Are patients aware of potential risks of weight reduction surgery? An internet based survey

BACKGROUND/AIM

Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reportedly overweight. Morbid obesity has been associated with an increased risk of many comorbidities and mortality. Bariatric surgery is currently considered the most effective treatment option for morbid obesity. However, there are many concerns regarding the short and long-term complications of weight reduction surgery. It is unclear whether the general population is adequately aware of these risks. Therefore, we aimed to assess awareness of the general population of bariatric surgery complications. Although effective, bariatric surgery has been associated with many acute complications, reported in a range of 0.3% to 8% of operations.

PATIENTS AND METHODS

We performed a cross-sectional study between July and August of 2017 in Jeddah, Saudi Arabia. We used a 26-item, Arabic, electronically distributed questionnaire, to examine public awareness of the acute complications of bariatric surgery. Hypothesis testing was used to examine associations.

RESULTS

In total, 624 questionnaires were completed electronically. Mean age of participants was 25 (±13.2) and 66% were females. Of the surveyed population, 64% reported being aware of acute complications of bariatric surgery. Participants who had previously undergone a bariatric operation had a higher degree of awareness when compared to those who had not undergone a bariatric operation before (80.4% vs. 61.3%, P < 0.001). Females had higher awareness compared to males (70.8% vs. 52.1%, P < 0.001). Awareness of complications was not statistically different when stratified by level of education (P = 0.131) but occupation predicted awareness (P = 0.007).

CONCLUSION

Two-thirds of the general population appears to be aware of the potential acute complications associated with bariatric surgery. Furthermore, awareness seems to be higher in females, individuals who had previously undergone weight reduction surgery, and health care workers.

The Spectrum of Familial Hypercholesterolemia (FH) in Saudi Arabia: Prime Time for Patient FH Registry

Background:

Familial hypercholesterolemia (FH) is a life-threatening inherited condition. Untreated patients have the risk to develop raised plasma levels of cholesterol, atherosclerosis and cardiovascular disease (CVD). If diagnosed and treated early in life, the pathological consequences due to atherosclerosis could be avoided and patients with FH can have an anticipated normal life. Mounting evidence suggests that FH is underdiagnosed and undertreated in all populations. The underlying molecular basis of FH is the presence of mutations in one or more genes in the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB) or proprotein convertase subtilisin/kexin 9 (PCSK9). However, their prevalence is largely unknown in Saudi Arabia but given the high rates of consanguinity, the prevalence appears to be higher. Furthermore, the high prevalence of obesity and diabetes mellitus in Saudi Arabia increases the vascular disease burden in FH cases by adding additional CVD risk factors.

Objective:

This article explores the spectrum of FH-causing mutations in the highly consanguineous Saudi community, the need for establishing the Saudi FH registry, the challenges in creating gene databases, and cascade screening.

Conclusion:

The establishment of FH registry and genetic testing should raise awareness not only among healthcare professionals, but the general population as well. It also helps to provide the best treatment regimen in a cost effective manner to this under-recognised population of FH patients.

A cross-sectional survey of multi-generation inflammatory bowel disease consanguinity and its relationship with disease onset

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.