The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD.

ABSTRACT: Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.

Awareness About Dry Eye Symptoms and Risk Factors Among Eastern Province Population in Saudi Arabia.

Background Dry eye syndrome (DES), also known as keratoconjunctivitis sicca (KCS), is a common cause of patient's visits to the ophthalmologist. It is characterized by a defect in the tear film homeostasis, symptoms of ocular discomfort, and visual disturbance. Also, it increases the risk of ocular surface damage if complicated by tear film hyperosmolarity and ocular surface inflammation. The present study aims to measure awareness about dry eye disease and the risk factors among the Eastern region population in Saudi Arabia via an online questionnaire. Methods This is a cross-sectional community-based study conducted in Saudi Arabia that assessed knowledge and awareness of dry eye among the eastern province population using a self-administered online questionnaire. The minimum sample size was 385 adults. Statistical analysis was performed using SPSS software, version 21.0 (IBM Corp., Armonk, NY), and participants' overall awareness level was evaluated based on correct answers. Results In this study, a total of 522 participants fulfilling the inclusion criteria completed the study questionnaire. Participants ranged from 18 to 65 years, with a mean age of 27.2 ± 14.6 years old. Females represented a higher percentage of the sample, 341 (65.3%). Public awareness regarding dry eye diseases in the Eastern region, Saudi Arabia of 149 participants (28.5%) is overall a good awareness level while 373 (71.5%) of them had poor awareness. Conclusion Participants showed unsatisfactory results in awareness of risk factors of dry eye symptoms, where the most reported causes were prolonged concentration while using electronic devices, climatic factors, and lacrimal gland disorders.

Knowledge of and Testing Rate for Hepatitis C Infection among the General Public of Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: The Ministry of Health in Saudi Arabia has announced a plan to eradicate hepatitis C virus (HCV) infection. This study sought to evaluate the knowledge levels and testing rate among the general population of Saudi Arabia. METHODS: A cross-sectional study was conducted using data collected from an online, self-administered survey. Multivariable analysis was conducted using multiple binary logistic regression models to identify factors associated with low knowledge levels as well as predictors of HCV testing. RESULTS: A total of 689 participants completed the survey. While most participants (88%) have heard of HCV infection, less than half (47.3%) understood that HCV is curable with medications. More than half of the participants (53.7%) have low knowledge about HCV infection. Testing for HCV was reported by 123 respondents (17.8%), and the odds of testing for HCV were significantly lower among residents of the Makkah region (OR = 0.59 [95% CI: 0.36-0.97]) and those with low knowledge level (OR = 0.47 [95% CI: 0.29-0.74]). HCV diagnosis was reported by nine respondents (1.3%), of whom only four reported receiving treatment (44%). CONCLUSIONS: Our study indicates inadequate knowledge levels and relatively low testing rate. These findings underscore the need for national awareness campaigns and more effective strategies for HCV screening.

Clinical epidemiology of ulcerative colitis in Arabs based on the Montréal classification.

AIM: To determine the clinical, epidemiological and phenotypic characteristics of ulcerative colitis (UC) in Saudi Arabia by studying the largest cohort of Arab UC patients. METHODS: Data from UC patients attending gastroenterology clinics in four tertiary care centers in three cities between September 2009 and September 2013 were entered into a validated web-based registry, inflammatory bowel disease information system (IBDIS). The IBDIS database covers numerous aspects of inflammatory bowel disease. Patient characteristics, disease phenotype and behavior, age at diagnosis, course of the disease, and extraintestinal manifestations were recorded. RESULTS: Among 394 UC patients, males comprised 51.0% and females 49.0%. According to the Montréal classification of age, the major chunk of our patients belonged to the A2 category for age of diagnosis at 17-40 years (68.4%), while 24.2% belonged to the A3 category for age of diagnosis at > 40 years. According to the same classification, a majority of patients had extensive UC (42.7%), 35.3% had left-sided colitis and 29.2% had only proctitis. Moreover, 51.3% were in remission, 16.6% had mild UC, 23.4% had moderate UC and 8.6% had severe UC. Frequent relapse occurred in 17.4% patients, infrequent relapse in 77% and 4.8% had chronic disease. A majority (85.2%) of patients was steroid responsive. With regard to extraintestinal manifestations, arthritis was present in 16.4%, osteopenia in 31.4%, osteoporosis in 17.1% and cutaneous involvement in 7.0%. CONCLUSION: The majority of UC cases were young people (17-40 years), with a male preponderance. While the disease course was found to be similar to that reported in Western countries, more similarities were found with Asian countries with regards to the extent of the disease and response to steroid therapy.

Clinical epidemiology and phenotypic characteristics of Crohn's disease in the central region of Saudi Arabia.

BACKGROUND/AIMS: Despite the remarkable increase in the incidence of Crohn's disease among Saudis in recent years, data about Crohn's disease in Saudi Arabia are scarce. The aim of this study was to determine the clinical epidemiology and phenotypic characteristics of Crohn's disease in the central region of Saudi Arabia. PATIENTS AND METHODS: A data registry, Inflammatory Bowel Disease Information System (IBDIS), was used to register Crohn's disease patients who presented to the gastroenterology clinics in four tertiary care centers in Riyadh, Saudi Arabia between September 2009 and February 2013. Patients' characteristics, disease location, behavior, age at diagnosis according to the Montreal classification, course of the disease, and extraintestinal manifestation were recorded. RESULTS: Among 497 patients with Crohn's disease, 59% were males with a mean age at diagnosis of 25 years [95% Confidence Interval (CI): 24-26, range 5-75 years]. The mean duration from the time of complaint to the day of the diagnosis was 11 months, and the mean duration of the disease from diagnosis to the day of entry to the registry was 40 months. Seventy-seven percent of our patients were aged 17-40 years at diagnosis, 16.8% were ≤16 years of age, and 6.6% were >40 years of age. According to the Montreal classification of disease location, 48.8% of patients had ileocolonic involvement, 43.5% had limited disease to the terminal ileum or cecum, 7.7% had isolated colonic involvement, and 16% had an upper gastrointestinal involvement. Forty-two percent of our patients had a non-stricturing, non-penetrating behavior, while 32.8% had stricturing disease and 25.4% had penetrating disease. CONCLUSION: Crohn's disease is frequently encountered in Saudi Arabia. The majority of patients are young people with a predilection for males, while its behavior resembled that of western societies in terms of age of onset, location, and behavior.