Saudi Journal of Gastroenterology
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   2020| March-April  | Volume 26 | Issue 2  
    Online since April 21, 2020

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Efficacy and safety of probiotics in irritable bowel syndrome: A systematic review and meta-analysis
Jian-Rong Sun, Chen-Fan Kong, Xiang-Ke Qu, Chao Deng, Yan-Ni Lou, Li-Qun Jia
March-April 2020, 26(2):66-77
DOI:10.4103/sjg.SJG_384_19  PMID:31898645
Background/Aim: Irritable Bowel Syndrome (IBS) is a common chronic functional bowel disorder and the evidence shows most drug therapies in the treatment of IBS are weak. Recently, some studies showed probiotics may have a positive effect in IBS and they are widely used to improve the symptom of IBS, which indicate probiotics may play an important role in the treatment of IBS. However, the exact effectiveness and safety of probiotics are largely unknown. This systematic review focuses on identifying the efficacy and safety of probiotics in the treatment of IBS. Materials and Methods: Data sources were searched up to February 2019. Databases included MEDLINE, CENTRAL, CINAHL, and Embase. Randomized controlled trials (RCTs) comparing probiotics including complex or individual probiotics with placebo or no therapy were screened, extracted, and appraised by two independent reviewers. The data were pooled using a random-effects model. The methodological quality of all RCTs was assessed using the Cochrane risk of bias and Jadad scale. Outcomes included symptom-relevant and patient-relevant characteristics, such as symptom relief, abdominal pain, bloating, flatulence, quality of life, and adverse event. Results: This review includes 28 studies with a total of 3606 participants. Particular combinations of probiotics, or specific species and strains, showed probiotics have beneficial effect on overall IBS symptoms (22 studies, n = 3144, RR of improvement in overall IBS symptoms = 1.5, CI 1.23 to 1.83) or overall IBS symptom and abdominal pain scores (18 studies, n = 2766, SMD = -0.31, CI -0.45 to -0.17). In addition, adverse events were not significantly higher with probiotics (8 studies, n = 923, RR = 1.05; 95% CI 0.85-1.31). However, there was no significant benefit on individual IBS symptom scores and quality of life. Conclusion: Current evidence shows particular combinations, species or strains of probiotics are effective for overall IBS symptoms. However, it is hard to derive a definite conclusion due to high heterogeneity and unclear risk of bias of some trials. Large well-designed and rigorous trials are warranted.
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Epidemiology of irritable bowel syndrome and its associated factors in Saudi undergraduate students
Omar F AlButaysh, Azam A AlQuraini, Abdulmohsen A Almukhaitah, Yasser M Alahmdi, Fahad S Alharbi
March-April 2020, 26(2):89-93
DOI:10.4103/sjg.SJG_459_19  PMID:32031159
Background/Aim: Irritable bowel syndrome (IBS) is common among undergraduate students and is associated with several modifiable risk factors. The present study aimed to explore the epidemiology of IBS in Saudi undergraduate students. Materials and Methods: A cross-sectional study was carried out from February 2018 to June 2018. A total of 767 undergraduate students from all regions of Saudi Arabia completed an online self-administered questionnaire. IBS symptoms were assessed using the Rome IV diagnostic criteria. Results: The mean age was 21.88 years (range 18–29); 56.1% of the study population were females and 50.1% were from the central region of Saudi Arabia. Students of medical colleges represented 30.2% of the sample. The overall prevalence of IBS was 15.8%. Significant independent risk factors for IBS were female sex (OR = 3.738; 95% CI = 2.093, 6.673), being a student in a medical college (OR = 7.216; 95% CI = 4.438, 11.733), living in a rented apartment (OR = 6.752; 95% CI = 2.586, 17.627), living on campus (OR = 6.563; 95% CI = 2.138, 20.145), poor sleep quality (OR = 3.156; 95% CI = 1.850, 5.385), exercise (OR = 0.394; 95% CI = 0.193, 0.803), smoking (OR = 5.256; 95% CI = 2.841, 9.724), family history of IBS (OR = 1.641; 95% CI = 1.012, 2.661), and emotional stress (OR = 2.184; 95% CI = 1.375, 3.469). Conclusion: Overall, 15.8% of participants in this study met the Rome IV criteria for IBS diagnosis. IBS was associated with several lifestyle factors, as well as family history and emotional stress.
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Treatment with compound Lactobacillus acidophilus followed by a tetracycline- and furazolidone-containing quadruple regimen as a rescue therapy for Helicobacter pylori infection
Airu Liu, Yuxin Wang, Yingxiao Song, Yiqi Du
March-April 2020, 26(2):78-83
DOI:10.4103/sjg.SJG_589_19  PMID:32295932
Background/Aim: Treatment of Helicobacter pylori infections has become more difficult because of increasing antibiotic resistance. We assessed the efficacy and safety of treatment with probiotics followed by a tetracycline- and furazolidone-containing quadruple regimen as rescue treatment for H. pylori infection. Patients and Methods: This retrospective study examined patients with at least two H. pylori eradication failures. Patients were given a two-week compound Lactobacillus acidophilus (1 g t.i.d.), followed by a quadruple antibiotic regimen (esomeprazole [20 mg b.i.d.] + bismuth potassium citrate [220 mg b.i.d.] + tetracycline [750 mg b.i.d.] + furazolidone [100 mg b.i.d.]) for 10 days as rescue therapy. Eradication was evaluated using the[13]C-urea breath test at 4 weeks after the end of therapy, and side effects were recorded. Results: The records of 50 patients were examined. Four cases experienced treatment failure, and one case received replacement with metronidazole because of allergy to furazolidone. The eradication rate was 92.0% [95% confidence interval (CI): 84.0–98.0%) in intention-to-treat (ITT) analysis and 91.8% (95% CI: 83.7–98.0%) in per protocol (PP) analysis. Side effects (mainly dizziness, dry mouth, and skin rash) occurred in 10 patients, all of which resolved after cessation of antibiotics. Conclusions: Patients who failed multiple attempts at H. pylori eradication may benefit from a treatment with probiotics followed by a tetracycline- and furazolidone-containing quadruple regimen.
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Incidence of symptomatic cholelithiasis after laparoscopic sleeve gastrectomy and its association with rapid weight loss
Faisal A Alsaif, Fahad S Alabdullatif, Mohammed K Aldegaither, Khalid A Alnaeem, Abdulrahman F Alzamil, Nouf H Alabdulkarim, Abdullah D Aldohayan
March-April 2020, 26(2):94-98
DOI:10.4103/sjg.SJG_472_19  PMID:32031160
Background/Aim: The worldwide prevalence of obesity has increased dramatically over the past years. In the Arab region, 66%–75% of adults and 25%–40% of children are either overweight or obese. Bariatric surgery has become the most effective approach for managing obesity and its co-morbidities. An expected outcome of bariatric surgery is cholelithiasis, which is one of the established risk factors of rapid weight loss. The aim of this study is to detect the incidence of symptomatic cholelithiasis among bariatric patients. Patients and Methods: A retrospective cohort study on 711 patients aged between 18 and 60 who underwent laparoscopic sleeve gastrectomy (LSG) was conducted at King Saud University Medical City from January 2016 to January 2018. Results: The postoperative incidence of symptomatic cholelithiasis was 3.5%. The mean duration of symptom development was 12.4 months. The rates of weight loss at 6 and 12 months for patients with symptomatic cholelithiasis were 28.94 ± 4.89% and 38.51 ± 6.84%, respectively (P = 0.002), which were significantly higher than in patients without symptomatic cholelithiasis during the same follow-up period (24.41 ± 6.6% and 32.29 ± 10.28%), respectively; (P = 0.012). Conclusion: We found a 3.5% incidence of symptomatic cholelithiasis among post-LSG patients in a period of 2 years. Rapid weight loss was the only risk factor that contributed to the development of post-LSG gallbladder disease. Statistical Analysis Used: Results were expressed as absolute numbers and percentages for categorical variables and as mean and standard deviation for continuous variables. A paired sample t-test was performed to determine significant differences between means at different time stamps. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 23.0.
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Efficacy of a bismuth-based quadruple therapy regimen for Helicobacter pylori eradication in Saudi Arabia
Fahad Alsohaibani, Mohammed Alquaiz, Khalid Alkahtani, Hamad Alashgar, Musthafa Peedikayil, Abdulrahman AlFadda, Majid Almadi
March-April 2020, 26(2):84-88
DOI:10.4103/sjg.SJG_626_19  PMID:32295933
Background/Aim: The treatment efficacy of Helicobacter pylori (H. pylori) has been decreasing over time due to resistance to multiple antimicrobial therapies. The most effective treatment regimen for Saudi Arabian patients infected with H. pylori is still unknown. We aimed to study the eradication rate of 10 days of quadruple therapy; bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg for H. pylori infection in a Saudi population. Patients and Methods: This was a prospective, open-label, non-randomized controlled trial. Patients with H. pylori infection were diagnosed by upper gastrointestinal (GI) endoscopy and rapid urease test (RUT) or histology. Patients who tested positive were recruited. Eligible patients were prescribed a 10-day course of quadruple therapy and received three capsules 4 times daily for 10 days along with omeprazole 20 mg twice daily. H. pylori was considered eradicated if the urea breath test (UBT) was negative after 6 weeks of completing the treatment. Results: Ninety-two patients with H. pylori infection were recruited. Three patients withdrew from the trial and another seven patients lost follow-up. We analyzed 82 patient's data as per-protocol analysis, of whom 66 (80%) were naive to H. pylori treatment. Four patients had failed previous treatment with the sequential regimen and 12 patients had treatment with clarithromycin-based triple therapy. The post-treatment UBT for H. pylori infection was negative by per-protocol analysis in 72/82 patients (87.8%), and 72/92 (78.3%) by intention-to-treat analysis. There was no correlation between previous treatment failure and treatment response to the bismuth-based quadruple therapy (P value = 0.28). Conclusions: Treatment with a bismuth-based quadruple therapy was effective in eradicating H. pylori infection in 78.3% of Saudi patients with an ITT analysis and in 87.8% as per-protocol analysis.
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Strategies for Helicobacter pylori eradication in the year 2020
Rinaldo Pellicano, Davide Giuseppe Ribaldone, Gian Paolo Caviglia
March-April 2020, 26(2):63-65
DOI:10.4103/sjg.SJG_95_20  PMID:32295934
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Percutaneous endoscopic gastrostomy in children less than 10 kilograms: A comparative study
Osama A Bawazir
March-April 2020, 26(2):105-110
DOI:10.4103/sjg.SJG_525_19  PMID:32031162
Background/Aim: Percutaneous endoscopic gastrostomy tube (PEG) has replaced the standard open surgical gastrostomy for enteral nutrition. However, several complications were reported, especially in children less than 10 kg. Our objective was to report the outcomes of percutaneous endoscopic gastrostomy in children according to their weight. Patients and Methods: 163 children had PEG tube insertion in our tertiary referral hospital from January 2007 to March 2019. Patients were divided into two groups according to the weight; group I (less than 10 kg; n = 112) and group II (more than 10 kg; n = 51). Comparisons were made between the two groups for incidence of postoperative complications, the need for reintervention, 30-day, and 1-year mortality. Results: There were 51 males (45.5%) in group I and 27 in group II (52.9%) (P = 0.38). The mean weight at the time of endoscopy was 5.9 ± 1.53 and 17.3 ± 8.23 kg and the mean American Society of Anesthesiologists (ASA) score was 2.6 ± 0.67 and 2.43 ± 0.57 in group I and II, respectively (P = 0.101). The most common associated condition was cerebral palsy (50 (44.6%) and 24 (47.1%) in group I and II, respectively; P = 0.77). The mean operative time was 30.28 ± 11.57 min in group I and 33.62 ± 23.36 min in group II (P = 0.221). Skin complications were the most commonly encountered complications of PEG, and 49% (n = 48) required the removal and replacement of the tube under general anesthesia in group I and 41% (n = 21) in group II (P = 0.84). There was no significant difference in the complication between groups. Conclusion: PEG is a safe technique in children less than 10 kg, and the complications rate is comparable with older children. The use of positive transillumination and small needle for measuring the distance between the skin and the stomach enhances the safety of the procedure. PEG should be considered in children less than 10 kg who need supportive or continuous enteral nutrition for different reasons.
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Social media usage pattern and its influencing factors among celiac patients and their families
Ahmed Al Sarkhy
March-April 2020, 26(2):99-104
DOI:10.4103/sjg.SJG_495_19  PMID:32031161
Background/Aim: The aim of this study was to investigate social media usage patterns among celiac patients and explore the potential factors that may influence the frequency of its usage. Patients and Methods: A cross-sectional survey was conducted, in which an online questionnaire was sent to celiac patients registered in the Saudi celiac patients' support group through email and its related social media accounts. Eligible participants included all patients with biopsy-confirmed celiac disease or their parents. Results: In total, 221 participants completed the survey. The majority (96%, n = 212/221) reported using social media networks for their disease management. We included only those participants in the analysis. The median age was 36 years (range; 18–60 years). The majority of respondents (59.4%) were female. Most participants (65.6%) were patients with celiac disease and 34.4% were parents of celiac patients. The median duration of the disease was three years (range; 1 month–26 years). The three most frequently visited social media platforms were WhatsApp by 175 (82.5%) participants, Instagram by 132 (62.3%), and Twitter by 124 (58.5%) participants. The median time spent on social media was 60 min per day (range; 10–720 min). Multivariate logistic regression showed that celiac disease patients used social media two times more than the parents of celiac patients (OR 2.37, 95% CI: 1.19 - 4.72; P = 0.014). Conclusions: Celiac patients are highly involved in social media activities for purposes related to their disease. We encourage healthcare providers to be available online to provide trustable and high-quality educational materials.
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