Retrospective review of epidemiological, pathological and clinical features of colorectal cancer diagnosed by colonoscopy at King Hussein Medical Center

To find out different characteristics and variables of patients diagnosed as Colorectal cancer at King Hussein Medical Center. A total of 204 cases of colonic cancer patients aged 16 years or more were identified over 4 yearperiod between January 2006 and December 2009 were reviewed at King Hussein Medical Center. The patients were divided into 2 groups according to their age; those < 55 years, and those > 55 to compare the study variables between the two age groups. Seventy five [37%] patients with colonic cancer aged under 55 years and 129 [63%] were 55 years or older. Colonic cancer was more common in men at both age groups than that in women. Localized disease was more common in the young age group. Left side colonic cancer was the most common in both age groups. Nodal involvement was almost similar in frequency in both age groups. Distant metastases were more common in the old age group > 55 years. At diagnosis, 48 [23.5%] of patients had advanced cancers [stage D] with either nodal or distant metastases. Moderately differentiated adenocarcinoma was the most common histological finding. Surgery was undertaken on 134 [65.7%] patients, with a postoperative mortality of 2 [1.5%] patients. Anti-cancer chemotherapy was given to 91 [44.5%] patients and radiotherapy was used in 7 [3.4%] patients. Eleven [5.3%] patients received chemo-radiotherapy and 20 [9.1%] patients received the three modalities of treatment. This study showed that; the frequency of colonic cancer increases with age, at the same time there is a considerable number of patients diagnosed at young age. It is common in our patients with colorectal cancers to present with advanced disease. Colorectal cancer in our group of patients had more aggressive pathological features at presentation in the young age group. Earlier diagnosis of these cancers could well serve as an achievable solution and may improve survival

Colonoscopy at King Hussein Medical Center; indications, effectiveness, safety and outcome

To find out the indications, effectiveness, safety and outcome of colonoscopy at King Hussein Medical Center. A retrospective analysis of the colonoscopy records for patients who underwent elective colonoscopy over a 7-year period [January 2000-October 2006] at King Hussein Medical Center in Amman, Jordan was done. Data collected included the number of the patients, age, gender, reason for doing the procedure, endoscopic findings, and any immediate complication. For all patients colonic preparation using Dulcolax [Biscodyl 5 mg tab] and Fortrans [Macrogol 4000-64 gm] or castor oil with normal saline and unistiffness endoscopes were used. Almost all colonoscopies were done with sedation using Mipiridine 25 mg and Midazolam 3 mg intravenously. A total of 3865 colonoscopies were included in the study, 42% percent of patients were aged less than 50 years. 89% of the colonoscopies were done for patients from physicians as outpatients and 11% for patients who were already in hospital. The number of endoscopies performed during the year 2006 per month was considerably higher [mean 65] than that done during the year 2000 [mean 30]. The main indications for colonoscopies were rectal bleeding [39%], constipation [17%], and diarrhea in 12%. In 3749 [97%] patients, the procedure was completed up to cecum. Normal colonoscopy was reported in 72.5% of patients. The most common abnormal findings were colonic cancer [29%], colonic polyps in 24% and inflammatory bowel disease in 16%. Other common findings were diverticulosis [13.4%], melanosis coli [2.4%], and vascular ectasias in 2.5%. Internal hemorrhoids was a coexistent finding in [n=30] those diagnosed as colonic cancer and [n=18] in those diagnosed as colonic polyps, but it was the only colonoscopic finding in 130 patients [12.2%]. Colonic polyps were also found as coexistent finding in 47 patients diagnosed as colonic cancer. Seven [0.018%] patients had a major complication related to the procedure in the form of colonic perforation [n=4], minor bleeding which did not necessitate blood transfusion [n=2], and stuck snare wire due to looping around a normal colonic mucosa that mandated removal by lapratomy [n=1]. Colonoscopy at King Hussein Medical Center, is safe and effective in establishing a definitive diagnosis, and rarely associated with major complications such as perforation or bleeding

Current advances in the management of Crohn's disease

Crohn's disease is a chronic relapsing and remitting inflammatory bowel disease believed to develop as a result of the stimulation of a dysfunctional immune response in genetically susceptible individuals. Crohn's disease is most commonly diagnosed in young adults [15 to 30 years] with a female-to-male ratio between unity and 1.2:1. Prevalence of Crohn's disease rapidly increased all through the world as different countries adopt a Western Lifestyle. The incidence is 5.8 cases per 100,000 people per year and the prevalence is 133 cases per 100,000 people. Mortality in Crohn's disease is now low, but morbidity is considerable, Thirty to sixty per cent of patients with Crohn's disease who attain medically induced remission will relapse within 1 year. It is estimated that 50% and 75% of Crohn's disease patients will require surgery within 5 to 15 years of diagnosis. Surgical resection is not curative as evidenced by the near universal recurrence of neoterminal ileal Crohn's disease following ileocolonic resection. In the absence of a definitive cure, the aim of therapy is to induce and maintain clinical remission at an acceptable cost, avoidance of surgeries, and improvement of health-related quality of life. The first line treatment is still based on combinations of steroids, amino-salicylic acid derivatives, imunomodulators, and nutritional regimens. Biological drugs have opened new therapeutic horizons for treating Crohn's disease, but have also brought with them issues related to immunogenicity, long-term efficacy, safety and cost. This review will highlight the current advances in the management of Crohn's disease as well as discuss areas that remain controversial and are awaiting resolution

Endoscopic findings in acute upper gastrointestinal hemorrhage at King Hussein Medical Center

To find out the diagnosis in patients presenting with acute upper gastrointestinal hemorrhage at King Hussein Medical Center. A total of 1118 cases of acute upper gastrointestinal hemorrhage patients aged over 16 years who underwent upper endoscopy over a six year-period at King Hussein Medical Center were studied. Most endoscopies were done within 24 hours from the occurrence of the gastrointestinal bleeding. Patients were divided into different age groups to compare the frequency of upper gastrointestinal hemorrhage between males and females in each group. The total number of patients was also divided into 2 subgroups: those below 50 years and above 50 years to compare the distribution of the endoscopic findings between young and older age groups. Upper gastrointestinal bleeding was more common in men at all age groups than that in women except in older patients [more than 70 years]. Eighty seven percent of the endoscopies were done for patients admitted to hospital through the emergency department, and 13% for patients who were already in hospital for some other reason. Sixty two percent of patients were aged over 50. The most common finding over all was duodenal ulcer [32%]. Normal endoscopy was reported in 21% of the cases. Other frequent sources of bleeding were stomach ulcers [18.5%], esophageal varices [5.2%], portal hypertensive gastropathy [0.6%]. Mallory-Weiss tears [3.3%], and gastric tumors [4.7%]. Gastric ulcers and malignancies were more common in older compared with younger age group [2 1.5%, 6.6% vs. 14%, 1.4% respectively]. Therapeutic endoscopic interventions were done in 17% of the patients; adrenaline injection for bleeding peptic ulcer in 16%. sclerotherapy for esophageal varices in 0.9% and banding in 0.1% patients. The frequency of acute upper gastrointestinal hemorrhage increases considerably with age. The most common finding for all age groups was duodenal ulcer. Malignancy was the most important finding in the older [> 50 years] age group

Outcome of investigating women presenting with chronic abdominal pain in Jordan

To characterize the possible risk factors, clinical features, and outcome for women referred with abdominal pain that subsequently underwent investigations including colonoscopy and were found to be normal. The records of 500 women with abdominal pain seen in outpatient clinics in three hospitals at Royal Medical Services-Jordan, between January 2001 and April 2005, who subsequently underwent various gastrointestinal investigations were analyzed. Subjects were divided into two groups according to results as women with underlying causes for their abdominal pain and women with normal investigation and considered to have Irritable Bowel Syndrome. Three hundred fifty two [70%] women had normal investigations, 148 [30%] women had underlying causes. Social restrictions [family or the cultural limitations] was the only possible risk factor more frequently encountered in women with irritable bowel syndrome group [P<0.05]. Abnormal stool form or passage was the most common associated symptom. One hundred ninety three 193 [55%] patients with irritable bowel syndrome continue to visit the clinics because of abdominal pain. One hundred and two [53%] of them continued to take medications. Thirty one [16%] patients were admitted to hospital because of severe abdominal pain, and three [1.6%] were found to have an underlying cause. In women referred with abdominal pain, a diagnosis of irritable bowel syndrome was common. A hidden pathology such as celiac disease, microscopic colitis, or food intolerance may still come under the diagnosis of irritable bowel syndrome in Jordan, therefore good assessment is always needed

Advances in management of ulcerative colitis

Ulcerative colitis [UC] is a chronic inflammatory disease that primarily affects the colonic mucosa; it is most commonly diagnosed in patients aged 15-35 years, although the condition can affect patients of any age and of either sex. It's exact etiology remains uncertain. The annual incidence of ulcerative colitis in western countries is estimated to be 6-8 cases per 100,000 individuals, with the prevalence reaching 70-150 cases per 100,000 individuals. The disease course is generally relapsing-remitting, with patients experiencing few or no gastrointestinal symptoms between symptomatic relapses. As medical options increase, decisions about the sequence and timing of therapy and surgery in particular become more difficult. Consequently, a therapeutic strategy is necessary, keeping an eye on the direction of travel to avoid going round in circles from one incompletely effective therapy to another. Patients live with a considerable symptom burden despite medical treatment in the hope that a cure for ulcerative colitis will emerge. This article reviews the new advances in ulcerative colitis, epidemiology, pathogenesis, diagnosis, new therapeutic goals, as well as therapy that occurred in the past year

Open-access upper endoscopy service at prince rashid Bin Al-Hasan Hospital is safe, effective and widely advocated

To evaluate the safety, benefits, and the spectrum of upper gastrointestinal diseases among I patients who underwent diagnostic upper endoscopy at an open-access service related to the Royal Medical Services. A retrospective analysis of the endoscopy records for patients who underwent elective upper endoscopy over 6-years period 2001-2006 at Prince Rashid Bin Al-Hassan Hospital in the north of Jordan was conducted. Emergency endoscopies were excluded from the study. All endoscopies were performed under local anesthesia using pharyngeal Lignocaine spray. Data collected included the number of patients, waiting time, reasons for performing the procedure, endoscopic findings, and any complication related to the age gender. Three thousand six-hundred seventy nine endoscopies were included in the study. Sixty-two percent of patients were aged less than 45 years. Ninety-four percent of the endoscopies were performed for patients referred from physicians as outpatients and 6% for patients who were already in the hospital. The number of endoscopies performed during the period 2005-2006 was considerably higher [51%] than that performed during the periods 2001-2002 [24%] and 2003-2004 [25%]. The main indications for upper endoscopy were epigastric pain [59%], and heartburn [16%]. Normal endoscopy was reported in 61% of the patients. The most common single abnormal findings were duodenal erosions [42%], gastric erosions [29%], hiatus hernia [21%], and esophagitis [18%]. Gastric cancer was detected in 29 patients [2%], and esophageal cancer in nine cases [0.6%]. About one third of the patients had more than one abnormal endoscopic finding. None of the patients had any major complication related to the procedure. Open-access upper endoscopy service is safe and effective in establishing fast definitive diagnosis, and elevates the need for subsequent consultations with other physicians and referral to gastroenterology clinic