Consensus Statement by an Expert Panel on the Diagnosis and Management of Iron Deficiency Anemia in the Gulf Cooperation Council Countries.

BACKGROUND: Iron deficiency (ID) and ID anemia (IDA) are common in the member states of the Gulf Cooperation Council (GCC). The unique genetic and lifestyle factors of the patient population in the region have necessitated the development of recommendations to help educate health-care professionals on appropriate diagnosis and management of ID/IDA. METHODS: A panel of regional experts, including gastroenterologists and hematologists with expertise in the treatment of IDA, was convened to develop regional practice recommendations for ID/IDA. After reviewing the regional and international literature, the expert panel developed consensus recommendations for screening, diagnosis, and treatment of patients with IDA in the GCC region. RESULTS: The recommendations proposed were customized to the patient population keeping in view the increasingly recognized burden of coeliac disease, high fertility and obesity rates, high prevalence of alpha- and beta-thalassemia traits, and poor tolerance and low treatment compliance with oral iron therapy. CONCLUSIONS: This consensus statement proposes recommendations for screening, diagnosis, and treatment of IDA in the GCC region.

Antioxidant activities for superoxide dismutase in patients with Crohn's disease.

BACKGROUND: In this study, we aimed to determine the levels of antioxidant activity for superoxide dismutase (SOD) enzymes in patients with Crohn's disease (CD) to investigate their contribution to tissue injury in CD. METHODS: Forty-two patients with CD and 38 matched healthy subjects (control group) were recruited. SOD enzymatic activity was measured by purely chemical system based on NAD(P)H oxidation. RESULTS: Plasma antioxidant activities for SOD in CD patients were significantly lower than that in the control group. CONCLUSIONS: Low antioxidant activity for SOD in CD is an important indication of oxidative stress. CD patients are more susceptible to oxidative stress. This study supports the hypothesis that increased oxidative stress and decreased antioxidant defense in CD.

Presenting features of childhood-onset inflammatory bowel disease in the central region of Saudi Arabia.

OBJECTIVE: To investigate the presenting features of childhood-onset inflammatory bowel disease (IBD) in the central region of Riyadh, Saudi Arabia and to compare with those reported in the literature. METHODS: This is a retrospective review of medical records of children below 18 years of age at onset of symptoms with confirmed diagnosis of IBD for age, gender, family history, presenting clinical and laboratory findings in the Divisions of Pediatric and Adult Gastroenterology, King Khalid University Hospital (which provides free health care) and the Department of Gastroenterology Al Mofarreh Poly Clinic, Riyadh, Saudi Arabia, between January 1993 and December 2010. RESULTS: Two hundred and eighteen children diagnosed with IBD with predominance of males in Crohn's disease (CD) (56%) and females in ulcerative colitis (UC) (59%). There was no significant difference between UC and CD regarding age of onset of symptoms (p=0.347); however, the difference in the age at presentation and age at final diagnosis were significant (p=0.027 and p=0.008). There was a significant increase of IBD diagnosis from the period 1993-2001 to 2002-2010 (p<0.0001). The family history was positive in 15.3%. CONCLUSION: The presenting clinical features and laboratory abnormalities are similar to those reported in other populations. Further studies are needed to establish the incidence and prevalence.

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

BACKGROUND/AIM: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Lipid peroxides in patients with inflammatory bowel disease.

BACKGROUND/AIMS: In this study, we aimed to determine the levels of malondialdehyde (MDA) in patients with inflammatory bowel disease (IBD) to investigate its contribution to tissue injury in IBD. MATERIALS AND METHODS: Forty-two patients with IBD (24 cases of Crohn's disease and 18 cases of ulcerative colitis) and 38 matched healthy subjects (control group) were considered for study. MDA levels were quantified by the measurement of thiobarbituric acid reactive substances. RESULTS: Plasma MDA levels of Crohn's disease patients were significantly higher than the control group, but not higher than the ulcerative colitis patients. Plasma MDA levels of patients with ulcerative colitis were higher than the control group but not significant. CONCLUSION: Increased levels of plasma MDA in IBD is an important indication of oxidative stress. Patients with Crohn's disease are more susceptible to oxidative stress than patients with ulcerative colitis.

Histological and laboratory features of patients undergoing liver biopsy at a university hospital in Central Saudi Arabia.

OBJECTIVE: To identify the most common liver pathologies seen in our center, to find the prevalence of advanced fibrosis and cirrhosis in patients with chronic hepatitis B and C, and to correlate the histological and laboratory features of the most common diseases and compare between them. METHODS: Liver biopsy procedures performed in our Gastroenterology Unit at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia were traced from records between the years 1997-2003. Clinical, histopathological, and laboratory features were recorded. RESULTS: We identified 574 liver biopsies during the study period. Of the 502 included patients, males were 58.6%. The mean age of the patients was 43.5 years. Approximately half of the biopsies (49%) were performed for patients with hepatitis C, followed by hepatitis B, for which 17% of the biopsies were performed. Patients with hepatitis B were approximately 10 years younger than patients with hepatitis C (p = 0.01). They were 10% more likely to be males. In terms of fibrosis, only approximately 17% of patients with hepatitis B and 27% of patients with hepatitis C had advanced fibrosis. CONCLUSION: Most liver biopsies performed in our center are performed for patients with hepatitis C. Rates of advanced fibrosis in our series are significantly lower than what was previously reported in other studies.