This review summarized the diagnostic value of fibrosis biomarkers and the efficacy of anti-viral treatments on fibrosis progression. Non­invasive biomarkers can facilitate the screening and management of chronic hepatitis C and B. Screening for significant fibrosis is-mandatory as very effective anti-viral treatments are available, permitting to stop or to reduce the fibrosis progression. The reduction of fibrosis progression will decrease the mortality due to complications of cirrhosis. In patients with chronic hepatitis C, pegylated interferons combined with ribavirin are effective in reducing fibrosis progression. In patients with chronic hepatitis B, lamivudine, adefovir and pegylated interferon are also effective in reducing fibrosis progression. In patients with chronic hepatitis Delta, pegylated interferon is also effective in reducing fibrosis progression

Brucellosis is hyperendemic in the Kingdom of Saudi Arabia (KSA) with more than 8,000 cases reported each year to the public health authorities. The disease can affect almost any organ system in the body including the gastrointestinal system. In some instances, gastrointestinal manifestations may be the only presenting features of the disease. These range from milder complaints like diarrhea, vomiting to more serious complications like involvement of the liver, the spleen and the gallbladder to rarely life­threatening complications like colitis, pancreatitis, peritonitis and intestinal obstruction. Recognition of this type of presentation of brucellosis is important because early diagnosis and treatment usually result in complete recovery without complications

Background: Nonalcoholic steatohepatitis (NASH) is characterized by morphological features indistinguishable from alcoholic hepatitis in individuals who do not consume excess alcohol. The role of leptin in the development of NASH is claimed to be through its inflammatory, fibrogenic and angiogenic effects. Aim of the study: to evaluate the leptin status in patients with NASH with the emphasis on its angiogenic effects and its relation to basic fibroblast growth (BFGF). Patients and Methods: This study was conducted on twenty­five patients with NASH and twenty normal persons of matched age and sex as control. For both groups, lipid profile, fasting and postprandial blood glucose, Serum leptin and BFGF were determined. All the results were tabulated and statistically evaluated. Results: Obesity, hyperlipidaemia and diabetes mellitus were prevalent among patients with NASH. There were significant increase of leptin and basic fibroblast growth factor in patients with NASH, as compared to control. Conclusion: Leptin plays an important role in the pathogenesis of NASH through its metabolic, fibrogenic and angiogenic effects. It may also have a role in the development of complications

Background: Pediatric colonoscopy is routinely performed in most hospitals in Saudi Arabia and yet published data are scarce. The objective of this report is to describe our experience in the practice of pediatric colonoscopy in Saudi Arabia. Patients and Methods: Retrospective analysis of data of all patients below 18 years of age who underwent colonoscopy over a 10-year period. Results: From 1414 H (1993 G) to 1423 H (2002 G), two hundred and seventeen colonoscopies, of which 183 diagnostic procedures, were performed on 183 children. The majority (94%) were Saudi nationals, the age range was between 5 months and 18 years, and the female to male ratio was 1: 0.8. Colonoscopy was total in 58 (32%) and limited in 125 patients (68%). The commonest reason for not completing the procedure was securing the diagnosis in 45/125 patients (36%). The commonest indication was rectal bleeding (35%). The highest yield was in children with bloody diarrhea (91%) and the lowest in those with abdominal pain (27%) with an overall yield of 44%. Colitis was the most common diagnosis occurring in 66% of the children. Conclusion: this report highlights the role of colonoscopy in the recognition of diseases of the colon in our community and identifies some of the problems areas associated with the performance of this procedure in our institution.

Aim of the study: To assess the clinical efficacy of 0.2% glyceryl trinitrate ointment in the management of acute and chronic anal fissures. Patients and methods: A prospective clinical study conducted on consecutive patients presented to the surgical clinic of King Khalid University Hospital, Riyadh with acute and chronic anal fissures, from January to December 2003. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. Results: This study comprised 121 patients, six of them were lost to follow-up and 109 (94.7%) of the remaining 115 patients were cured. Of those cured, 13 patients (11.3%) presented with acute and 102 (88.7%) with chronic fissures. There were 98 male and 17 female patients with median age of 41 years (range, 14-70 years). Complete symptomatic relief was achieved in all patients within one month of therapy. Two patients, with chronic anal fissures presented with recurrent symptoms within one month of the completion of therapy both of them were successfully treated with repeat glyceryl trinitrate course. Treatment had to be terminated in six (5.2%) patients: five (4.3%) experienced intolerable adverse effects and one (0.8%) patient failed to respond. All these patients were successfully treated with lateral internal sphincterotomy. No patient complained of change in continence. Conclusion: Glyceryl trinitrate ointment produces adequate symptomatic control and healing of the anal fissures and can be considered as one of the recommended treatment options