One year before the close of the 19th century it was recognized that intestinal peristalsis was controlled by nerve plexuses in the wall of the gut independent of the central nervous system (CNS). This concept was developed further during the first quarter of the 20th century but was almost forgotten during the next 50 years until it was revived by the early 1970s. It is now recognized that the myenteric and submucous plexuses, referrred to as the enteric nervous system (ENS), contain as many neurons as in the spinal cord. In addition to autonomy from the CNS, the ENS employs not only noradrenaline and acetylcholine but also serotonin (5-HT), ATP, peptides and nitric oxide as neurotransmitters, and controls gut movements, exocrine and endocrine secretions and the microcirculation, thus qualifying for being considered the brain of the gut. Reflexes involving the ENS may be entirely intrinsic such as that controlling peristalsis, between parts of the gut through prevertebral ganglia e.g. the enterogastric reflex, or between the gut and the CNS as examplified by the vago-vagal reflexes. Absent, defective or dysfunctional enteric neurons may result in achalasia, infantile hypertrophic pyloric stenosis, paralytic ileus, intestinal pseudo-obstruction, Hirschsprung's disease or idiopathic chronic constipation. Further, the ENS may be involved in the pathogenesis of secretory diarrhoea and inflammatory bowel disease. More research on the gut brain will deepen our understanding of the physiology and pathophysiology of the gastrointestinal tract.

To determine the pattern of lower gastrointestinal disease in the Eastern region of Saudi Arabia we analysed 1907 colorectal biopsies obtained from 1590 consecutive patients (1256 males & 334 females), evaluated during a 13 year period (1983-1996) in a tertiary care teaching hospital. The age range was 6-81 years with a mean of 37 + 15. During the same period 6874 new patients were seen in the Gastroenterology Clinics. Saudi Arabs constituted 970 (61 %) of all patients. The remaining 620 (39%) were non-Saudi, mostly of Arab origin from neighbouring countries. The most common presenting symptom for referral was abdominal pain (1193 patients, 75%) followed by diarrhea (636 patients, 40%). The most frequent histologic diagnosis was a normal mucosa followed by non specific proctocolitis accounting respectively for 37.9% and 37.4% of all cases. These were followed by schistosomiasis, 113 (7.1%), adenocarcinoma, 91 (5.7%) and ulcerative colitis, 91 cases with a relative frequency of 5.7% and a calculated prevalence of 1.3%. Of significance was the encounter of 14 cases of Crohn's disease amounting to 0.9% of all cases with a calculated prevalence of 0.2%. A minority of 83 patients (5.2%) were cases of either a benign polyp, diverticular disease, tuberculosis, ischaemia, lymphoma, pseudomembranous colitis (PMC), eosinophilic gastroenteritis or malacoplakia. These data show that although a "normal mucosa" and "nonspecific proctocolitis" were the dominant diagnoses, significantly, ulcerative colitis and Crohn's disease exist and should be considered in the differential diagnosis of lower GI disease.

Since the discovery of Helicobacter pylori (H. pylori), several invasive and non invasive tests have become available. The aim of this study was to test the performance of immunoglobulins IgG and IgA by using an enzyme linked immunosorbent assay (ELISA) test (In vitro diagnostika GmbH, Germany) for the diagnosis of H. pylori among dyspeptic patients. Blood samples from 152 dyspeptic patients and 51 asymptomatic controls were analyzed in a case control study. IgG and IgA were positive in 33.5% and 41.1% respectively compared to 13.8% for both IgG and IgA in controls (P=0.002). We support the future use of serology as a non invasive, and rapid test for the diagnosis of H. pylori infection among dyspeptic patients in areas with low prevalence. Endoscopy remains the method of choice for elderly dyspeptic patients and for those with possible gastric or duodenal pathology.

Background and objectives: Acute pancreatitis is a serious complication of ERCP. Octreotide as prophylaxis against ERCP-induced hyperamylasemia has produced conflicting results. A review article has called for additional controlled studies. This work was undertaken to see the effect of octreotide in ERCP-induced enzyme changes in a predominantly Saudi population. Subjects & methods: The setting was a university teaching hospital, Eastern Saudi Arabia. The study was prospective, randomized and controlled and the subjects were 50 consecutive adult in-patients. Octreotide, 200 tg subcutaneous, was used in the study group (27 patients). Levels of serum amylase and lipase were estimated three times post-ERCP; mean values were compared with the control group (23 patients) using student t test. Results: A total of 50 patients were studied. Their mean age was 43 (range 19 to 70); 30 were female, a male:female ratio of 1:1.5. The two groups were comparable in terms of age, sex and nationality as well as clinical, haematological and biochemical variables. In both groups, the serum levels of amylase and lipase 4 hours post-ERCP were significantly higher compared with base line levels. However, there were no statistical differences between the mean post-ERCP values within as well as between the two groups of patient studied. However, the pattern of response appeared to be different when amylase was compared with lipase. Conclusion: Prophylactic octreotide, in the regimen used in this study, does not protect against post-ERCP hyperamylasemia and hyperlipasemia. The observed apparent difference in the pattern of serum amylase and lipase remains to be confirmed.

This is a retrospective analysis of the medical records of 116 patients who presented to the gastroenterology division, department of medicine at King Khalid University Hospital (KKUH) in Riyadh, Kingdom of Saudi Arabia and subsequently had a histopathologic diagnosis of hepatic granulomas. Infections contributed to 56% and were represented mainly by schistosomiasis and to a lesser extent by tuberculosis, brucellosis and hydatid disease. Lymphomas (8%) were the major representative of noninfectious causes. The etiology of 25% of granulomas remained undetermined. Weight loss, fever, anorexia and abdominal pain were the most frequent presenting symptoms in 53, 45, 43 and 42% of patients, respectively. Ten percent of the patients were asymptomatic. Hepatomegaly and splenomegaly were the predominant physical findings in 55% and 43% of patients respectively. Hepatic granulomas in this study are mainly caused by infections. Schistosomiasis, tuberculosis and brucellosis represented the most common etiologic factors.