The clinical profile of cyclic vomiting syndrome in a regional hospital, Saudi Arabia.

BACKGROUND: Cyclic-vomiting syndrome is an uncommon disorder in adults. The aim was to determine the frequency and define the clinical characteristics of the syndrome among Saudi patients. METHODS: The subjects were patients with recurrent vomiting who were evaluated and treated in a regional referral centre in Saudi Arabia. RESULTS: Of 4290 patients who had endoscopic examinations during a period of 7 years (1995-2001), 13 patients (11 females and 2 males, mean age = 18.4 years) were diagnosed as cyclic vomiting. Precipitating factors were rarely identified and none of the cases was associated with migraine. Responses to therapy, which comprised reassurance, tricyclic drugs and prokinetic drugs were variable. CONCLUSIONS: The study indicated that the syndrome is relatively rare among Saudi patients with a frequency of 2.6 per 1000. The delay in the referral of these patients to a specialized unit was striking. It is probable that the syndrome is under-diagnosed and under-reported, in general. This report may stimulate more awareness of this disorder among health care givers in Saudi Arabia and may avoid unnecessary and protracted investigations.

Barrett's esophagus: a review.

Barrett's esophagus [BE] is usually an acquired, condition in which specialized metaplastic intestinal columnar epithelium with goblet cells replaces the normal stratified squamous epithelium anywhere in the esophagus. It results from chronic irritation of esophageal mucosa by refluxed gastric contents. The importance of BE comes from its potential risk of progression to adenocarcinoma. The development of dysplastic changes in Barrett's metaplasia increases this risk markedly. However, the true incidence and the likelihood of adenocarcinoma developing in such individuals with dysplasia over a lifetime are not well defined. Histopathology of esophageal biopsy is mandatory for the diagnosis, because clinical, radiological and endoscopic findings in such cases can only suspect the disease. The exact prevalence of BE in the general population is difficult to estimate, however worldwide distribution of the disease vary considerably. BE has also been reported to occur in children. It has bimodal age distribution in adults. Despite the considerable attempts to treat BE, complete elimination of this premalignant epithelium is rare. The impact of medical or surgical therapy on the risk of malignancy remains obscure. To date, the optimal form of treatment whether by drugs and/or endoscopic ablation or by surgery remains undetermined.

Primary malignant melanoma of the oesophagus: case report and review.

Primary malignant melanoma of the oesophagus [PMME] is a rare tumour. Worldwide, less than 200 cases have been reported to date. We report here a 72 year-old Saudi male who presented with abdominal pain and anorexia. On endoscopy a dark lesion was found in the oesophagus. Its histopathological features were consistent with malignant melanoma. There were no other melanotic lesions elsewhere. PMME occurs most frequently in the 7th and 8th decades of life with a male predominance. It is an aggressive tumour with the majority of patients dying in less than 2 years due to metastases to vital organs. Surgery is the treatment of choice. However, radiation may be useful as adjuvant therapy.

Upper gastrointestinal diseases in Saudi Arabian children.

In contrast to the experience in the adults, there are limited data concerning the efficacy and safety of upper gastrointestinal endoscopy (UGIE) in paediatric patients. The information on this procedure is very scanty from non-western countries. We analysed 72 children evaluated in Gizan, Saudi Arabia, an area of high endemic hepatitis B and chronic liver disease. The indications comprised abdominal pain (49%), UGI bleeding (24%) and evaluation of suspected portal hypertension. No abnormality was detected in 33 (46%). Mucosal inflammatory lesions (oesophagitis, gastritis and duodenitis) are the commonest abnormal lesions, occurring in 24 (33%). Duodenal ulcer (4 cases) and gastric ulcer (1 case) were relatively few. No case of malignancy was found. Sclerotherapy for variceal bleeding was effective in 4 patients. Helicobacter pylori was detected in 12 of 23 patients and associated with histologically identified gastritis in the majority of these cases. It is concluded that paediatric UGIE is safe and useful in the diagnosis and therapeutic intervention for UGI diseases in children. Our findings provide additional information on the pattern of diseases among Saudi Arabian children.

Barrett's oesophagus and oesophageal cancer in Saudi Arabia.

BACKGROUND/AIMS: Gastrooesophageal reflux disease (GERD) and Barrett's oesophagus (BE) are presumed to be rare among non-western populations. This retrospective survery determined the prevalence of BE and its associated complications of dysplastic lesions (DL) and oesophageal adenocarcinoma (AD) among an Arabian population. METHODOLOGY: From 2572 patients who had endoscopy in King Fahd Central Hospital (KFCH) Gizan, Saudi Arabia, patients (n = 776) were selected for analysis if they had biopsies of the upper gastrointestinal (UGI) tract. The patients (159 of 776) with biopsy-proven oesophageal lesions were categorized and compared. RESULTS: The relative frequencies of BE, DL and AD in 159 patients were 8(5%), 5(3%) and 16 (10%) respectively. These interpreted to prevalence rates of 0.31%, 1.9%, and 0.62% for the respective lesions. The comparison of the mean age +/- SD (in years) of the patients with BE (59.6 +/- 19.8), DL (66 +/- 16.7) and AD (70.6 +/- 12.2) showed to statistically significant difference. Major symptoms in the patients with BE were dyspepsia (4 cases), hematemesis (2 cases) and dysphagia (2 cases). This profile was not different from that observed in 79 patients with GERD. CONCLUSION: The prevalence of 0.31% in our endoscopy population is at the lower range of the 0.3% to 10% reported in the western world. It is likely that the rate was underestimated by this retrospective survey, in which patients were selectively biopsied. Also, it is probable that the majority of individuals in our population with no or minimal symptoms of GERD do not present themselves or are not referred for evaluation. Despite this limitation, our study confirms the occurrence of BE and its complications among a Saudi population. The incidence of BE may increase with the current changes in the life-style and increase in the life-span of the Saudi Arabian population.

Hepatic manifestations of Wilson's disease: frequency and pattern in Saudi patients.

Seven symptomatic patients with Wilson's disease have so far been diagnosed at King Khalid University Hospital (KKUH), Riyadh, over the last six years. On family screening, another three asymptomatic patients were found to be affected. Five of the symptomatic patients had clinical features of liver disease on initial presentation and was preceded by renal dysfunction in another patient. The remaining patient presented with neurological features. Six patients had Kayser-Fleisher ring. Abnormal liver function tests were found in half of the patients. Ceruloplasmin was reduced in 7 of 10 patients. Serum copper and urinary copper estimations were most useful diagnostic laboratory tests. Morphological alteration was found in all 9 patients who had a percutaneous liver biopsy. All patients were treated initially with D-penicillamine and clinical response was noted in seven, of whom one developed neurological manifestations while receiving the treatment. D-penicillamine was replaced by zinc sulfate in 3 patients who developed thrombocytopenia. The data suggest that Wilson's disease may not be rare in Saudi Arabia. For early detection and prompt treatment, the disease should be suspected under appropriate clinical circumstances especially in young patients with liver diseases. Close relatives of such index patients should be routinely screened.

Helicobacter pylori; histological and cultural correlation in chronic gastritis.

Seventy seven antral biopsies were collected from patients attending endoscopy clinic at King Khalid University Hospital, Riyadh, Saudi Arabia during a period of six months between December 1988 to May 1989. Of these 69 (89.6%) showed chronic gastritis as well as Helicobacter-like organisms (HLOs) in the biopsy specimens while 63 (81.8%) of biopsies grew Helicobacter pylori on culture. These findings indicate a good correlation between the histological diagnosis of chronic gastritis and isolation of H. pylori on culture.

Use of selective and non-selective media for the isolation of Helicobacter pylori.

Antral biopsy specimens from patients having gastroduodenal disorders were cultured in parallel on sheep blood agar (SBA) and Skirrow's selective medium (SSM) for Helicobacter pylori. It was found that the overall isolation rate of the organism was much lower in SSM (54.5%) than on SBA (87.9%), a difference which is statistically significant (P less than 0.01). This may be due to the incorporation of polymyxin B in SSM. In absence of a suitable selective medium, blood agar may be used. Although consideration must be given to contamination, we found that contamination of SBA culture plates was not significant enough to hamper the isolation of the organism in the vast majority of the cases (98.5%).