Spices, herbal xenobiotics and the stomach: friends or foes?

Spices and herbal remedies have been used since ancient times to treat a variety of disorders. It has been experimentally demonstrated that spices, herbs, and their extracts possess antimicrobial, anti-inflammatory, antirheumatic, lipid-lowering, hepatoprotective, nephroprotective, antimutagenic and anticancer activities, besides their gastroprotective and anti-ulcer activities. Despite a number of reports on the toxicity of herbs and spices, they are generally accepted as safer alternatives to conventional therapy against gastric ulcers. To this end, it is also believed, that excessive consumption of spices may favor the pathogenesis of gastric and duodenal ulcer and some studies have substantiated this common perception. Based on various in vivo experiments and clinical studies, on the effects of spices and herbs on gastric ulcers, it has indeed been shown that certain spices do possess remarkable anti-ulcer properties mediated by antisecretory, cytoprotective, antioxidant, and anti-Helicobacter pylori effects and mechanisms regulated by nitric oxide, prostaglandins, non-protein sulfhydryl molecules and epidermal growth factor expression. Accordingly, their consumption may attenuate and help prevent peptic ulcer disease. In the present review, the beneficial effects of spices and herbal nutritive components on the gastric mucosa are discussed against the paradigm of their deleterious potential.

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.

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.

Management of postlaparoscopic cholecystectomy major bile duct injury: comparison of MRCP with conventional methods.

BACKGROUND: Postlaparoscopic cholecystectomy bile duct injury remains one of the devastating complications seen in current surgical practice. AIM OF STUDY: This study describes the diagnostic role of magnetic resonance cholangiopancreatography (MRCP) in such injuries compared with conventional methods. PATIENTS AND METHODS: Eighteen patients referred to the Division of Hepatobiliary Surgery, King Khalid University Hospital from July 1998 to September 2000 were retrospectively studied. The technique of the repair was by utilizing Roux-en-Y hepaticojejunostomy with establishment of mucosa-to-mucosa anastomosis.The study included presentation, age and gender. RESULTS: The presentation of patients were variable and frequently included pain, jaundice with or without cholangitis in 13 patients, bile leakage with development of biliary peritonitis in three, and development of external biliary fistula in two patients. Besides lower incidence of complication, MRCP was more diagnostic and informative in planning surgery by mapping both ducts proximal and distal to site of injury or stricture in 14 out of 18 patients. The Bismuth level of bile duct injuries were type I in one, type 11 in five, type III in 11 and type IV in one patient. All patients are alive, well and no complications occurred in the immediate postoperative period. Only two patients developed stricture within four months after surgery, one of them treated conservatively with repeated dilatation and stenting was done for the other. CONCLUSION: Hepaticojejunostomy is the procedure of choice for repair of bile duct injuries and provides adequate bilairy drainage. MRCP is an ideal diagnostic test when bile duct injury is suspected following laparoscopic cholecystectomy.

Concepts in leptin and liver disease.

Leptin is a cytokine l6kd peptide hormone. Its crucial role is regulation of appetite and the body fat mass mainly through action on the hypothalamus. It is produced mainly in adipocytes of white fat, as well as from other tissues e.g. placenta, skeletal muscles, fundus of the stomach and activated hepatic stellate cell (HSC) and recently reported that leptin is produced from B cell of islands of the pancreas. The gene responsible for production is present on chromosome 7 called obse gene (ob/gene). Leptin receptors (OB-R) were present in two forms short (OB-Ra or OB-RS) and long one (OB-Rb or OB-RI). The main action of leptin depends on long form (OB-Rl), where very little evidence is available implicating a role for the short form in the action of leptin. One of the unconventional areas in which leptin is now receiving great attention is liver diseases as several published studies indicate that circulating leptin level are increased in cirrhosis, hepatitis C virus (HCV) and non-alcoholic steatohepatitis (NASH).

Gammaglutamyl transpeptidase activity in patients with schistosomiasis.

BACKGROUND: Schistosoma mansoni infestation may induce liver fibrosis and portal hypertension, with possible elevation of liver enzymes. AIM OF THE STUDY: The aim of this study was to evaluate the serum gammaglutamyl transpeptidase (GGT) activity in a group of non-alcoholic and non-obese patients with hepatointestinal schistosomiasis. PATIENTS AND METHODS: Medical records of 174 patients diagnosed to have hepatointestinal schistosomiasis on the basis of clinical and laboratory data were reviewed. Body mass index (BMI) was calculated for all patients. Direct stool smear and formol-ether concentration (FEC) methods and hematological and biochemical blood tests were performed. Other studies including abdominal ultrasonography, upper and lower gastrointestinal endoscopy was also performed when feasible. All (174) patients were adults with male to female ratio of 3.8:1. BMI was similar in both groups. Patients were divided into two groups: group 1 (57) with elevated GGT and group 2 (117) patients with normal GGT. Both groups had positive indirect hemagglutination test (IHA) for schistosomiasis. Other causes of liver disease were excluded. RESULTS: Group 1 had significant elevation of alanine aminotransferase (ALT), alkaline phosphatase (ALP) and reduction in platelets (p < 0.001), low albumin and high globulin levels (p < 0.01) compared to group 2. Abnormal ultrasonographic findings were more frequently encountered in group 1 (p < 0.001). CONCLUSION: The above data indicated that GGT elevation was most likely secondary to hepatobiliary involvement by Schistosoma mansoni and may indicate chronicity. Therefore schistosomiasis has to be considered in our community whenever GGT is elevated in non-alcoholic population.