Saudi Journal of Gastroenterology
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   2019| January-February  | Volume 25 | Issue 1  
    Online since January 28, 2019

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Inflammation and pancreatic cancer: An updated review
Kamleshsingh Shadhu, Chunhua Xi
January-February 2019, 25(1):3-13
DOI:10.4103/sjg.SJG_390_18  PMID:30588953
Pancreatic cancer is a devastating disease with poor prognosis in the modern era. Inflammatory processes have emerged as key mediators of pancreatic cancer development and progression. Recently, studies have been carried out to investigate the underlying mechanisms that contribute to tumorigenesis induced by inflammation. In this review, the role of inflammation in the initiation and progression of pancreatic cancer is discussed.
  32 9,947 1,400
The gap between knowledge and undergoing colorectal cancer screening using the Health Belief Model: A national survey
Majid A Almadi, Faisal Alghamdi
January-February 2019, 25(1):27-39
DOI:10.4103/sjg.SJG_455_18  PMID:30618441
Background/Aims: Colorectal cancer (CRC) is a public health issue, and before the initiation of a national cancer screening program, there is a need to examine the acceptance of the public to undergo CRC screening and explore potential barriers. Materials and Methods: A nationwide survey was conducted using an electronic platform to collect demographic variables and using the Health Belief Model to assess attitudes and behavior of participants as well as the knowledge about and intent to undergo CRC screening. At the end of the survey, participants from Riyadh were invited to get screened for CRC. Results: Responses from 5720 individuals covering all the 13 jurisdictions of Saudi Arabia were collected. Males represented 71.53% of the respondents; the mean age was 43.28 years and 15.24% had already undergone CRC screening using various methods, mostly colonoscopy (72.73%). The mean knowledge score was 11.05 (standard deviation 4.4, range 1–23), with no difference between genders, jurisdictions of the Kingdom, between those who expressed interest in screening and those who did not, and between those who accepted the invitation to undergo CRC screening and those who did not. Participants displayed positive attitudes toward both CRC screening and colonoscopy as a screening tool, and 73% expressed willingness to undergo screening. On multivariate analysis, male gender was the only factor associated with a higher probability of accepting screening, whereas neither knowledge nor willingness to undergo screening predicted accepting the invitation to screening. Conclusion: Although the majority of participants were willing to undergo screening, no significant correlation between knowledge and willingness to undergo screening were predictors of screening uptake. Other areas that could be targeted in the promotion of CRC screening uptake to bridge the gap between “knowing” and “doing” should be explored.
  15 5,234 759
A meta-analysis of early oral refeeding and quickly increased diet for patients with mild acute pancreatitis
Jiran Zhang, Sha Zhu, Dingyu Tan, Aiwen Ma, Yan Yang, Jiyang Xu
January-February 2019, 25(1):14-19
DOI:10.4103/sjg.SJG_240_18  PMID:30226482
Background/Aim: The objective of the study is to clarify whether early oral refeeding (EORF) and quickly increasing diet (QID) are of benefit to patients with mild acute pancreatitis compared with a traditional oral refeeding strategy. Materials and Methods: Studies were searched in PubMed, Cochrane library, ScienceDirect, SpringerLink, China Biology Medicine disc and Embase. A meta-analysis was then performed, using relapse of abdominal pain, nausea/vomiting, and length of hospital stay (LOHS) as the evaluation indices. Results: Eight trials met the inclusion criteria. For the oral refeeding time group, EORF could significantly decrease the LOHS (mean deviation [MD] −1.97; 95% confidence interval (CI) −3.32 to −0.62;P = 0.004), and there was no significant difference for relapse of abdominal pain (relative risk [RR] 1.17; 95% CI 0.69–2.00;P = 0.56) or nausea/vomiting (RR 1.30; 95% CI 0.19–8.82;P = 0.79) when compared with conventional oral refeeding. For the oral refeeding material group, there was no significant difference for relapse of abdominal pain (RR 0.86; 95% CI 0.53–1.40;P = 0.54), nausea/vomiting (risk difference −0.01; 95% CI −0.19–0.18;P = 0.94), or LOHS (MD −0.88; 95% CI −2.24–0.48;P = 0.20) between the QID and stepwise increasing diet groups. Conclusion: Pure EORF or QID caused no damage to patients with mild acute pancreatitis, and EORF could significantly decrease the LOHS.
  8 6,466 726
Low expression of MUC2 is associated with longer disease-free survival in patients with colorectal carcinoma
Jaudah Al-Maghrabi, Shabnum Sultana, Wafaey Gomaa
January-February 2019, 25(1):61-66
DOI:10.4103/sjg.SJG_199_18  PMID:30226481
Background/Aim: The objective of this study was to investigate the relationship between MUC2 immunostaining and clinicopathological characteristics in a subset of colorectal carcinomas (CRCs). Materials and Methods: A total of 128 CRCs, 50 local nodal metastases, and 42 normal colonic mucosae were retrieved from the archives at the Department of Pathology at King Abdulaziz University, Jeddah, Saudi Arabia. Immunohistochemistry was performed using anti-MUC2 antibody. A cut-off of 25% of positive immunostaining was used to define low and high immunostaining. Statistical tests were used to determine the association of MUC2 with clinicopathological characteristics and survival. Results: MUC2 immunostaining was observed in 66.7% in normal colonic mucosa. Low MUC2 immunostaining was higher in primary CRC (P = 0.003) and nodal metastasis (80%) (P < 0.001). There was significant association of low MUC2 immunostaining in CRC with age group below 60 years (P = 0.05) and occurrence of lymphovascular invasion (P = 0.034). Other clinicopathological parameters were not correlated with MUC2 immunostaining. Regression analysis revealed that low MUC2 immunostaining was an independent predictor of lymphovascular invasion (P = 0.041). In the Kaplan–Meier survival analysis, there was a significant longer disease-free survival in patients with low MUC2 immunostaining (P = 0.045). However, there was no association between MUC2 immunostaining and overall survival (P = 0.601). Conclusion: MUC2 immunostaining may have distinct clinical significance and provide valuable information and could be considered as an important independent prognostic factor while planning the adjuvant therapy in CRC. In future perspective, characterization of MUC2 immunostaining on a large number of cases and molecular studies may be needed.
  6 3,471 355
High HOXD4 protein expression in gastric adenocarcinoma tissues indicates unfavorable clinical outcomes
Hui Liu, Hequn Tian, Jing Zhao, Yong Jia
January-February 2019, 25(1):46-54
DOI:10.4103/sjg.SJG_105_18  PMID:30588951
Background/Aim: Homeobox D4 (HOXD4) belongs to the homeobox (HOX) family, which plays a crucial role in the early embryo development and cell differentiation. The role of HOXD4 in human gastric adenocarcinoma has not been elucidated. In the present study, we aimed to examine the expression levels of HOXD4 and dissect whether the HOXD4 expression is associated with aggressive clinicopathological outcomes of patients with gastric adenocarcinoma. Patients and Methods: Clinicopathological analyses were performed in 127 patients with gastric adenocarcinoma. Expression of HOXD4 was tested by immunohistochemistry staining and quantitative RT-PCR. Clinical outcomes were evaluated by the Kaplan–Meier method and log-rank test. The prognostic role of HOXD4 in gastric adenocarcinoma patients was assessed by univariate and multivariate analyses. The effects and mechanisms of HOXD4 on cell proliferation, migration and invasion were explored through cellular experiments. Results: HOXD4 expression was elevated in gastric adenocarcinoma tissues compared to non-tumorous gastric tissues (P = 0.018). High expression of HOXD4 was significantly associated with larger tumor size (P = 0.008), advanced tumor invasion depth (P = 0.014), and positive lymph node metastasis (P < 0.001). Moreover, patients with high HOXD4 expression had poorer overall survival (P = 0.001), and HOXD4 was identified as an independent prognosis factor according to multivariate analysis [hazard ratio (HR) =2.253, 95% confident interval (CI) 1.028–4.979, P = 0.044]. Cellular results revealed that HOXD4 can promote tumor cell proliferation by upregulating c-Myc and cyclin D1. Conclusions: Our study demonstrated that overexpression of HOXD4 was significantly correlated with poorer prognosis of gastric adenocarcinoma patients, indicating the potential of HOXD4 as a novel clinical predictive biomarker and drug target.
  5 3,165 259
In-hospital post-transplant acute hepatitis A viral (HAV) infection in a liver transplant recipient who was HAV seropositive pre-transplant
Julie Zhu, Fatema Alalkim, Trana Hussaini, Siegfried R Erb, Vladimir Marquez, Mel Krajden, Douglas Webber, Eric M Yoshida
January-February 2019, 25(1):67-70
DOI:10.4103/sjg.SJG_230_18  PMID:30117491
Acute hepatitis A viral (HAV) infection is rare in the liver transplant population due to recommended pre-transplant vaccinations. We report a case of acute hepatitis A infection in a liver transplant recipient. This individual had immunity to hepatitis A with protective IgG antibodies and presented with abnormal liver biochemistry in the post-transplant in-patient setting. Hepatitis A infection was confirmed by positive HAV IgM whereas other etiologies, including acute cellular rejection, were ruled out by laboratory tests and liver biopsies. He was treated conservatively with supportive care and liver enzymes recovered to normal baseline. Despite adequate pre-transplant immunity, in the post-transplant setting there may be loss of protective immunity due to profound immunosuppression and hence hepatitis A should remain an important differential diagnosis in the setting of acute hepatitis.
  4 3,791 363
Findings during screening colonoscopies in a Middle Eastern cohort
Majid A Almadi, Abed Allehibi, Mohammad A Aljebreen, Othman R Alharbi, Nahla Azzam, Abdulrahman M Aljebreen
January-February 2019, 25(1):20-26
DOI:10.4103/sjg.SJG_353_18  PMID:30479321
Background/Aims: Colorectal cancer is the most common cancer in males and the third most common cancer in females. We aim to determine the polyp and adenoma prevalence in a cohort of patients who underwent opportunistic screening colonoscopies. Patients and Methods: A retrospective cohort study was conducted using an endoscopic reporting database of individuals seen at three tertiary care hospitals (two public hospitals and one private) in Riyadh, Saudi Arabia. Consecutive patients who were 45 years of age and older and underwent opportunistic screening colonoscopies between November 2016 and October 2017 were included. We excluded those with a history of colon cancer or colonic resection for any reason, inflammatory bowel disease, gastrointestinal bleeding, or anemia. Results: Around 1180 patients were included in the study with a mean age of 58.6 years (SD = 7.3), with males representing 53.6% and an overall cecal intubation rate of 92.4%. Masses were found in 1.6% of the study population (50% in the sigmoid or rectosigmoid, 37.5% in the rectum). The polyp detection rate in colonoscopies was 24.8% and the adenoma detection rate was 16.8%. The histology of removed polyps was tubular adenomas in 56.6%, hyperplastic polyps in 32.7%, tubulovillous adenomas in 8.2%, and villous adenomas in 2.5%. The majority of the polyps were in the sigmoid colon (28.3%) and rectum (22.0%), followed by the ascending colon (11.2%) and cecum (10.3%), then the transverse colon and descending colon (9.4% each), and multiple locations in the remainder. Conclusion: The prevalence of polyps and adenomas in this cohort is less than that reported in the Western populations.
  4 3,672 365
Treatment efficacy of ledipasvir/sofosbuvir for 8 weeks in non-cirrhotic chronic hepatitis C genotype 4 patients
Mohammed A Babatin, Abdullah S AlGhamdi, Abdullah M Assiri, Haziz AlBiladi, Hammad S AlOthmani, Mohammed H Mogharbel, Wedad Mahallawi, Tarik Asselah, Faisal M Sanai
January-February 2019, 25(1):55-60
DOI:10.4103/sjg.SJG_189_18  PMID:30117490
Background/Aims: Ledipasvir/sofosbuvir (LDV/SOF) combination is administered for 12 to 24 weeks to treat hepatitis C virus (HCV); guidelines recommend 8 weeks treatment duration for HCV genotype (GT) 1 infection based on the patient's baseline characteristics. Data on treating HCV GT4 with LDV/SOF are limited. In this prospective cohort study, the efficacy and safety of 8 weeks treatment duration with LDV/SOF was evaluated in HCV GT4 patients in Saudi Arabia. Patients and Methods: Treatment-naïve, non-cirrhotic HCV GT4 patients received LDV/SOF for 8 weeks. HCV RNA levels and laboratory evaluations were recorded at baseline and at Weeks 4, 8, and 20. The primary endpoint was sustained virologic response 12 weeks after the end of the treatment (SVR12). Safety data were also recorded. Results: Forty-five patients with a mean age of 43.9 ± 17.2 years participated, of whom 57.8% were male. Mean log10HCV RNA was 6.26 ± 6.32 IU/mL and most (91.1%) had baseline HCV RNA levels <6 million IU/mL. The most frequent comorbidities were hypertension and diabetes mellitus (20.0% each). Concomitant medication was taken by 18 patients (40.0%), of whom two took proton pump inhibitors. Overall, SVR12 was 97.8% (95% confidence interval [CI]: 88.2%–99.9%); one patient (2.2%) relapsed post treatment. No serious adverse events or discontinuations were reported. Eighteen patients (44.4%) had 38 adverse events related to LDV/SOF; the most frequent was headache. Conclusions: An 8-week regimen of LDV/SOF was well tolerated and efficacious in this treatment-naïve, non-cirrhotic HCV GT4–infected population. This study provides valuable information on a short treatment regimen for HCV GT4 infection in a real-world setting.
  2 4,018 315
Colorectal cancer screening in middle eastern countries: Current status and future strategies to enhance screening
Martin C. S. Wong, Francis K. L. Chan
January-February 2019, 25(1):1-2
DOI:10.4103/sjg.SJG_611_18  PMID:30665995
  1 5,048 480
Association between hypokalemia and small bowel capsule endoscopy completion rates in patients in South China: A prospective single-center study
Huo-Ye Gan, Tie-Li Peng, Kai-Hua Su, Lin-Li Zhao, Li-Qin Jian, Rong-Jiao Yang, Han-Xian Zhang, Ru-Yin Pan
January-February 2019, 25(1):40-45
DOI:10.4103/sjg.SJG_77_18  PMID:30479322
Background/Aims: Approximately 20–30% of small bowel capsule endoscopies (SBCEs) do not reach the cecum at the completion of the examination. We aimed to determine whether hypokalemia influences the completion rate and small bowel transit time (SBTT) of SBCE. Patients and Methods: From January to December 2017, 112 patients (18–75 years old) who underwent SBCE were assessed consecutively for enrolment in our study. On the day of the procedure, a blood test was performed prior to capsule ingestion. The completion rate, gastric transit time (GTT), SBTT, and diagnostic yield were recorded for each SBCE. Results: The SBCE completion rate was lower in the hypokalemia group than that in the normal potassium group (55.6% (15/27) vs. 76.5% (65/85), P = 0.036). The median GTT was 55.5 ± 47.1 min in the hypokalemia group and 46.7 ± 44.5 min in the normal potassium group (P > 0.05). The median SBTT was 412.8 ± 123.3 min in the hypokalemia group and 367.3 ± 172.5 min in the normal potassium group (P > 0.05). The diagnostic yields of the hypokalemia and normal potassium groups were 74.1% and 78.8%, respectively (P = 1.00). Conclusion: Hypokalemia may decrease the SBCE completion rate. Physicians should consider the possibility of hypokalemia after bowel preparation because this condition is not rare. Potassium deficiencies should be rectified prior to performing SBCE procedures to increase the SBCE completion rate.
  1 3,566 296
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