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Sanat ZM, Vahedi H, Malekzadeh R, Fanni Z. Epidemiologic profile of inflammatory bowel disease in Eastern Mediterranean Region (EMRO) countries: a systematic review and meta-analysis. BMC Public Health 2024; 24:1395. [PMID: 38789987 PMCID: PMC11127456 DOI: 10.1186/s12889-024-18816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) consists of two main types: Crohn's disease (CD) and ulcerative colitis (UC). The epidemiology of IBD patients has not been comprehensively studied in EMRO countries; therefore, we conducted this meta-analysis to study the epidemiology of this disease in these countries. METHODS We searched four international databases, namely Scopus, Web of Knowledge (ISI), Medline/PubMed, and ProQuest, from inception up to the end of May 2023. The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline was used to carry out this systematic review and meta-analysis investigation. Using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, the quality of the selected papers was assessed. RESULTS Based on the results of this study, the incidence of UC in EMRO countries was 2.65 per 100,000 (95% CI: 1.39-3.90), and the incidence of CD was 1.16 per 100,000 (95% CI: 0.73-1.59). The most commonly involved intestinal segment in CD was the terminal ileum (44.7%, 95% CI: 34.7-55.2), followed by the ileum (29.8%, 95% CI: 22.2-38.6), and colon (18.7%, 95% CI: 10.8-30.4). However, in UC patients, extensive colitis was the most common finding (32.3%, 95% CI: 26.4-38.8), followed by proctosigmoiditis (27.9%, 95% CI: 21.1-35.8), left-sided colitis (27.4%, 95% CI: 22.7-32.7), and proctitis (22.6%, 95% CI: 17.5-28.5). CONCLUSION As a result, we were able to establish the traits of IBD patients in EMRO nations. UC patients had a higher incidence than CD patients. The most common regions of involvement in CD and UC patients, respectively, were the colon and pancolitis. Compared to UC patients, CD patients had a higher history of appendectomy.
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Affiliation(s)
- Zahra Momayez Sanat
- Assistant Professor of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoon Vahedi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Fanni
- Assistant Professor of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran, Iran.
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Meeralam Y, Al-Zanbagi AB, Al Saedi M, Alharthi W, Sabbahi HA, Alhejaili T, Shariff MK. IBD-Disk as a tool estimating the prevalence of inflammatory bowel disease-related disability and associated influencing factors in Saudi Arabia: A cross-sectional study. Saudi J Gastroenterol 2023; 29:309-315. [PMID: 37787349 PMCID: PMC10644998 DOI: 10.4103/sjg.sjg_3_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 06/15/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) disk is an easy tool to use in clinical practice to measure IBD-related disability, with a score >40 correlating with high daily-life burden. Its use has been limited mainly to the western world. We aimed to estimate the prevalence of IBD-related disability and evaluate the associated risk factors in Saudi Arabia. Methods In this cross sectional study conducted at a tertiary referral center for IBD, the English IBD disk was translated into Arabic, and patients with IBD were approached to complete it. Total IBD disk score (0 = no disability; 100 = severe disability) was documented and a score of >40 was set as a threshold to estimate the prevalence of disability. Results Eighty patients with a mean age of 32.5 ± 11.9 years and disease duration of 6 years, including 57% females, were analyzed. The mean IBD-disk total score was 20.70 ± 18.69. The mean subscores for each function within the disk ranged from 0.38 ± 1.69 for sexual functions to 3.61 ± 3.29 for energy. The overall prevalence of IBD-related disability was 19% (15/80 scoring >40) and was much higher in active disease, in males and in IBD of long duration (39%, 24%, and 26%, respectively). A clinically active disease, high CRP, and high calprotectin were strongly associated with higher disk scores. Conclusion Although the overall mean IBD disk score was low, nearly 19% of our population had high scores signifying a high prevalence of disability. As demonstrated by other studies, active disease and high biomarkers were significantly associated with higher IBD-disk scores.
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Affiliation(s)
- Yaser Meeralam
- Gastroenterology and Hepatology Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Adnan B. Al-Zanbagi
- Gastroenterology and Hepatology Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Mona Al Saedi
- Gastroenterology and Hepatology Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Walaa Alharthi
- Internal Medicine Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Hanadi A. Sabbahi
- Internal Medicine Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Talal Alhejaili
- Gastroenterology and Hepatology Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Mohammed. K Shariff
- Gastroenterology and Hepatology Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
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Almakadma AH, De Vol A, Alabdaljabar MS, Aldosari S, Muhsen I, AlFreihi O, Kurdi A, Almadi M, Alsohaibani F. Complementary and alternative medicine use and its association with medication adherence in inflammatory bowel disease and other gastrointestinal diseases. Saudi J Gastroenterol 2023; 29:233-239. [PMID: 37282444 PMCID: PMC10445501 DOI: 10.4103/sjg.sjg_468_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 06/08/2023] Open
Abstract
Background The use of complementary and alternative medicines (CAMs) has been embedded in populations for decades. In this study, we aimed to determine the rate of their usage among inflammatory bowel disease (IBD) patients and their association with adherence to conventional therapies. Methods In this cross sectional, survey-based study, IBD patients' (n=226) adherence and compliance were evaluated using the Morisky Medication Adherence Scale-8. A control sample of 227 patients with other gastrointestinal diseases was included to compare trends of CAM use. Results Crohn's disease represented 66.4% of those with IBD, with a mean age of 35 ± 13.0 years (54% males). The control group had either chronic viral hepatitis B, gastroesophageal reflux disease, Celiac disease, or other non-IBD diseases, with a mean age of 43.5 ± 16.8 years (55% males). Overall, 49% of patients reported using CAMs (54% in IBD group and 43% in the non-IBD group, P =0.024). Across both groups, the most used CAMs were honey (28%) and Zamzam water (19%). There was no significant association between the severity of the illness and use of CAMs. Patients who used CAMs had a lower adherence to conventional therapies vs. those who did not use CAMs (39% vs. 23%, P =0.038). Using the Morisky Medication Adherence Scale-8, low adherence to medications was reported in 35% of the IBD group vs. 11% of non-IBD group (P = 0.01). Conclusion In our population, patients with IBD are more likely to use CAMs and are less adherent to medications. Furthermore, the use of CAMs was associated with a lower adherence rate to conventional therapies. Consequently, further studies assessing the causes associated with the use of CAMs and nonadherence to conventional therapies should be explored and interventions designed to mitigate nonadherence.
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Affiliation(s)
| | | | | | - Sarah Aldosari
- Department of General Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Omar AlFreihi
- Department of Orthopedic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amr Kurdi
- Department of Medicine, Division of Gastroenterology, King Abdullah Bin Abdulaziz University Hospital,Riyadh, Saudi Arabia
| | - Majid Almadi
- Department of Medicine, Division of Gastroenterology, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alsohaibani
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Al-Fawzan AA, Al-Radhi SA, Al-Omar AS, Al-Mutiri NH, Al-Ammari AM, El-Gohary M, Shamsan AN, Al Shehri HM, ALGhasab NS. A Study of the Epidemiology, Clinical, and Phenotypic Characteristics of Inflammatory Bowel Disease in the Northen-Central Region of Saudi Arabia. Diagnostics (Basel) 2023; 13:2135. [PMID: 37443529 DOI: 10.3390/diagnostics13132135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is becoming increasingly prevalent in Saudi Arabia. However, there is limited data on the characteristics and manifestations of IBD in this population. This study aimed to establish a multi-center database of patients with IBD in the Qassim region of Saudi Arabia to better understand the demographics, prevalence, and manifestations of IBD in this population. METHODS This retrospective study included patients diagnosed with IBD at three healthcare facilities in the Qassim region of Saudi Arabia. The patient's demographic and clinical characteristics, disease location and behavior, age at diagnosis, medication use, related surgeries, and extraintestinal manifestations were recorded based on the Montreal classification. A total of 257 patients with IBD were included in the study, of which 126 had UC and 131 had CD. RESULTS Of the 257 patients with IBD, 134 (52.2%) were male and 123 (47.8%) were female. The mean age of patients with CD and UC were 28.74 (range 15-67) and 38.79 (range 15-75) years, respectively. There was a significant difference between all age groups (p < 0.005), with more patients aged over 40 years being diagnosed with UC. UC was most commonly classified as left-sided UC (E2) (60; 47.6%), while the most common location of CD was the ileocolon (L3) (76; 58%). Non-stricturing and non-penetrating CD was the most common behavior (B1) (70; 53.8%). Approximately one-third of the patients with Crohn's disease developed perianal disease (70; 27.2%), with fistulizing Crohn's being the most prevalent manifestation (40; 30.5%), followed by abscess formation (10; 7.6%) and fissures (9; 6.8%). The most common extraintestinal manifestation was arthropathy (15; 5.8%). Significant p-values were detected for UC and CD (p = 0.036). CONCLUSIONS This study provides crucial insights into the demographics, patterns, and manifestations of IBD in Saudi Arabia. The findings highlight the need for improved diagnosis, management, and treatment strategies for IBD in this population. The establishment of a multi-center database will help to facilitate future research and improve patient care in Saudi Arabia.
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Affiliation(s)
- Ahmed A Al-Fawzan
- Department of Internal Medicine, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
| | - Sulaiman A Al-Radhi
- Department of Internal Medicine, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
| | - Ahmed S Al-Omar
- Department of Internal Medicine, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
| | - Nawaf H Al-Mutiri
- Department of Internal Medicine, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
- Gastroenterology and Endoscopy Unit, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
| | - Ammar M Al-Ammari
- Department of Internal Medicine, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
- Gastroenterology and Endoscopy Unit, King Fahad Specialist Hospital, Burydah 52366, Saudi Arabia
| | - Mohammad El-Gohary
- Department of Internal Medicine, Buraydah Central Hospital, Burydah 52361, Saudi Arabia
| | - Amal N Shamsan
- Department of Internal Medicine, King Saud Hospital, Onaizah 56437, Saudi Arabia
| | - Hamdan M Al Shehri
- Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | - Naif S ALGhasab
- Department of Internal Medicine, Medical College, Ha'il University, Ha'il 55476, Saudi Arabia
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Mosli MH, Almudaiheem HY, AlAmeel T, Bakkari SA, Alharbi OR, Alenzi KA, Khardaly AM, AlMolaiki MA, Al-Omari BA, Albarakati RG, Al-Jedai AH, Saadah OI, Almadi MA, Al-Bawardy B. Saudi Arabia consensus guidance for the diagnosis and management of adults with inflammatory bowel disease. Saudi J Gastroenterol 2022; 29:361671. [PMID: 36412460 PMCID: PMC10540981 DOI: 10.4103/sjg.sjg_277_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 02/10/2023] Open
Abstract
Optimal management of inflammatory bowel disease (IBD) relies on a clear understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This article provides concise guidelines for the management of IBD in adults, based on the most up-to-date information at the time of writing and will be regularly updated. These guidelines were developed by the Saudi Ministry of Health in collaboration with the Saudi Gastroenterology Association and the Saudi Society of Clinical Pharmacy. After an extensive literature review, 78 evidence-and expert opinion-based recommendations for diagnosing and treating ulcerative colitis and Crohn's disease in adults were proposed and further refined by a voting process. The consensus guidelines include the finally agreed on statements with their level of evidence covering different aspects of IBD diagnosis and treatment.
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Affiliation(s)
- Mahmoud H. Mosli
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Inflammatory Bowel Disease Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Turki AlAmeel
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shakir A. Bakkari
- Division of Gastroenterology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Othman R. Alharbi
- Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalidah A. Alenzi
- Regional Drug Information and Pharmacovigilance Center, Ministry of Health, Tabuk, Saudi Arabia
| | | | - Maha A. AlMolaiki
- Department of Pharmaceutical Care, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bedor A. Al-Omari
- Pharmaceutical Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rayan G. Albarakati
- Department of Obstetrics and Gynecology, Majmaah University, Riyadh, Saudi Arabia
| | - Ahmed H. Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Omar I. Saadah
- Inflammatory Bowel Disease Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majid A. Almadi
- Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Badr Al-Bawardy
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
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Altuwaijri M, Hakami L, Alharbi O, Almadi M, Alshankiti S, Aljebreen A, Azzam N. The Long-Term Clinical Effectiveness of Ustekinumab in Antitumor Necrosis Factor-Experienced Crohn’s Disease Patients. Cureus 2022; 14:e28536. [PMID: 36185868 PMCID: PMC9514158 DOI: 10.7759/cureus.28536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) of unknown etiology. Ustekinumab (UST), an interleukin (IL)-12 and IL-23 antibody, has been approved in the recent years to treat IBD, both Crohn’s disease and ulcerative colitis. This study clarifies the long-term effectiveness of ustekinumab (UST) in antitumor necrosis factor (anti-TNF) refractory Crohn’s disease in Middle Eastern patients. Methods A retrospective review study, including 30 refractory or medication-intolerant patients with Crohn’s disease, was conducted at a tertiary care center in Riyadh, Saudi Arabia. The patients were started on ustekinumab and followed up for at least 52 weeks. Follow-up was performed on weeks 12, 24, and 52. Data related to demographic and laboratory parameters, the dosing schedule of ustekinumab administration, and the Harvey-Bradshaw index (HBI) were collected. Clinical remission and response rates were assessed. Statistical analysis was performed using SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). A statistical significance threshold of p < 0.05 was adopted. Results The mean age of the study subjects was 34.2 ± 17.9 years (95% confidence interval (CI): 27.5-40.9), with a mean disease duration of 10.6 ± 4.9 years (95% CI: 8.8-12.5). Of our cohort, 56.7% failed two biologics during their disease course, and about 20% failed three different biologics. The percentage of patients who used thiopurines was 76.7%, while 6.7% used methotrexate. Concurrent immunomodulators were used by 58.6% of the patients. Corticosteroids were given to 13.3% of the patients. Intravenous induction of UST at 6 mg/kg was used for 90% of the patients, while only 10% used a 260 mg subcutaneous dose. At week 12, 73.3% of the patients had a clinical response, and 66.7% achieved clinical remission. Corticosteroid-free remission, clinical response, and clinical remission showed a decreasing percentage trend between weeks 12 and 24 compared to week 52 where a spike was observed in all aforementioned parameters. The clinical response rate at week 52 was 76.7%. The p-values from cross-tabulation were significant for clinical response and remission when comparing week 12 to weeks 24 and 52. Conclusion Ustekinumab presents a safe and effective treatment option in moderate to severe Crohn’s disease patients with previous exposure to multiple biologics.
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Beverage Consumption and Ulcerative Colitis: A Case-Control Study from Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042287. [PMID: 35206479 PMCID: PMC8872579 DOI: 10.3390/ijerph19042287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/30/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023]
Abstract
Background: The association between beverage intake and ulcerative colitis (UC) is not well-established, with no available data from Arab countries. Herein, we investigated the potential association of consuming coffee, tea, and carbonated soft drinks with UC among a population from Saudi Arabia. Methods: This hospital-based case-control study used data of 171 newly diagnosed UC patients and 400 patients with other gastrointestinal conditions who served as controls. All UC cases were ascertained by endoscopy, while beverage intake was assessed by a questionnaire that was completed before diagnosis. We computed odds ratios (ORs) and 95% confidence intervals (95% CIs) of UC and UC extension for frequent versus infrequent intakes of coffee, tea, and carbonated soft drinks using logistic regression. Results: Overall, 23.4% of UC patients had pancolitis, 21.1% extensive, 51.4% left-sided, and 4.1% proctitis. UC patients had a similar sex distribution to the controls but were older and had a lower BMI. After adjustment for age, sex, body mass index, and smoking history, frequent intakes of coffee and tea were associated with lower odds of UC: 0.62 (0.42, 0.91) and 0.53 (0.35, 0.79), respectively. On the other hand, frequent intakes of carbonated soft drinks were associated with increased odds of UC: 9.82 (6.12, 15.76). The frequency of beverage consumption was not associated with UC extension. Conclusion: UC was negatively associated with frequent coffee and tea consumption but positively associated with frequent carbonated soft drink intake in Saudi people. More population-based prospective cohort studies are needed to confirm our findings.
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Qari Y. Clinical characteristics of Crohn's disease in a cohort from Saudi Arabia. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:56-62. [PMID: 35283715 PMCID: PMC8869273 DOI: 10.4103/sjmms.sjmms_35_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/21/2020] [Accepted: 01/08/2021] [Indexed: 12/07/2022] Open
Abstract
Objective: In Saudi Arabia, there are limited studies on the clinical characteristics of patients specifically with Crohn's disease (CD). This study was conducted to describe the clinical characteristics of CD at a tertiary care center in Jeddah, Saudi Arabia. Methods: This retrospective study included all patients aged >14 years who had a definitive diagnosis of CD and were managed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between 2012 and 2018. Data were collected for the following categories: clinical, laboratory, radiological, histological features at presentation, and disease-related complications. Results: The study included 245 newly diagnosed CD patients, aged 14–73 years (median: 26.3 years). All subjects presented with abdominal pain. Majority of the patients (59.7%) received a definitive diagnosis of CD >3 months after the onset of symptoms; 15.1% were initially suspected to have intestinal tuberculosis. Diarrhea and bleeding per rectum were reported in 60.8% and 49.7% of the patients, respectively. Sacroiliitis was the most frequent extraintestinal manifestations (11.4%). In terms of disease location, the terminal ileum (L1) was the most affected area (46.9%). Twenty-five patients had perianal disease, of which 40% had complex fistulae and 36% had perianal abscesses. The majority had hemoglobin levels >10 g/dl (74.1%), decreased serum iron (69.6%) and ferritin (50.5%) levels, and elevated erythrocyte sedimentation rate (68.2%) and C-reactive protein (82.2%). Conclusions: The majority of the patients in our cohort presented with the characteristic quartet of abdominal pain, weight loss, fever, and diarrhea. This study also found a significant number of patients with CD in Saudi Arabia experience diagnostic delay, which may contribute to disease morbidity and complications. These findings highlight the need for future studies to determine factors influencing this diagnostic delay.
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Mosli M, Alawadhi S, Hasan F, Abou Rached A, Sanai F, Danese S. Incidence, Prevalence, and Clinical Epidemiology of Inflammatory Bowel Disease in the Arab World: A Systematic Review and Meta-Analysis. Inflamm Intest Dis 2021; 6:123-131. [PMID: 34722642 DOI: 10.1159/000518003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives Despite the recent findings of the rising incidence of inflammatory bowel disease (IBD) in Arab countries, there are limited data on the characteristics of IBD patients and the disease course in the Arab world. This systematic review aimed to investigate the incidence and epidemiology of IBD in the Arab world. Material and Methods We conducted a systematic literature review that utilized a comprehensive search of PubMed, Cochrane Central, SCOPUS, Google Scholar, and Web of Science from their inception till August 2020. We included cross-sectional, prospective, and retrospective studies that examined the prevalence and/or epidemiological characteristics of IBD in Arab countries. Results A total of 16 studies that examined IBD in Saudi Arabia, Egypt, Kuwait, the United Arab Emirates, Bahrain, Lebanon, and Oman were included. Generally, the included studies covered the period from the early 1990s to the late 2010s. A total of 1,627 ulcerative colitis (UC) patients and 1,588 Crohn's disease (CD) patients were included in this systematic review. The mean age at diagnosis ranged from 24.13 to 43.6 years in adult cases and from 4.5 to 16 years in pediatric cases. In most of the included studies, the majority of patients were male. The quantitative analysis revealed a pooled incidence rate of 2.33 (95% confidence interval [CI] 1.2-3.4) per 100,000 persons per year for UC in the Arab world. Likewise, the pooled incidence rate for CD in the Arab world was 1.46 (95% CI 1.03-1.89) per 100,000 persons per year. Conclusion There is a growing incidence of IBD in the Arab world, while IBD patients from Arab countries may present with some different characteristics, compared to their counterparts in Europe.
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Affiliation(s)
- Mahmoud Mosli
- Gastroenterologist and Inflammatory Bowel Disease Specialist, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sameer Alawadhi
- Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Fuad Hasan
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Faisal Sanai
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Silvio Danese
- Professor of Gastroenterology, Faculty of Medicine, Humanitas University, Milan, Italy
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Mosli M, Alzahrani AM, Bahafzalla RA, Gazzaz TA, Slaghour RM, Altabsh GZ, Aljadani SB, Alturkestani RN, Hussein SS, Kashgary A, Saadah OI. Prevalence of Renal Stones Among Patients With Inflammatory Bowel Disease in Saudi Arabia. Cureus 2021; 13:e15787. [PMID: 34295595 PMCID: PMC8292829 DOI: 10.7759/cureus.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) that affect the gastrointestinal tract with no identified etiology. IBD has been associated with several extraintestinal manifestations (EIMs), including renal involvement such as renal stones (nephrolithiasis), resulting in significant morbidity. This study aims to estimate the prevalence of renal stones among IBD patients in Saudi Arabia. METHODS This is a retrospective study conducted at King Abdulaziz University Hospital between January 2019 and December 2020. All IBD patients with abdominal imaging studies were included in the study regardless of their age. Data were collected from the electronic hospital information system and analyzed. RESULTS A total of 363 IBD patients fulfilled the study inclusion criteria. Nephrolithiasis was detected radiologically in 3.6% of the cohort (5.1% of UC and 2.7% of CD patients). Patients with renal stones are older (P=0.002) and more likely to be diabetic (P=0.047), have microscopic hematuria (P<0.001), and proteinuria (P=0.002). Binary logistic regression analysis showed that older age at diagnosis (P=0.003) and microscopic hematuria (P=0.02) are independent predictors for renal stones. CONCLUSION The study reported that 3.6% of Saudi IBD patients had renal stones, with a higher prevalence of renal stones formation among UC patients than Crohn's. Older age at diagnosis and the presence of microscopic hematuria may predict the development of renal stones. Future studies should be conducted in a prospective manner at multiple centers across Saudi Arabia for further investigation.
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Affiliation(s)
- Mahmoud Mosli
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulrahman M Alzahrani
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Tala A Gazzaz
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | | | | | - Abdullah Kashgary
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Omar I Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Mosli MH, Alamri AA, Saadah OI. Work and School Absenteeism in Inflammatory Bowel Disease Patients in Jeddah, Saudi Arabia: A Cross-Sectional Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:159-166. [PMID: 34084107 PMCID: PMC8152386 DOI: 10.4103/sjmms.sjmms_79_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/01/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022]
Abstract
Background: Inflammatory bowel disease (IBD), which can have a considerable effect on quality of life, productivity and performance, is typically diagnosed during periods of life in which patients have academic and career-related responsibilities. Objective: The objective of the study was to determine the effect of IBD symptoms on work and school absenteeism in patients from Saudi Arabia. Patients and Methods: This cross-sectional survey included patients diagnosed with IBD, aged >8–60 years, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The validated 32-question IBD quality-of-life questionnaire was used to elicit information regarding quality of life and another 9-question validated questionnaire was used to assess work and school absenteeism. A logistic regression analysis was used to identify possible determinants of absenteeism. Results: A total of 123 IBD patients were included, with a 1:1 male-to-female ratio. The median age at presentation was 26 years (range: 8–59 years), 56.9% had Crohn's disease, and 43.1% had ulcerative colitis. Further, 58 (47.2%) were employed, 49 (39.8%) were students and 16 (13%) were unemployed. Forty-seven (43.9%) participants reported absenteeism: 26 were employees (55.3%) and 21 were students (44.7%). A binary logistic regression analysis identified IBD subtype (P = 0.006) and the presence of perianal disease (P = 0.028) as clinical predictors for absenteeism from school or work. A feeling of abdominal pain (P = 0.015), fatigue (P = 0.015) and difficulty taking part in social engagements (P < 0.001) were also significantly associated with absenteeism. Conclusions: A sizeable proportion of the participants reported absenteeism owing to the effects of IBD. IBD subtype, perianal disease, presence of ongoing abdominal pain, fatigue and difficulty in social engagement were strongly associated with nonattendance.
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Affiliation(s)
- Mahmoud H Mosli
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah A Alamri
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar I Saadah
- Inflammatory Bowel Disease Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pediatrics, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Ewid M, Al Mutiri N, Al Omar K, Shamsan AN, Rathore AA, Saquib N, Salaas A, Al Sarraj O, Nasri Y, Attal A, Tawfiq A, Sherif H. Updated bone mineral density status in Saudi patients with inflammatory bowel disease. World J Gastroenterol 2020; 26:5343-5353. [PMID: 32994692 PMCID: PMC7504241 DOI: 10.3748/wjg.v26.i35.5343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/15/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Little is known about inflammatory bowel disease (IBD) burden and its impact on bone mineral density (BMD) among adult patients in Saudi Arabia. To the best of our knowledge, our study is the only study to give an update about this health problem in adult Saudi patients with IBD. IBD is a great risk factor for reduced BMD due to its associated chronic inflammation, malabsorption, weight loss and medication side effects. Consequently, screening for reduced BMD among patients with IBD is of utmost importance to curb and control anticipated morbidity and mortality among those patients. AIM To assess the relationship between IBD and BMD in a sample of adult Saudi patients with IBD. METHODS Ninety adult patients with IBD - 62 Crohn's disease (CD) and 28 ulcerative colitis (UC) - were recruited from King Fahad Specialist Hospital gastroenterology clinics in Buraidah, Al-Qassim. All enrolled patients were interviewed for their demographic information and for IBD- and BMD-related clinical data. All patients had the necessary laboratory markers and dual-energy x-ray absorptiometry scans to evaluate their BMD status. Patients were divided into two groups (CD and UC) to explore their clinical characteristics and possible risk factors for reduced BMD. RESULTS The CD group was significantly more prone to osteopenia and osteoporosis compared to the UC group; 44% of the CD patients had normal BMD, 19% had osteopenia, and 37% had osteoporosis, while 78% of the UC patients had normal BMD, 7% had osteopenia, and 25% had osteoporosis (P value < 0.05). In the CD group, the lowest t-score showed a statistically significant correlation with body mass index (BMI) (r = 0.45, P < 0.001), lumbar z-score (r = 0.77, P < 0.05) and femur z-score (r = 0.85, P < 0.05). In the UC group, the lowest t-score showed only statistically significant correlation with the lumbar z-score (r = 0.82, P < 0.05) and femur z-score (r = 0.80, P < 0.05). The ROC-curve showed that low BMI could predict the lowest t-score in the CD group with the best cut-off value at ≤ 23.43 (m/kg2); area under the curve was 0.73 (95%CI: 0.59-0.84), with a sensitivity of 77%, and a specificity of 63%. CONCLUSION Saudi patients with IBD still have an increased risk of reduced BMD, more in CD patients. Low BMI is a significant risk factor for reduced BMD in CD patients.
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Affiliation(s)
- Mohammed Ewid
- Internal Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Nawaf Al Mutiri
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Khalid Al Omar
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Amal N Shamsan
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Awais A Rathore
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Nazmus Saquib
- Epidemiology Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Anas Salaas
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Omar Al Sarraj
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Yaman Nasri
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Ahmed Attal
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Abdulrahman Tawfiq
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Hossam Sherif
- Critical Care Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Waheed KB, Shah WJ, Altaf B, Amjad M, Hameed F, Wasim S, UlHassan MZ, Abuabdullah ZM, Rajamonickam SN, Arulanatham ZJ. Magnetic resonance imaging findings in patients with initial manifestations of perianal fistulas. Ann Saudi Med 2020; 40:42-48. [PMID: 32026703 PMCID: PMC7012033 DOI: 10.5144/0256-4947.2020.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a serious cause of perianal disease and the incidence is increasing in Saudi Arabia. MR imaging may document specific features that may help to foresee Crohn's disease in patients making an initial presentation. OBJECTIVE Present MR imaging findings of perianal fistulas in patients making an initial presentation. DESIGN Retrospective, observational. SETTING Radiology clinic in in Dhahran. PATIENTS AND METHODS All previously undiagnosed and untreated patients who presented for the first time to the outpatient clinics from September 2015-2018 with perianal fistulas were retrospectively evaluated. Previously diagnosed CD patients, post-surgical or intervention cases were excluded. Fistulas were categorized as low or high anal, simple or complex, and were graded per St. James University Hospital Classification. Imaging was interpreted by two experienced readers based on the Van Assche score. MAIN OUTCOME MEASURES Fistula features on MR imaging and diagnosis of CD. SAMPLE SIZE 171 patients. RESULTS Of 171 patients, 139 (81.3%) were males with mean age of 37.2 (12.7) years; the 32 females had a mean age of 35.8 (10.6) years. Twenty-one patients (12.3%) had CD. Fourteen (40.4%) patients with complex fistulas had CD in comparison to only 5 (4.8%) simple fistula patients ( P=.0005). More than half of patients with complex and high anal fistulas had CD ( P=.0005). Females were more affected than males ( P=.0005). CONCLUSION Complex or high anal fistula on MR imaging may be the initial presentation of CD and warrant further work up to establish the diagnosis. LIMITATIONS Retrospective, small sample, single center, and short duration study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Khawaja Bilal Waheed
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Waseem Jan Shah
- From the Department of Pediatric Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Bilal Altaf
- From the Department of General Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Muhammad Amjad
- From the Department of Internal Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Fawad Hameed
- From the Department of General Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Sana Wasim
- From the Department of Radiology, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Muhammad Zia UlHassan
- From the Department of Radiology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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Alharbi R, Almahmudi F, Makhdoom Y, Mosli M. Knowledge and attitudes of primary healthcare physicians toward the diagnosis and management of inflammatory bowel disease following an educational intervention: A comparative analysis. Saudi J Gastroenterol 2019; 25:277-285. [PMID: 31187783 PMCID: PMC6784430 DOI: 10.4103/sjg.sjg_169_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS Inflammatory bowel disease (IBD) is a chronic inflammatory condition that requires early diagnosis and proper management. Patients with early symptoms of IBD are typically evaluated first by primary healthcare (PHC) physicians, who in turn refer patients with suspected IBD to specialists. Therefore, we aimed to assess the knowledge and attitude of PHC physicians toward IBD. MATERIALS AND METHODS We conducted a comparative cross-sectional survey of PHC physicians practicing at the Ministry of Health PHC centers in Jeddah, KSA. Demographics and data on the knowledge and practices of physicians were collected through a predefined and tested questionnaire that included three domains (Eaden, Leong, and Sign/Symptom Awareness). A subgroup of the cohort was educated about IBD referral criteria (group A, n = 65) prior to study initiation and their responses were compared with those from the remaining group (group B, n = 135). Regression analysis was used to test associations with the significance threshold set at 5%. RESULTS A total of 211 PHC physicians were surveyed with a response rate of 95%. Female physicians comprised 66.5% of the cohort and the mean age was 32.26 ± 6.6 years. About 91% of physicians were Saudi nationals, and 75.5% were MBBS degree holders. The majority of the respondents (93%) reported seeing zero to five patients with IBD per month, and almost half of the physicians preferred to always refer patients to specialists (49.5%). Most of the respondents were uncomfortable (3.27 ± 1.4 to 4.35 ± 1.2) with initiating or managing specific medical therapies (maintenance therapy, therapy for acute flare, corticosteroids, immunomodulators, and biologics) for patients with IBD. With regard to knowledge, group A had higher scores in all three domains especially in the Sign/Symptom Awareness domain (mean score 6.17 ± 1.1 vs. 3.5 ± 1.01, P < 0.001). According to multivariate analyses, both groups' knowledge showed no significant relationship with any of the medical therapies, except for the Sign/Symptom Awareness domain which was shown to be significantly affecting the comfort of doctors in managing maintenance therapy among patients with IBD [odds ratio (OR) =1.61, P = 0.008]. Gender, nationality, and qualifications were found to have a significant influence on the comfort in initiating specific medical therapies. Group A was identified as a significant factor in predicting comfort with managing corticosteroids (OR = 8.25, P = 0.006) and immunomodulators (OR = 6.03, P = 0.02) on patients with IBD. CONCLUSION The knowledge and comfort of PHC physicians with IBD medication prescription appears to be higher when education is provided. This observation is important, since PHC physicians are responsible for early identification and referral of patients suspected of having IBD, to specialists.
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Affiliation(s)
- Rwan Alharbi
- The Joint Program of Family Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faizah Almahmudi
- The Joint Program of Family Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yahya Makhdoom
- The Joint Program of Family Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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AlRuthia Y, Alharbi O, Aljebreen AM, Azzam NA, Almadi MA, Bahari OH, Almalki KA, Atham AT, Alanazi AS, Saeed M, HajkhderMullaissa B, Alsenaidy M, Balkhi B. Drug utilization and cost associated with inflammatory bowel disease management in Saudi Arabia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:25. [PMID: 31827409 PMCID: PMC6894268 DOI: 10.1186/s12962-019-0194-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries. Treatment costs are an essential component for healthcare planning and priority setting. The utilization patterns and annual administration and cost of IBD medications are largely unknown in countries with an increasing incidence of disease, Saudi Arabia being an example. AIM To evaluate the use of non-biologic and biologic agents and their associated annual administration costs in a sample of patients with Crohn's disease (CD) and ulcerative colitis (UC) in Saudi Arabia. METHODS Single-center retrospective chart review was performed to determine the use of biologic and non-biologic medications among IBD patients in a tertiary care hospital in Riyadh, Saudi Arabia. Daily and the annual acquisition cost of different IBD therapeutic agents was calculated. The utilization rates and cost of each type of medication by CD and UC patients were compared. RESULTS Data of 258 CD patients and 249 UC patients were analyzed. Infliximab and adalimumab were the most commonly prescribed biologics among the study sample, however, their utilization rates were significantly higher among CD than UC patients (36.82% vs. 11.24%, and 20.54% vs. 9.64%, respectively, P < 0. 01). Azathioprine utilization rate was also higher among CD patients compared to their UC counterparts (71.71% vs. 40.16%, respectively, P < 0.01). However, the utilization rate of mesalazine in the UC patients was significantly higher than their CD counterparts (85.53% vs. 14.34% for CD, P < 0.01). The annual cost of biologics (including administration and lab test cost) ranged from 5572 USD for ustekinumab to 18,424 USD for vedolizumab. On the other hand, the annual cost of non-biologics ranged from 16 USD for prednisone to 527 USD for methotrexate. CONCLUSION Biologics are extensively used in the management of IBD, particularly CD, and their utilization costs are significantly higher than non-biologics. Future studies should examine the cost effectiveness of IBD medications especially in countries with increasing incidence such as Saudi Arabia.
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Affiliation(s)
- Yazed AlRuthia
- 0000 0004 1773 5396grid.56302.32Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia
- 0000 0004 1773 5396grid.56302.32Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Othman Alharbi
- 0000 0004 1773 5396grid.56302.32Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman M. Aljebreen
- 0000 0004 1773 5396grid.56302.32Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nahla A. Azzam
- 0000 0004 1773 5396grid.56302.32Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Majid A. Almadi
- 0000 0004 1773 5396grid.56302.32Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- 0000 0004 1936 8649grid.14709.3bDivision of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
| | - Ohud H. Bahari
- 0000 0004 1773 5396grid.56302.32Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia
| | - Khalid A. Almalki
- 0000 0004 1773 5396grid.56302.32Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia
| | - Abdulaziz T. Atham
- 0000 0004 1773 5396grid.56302.32Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia
| | - Ahmed S. Alanazi
- 0000 0004 1773 5396grid.56302.32Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia
| | - Maria Saeed
- 0000 0004 1773 5396grid.56302.32Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Baraa HajkhderMullaissa
- 0000 0004 1773 5396grid.56302.32Gastroenterology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alsenaidy
- 0000 0004 1773 5396grid.56302.32Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- 0000 0004 1773 5396grid.56302.32Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451 Saudi Arabia
- 0000 0004 1773 5396grid.56302.32Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Sharara AI, Al Awadhi S, Alharbi O, Al Dhahab H, Mounir M, Salese L, Singh E, Sunna N, Tarcha N, Mosli M. Epidemiology, disease burden, and treatment challenges of ulcerative colitis in Africa and the Middle East. Expert Rev Gastroenterol Hepatol 2018; 12:883-897. [PMID: 30096985 DOI: 10.1080/17474124.2018.1503052] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ulcerative colitis is an idiopathic, chronic, inflammatory bowel disorder characterized by an unpredictable course of alternating cycles of relapse and remission. Traditionally viewed as a disease of Western countries, the prevalence of ulcerative colitis is reported to be increasing in the developing world. In these regions, there is the potential to further explore the etiology of the disease, mainly through genetic studies. With this in mind, we consider available data relating to the epidemiology, clinical manifestations, and disease course of ulcerative colitis in Africa and the Middle East. Current treatment approaches in these countries are also reviewed and discussed in the context of new, small molecule, orally administered therapies. Areas covered: Available data on the epidemiology, clinical manifestations, and risk factors of ulcerative colitis in Africa and the Middle East are reviewed using a PubMed database search. Expert commentary: Epidemiologic studies from African and Middle Eastern countries suggest disease trends similar to the West, and an important health and economic burden. The management of ulcerative colitis within these developing countries is challenging, with the need to improve early diagnosis, access to healthcare, and patient education, along with facilitation of access to treatment options and improvement of medication adherence.
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Affiliation(s)
- Ala I Sharara
- a Division of Gastroenterology , American University of Beirut Medical Center , Beirut , Lebanon
| | | | - Othman Alharbi
- c Gastroenterology Division , King Khalid University Hospital, King Saud University , Riyadh , Kingdom of Saudi Arabia
| | - Hisham Al Dhahab
- d Department of Gastroenterology , Royal Hospital , Muscat , Oman
| | | | - Leonardo Salese
- f Department of Gastroenterology , Inflammation and Immunology Medical Affairs, Pfizer Inc , Collegeville , PA , USA
| | - Ena Singh
- f Department of Gastroenterology , Inflammation and Immunology Medical Affairs, Pfizer Inc , Collegeville , PA , USA
| | - Nancy Sunna
- g Department of Inflammation and Immunology , Pfizer Inc , Amman , Jordan
| | | | - Mahmoud Mosli
- h Department of Medicine , King Abdulaziz University , Jeddah , Kingdom of Saudi Arabia
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Isa HM, Mohamed AM, Al-Jowder HE, Matrook KA, Althawadi HH. Pediatric Crohn's Disease in Bahrain. Oman Med J 2018; 33:299-308. [PMID: 30038729 PMCID: PMC6047177 DOI: 10.5001/omj.2018.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/21/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Our study aimed to report the epidemiology, clinical presentations, diagnostic and therapeutic approaches, and outcomes of Crohn's disease (CD) in pediatric patients in Bahrain. METHODS We conducted a retrospective review of the medical records of patients with CD diagnosed in the pediatric department, Salmaniya Medical Complex, Bahrain, between 1984 and 2017. We used the data to calculate the annual incidence and cumulative prevalence. Data about gender, nationality, clinical presentation, age at presentation and diagnosis, duration of illness, consanguinity, family history, contact with smokers, and comorbidities were gathered. Results of hematological, biochemical, and serological tests were also collected. All radiological, endoscopic, and histopathological findings were reviewed. Data about medical therapy, relapse episodes, hospital admissions, complications, and outcomes were collected. RESULTS Of 108 pediatric patients diagnosed with inflammatory bowel disease (IBD), 51 (47.2%) patients had CD. The annual incidence was 1 in 100 000 per year (range = 0-5 patients/year) with significant rise on comparing the three decades (p = 0.0001). Prevalence was 9.32 patients per 100 000 pediatric populations. Thirty-four patients (66.7%) were males, and the median age was 18.5 years (range = 6.4-35.0). Common clinical presentations were recurrent abdominal pain and weight loss. Family history of IBD was found in 10 patients. One patient had positive antineutrophil cytoplasmic antibody. The terminal ileum was involved in 68.1%, colon in 63.8%, and perianal area in 17.0% patients. Biological therapy was used in five patients. Surgical intervention was required in six patients. The mean follow-up period was 9.2±5.6 years. CONCLUSIONS The clinical characteristics of our population are comparable to that reported in neighboring countries and worldwide.
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Affiliation(s)
- Hasan M. Isa
- Pediatric Department, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain
| | - Afaf M. Mohamed
- Consultant Family physician, Shaikh Jaber Health Centre, Manama, Bahrain
| | - Halima E. Al-Jowder
- Pediatric Department, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain
| | - Khadija A. Matrook
- Pediatric Department, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain
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Zhang M, Sun K, Wu Y, Yang Y, Tso P, Wu Z. Interactions between Intestinal Microbiota and Host Immune Response in Inflammatory Bowel Disease. Front Immunol 2017; 8:942. [PMID: 28855901 PMCID: PMC5558048 DOI: 10.3389/fimmu.2017.00942] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract. Although the etiology and pathogenesis of IBD remain unclear, both genetic susceptibility and environmental factors are implicated in the initiation and progression of IBD. Recent studies with experimental animal models and clinical patients indicated that the intestinal microbiota is one of the critical environmental factors that influence nutrient metabolism, immune responses, and the health of the host in various intestinal diseases, including ulcerative colitis and Crohn’s disease. The objective of this review is to highlight the crosstalk between gut microbiota and host immune response and the contribution of this interaction to the pathogenesis of IBD. In addition, potential therapeutic strategies targeting the intestinal micro-ecosystem in IBD are discussed.
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Affiliation(s)
- Ming Zhang
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China
| | - Kaiji Sun
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China
| | - Yujun Wu
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China
| | - Ying Yang
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China
| | - Patrick Tso
- Department of Pathology and Laboratory Medicine, Metabolic Diseases Institute, University of Cincinnati, Cincinnati, OH, United States
| | - Zhenlong Wu
- State Key Laboratory of Animal Nutrition, Department of Animal Nutrition and Feed Science, China Agricultural University, Beijing, China.,Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China
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Abdulla M, Al Saeed M, Fardan RH, Alalwan HF, Ali Almosawi ZS, Almahroos AF, Al Qamish J. Inflammatory bowel disease in Bahrain: single-center experience. Clin Exp Gastroenterol 2017; 10:133-145. [PMID: 28765713 PMCID: PMC5524702 DOI: 10.2147/ceg.s127909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The number of newly diagnosed inflammatory bowel disease (IBD) cases such as ulcerative colitis (UC), Crohn’s disease (CD), and indeterminate colitis (IC) is rapidly increasing in Gulf countries and Saudi Arabia. The aim of this study was to investigate the incidence and prevalence of IBD in patients who have attended the Salmaniya Medical Complex, Bahrain, between the years 1984 and 2014. Patients and methods All patients who had attended the Salmaniya Medical Complex, Bahrain, and had been diagnosed with UC, CD, or IC, between the years 1984 and 2014, were included in the analysis. Data collected were: patient demographics, symptoms, clinical signs, complications, surgical interventions, extent of disease, endoscopic findings, histopathology, and lab measurements. Results A total of 187 cases were included; 61 had CD, 123 had UC, and a further 3 cases presented with IC. A clear increase in the incidence and prevalence of IBD can be seen in this cohort. The prevalence of IBD was calculated to be 26.25/105 cases. The average number of IBD cases increased from 3 cases (average for the years 1984–2001) to 12 cases (average for the years 2002–2014). A number of factors correlate positively or negatively with CD and UC. In the current study, a link between gastrointestinal complications in CD cases and the use of steroids as a treatment was noted (p-value −0.02). Age also had a significant influence on the need for surgery in CD cases (p-value −0.04), and a family history of UC was statistically linked to surgical intervention (p-value −0.05). Conclusions IBD can no longer be considered a rare disease in Bahrain. The incidence of both UC and CD is steadily increasing. There is a need for increasing awareness of the Bahraini public to IBD in order for proper medical care to be given.
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Affiliation(s)
- Maheeba Abdulla
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
| | - Mahmood Al Saeed
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
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Ono Y, Kanmura S, Morinaga Y, Oda K, Kawabata K, Arima S, Sasaki F, Nasu Y, Tanoue S, Hashimoto S, Taguchi H, Uto H, Tsubouchi H, Ido A. The utility of apoptosis inhibitor of macrophages as a possible diagnostic marker in patients with Crohn's disease. BMC Gastroenterol 2017; 17:40. [PMID: 28284201 PMCID: PMC5346245 DOI: 10.1186/s12876-017-0591-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/25/2017] [Indexed: 01/14/2023] Open
Abstract
Background Apoptosis inhibitor of macrophages (AIM) was initially identified as an apoptosis inhibitor that supports the survival of macrophages against various apoptosis-inducing stimuli, and AIM produced by macrophages may contribute to the pathogenesis of inflammatory bowel diseases (IBDs). However, there have been no reports on the kinetics of AIM in IBD and the impact of AIM on the pathogenesis of IBD. In this study, we aimed to investigate the diagnostic utility of levels of AIM and their correlation with the activity of Crohn’s disease (CD) and IBD. Methods We used an enzyme-linked immunosorbent assay (ELISA) to examine AIM serum levels in 16 healthy subjects and 90 patients with inflammatory bowel diseases, namely 39 with CD and 51 with ulcerative colitis (UC), as well as 17 patients with Behcet’s disease (BD) as intestinal disease controls. We compared serum AIM levels among groups and examined whether there were correlations between serum AIM levels and disease activity and type. We also performed immunohistochemical staining of AIM in intestinal tissues of patients with CD. Results Serum AIM levels were significantly higher in patients with CD than in patients with UC, BD, and controls (3.27 ± 2.14, 1.88 ± 1.43, 2.34 ± 1.37, and 2.13 ± 0.64 μg/ml, respectively; P < 0.01). There was no difference in serum AIM levels before and after treatment in patients with CD. However, in these patients the diagnostic rate using AIM was better than that based on anti-Saccharomyces cerevisiae antibodies. AIM was expressed in macrophages that were positive for CD14, CD16, or both in the intestinal tissues of patients with CD. Conclusions AIM is a novel biomarker of CD that can distinguish CD from UC or BD. It is suggested that AIM may contribute to intestinal inflammation by inhibiting the apoptosis of macrophages.
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Affiliation(s)
- Yohei Ono
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Yuko Morinaga
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kohei Oda
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Katsuto Kawabata
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuichirou Nasu
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shiroh Tanoue
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroki Taguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hirofumi Uto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.,Center for Digestive and Liver Diseases, Miyazaki Medical Center Hospital, Miyazaki, Japan
| | | | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
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21
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Haskey N, Gibson DL. An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. Nutrients 2017; 9:nu9030259. [PMID: 28287412 PMCID: PMC5372922 DOI: 10.3390/nu9030259] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 12/11/2022] Open
Abstract
Diet has been speculated to be a factor in the pathogenesis of inflammatory bowel disease and may be an important factor in managing disease symptoms. Patients manipulate their diet in attempt to control symptoms, often leading to the adoption of inappropriately restrictive diets, which places them at risk for nutritional complications. Health professionals struggle to provide evidence-based nutrition guidance to patients due to an overall lack of uniformity or clarity amongst research studies. Well-designed diet studies are urgently needed to create an enhanced understanding of the role diet plays in the management of inflammatory bowel disease. The aim of this review is to summarize the current data available on dietary management of inflammatory bowel disease and to demonstrate that dietary modulation may be an important consideration in managing disease. By addressing the relevance of diet in inflammatory bowel disease, health professionals are able to better support patients and collaborate with dietitians to improve nutrition therapy.
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Affiliation(s)
- Natasha Haskey
- Department of Biology, The Irving K. Barber School of Arts and Sciences, University of British Columbia, Room, ASC 368, 3187 University Way, Okanagan campus, Kelowna, BC V1V 1V7, Canada.
| | - Deanna L Gibson
- Department of Biology, The Irving K. Barber School of Arts and Sciences, University of British Columbia, Room, ASC 368, 3187 University Way, Okanagan campus, Kelowna, BC V1V 1V7, Canada.
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22
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Mosli M, Alzahrani A, Showlag S, Alshehri A, Hejazi A, Alnefaie M, Almaymuni A, Abdullahi M, Albeshir M, Alsulais E, Jawa H, Aljahdli E, Bazarah S, Qari Y. A cross-sectional survey of multi-generation inflammatory bowel disease consanguinity and its relationship with disease onset. Saudi J Gastroenterol 2017; 23:337-340. [PMID: 29205186 PMCID: PMC5738795 DOI: 10.4103/sjg.sjg_125_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Mahmoud Mosli
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia,Address for correspondence: Dr. Mahmoud Mosli, Department of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail:
| | - Abdulelah Alzahrani
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Showlag Showlag
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah Alshehri
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Hejazi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Majed Alnefaie
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Adel Almaymuni
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mubarak Abdullahi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Albeshir
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Eman Alsulais
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Hani Jawa
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Emad Aljahdli
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Salem Bazarah
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Yousif Qari
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
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23
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Al-Bawardy B. Inflammatory bowel disease: Clinical screening and transition of care. Saudi J Gastroenterol 2017; 23:213-215. [PMID: 28721973 PMCID: PMC5539673 DOI: 10.4103/sjg.sjg_294_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA,Address for correspondence: Dr. Badr Al-Bawardy, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, Minnesota, USA. E-mail:
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24
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Abstract
The cause of Crohn’s disease (CD) has posed a conundrum for at least a century. A large body of work coupled with recent technological advances in genome research have at last started to provide some of the answers. Initially this review seeks to explain and to differentiate between bowel inflammation in the primary immunodeficiencies that generally lead to very early onset diffuse bowel inflammation in humans and in animal models, and the real syndrome of CD. In the latter, a trigger, almost certainly enteric infection by one of a multitude of organisms, allows the faeces access to the tissues, at which stage the response of individuals predisposed to CD is abnormal. Direct investigation of patients’ inflammatory response together with genome-wide association studies (GWAS) and DNA sequencing indicate that in CD the failure of acute inflammation and the clearance of bacteria from the tissues, and from within cells, is defective. The retained faecal products result in the characteristic chronic granulomatous inflammation and adaptive immune response. In this review I will examine the contemporary evidence that has led to this understanding, and look for explanations for the recent dramatic increase in the incidence of this disease.
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25
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Abstract
The cause of Crohn's disease (CD) has posed a conundrum for at least a century. A large body of work coupled with recent technological advances in genome research have at last started to provide some of the answers. Initially this review seeks to explain and to differentiate between bowel inflammation in the primary immunodeficiencies that generally lead to very early onset diffuse bowel inflammation in humans and in animal models, and the real syndrome of CD. In the latter, a trigger, almost certainly enteric infection by one of a multitude of organisms, allows the faeces access to the tissues, at which stage the response of individuals predisposed to CD is abnormal. Direct investigation of patients' inflammatory response together with genome-wide association studies (GWAS) and DNA sequencing indicate that in CD the failure of acute inflammation and the clearance of bacteria from the tissues, and from within cells, is defective. The retained faecal products result in the characteristic chronic granulomatous inflammation and adaptive immune response. In this review I will examine the contemporary evidence that has led to this understanding, and look for explanations for the recent dramatic increase in the incidence of this disease.
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26
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Mahalli AAE, Alharthi HMA. Assessment of health-related quality of life of patients with inflammatory bowel diseases in Eastern Province, Saudi Arabia. J Infect Public Health 2016; 10:93-101. [PMID: 27020642 DOI: 10.1016/j.jiph.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/22/2016] [Accepted: 02/20/2016] [Indexed: 01/30/2023] Open
Abstract
Inflammatory bowel disease patients have impaired quality of life with physical, social and emotional dysfunction. This project aimed to assess the effects of socio-demographic and clinical variables on quality of life and to identify its predictors. In a cross-sectional paper-based study, 50 consecutive non-selected patients attending the teaching hospital completed a disease-specific McMaster quality of life tool. Socio-demographic and clinical data were collected from patients' records. The t-test and Mann-Whitney test were used to determine the probability of significant differences between quality of life domains and independent variables. Multiple linear regression was used to determine quality of life predictors. Younger and highly educated patients had higher social scores. Those with shorter disease durations had higher systemic scores. Patients in remission had higher systemic, social, bowel and overall scores. Relapse was a significant predictor of decreased systemic, social, bowel and overall scores. Long disease duration was a significant predictor of decreased systemic and overall scores. Younger age at disease onset was a significant predictor of decreased emotional score. However, high education was a significant predictor of improved social score. Relapse, long disease duration, low education and young age at disease onset were associated with low quality of life. Prospective studies should investigate how interventions addressing these predictors may lead to improved quality of life.
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Affiliation(s)
- Azza A E Mahalli
- College of Applied Medical Sciences, University of Dammam, Saudi Arabia.
| | - Hana M A Alharthi
- College of Applied Medical Sciences, University of Dammam, Saudi Arabia.
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27
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Mosli MH, Al-Harbi O, Feagan BG, Almadi MA. A Saudi Gastroenterology association position statement on the use of tumor necrosis factor-alfa antagonists for the treatment of inflammatory bowel disease. Saudi J Gastroenterol 2015; 21:185-97. [PMID: 26228361 PMCID: PMC4542416 DOI: 10.4103/1319-3767.161635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022] Open
Abstract
The objective of this position statement from the Saudi Gastroenterology Association is to guide gastroenterologists on the use of tumor necrosis factor-alfa (TNF-α) antagonists for the treatment of the idiopathic inflammatory bowel diseases, Crohn's disease, and ulcerative colitis. In this article, we summarize the relevant literature regarding the safety and efficacy of TNF-α antagonists, highlight relevant safety concerns specific to the environment in Saudi Arabia, and provide specific recommendations for the use of these agents.
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Affiliation(s)
- Mahmoud H. Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Othman Al-Harbi
- Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Brian G. Feagan
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Majid A. Almadi
- Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
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28
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Abstract
IBD, comprising Crohn's disease and ulcerative colitis, is a chronic immunologically mediated disease at the intersection of complex interactions between genetics, environment and gut microbiota. Established high-prevalence populations of IBD in North America and Europe experienced the steepest increase in incidence towards the second half of the twentieth century. Furthermore, populations previously considered 'low risk' (such as in Japan and India) are witnessing an increase in incidence. Potentially relevant environmental influences span the spectrum of life from mode of childbirth and early-life exposures (including breastfeeding and antibiotic exposure in infancy) to exposures later on in adulthood (including smoking, major life stressors, diet and lifestyle). Data support an association between smoking and Crohn's disease whereas smoking cessation, but not current smoking, is associated with an increased risk of ulcerative colitis. Dietary fibre (particularly fruits and vegetables), saturated fats, depression and impaired sleep, and low vitamin D levels have all been associated with incident IBD. Interventional studies assessing the effects of modifying these risk factors on natural history and patient outcomes are an important unmet need. In this Review, the changing epidemiology of IBD, mechanisms behind various environmental associations and interventional studies to modify risk factors and disease course are discussed.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Massachusetts General Hospital Crohn's and Colitis Centre, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA
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29
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Albasri AM. Histopathological Profile of Benign Colorectal Diseases in Al-Madinah Region of Saudi Arabia. Asian Pac J Cancer Prev 2014; 15:7673-7. [DOI: 10.7314/apjcp.2014.15.18.7673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Abstract
Understanding a complex pathology such as inflammatory bowel disease, where host genetics (innate and adaptive immunity, barrier function) and environmental factors (microbes, diet, and stress) interact together to influence disease onset and severity, requires multipronged approaches to model these numerous variables. Researchers have typically relied on preclinical models of mouse and rat origin to push the boundary of knowledge further. However, incorporation of novel vertebrate models may contribute to new knowledge on specific aspects of intestinal homeostasis. An emerging literature has seen the use of zebrafish as a novel animal system to study key aspects of host-microbe interactions in the intestine. In this review, we briefly introduce components of host-microbiota interplay in the developing zebrafish intestine and summarize key lessons learned from this animal system; review important chemically induced and genetically engineered zebrafish models of intestinal immune disorders; and discuss perspectives and limitations of the zebrafish model system.
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Affiliation(s)
- Ye Yang
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Sarah Tomkovich
- Department of Medicine, University of Florida, Gainesville, Florida,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christian Jobin
- Department of Medicine, University of Florida, Gainesville, Florida,Department of Infectious Diseases and Pathology, University of Florida, Gainesville, Florida
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31
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Gulinaer A, Sang W, Shi XL, Zhang W, Li XX. Clinical and pathologic characteristics of inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2014; 22:1027-1032. [DOI: 10.11569/wcjd.v22.i7.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical and pathological characteristics of inflammatory bowel disease to raise the early diagnosis of this disease.
METHODS: One hundred and twenty-two cases of inflammatory bowel disease including 101 cases of ulcerative colitis and 21 cases of Crohn's disease were analyzed.
RESULTS: Non-necrotizing granuloma, fissure ulcer and chronic inflammation were morphological features of Crohn's disease. Massive inflammatory cell infiltration in the lamina propria, destroyed glands and reduced secretion, and polyangitis were the hallmarks of ulcerative colitis.
CONCLUSION: The diagnosis of inflammatory bowel disease should be made based on endoscopic, macroscopic and clinical findings. Awareness of the clinical and pathologic features of inflammatory bowel disease can help make an early diagnosis of this disease.
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32
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Affiliation(s)
- Xiaofa Qin
- Department of Surgery, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA E-mail:
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33
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Zahedi MJ, Darvish Moghadam S, Hayat Bakhsh Abbasi M, Dehghani M, Shafiei pour S, Zydabady nejad H, Broumand K. The incidence rate of inflammatory bowel disease in an urban area of iran: a developing country. Middle East J Dig Dis 2014; 6:32-6. [PMID: 24829703 PMCID: PMC4005476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The incidence of inflammatory bowel disease (IBD) varies among different societies. The aim of this study is to determine the incidence rate of IBD in Kerman, a city in Southeast Iran. METHODS All medical records that indicated a new diagnosis of ulcerative colitis (UC) or Crohn's disease (CD) were retrieved from the gastrointestinal endoscopy and pathology departments of 12 centers from October 2011 to September 2012. RESULTS The incidence rate of UC in Kerman was estimated at 4.98/100,000 (95% CI: 2.44-6.94). The mean age of patients was 39.4 years and male to female ratio was 0.89:1.0. UC patients had the following prevalence: cigarette smoking (30%), appendectomy (36%) and oral contraceptive (OCP) use (78.9%). The incidence rate of CD was 0.8/100,000 (95% CI: 0.6 4-1.14). The mean age at diagnosis was 33.3 years and male to female ratio was 0.5:1.0. Cigarette smoking was reported in 33.3%, appendectomy in 66.6% and OCP useing in 75% of CD patients. Rectal and distal colitis, left side colitis and extensive colitis was seen in 20 (55.4%), 12 (33.3%) and 4 (11.1%) of patients with UC, respectively. All patients with CD had large intestinal involvement and one case (16.6%) had ileocolonic disease. CONCLUSION Our study has shown that the incidence rate of both UC and CD in Kerman is lower than Western populations but it is the same as some Asian countries. Characteristics of disease involvement in this study are similar to other studies that have been conducted in Iran and elsewhere.
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Affiliation(s)
- Mohammad Javad Zahedi
- 1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Sodaif Darvish Moghadam
- 1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Masood Dehghani
- 1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Shafiei pour
- 1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
,Corresponding Author: Sara Shafieipour, MD Clinical Research Unit, Afzalipour Hospital, Kerman, Iran Telefax: +98 341 3222270
| | - Hamideh Zydabady nejad
- 1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Kiekam Broumand
- 1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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34
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Affiliation(s)
- Subrata Ghosh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada E-mail: E-mail:
| | - Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
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