Saudi Journal of Gastroenterology最新文献

Background: Patients with multiple organ metastases from hepatic alveolar echinococcosis have a high mortality rate. However, predictors of multi-organ metastasis have not been identified. We aimed to develop a nomogram that predicts multi-organ metastasis in patients with hepatic alveolar echinococcosis.

Methods: We retrospectively screened patients with hepatic alveolar echinococcosis who were treated between January 2016 and December 2021 at Qinghai Provincial People's Hospital, China. The outcome of the nomogram was multi-organ metastasis of hepatic alveolar echinococcosis. We collected patients' basic characteristics, disease course, imaging, and blood laboratory results. The Least Absolute Shrinkage Selection Operator (LASSO) analysis selected the predictors preliminarily. A predictive model was constructed by multivariate logistic regression and presented as a nomogram. The performance of the nomogram was measured by the receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis (DCA). The model was internally validated by calculating the performance of the validation cohort.

Results: A total of 353 patients were enrolled in this study. Ninety five (26.9%) patients presented with multi-organ metastases. All participants were randomized into a development cohort (n = 249) and a validation cohort (n = 104). Predictors in this nomogram were the course of the disease, the long diameter of the lesion, multiple intrahepatic lesions, and medication. The ROC curve of the training set was 0.907 (95% CI: 0.870, 0.943). A similar ROC curve was achieved at the validation set (0.927, 95% CI: 0.876, 0.979). The calibration curve demonstrated that the prediction outcome was correlated with the observed outcome.

Conclusion: The nomogram can predict the risk of multi-organ metastasis in patients with hepatic alveolar echinococcosis, and help clinicians develop or adjust a reasonable diagnosis and treatment plan in time.

Background: The emergence of tumor necrosis factor inhibitors (anti-TNF) has considerably changed the management of inflammatory bowel disease (IBD) in patients who do not respond to traditional therapies. This study assesses the prevalence of anti-TNF drug levels (DLs) and antibodies (ATAbs) in patients with IBD in Saudi Arabia and explores their associations with IBD type and prior anti-TNF failure.

Methods: This cross-sectional study included patients aged 14-75 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC), treated with anti-TNF medications at King Fahad Medical City over January 2016 to December 2022. Data were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, Pearson's Chi-squared test, and multinomial logistic regression.

Results: Among 392 patients with IBD (median age, 31 years), 75.8% were diagnosed with CD and 24.2% with UC. Anti-TNF levels were subtherapeutic in 27.0% patients, therapeutic in 21.5%, and supratherapeutic in 51.5%. ATAbs were negative in 73.1% patients, weakly positive in 9.8%, and positive in 17.1%. Subtherapeutic anti-TNF levels were significantly associated with positive ATAbs (P < 0.001). Prior anti-TNF therapy failure was observed in 37.2% cases, with 15.3% showing immunogenicity. No significant demographic differences were noted across ATAbs groups.

Conclusion: We highlight the prevalence of subtherapeutic and supratherapeutic anti-TNF levels among patients with IBD in Saudi Arabia and their association with ATAbs. The findings underscore the importance of monitoring anti-TNF DLs and ATAbs to optimize treatment outcomes in IBD management. Future research should focus on the longitudinal impact of these factors and explore genetic predictors of treatment response.

Background: To compare the long-term safety and efficacy of Adalimumab (ADA) and Infliximab (IFX) agents in biologic-naive patients with Ulcerative colitis (UC).

Methods: The key focus was on specific outcomes such as the requirement of hospitalization due to UC, colectomy, steroid administration, and severe infections that led to the discontinuation of therapy.

Results: Anti-TNF treatment was initiated in 208 of the 475 patients with ulcerative colitis. The final study population consisted of 86 biologic-naive patients with UC, including 41 treated with IFX and 45 treated with ADA. No significant differences in treatment details, baseline Mayo scores, risk factors, or demographic features were observed. The ADA group displayed a significantly increased need for steroids (44.4%) compared to the IFX group (14.6%). The UC-associated hospitalization, colectomy, and serious infections were similar between the ADA and IFX groups. Similar outcomes were observed with IFX or ADA as monotherapy or in combination with immunomodulators. The survival analysis revealed IFX had a longer time to secondary loss of response compared to ADA, however, without statistical significance (72.5% versus 46.7%, P = 0.057).

Conclusion: Our results hint at the likelihood of IFX and ADA presenting similar clinical outcomes as first-time agents in UC. Nonetheless, the need for steroids with ADA should be taken into consideration.

Abstract: Hepatitis D virus (HDV) prevalence data and country-specific HDV guidelines are not widely available in the Gulf Cooperation Council (GCC) states. We developed consensus recommendations to guide healthcare professionals, policymakers, and researchers in improving HDV management and patient health outcomes in three GCC states: Kuwait, Saudi Arabia, and the United Arab Emirates. A consensus panel comprising hepatology experts (n = 6) from the three GCC societies was formed. The panel identified two broader areas related to clinical practice (screening and diagnosis, and treatment and management), addressed critical questions, and developed draft recommendations in February 2024. The strength of the final set of recommendations was subjected to consensus voting in March 2024. A majority was defined apriori with a two-thirds vote (67%). The paper outlines those recommendations alongside showcasing the current epidemiology of HDV in the GCC states, emphasizing the variability in prevalence, demographic patterns, and region-specific risk factors. It also highlights the current state of screening and diagnosis practices, identifying key obstacles, such as access to advanced screening protocols and diagnostic tools. Furthermore, HDV treatment landscape and preventative strategies are outlined, focusing on vaccination, public health initiatives, and the crucial role of public awareness and education. Ethical and sociocultural considerations are discussed, underscoring the importance of culturally sensitive healthcare practices. These recommendations present a comprehensive overview of the challenges and strategies for managing HDV in these states. Policy recommendations are provided to support HDV management, including standardizing care protocols and promoting public health measures.

Background: Approximately 25% of individuals with inflammatory bowel disease (IBD) concurrently experience immune-mediated inflammatory diseases (IMIDs), while the overall prevalence of these conditions in the general population is 5-7%. Individuals with IBD and concurrent IMIDs tend to have a more aggressive disease profile. We aimed to assess the prevalence of coexisting autoimmune disorders among patients with IBD and their association with inflammatory bowel disease type.

Methods: In this cross-sectional study at a tertiary care center in Riyadh, Saudi Arabia, we examined 875 patients with IBD (530 with Crohn's disease and 345 with ulcerative colitis). Patient demographics, disease types, treatment modalities, and co-occurring autoimmune conditions were analyzed using statistical and regression analyses.

Results: Overall, 21.7%, 19.4%, and 25.2% of the patients had IMIDs, Crohn's disease, and ulcerative colitis, respectively. Patients with ulcerative colitis had higher rates of hepatic autoimmune conditions (9.6%) and endocrine autoimmune diseases (4.1% vs 1.3%; P = 0.010) than those with Crohn's disease (4.5%; P = 0.003). Regression analysis revealed significant associations between hepatic (P = 0.012) and endocrine autoimmune diseases (P = 0.018) with ulcerative colitis diagnosis, although the model's predictive accuracy was moderate (overall, 63%; specificity, 95%; sensitivity, 14%).

Conclusions: Our study highlights the significant co-occurrence of autoimmune diseases with IBD, particularly the distinct autoimmune profiles of Crohn's disease and ulcerative colitis. Identifying the specific ulcerative colitis-associated autoimmune comorbidities could guide personalized therapeutic strategies and inform future research on the pathophysiological relationship between these conditions.

Background: Although the role of fungi in gut inflammation in IBD has been suggested, data are still limited in ulcerative colitis (UC). Our aim was to describe the gut fungal profile in a pediatric UC in Saudi Arabia.

Methods: Fecal samples from children with UC and control samples provided by healthy school children were collected. The fungal DNA was analyzed using Shotgun metagenomic procedures. Shannon alpha diversity, beta diversity, differential abundance, random forest classification algorithm, and area under the curve were analyzed.

Results: There were 20 children with UC and 20 healthy school children. The median age and range were 13 (0.5-21) and 13 (7-16) years for children with UC and controls, respectively. Male subjects were 40% and 35% for UC and controls, respectively. At diagnosis, the UC extent was E4 (38%); E3 (25%); E2 (37%) and 35% had a PUCAI ≥65. The reduction of alpha diversity and the significant dissimilarity in children with UC were similar to those of most published studies. However, a significant difference was found at all taxa levels with a remarkable enhancement of Candida genus and Saccharomyces cerevisiae in children with UC. Three species were identified as fungal signatures and an area under the curve of 98.4% (95.1-100% CI), indicating an association with UC that has not been reported thus far.

Conclusion: We report significant fungal dysbiosis in children with UC consistent with published literature. However, the report of potential fungal signature and a strong association with UC deserves further studies with a bigger sample size from other populations.

Background: The role of microbiota in the pathogenesis of ulcerative colitis (UC) has been increasingly recognized. However, most of the reports are from Western populations. In Middle Eastern countries, including Saudi Arabia, little is known about the role of microbiota. Therefore, our aim was to describe the bacterial microbiota profile and signature in pediatric UC in Saudi Arabia.

Methods: Twenty children with UC and 20 healthy controls enrolled in the study gave stool samples. Twenty rectal mucosal samples were taken from UC and 20 from non-UC controls. Inclusion criteria included newly diagnosed and untreated children and lack of antibiotic exposure for at least 6 months before stool collection was required for children with UC and controls. Bacterial deoxyribonucleic acid was extracted and sequenced using shotgun metagenomic analysis. Statistical analysis included Shannon alpha diversity metrics, Bray-Curtis dissimilarity, DESeq2, and biomarker discovery.

Results: The demographic characteristics were similar in children with UC and controls. There was a significant reduction in alpha diversity ( P = 0.037) and beta diversity in samples from children with UC ( P = 0.001). Many taxa were identified with log2 abundance analysis, revealing 110 and 102 species significantly depleted and enriched in UC, respectively. Eleven bacterial species' signatures were identified.

Conclusions: In Saudi Arabian children with UC, we demonstrate a dysbiosis similar to reports from Western populations, possibly related to changes of lifestyle. Microbial signature discovery in this report is an important contribution to research, leading to the development of adjunctive non-invasive diagnostic options in unusual cases of UC.

Background: The prevalence of inflammatory bowel disease (IBD) continues to increase worldwide, including in the Arab world. This study investigates IBD research output in Arab countries from 2009 to 2023, alongside prevalence and incidence trends.

Methods: We utilized bibliometric analysis with data from Clarivate Analytics, the Institute for Health Metrics and Evaluation, and the World Bank. We compared the research output, citation impact, and funding across 22 Arab countries with global averages. Spearman's correlation examined relationships between IBD publications and prevalence, incidence rates, gross domestic product (GDP), and population size.

Results: Between 2009 and 2023, Arab countries produced 1004 IBD-related publications (2.9% of global output), with Saudi Arabia (37.7%) and Egypt (27.5%) being the leading countries. The median IBD incidence rose from 2.42 to 3.06 per 100,000, with the prevalence increasing from 28.93 to 33.95 per 100,000 from 2009 to 2019. Arab IBD research had a citation impact of 14.49 compared to the global average of 23.98. Funded research constituted 18.7% of Arab publications, lower than the global rate of 32.4%. We found positive correlations between IBD publication counts and prevalence (r s = 0.753), incidence rates (r s = 0.734), and GDP (r s = 0.782), all with P < 0.001. Population size showed a nonsignificant correlation (r s = 0.371, P = 0.090) with IBD publication counts.

Conclusions: Arab nations contribute 2.9% of global IBD research, with lower citation impact and funding than the global average. Enhanced local support is crucial to improving research impact and addressing the rising prevalence of IBD in the Arab world.