Background: Summary and background data: The Hypertensive lower esophageal sphincter (HLES) is an unusual primary motor disorder of the esophagus. The significance of this motility disorder is still questionable. Objective: The objectives were: (a) identification of the prevalence of HLES in these patients, (b) identification of the common presenting symptoms of HLES, (c) study of the correlation of the symptoms with LESP and (d) study of the effectiveness of pneumatic balloon dilation in cases that fail to respond to medical treatment. Methods: A retrospective study that includes four thousand one hundred and seventy patients, who were subjected to esophageal manometry in the period from January 1994 to December 2003, among whom sixty-six patients with HLES (LESP >40 mmHg) were found. In addition to manometry, upper endoscopy was done to forty-nine patients, upper GI barium studies to thirtyeight patients and esophageal pH- metry to sixteen patients. Results: showed that most of our patients were females (45 females and 21 males), with a mean age of 36.6 ±±14 years. Patients with dysphagia (57.5%) had the highest LESP (52.1 ±±21, mmHg) while patients with chest pain (47%) had the highest distal esophageal contraction amplitude (153.9 ±± 93.2 mmHg). Endoscopy showed varying degrees of esophagitis in 17 patients (34%). Barium studies showed corkscrew esophagus in seven patients (18.4%) and dilated esophagus in nine patients (23.7%). LESP was highest in patients with dilated esophagus (57.5 ±± 33.4 mmHg). All our patients were subjected to medical treatment, of which twelve patients underwent pneumatic dilation with successfully reduced LESP and symptoms relief in 91% of patients. Conclusions: It was concluded that the prevalence of HLES is around 1.6, in which dysphagia and chest pain are the usual presenting symptom, and that pneumatic balloon dilatation is very effective when properly applied. It will probably occupy the same position it has in achalasia.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF]  [PubMed]

Background:Interferon-Alfa (IFN-α) has been the mainstay of treatment for chronic hepatitis C. It has the potential to alter the course of chronic hepatitis C and prevent complications. Aims: This review summarizes current knowledge about the presentation, mechanism, course, and treatment of neuropsychiatric problems associated with interferon alfa (IFN-α) treatment. Methods: Studies were identified by computerized searches, and further references were obtained from bibliographies of the reviewed articles. Results: Neuropsychiatric symptoms frequently occur in hepatitis C patients treated with IFNAlfa. These side effects are troublesome and frequently account for dose reduction or treatment discontinuation. Sometimes, they could be serious and possibly life threatening. Frequent psychiatric evaluations of high risk individuals and, when required, early administration of antidepressants could possibly help to avoid the development of an impending depression or reduce its severity and duration and thus increase adherence to treatment. Conclustion: Greater cooperation between psychiatrists and hepatologists would mean less risk of having the serious side effects with more importance needs to be given to the identification of patients at risk.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Video capsule endoscopy (VCE) has recently been introduced to fill the gap between examinations of the upper and lower gastrointestinal tract, mainly to examine the small bowel (SB) for sources of obscure bleeding in addition to many other indications. VCE represents a minute endoscope, embedded in a swallowable capsule that is propelled by peristalsis and achieves the journey to the right colon in 5-8 hours. Images captured by the capsule are recorded on a hard drive attached to the patient's belt. Many studies have recently shown that the diagnostic yield of VCE is superior to that of push enteroscopy. This mini-review contains information on the technical aspects, indications, safety and tolerance of VCE. It is well known that radiological investigations of the small bowel (SB) have a limited diagnostic yield, are relatively invasive, and often lead to late discovery of diseases, especially malignancy and profuse bleeding, at a worse stage. Also, push enteroscopy is limited by the depth of the insertion of the instrument to the proximal jejunum and, in the retrograde, to the last 50-80 cm of the terminal ileum, with an ability to visualize the entire SB only in 10-70% of cases. Introduction of video capsule endoscopy (VCE) is therefore regarded a significant advance in investigating intestinal diseases, and closes the gap in evaluating the SB, "the black box" of endoscopy(1). This mini-review describes the current indications of VCE and the prerequisites for accurate examination, and briefly discusses its tolerance and safety.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Objective: To report the pattern of presentation of colorectal carcinoma and the outcome of surgical therapy in a tertiary care hospital in Riyadh Saudi Arabia. Methods: The case reports of all patients diagnosed to have colorectal cancer were retrospectively examined for: age, sex, symptoms and clinical findings, site of primary tumour and extent of metastases, operative management, histopathology results and the outcome of surgical therapy. Results: There were forty-three (33 male, 10 female) patients, with a mean age of 42.7 years (range, 23-79 years). Sixteen (37.2%) cases presented with rectal bleeding, ten (23.2%) with abdominal pain, eight (18.5%) had altered bowel habits whereas anaemia was found to be the most frequent clinical result reported in twenty (46.4%) patients. Right side tumour was encountered in twentyone (48.8%) cases, left side tumour in twelve (27.9%) and anorectal cancer in ten (23.2%).For these lesions, thirty (69.7%) curative and thirteen (30.3%) palliative procedures were undertaken. All patients were reported to have adenocarcinomas: six (13.9%) patients had Dukes Stage A, eight (18.6%) Dukes B, twenty (46.1%) Dukes C and nine (20.9%) Dukes D. There were two post operative deaths, and four (9.3%) patients died due to tumour dissemination and cachexia, while twenty nine (67.4%) subjects had disease free survival. Conclusion: There is a substantial proximal shift of the colorectal carcinoma with more advanced lesions at the time of presentation. Surgical resection should be the mainstay treatment with potentially curable tumours.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background: The role of steatosis in the pathogenesis of chronic liver disease (CLD) is now believed to form part of a continuum in non-alcoholic fatty liver disease (NAFLD). One of the unconventional areas in which leptin is now receiving great attention is liver diseases. Several published studies indicate that circulating leptin is increased in patients with cirrhosis, chronic HCV, and non-alcoholic steatohepatitis (NASH). Aims: the present study aims to assess serum leptin levels in patients with NAFLD with and without HCV infection, and to correlate it with the biochemical markers and histopathology of liver diseases. Patients and Methods: the present study included 67 Saudi subjects divided into 3 age and sexmatched groups. Group A: 22 patients with DM (8 males and 14 females, mean age 44 ± 12.9 years). Group B: 20 patients with chronic HCV infection (7 males and 13 females, mean age 48.9 ± 14.1 years). Group C: 25 control healthy volunteers (15 males and 10 females, mean age 40.7 ± 12.6 years). Serum leptin, C-peptide, and insulin levels were measured by radioimmunoassay. Liver biopsy was done for the HCV group only. Results: Patients with chronic HCV infection had significantly lower mean ± SD serum leptin levels (25.6 ± 37.2 ng/mL) compared with the diabetic and control groups, 55.7 ± 59.0 and 81.8 ± 41.7 ng/mL (p = 0.002 and p = 0.046 respectively). However, in the HCV group, leptin levels did not differ significantly as regard steatosis grade, and fibrosis stage. Steatosis in the HCV group patients correlated with the body mass index and hyperglycemia, but not with leptin levels. Serum leptin correlated positively with serum insulin and C-peptide levels in both the HCV and diabetic groups, but not in the control group). Conclusion: Serum leptin can't be used as a non-invasive marker for the predication of steatosis and fibrosis in patients with NAFLD.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Tuberculous peritonitis is a common form of abdominal tuberculosis and is frequently associated with liver disease. Diagnosis of this disease presents a diagnostic dilemma and the presence of liver cirrhosis further confounds the clinical picture. Moreover, the co-existence of these two diseases casts doubt on the validity of various diagnostic tests available. The interpretation of tests of ascitic fluid analysis becomes questionable despite the fact that peritoneal tuberculosis and liver disease cause ascites to develop through separate mechanisms. In addition, the treatment of tuberculosis mandates a better understanding of the co-existent disease in view of the potential hepatotoxicity of anti-tuberculous medication. This review aims to address the prevalence of coexistent liver disease in patients with tuberculous peritonitis, the diagnostic difficulties posed by such and the various treatment approaches to be adopted.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Background: Autoimmune hepatitis (AIH) is a relapsing inflammatory disease of the liver of unknown cause. Little is known about AIH in Saudi Arabia. Objectives: Our aim is to [1] identify the special clinical or histological features in our patients[2], describe the initial response to immunosuppressive therapy and long term relapse[3], identify clinical and laboratory predictors of response to therapy, and [4] examine the utility of laboratory markers (platelet count, AST/ALT ratio, and the AST to platelet ratio index (APRI score) in predicting the presence of advanced fibrosis. Methods: Patients were identified using a computer database. Patients responding to initial therapy were compared with patients who did not respond in terms of laboratory and histology parameters. The utility of three fibrosis markers/models were then examined. Results: Thirty-nine patients with AIH were included in this analysis. The mean age was 45.4; 65% of patients were females. Mean ALT at presentation was 268 U/L and AST was 277 U/ L. GGT level was found to be the only statistically significant laboratory or histopathological parameter difference between responders and non-responders. Platelet count and AST/ALT ratio were found to be the best predictors of advanced fibrosis. Conclusion: In Saudi patients with AIH, we found that the GGT level at presentation may serve as a useful predictor for response to therapy. Platelet count and AST/ALT ratio may be used to predict advanced fibrosis.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF]  [PubMed]