Saudi Journal of Gastroenterology最新文献

Abstract: Inflammatory bowel disease (IBD) is a complex condition influenced by various intestinal factors. Advances in next-generation sequencing, high-throughput omics, and molecular network technologies have significantly accelerated research in this field. The emergence of artificial intelligence (AI) has further enhanced the efficient utilization and interpretation of datasets, enabling the discovery of clinically actionable insights. AI is now extensively applied in gastroenterology, where it aids in endoscopic analyses, including the diagnosis of colorectal cancer, precancerous polyps, gastrointestinal inflammatory lesions, and bleeding. Additionally, AI supports clinicians in patient stratification, predicting disease progression and treatment responses, and adjusting treatment plans in a timely manner. This approach not only reduces healthcare costs but also improves patient health and safety. This review outlines the principles of AI, the current research landscape, and future directions for its applications in IBD, with the goal of advancing targeted treatment strategies.

Background: Gut microbiome imbalance is well established in ulcerative colitis (UC) in Western populations. Significantly less is known about the gut virome and whether geography impacts the UC-associated microbiome. The aim of this study was to characterize gut bacteriophage changes, as well as to identify phage-bacterial associations that can serve as potential biomarkers of UC.

Methods: Twenty children with UC and 20 healthy controls were enrolled in the study. Inclusion criteria included newly diagnosed treatment-naïve children with UC with no antibiotic exposure for at least six months prior to sample collection. Deoxyribonucleic acid (DNA) was extracted from stool and rectal biopsies and was processed for shotgun metagenomic sequencing. Bioinformatics and statistical analyses were performed to assess phage diversity and their associations with gut bacteria. Candidate biomarkers were identified using the random forest classifier.

Results: In fecal samples, bacteriophage diversity was not significantly altered, but 72 species were significantly altered in UC, five of which ( Salmonella_phage_SEN4 , uncultured_crAssphage, Staphylococcus_phage_SPbeta-like , Streptococcus_phage_YMC-2011 and Siphoviridae_u_s ) were identified as candidate biomarker signatures.

Conclusions: We found a significantly altered bacteriophage signature in children with new onset, treatment naïve UC in Saudi children, a Middle Eastern population. These changes differed from previously reported Western UC cases, indicating that demographic bias needs to be considered when developing microbiota-based diagnostics and therapeutic applications for non-Western populations.

Background: Endoscopic resection (ER) is regarded as the treatment of choice for gastric adenoma. Argon plasma coagulation (APC) is also widely used, but its efficacy and safety have not been fully established. We performed a systematic review and meta-analysis to assess the efficacy and safety of APC compared with ER in treating gastric adenoma.

Methods: PubMed, EMBASE, and the Cochrane Library were searched up to April 2024. All studies that evaluated the clinical outcomes of APC or ER for treating gastric adenomas were included. The primary outcome was the local recurrence rates of APC versus ER. Secondary outcomes included procedure time, length of hospital stay, and complications.

Results: A total of seven studies were included, of which four were retrospective studies that compared the outcomes of APC and ER, and three were retrospective single-arm studies that reported only outcomes of APC. APC was associated with a higher local recurrence rate in treating gastric adenoma than ER [risk ratio (RR) 4.378, 95% CI 1.995-9.607] but involved shorter procedure times (MD -45.228, 95% CI -49.436 to -41.021), shorter hospital stays (MD -2.684, 95% CI -2.932 to -2.437), and fewer complications (RR 0.329, 95% CI 0.124-0.869).

Conclusions: APC results in more local recurrence but involved a lower risk of complications than ER. APC may be considered an alternative to ER in treating gastric adenomas.

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.

Abstract: The management of inflammatory bowel disease (IBD) in children and adolescents is challenging. Clear evidence-based guidelines are required for this population. This article provides recommendations for managing IBD in Saudi children and adolescents aged 6-19 years, developed by the Saudi Ministry of Health in collaboration with the Saudi Society of Clinical Pharmacy and the Saudi Gastroenterology Association. All 57 guideline statements are based on the most up-to-date information for the diagnosis and management of pediatric IBD.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) presents a significant global health challenge, with the Arab region exhibiting a markedly higher prevalence. We aim to evaluate MASLD research output, collaboration patterns, and funding impact in the Arab region over the last decade.

Methods: We conducted a bibliometric analysis of MASLD research in 22 Arab countries (2014-2023) using Clarivate Analytics' InCites. Data on MASLD prevalence were extracted from the Global Burden of Disease, while population and economic data from the World Bank. We assessed MASLD-related publications, prevalence, collaboration patterns, and citation and funding impact.

Results: Between 2014 and 2023, Arab countries contributed 844 publications (3.3% of global MASLD research). We identified positive correlations between MASLD-related publications and gross domestic product (GDP) ( rs = 0.825, P < 0.001), age-standardized prevalence ( rs = 0.627, P = 0.002), and population size ( rs = 0.509, P = 0.016). International collaborations accounted for 48.7% of these publications, with a citation impact of 15.7 compared to the global average of 23.7. Arab-funded MASLD-related publications constituted 19.4% of MASLD publications in the Arab world versus 42.3% globally funded. Citation impacts were similar between Arab-funded (30.6) and globally funded publications (30.3). Of the top 10 countries globally with the highest GDP, 47.8% of the MASLD publications received funding, yielding a citation impact of 33.5.

Conclusion: Despite the high MASLD prevalence, Arab countries exhibit lower research output, impact, and funding compared to global levels. Increased regional collaboration and investment in MASLD research are critical to addressing this disparity.

Background: Colonoscopy is essential for diagnosing and managing colorectal conditions, and is recognized as the gold standard for early cancer detection and removal of precancerous lesions. The American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology have established benchmark indicators to minimize the risk of interval colorectal cancer. Despite their importance, research on these metrics in Saudi Arabia is limited. This study analyzes key intraprocedural indicators of colonoscopies at a tertiary care center to evaluate adherence to care standards.

Methods: This retrospective study examined 3763 colonoscopies conducted by adult gastroenterologists at Johns Hopkins Aramco Healthcare from January 2021 to December 2022. Procedures were categorized as screening and non-screening, with demographic data collected alongside withdrawal time (WT), cecal intubation rate (CIR), polyp detection rate (PDR), adenoma detection rate (ADR), Boston Bowel Preparation Scale (BBPS), polyp retrieval rate, rectal retroflexion, and adverse events.

Results: The mean age of participants was 54.13 years, with 81.56% of them Saudis and 44.6% female. The average WT was 10 min. The overall CIR was 93.6% (94.78% for screening), with a PDR of 33.9% and a retrieval rate of 96.6%. ADR for screening participants was 25.63%, and 88.94% of participants achieved a BBPS score of 6 or more. The adverse event rate was at 0.2%, primarily due to bleeding.

Conclusions: The study indicates that colonoscopy procedures adhere to care standards, with ADR among male screening patients approaching 30%. Further research is necessary to evaluate pre- and post-procedural indicators.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is the main method to prevent the rebleeding of esophagogastric varices. Many studies have demonstrated that pre-emptive TIPS (p-TIPS) is superior to medicine combined with endoscopic standard therapy in the efficacy of high-risk patients, but very few relevant studies reported whether p-TIPS is more effective than elective TIPS. This study aims to compare the efficacy and prognosis of p-TIPS and elective TIPS for the treatment of esophagogastric variceal bleeding (EGVB) patients with cirrhosis.

Methods: In this retrospective study, clinical data of 92 patients with cirrhosis who accepted TIPS treatment after EGVB of cirrhosis were collected. According to the different times of TIPS, the patients were divided into the p-TIPS group and the elective TIPS group. The following information is documented: clinical manifestations and laboratory examination at 1, 3, and 6 months after the operation, survival state, the rates of rebleeding at 6 weeks and 6 months, and postoperative complications and serious adverse events during follow-up.

Results: The Child-Pugh score ( P = 0.002) and MELD score ( P = 0.006) in the p-TIPS group were significantly lower than those in the elective TIPS group in the 6 th month after treatment. The rate of no gastric coronary vein embolization in the p-TIPS group was higher than in the elective TIPS group ( P = 0.034). The hospitalized days ( P < 0.001) and hospitalized costs ( P < 0.001) were significantly lower in the p-TIPS group than in the elective TIPS group. No significant differences were observed between the two groups concerning rebleeding, overt hepatic encephalopathy, ascites, complications, and serious adverse events, occurrence.

Conclusion: The p-TIPS contributes to liver function recovery and enhances patient survival benefits at 6-months postoperation in the treatment of EGVB compared with elective TIPS, without increasing the incidence of complications and adverse events.

Background: This study aimed to identify the predictors of liver decompensation and mortality in patients with HCC treated with trans arterial radioembolization (TARE).

Methods: A retrospective analysis of 140 HCC patients who underwent TARE was conducted. Kaplan-Meier and multivariate Cox regression analyses were performed to identify the key predictors of mortality and liver decompensation, defined as a total bilirubin level greater than 50 μmol/l or an upgrade in the Child-Pugh class within three months of the first TARE procedure.

Results: The cohort comprised 69.3% males with a mean age of 71.3 ± 11.9 years. Most patients (73.6%) had Child-Pugh class A cirrhosis and 34.3% had BCLC stage B disease. Liver decompensation was recorded in 55 patients (39.2%) within three months of the first TARE procedure. A total of 80 patients (57.1%) died during the follow-up period. The median survival was significantly longer in those without liver decompensation (3.2 vs. 0.7 years, P < 0.001). Multivariate analysis revealed that male gender (adjusted odds ratio [aOR] 5.889, P = 0.009), cirrhosis (aOR 6.82, P = 0.047), and baseline international normalized ratio (INR) (aOR 316.664, P = 0.013) were independent predictors of liver decompensation. Cox regression analysis revealed several significant predictors of increased mortality including ascites (HR 2.012, 95% CI, 1.122-3.61; P = 0.019), portal vein invasion (HR 1.695, 95% CI, 1.057-2.718; P = 0.029), and diabetes mellitus (HR 1.823, 95% CI, 1.017-3.265; P = 0.044). Conversely, non-multifocal HCC (HR 0.593, 95% CI, 0.369-0.955; P = 0.031), treatment of the liver lobe other than the right lobe (HR, 0.482; 95% CI 0.236-0.986, P = 0.046), and age ≥60 years (HR 0.288, 95% CI, 0.139-0.597; P = 0.001) were associated with a reduced risk of mortality.

Conclusion: This study identified the key predictors of liver decompensation and mortality in patients with HCC undergoing TARE, potentially improving patient selection and management strategies.