The Prevalence of Barrett's Esophagus Among a Saudi Arabian Population.

BACKGROUND: While gastroesophageal reflux disease (GERD) is common in Middle Eastern countries, little data exists on the epidemiology of Barrett's esophagus (BE). AIMS: We aimed to determine the prevalence of BE among patients undergoing esophagogastroduodenoscopy (EGD) in a cohort of Saudi patients. METHODS: We retrospectively reviewed the endoscopy database at an academic tertiary care center. Consecutive adult patients who underwent an EGD for any indication between May 2014 and December 2018 were included. The prevalence of both endoscopically and histologically reported BE was determined. Multivariate regression analysis was used to identify factors associated with BE. RESULTS: A total of 2805 patients were included. The mean age was 48 years (± 18.6) and 38.7% were male patients. BE was reported endoscopically in 18 (0.64%) and confirmed histologically in 9 patients (0.32%). Among patients with endoscopically reported BE, the mean age was 50.3 (± 16.1) years and 13 (72.2%) were male patients. Of patients with BE, short-segment BE was reported in 14 (77.8%) patients. Among the 9 patients with histologically confirmed BE; only one patient had dysplastic BE. On univariate analysis, BE was associated with male gender (p < 0.01), but not with age > 50, hiatal hernia, obesity or EGD performed for GERD related indications. On multivariate regression analysis, male gender was the only factor associated with BE (aOR 3.77, 95% CI 1.39-11.97, p = 0.01). CONCLUSION: BE was endoscopically reported in 0.64% and histologically confirmed in 0.32% of this cohort of Saudi patients. Male gender was the only factor associated with BE.

Prevalence of Esophageal Eosinophilia, Eosinophilic Esophagitis, and Lymphocytic Gastritis in Children with Celiac Disease: A Saudi Tertiary Center Experience.

Background: Celiac disease (CD) is an immune-mediated enteropathy that has been associated with other immune-related gastrointestinal disorders, such as eosinophilic esophagitis (EoE) and lymphocytic gastritis (LG). To our knowledge, this is the first study in Saudi Arabia that has described such an association. Aim: To evaluate the prevalence of EoE and LG in children and adolescents with CD. Methods: This was a retrospective cross-sectional study of all pediatric patients (aged 0-18 years) with CD following up at King Abdulaziz University Hospital, between January, 2014, and December, 2021. The study examined clinical, demographic, endoscopic, and histopathological data. Results: Seventy-five patients with CD were included in the analysis. The median age was 12 years (range, 2-18 years). Male constituted 54.7% of the overall cohort (n = 41). The most common clinical symptoms were short stature (54.7%), weight loss (34.7%), abdominal pain (33.3%), abdominal distension (29.3%), anorexia (29.3%), diarrhea (24%), and vomiting (21.3%). The esophageal biopsy results reported were basal cell hyperplasia in 24 patients (32.9%), esophageal eosinophilia in 23 patients (31.5%), and EoE in 3 patients (4.1%). The gastric biopsy results were normal in 40 patients (53.3%). The most common abnormality was chronic inactive gastritis with no Helicobacter pylori (HP) infection (16%). LG was found in 3 patients (4%). Conclusions: The prevalence of EoE in this cohort of patients with CD was lower than the prevalence recorded in a number of other studies. Further studies are needed to determine the effects of a gluten-free diet (GFD) on EOE and LG.

The use of therapeutic drug monitoring for early identification of vedolizumab response in Saudi Arabian patients with inflammatory bowel disease.

Vedolizumab is a humanized monoclonal antibody used to treat moderate-to-severe inflammatory bowel disease (IBD). The aim of the study was to assess the effectiveness of the induction of vedolizumab trough level in predicting short-term (week 14) clinical outcomes, and covariates that affect the response in Saudi Arabian patients. This prospective, real-life study included a total of 16 patients (4 Crohn's disease (CD) and 12 ulcerative colitis (UC)) with a confirmed diagnosis of IBD and generally naïve to receiving vedolizumab therapy. Using ELISA assay, vedolizumab induction trough and peak levels were measured at weeks 0, 2, and 6. The follow-up assessment was at week 14, where clinical outcomes were measured using the partial Mayo score for UC, and the CD activity score (CDAI), and Harvey Bradshaw index (HBI) for CD. At week 14, 9 patients (52.9%) out of 16 patients demonstrated response to therapy; clinical remission was reported in 5 patients (29.4%), and in 4 cases a clinical response was noted (23.5%). Clinical remission at week 14 was linked significantly with week 6 median vedolizumab levels in responders (25.1 µg/ml 95% CI: 16.5-42.9) compared to non-responders (7.7 µg/ml, 95% CI: 4.6-10.6) (P = 0.002). Receiver operator curve analysis at week 6 identified a cut-off > 8.00 µg/mL for short-term clinical remission. Also, at week 14, BMI significantly correlated with week 6 vedolizumab trough levels (P = 0.02). No other covariates correlated with drug levels at any time point examined. Week 6 early vedolizumab trough level measurements in IBD patients predicted short-term week 14 clinical remission.

Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer.

BACKGROUND: Several modalities are available for the diagnosis of rectal cancer, including conventional gold standard rigid endoscopy and recent flexible endoscopy and magnetic resonance imaging (MRI). Each modality affects the management of these patients. AIM: To compare the accuracy of flexible endoscopy and MRI in the measurement of tumor height in patients with rectal cancer. METHODS AND RESULTS: This study included 174 patients with rectal cancer who underwent flexible endoscopy and MRI for the measurement of tumor height. Data on patient demographics, comorbidities, treatment, and histopathology were identified and collected. We evaluate intraclass correlation coefficient (ICC) and Bland-Altman plot to test the agreement between the measurements. ICC were excellent with an ICC of 89% (95%CI 48%-99%). The mean ± standard deviation of the distance from the anal verge to the distal part of the tumor was 7.73 ± .47 for flexible endoscopy and 6.21 ± 0.39 for MRI, with mean difference of 1.52 (p Ë‚ .001). The accordance between the two modalities was not affected by sex, age, body mass index, histopathology, or metastasis. CONCLUSION: Excellent agreement between flexible endoscopy and MRI was noted, and no factor was found to affect such concordance.

Granulomatous hepatitis in a Saudi child with IL2RA defect: a case report and literature review.

Interleukin-2 receptor alpha (IL2RA) defect (OMIM- # 606367) is an immune disease where affected patients are vulnerable to developing recurrent microbial infections in addition to lymphadenopathy and dermatological manifestations. This condition is known to be caused by pathogenic variants in the IL2RA gene, which are inherited in an autosomal recessive fashion. In this case report, we present a patient with IL2RA defect from Saudi Arabia who presented with chronic diarrhea, poor weight gain, mild villous atrophy, malnutrition, hepatomegaly, nonspecific inflammation, and an eczematous skin rash. His genetic analysis revealed a novel, homozygous, and likely pathogenic variant, that is, c.504 C>A (Cys168Ter), located in the exon 4of the IL2RA gene, which was inherited from his parents in an autosomal recessive mode of inheritance. This variant produces a 272-amino-acid shorter IL2RA protein chain, which most likely becomes degraded in the cytosol. Thus, we assume that the c.504 C>A is a null allele that abolishes the synthesis of IL2RA, malforms the IL-2 receptor complex, and eventually causes immunodeficiency manifestations. To our knowledge, this is the first time a person with IL2RA defect has shown signs of granulomatous hepatitis on a liver biopsy.

Solitary rectal ulcer syndrome in children and adolescents: a descriptive clinicopathologic study.

Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of the rectum. While benign, it can cause concern for patients and affect quality of life. Reported studies on SRUS worldwide are scarce. The aim of this study is to describe the clinicopathologic characteristics of SRUS in a cohort of children based in Saudi Arabia. In this study, children with a confirmed diagnosis of SRUS at King Abdulaziz University Hospital (KAUH) were included, during the period November 2003 to November 2017. Data were collected from hospital medical records. The study comprised twenty-one patients: 17 males (81%) and 4 females (19%); the median age was 11.4 years (range, 5.43-17.9 years). The most common presenting symptoms were rectal bleeding in 21 patients (100%), passage of mucus in 16 (76.1%), abdominal pain in 14 (66.6%), constipation in 13 (61.9%), straining in 9 (42.9%), and rectal prolapse in 5 (23.8%). The most common finding at initial colonoscopy was a single ulcer in 7 patients (33.3%), multiple ulcers in 6 (28.5%), polypoid lesions in 5 (23.8%), and hyperemic mucosa in 3 (14.2%). All patients received medical treatment and 14 (81%) continued to manifest one or more of the symptoms following treatment, which required subsequent modification of the treatment course. None of the patients required surgery. In conclusion, the study found rectal bleeding to be the most common presentation, with a single ulcer being the most prevalent lesion in endoscopy. Treatment response was variable, but almost half of patients reported relief of symptoms following treatment.

Ovarian Crohn's Disease: A Case Report and Review of the Literature.

We present to you a rare case of Crohn's disease involving the ovary in a 28-year-old nulligravida Eritrean patient. This is considered a rare manifestation of Crohn's disease that is believed to be due to fistulization between the ovary and intestines.

The outcomes of renal cell carcinoma in a single tertiary care facility in Saudi Arabia.

BACKGROUND: Amidst an era of rising malignancies worldwide, renal cell carcinoma (RCC) is the 7th most commonly detected, owing to 144,000 cancer-related deaths annually. Demographic knowledge of such cases in Saudi Arabia is poorly portrayed. According to the 2014 Saudi Cancer Registry, RCC has rated the 10th most common malignancy among males, posing a significant disease burden. Global studies have depicted a great discrepancy of 15 folds in the incidence of RCC among different countries, which is commonly attributed to variations in each countries development. We aimed to assess the overall survival (OS) and disease-free survival (DFS) in patients who underwent nephrectomy in our health-care facility. MATERIALS AND METHODS: This is a retrospective study done at a tertiary care facility of all cases of RCC as per the pathology department database for the period of 2007-2017. The OS and DFS were statistically determined using Stata/SE 15.0. RESULTS: Overall, 109 RCC patients were included in the study. Mean age at diagnosis was 53.8 (range: 24-89) years. Demographic data revealed a total of 71 (65.14%) males included in the study and 38 (34.86%) females. The OS at 2 years and 5 years was noted to be 95.3% and 92.6%, respectively. The DFS was found to be 90.8% at 2 years and 85.4% at 5 years. On multivariate analysis of the results, step-wise model was utilized to eliminate irrelevant variables affecting the OS, with a probability to eliminate variables with P > 0.2. Metastasis (M) was found to be a relevant variable (hazards ratio [HR]: 52.25 [P = 0.003]; 95% confidence interval [CI]: 3.75-728.88). On multivariate analysis of the DFS, variables were found to be significant which include gender (HR: 0.15 [P = 0.063]; 95% CI: 0.02-1.105), nationality (HR: 16.1 [P = 0.034]; 95% CI: 1.24-209.13), age at diagnosis (HR: 0.93 [P = 0.031]; 95% CI: 0.87-0.99), and pathological stage (T) (HR: 7.89 [P = 0.003]; 95% CI: 1.98-31.36). CONCLUSIONS: Our results revealed a notable discrepancy in the 5-year OS and the 5-year DFS as compared to studies in the literature. However, our study was limited to a single center and the majority of our patients were diagnosed at a rather early stage. With the rising number of RCC cases worldwide and in Saudi, this further necessitates extensive disease surveillance for trends in all parameters.

Histologically confirmed upper gastrointestinal Crohn's disease: is it rare or are we just not searching hard enough?

BACKGROUND/AIMS: Crohn's disease (CD) may involve the upper parts of the gastrointestinal (GI) tract including the esophagus, stomach, and duodenum. Clinical features of upper GI CD (UGICD) are not well characterized in the Gulf region. We therefore aimed to assess the prevalence and clinical characteristics of patients diagnosed with UGICD. METHODS: We performed a retrospective analysis of all patients diagnosed with CD who underwent upper GI endoscopy between 2012 and 2017 at King Abdulaziz University Hospital, irrespective of age. Patients who had endoscopy of the upper GI tract at baseline and had histologically confirmed UGICD were included. Data on patients' demographics, clinical characteristics, extraintestinal manifestations and complications were reviewed. RESULTS: We identified 78 CD patients who underwent upper GI endoscopy from our medical records. The mean age was 17.2±8.7 years and 55.1% were males. Of the total, 19 out of 78 patients (24.4%) had histologically confirmed UGICD (3 esophageal, 16 gastric, and 9 duodenal), of which 52.6% were symptomatic. Disease distribution was ileal in 57.8%, colonic in 21.1% and ileo-colonic in 21.1%. A non-stricturing and non-penetrating phenotype was reported in 89.4%, stricturing in 5.3%, and penetrating in 5.3%. Perianal disease was found in 10.5%. UGICD was complicated by stricture formation in 2 patients (esophageal and gastric). CONCLUSIONS: The prevalence of UGICD is considered high among CD Saudi patients who undergo upper GI endoscopy at baseline, and is asymptomatic in 47.4% of patients. This reported prevalence is not dissimilar from reports originating from Western countries.

Extragastrointestinal stromal tumor of prostate.

Gastrointestinal stromal tumors (GISTs) that originate outside the GI tract are extremely uncommon. In this case report, we describe a GIST of primary origin in the prostate gland of an 84-year-old male who presented with severe urinary retention at King Abdulaziz University Hospital in Saudi Arabia. Diagnosis was based on patient history, radiological studies, pathologic findings, and immunohistochemical data. Digital rectal examination revealed a hugely enlarged prostate encroaching upon the rectal lumen with a smooth and firm surface. Transrectal ultrasound showed a markedly enlarged prostate with an estimated volume of 360 ml; prostate-specific antigen was 5.4 ng/ml. Immediate preoperative cystoscopy demonstrated only a moderate enlargement of the prostate, which was disproportionate to its actual size. Postoperative abdominal computed tomography showed residual prostatic tissue with an estimated weight of 78 g, multiple diffuse colonic diverticulosis, and scattered subcentimeter mesenteric lymph nodes. Histopathological examination of the prostatic tissue showed cellular spindle cell neoplastic proliferation which was diffusely positive for CD117 (c-kit), DOG1, and CD34. GISTs must be considered in the differential diagnosis of spindle cell tumors detected in the prostate.

The Diagnostic Accuracy of Cytology for the Diagnosis of Hepatobiliary and Pancreatic Cancers.

OBJECTIVE: Although cytology testing is considered a valuable method to diagnose tumors that are difficult to access such as hepato-biliary-pancreatic (HBP) malignancies, its diagnostic accuracy remains unclear. We therefore aimed to investigate the diagnostic accuracy of cytology testing for HBP tumors. STUDY DESIGN: We performed a retrospective study of all cytology samples that were used to confirm radiologically detected HBP tumors between 2002 and 2016. The cytology techniques used in our center included fine needle aspiration (FNA), brush cytology, and aspiration of bile. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated in comparison to histological confirmation. RESULTS: From a total of 133 medical records, we calculated an overall sensitivity of 76%, specificity of 74%, a negative likelihood ratio of 0.30, and a positive likelihood ratio of 2.9. Cytology was more accurate in diagnosing lesions of the liver (sensitivity 79%, specificity 57%) and biliary tree (sensitivity 100%, specificity 50%) compared to pancreatic (sensitivity 60%, specificity 83%) and gallbladder lesions (sensitivity 50%, specificity 85%). Cytology was more accurate in detecting primary cancers (sensitivity 77%, specificity 73%) when compared to metastatic cancers (sensitivity 73%, specificity 100%). FNA was the most frequently used cytological technique to diagnose HBP lesions (sensitivity 78.8%). CONCLUSION: Cytological testing is efficient in diagnosing HBP cancers, especially for hepatobiliary tumors. Given its relative simplicity, cost-effectiveness, and paucity of alternative diagnostic methods, cytology should still be considered as a first-line tool for diagnosing HBP malignancies.

Activated mucosal mast cells differentiate eosinophilic (allergic) esophagitis from gastroesophageal reflux disease.

OBJECTIVES: To evaluate the utility of activated mucosal mast cells (MC) in the differential diagnosis of eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD). METHODS: Intraepithelial eosinophils and MC were quantified in esophageal biopsies from 25 children with EE, 22 children with GERD and 22 controls. MCs were identified by immunohistochemistry for MC tryptase, whereas MC activation status was evaluated by immunohistochemistry for immunoglobulin E (IgE) and by electron microscopy. RESULTS: Esophageal biopsies from patients with EE showed higher intraepithelial eosinophil counts (55 +/- 27.5 vs 6.9 +/- 9.7, P < 0.0001) and MC counts (26.3 +/- 12.7 vs 7.8 +/- 8.9, P < 0.0001) than those from patients with GERD. Almost all EE biopsies (24 of 25 patients; 96%) contained IgE-bearing cells compared with 9 of 22 (41%) GERD biopsies (P < 0.001). GERD biopsies with intraepithelial eosinophil counts >7/high-power field (suggesting an allergic component) contained IgE-bearing cells in 6 of 7 (86%) cases compared to 3 of 15 (20%) cases with eosinophil counts <7/h.p.f (P < 0.01). No intraepithelial eosinophils, MC or IgE-positive cells were present in controls. Electron microscopy confirmed the presence of intraepithelial MC and changes in cytoplasmic granules indicative of MC and eosinophil activation. CONCLUSIONS: Intraepithelial MC counts and IgE-bearing cells may help to differentiate EE and GERD and to define a subset of GERD patients in which an allergic component is present. The findings support a role for a MC-mediated hypersensitivity reaction in the pathogenesis of EE.

Management of postoperative gastrointestinal leakage with autologous stromal vascular fraction.

To assess the efficacy of using autologous stromal vascular fraction (SVF) to promote healing of controlled fistula tracts in the management of postoperative upper gastrointestinal leakage. This is an experimental study conducted on 10 experimental rabbits. Animal models were divided into the SVF group which received an autologous SVF and the control group which did not receive the implantation. Surgery was performed on both groups to induce a gastric leak and create a controlled fistula tract between the leakage site in the stomach and the skin. After 2 weeks, surgery was performed on the SVF group to harvest, process and then implant the autologous SVF in the fistula tract. Animal models were followed up and their fistula tracts were evaluated for healing by gross and microscopic examination of the fistula tracts before the SVF implantation and at 24 hours, 1 week, 2 weeks and 3 weeks after implantation. The control group revealed no closure of fistula tracts by the 3(rd) week after implantation and there were no signs of inflammation or drainage. On the other hand, the SVF group showed signs of healing process with progressive closure of the fistula tract to about 95% by the 3(rd) week after implantation. The use of autologous SVF implantation to promote the healing of controlled fistula tracts seems to be a novel, safe and effective method in the management of postoperative upper gastrointestinal leakage. It could prevent reoperation and reduce hospital stay, morbidity and mortality. These results are promising and provide support for further clinical studies.

Hybrid thyroid carcinoma with a coarse chromatin pattern and nuclear features of papillary thyroid carcinoma.

Hybrid follicular carcinoma (FC) and papillary thyroid carcinoma (PTC) have not been previously well described. Consecutive cases of 29 FC, 12 Hurthle cell carcinomas (HC), 247 PTC and 13 Hurthle cell PTC (HPTC) were reviewed with special attention to the coarse (CC) and fine chromatin patterns (FIC), as well as to the presence of nuclear grooves, pseudoinclusions or optically clear appearance. Limited nuclear features of PTC (LNF-PTC) are defined as areas of tumor with FIC in addition to some other nuclear features, but insufficient for the diagnosis of PTC. Tumors with nuclei showing an admixture of CC and PTC or LNFPTC were submitted for immunostaining for cytokeratin 19, HBME and Ret/PTC. FC and HC contained areas of LNFPTC in 25 tumors and focal PTC in 3 tumors. None of these cases was associated with lymph node metastasis. Areas with CC were found in 54 PTC and 3 HPTC. The rates of vascular invasion and distant metastasis tended to be higher for PTC with areas of coarse chromatin pattern than for PTC without such areas; however, the difference was not statistically significant. Immunoreactivity for cytokeratin 19 and HBME was moderate to strong for PTC and focal areas of PTC or LNFPTC in FC without Hurthle cell changes. Ret/PTC immunostaining was positive in areas of LNFPTC or focal PTC in three FC. Focal PTC or areas of LNFPTC are frequently seen in FC. Likewise, areas of CC are often present in PTC. The presence of these focal areas does not appear to change the clinical behavior of the tumor and therefore does not warrant a change of nomenclature.

Metaplastic carcinoma of the breast: an immunohistochemical study.

BACKGROUND: Metaplastic breast carcinoma is a rare entity of breast cancer expressing epithelial and/or mesenchymal tissue within the same tumor. The aim of this study is to evaluate the clinicopathological features of metaplastic breast carcinoma and to confirm the triple negative, basal-like and/or luminal phenotype of this type of tumor by using immunohistochemical staining. METHODS: Seven cases of MBC were evaluated for clinico-pathological features including follow up data. Cases were studied immunohistochemically by CK-Pan, Vimentin, ER, PR, HER2, basal markers (CK5/6, p63, EGFR, SMA and S-100), luminal cytokeratins (CK8, CK18 and CK19), markers for syncytial cells (ß-HCG and PLAP), as well as prognostic markers (p53, ki-67 and calretinin). RESULTS: The mean age of the patients was 36 years. Three cases showed choriocarcinomatous features. All of our cases were negative for ER, PR and HER2. Six out of the 7 cases showed basal-like differentiation by demonstrating positivity with at least one of the basal/myoepithelial markers. Also 6 out of the 7 cases expressed luminal type cytokeratins (CK8, CK18 and/or CK19). P53 was positive in 3 cases, ki-67 was strongly expressed in only one case, while calretinin was expressed in 6 cases. CONCLUSION: Metaplastic breast carcinoma presents in our population at a younger age group than other international studies. All cases are categorized immunohistochemically under the triple negative group of breast cancer and 86% of them exhibited basal-like and luminal phenotype. Majority of cases developed local recurrence and distant metastasis in a relatively short period of time. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1101289295115804.

Propagation and titration of Alkhumra hemorrhagic fever virus in the brains of newborn Wistar rats.

Alkhumra hemorrhagic fever virus (AHFV) is a novel flavivirus identified first in Saudi Arabia. In this study, successful propagation of AHFV in the brains of newborn Wistar rats is described and the median rat lethal dose (RLD50) is determined. AHFV-RNA-positive human sera diluted 1:10 were injected intracerebrally into 16, ≤24h old rats. Post-inoculation, the rats were observed daily for 30 days. Brains of moribund rats were tested for AHFV-RNA using RT-PCR and cultured in LLC-MK2 cells. The titer of the isolated virus was determined and expressed in median tissue culture infectious dose (TCID50). To determine the RLD50, AHFV brain suspension was 10-fold diluted serially and each dilution was inoculated in the cerebral hemispheres of 10 rats for a total of 90 rats. Three days post-inoculation, the rats developed tremor, irritability, convulsion, opisthotonus, and spastic paresis starting in the hind limbs and ascending to involve the whole body. All infected rats died within 3-7 days with histopathologically confirmed meningoencephalitis. AHFV-RNA was detected in the brains of all infected rats and the virus titer was 10(9.4) RLD50/ml. The virus titer in LLC-MK2 was 10(8.2) TCID50/ml. In conclusion, AHFV was propagated successfully to high titers in the brains of newborn Wistar rats.

Anti-mitochondrial antibody positive autoimmune hepatitis triggered by EBV infection in a young girl.

Autoimmune hepatitis (AIH) is rare in children. Two types of childhood autoimmune hepatitis are recognized: AIH type 1 which is characterized by the presence of smooth muscle (SMA) and/or antinuclear (ANA) antibodies; and AIH type 2 which is positive for anti-liver kidney microsomal type 1 (anti-LKM-1) antibody. Anti-mitochondrial antibody (AMA) is considered the hallmark for primary biliary cirrhosis (PBC) that occurs primarily in adult women and is characterized by destruction of the intralobular bile ducts and progression to cirrhosis and liver failure. Antimitochondrial-antibody-positive AIH is extremely rare in children. We report a 13year old Saudi girl with type-1 AIH who had a strongly positive anti-mitochondrial antibody and no evidence of small bile duct disease in the liver biopsy.

Prevalence of celiac disease in children with type 1 diabetes mellitus screened by anti-tissue transglutaminase antibody from Western Saudi Arabia.

OBJECTIVE: To determine the prevalence of celiac disease (CD) in children and adolescents with type 1 diabetes mellitus (T1DM) using anti-tissue transglutaminase (anti-tTG) antibodies. METHODS: A retrospective hospital record-based study of all children and adolescents with T1DM who were screened for CD was conducted at the Pediatric Diabetes Clinic of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia (KSA) between October 2002 and June 2011. RESULTS: A total of 430 children with T1DM were screened by anti-tTG antibody. The median age at screening was 10.7 years (range; 1.1-18). The study cohort included 232 (54%) Saudi patients, and females constituted 58.8% of the total number. Anti-tTG antibody screening was positive in 91 (21.2%) patients. Forty-eight (11.2%) out of 430 children screened had biopsy-proven CD. Forty-two patients with CD (87.5%) were asymptomatic. Patients with CD had less weight for age (p=0.007), and height for age (p=0.03) z-scores than non-CD patients. They showed more association with anemia (p<0.001), low albumin level (p<0.001), and autoimmune thyroid disease (p=0.002). There was no difference in the mean glycosylated hemoglobin level (p=0.38), or insulin requirements (p=0.74) between the 2 groups. CONCLUSION: The prevalence of CD in patients with T1DM from the Western region of KSA is considered among the highest reported. Therefore, routine screening through proper serological testing is recommended.

Gastrointestinal stromal tumors in western Saudi Arabia.

OBJECTIVE: To determine the pattern of gastrointestinal stromal tumors (GIST) in the population of 2 large tertiary centers in the western province of the Kingdom of Saudi Arabia (KSA). METHODS: This retrospective study used cases diagnosed as GIST at the histopathology laboratories of King Abdul-Aziz University Hospital between January 2000 and October 2009, and King Faisal Specialist Hospital and Research Center, Jeddah, KSA, between January 2002 and December 2008. Additionally, cases diagnosed as gastrointestinal spindle cell tumors, sarcomas, schwannomas, leiomyomas, and leiomyosarcomas at King Abdul-Aziz University Hospital between January 1995 and December 1999 prior to the introduction of CD117 immunostain testing in the lab were tested for it. Positive cases were included in the study. Age and gender of the patients, as well as tumor location, maximum diameter, and mitotic count were analyzed. RESULTS: Thirty-seven cases were found in which the mean age was 55.6 years. Nineteen tumors were located in the stomach (51.4%), 7 in the small bowel (18.9%), 2 in the colorectum (5.4%), 4 in the mesentery (10.8%), and 5 in the abdomen (13.5%). Fifteen cases (40.5%) were high risk, 13 (35.2%) were intermediate risk, 3 (8.1%) were low risk, and one case (2.7%) was very low risk for aggressive behavior. CONCLUSION: The GISTs are more prevalent in Saudi Arabia than is generally thought. Most cases occurred in male adults over 40 years of age. The stomach is the most frequent location of occurrence. Most tumors are of the high-risk group.