Saudi Journal of Gastroenterology
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REVIEW ARTICLE
Diseases of the appendix recognized during colonoscopy
Fazal Imtiaz Khawaja
May-August 2002, 8(2):43-52
PMID:19861790
  52,281 0 -
Asymptomatic gallstones: Should we operate?
Khalid R Murshid
April-June 2007, 13(2):57-69
DOI:10.4103/1319-3767.32179  PMID:19858615
Symptomatic gallstones are easy to treat, unfortunately however asymptomatic gallstones are as easy to treat. This creates a problem for health care planners in the form of the financial implications involved, since asymptomatic gallstones are even more common than gallstones associated with symptoms and require no surgical intervention, while the funds diverted towards dealing with them drains the health care establishment of much needed funds in an era of costly health care. In this review we attempt to clarify the fact that asymptomatic gallstones need no intervention in most cases, thereby saving the patient unnecessary surgery and the health care establishment costs, both in the financial form and in manpower.
  27,861 1,620 4
The role of ultrasonography in portal hypertension
Nizar A Al-Nakshabandi
September-December 2006, 12(3):111-117
DOI:10.4103/1319-3767.29750  PMID:19858596
Portal hypertension is a commonly encountered clinical condition with multiple causes and several squeal. Ultrasound is an accurate non-invasive means of assessing its aetiology, severity and complications. I will review the role of ultrasonography in portal hypertension. The ultrasonic features that help identify its aetiology will be discussed as will the criteria that allow an assessment of disease severity and its complications.
  26,653 2,298 7
The physiology of the biliary tree. Motility of the gallbladder - part 2
Mansour Abdul Gadir Ballal, Paul Anthony Sanford
January-April 2000, 6(1):3-17
PMID:19864723
  23,633 1 -
IN FOCUS
Fibroscan® : A noninvasive test of liver fibrosis assessment
Abdullah S Al-Ghamdi
July-September 2007, 13(3):147-149
DOI:10.4103/1319-3767.33470  PMID:19858635
Determination of the extent of progress of hepatic fibrosis is important in clinical practice, where it may reflect the severity of liver disease and predict response to treatment. Percutaneous liver biopsy is the gold standard for grading and staging of liver disease. However, liver biopsy is an invasive procedure with certain unavoidable risks and complications. Several methods have been studied in an attempt to reach a diagnosis of cirrhosis by noninvasive means. Fibroscan® has been designed to quantify liver fibrosis by means of elastography and found to have reasonably good sensitivity and specificity patterns, especially in patients with advanced fibrosis and can be used as an alternative to liver biopsy.
  21,829 1,278 1
ARTICLES
Parasitic disease of the liver and biliary tree
Abdulrahman E Mohamed, Mohamed A Al Karawi, Zuhul Ghandour
January-April 1997, 3(1):22-28
PMID:19864809
Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. Bile iry tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliary tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobiliary parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography (ERCP) is safe and effective in diagnosis and management of biliary tree parasites.
  22,918 1 -
REVIEW ARTICLE
Acute biliary pancreatitis: Diagnosis and treatment
Zakaria M Hazem
July-September 2009, 15(3):147-155
DOI:10.4103/1319-3767.54740  PMID:19636174
Gallstones are the commonest cause of acute pancreatitis (AP), a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP) is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis
  19,634 3,163 6
EDITORIAL
Perspective on the Saudi council for health specialities
Hussein Al-Freihi
January-April 2003, 9(1):1-5
PMID:19861802
  22,432 0 -
REVIEW ARTICLE
Physiology of the Sphincter of Oddi - the present and the future? - part 1
Mansour A Ballal, Paul A Sanford
September-December 2000, 6(3):129-146
PMID:19864708
The mechanisms controlling the sphincter of Oddi (SO) have received considerable attention over the past two decades. Progress towards their elucidation has been slow, perhaps because of the sphincter's relative inaccessibility and the different responses of the human "resistor" as compared to the "pumper" observed in several animal models. The list of agents affecting the sphincter grows alarmingly. In this review, divided into two parts, substances have been classified as neurotransmitters, hormones, local factors and pharmacological agents. The first part considers the roles of neurotransmitters. These include (a) vasoactive intestinal polypeptide (VIP) and nitric oxide (NO). Both cause relaxation. A recent model of their complex interrelationships in smooth muscle is described. (b) Substance P (SP) and enkephalins. These produce contractions. The former can act directly. An indirect effect via cholinergic neurones may be the result of SP release from vagal afferents. (c) Catecholamines, which cause contraction or relaxation via activation of α- or β-adrenoreceptors, respectively. In the second part attention is focussed on cholecystokinin (CCK) which normally relaxes the SO via neuronal mechanisms. A CCK-sensitive pathway from sensory duodenal neurones to SO ganglia has been described. Reactive oxygen species are among the local factors discussed. Their description as being "the good, the bad and the ugly" seems merited. Pharmacological agents include NO donors, octreotide and botulinum toxin (BTX). Octreotide induces tachyoddia and may impair biliary flow. BTX has exciting potential in the diagnosis of SO abnormalities and as a therapeutic alternative to sphincterotomy. In both parts of the review current concepts of different aspects of smooth muscle control are presented. In several instances data regarding the SO is lacking. We discuss (a) the role of interstitial cell of Cajal in the control of slow waves, (b) different pathways contributing to tonic and phasic contractions, (c) the 4 levels of neural control, (d) interrelationships of immune and nervous systems, and (e) links between emotional states and gut functions.
  19,275 1 -
CASE REPORT
Colonoscopic removal of an appendiceal polyp
Fazal Imtiaz Khawaja
September-December 2002, 8(3):93-95
PMID:19861799
  18,166 0 -
REVIEW ARTICLE
Sphincter of Oddi and its dysfunction
Prasad Seetharam, Gabriel Rodrigues
January-March 2008, 14(1):1-6
DOI:10.4103/1319-3767.37793  PMID:19568485
Sphincter of Oddi though mostly heard about in 'anatomy textbooks' is making its way into surgical practice due to various disease states affecting it and its dysfunction seems to be an important condition to be observed while treating patients with abdominal pain. In this review, we have attempted to discuss all the relevant conditions affecting it, particularly the dysfunction with a detailed literature review.
  16,060 955 3
CASE REPORT
Biliary ascariasis: Report of a complicated case and literature review
FM Sanai, MA Al-Karawi
January-March 2007, 13(1):25-32
DOI:10.4103/1319-3767.30462  PMID:19858609
Invasion of the Ascaris worm into the biliary system leads to a wide variety of clinical syndromes. Most of the descriptions of the disease have originated from the developing world, where due to the environmental factors there is a high level of parasitism. An increased incidence of biliary ascariasis borne out of population migration and increased facilities for diagnosis has led to a renewal of interest in this disease in the developed world. Significant morbidity and mortality is associated with the concomitant complications, and early diagnosis and management is of utmost importance. Common disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, and cholangitis. Although with a potential for serious mortality, pancreatitis, and cholangiocarcinoma constitute relatively less common threats. Recent advances in endoscopy have shifted the attention of this disease from the surgeon to the gastroenterologist and a consensus of opinion is arising for early intervention. We present here a patient with biliary ascariasis managed endoscopically and review the epidemiology, prevalence, clinical presentation, diagnosis, and management of this disease.
  15,472 1,050 11
ARTICLES
Chronic diarrhea in children : Part II. Clinical Approach and Management
Mohamed I El Mouzan
May-August 1995, 1(2):81-86
PMID:19864855
Chronic diarrhea is a complex symptom. The clinical approach and management should be based on pathophvsiologic considerations and stepwise laboratory investigations. In infants with severe malnutrition, nutritional support is a priority in the management of this condi­tion.
  16,280 0 -
The postcholecystectomy syndrome: A review
Khalid R Murshid
September-December 1996, 2(3):124-137
PMID:19864820
The objective is to study the Postcholecystectomy Syndrome (PCS); its causes, different methods of diagnosis and different treatment options and their results in order to deduce from the above data the best method of prevention of its occurrence and the best method of treatment once it has occurred. Data sources include a medline search of articles covering this topic in the English literature and the abstracts of non-English articles from 1966-1994. The total number of articles of interest to the study being approximately 120. There are many causes of PCS, some related to improper preoperative diagnosis and some related to avoidable and unavoidable consequences of cholecystectomy. The different diagnostic modalities are dependent on the cause as are the different treatment options. The best treatment of this condition remains prevention whenever possible. Proper diagnosis of those patients who truly require cholecystectomy and care in performing the cholecystectomy will minimize the incidence of this syndrome.
  16,247 2 -
CASE REPORTS
Rupture of multiple splenic artery aneurysms: A common presentation of a rare disease with a review of literature
Ahmad Zubaidi
January-March 2009, 15(1):55-58
DOI:10.4103/1319-3767.45061  PMID:19568559
The splenic artery is the most frequent site of visceral arterial aneurysms. Usually a splenic artery aneurysm occurs as a single event; rupture is frequent, sometimes occurring as the first symptom and is sometimes fatal. This article presents a case of ruptured multiple splenic artery aneurysms-the symptoms and signs, operative and perioperative management, as well as a literature review of this clinically important entity.
  15,184 690 7
ARTICLES
Endoscopic features of Helicobacter pylori induced gastritis
Mohammed Qaseem Khan, Zuhair Alhomsi, Sami Al-Momen, Mahmuda Ahmad
January-April 1999, 5(1):9-14
PMID:19864753
It's still controversial whether certain macroscopic endoscopic features can be used to diagnose Helicobacter pylori (HP) related gastritis. The literature dealing with this subject is confusing, because of the lack of precise terminology, no large control trials, major discrepancies in interpretations of macroscopic changes and poor correlation of the macroscopic appearance and histological finding of gastritis. We conducted a prospective study of 208 dyspeptic patients, who underwent upper gastrointestinal endoscopies from February 1997 to June 1997. Only those patients who had either normal looking gastric mucosa or macroscopic gastritis were included in the study. Endoscopically normal looking mucosa was seen in 67 patients (65.6%), erythematous gastritis in 51 (74%), mosaic appearance in 18 (88%), erosive gastritis in 14 (85%), nodular gastritis in 17 (94%), atrophic gastritis in 12 (75%), and fundal rugae hypertrophies in 5 (80%). We suggest that the antral nodularity, raised erosions, mosaic appearance and mixed findings, are the reliable indicators of the underlying HP induced gastritis. However, these endoscopic findings are very specific, though not sensitive, for HP gastritis.
  15,255 1 -
Formol-ether concentration method in the diagnosis of active schistosoma mansoni in patients with detectable IHA
Mohammad A Al Mofarreh, Ahmad M Al Akwaa, Sayed W Hasan, Ibrahim A Al Mofleh
September-December 2000, 6(3):157-160
PMID:19864711
Schistosomiasis is a world wide human infection. In Saudi Arabia there are multiple endemic foci. Various methods have been used to diagnose Schistosoma mansoni. We studied 1410 patients coming from S. mansoni endemic areas with detectable antibodies by indirect hemagglutination (IHA). Stool specimens were tested for S. mansoni ova by direct smear and formol-ether concentration (FEC) methods. The objective of the study was to identify patients with active schistosomiasis using FEC method and a single direct smear. Twenty percent of IHA positive patients had active infection detected by FEC, while a single direct stool smear diagnosed only 2.4% (P<0.0001). The percentage of positive FEC was significantly increasing in linear trend with IHA level. This trend wasn't observed with direct smear examination. The current data suggest that FEC is helpful to diagnose active schistosomiasis, therefore it is recommended in IRA positive individuals.
  14,643 0 -
Small intestinal obstruction in pregnancy and puerperium
Lawrence C Chiedozi, Linus N Ajabor, Florentus I Iweze
September-December 1999, 5(3):134-139
PMID:19864739
The problem of intestinal obstruction in pregnancy and puerperium is worsened by the risk it poses not just to the mother, but also to the fetus. In this review of 10 pregnant/puerperium patients the maternal mortality was 10% and fetal wastage 20%. In pregnancy and puerperium, intestinal obstruction carries a higher mortality, 10-33%, than in non-pregnant patients, 6-10%. The rarity of the problem, delay in diagnosis, anxiety over radiological examination in pregnant women, worry over laparotomy in pregnant women, all result in delay in instituting definite treatment and contribute to the morbidity. Application of established principles in the management of intestinal obstruction even when it occurs in pregnancy and puerperium might help to improve the results of management and reduce the current level of morbidity and mortality.
  13,626 1 -
Swallowed foreign body: Is interventional management always required?
Gharamah Yahya Al Shehri, Talal Abdullah Al Malki, Mohammed Yahya Al Shehri, Oluwole Gbolagunte Ajao, Suleiman Abdulaziz Jastaniah, Kamal Sidiq Haroon, Mohammed Makram Mahfouz, Mubarak Mohammed Al Shraim
May-August 2000, 6(2):84-86
PMID:19864717
A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.
  13,450 0 -
Chronic diarrhea in children : Part I. physiology, pathophysiology, etiology
Mohamed I El Mouzan
January-April 1995, 1(1):37-42
PMID:19864866
Chronic diarrhea is an important cause of morbidity and mortality in children. Although the pattern of the problem is well established in Western countries. limited data are available from Saudi Arabia. The purpose of this review is to provide an updated overview of the physiology of digestion, pathophysiology and etiology of diarrhea with particular emphasis on patterns prevalent in Saudi Arabia
  13,368 1 -
REVIEW ARTICLE
Enterocutaneous fistula
Oluwole Gholagunte Ajao, Mohammed Yahya Shehri
May-August 2001, 7(2):51-54
PMID:19861768
Based on the modality of treatment, historically the management of enterocutaneous fistula has been grouped into three periods. The era of antibiotics (1945-1960), the era of intensive nurse care (1960-1970) and the era of intravenous hyperalimentation (1970-1975). Schein's modification of Sitges-Serra classification of enterocutaneous fistula is now preferred to the old classification of high-output type and low output type. A major cause of enterocutaneous fistula is technical failure. Serum level of short-turn over proteins such as albumin retinal-binding protein, thyroxin binding pre-albumin as serum transferring are predictors of mortality and spontaneous fistula closure. Immediate surgical correction of the fistula is not a priority of treatment. The control of sepsis and adequate nutrition are the two most important aspects of management. The use of somatostatin and octreotide has been shown to shorten the period of spontaneous closure of the fistula.
  12,936 1 -
ARTICLES
Management of complicated gallstone disease during pregnancy
Mohammed Hamad Al-Akeely
September-December 2003, 9(3):135-138
PMID:19861817
Background: Controversy still exists regarding the optimal management of complicated gallstones during pregnancy owing to the possible risks for the fetus. Generally the management of such problems during pregnancy is conservative, however, endoscopic retrograde cholangiopancreatography (ERCP) and/or operative intervention may be required in some patients. Aim of study: The aim is to evaluate the management of complicated gallstone disease with particular reference to the indications, timing and risks of ERCP and operative intervention during pregnancy and its effect on fetus outcome. Patients and methods: This retrospective study was conducted on 32 pregnant women, who were admitted with complication of cholelithiasis at Riyadh Medical Complex (RMC) through the emergency during the period of March 1998-October 2002. Their files were evaluated for age, presentation, gestational age, hematological, radiological, fetus assessment, management, fetus out come and how ERCP and surgery were performed. Results: Among the 32 pregnant women studied, 22 responded satisfactorily to conservative treatment. They had laparoscopic cholecystectomy (LC) after delivery. Ten patients needed further treatment, two were operated for acute cholecystitis (AC) and recurrent biliary colic (BC). Eight patients had ERCP for obstructive jaundice and recurrent pancreatitis following which two had LC cholecystectomy. All patients remained well until delivery. Conclusion: Majority of gallstone complications during pregnancy can be managed conservatively. Surgery can be deferred until delivery. Few patients who needed ERCP and/or surgery can be managed safely during second and third trimester
  12,413 1 -
Ascites: Tips on diagnosis and management
Ibrahim A Al Mofleh, Rashed S Al Rashed
May-August 1996, 2(2):80-86
PMID:19864832
Clinical evaluation and diagnostic paracentesis with estimation of the serum-ascitic albumin gradient (SAAG) is the most important step in identifying the etiology of ascites. At a level of 1.1 g/dl, SAAG, accurately (96.7%) differentiate portal hypertension from nonportal hypertension-associated ascites. The majority of patients with ascites (>80%) have portal hypertension associated etiology mainly, liver cirrhosis. Approximately 90% of patients with ascites complicating cirrhosis respond to salt restriction and diuretics. The remainder (10%),have refractory ascites which commonly respond well to large volume paracentesis (LVP). Asymptomatic complications occurring in patients treated with LVP may not necessitate treatment. Other alternative methods for treatment of refractory ascites include: ascitic fluid recirculation (AR), peritoneovenous shunting (PVS),transjugular intrahepatic portosystemic stent-shunting (TIPS) and orthotopic liver transplantation (OLT).
  12,176 2 -
Gastroenterological manifestations of sickle cell disease
Abdul-Wahed Nasir Meshikhes
January-April 1997, 3(1):29-33
PMID:19864810
Sickle cell hemoglobinopathy is a common genetic disorder which is prevalent in certain areas of the Kingdom of Saudi Arabia. It is characterized by repeated hemolytic and vasoocclusive crises which lead to widespread vascular occlusion and subsequent multiple organ infarctions. Affected individuals present with a wide variety of gastrointestinal disorders mimicking vasoocclusive episodes causing diagnostic confusion and delays that may catch the unwary clinician. This article briefly reviews the gastroenterological manifestations of sickle cell disease.
  11,909 3 -
Bilateral paravertebral block in advanced schistosomal liver disease: A prospective study
Haitham Ahmed Abou Zeid, Abdul Mohsen Abdulah Al-Ghamdi, Maha Sid-Ahmed Abdel-Hadi, Hazem Mohamed Zakaria, Abdel Aziz Abdulatif Al-Quorain, Maisa Noureldin Shawkey
May-August 2004, 10(2):67-77
PMID:19861829
Background: Surgery in patients with schistosomal liver disease is usually associated with high risks of morbidity and mortality. Bilateral paravertebral block (BPVB) has been advocated as a useful technique for ventral abdominal hernias' repairs. Aim of the study: To compare the efficacy of BPVB with general anesthesia (GA) for anterior abdominal wall hernias in advanced schistosomal liver disease patients. Patients and Methods: Sixty patients were randomly allocated into two groups to receive either GA or BPVB. Variables were hospital stay, hemodynamic stability, postoperative nausea and vomiting (PONY), postoperative pain measured on a visual analogue scale (VAS) with assessment of the hepatic cell integrity using glutathione S transferase alpha (GSTA) and other liver enzymes. Results: The main significant finding was an apparently significant shorter length of hospital stay following BPVB as compared with GA in patients (P < 0.005). Conclusions: BPVB was superior to GA following abdominal ventral hernia repair in schistosomal liver fibrosis patients
  11,862 1 -
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