Epidemiology of juvenile-onset inflammatory bowel disease in central Saudi Arabia.

There is limited information about inflammatory bowel disease in Arab children. Hence, the objective of this study was to report on the epidemiology of this condition in our community. Medical records were analysed for all children below 18 years of age diagnosed with inflammatory bowel disease (IBD) and followed up in our institution over a period of 10 years. From 1993 to 2002, 50 consecutive children were diagnosed to have IBD. This gives an estimated incidence of 0.5 cases/100 000/year and a prevalence of 5 cases/100 000 populations for the region of Riyadh, Saudi Arabia. Most of the children (90 per cent) were Saudi nationals and the female to male ratio was 1 : 0.6. The age range was between 5 and 18 years with 16 per cent of the cases diagnosed in children below 12 years of age. Chronic ulcerative colitis was the commonest form accounting for 48 per cent, followed by Crohn's disease and indeterminate colitis in 38 per cent and 16 per cent of the children, respectively. The best agreement between colonoscopic and histopathologic findings (89 per cent) was in children with ulcerative colitis followed by normal findings and Crohn's disease in 63 per cent and 35 per cent of the cases, respectively. It was concluded that the incidence and prevalence of IBD in this report are lower than in any other population. Nevertheless, comparison with older data suggests that the incidence is increasing.

The pattern of dysphagia in children.

BACKGROUND: Difficulty in swallowing is not uncommon among children and yet little information is available in the literature. We report our experience on the pattern of this condition. METHODS: We extracted data from the medical records of 42 children with dysphagia on age at presentation, nationality, gender, and final diagnosis. RESULTS: From 1993 to 2002, 96% of 42 children presenting with dysphagia were Saudi nationals, ranging in age from 3 months to 18 years, with a male to female ratio of 1:0.6. An etiologic diagnosis was found in 30 children (72%). Esophagitis, esophageal strictures and motility disorders were the most common causes of dysphagia, occurring in 16 (38%), 7 (17%), and 4 (10%) children, respectively. Two children had esophageal webs and one had an esophageal ring. Age-related analysis indicated that most of the cases of esophagitis (11/16, 69%) and strictures (5/7, 71%) occurred in young children whereas most nondemonstrable causes occurred in older children (9/12, 75%). CONCLUSION: This report documents a pattern of dysphagia in Saudi Arab children that is similar to descriptions from other countries.

Colonoscopy in children.

BACKGROUND: Pediatric colonoscopy is routinely performed in most hospitals in Saudi Arabia and yet published data are scarce. The objective of this report is to describe our experience in the practice of pediatric colonoscopy in Saudi Arabia. PATIENTS AND METHODS: Retrospective analysis of data of all patients below 18 years of age who underwent colonoscopy over a 10-year period. RESULTS: From 1414 H (1993 G) to 1423 H (2002 G), two hundred and seventeen colonoscopies, of which 183 diagnostic procedures, were performed on 183 children. The majority (94%) were Saudi nationals, the age range was between 5 months and 18 years, and the female to male ratio was 1:0.8. Colonoscopy was total in 58 (32%) and limited in 125 patients (68%). The commonest reason for not completing the procedure was securing the diagnosis in 45/125 patients (36%). The commonest indication was rectal bleeding (35%). The highest yield was in children with bloody diarrhea (91%) and the lowest in those with abdominal pain (27%) with an overall yield of 44%. Colitis was the most common diagnosis occurring in 66% of the children. CONCLUSION: this report highlights the role of colonoscopy in the recognition of diseases of the colon in our community and identifies some of the problems areas associated with the performance of this procedure in our institution.

Peptic ulcer disease in children and adolescents.

Peptic ulcer disease (PUD) has been reported to occur in children worldwide, but no information is available for our community. The aim of the study was to report our experience on the pattern of this condition in Saudi Arabian children. The records of all children below 18 years of age who were diagnosed by endoscopy to have PUD over a period of 10 years were analysed. From 1993 to 2002, 24 children out of 521(5 per cent) who presented with upper gastrointestinal tract (GIT) symptoms were diagnosed by endoscopy to have PUD. All but one (96 per cent) were Saudi nationals, the average age was 15 years (range 5-18 years), and the male to female ratio was 7:1. The commonest presentation was chronic abdominal pain in 15/24 (63 per cent) of the children, followed by vomiting associated with abdominal pain in four (17 per cent). Hematemesis and melena occurred in three (13 per cent), and two children (8 per cent), respectively. There were 20 duodenal (92 per cent) and four gastric ulcers. The primary type was the most common, occurring in 19 (79 per cent) of the children. Histopathology results of antral biopsies were available for 15 children; all of them had antral gastritis. Helicobacter pylori organisms were present in 13/15 (87 per cent) of the antral biopsy specimens. In Saudi children, peptic ulcer disease occurs more commonly in boys. It is a rare cause of upper GIT symptoms, but highly associated with H. pylori antral gastritis. This study documents a pattern similar to descriptions from other countries.

Yield of endoscopy in children with hematemesis.

Upper gastrointestinal (UGI) endoscopy is an important tool in the evaluation of patients presenting with haematemesis. The objective of this study was to report the yield of this procedure in a Saudi Arabian population. We analysed the result UGI endoscopy in children and adolescents of 0-18 years of age who presented with haematemesis over a period of 10 years. From 1993 to 2003, endoscopy was performed on 60 consecutive children presenting with haematemesis. This group represented 12% of the indications during the same period. The majority (98%) were Saudi nationals, with an age range from 4 days to 18 years, and a male to female ratio of 1:1.5. The overall yield of endoscopy was 75%; however, the yield was higher (91%) in children below 12 years of age. Gastritis was the commonest cause of haematemesis (44%), followed by oesophagitis (36%). However, age-related analysis shows that oesophagitis was a more common cause of haematemesis in the younger age group (45%) than gastritis in adolescents (30%). In contrast, gastritis was more common in older children (56%) than oesophagitis (28%). Peptic ulcer disease and oesophageal varices were seen in only 3 (7%) and 2 children (4.3%), respectively. The overall yield of endoscopy in our patients is similar to that in most reports. However, oesophagitis and gastritis were the commonest causes of haematemesis, whereas oesophageal varices and peptic ulcer disease were much less common.