Prevalence of helicobacter pylori infection among patients with dyspepsia in South-Western Saudi Arabia

Helicobacter pylori [H. pylori] infection is a major cause of various upper gastrointestinal [UGI] disorders. The aim of this study was to determine the prevalence of H. pylori among patients with dyspepsia. A prospective study was carried out in the Gastroenterology Division, King Fahd Central Hospital, Gizan, Kingdom of Saudi Arabia from January 1995 to December 1998. Four hundred and eighty-eight patients with dyspepsia were consecutively examined using the UGI endoscopy during a 4-year period. Data analyzed included demographic details, clinical indications for the examination, endoscopic findings and results of the histopathologic assessment for H. pylori. Overall, H. pylori were detected in 268 [54.9%] of the gastric biopsies from 488 patients [322 males and 166 females, aged 13-90 years]. Helicobacter pylori infection was present in 140 [60.1%] of 253 patients with chronic gastritis diagnosed by endoscopy and in 49 [62.8%] of 78 patients with duodenal ulcers [DU]. The rate in DU patients was significantly higher than the rate [43.6%] in patients with normal endoscopic findings [odds ratio [OR]=2.18, 95% confidence interval [CI] 1.02-4.70; p=0.04]. Of 455 biopsies with histologic gastritis, 268 [OR=58.9%, 95% CI 54.2-63.4] were positive for H. pylori and all specimens [n=33] with no histological evidence of gastritis were negative. The well-described association of H. pylori with DU and non-ulcer dyspepsia was confirmed by our study. However, the rate of H. pylori in our patients was at the lower end of the range [50-80%], which was previously reported among largely urban populations in Saudi Arabia suggests differences in the prevalence of H. pylori-infections between urbanized and rural populations. Helicobacter pylori negative peptic ulcer disease remains an important entity that may be associated with the use of non-steroidal anti inflammatory drugs and in our environment, the habitual chewing of qat leaves [catha edulis]

Profile of stroke in Gizan, Kingdom of Saudi Arabia

The epidemiological characteristics of stroke at different geographical locations in the Kingdom of Saudi Arabia [KSA] have not been fully investigated. Reports from some areas indicate that stroke is one of the major causes of morbidity and mortality in the population. The present study was carried out to determine the clinical profile of stroke, its subtypes and associated risk factors in Gizan Province, KSA. Data on consecutive patients with stroke admitted to King Fahd Central Hospital, Gizan, KSA over a 2-year period from January 1997 to December 1998, were retrospectively analyzed. Diagnosis was confirmed by computerized tomography of the brain. Etiologic and risk factors were identified by relevant clinical, laboratory and imaging investigations. Two hundred and forty-one patients [146 males and 95 females; mean age 64.5] were hospitalized during the study period. The subtypes of stroke comprised cerebral infarction [65.6%]; intracerebral hemorrhage [30.7%] and sub-arachnoid hemorrhage [3.7%]. Coma and convulsions were more frequent among patients with hemorrhagic strokes compared to the subgroup with cerebral infarction. Major risk factors included hypertension [45.6%], heart diseases with or without atrial fibrillation [31.1%] and diabetes mellitus [22.8%]. In 19 [7.9%] patients, no risk factor was found. In-hospital mortality occurred in 20.3% [49 of 241 patients], with no significant difference in the rates in the different subtypes. The crude incidence [estimated as 15.9 per 100, 000] in Gizan, KSA, a largely rural area is lower than the reported rates in urban areas of KSA. However, intracerebral hemorrhage had a higher relative frequency, suggesting a geographic variation in the subtypes at different areas. The establishment of rehabilitation centers in the province will reduce the heavy burden on health services and relatives. The incidence and prevalence of stroke must be reduced by appropriate strategy with the objectives of preventing or modifying risk factors such as hypertension, diabetes mellitus and smoking. A national stroke registry should be strengthened to provide further information on the epidemiology of stroke in KSA

Profile of acute pancreatitis in Jizan, Saudi Arabia

The epidemiology of acute pancreatitis in the Kingdom of Saudi Arabia [KSA] may be different from the West. The present study describes the profile of acute pancreatitis in Jizan, KSA. Patients diagnosed as acute pancreatitis in the King Fahd Central Hospital [KFCH], Jizan, KSA over a period of 12 years [1411-1422 Hijra year] were retrospectively analyzed with particular reference to the clinical features, disease severity, and result on management. There were 71 episodes in 62 patients [26 males and 36 females; 53 Saudis, whose ages ranged from 13-82 years [mean age: 42.6 years.]. Of these patients, 5 had 2 episodes each one had 5 recurrent episodes. The etiology included gallstone disease in 26 [42%] cases; endoscopic retrograde cholangiopancreatography [ERCP] in 11 [18%] cases. No cause could be identified in 16 [26%]. Patients. with ERCP - related pancreatitis were asymptomatic. In the symptomatic group [60 episodes], abdominal pain [100%], vomiting [78%] and fever [20%] were the most frequent features. Overall the clinical course was mild in 61 [86%] episodes and severe in 10 [14%]. Ranson's scoring accurately identified 60 of the 61 mild episodes and only 6 of the severe illness. Complications in the latter sub-group of cases, included pseudocyst [4 cases] and pancreatic abscess in 2 cases. Three of the patients died, giving overall mortality of 4.2%. Two deaths were directly related to the severe pancreatitis and one was due to massive vomiting and aspiration. It is concluded that 1. Cholelithiasis is the most frequent cause of acute pancreatitis; 2. Biliary pancreatitis occurred more frequently in elderly females and was associated with higher mean levels of lactic dehydrogenase and aspartate transaminase as compared to patients with non-biliary causes. In Jizan, acute pancreatitis presents in a mild form with low morbidity and mortality, irrespective of the cause

decline of hepatitis B viral infection in South-Western Saudi Arabia

Hepatitis B virus [HBV] infection is endemic in the Kingdom of Saudi Arabia [KSA]. The Jizan region in the South-Western area of the country was noted for a high prevalence of hepatitis B surface antigen [HbsAg] carrier rate. The study was carried out to determine the prevalence of HBsAg and other markers of HBV among residents of Jizan and evaluate the impact of the measures adopted in the last decade, to control HBV. The study was carried out between 1995 and 1998. The subject were studied in 4 groups: Group A consisted of voluntary blood donors [n=14883] tested within the blood banking system during the time period June 1995 to June 1997, Group B were patients treated in the hospitals [n=4692] during the period June 1995 to June 1996, Group C consisted of volunteers recruited from the community [n=1172] and Group D children aged <10 years [n=229]. Serum samples were obtained from the subjects tested for HBsAg, total antibody to hepatitis B core antigen, antibody to HBsAg and antibody to hepatitis C virus. Hepatitis B surface antigen was positive in 5.4% of 14883 voluntary blood donors [Group A] and in 5.1% of 1172 persons recruited from the community [Group C] 40.2% were positive for at least one marker of HBV. The prevalence of HBsAg in-patients in Group B was 9.7% [456 of 4692]. These prevalence rates are significantly lower than the prevalence of 12% and 32% reported in 1985 and 1986. Only 2 [0.9% of 229] children in Group D were positive for HBsAg, indicating a major decline from the rate of 8.8% observed in an earlier survey. The low prevalence of HBsAg in children, provides evidence for the effectiveness and efficacy of the integration of hepatitis B vaccination into the extended program of immunization in KSA. The significant decline of HBV markers among unvaccinated Saudi adults indicated an indirect effect of other factors [for example health education and socio-economic progress] on the prevalence and transmission of HBV in Jizan. In areas of high endemicity, the epidemiological characteristics HBV are modified significantly by the combination of HBV vaccination and other complimentary control strategies

Hepatitis A in Saudi Arabia: a comparative sero-epidemiological study

To determine the prevalence of Hepatitis A Virus infection among Saudi children [1-12 years] in 1997. To compare the results with our previous study in 1989. This is a randomized community-based study involving all of the regions of Saudi Arabia. All children were tested for antibody Hepatitis A Virus immunoglobulin [IgG] class. The prevalence of anti-Hepatitis A Virus IgG among 5355 Saudi children tested ranged from 10% in Taif to 82% in Gizan regions with an overall prevalence of 25%. There is a reduction of the overall prevalence from 50.5% in 1989 to 25% in 1997. This study shows a marked decline in Hepatitis A Virus infection in Saudi children 8 years after the first study. There is an almost 50% reduction of the overall Hepatitis A Virus prevalence. This dramatic decline in Hepatitis A Virus infection among the Saudi children will lead to a later exposure of elderly population groups to the Hepatitis A Virus infection and a new preventive strategy needing to be adopted