Summary:We conducted a retrospective study with the aim of identifying risk factors and clinical characteristics associated with HBV reactivation and clinical flare after allogeneic stem cell transplantation (aSCT). We

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BACKGROUND AND OBJECTIVESThe epidemiology, clinical characteristics, and natural course of inflammatory bowel disease (IBD) in Saudi Arabia are still largely unknown. Hence, we decided to conduct a large retrospective, cohort study to determine these features of the disease.DESIGN AND SETTINGRetrospective study conducted in a tertiary care hospital in Riyadh from January 1970 to December 2008.PATIENTS AND METHODSWe reviewed all the cases of IBD diagnosed and collected all data pertaining to patients with IBD.RESULTSA total of 312 patients with IBD were included for this analysis, including 197 (63%) patients with Crohn disease (CD) and 115 (37%) patients with ulcerative colitis (UC). The mean age (standard deviation) of patients with IBD was 25.5 (10.6) years; 152 (48.7%) were males and 160 females. The referral rate in the past 10 years was 72.1% compared with preceding 20 years, and 56% (n=178) of patients with IBD were from the central region of Saudi Arabia. The patients were followed up for a mean duration of 9.5 years; during their follow-up, 206 patients (66%) required hospital admission and 9 patients (2.9%) with UC developed colon cancer. A total of 6 patients died during the follow-up. Fifty-three percent (n=104) of the patients with CD underwent surgeries as part of their treatment, whereas only 20% (n=23) of the patients with UC underwent colectomy.CONCLUSIONSThe incidence of IBD has been gradually increasing in Saudi Arabia over the years. Clinical features and morbidity in patients are not different from patients with IBD seen in the West.

Medical therapy is an attractive adjuvant to endoscopic treatment in upper gastrointestinal (UGI) bleeding. This review aims to assess the treatment effects of proton pump inhibitor (PPI) therapy in acute nonvariceal UGI bleeding. Outcome measures evaluated were further bleeding, surgery, all-cause deaths, ulcer deaths and non-ulcer deaths. We searched MEDLINE (1966MEDLINE ( -2002 and EMBASE (1974EMBASE ( -2002 using the terms 'gastrointestinal hemorrhage', 'peptic ulcer hemorrhage', 'proton pump inhibitor', 'omeprazole', 'pantoprazole', 'lansoprazole', 'rabeprazole' and 'esomeprazole'. The search was extended to the Cochrane controlled trials registry database, published abstracts from five international gastroenterology conferences, manufacturers of PPI, known contacts and bibliographies from each full-length published report. We included trials published in English and non-English languages. Eligible studies were randomized controlled trials that compared the treatment effects of PPI therapy with placebo or H 2 receptor antagonists in patients with acute non-variceal UGI bleeding. Of the 175 articles screened, 26 controlled trials including 4670 subjects (2317 in treatment arm and 2353 in control arm) were analyzed. The methodology, population, intervention, and outcomes of each selected trial were evaluated using duplicate independent review. Disagreements were resolved by consensus. PPI therapy significantly reduced rates of further bleeding (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.40-0.57) and surgery (OR, 0.61; 95% CI, 0.48-0.76). All-cause deaths were unaffected (OR, 1.02; 95% CI, 0.76-1.37). Ulcer deaths showed a significant reduction (OR, 0.58; 95% CI, 0.35-0.96), while nonulcer deaths showed a significant increase (OR, 1.60; 95% CI, 1.06-2.41) in the PPI therapy group. Sensitivity analysis of 22 trials published in peer-reviewed journals, 10 trials with double-blind design and 19 trials with high quality score and 22 trials using omeprazole in the treatment group showed results similar to those seen in the analysis of all 26 trials, confirming the stability of the conclusions. Subgroup analysis revealed that summary outcome measures were not influenced by control group therapy (placebo vs H 2 receptor antagonists) or the use of prior endoscopic treatment to achieve hemostasis (given vs not given). However, the summary treatment effects for further bleeding and need for surgery were significant in only those trials enrolling patients with peptic ulcers having high risk for rebleeding and not in those trials enrolling patients with all causes of UGI bleeding. The summary treatment effects for further bleeding and need for surgery were significant in trials using intravenous as well as oral PPI. However, summary OR for all-cause deaths and non-ulcer deaths in trials using intravenous PPI were higher in the treatment group and not in trials using oral PPI. This raised the possibility of intravenous PPItherapy-associated non-ulcer deaths in high-risk patients. PPI therapy in acute no...

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BACKGROUND AND OBJECTIVES:Knowledge of the predictors of sustained viral response (SVR) to pegylated interferon (PEG-INF) alfa-2a and ribavirin (RBV) therapy in patients with hepatitis C genotype-4 (HCV-4) is crucial for selecting patients who would benefit most from therapy. We assessed the predictors of SVR to this combination therapy in Saudi patients with chronic HCV-4 infection.PATIENTS AND METHODS:This retrospective study included 148 patients with HCV-4 infection who underwent clinical, biochemical and virological assessments before treatment and at 12, 24, 48 and 72 weeks post-treatment.RESULTS:Of the 148 patients, 90 (60.8%) were males. Mean (SD) for age was 48.5 (12.7) years and BMI was 27.9 (7.5) kg/m2. Seventy-nine of 148 (60.1%) patients were treatment naïve and 110 (74.3%) underwent pre-treatment liver biopsy. Eighteen (12.2%) patients did not complete therapy because of side effects or they were lost to follow up. Early virological response was achieved in 84 of 91 (92.3%) patients. In the 130 (87.8%) patients who completed therapy, 34 (26.2%) were non-responders and 96 (63.8%) achieved end-of-treatment virological response (ETVR). SVR and virological relapse (24 weeks after ETVR) occurred in 66/130 (50.7%) and 30/130 (31.2%) patients, respectively. Compared to relapsers, sustained responders were significantly younger (P=.005), non-diabetic (P=.005), had higher serum albumin (P=.028), lower alpha-fetoprotein level (P=.026), lower aspartate aminotransferase (AST) (P=.04) levels, and were treatment-naivve (P=.008). In a multivariate regression analysis, the independent predictors of SVR were younger age (P=.016), lower serum AST (P=.012), and being treatment naivve (P=.021).CONCLUSION:Approximately half of HCV-4 patients who complete the course of combination therapy achieve an SVR, especially if they are young, treatment naivve and have lower AST levels.

This study reports the findings on endoscopy and the final diagnoses of 172 consecutive patients with dyspepsia from a primary health care center. The purpose of our study was to carry out a thorough gastroenterologic investigation of all patients consulting their general practitioner and reporting dyspepsia during 1 full year, from a population within a defined geographic area. The examinations included patient history, physical examination, laboratory tests, esophagogastroduodenoscopy (EGD), and sigmoidoscopy. All the examinations, including the EGDs, were done at the primary care center. A final diagnosis was settled after a minimum of 6 months. Six per cent had esophagitis, 13% had peptic ulcer disease, 1% had gastric cancer, and 1% had irritable bowel disease. Completely normal endoscopies were seen in 19%. No patient had villous atrophy. Sixty-four per cent had non-ulcer dyspepsia, and 26% had inflammatory bowel syndrome, with great overlapping. It is concluded that open-access endoscopy is a valuable service to primary care, the result of which greatly enhances the diagnostic accuracy in dyspeptic patients entering primary care.

Background/Aims:Treatment success for Helicobacter pylori infection in Saudi Arabia is relatively unexplored. This prospective study compared the efficacy of sequential versus standard triple therapy in curing H. pylori infections.Patients and MethodsEligible patients underwent upper endoscopy at a single center in Saudi Arabia from October 2011 to February 2014. Patients who tested positive for H. pylori infection were randomly assigned to sequential therapy or standard triple therapy. Sequential treatment: Esomeprazole (20 mg bid for 10 days), amoxicillin (1000 mg for 5 days), then clarithromycin 500 mg and tinidazole 500 mg; both bid for 5 days. Standard triple treatment: Esomeprazole 20 mg, clarithromycin 500 mg, and amoxicillin 1000 mg each bid for 14 days. After 6 weeks of treatment, patients were tested for cure using a validated urea breath test. Application of the E-test determined susceptibility of H. pylori to different antibiotics.Results:Of the 115 patients who received sequential therapy, 93 completed treatment. In the triple-therapy arm, 103 of 117 patients completed treatment. The eradication rate was 58/93 (62.3%) with sequential therapy and 69/102 (67.6%) with standard triple therapy, P = 0.44. Risk ratio was 0.92 (95% CI; 0.75–1.13), and number needed to treat was 19. Overall primary resistance: Metronidazole (48.5%), clarithromycin (23.3%), amoxicillin (14.8%), levofloxacin (11.1%), and tetracycline (2.3%). Mild adverse events occurred in 35 and 17 patients in the sequential and standard therapy groups, respectively.Conclusion:Sequential and standard triple therapies were similarly effective at eradicating H. pylori in two-thirds of Saudi patients. Metronidazole and clarithromycin resistance to H. pylori strains was common.