Saudi Journal of Gastroenterology
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   2022| July-August  | Volume 28 | Issue 4  
    Online since July 14, 2022

 
 
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ORIGINAL ARTICLES
Comparison of safety and efficacy of intragastric botulinum toxin-A versus gastric balloon
Raed M Tayyem, Haitham G Qandeel, Hamzeh I Al-Balas, Farah R Tayyem, Jehad Z Fataftah, Mahmoud I Al-Balas
July-August 2022, 28(4):276-281
DOI:10.4103/sjg.sjg_534_21  PMID:35083975
Background: A prospective case-matched study was conducted to compare the safety and efficacy of endoscopic intragastric botulinum toxin-A (EIBT) versus endoscopically planned gastric balloon (EPGB), as a treatment for obesity. Methods: A total of 176 patients (matched for age and sex) were equally divided to undergo EIBT (n = 88) or EPGB (n = 88). Patients who received EIBT were restricted to a body mass index (BMI) of 25 to 35 kg/m2, whereas a BMI >25 kg/m2 was allowed in the EPGB group. The main measured outcomes were weight loss, procedure duration, complications, early satiety, and quality of life (QoL). Results: The patients were followed up for a mean of 6 months. The mean weight loss was greater in the EPGB group than in the EIBT group (15.6 kg vs. 9.3 kg, P < 0.001). However, the percentage excess weight loss and the satiety score were greater in the EIBT group (59.1% vs. 42.2%, P < 0.001; and 3.5 vs. 2.3, P < 0.001) respectively. The procedure duration was shorter for EIBT patients (10 min vs. 15 min, P < 0.001). The postoperative complication rate recorded in the EPGB group was significantly higher (30% vs. 9%, P = 0.001). Adverse symptoms lasted longer in EPGB (5.2 days vs. 0.7 days, P < 0.001). Both groups enjoyed similar improvements in QoL. Conclusion: EIBT is a safe and effective treatment for mild obesity. Although the weight loss was greater in the EPGB group, the percentage excess weight loss, procedure duration, postoperative complications, and symptom duration were significantly better in the EIBT group. QoL improvement was comparable between the two groups.
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REVIEW ARTICLE
Methotrexate in inflammatory bowel disease: A primer for gastroenterologists
Turki AlAmeel, Eman Al Sulais, Tim Raine
July-August 2022, 28(4):250-260
DOI:10.4103/sjg.sjg_496_21  PMID:35042318
Methotrexate is an antineoplastic agent that is also used at lower doses for anti-inflammatory properties. Along with thiopurines (azathioprine and 6-mercaptopurine), it has historically been an important part of pharmacological treatment for patients with inflammatory bowel disease. Despite an increase in therapeutic options, these immunomodulators continue to play important roles in the management of inflammatory bowel disease, used either as a monotherapy in mild to moderate cases or in combination with monoclonal antibodies to prevent immunogenicity and maintain efficacy. In light of data linking the use of thiopurines with the risk of malignancies, methotrexate has regained attention as a potential alternative. In this article, we review data on the pharmacology, safety, and efficacy of methotrexate and discuss options for the positioning of methotrexate alone, or in combination, in therapeutic algorithms for Crohn's disease and ulcerative colitis.
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SYSTEMATIC REVIEW/META-ANALYSIS
Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials
Zaheer Nabi, Rupjyoti Talukdar, Harshal Mandavdhare, D Nageshwar Reddy
July-August 2022, 28(4):261-267
DOI:10.4103/sjg.sjg_438_21  PMID:34806659
Background: Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short versus long myotomy during POEM. Methods: We searched multiple databases from January 2010 to March 2021 to identify studies reporting on POEM. We selected studies that reported on comparative outcomes of POEM using short versus long myotomy. We performed a comparative analysis of clinical success, procedural duration, gastroesophageal reflux disease (GERD), and adverse events with short and long myotomy in POEM by meta-analysis. Results: A total of 521 patients from five studies in which 241 patients were treated with short and 280 patients with long myotomy approaches were analyzed. The pooled rate for clinical success gave an odds ratio (OR) of 1.27 (95% confidence interval [CI] 0.50–3.26; I2 = 0; P = 0.62); for hospital stay OR 0.22 (95% CI − 0.03 to 0.46; I2 = 0; P = 0.08); for GERD by esophagogastroduodenoscopy (EGD) OR 0.58 (95% CI 0.31–1.07; I2 = 0; P = 0.08), and for adverse events OR 0.67 (95% CI 0.29–1.53; I2 = 51; P = 0.34). Abnormal esophageal acid exposure was less frequent with OR 0.45 (95% CI 0.22–0.90; P = 0.02; I2 = 0) and the procedure duration was significantly shorter in the short myotomy group with OR − 0.76 (95% CI − 1.00 to − 0.52; I2 = 43; P =0.001). Conclusion: Short myotomy and long myotomy in POEM seem comparable with each other in terms of clinical success and adverse events. Short myotomy is associated with significantly shorter procedural duration and possibly reduced esophageal acid exposure compared with long myotomy.
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ORIGINAL ARTICLES
Intestinal microbiota profile in healthy Saudi children: The bacterial domain
Mohammad El Mouzan, Abdulrahman A Al-Hussaini, Ahmed Al Sarkhy, Asaad Assiri, Mona Alasmi
July-August 2022, 28(4):312-317
DOI:10.4103/sjg.sjg_585_21  PMID:35848701
Background: Knowledge of microbiota in health is essential for clinical research on the role of microbiota in disease. We aimed to characterize the intestinal microbiota in healthy Saudi children. Methods: In this community-based study, stool samples were collected from a randomly selected sample of 20 healthy school children of Saudi origin. The samples were frozen at –80°C till analysis. Bacterial DNA was isolated and libraries were prepared using the Illumina Nextera XT library preparation kit. Unassembled sequencing reads were directly analyzed and quantified for each organism's relative abundance. The abundance for each organism was calculated and expressed as the average relative percentage from phyla to species. Results: The median age was 11.3 (range 6.8-15.4) years, and 35% of them were males. The three most abundant phyla were Firmicutes, Bacteroidetes, and Actinobacteria accounting for 49%, 26%, and 24%, respectively. The most abundant genera included Bifidobacterium, Bacteroides, and Blautia accounting for 18.9%, 12.8%, and 8.2%, respectively. Finally, the most abundant species included 14 species belonging to the genus Bacteroides and nine species belonging to Bifidobacterium. Conclusions: The abundance of intestinal microbiome in healthy Saudi children is different from that of other populations. Further studies are needed to understand the causes of variation between populations, which might lead to new preventive methods and treatment strategies of diseases caused by microbial dysbiosis.
  2,249 159 -
Prevalence and socioeconomic correlates of growth impairment among Saudi children and adolescents
Abdulrahman Al-Hussaini, Muhammad Salman Bashir, Musa Khormi, Wahid Alkhamis, Mona Alrajhi, Thana Halal
July-August 2022, 28(4):288-295
DOI:10.4103/sjg.sjg_338_21  PMID:34856724
Background: Saudi Arabia has witnessed economic prosperity leading to changes in diet and lifestyle. Concurrent with these changes, the prevalence rates of overweight and obesity are rising. No recent data exist on the trends and pattern of growth impairment among Saudi children. We aimed to provide the most recent estimate of the prevalence of thinness and short stature among healthy school-aged children in Riyadh, Saudi Arabia, and to investigate the effect of parental socioeconomic status (SES) on growth impairment. Methods: A cross-sectional study was conducted in 2015 among schoolchildren in Riyadh. A sample of 7931 children (67% girls) aged 6–16 years was randomly selected. Body mass index (BMI) z-score <−2 SD and height z-score <−2 SD, for age and sex, using the WHO reference 2007, defined thinness and short stature, respectively. To assess the impact of SES on growth, we categorized SES into 4 levels by incorporating 4 main indicators: parents' educational level, family income, type of residence, and parents' jobs. Results: The prevalence of short stature was 15%, and the prevalence of thinness was 3.5%. Stratification of the thinness prevalence rate according to gender indicated that boys were significantly thinner than girls (4.7% versus 2.8%, P = 0.048). Short stature was significantly higher among children in the lower SES classes than among their counterparts in the higher SES classes. Parents of thin children were more likely to be less educated, have less income, live in apartments, and have a lower SES than parents of overweight and obese children. Conclusions: The rate of thinness among Saudi children is low, similar to that in developed countries, and is significantly correlated with SES.
  2,230 147 -
Outcomes of combined pyloric botulinum toxin injection and balloon dilation in dyspepsia with and without delayed gastric emptying
Neha R Santucci, Sarah Kemme, Khalil I El-Chammas, Maneesh Chidambaram, Manav Mathur, Daniel Castillo, Qin Sun, Lin Fei, Ajay Kaul
July-August 2022, 28(4):268-275
DOI:10.4103/sjg.sjg_493_21  PMID:35083974
Background: Pyloric botulinum toxin injection has improved symptoms in children with delayed gastric emptying. We aimed to determine the clinical response to combined endoscopic intra-pyloric botulinum toxin injection and pyloric balloon dilation (IPBT-BD) in patients with dyspepsia. Methods: Electronic medical records were reviewed to gather demographic data, symptoms, and follow-up on patients with dyspepsia. Cases were defined as those who underwent IPBT-BD in addition to their ongoing management. Controls received pharmacotherapy, behavioral intervention, or dietary management alone. Clinical response was defined as no change, partial, or complete improvement in symptoms within 12 months. Propensity score matching based on age, gender, and symptom duration was used to pair cases and controls. Results: In total, 79 cases and 83 controls were identified. After propensity matching, 63 patients were included in each group. The mean age for cases was 14.5 ± 3.9y; 62% were females and 98% were Caucasian. Further, 83% of 46 cases and 94% of 49 controls who had scintigraphy scans showed delayed gastric emptying. After matching, 76% of cases showed partial or complete improvement compared with 49% controls within 12 months (P = 0.004). Younger children tended to respond more favorably to the procedure (P = 0.08). Conclusions: In our propensity-matched analysis, combined IPBT-BD in addition to pharmacotherapy, behavioral, or dietary management clearly showed a benefit over these modalities alone. This favorable response lasted up to 12 months.
  2,192 166 -
Correlation between serum total bile acid and nonalcoholic fatty liver disease: A cross-sectional study
Yingying Chen, Huang Su, Haibo Xue, Tingting Wang, Ting Qian, Chengwei Liao, Jinming Wu
July-August 2022, 28(4):304-311
DOI:10.4103/sjg.sjg_512_21  PMID:35170435
Background: Nonalcoholic fatty liver disease (NAFLD) is a common component of chronic liver disease. Total bile acid (TBA) may influence the NAFLD progression through its signaling pathways. We attempted to find out if there is a correlation between TBA and NAFLD. Methods: 427,507 subjects were enrolled in health examinations conducted by The First Affiliated Hospital of Wenzhou Medical University. Among them, only 67616 met the inclusion criteria. Demographic, clinical, and laboratory data were gathered from all subjects. We used multivariate logistic regression model to find the correlation between serum TBA and NAFLD after adjusting for acknowledged risk factors for NAFLD. Results: A negative correlation was found between the TBA and NAFLD after adjusting for confounders in the multivariate logistic regression model (OR: 0.80; 95% CI: 0.72, 0.88, P < 0.001). After subgroup analysis, we found the interaction between NAFLD and diabetes was significant (P = 0.043). In patients with NAFLD without diabetes, TBA showed a protective effect in NAFLD (OR: 0.75; 95% CI: 0.67, 0.85). Conclusion: TBA is protective for NAFLD, but not in patients with NAFLD and diabetes. Further studies are urgently required to completely explore the underlying mechanisms of TBA in the pathogenesis of NAFLD.
  2,187 167 -
EDITORIAL
Intragastric botulinum toxin injection: Is it the solution to all gastric ailments?
Abed H AlLehibi, Mohammad Al-Haddad
July-August 2022, 28(4):247-249
DOI:10.4103/sjg.sjg_261_22  PMID:35848699
  1,825 242 -
ORIGINAL ARTICLES
Different clinical characteristics between recurrent and non-recurrent acute pancreatitis: A retrospective cohort study from a tertiary hospital
Kun Song, Cuirong Guo, Liudang He, Changluo Li, Ning Ding
July-August 2022, 28(4):282-287
DOI:10.4103/sjg.sjg_324_21  PMID:35259860
Background: Acute pancreatitis (AP) is a common digestive disorder with different clinical outcomes, some of which develop into recurrent acute pancreatitis (RAP). This study aimed to explore the differences between AP and RAP. Methods: All patients with AP admitted to Changsha Central Hospital between January 2015 and December 2020 were included. Characteristics between RAP and non-RAP groups were compared. Independent factors associated with RAP were identified by multivariate logistic regression analyses. Results: This was a retrospective study. A total of 1567 patients, including 262 patients in the RAP group and 1305 patients in the non-RAP group, were enrolled. Compared to the non-RAP group, results indicated that the RAP group was younger (P < 0.001), had a male predominance (P < 0.001), and had higher incidences of diabetes (P < 0.001) and hypertriglyceridemia (HTG) (P < 0.001). Lower incidences of cholelithiasis (P < 0.001) and acute liver injury (P < 0.001) were also noted in the RAP group. Scores of Ranson, BISAP, SOFA, and APACHE II were significantly higher in the non-RAP group (P < 0.001 for all). Three independent factors associated with RAP, including male gender (P = 0.006), diabetes (P < 0.001), and HTG (P < 0.001), were identified by multivariate logistic regression. Conclusion: Compared to the non-RAP, the incidence of cholelithiasis and acute liver injury was lower in RAP. Three independent factors associated with RAP, namely male, diabetes, and HTG, were identified.
  1,883 142 -
Effect of Portulaca Oleracea L. extract on functional constipation: A randomized, double-blind, placebo-controlled trial
Ki Bae Bang, Jung Ho Choi, Jee Hun Park, Seong Lee, Mun-Chual Rho, Seung W Lee, Soyoung Lee, Jeong Eun Shin
July-August 2022, 28(4):296-303
DOI:10.4103/sjg.sjg_400_21  PMID:35848700
Background: This study aimed to investigate the efficacy of P. oleracea in the management of patients with functional constipation. Methods: A total of 60 patients with functional constipation as defined by the Rome IV criteria were enrolled in this randomized, double-blind, placebo-controlled study; 70% ethanol extracts of the aerial parts of P. oleracea were used for the intervention. Patients were randomly assigned to the P. oleracea or placebo groups. Treatment response, quality of life, and changes in colonic transit time (CTT) were evaluated. Results: Complete spontaneous bowel movement (CSBM) improved significantly in the P. oleracea group compared with that in the placebo group over 8 weeks of treatment (P = 0.003). Overall Patient Assessment of Constipation Quality of Life (PAC-QOL) and Patient Assessment of Constipation Symptoms (PAC-SYM) score improvements were observed in the P. oleracea group (P < 0.05). Moreover, CTT decreased from 44.5 ± 22.0 h to 33.7 ± 22.7 h in the P. oleracea group after 7 weeks of treatment (P = 0.04). There were no significant differences in the Bristol Stool Form Scale (BSFS) or adverse events between the groups. Conclusions: Compared to placebo, the use of P. oleracea in patients with functional constipation significantly improved CSBM, severity of symptoms, and quality of life. Further large studies are required to assess the benefits of P. oleracea in the treatment of functional constipation.
  1,824 161 -
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