Background Non-alcoholic fatty liver disease (NAFLD) has been progressively identified in patients with inflammatory bowel disease (IBD) in Qatar. We aim to characterise NAFLD in IBD patients in Qatar and to determine predictors for its severity. Methods A retrospective observational study was conducted on 913 IBD patients in Hamad hospital between January 2008 and December 2017. The prevalence of NAFLD among IBD cases was estimated and associations between two or more qualitative variables were assessed using χ2-test. Quantitative data between two independent groups were analysed using unpaired t-test. Univariate and multivariate logistic regression analysis were applied to determine the predictive values of each predictor for NAFLD among IBD patients. Results Among 913 IBD patients with a mean age of 36.9 ± 13.2 years and BMI 26.9 ± 6.1; 550 were males (60.2%), 383(41.9%) with Crohn’s disease and 530 (58.1%) with Ulcerative colitis. 24 (22.2%) patients had severe steatosis. The overall prevalence of NAFLD was 11.8% (95% CI 9.9, 14.1) and does not differ significantly between CD and UC patients (11.7% vs. 11.9%; p = 0.949). Patients who developed NAFLD were older at baseline, higher BMI and had a higher prevalence of diabetes and hypertension. Age >50 years (OR 3.34; 95% CI 1.82, 6.14; p = 0.001), BMI >30kg/m2 (OR 2.87; 95% CI 1.71, 4.84; p = 0.001), the presence of hypertension (OR 1.98; 95% CI 1.16, 3.38; p = 0.01) and diabetes mellitus (OR 3.05; 95% CI 1.87, 4.95; p = 0.001), were all positive and significantly associated with an increased risk whereas gender female associated with significantly decreased risk for NAFLD (OR 0.63; 95% CI 0.41, 0.98; p = 0.04). Multivariate analysis showed age >40 to 50 years (adjusted OR 2.98; 95% CI 1.62, 5.48; p = 0.001), age >50 years (adjusted OR 2.03; 95% CI 1.03, 4.0; p = 0.04), BMI>30 kg/m2 (adjusted OR 2.24; 95% CI 1.28, 3.91; p = 0.01) and diabetes mellitus (adjusted OR 1.98; 95% CI 1.15, 3.4; p = 0.02) significantly associated with an increased risk of NAFLD whereas gender female showed protective effect and have decreased risk (adjusted OR 0.58; 95% CI 0.36, 0.93; p=0.02). The treatment with biologic does not increase the risk of steatosis and the predicted cut-off NAFLD score of ≥ -1.67 had good predictive ability for significant steatosis. Conclusion The prevalence of NAFLD in IBD patients was 11.8% in Qatar. We did not find an association between the medications used and the progression to NAFLD in IBD patients. Older age, high BMI and diabetes mellitus increase its risk. Non-invasive screening using NAFLD Score could help early diagnosis and initiation of interventions in such patients.

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To study the prevalence of Helicobacter pylori (H. pylori) infection among dyspeptic patients of various ethnic origins in Qatar and determine the association between H. pylori infection and various demographic factors and endoscopic findings. MethodsA retrospective data review was carried at Alkhor Hospital, Hamad Medical Corporation, Qatar. Adult patients who underwent endoscopy for the evaluation of dyspepsia between January 2011 to December 2017 were included. Patients who underwent endoscopy for reasons other than dyspepsia and those with incomplete data were excluded. ResultsOf the 638 subjects included, 58.9% were males, and the mean age of the subjects was 42.2 years (range 18-79 years). Epigastric pain (80.6%) was the most common symptom, followed by heartburn (26.2%). Forty point nine percent (40.9%) had a positive Campylobacter-like organism (CLO) test for H. pylori. A higher prevalence of H. pylori infection was observed among subjects between 31-50 years of age (43.6%) and 18-30 years (40.5%), and in Asian (42.2%) and Middle East and North African nationals (MENA) nationals (40%). Among the endoscopic findings, esophagitis (P=0.002) and gastritis (P=0.001) showed a statistically significant correlation with H. pylori positivity. Univariate regression analysis revealed an increased risk for H. pylori infection among all age groups except above 65 years, with an odds ratio (OR) of more than 2 in all the three age groups. Among various ethnicities, patients from Asia and MENA countries showed an increased risk of getting H. pylori infection (OR 1.16, 95% CI; 0.77,1.75 and OR 1.06, 95% CI 0.70,-1.61 respectively). The multivariable logistic regression analysis showed that subjects with endoscopic findings of esophagitis (adjusted OR 1.67, 95%CI 1.19, 2.34; P=0.003), gastritis (adjusted OR 1.79, 95%CI 1.27, 2.57; P=0.001), and duodenal ulcer (adjusted OR 2.41, 95%CI 1.24, 4.70; P=0.010) remained significantly associated with an increased risk of having H. pylori infection. ConclusionThe burden of H. pylori infection in patients with dyspepsia undergoing endoscopy is not low in Qatar. Less than 65 years of age, Asian nationals, and being from the MENA region were the demographic predictors for H. pylori infection. The finding of esophagitis, gastritis, and duodenal ulcer on endoscopy were independent endoscopic predictors for having H. pylori infection.

Background and aimsSpontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis. This study aimed to identify the factors impacting morbidity and short-term mortality in a cohort of patients with cirrhosis following an index episode of SBP. MethodsIn a retrospective study of hospitalized cirrhotic cohort, 333 patient records were reviewed. Demographic, clinical, and laboratory, as well as radiological characteristics of the patient population were analyzed on day 1 of admission. The diagnosis of cirrhosis was based on the combination of laboratory, clinical, and radiological features. The diagnosis of SBP was established by abdominal paracentesis in the presence of cellular, biochemical, and microbiological features consistent with SBP. All independent variables were analyzed to generate a predictive model of mortality by using the Cox proportional hazards regression analysis (adjusted for age and gender). ResultsA total of 61 cirrhotic patients with ascites and a first episode of SBP were identified. The overall mortality among hospitalized patients was 19.7% and was associated with longer length of stay (12.6 vs. 7.6 days; p=0.01). Patient cohorts with multiple antibiotic resistant bacteria as a cause of SBP had a significantly higher mortality compared to those with other bacterial phenotypes (p=0.03). Multivariate analyses showed that a model for end-stage liver disease (MELD) score (hazard ratio [HR]=1.29; 95% CI: 1.10 to 1.92; p=0.023), Child-Turcotte-Pugh score (HR=1.23; 95% CI: 1.05 to 1.82; p=0.027), and acute kidney injury (HR=2.09; 95% CI: 1.41 to 3.47; p=0.01) were the predictors of mortality from SBP. ConclusionSBP predicts in-hospital mortality in cirrhotic patients. In addition to multiple antibiotic resistant bacteria, thresholds of both hepatic and renal injury independently predict adverse outcomes.