Crohn's disease in a Saudi outpatient population: is it still rare?

To determine the epidemiology of Crohn's disease [CD] in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance [2.3:1]. The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain [88%], diarrhea [70%], bloating [61%], rectal bleeding [50%], weight loss [33%], constipation [24%] and perianal disease [23%]. The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years

Inital factors predicting rebleeding and death in bleeding peptic ulcer disease

Bleeding peptic ulcer constitutes approximately half of the cases admitted with upper gastrointestinal bleeding. Although the bleeding episode stops spontaneously in most of them, rebleeding occurs in as much as 10-30% of them and has a mortality rate of 5-10%. In this study, we have evaluated the possible significant predictors associated with this adverse outcome. The records of 205 patients admitted to gastrointestinal bleeding unit [GIBU] in Riyadh Central Hospital, during the period May 1996 through to April 1999, with endoscopic confirmed diagnosis of bleeding peptic ulcer disease were reviewed for demography, clinical presentation, hematology, biochemistry, initial blood pressure, nasogastric lavage color, co-morbid disease and endoscopic findings. All the significant factors found initially [P<0.05] were entered into odds ratio and its 95% confidence interval and finally the unconditioned logistic regression model was used to find out the significant independent predictors for both rebleeding and mortality in these patients. The majority of patients [85%] were males and below the age of 60 [73%]. Duodenal ulcer was the source of bleeding in 84%. Endoscopy was performed in all patients within 24 hours of admission. Only 15% were actively bleeding at the time of initial endoscopy. Thirty-six patients [17%] rebelled, majority within 72 hours of initial hemostasis. Overall, 11 patients [5%] died, 6 of them were rebleeders. Initial presentation of systolic blood pressure <100 mm Hg, blood in nasogastric tube and visible vessel within the ulcer in endoscopy were independent predictors of rebleeding while initial systolic blood pressure <100 mm Hg and age >60-years were independent predictors of mortality. Improvement of outcome in patients with bleeding peptic ulcer disease can be achieved by early detection of those patients who are at risk of adverse outcome. Patients with the above mentioned independent predictors of rebleeding and mortality are best managed in the intensive care unit with endoscopic hemostasis and proton pump inhibitor [PPI] therapy for a minimum of 5- days of admission

Biliary fascioliasis clinical spectrum and endoscopic management

Human fascioliasis is well documented throughout the world, both the acute and chronic phases of the disease have been well described. Cholelithiasis with obstructive jaundice and discovery of fasciola hepatica worms during surgical exploration is a frequent mode of first diagnosis of chronic fascioliasis. Here the presentation of six proven cases are described, all were diagnosed and treated by endoscopic retrograde cholangiopancreatography with details of the almost characteristic cholangiographic picture that can be hardly confused with anything else, the clinical picture of the cases and their follow up together with a review of the disease is discussed