Emerging inflammatory bowel disease in Saudi outpatients: a report of 693 cases

Inflammatory bowel disease [IBD] is a chronic disease of unknown etiology and considered traditionally as a disease of the western world. Recently, rising trends have been observed in countries previously known to have a low prevalence and incidence. The aim of this study is to collect epidemiological data on IBD outpatients and to add data from the Kingdom of Saudi Arabia [KSA] to the available IBD literature. The medical records of 693 Saudi patients with IBD over a period of 17 years, between 1993 and 2009, were reviewed. The demographic and clinical data and methods of diagnosis were retrieved. The total number of patients in this cohort was 693. It constituted 238 [34.3%] ulcerative colitis [UC] and 455 [65.7%] Crohn's disease [CD] patients. UC was steady throughout the years, whereas only 1.2 CD patients were diagnosed per year in the first 11 years, and 73.7 per year in the last six years. The median age of UC patients was 34 years, ranging from 10 to 80 years with a peak between 21 and 40 years and in CD it was 27 years, ranging from 11 to 73 years with a peak between 11 and 30 years. There was a male preponderance of 1.5:1 and 2:1, respectively. The rest of the data is discussed in this study. IBD is no longer a rare disease in KSA. UC is in a steady state, whereas CD is increasing significantly and far outnumbering UC

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

Formol-ether concentration method in the diagnosis of active schistosoma mansoni in patients with detectable IHA

Schistosomiasis is a world wide human infection. In Saudi Arabia there are multiple endemic foci. Various methods have been used to diagnose Schistosoma mansoni. We studied 1410 patients coming from S. mansoni endemic areas with detectable antibodies by indirect hemagglutination [IHV]. Stool specimens were tested for S. mansoni ova by direct smear and formol-ether concentration [FEC] methods. The objective of the study was to identify patients with active schistosomiasis using FEC method and a single direct smear. Twenty% of IHA positive patients had active infection detected by FEC, while a single direct stool smear diagnosed only 2.4% [P<0.0001]. The percentage of positive FEC was significantly increasing in linear trend with IHA level. This trend wasn't observed with direct smear examination. The current data suggest that FEC is helpful to diagnose active schistosomiasis, therefore it is recommended in IHA positive individuals

Esophageal candidiasis among a dyspeptic population

This is a retrospective study of 59 patients endoscoped over a period of six years at a private clinic and were found to have esophageal candidiasis. The median age was 46.68 years. Thirty [51%] patients has no precipitating factors. Only 18 [30%] patients had typical symptoms. The distal part of the escophagus was more often involved. The thrush was scattered in 57 [97%] patients. The endoscopic finding was confirmed by cytology in all patients included. Symptoms improved on oral nystatin treatment and simultaneous treatment of associated conditions in all 46 patients followed up. In conclusion, esophageal cadidiasis appear to be not uncommon among dyspetic population. It presents more frequently with atypical symptoms and responds well to oral nystatin treatment

Doxycline-induced esophageal ulcerations

Over a period of six years 16 patients presented to Dr. Al Mofarreh's polyclinic with drug-induced esophageal ulcerations. One patient had esophagitis without ulcerations and two patients, who declined endoscopy were not included in this analyzis. The mean age of the remaining 13 patients was 28.92 +/- 10.39 years. The mean ulcers number was 3.69 +/- 2.76. The ulcers were located at the mid-esophagus, 29.23 +/- 3.94 cm from the incisors teeth. Odynophagea, retrosternal pain and dysphagea in 13 [100%], 12[92%] and 9[69%] patients, respectively, were the most frequent presenting symptoms. All patients took a doxycycline preparation at bed time with little water. The mean elapse between the drug intake and endoscopy was 7.85 +/- 9.96 days. The symptoms resolved within a maximum of one week of antireflux treatment despite the continuation of doxycycline therapy in three patients with brucellosis. The current data confirmed the role of oral doxycycline intake, the timing and the amount of concurrent fluid in the etiology of esophageal ulcerations