Identifying the Demographic, Clinical, and Endoscopic Findings of Gastroesophageal Reflux Disease in Patients With Helicobacter pylori Infection at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

BACKGROUND:  Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) are widely spread clinical terms. GERD refers to the backflow of gastric acid to the esophagus and upper gastrointestinal tract, causing irritation. H. pylori is a gram-negative bacillus that adheres mainly to the gastric mucosa, causing peptic ulcers and gastritis. The nature of the relationship between GERD and H. pylori is yet to be explored, and few studies have been conducted. In contrast, some studies suggest a protective role of H. pylori against GERD. This study aimed to identify the demographic, clinical, and endoscopic findings of patients with GERD who underwent H. pylori testing. METHODS:  A retrospective review of medical records at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between 2015 and 2021 was conducted in June 2021. Our sample consisted of 255 individuals enrolled based on age and H. pylori status. In univariate analysis, we used frequency tests for qualitative data and measure of central tendency (MCT) for quantitative data. In bivariate analysis, we used the t-test and Pearson's chi-square test. RESULTS: Of 255 GERD patients enrolled, 90 were positive and 165 were negative for H. pylori. The majority were females (54 were positive and 93 were negative for H. pylori). Both groups mainly complained of abdominal pain. Endoscopically, gastritis was higher in the H. pylori-positive group than in the H. pylori-negative group. CONCLUSION:  In conclusion, the majority of GERD patients were H. pylori-negative, females, Saudis, and non-smokers.

Deciphering the Significance of Plasma Chemokines as Prognostic Biomarkers in Pegylated IFN-Α-2a /Ribavirin-Treated Chronic Hepatitis C Genotype 4 Patients.

BACKGROUND: Hepatitis C viral (HCV) infection is a major clinical burden globally. Pegylated IFN-α-2a (PEG-IFN-α-2a) with ribavirin (RIB) therapy induces an array of cellular antiviral responses, including dsRNA kinases (PKR), chemokines, and cytokines to tackle the HCV infection. However, many HCV patients develop resistance to PEG-IFN/RIB therapy rendering the therapy ineffective. OBJECTIVES: Here, we assess the significance of chemokines in response to PEG-IFN-α-2a with ribavirin (PEG-IFN/RIB) therapy. METHODS: Twenty patients with HCV infection and ten healthy controls were enrolled in this study and patients were categorized into two groups 1), HCV-Responder (HCV-R), and 2) HCV-non-responder (HCV-NR). We analyzed IP-10, MIG, MCP-1, EOTAXIN, RANTES, IL-8, MIP-1a, and MIP-1b by a magnetic bead-based multiplex immunoassay approach based on Luminex X-MAP multiplex technology, using a MAGPIX instrument (Luminex Corporation, USA). RESULTS: A significant elevation of ALT and AST enzymes was observed in HCV-NR. Besides, the PEG-IFN/RIB therapy in both MIG and MCP-1 in HCV-NR patients was significantly induced. PEGIFN/ RIB therapy significantly increased the levels of chemokines, such as IL-8, IP-10, EOTAXIN, MIG, RANTES, and MIP-1ß, in HCV-R, indicating the chemokine response to PEG-IFN/RIB therapy. CONCLUSION: Hence, MCP-1 and MIG could be the potential biomarkers in HCV-NR and might be associated with the development of liver fibrosis, liver failure, and hepatocellular carcinoma. LIMITATIONS: Our study has only twenty samples of PEG-IFN/RIB treated HCV patients. This might be the reason for the lack of association between some of the inflammatory markers evaluated and the SVR, therefore, the association found between the chemokine levels observed in the plasma of HCV-R and HCV-NR and EVR cannot be extrapolated to patients infected with other HCV genotypes.

Gastrostomy Tube Insertion Complications and Patient Care Outcomes in a Tertiary Care Hospital.

Background Percutaneous endoscopic gastrostomy (PEG) is a widely known procedure where an endoscopist inserts a tube through the stomach to provide enteral nutrition. The existing literature shows inconsistent results regarding complication rates, and very few studies have examined the relationship between patient characteristics and PEG outcomes. Therefore, we aimed to investigate PEG tube insertion outcomes and determine different variables associated with these outcomes. Methods This retrospective record review included 207 patients who underwent PEG tube insertion at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2010 and 2021. We obtained variables such as demographics, complications, and length of hospitalization. The Student t-test, chi-square test, and Mann-Whitney test were used in the data analysis. Results Of 207 patients, 106 were male (51.2%). The patient's median age was 10 years, and the median length of hospital stay was two days. The PEG-related complication rate was 32.4%, while the 1-year adverse outcome rate was 44.9%. The most common complications were unspecified fever (21.3%) and vomiting (14%). We found a significant relationship between dysphagia and length of hospitalization (P=0.015) and between age and the occurrence of tube leakage (P=0.021). Another significant relationship was found between the number of PEG insertions and gastrostomy-site infection (P=0.046). Conclusions This study's results indicate the importance of a thorough review of patients' medical records; some patient characteristics can be valuable predictors of PEG outcomes. Thus, we urge physicians to study each patient to anticipate PEG tube insertion outcomes carefully. Moreover, we recommend that researchers with access to larger patient registries study more variables to reach unified guidelines that ensure the best possible outcomes.

Risk Stratification of Patients with Crohn's Disease: A Retrospective Analysis of Clinical Decision Making and Its Impact on Long-Term Outcome.

BACKGROUND AND AIMS: Complications such as need for bowel resections and hospitalization due to Crohn's disease (CD) occur when disease activity persists due to ineffective therapy. Certain "high-risk" features require an early introduction of anti-tumor necrosis factor-α therapy to prevent such complications. We aim to evaluate the prevalence of "high-risk" features among a cohort of patients with CD and examine the association between discordance of early therapy with baseline risk stratification and disease outcome. PATIENTS AND METHODS: All adult patients with CD were retrospectively identified and their medical records were reviewed. Clinical, endoscopic, laboratory, and radiological data were collected. Patients were divided into "low" and "high" risk groups according to the presence or absence of penetrating disease, perianal involvement, foregut involvement, extensive disease seen on endoscopy or cross-sectional imaging, young age at the time of diagnosis (<40), persistent cigarette smoking and frequent early requirements for corticosteroid therapy. Initial treatment selection and treatment approach ("step-up" vs. "accelerated step-up" vs. "top-down") within 6 months of diagnosis were recorded. Rates of CD-related bowel resections and hospitalization within 5 years of diagnosis were calculated. Logistic regression analysis was used to examine the association between "discordance" of early treatment selections and risk stratification categories with outcomes. RESULTS: Eighty-five CD patients were included. The median age and duration of disease were 25 (interquartile range [IQR] 19-32) and 5 (IQR 4-6) years, respectively. Sixty five percent were females and 66% were native Saudis. Smoking was reported in 12% of patients and perianal disease in 18%. "High-risk" features were identified in 43 (51%) patients, of which only 6 (14%) were treated with "top-down" therapy and 7 (16%) with "accelerated step-up" care. The risk of requiring a bowel resection, and hospitalization was higher for "high-risk" patients compared to "low-risk" patients (risk ratio [RR] 13.67, 95% CI 1.88-99.41; p = 0.003, and RR 1.86, 95% CI 0.03-0.43; p = 0.0312, respectively). "Discordance" occurred in 34% of cases. Bowel resection was required in 15/85 (18%) patients and 32/85 (38%) required at least one hospitalization within 5 years of diagnosis. Logistic regression analysis identified a statistically significant association between "discordance" and need for bowel resections (OR 6.50, 95% CI 1.59-26.27, p = 0.009), and hospitalizations (OR 3.01, 95% CI 1.08-8.39, p = 0.035) within 5 years of diagnosis. CONCLUSIONS: "Discordance" between patient risk-profile and treatment selection early in the course of CD has a significant impact on disease outcome, specifically need for bowel resection and hospitalization, which are more likely to occur in the presence of "high-risk" features. Early identification of "high-risk" features could help prevent long-term complications.

Knowledge, attitude, and practices of primary health care physicians toward colorectal cancer screening.

BACKGROUND/AIM: Early diagnosis of chronic illnesses and cancers mainly occurs at primary health care centers (PHCs) by primary health care physicians (PHPs). The incidence of colorectal cancer (CRC) in the Kingdom of Saudi Arabia (KSA) is rising and this has been attributed to many factors. The increasing incidence of CRC is compounded by nonadherence to screening recommendations. Therefore, evaluating PHPs knowledge, attitudes, and practices of screening for CRC is clinically important. We aimed to evaluate the knowledge, attitudes, and practices of PHPs regarding CRC screening and to identify the factors associated with nonadherence of PHPs to screening recommendations. MATERIALS AND METHODS: PHPs working at three tertiary care centers and PHCs across the city of Jeddah were randomly recruited. Participants were surveyed using a comprehensive questionnaire that recorded data on demographics, qualifications, and knowledge of various modalities and guidelines related to CRC screening. Perspectives about effectiveness of, or adherence to, factors that influence physicians' perspectives or recommendations for CRC screening were also assessed. Logistic regression analysis was used to identify physician characteristics associated with PHPs perspectives and nonadherence to CRC screening. RESULTS: A total of 127 PHPs were recruited. The average age of participants was 34 (±8.4) years, 86.6% were native Saudi's and 56.7% were females. The majority of surveys (66.9%) were completed at 24 PHCs and the remaining at hospital-based family medicine clinics. Most of the PHPs (55%) had a bachelor's degree and 31.5% were board-certified or carried a PhD in family medicine; 95% of participants believed that CRC screening in general was effective, but as much as 55% reported that they did not practice screening. The male physicians [odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.19-0.99, P = 0.048)] and PHPs with only a bachelor degree or less (OR = 0.72, 95% CI = 0.55-0.93, P = 0.011) were less likely to recommend screening for CRC. CONCLUSIONS: A considerable proportion of PHPs do not adhere to CRC screening recommendations despite a wide belief that screening is effective. Male PHPs with lower qualifications appear to be less likely to recommend screening.

A cross-sectional survey of multi-generation inflammatory bowel disease consanguinity and its relationship with disease onset.

Background\Aim: Consanguinity influences the phenotypic variations of some hereditary and immune-mediated disorders, including inflammatory bowel disease. This study estimated the prevalence of consanguinity among the ancestors of patients with inflammatory bowel disease and examined the effect of various consanguinity levels on inflammatory bowel disease onset. PATIENTS AND METHODS: Patients with inflammatory bowel disease who were seen at two gastroenterology outpatient clinics were consecutively recruited and surveyed for demographics, disease onset, and presence of ancestral consanguinity within three generations. The prevalence of different consanguinity levels was calculated. The association between age at inflammatory bowel disease onset and consanguinity was examined. RESULTS: Two hundred seventeen patients were recruited. The mean age, mean age at diagnosis, and mean illness duration were 32.9 ± 13.4, 18.6 ± 11.5, and 8.6 ± 7.7 years, respectively. Of the cohort, 53.5% were women, and 74.2% were native Saudis. Cigarette smoking was reported in 17.1%; 51% had Crohn's disease, while the remaining patients had ulcerative colitis. A family history of inflammatory bowel disease was reported in 29.5% of patients; consanguinity within three generations was reported in 57.6%. Consanguinity in more than one generation was reported in 38.7%; 17.5% had consanguinity in three consecutive generations. There was no association between inflammatory bowel disease onset and multi-generation consanguinity, but there was an association with disease subtype in favor of ulcerative colitis (b coefficient = 7.1 [95% confidence interval = 4.1, 10]). CONCLUSIONS: Consanguinity is extremely common among Saudi patients with inflammatory bowel disease but does not seem to influence age at disease onset. Genetic studies are needed to further clarify the effect of consanguinity on disease behavior.

Biomarkers for virus-induced hepatocellular carcinoma (HCC).

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and is advanced by severe viral hepatitis B or C (HBV or HCV) as well as alcoholic liver disease. Many patients with early disease are asymptomatic therefore HCC is frequently diagnosed late requiring costly surgical resection or transplantation. The available non-invasive detections systems are based on the clinical utility of alpha fetoprotein (AFP) measurement, together with ultrasound and other more sensitive imaging techniques. The hallmark of liver disease and its propensity to develop into fully blown HCC is depended on several factors including the host genetic make-up and immune responses. While common symptoms involve diarrhea, bone pain, dyspnea, intraperitoneal bleeding, obstructive jaundice, and paraneoplastic syndrome, the evolution of cell and immune markers is important to understand viral induced liver cancers in humans. The circulating miRNA, cell and immune based HCC biomarkers are imperative candidates to successfully develop strategies to restrain liver injury. The current molecular genetics and proteomic analysis have lead to the identification of number of key biomarkers for HCC for earlier diagnosis and more effective treatment of HCC patients. In this review article, we provide latest updates on the biomarkers of HBV or HCV-associated HCC and their co-evolutionary relationship with liver cancer.

Choroidal neovascularization with interferon associated retinopathy: case report and review of literature.

We report a case of new interferon-associated ocular complication during treatment with combination of pegylated interferon plus ribavirin for chronic hepatitis C infection. Our patient developed choroidal neovascularization in addition to the classic interferon associated retinopathy. Choroidal neovascularization has not been reported before in association with interferon induced retinopathy. We describe our management to control the ocular symptoms and the retinal lesions with one year follow up. We also provide literature report on the natural history, the pathophysiology and the variable characteristics of interferon associated retinopathy versus hepatitis C related ophthalmopathy.

Utility of MELD and Child-Turcotte-Pugh scores and the Canadian waitlisting algorithm in predicting short-term survival after liver transplant.

BACKGROUND: The Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores are important predictors for survival after liver transplantation (LT). The objective of this study was to compare the utility of MELD and CTP scores with Canadian waitlisting algorithm in transplantation (CanWAIT) status for predicting 90-day survival after LT. METHODS: Retrospectively, we analyzed all 228 liver transplants performed in adults by the Atlantic Liver Transplant Program since 1985. These cases included combined transplants, retransplants and those after fulminant liver failure. MELD and CTP scores were calculated, and CanWAIT status and waiting time on the day of LT determined. We used c-statistic for 90-day outcome as the endpoint (survival), comparing areas under the receiver operating characteristic (ROC) curves for MELD and CTP scores and CanWAIT status. RESULTS: Mean (and standard deviation [SD]) MELD score was 18 (SD 12); CTP score, 10 (SD 3); and waiting time, 97 (SD 132) days. At the time of LT, 54% were in CanWAIT status 1; 4% in 1T; 14% in 2; 11% in 3; 6% in 3F; 4% in 4; and 7% in status 4F. Overall 90-day survival was 80% (95% confidence interval [CI] 75%-85%), exceeding the predicted survival by MELD scale with transplant of only 51% (CI 47%-55%). By c-statistic, CanWAIT is a clinically relevant predictor of 90-day outcomes in LT. By multivariate regression analysis, only CanWAIT status and age were found to have independent associations for short-term outcomes after LT. INTERPRETATION: CanWAIT status stratifies LT patients better and predicts short-term outcome more accurately than MELD or CTP scores, and so should not be replaced by MELD or CTP scores. This observation should be confirmed by a prospective and multicentre study in Canada.

Percutaneous gastrostomy and gastrojejunostomy: radiological and endoscopic approach.

BACKGROUND: The aim of the study was to report our experience, comparing and evaluating the effectiveness, safety, indications, and obstacles of percutaneous placement of gastrostomy and gastrojejunostomy catheters by fluoroscopic (percutaneous fluoroscopic gastrostomy--PFG) and endoscopic (percutaneous endoscopic gastrostomy--PEG) techniques. PATIENTS AND METHODS: In this retrospective comparative study over a five-year period, 52 patients were referred for gastrostomy or transgastric jejunostomy procedure for various reasons. Of these, 19 patients (36.5%) were referred for PEG and 33 patients (63.5%) were referred for PFG. The mean age was 65 years for PEG; 14 patients were male and 5 were female. The mean age for PFG was 51 years; 16 patients were male and 17 were female. The medical files and follow-up records of these patients were studied thoroughly. RESULTS: Success rate for catheter placement was high for both approaches (PFG and PEG), with a higher rate for PFG (100% vs. 89%). Major complications were 0% for PFG and 5.3% for PEG (P>0.05), whereas minor complications were 29% for PEG and 27% for PFG (P>0.05). Thirty-day procedure-related mortality was 0% for both techniques. CONCLUSION: Both PEG and PEG are successful, safe, and effective techniques for the installment of catheters in the stomach or jejunum. PEG technique appears to have no major complications, and is capable of overcoming some of the obstacles that may render PEG unsuccessful.