Saudi Journal of Gastroenterology最新文献

{"title":"Performance of artificial intelligence in the characterization of colorectal lesions.","authors":"Carlos E O Dos Santos,&nbsp;Daniele Malaman,&nbsp;Ivan D Arciniegas Sanmartin,&nbsp;Ari B S Leão,&nbsp;Gabriel S Leão,&nbsp;Júlio C Pereira-Lima","doi":"10.4103/sjg.sjg_316_22","DOIUrl":"10.4103/sjg.sjg_316_22","url":null,"abstract":"<p><strong>Background: </strong>Image-enhanced endoscopy (IEE) has been used in the differentiation between neoplastic and non-neoplastic colorectal lesions through microvasculature analysis. This study aimed to evaluate the computer-aided diagnosis (CADx) mode of the CAD EYE system for the optical diagnosis of colorectal lesions and compare it with the performance of an expert, in addition to evaluating the computer-aided detection (CADe) mode in terms of polyp detection rate (PDR) and adenoma detection rate (ADR).</p><p><strong>Methods: </strong>A prospective study was conducted to evaluate the performance of CAD EYE using blue light imaging (BLI), dichotomizing lesions into hyperplastic and neoplastic, and of an expert based on the Japan Narrow-Band Imaging Expert Team (JNET) classification for the characterization of lesions. After white light imaging (WLI) diagnosis, magnification was used on all lesions, which were removed and examined histologically. Diagnostic criteria were evaluated, and PDR and ADR were calculated.</p><p><strong>Results: </strong>A total of 110 lesions (80 (72.7%) dysplastic lesions and 30 (27.3%) nondysplastic lesions) were evaluated in 52 patients, with a mean lesion size of 4.3 mm. Artificial intelligence (AI) analysis showed 81.8% accuracy, 76.3% sensitivity, 96.7% specificity, 98.5% positive predictive value (PPV), and 60.4% negative predictive value (NPV). The kappa value was 0.61, and the area under the receiver operating characteristic curve (AUC) was 0.87. Expert analysis showed 93.6% accuracy, 92.5% sensitivity, 96.7% specificity, 98.7% PPV, and 82.9% NPV. The kappa value was 0.85, and the AUC was 0.95. Overall, PDR was 67.6% and ADR was 45.9%.</p><p><strong>Conclusions: </strong>The CADx mode showed good accuracy in characterizing colorectal lesions, but the expert assessment was superior in almost all diagnostic criteria. PDR and ADR were high.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/72/SJG-29-219.PMC10445495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10066748","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 prevalence and clinical characteristics of Clostridium difficile infection in Saudi patients admitted with inflammatory bowel disease: A case-control study.","authors":"Abdulrahman AlKhormi,&nbsp;Abdullah M Altheyabi,&nbsp;Saud A AlGhamdi,&nbsp;Osama Alshahrani,&nbsp;Abdulwahed A Alotay,&nbsp;Ahmad Deeb","doi":"10.4103/sjg.sjg_476_22","DOIUrl":"10.4103/sjg.sjg_476_22","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) patients are at increased risk of Clostridium difficile infection (CDI), causing significant morbidity and mortality. This study examined CDI's prevalence, predisposing factors, and clinical outcomes in Saudi hospitalized IBD patients.</p><p><strong>Methods: </strong>: A retrospective case-control study was conducted at a tertiary medical city in Riyadh, Saudi Arabia. All Saudi adult patients with IBD, admitted over the preceding four years were identified from the hospital's database. Eligible patients were divided into those with CDI and those without CDI. Binary logistic regression was used to determine the predisposing factors for CDI among admitted IBD patients.</p><p><strong>Results: </strong>During the study period, 95 patients were admitted with IBD. Crohn's disease (CD) was the predominant type (71.6%), whereas 28.4% of the patients were with ulcerative colitis (UC). Only 16 (16.8%) patients had positive CDI. CDI-positive patients tend to have hypertension and previous use of steroids. Patients with UC tend to have a higher risk of CDI than those with CD. Most patients recovered from the CDI (81.3%) with a median time to CDI clearance of 14 days. Three patients (18.8%) had recurrent CDI; among them, one died.</p><p><strong>Conclusion: </strong>The prevalence of CDI in Saudi IBD patients is similar to that reported elsewhere. UC, steroid treatment, and hypertension are risk factors for CDI in IBD patients. Recurrence of CDI in IBD patients is common and associated with a poor prognosis.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/2f/SJG-29-251.PMC10445497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10120044","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":"Inflammatory bowel disease in the elderly: A focus on disease characteristics and treatment patterns.","authors":"Mahmoud H Mosli,&nbsp;Maha K Alghamdi,&nbsp;Omar A Bokhary,&nbsp;Maria A Alzahrani,&nbsp;Siba Z Takieddin,&nbsp;Tala A Galai,&nbsp;Majid A Alsahafi,&nbsp;Omar I Saadah","doi":"10.4103/sjg.sjg_503_22","DOIUrl":"10.4103/sjg.sjg_503_22","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, the number of elderly inflammatory bowel disease (IBD) patients is expected to increase. The clinical features and therapeutic options for young and old patients may differ, as elderly IBD patients are likely to have different comorbidities and disease characteristics. The goal of this study was to examine the clinical aspects and therapeutic choices for elderly Saudi IBD patients.</p><p><strong>Methods: </strong>We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD in elderly patients (≥60 years) who followed up at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The data was extracted from the KAUH inflammatory bowel disease information system (IBDIS) registry. The primary outcome was to describe disease characteristics in accordance with the Montréal classification and the secondary outcomes were to describe treatment patterns and identify significant clinical associations.</p><p><strong>Results: </strong>Our data were collected from 76 patients who fulfilled the study inclusion criteria. Females outnumbered males (53.9% vs 46.1%) and the mean age was 51.5 ± 9.7 years. Essential hypertension (26.3%) was the most common comorbidity followed by diabetes mellitus (23.6%), and malignant neoplasms (9.21%). More than half of the patients with Crohn's disease (CD) had disease onset after forty years of age. The most common form of disease distribution was ileocolonic disease (64.7%). Less than 17% of patients had a penetrating disease phenotype. About 88 percent of patients with UC presented >40 years of age. Approximately, half of the cohort had left-sided ulcerative colitis (UC) (48%), followed by pancolitis (40%). The most prescribed medication class for IBD was 5-aminosalicylic acid (5-ASA) derivatives (56.58%) followed by corticosteroids and immunosuppressive drugs.</p><p><strong>Conclusions: </strong>In Saudi Arabia, age-specific concerns including comorbidities and polypharmacy remain the major challenges in the management of elderly IBD patients.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/0c/SJG-29-212.PMC10445499.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060224","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 in the elderly - beware of pitfalls!","authors":"Mohmmed T Sharip,&nbsp;Sreedhar Subramanian","doi":"10.4103/sjg.sjg_185_23","DOIUrl":"10.4103/sjg.sjg_185_23","url":null,"abstract":"Inflammatory bowel diseases (IBD), Crohn’s disease (CD), and ulcerative colitis (UC) typically affect people between the ages of 15 and 30, but there is a second smaller peak in the elderly, referred to as elderly‐onset IBD.[1] Typically, patients diagnosed over the age of 60 are referred to as elderly‐onset IBD patients. Recent studies have reported a marked increase in IBD incidence in the elderly.[2] The reasons for this are unclear but likely to include a combination of improved diagnosis, increased life expectancy, and, finally, a more pronounced effect of environmental factors on the risk of IBD in the elderly. For instance, the magnitude of risk for IBD with antibiotic exposure is higher with increasing age.[3]","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/46/SJG-29-201.PMC10445498.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065604","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":"Acute peripancreatic fluid collection in acute pancreatitis: Incidence, outcome, and association with inflammatory markers.","authors":"Tevfik Solakoglu,&nbsp;Nurten Turkel Kucukmetin,&nbsp;Mustafa Akar,&nbsp;Hüseyin Koseoglu","doi":"10.4103/sjg.sjg_443_22","DOIUrl":"10.4103/sjg.sjg_443_22","url":null,"abstract":"<p><strong>Background: </strong>The hospital outcomes and predictors of acute peripancreatic fluid collection (APFC) have not been well-characterized. In this study, we aimed to investigate the clinical outcomes of APFC in patients with acute pancreatitis (AP) and the role of the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and C-reactive protein (CRP) level in predicting the occurrence of APFC.</p><p><strong>Methods: </strong>In this retrospective study, the complicated group (patients with APFC) and the uncomplicated group (patients without APFC) were compared for their clinical characteristics, hospital outcomes (mortality rate, intensive care unit admission rate, and length of hospital stay), pseudocyst formation, CRP levels, SII, and SIRI on admission and at 48 hours.</p><p><strong>Results: </strong>Of 132 patients with AP, 51 (38.6%) had APFC and eight (6.1%) had pancreatic pseudocysts. Of 51 patients with APFC, 15.7% had pancreatic pseudocysts. Pseudocyst did not develop in the uncomplicated group. SII value at 48 h [median 859 (541-1740) x 10⁹/L vs. 610 (343-1259) x 10⁹/L, P = 0.01] and CRP level at 48 h [89 (40-237) mg/L vs. 38 (12-122) mg/L, P = 0.01] were higher in the complicated group than in the uncomplicated group. The length of hospital stay was longer in the complicated group, compared with the uncomplicated group [median 8 days (5-15), vs. 4 days (3-7), P < 0.001, respectively]. No significant difference was detected between the two study groups' mortality rates and intensive care unit admission rates.</p><p><strong>Conclusions: </strong>While 38.6% of the AP patients had APFC, 6.1% of all patients and 15.7% of the patients with APFC had pancreatic pseudocysts. APFC was found to lengthen the hospital stay and to be associated with the SII value and CRP level measured at 48 h.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/f4/SJG-29-225.PMC10445500.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065609","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":"Association between smoking and colorectal cancer in Eastern Mediterranean Regional Office (EMRO): A systematic review and meta-analysis.","authors":"Mohammad-Hossein Keivanlou, Ehsan Amini-Salehi, Soheil Hassanipour, Abinash Mahapatro, Nakka Raghuma, Farahnaz Joukar, Negin Letafatkar, Arman Habibi, Naeim Norouzi, Maryam Sadat Aleali, Mona Javid, Arian Mirdamadi, 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":1.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299237","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":"Complementary and alternative medicine use and its association with medication adherence in inflammatory bowel disease and other gastrointestinal diseases.","authors":"Abdul Hakim Almakadma,&nbsp;Abdelkarim De Vol,&nbsp;Mohamad S Alabdaljabar,&nbsp;Sarah Aldosari,&nbsp;Ibrahim Muhsen,&nbsp;Omar AlFreihi,&nbsp;Amr Kurdi,&nbsp;Majid Almadi,&nbsp;Fahad Alsohaibani","doi":"10.4103/sjg.sjg_468_22","DOIUrl":"10.4103/sjg.sjg_468_22","url":null,"abstract":"<p><strong>Background: </strong>The use of complementary and alternative medicines (CAMs) has been embedded in populations for decades. In this study, we aimed to determine the rate of their usage among inflammatory bowel disease (IBD) patients and their association with adherence to conventional therapies.</p><p><strong>Methods: </strong>In this cross sectional, survey-based study, IBD patients' (n=226) adherence and compliance were evaluated using the Morisky Medication Adherence Scale-8. A control sample of 227 patients with other gastrointestinal diseases was included to compare trends of CAM use.</p><p><strong>Results: </strong>Crohn's disease represented 66.4% of those with IBD, with a mean age of 35 ± 13.0 years (54% males). The control group had either chronic viral hepatitis B, gastroesophageal reflux disease, Celiac disease, or other non-IBD diseases, with a mean age of 43.5 ± 16.8 years (55% males). Overall, 49% of patients reported using CAMs (54% in IBD group and 43% in the non-IBD group, P =0.024). Across both groups, the most used CAMs were honey (28%) and Zamzam water (19%). There was no significant association between the severity of the illness and use of CAMs. Patients who used CAMs had a lower adherence to conventional therapies vs. those who did not use CAMs (39% vs. 23%, P =0.038). Using the Morisky Medication Adherence Scale-8, low adherence to medications was reported in 35% of the IBD group vs. 11% of non-IBD group (P = 0.01).</p><p><strong>Conclusion: </strong>In our population, patients with IBD are more likely to use CAMs and are less adherent to medications. Furthermore, the use of CAMs was associated with a lower adherence rate to conventional therapies. Consequently, further studies assessing the causes associated with the use of CAMs and nonadherence to conventional therapies should be explored and interventions designed to mitigate nonadherence.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/92/bb/SJG-29-233.PMC10445501.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10120043","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":"Clinicopathological and prognostic features of Borrmann type IV gastric cancer versus other Borrmann types: A unique role of signet ring cell carcinoma.","authors":"Chengcai Liang,&nbsp;Yao Liang,&nbsp;Biyi Ou,&nbsp;Lei Yuan,&nbsp;Shuqiang Yuan","doi":"10.4103/sjg.sjg_469_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_469_22","url":null,"abstract":"<p><strong>Background: </strong>Evidence specifically comparing the clinicopathology of Borrmann type IV (B-IV) gastric cancer with that of other Borrmann types is insufficient.</p><p><strong>Methods: </strong>A total of 3130 patients with advanced gastric cancer who underwent gastrectomy from January 2001 to September 2017 were enrolled in the analysis. Logistic regression and survival analysis methodology were used to investigate factors associated with peritoneal metastasis and overall survival (OS).</p><p><strong>Results: </strong>Of the total cohort, 264 (8.43%) patients were B-IV type, 1752 (55.97%) were small-size other Borrmann types, and 1114 (35.59%) were large-size other Borrmann types. Signet ring cell carcinoma (SRC) was more common in B-IV types than in other Borrmann types (33.71% vs 11.42% vs 12.66%, P < 0.001). In B-IV gastric cancers, SRC was significantly associated with peritoneal metastasis (HR = 1.898, 95% CI = 1.112 ~ 3.241, P = 0.019) and poorer OS (HR = 1.492, 95% CI = 1.088 ~ 2.045, P = 0.013) in multivariable analysis. Furthermore, stratified analysis revealed that SRC had worse survival than adenocarcinoma in the B-IV subgroups, with locally advanced stages (stages II ~ III) or negative surgical margins (all P < 0.05). In contrast, SRC failed to be significantly associated with peritoneal metastasis and poor OS in other Borrmann types (all P > 0.05).</p><p><strong>Conclusion: </strong>SRC was more common in B-IV gastric cancer than in other Borrmann types. It was significantly associated with peritoneal metastasis and poorer OS in the B-IV type but not in other Borrmann types. As a unique prognostic factor for B-IV gastric cancer, SRC might help evaluate risk stratification and optimize treatment for this entity, especially for patients with locally advanced stages or R0 resection.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10200586","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":"Peroral endoscopic myotomy (POEM) for achalasia in the Middle East: The type of myotomy matters.","authors":"Bahtiyar Muhammedoğlu","doi":"10.4103/sjg.sjg_167_23","DOIUrl":"https://doi.org/10.4103/sjg.sjg_167_23","url":null,"abstract":"Sir, Achalasia is a rare disease, that negatively affects human life with progressive dysphagia.[1] The Chicago Classification and the introduction of the peroral endoscopic myotomy (POEM) procedure (PP) into clinical practice revolutionized the treatment of achalasia.[2] The main goal of current therapeutic modalities is to reduce lower esophageal sphincter (LES) pressure.[3] Recently, Al Lehibi et al. examined 67 patients with achalasia where 95.5% achieved Eckardt scores of ≤3 at ≥3 months after the procedure.[3] It is important to determine myotomy according to the achalasia type, but as the authors stated, 10 cm in types I–II and 12 cm in type III may not be sufficient. It should be noted that in another study, good results were obtained when performing a myotomy with an average of 14.4 cm.[4] Similarly, long myotomy in the PP in patients with type III achalasia (16 vs 8 cm) is associated with better clinical outcomes.[5] The length of myotomy distal to the gastroesophageal junction (GEJ) is important in achalasia. Adequate gastric myotomy has been shown to prevent recurrent dysphagia in achalasia cases. Traditionally, the length of gastric myotomy varies from 2 to 3 cm.[6] İn the study by Al Lehibi et al, we believe that the myotomy was short, which is performed up to 2 cm distal to the GEJ. The authors did not specify what type of myotomy they performed in their study, but several randomized trials and systematic reviews have confirmed that the orientation of myotomy (anterior or posterior), has no substantial impact on the outcomes of POEM.[6] However, Al Lehibi et al. did not state whether selective circular myotomy or full‐thickness myotomy was performed in their study. In addition, the rate of pneumoperitoneum was relatively high (32.8%) during PP, which may be related to the general anesthesia‐related positive pressure ventilation utilized to prevent adverse events of CO2. Sometimes, it is necessary to pause the POEM for a while to prevent CO2 from leaking into the various tissue planes.[7] Generally, air leaks resolve spontaneously and a chest tube should be inserted when severe pneumothorax develops. In essence, POEM is a safe procedure for the treatment of achalasia. Myotomy length should be determined according to achalasia type and distal segment involvement. It may require redo POEM in the case of recurrent disease or esophagectomy in the case of the sigmoid esophagus.","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/17/SJG-29-199.PMC10358800.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9839173","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":"Urinary coproporphyrins as a diagnostic biomarker of Dubin-Johnson syndrome in neonates: A diagnostic pathway is proposed.","authors":"Abdulrahman Al-Hussaini,&nbsp;Ali Asery,&nbsp;Omar Alharbi","doi":"10.4103/sjg.sjg_480_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_480_22","url":null,"abstract":"<p><strong>Background: </strong>Dubin-Johnson syndrome (DJS) presents during the neonatal period with a phenotype that overlaps with a broad list of causes of neonatal cholestasis (NC), which makes the identification of DJS challenging for clinicians. We conducted a case-controlled study to investigate the utility of urinary coproporphyrins (UCP) I% as a potential diagnostic biomarker.</p><p><strong>Methods: </strong>We reviewed our database of 533 cases of NC and identified 28 neonates with disease-causing variants in ATP-binding cassette-subfamily C member 2 (ABCC2) gene \"Cases\" (Study period 2008-2019). Another 20 neonates with cholestasis due to non-DJS diagnoses were included as \"controls.\" Both groups underwent UCP analysis to measure CP isomer I percentage (%).</p><p><strong>Results: </strong>Serum alanine aminotransferase (ALT) levels were within the normal range in 26 patients (92%) and mildly elevated in 2 patients. ALT levels were significantly lower in neonates with DJS than in NC from other causes (P < 0.001). The use of normal serum ALT levels to predict DJS among neonates with cholestasis had a sensitivity of 93%, specificity 90%, positive predictive value (PPV) 34%, and negative predictive value (NPV) 99.5%. The median UCPI% was significantly higher in DJS patients [88%, interquartile range (IQR) 1-IQR3, 84.2%-92.7%] than in NC from other causes [67%, (IQR1-IQR3, 61%-71.5%; Confidence interval 0.18-0.28; P< 0.001)]. The use of UCPI% >80% to predict DJS had a sensitivity, specificity, PPV, and NPV of 100%.</p><p><strong>Conclusion: </strong>Based on the results from our study, we propose sequencing of the ABCC2 gene in neonates with normal ALT, presence of cholestasis and UCP1% >80%.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/72/SJG-29-183.PMC10358799.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206730","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}