monoclonal antibody to TNF, in inducing and maintaining disease remission in patients with moderate to severe CD, including those with draining fistulas. However, infliximab is administered intravenously and is associated with immunological reactions and development of antibodies, and hence reduced efficacy. In this article, we describe the efficacy and safety profiles of a newly available recombinant, fully humanized, subcutaneously-administered, anti-TNF-α monoclonal antibody, adalimumab (Humira) in patients with moderate to severe CD. Many recent RCTs have shown that adalimumab is not only similar to infliximab in the mode of action, efficacy, and safety, but it has the advantages of causing less anaphylactic or immunological reactions, being administered by the subcutaneous route, less need for hospitalization, and a half-life of 2 weeks that allows every other week dosage. Adalimumab has also shown some efficacy in infliximab-intolerant or resistant cases. Therefore, it represents a new horizon in the treatment of CD patients, and may reduce the number of patients who require surgical intervention.
  1 5,272 590
Hepatitis B genotyping and its clinical implications
Awad A Saeed, Abdelrahman E Mohamed
April-June 2007, 13(2):101-101
DOI:10.4103/1319-3767.32188  PMID:19858624
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Authors' reply
Badr Al-Jarallah
April-June 2007, 13(2):102-102
  - 2,041 278
Longitudinal pancreatico-gastrostomy: An effective means of pain control in chronic pancreatitis
Prosanta K Bhattacharjee
April-June 2007, 13(2):70-75
DOI:10.4103/1319-3767.32180  PMID:19858616
Aim: To assess the effectiveness of longitudinal pancreatico-gastrostomy (LPG) in relieving intractable abdominal pain in patients of chronic pancreatitis (CP) with dilated main pancreatic duct (MPD). Materials and Methods: This prospective study was conducted from 1997-2005 at two university-affiliated hospitals in India. Ductal decompression by LPG was performed in 30 patients (26 males, 4 females) suffering from intractable pain due to CP. The operative outcomes were classified as satisfactory and unsatisfactory according to whether the patients were completely / almost completely relieved of pain or continued to be troubled by pain. Main outcome measures: The main outcome measures were pain-relief, postoperative morbidity, and mortality. Results: There was no postoperative mortality. Morbidity included pancreatic fistula in one patient, which closed spontaneously, gastric hemorrhage in two, prolonged ileus in one and wound infection in another. Twenty eight patients (93%) patients could be followed up till the end, the mean follow-up period being 23.8 (range 3-96) months. Operative result was satisfactory (no pain or mild pain) in 23 (82%) and unsatisfactory (moderate to severe pain) in 5 (18%) patients. Complete pain relief was seen in 14 (50%) patients. The functional results, in terms of pain relief, were better in patients who had abstained from alcohol postoperatively. Conclusion: LPG is a good operative procedure to relieve intractable pain in patients of CP with an MPD diameter of at least 7 mm.
  - 5,057 504
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