SummaryBackgroundThe vascular and gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors (coxibs) and traditional non-steroidal anti-inflammatory drugs (tNSAIDs), are not well characterised, particularly in patients at increased risk of vascular disease. We aimed to provide such information through meta-analyses of randomised trials.MethodsWe undertook meta-analyses of 280 trials of NSAIDs versus placebo (124 513 participants, 68 342 person-years) and 474 trials of one NSAID versus another NSAID (229 296 participants, 165 456 person-years). The main outcomes were major vascular events (non-fatal myocardial infarction, non-fatal stroke, or vascular death); major coronary events (non-fatal myocardial infarction or coronary death); stroke; mortality; heart failure; and upper gastrointestinal complications (perforation, obstruction, or bleed).FindingsMajor vascular events were increased by about a third by a coxib (rate ratio [RR] 1·37, 95% CI 1·14–1·66; p=0·0009) or diclofenac (1·41, 1·12–1·78; p=0·0036), chiefly due to an increase in major coronary events (coxibs 1·76, 1·31–2·37; p=0·0001; diclofenac 1·70, 1·19–2·41; p=0·0032). Ibuprofen also significantly increased major coronary events (2·22, 1·10–4·48; p=0·0253), but not major vascular events (1·44, 0·89–2·33). Compared with placebo, of 1000 patients allocated to a coxib or diclofenac for a year, three more had major vascular events, one of which was fatal. Naproxen did not significantly increase major vascular events (0·93, 0·69–1·27). Vascular death was increased significantly by coxibs (1·58, 99% CI 1·00–2·49; p=0·0103) and diclofenac (1·65, 0·95–2·85, p=0·0187), non-significantly by ibuprofen (1·90, 0·56–6·41; p=0·17), but not by naproxen (1·08, 0·48–2·47, p=0·80). The proportional effects on major vascular events were independent of baseline characteristics, including vascular risk. Heart failure risk was roughly doubled by all NSAIDs. All NSAID regimens increased upper gastrointestinal complications (coxibs 1·81, 1·17–2·81, p=0·0070; diclofenac 1·89, 1·16–3·09, p=0·0106; ibuprofen 3·97, 2·22–7·10, p<0·0001; and naproxen 4·22, 2·71–6·56, p<0·0001).InterpretationThe vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs. Although NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which could help guide clinical decision making.FundingUK Medical Research Council and British Heart Foundation.
Background/Aim:A large number of diseases are ascribed to Helicobacter pylori (H. pylori), particularly chronic active gastritis, peptic ulcer disease and gastric cancer. Successful treatment of H. pylori infection with antimicrobial agents can lead to regression of H. pylori–associated disorders. Antibiotic resistance against H. pylori is increasing, and it is necessary to find new effective agents. Nigella sativa seed (NS), a commonly used herb, possesses in vitro anti-helicobacter activity. The present study was undertaken to evaluate the efficacy of NS in eradication of H. pylori infection in non-ulcer dyspeptic patients.Materials and Methods:The study was conducted on 88 adult patients attending King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, from 2007 to 2008, with dyspeptic symptoms and found positive for H. pylori infection by histopathology and urease test. Patients were randomly assigned to four groups, receiving i) triple therapy (TT) comprising of clarithromycin, amoxicillin, omeprazole [n= 23], ii) 1 g NS + 40 mg omeprazole (OM) [n= 21], iii) 2 g NS + OM [n= 21] or iv) 3 g NS + OM [n= 23]. Negative H. pylori stool antigen test four weeks after end of treatment was considered as eradication.Results:H. pylori eradication was 82.6, 47.6, 66.7 and 47.8% with TT, 1 g NS, 2 g NS and 3 g NS, respectively. Eradication rates with 2 g NS and TT were statistically not different from each other, whereas H. pylori eradication with other doses was significantly less than that with TT (P < 0.05). Dyspepsia symptoms improved in all groups to a similar extent.Conclusions:N. sativa seeds possess clinically useful anti-H. pylori activity, comparable to triple therapy. Further clinical studies combining N. sativa with antibiotics are suggested.
The role of schistosomes in the pathologenesis of acute appendicitis in an endemic area was investigated. Of 1600 appendicectomies received in our laboratory, 26 showed appendiceal schistosomiasis, which prompted what we believe to be the first detailed histopathological evaluation of all appendices with schistosomal infestation, without prior knowledge of the clinical and operative diagnoses. The results suggest that there are two types of schistosomal appendicitis, each with distinct clinicopathological features and different pathogenetic mechanisms. They could be called obstructive and granulomatous schistosomal acute appendicitis, respectively.
In this report we present our experience with 76 cases of chronic idiopathic ulcerative colitis (IUC) out of 1279 consecutive colorectal biopsies (6.0%), seen during an 11-year period (1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994), in a tertiary care teaching hospital. During the same period, 12 (0.8%) patients with Crohn's disease were seen. Of the 76 patients with IUC, forty-nine were male and 27 were female, with an age range of six to 88 years, a mean of 38 ± 16 and a median of 36 years. Forty-nine patients were Saudi Nationals (27M, 22F), 21 were non-Saudi Arabs and six were Asians. In most patients, the onset of IUC was at 20 to 49 years (70%). The disease duration at diagnosis ranged from one month to five years, with a median of 12 months. The follow-up period ranged from 13 months to 11 years, with a median of three years. Diarrhea, hematochesia and abdominal pain were the dominant symptoms. The disease grade was generally of mild to moderate severity (55 patients, 72%) and was of low stage (distal involvement in 69 patients, 91%). The rarity of skin manifestations and of development of colonic cancer is to be noted in spite of the relatively short period of follow-up. Our findings compare with experience from the region, confirming the mild course of the disease as contrasted to Western experience. These findings will be discussed. Ann Saudi Med 1996;16(6):637-640. Until recently, it was generally believed that chronic idiopathic ulcerative colitis (IUC) and Crohn's disease were rarely seen in underdeveloped nations, including Middle Eastern, Asian and African countries. Only a few reports had emerged from such areas.1-3 However, during the last 12 years more cases have been encountered, particularly from the Middle East.3-7 It appears that the current frequent encounter of IUC in such countries parallels the exponential growth in development and industrialization, a tendency to more Western dietary habits and exposure to more psychological stress associated with such a life. Furthermore, increased awareness of the disease and improvement in diagnostic modalities plays a significant role. This study from Saudi Arabia further documents that idiopathic chronic ulcerative colitis exists in the Arabian Peninsula, though with much less frequency than in developed Western hemisphere countries. Material and MethodsA retrospective evaluation of all lower gastointestinal (LGI) endoscopies during the period 1983-1994 at King Fahd Hospital of the University, Al-Khobar, was performed. Of all such cases, only those who had a biopsy were included. The medical records were reviewed for age, sex, nationality, symptoms and duration, endoscopic findings and follow-up information.All pertinent histological sections and paraffin blocks were retrieved for review and evaluation. Using standard histological criteria and in light of clinical and endoscopic findings, patients were categorized into various diagnostic entities.Patients presenting with recurrent abdominal pain, chronic diarrhea with or ...
Cisapride is an effective and well-tolerated treatment for FD in Saudi Arabs. Pharmacogenetic factors are unlikely to play any role in its effects.
Background/Aims:The prevalence of gastroesophageal reflux disease (GERD) in chronic renal failure patients and in renal transplant recipients (RTR) has been a subject of discussion in the last few years. Our aims are to clarify this association and its relation to Helicobacter pylori infection, and also to identify possible pathogenic factors in the development of this disease in both groups.Methods:The study involved 40 end-stage renal disease (ESRD) patients with upper gastrointestinal (GI) symptoms (group I), 36 patients who had undergone kidney transplantation and had similar symptoms (group II), and 44 age- and sex-matched controls with the same upper GI symptoms (group III). All patients were subjected to esophagogastroduodenoscopy, and biopsies were obtained from the antrum for histological evaluation and identification of H. pylori.Results:The prevalence of GERD in the first two groups was similar (77.5 vs. 75.0%, P = 0.412), while it was significantly lower in the control group (38.6%, P < 0.01). H. pylori infection was present in 40.0, 36.1 (P > 0.05) and 75% (P < 0.01 and < 0.001) of the patients in groups I, II, and III, respectively. Multivariate logistic regression analysis in groups I and II showed that high serum creatinine (Odds ratio [OR] = 6.78, 95% Confidence Interval (CI) = 1.12-45.82), immunosuppressive therapy (OR = 5.78, 95% CI = 1.01-32.5), and absence of H. pylori infection (OR = 3.58, 94% CI = 1.11-18.6) were significantly associated with GERD. The duration of ESRD correlated significantly with the prevalence of GERD in group I.Conclusions:This study showed a similar prevalence of H. pylori infection and GERD in ESRD and RTR patients. GERD prevalence was higher in these two groups than in the controls. Renal transplantation, chronic renal disease, immunosuppressive therapy, and the absence of H. pylori infection seem to be risk factors for the development of GERD.
The study demonstrates the comparatively high frequency of gastric lymphoma in this population and confirms the intimate association of H-pylori infection to both gastric adenocarcinoma and MALT-lymphoma. Gastric lymphoma should always be considered in the differential diagnosis of gastric malignancy and the use of immunohistochemistry is essential for the differential diagnosis of some of these tumors.
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