Chronic Idiopathic Ulcerative Colitis in Saudi Arabia: A Clinicopathological Study of 76 Cases

Abstract

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 ...

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