Saudi Journal of Gastroenterology最新文献

{"title":"Evaluation of intestinal ultrasound for disease activity assessment in patients with inflammatory bowel disease: A cross-sectional study at a tertiary centre in Malaysia.","authors":"Kuan Yee Lim, Raja Affendi Raja Ali, Zhiqin Wong, Faizah Mohd Zaki, Juliana Fairuz Maktar, Khairul Najmi Muhammad Nawawi","doi":"10.4103/sjg.sjg_531_22","DOIUrl":"10.4103/sjg.sjg_531_22","url":null,"abstract":"<p><strong>Background: </strong>The use of intestinal ultrasound (IUS) in the management of inflammatory bowel disease (IBD) is emerging. We aim to determine the performance of IUS in the assessment of disease activity in IBD.</p><p><strong>Methods: </strong>This is a prospective cross-sectional study of IUS performed on IBD patients in a tertiary centre. IUS parameters including intestinal wall thickness, loss of wall stratification, mesenteric fibrofatty proliferation, and increased vascularity were compared with endoscopic and clinical activity indices.</p><p><strong>Results: </strong>Among the 51 patients, 58.8% were male, with a mean age of 41 years. Fifty-seven percent had underlying ulcerative colitis with mean disease duration of 8.4 years. Against ileocolonoscopy, IUS had a sensitivity of 67% (95% confidence interval (CI): 41-86) for detecting endoscopically active disease. It had high specificity of 97% (95% CI: 82-99) with positive and negative predictive values of 92% and 84%, respectively. Against clinical activity index, IUS had a sensitivity of 70% (95% CI: 35-92) and specificity of 85% (95% CI: 70-94) for detecting moderate to severe disease. Among individual IUS parameters, presence of bowel wall thickening (>3 mm) had the highest sensitivity (72%) for detecting endoscopically active disease. For per-bowel segment analysis, IUS (bowel wall thickening) was able to achieve 100% sensitivity and 95% specificity when examining the transverse colon.</p><p><strong>Conclusions: </strong>IUS has moderate sensitivity with excellent specificity in detecting active disease in IBD. IUS is most sensitive in detecting a disease at transverse colon. IUS can be employed as an adjunct in the assessment of IBD.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10837838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in endoscopy: Overview, applications, and future directions.","authors":"Arif A Arif, Shirley X Jiang, Michael F Byrne","doi":"10.4103/sjg.sjg_286_23","DOIUrl":"https://doi.org/10.4103/sjg.sjg_286_23","url":null,"abstract":"<p><p>Since the emergence of artificial intelligence (AI) in medicine, endoscopy applications in gastroenterology have been at the forefront of innovations. The ever-increasing number of studies necessitates the need to organize and classify applications in a useful way. Separating AI capabilities by computer aided detection (CADe), diagnosis (CADx), and quality assessment (CADq) allows for a systematic evaluation of each application. CADe studies have shown promise in accurate detection of esophageal, gastric and colonic neoplasia as well as identifying sources of bleeding and Crohn's disease in the small bowel. While more advanced CADx applications employ optical biopsies to give further information to characterize neoplasia and grade inflammatory disease, diverse CADq applications ensure quality and increase the efficiency of procedures. Future applications show promise in advanced therapeutic modalities and integrated systems that provide multimodal capabilities. AI is set to revolutionize clinical decision making and performance of endoscopy.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The when, why and whom to biopsy of type 1 diabetes mellitus children with positive anti-tissue transglutaminase serology.","authors":"Stefano Guandalini","doi":"10.4103/sjg.sjg_253_23","DOIUrl":"10.4103/sjg.sjg_253_23","url":null,"abstract":"","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10029537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IBD-Disk as a tool estimating the prevalence of inflammatory bowel disease-related disability and associated influencing factors in Saudi Arabia: A cross-sectional study.","authors":"Yaser Meeralam, Adnan B Al-Zanbagi, Mona Al Saedi, Walaa Alharthi, Hanadi A Sabbahi, Talal Alhejaili, Mohammed K Shariff","doi":"10.4103/sjg.sjg_3_23","DOIUrl":"10.4103/sjg.sjg_3_23","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) disk is an easy tool to use in clinical practice to measure IBD-related disability, with a score >40 correlating with high daily-life burden. Its use has been limited mainly to the western world. We aimed to estimate the prevalence of IBD-related disability and evaluate the associated risk factors in Saudi Arabia.</p><p><strong>Methods: </strong>In this cross sectional study conducted at a tertiary referral center for IBD, the English IBD disk was translated into Arabic, and patients with IBD were approached to complete it. Total IBD disk score (0 = no disability; 100 = severe disability) was documented and a score of >40 was set as a threshold to estimate the prevalence of disability.</p><p><strong>Results: </strong>Eighty patients with a mean age of 32.5 ± 11.9 years and disease duration of 6 years, including 57% females, were analyzed. The mean IBD-disk total score was 20.70 ± 18.69. The mean subscores for each function within the disk ranged from 0.38 ± 1.69 for sexual functions to 3.61 ± 3.29 for energy. The overall prevalence of IBD-related disability was 19% (15/80 scoring >40) and was much higher in active disease, in males and in IBD of long duration (39%, 24%, and 26%, respectively). A clinically active disease, high CRP, and high calprotectin were strongly associated with higher disk scores.</p><p><strong>Conclusion: </strong>Although the overall mean IBD disk score was low, nearly 19% of our population had high scores signifying a high prevalence of disability. As demonstrated by other studies, active disease and high biomarkers were significantly associated with higher IBD-disk scores.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and predictive factors for spontaneous normalization of anti-tissue transglutaminase-IgA serology among Saudi children with type 1 diabetes mellitus: A cohort study.","authors":"Ahmed Al Sarkhy, Ali Al Hassan, Heba Assiri, Hayfa Alabdulkarim, Noor AlAnazi, Nawaf Alshammari, Najla AlOtaibi, Mona Al Asmi, Asaad Assiri, Reem Al-Khalifah, Shaik Shaffi Ahamed, Mohammad El Mouzan","doi":"10.4103/sjg.sjg_25_23","DOIUrl":"10.4103/sjg.sjg_25_23","url":null,"abstract":"<p><strong>Background: </strong>Celiac serology can be transiently elevated in patients with type 1 diabetes mellitus (T1DM) and normalized despite gluten consumption. This study aimed to identify the frequency and predictive factors of spontaneous normalization of anti-tissue transglutaminase (anti-TTG-IgA) antibodies in these patients.</p><p><strong>Methods: </strong>The charts of all patients (≤18 years) with T1DM were retrospectively reviewed from 2012 to 2021 at a tertiary care center in Riyadh, Saudi Arabia. The following data were collected: clinical characteristics of the participants, anti-TTG-IgA-immunoglobulin (Ig) A antibody, and histological findings. The outcome of positive anti-TTG-IgA-IgA in patients with T1DM and the predictive factors for spontaneous normalization were investigated.</p><p><strong>Results: </strong>Of the 1,006 patients with T1DM, 138 (13.7%) had elevated anti-TTG-IgA antibodies, celiac disease was diagnosed in 58/138 (42%) patients, spontaneous normalization of anti-TTG-IgA was observed in 65 (47.1%) patients, and fluctuating anti-TTG-IgA antibodies were seen in 15 (10.9%) patients. The patients with anti-TTG-IgA levels at 3-10 times the upper normal limits (UNL), and those with levels ≥10 times UNL were less likely to have spontaneous normalization of anti-TTG-IgA compared to patients with levels at 1-3 times UNL (hazard ratio [HR] = 0.28, 95% confidence interval [Cl] = 0.13-0.61, P = 0.001, and HR = 0.03, 95% Cl = 0.00-0.19, P < 0.001, respectively).</p><p><strong>Conclusion: </strong>Asymptomatic patients with T1DM with mild elevation of anti-TTG-IgA need not be rushed for invasive endoscopy or exposed to an un-needed gluten-free diet but should rather have a regular follow-up of their celiac serology.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological outcomes of elective versus emergency surgery for colon cancer: A tertiary academic center experience.","authors":"Thamer A Bin Traiki, Sulaiman A AlShammari, Razan N AlRabah, Amirah M AlZahrani, Saud T Alshenaifi, Noura S Alhassan, Maha-Hamadien Abdulla, Ahmad M Zubaidi, Omar A Al-Obeed, Khayal A Alkhayal","doi":"10.4103/sjg.sjg_31_23","DOIUrl":"10.4103/sjg.sjg_31_23","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to identify the oncological outcomes in colon cancer patients who underwent elective versus emergency curative resection.</p><p><strong>Methods: </strong>All patients who underwent curative resection for colon cancer between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into two groups based on the presentation into elective and emergency groups.</p><p><strong>Results: </strong>A total of 215 patients with colon cancer were admitted and underwent curative surgical resection. Of those, 145 patients (67.4%) were elective cases, and 70 (32.5%) were emergency cases. Family history of malignancy was positive in 44 patients (20.5%) and significantly more common in the emergency group (P = 0.016). The emergency group had higher T and TNM stages (P = 0.001). The 3-year survival rate was 60.9% and significantly less in the emergency group (P = 0.026). The mean duration from surgery to recurrence, 3-year disease-free survival, and overall survival were 1.19, 2.81, and 3.11, respectively.</p><p><strong>Conclusion: </strong>Elective group was associated with better 3-year survival, longer overall, and 3-year disease-free survival compared to the emergency group. The disease recurrence rate was comparable in both groups, mainly in the first two years after curative resection.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of early biologic therapy versus late/conventional therapy in children and adolescents with Crohn's disease: A systematic review and meta-analysis.","authors":"Lei Zhang, Zhixiao Jin, Jia Hao","doi":"10.4103/sjg.sjg_190_23","DOIUrl":"10.4103/sjg.sjg_190_23","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to estimate the effectiveness of early biologics compared to conventional treatment in the management of Crohn's disease among pediatric and adolescent patients.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in four electronic databases to identify relevant studies published from inception to 2023. The inclusion criteria comprised randomized controlled trials (RCTs) and cohort studies that reported on the efficacy and clinical outcomes of early biologic therapy compared to late/conventional therapy in children with Crohn's disease. The quality of the studies was assessed using the Cochrane Risk of Bias tool and the Newcastle Ottawa scale.</p><p><strong>Results: </strong>A total of 13 studies (2 RCTs and 11 cohort studies), involving 861 patients, were included in the meta-analysis. The results demonstrated that early biologic therapy was associated with a significantly higher rate of clinical remission (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.10-1.54), lower relapse rates (RR 0.33, 95% CI 0.21-0.53), and improved mucosal healing (RR 1.47, 95% CI 1.10-1.97) compared to late/conventional therapy. However, it should be noted that there was evidence of publication bias among studies reporting clinical remission.</p><p><strong>Conclusion: </strong>In conclusion, early biologic therapy is significantly more effective in achieving clinical remission (within two years of diagnosis), promoting mucosal healing, and reducing relapse rates in pediatric and adolescent patients with Crohn's disease, compared to late/conventional therapy. These findings emphasize the importance of initiating biological therapy early in the treatment of Crohn's disease in this patient population.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of biliary atresia outcome: Saudi National Study (2000 - 2018).","authors":"Mohammed Abanemai, Mohammed AlEdreesi, Ahmed Al Sarkhy, Omar I Saadah, Homoud Alhebbi, Razan Bader, Maher Alhatlani, Hana Halabi, Ahmed Aladsani, Sami Wali, Talal Alguofi, Fahad Alsayed, Amira NasserAllah, Ahmed Almehmadi, Afnan Qurban, Muhammed Salman Bashir, Aisha Alamri, Abdulrahman Al-Hussaini","doi":"10.4103/sjg.sjg_512_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_512_22","url":null,"abstract":"<p><strong>Background: </strong>Outcomes in biliary atresia (BA) have been well-documented in large national cohorts from Europe, North America, and East Asia. Understanding the challenges that preclude success of the Kasai portoenterostomy (KPE) is the key to improve the overall outcomes of BA and implementing intervention strategies. Here, we analyzed the data from the Saudi national BA study (204 BA cases diagnosed between 2000 and 2018) to identify the prognostic factors of BA outcomes.</p><p><strong>Methods: </strong>One hundred and forty-three cases underwent KPE. Several prognostic factors (center case load, congenital anomalies, serum gamma-glutamyl transferase, use of steroids, ascending cholangitis post-operatively, and degree of portal fibrosis at time of KPE) were investigated and correlated with the primary outcomes of interest: 1) success of KPE (clearance of jaundice and total serum bilirubin <20 mmol/l after KPE), 2) survival with native liver (SNL), and 3) overall survival.</p><p><strong>Results: </strong>Use of steroids after KPE was associated with clearance of jaundice, 68% vs. 36.8% in the BA cases that did not receive steroids (P = 0.013; odds ratio 2.5) and a significantly better SNL rate at 2 - and 10-year of 62.22% and 57.77% vs. 39.47% and 31.57%, respectively (P = 0.01). A better 10-year SNL was observed in centers with caseload <1/year (group 1) as compared to centers that performed ≥1/year (group 2) [45.34% vs. 26.66%, respectively; P = 0.047]. On comparison of the 2 groups, cases in group 1 had KPE at significantly earlier age (median 59.5 vs. 75 days, P = 0.006) and received steroids after KPE more frequently than group 2 (69% vs. 31%, P < 0.001). None of the remaining prognostic variables were identified as being significantly related to BA outcome.</p><p><strong>Conclusion: </strong>Steroids use post-KPE predicted clearance of jaundice and better short- and long-term SNL. There is a need to establish a national BA registry in Saudi Arabia aiming to standardize the pre- and post-operative clinical practices and facilitate clinical and basic research to evaluate factors that influence BA outcome.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ramadan fasting model exerts hepatoprotective, anti-obesity, and anti-hyperlipidemic effects in an experimentally-induced nonalcoholic fatty liver in rats.","authors":"Abeer A Alasmari,&nbsp;Abdulrahman S Al-Khalifah,&nbsp;Ahmed S BaHammam,&nbsp;Noura M S Alshiban,&nbsp;Ahmad T Almnaizel,&nbsp;Hesham S Alodah,&nbsp;Maha H Alhussain","doi":"10.4103/sjg.sjg_153_23","DOIUrl":"https://doi.org/10.4103/sjg.sjg_153_23","url":null,"abstract":"<p><strong>Background: </strong>The epidemic of nonalcoholic fatty liver disease (NAFLD) and its metabolic effects present a serious public health concern. We hypothesized that the Ramadan fasting model (RFM), which involves fasting from dawn to dusk for a month, could provide potential therapeutic benefits and mitigate NAFLD. Accordingly, we aimed to validate this hypothesis using obese male rats.</p><p><strong>Methods: </strong>Rats were split into two groups (n = 24 per group), and they were given either a standard (S) or high-fat diet (HFD) for 12 weeks. During the last four weeks of the study period, both S- and HFD-fed rats were subdivided into eight groups to assess the effect of RFM with/without training (T) or glucose administration (G) on the lipid profile, liver enzymes, and liver structure (n = 6/group).</p><p><strong>Results: </strong>The HFD+RFM group exhibited a significantly lower final body weight than that in the HFDC group. Serum cholesterol, low-density lipoprotein, and triglyceride levels were significantly lower in the HFD+RFM, HFD+RFM+T, and HFD+RFM+G groups than those in the HFDC group. Compared with the HFDC group, all groups had improved serum high-density lipoprotein levels. Furthermore, HFD groups subjected to RFM had reduced serum levels of aspartate transaminase and alanine transaminase compared with those of the HFD-fed group. Moreover, the liver histology improved in rats subjected to RFM compared with that of HFD-fed rats, which exhibited macro- and micro-fat droplet accumulation.</p><p><strong>Conclusion: </strong>RFM can induce positive metabolic changes and improve alterations associated with NAFLD, including weight gain, lipid profile, liver enzymes, and hepatic steatosis.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10029539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between smoking and colorectal cancer in Eastern Mediterranean Regional Office (EMRO): A systematic review and meta-analysis.","authors":"Mohammad-Hossein Keivanlou,&nbsp;Ehsan Amini-Salehi,&nbsp;Soheil Hassanipour,&nbsp;Abinash Mahapatro,&nbsp;Nakka Raghuma,&nbsp;Farahnaz Joukar,&nbsp;Negin Letafatkar,&nbsp;Arman Habibi,&nbsp;Naeim Norouzi,&nbsp;Maryam Sadat Aleali,&nbsp;Mona Javid,&nbsp;Arian Mirdamadi,&nbsp;Fariborz Mansour-Ghanaei","doi":"10.4103/sjg.sjg_163_23","DOIUrl":"https://doi.org/10.4103/sjg.sjg_163_23","url":null,"abstract":"<p><strong>Background: </strong>Smoking poses a significant risk for colorectal cancer (CRC), considered the third leading reason for cancer-related deaths worldwide. However, there has been limited research on the relationship between smoking and CRC in the Eastern Mediterranean Regional Office (EMRO). Therefore, a meta-analysis was conducted to combine available data and gain a comprehensive understanding of the relationship between smoking and CRC in EMRO.</p><p><strong>Methods: </strong>Two independent researchers searched PubMed, Scopus, and Web of Science until December 2022. The included studies were checked for risk of bias administering the Newcastle-Ottawa scale. Heterogeneity was evaluated using I2 statistics and the Cochrane test. Publication bias was determined through funnel plot analysis and Egger's regression test. Additionally, a meta-regression analysis explored the impact of a country's Human Development Index (HDI) on the relationship between smoking and CRC.</p><p><strong>Results: </strong>The final analysis included 26 studies, revealing a significant association between smoking and CRC (OR = 1.40; 95% CI: 1.11 - 1.78; P = 0.004). Moreover, smoking had a more pronounced adverse effect on CRC in countries with higher HDIs compared to those with lower HDIs (OR = 1.30; 95% CI: 0.99 - 1.71; P = 0.054).</p><p><strong>Conclusions: </strong>Our findings underscore the importance of implementing smoking cessation programs and policies in EMRO countries, as they demonstrate a positive relationship between smoking and the risk of CRC. Furthermore, the results suggest that a country's level of human development may influence the association between smoking and CRC. Further research is needed to investigate this potential connection and develop targeted public health interventions.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10219892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}