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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 d...
Citations
... The adoption of a Western diet, characterized by a high intake of refined grains, saturated fats, overrefined sugars, and animal protein, is believed to predispose individuals to gastrointestinal diseases. This predisposition is likely mediated by alterations in the gut microbiota [66]. ...
Background
Herbal medicine is commonly integrated with conventional medicine in Saudi Arabia, especially for the management of digestive disorders. However, the majority of Saudis use herbal remedies without prior consultation with a physician, which raises concerns about their appropriate and safe use. The aim of this study was to assess the level of awareness among the Saudi population regarding the proper utilization and potential adverse effects of frequently used herbs for the treatment of gastrointestinal (GI) diseases.
Methods
A cross-sectional survey was conducted in Saudi Arabia from January to March 2021. An electronic self-administered questionnaire was distributed.
Results
A total of 543 participants from different age groups, educational levels, and cities across Saudi Arabia completed the study questionnaire. The most commonly used herbs at home by the participants were: myrrh, parsley, black seed, chamomile, mint, anise, clove, and green tea. 57.7% of the participants perceived herbs as safer than conventional medicines; 27.3% reported that using herbal remedies over conventional medicine was a family tradition, and 21.4% used herbs because they were cheaper than conventional medicines.
Conclusion
Herbal remedies, including myrrh, parsley, blackseed, chamomile, mint, and anise, are commonly employed for the treatment of gastrointestinal disorders in Saudi Arabia. However, the knowledge level of participants regarding potential side effects and drug-herb interactions was found to be deficient. As such, there is a pressing need for educational campaigns and community awareness programs to elucidate the proper usage of herbal remedies and to caution against their potential adverse effects.
... Our data show that in 17.5% of patients with IBD that developed extraintestinal manifestations, arthropathy involvement was the most common, followed by skin manifestations and eye manifestations, similar data were reported in our country and North America [16,[27][28][29]. A significant difference was noted in the prevalence of arthritis and osteoporosis between patients with CD and those with UC across the age groups, as shown in Table 1. ...
... Thromboembolism occurred at a rate of 1.5% (n = 4) in IBD, while a rate of 0.8% (n = 1) was observed in patients with CD, and 2.3% (n = 4) in patients with UC. In our study, we observed a lower prevalence of thromboembolism than what was reported in the literature (Alberene, 2% for CD; Adam et al., 3.8% for IBD; and similar reported rates of venous thromboembolism were reported in North America 1.22%) [28][29][30]. ...
... In patients with CD, the non-stricturing and non-penetrating (B1) behavior was the most common (n = 70, 53.4%), and this is similar to the report by Aljebreen et al. However, our data is different from those of some Western countries in terms of the behavior of CD according to the course of the disease [27,28,31]. ...
Background:
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is becoming increasingly prevalent in Saudi Arabia. However, there is limited data on the characteristics and manifestations of IBD in this population. This study aimed to establish a multi-center database of patients with IBD in the Qassim region of Saudi Arabia to better understand the demographics, prevalence, and manifestations of IBD in this population.
Methods:
This retrospective study included patients diagnosed with IBD at three healthcare facilities in the Qassim region of Saudi Arabia. The patient's demographic and clinical characteristics, disease location and behavior, age at diagnosis, medication use, related surgeries, and extraintestinal manifestations were recorded based on the Montreal classification. A total of 257 patients with IBD were included in the study, of which 126 had UC and 131 had CD.
Results:
Of the 257 patients with IBD, 134 (52.2%) were male and 123 (47.8%) were female. The mean age of patients with CD and UC were 28.74 (range 15-67) and 38.79 (range 15-75) years, respectively. There was a significant difference between all age groups (p < 0.005), with more patients aged over 40 years being diagnosed with UC. UC was most commonly classified as left-sided UC (E2) (60; 47.6%), while the most common location of CD was the ileocolon (L3) (76; 58%). Non-stricturing and non-penetrating CD was the most common behavior (B1) (70; 53.8%). Approximately one-third of the patients with Crohn's disease developed perianal disease (70; 27.2%), with fistulizing Crohn's being the most prevalent manifestation (40; 30.5%), followed by abscess formation (10; 7.6%) and fissures (9; 6.8%). The most common extraintestinal manifestation was arthropathy (15; 5.8%). Significant p-values were detected for UC and CD (p = 0.036).
Conclusions:
This study provides crucial insights into the demographics, patterns, and manifestations of IBD in Saudi Arabia. The findings highlight the need for improved diagnosis, management, and treatment strategies for IBD in this population. The establishment of a multi-center database will help to facilitate future research and improve patient care in Saudi Arabia.
... [4] The clinical characteristics and morbidity in Saudi patients suffering from IBD were reported to be similar to patients with IBD in Western countries. [5] The mean age of onset of IBD is 25.5 ± 10.6 years. [5] However, a second smaller peak (~15% of cases) is reported at age more than 60 years, referred to as an elderly onset IBD. ...
... [5] The mean age of onset of IBD is 25.5 ± 10.6 years. [5] However, a second smaller peak (~15% of cases) is reported at age more than 60 years, referred to as an elderly onset IBD. [6] Very early onset IBD also occurs in children less than 6 years of age. ...
Optimal management of inflammatory bowel disease (IBD) relies on a clear understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This article provides concise guidelines for the management of IBD in adults, based on the most up-to-date information at the time of writing and will be regularly updated. These guidelines were developed by the Saudi Ministry of Health in collaboration with the Saudi Gastroenterology Association and the Saudi Society of Clinical Pharmacy. After an extensive literature review, 78 evidence-and expert opinion-based recommendations for diagnosing and treating ulcerative colitis and Crohn's disease in adults were proposed and further refined by a voting process. The consensus guidelines include the finally agreed on statements with their level of evidence covering different aspects of IBD diagnosis and treatment.
... The annual CD incidence in Saudi Arabia is estimated to be 0.94 per 100,000 persons per year over these 20 years [5]. However, the overall prevalence of IBD was found to be 26.25 per 100,000 persons [6,7]. ...
Background
Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) of unknown etiology. Ustekinumab (UST), an interleukin (IL)-12 and IL-23 antibody, has been approved in the recent years to treat IBD, both Crohn’s disease and ulcerative colitis. This study clarifies the long-term effectiveness of ustekinumab (UST) in antitumor necrosis factor (anti-TNF) refractory Crohn’s disease in Middle Eastern patients.
Methods
A retrospective review study, including 30 refractory or medication-intolerant patients with Crohn’s disease, was conducted at a tertiary care center in Riyadh, Saudi Arabia. The patients were started on ustekinumab and followed up for at least 52 weeks. Follow-up was performed on weeks 12, 24, and 52. Data related to demographic and laboratory parameters, the dosing schedule of ustekinumab administration, and the Harvey-Bradshaw index (HBI) were collected. Clinical remission and response rates were assessed. Statistical analysis was performed using SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). A statistical significance threshold of p < 0.05 was adopted.
Results
The mean age of the study subjects was 34.2 ± 17.9 years (95% confidence interval (CI): 27.5-40.9), with a mean disease duration of 10.6 ± 4.9 years (95% CI: 8.8-12.5). Of our cohort, 56.7% failed two biologics during their disease course, and about 20% failed three different biologics. The percentage of patients who used thiopurines was 76.7%, while 6.7% used methotrexate. Concurrent immunomodulators were used by 58.6% of the patients. Corticosteroids were given to 13.3% of the patients. Intravenous induction of UST at 6 mg/kg was used for 90% of the patients, while only 10% used a 260 mg subcutaneous dose. At week 12, 73.3% of the patients had a clinical response, and 66.7% achieved clinical remission. Corticosteroid-free remission, clinical response, and clinical remission showed a decreasing percentage trend between weeks 12 and 24 compared to week 52 where a spike was observed in all aforementioned parameters. The clinical response rate at week 52 was 76.7%. The p-values from cross-tabulation were significant for clinical response and remission when comparing week 12 to weeks 24 and 52.
Conclusion
Ustekinumab presents a safe and effective treatment option in moderate to severe Crohn’s disease patients with previous exposure to multiple biologics.
... However, a few studies have reported an annual incidence rate of CD that ranges between 1.46 and 1.66 per 100,000 people for CD, and of 2.33 per 100,000 people for UC [11,12]. The majority of CD patients in Saudi Arabia are young (17-40 years of age), with a significant proportion of them (e.g., 49%) having ileocolonic involvement and non-stricturing-non-penetrating disease behavior [13], while the majority of UC patients are male, young, and have extensive UC (43%) or left-sided colitis (35%) [14]. ...
Background:
The advent of monoclonal antibodies (mAbs) has revolutionized the management of many immune-mediated diseases such as inflammatory bowel disease (IBD). Infliximab and adalimumab were the first mAbs approved for the management of IBD, and are still commonly prescribed for the treatment of both Crohn's disease (CD) and ulcerative colitis (UC). Although mAbs have demonstrated high effectiveness rates in the management of IBD, some patients fail to respond adequately to mAbs, resulting in disease progression and the flare-up of symptoms.
Objective:
The objective was to explore the predictors of treatment failure among IBD patients on infliximab (INF) and adalimumab (ADA)-as demonstrated via colonoscopy with a simple endoscopic score (SES-CD) of ≥1 for CD and a Mayo score of ≥2 for UC-and compare the rates of treatment failure among patients on those two mAbs.
Methods:
This was a prospective cohort study among IBD patients aged 18 years and above who had not had any exposure to mAbs before. Those patients were followed after the initiation of biologic treatment with either INF or ADA until they were switched to another treatment due to failure of these mAbs in preventing the disease progression. Univariate and multiple logistic regressions were conducted to examine the predictors and rates of treatment failure.
Results:
A total of 146 IBD patients (118 patients on INF and 28 on ADA) met the inclusion criteria and were included in the analysis. The mean age of the patients was 31 years, and most of them were males (59%) with CD (75%). About 27% and 26% of the patients had penetrating and non-stricturing-non-penetrating CD behavior, respectively. Patients with UC had significantly higher odds of treatment failure compared to their counterparts with CD (OR = 2.58, 95% CI [1.06-6.26], p = 0.035). Those with left-sided disease had significantly higher odds of treatment failure (OR = 4.28, 95% CI [1.42-12.81], p = 0.0094). Patients on ADA had higher odds of treatment failure in comparison to those on INF (OR = 26.91, 95% CI [7.75-93.39], p = 0.0001).
Conclusion:
Infliximab was shown to be more effective in the management of IBD, with lower incidence rates of treatment failure in comparison to adalimumab.
... In Saudi Arabia, the IBD pattern has also been described in terms of prevalence, natural course of the disease, and therapeutic strategies, despite the limited number of publications [8][9][10][11][12][13][14][15][16][17][18][19][20]. In 1982, IBD was almost absent in Saudi Arabia [11]. ...
... This high incidence rate in Saudi Arabia can be explained by the increased lifestyle changes of the country toward lifestyles seen in Western countries [16,18,20] and many other factors, such as consanguinity [28]. ...
... In 2017, UC incidence rates ranged from 0.97 to 57.9 per 100,000 in Europe, 8.8 to 23.14 per 100,000 in North America, and 0.15 to 6.5 per 100,000 in Asia and the ME [5]. Nonetheless, recent trends have shown a significant rise in the incidence of IBD in ME countries, which were linked to "westernization" in lifestyle, including dietary habits in these countries [1,2,[5][6][7]. ...
... A total of 2 case series [1,10], 1 cross-sectional [11], 1 prospective study [12], and 12 retrospective studies [6,[13][14][15][16][17][18][19][20][21][22][23][24] were included in the present systematic review. Eight articles examined IBD in Saudi Arabia [6,10,14,[16][17][18][19][20], while the rest of the studied included patients from Egypt [1], Kuwait [11,13,24], the UAE [15], Bahrain [21], Lebanon [22], and Oman [12]. ...
... A total of 2 case series [1,10], 1 cross-sectional [11], 1 prospective study [12], and 12 retrospective studies [6,[13][14][15][16][17][18][19][20][21][22][23][24] were included in the present systematic review. Eight articles examined IBD in Saudi Arabia [6,10,14,[16][17][18][19][20], while the rest of the studied included patients from Egypt [1], Kuwait [11,13,24], the UAE [15], Bahrain [21], Lebanon [22], and Oman [12]. Generally, the included studies covered the period from the early 1990s to the late 2010s ( Incidence and Prevalence of IBD Six included studies reported the incidence and/or prevalence of IBD in the aforementioned countries. ...
Objectives:
Despite the recent findings of the rising incidence of inflammatory bowel disease (IBD) in Arab countries, there are limited data on the characteristics of IBD patients and the disease course in the Arab world. This systematic review aimed to investigate the incidence and epidemiology of IBD in the Arab world.
Material and methods:
We conducted a systematic literature review that utilized a comprehensive search of PubMed, Cochrane Central, SCOPUS, Google Scholar, and Web of Science from their inception till August 2020. We included cross-sectional, prospective, and retrospective studies that examined the prevalence and/or epidemiological characteristics of IBD in Arab countries.
Results:
A total of 16 studies that examined IBD in Saudi Arabia, Egypt, Kuwait, the United Arab Emirates, Bahrain, Lebanon, and Oman were included. Generally, the included studies covered the period from the early 1990s to the late 2010s. A total of 1,627 ulcerative colitis (UC) patients and 1,588 Crohn's disease (CD) patients were included in this systematic review. The mean age at diagnosis ranged from 24.13 to 43.6 years in adult cases and from 4.5 to 16 years in pediatric cases. In most of the included studies, the majority of patients were male. The quantitative analysis revealed a pooled incidence rate of 2.33 (95% confidence interval [CI] 1.2-3.4) per 100,000 persons per year for UC in the Arab world. Likewise, the pooled incidence rate for CD in the Arab world was 1.46 (95% CI 1.03-1.89) per 100,000 persons per year.
Conclusion:
There is a growing incidence of IBD in the Arab world, while IBD patients from Arab countries may present with some different characteristics, compared to their counterparts in Europe.
... However, there has been a lack of population-based studies on the long-term outcomes of CD in non-Caucasian populations. Previous investigations on the long-term clinical courses and outcomes of Asian patients with CD should be interpreted with caution because they were hospital-based studies, 8,10,[13][14][15][16] and recent populationbased studies from Asia were limited by their short followup periods. [17][18][19] Therefore, the aim of the present study was to investigate the long-term course of Korean patients diagnosed with CD between 1986 and 2015 using the SK-IBD cohort. ...
Background/aims:
The long-term course of Crohn's disease (CD) has never been evaluated in non-Caucasian population-based cohorts. The aim of the present study was to evaluate the longterm prognosis of Korean CD patients in the well-defined population-based Songpa-Kangdong inflammatory bowel disease cohort.
Methods:
Outcomes of disease and their predictors were evaluated for 418 patients diagnosed with CD between 1986 and 2015.
Results:
During a median of 123 months, systemic corticosteroids, thiopurines, and anti-tumor necrosis factor (TNF) agents were administered to 58.6%, 81.3%, and 37.1% of patients, respectively. Over time, the cumulative probability of starting corticosteroids significantly decreased (p=0.001), whereas that of starting thiopurines and anti-TNFs significantly increased (both p<0.001). The cumulative probability of behavioral progression was 54.5% at 20 years, and it significantly decreased during the anti-TNF era. Intestinal resection was required for 113 patients (27.0%). The cumulative probabilities of intestinal resection at 1, 5, 10, 20, and 25 years after CD diagnosis were 12.7%, 16.5%, 23.8%, 45.1%, and 51.2%, respectively. Multivariable Cox regression analysis identified stricturing behavior at diagnosis (adjusted hazard ratio [aHR], 2.70; 95% confidence interval [CI], 1.55 to 4.71), penetrating behavior at diagnosis (aHR, 11.15; 95% CI, 6.91 to 17.97), and diagnosis of CD during the anti-TNF era (aHR, 0.51; 95% CI, 0.35 to 0.76) as independently associated with intestinal resection. The standardized mortality ratio among CD patients was 1.36 (95% CI, 0.59 to 2.68).
Conclusions:
The long-term prognosis of Korean patients with CD is at least as good as that of Western CD patients, as indicated by the low intestinal resection rate. Moreover, behavioral progression and intestinal resection rates have decreased over the past 3 decades.
... Further description of the registry has been outlined in a previous publication. [4,[16][17][18][19][20] From the IBDIS registry, we identified all patients who had a radiologically confirmed diagnosis of abscess or phlegmon based on ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) of the abdomen. A phlegmon was defined as a spontaneously occurring inflammatory mass adjacent to an area of inflamed/matted bowel loops that lacks any evidence of a fluid collection [9] and an abscess as any extra-luminal fluid collection. ...
Background:
Intra-abdominal collections in the form of abscesses or matted bowel loops, called phlegmons, might occur in patients with Crohn's disease (CD). The clinical characteristics and management of such conditions are not well described. We aim to characterize CD-related intra-abdominal collections clinically, and identify predictors of need for surgical interventions and the time to surgery.
Methods:
We utilized the Saudi Inflammatory Bowel Disease Information System (IBDIS) database to identify all patients treated for radiologically proven intra-abdominal abscesses or phlegmons since inception. Demographics, clinical data, clinical course, and treatment outcomes were recorded. Logistic regression analysis and survival analysis were used to identify predictors of surgical resection and differences in time to surgery between patient subgroups, respectively.
Results:
A total of 734 patients with a diagnosis of CD were screened and 75 patients were identified. The mean age was 25.6 ± 9.9 years and 51% were males. Nearly 60% of patients had abscesses larger than 3 cm while 13% had smaller abscesses and 36% had phlegmons. On presentation, the most commonly reported symptom was abdominal pain (99%) followed by weight loss (27%). About 89% of patients were treated with antibiotics during hospitalization for an average of 2.7 weeks. Steroids were prescribed for 52% of patients and tumor necrosis factor alpha (TNF-alpha) antagonists for 17%. Surgical resection was required for 33 patients (44% of the cohort) while 51% were managed with antibiotics and/or percutaneous drainage. The most common surgical intervention was ileocecal resection (45%). Although patients who underwent follow-up imaging were more likely to require early surgical intervention (P = 0.04), no statistically significant predictor of surgery could be identified from this cohort. Time to surgery varied numerically according to abscess size (HR = 1.18, 95% CI = 0.62-2.27, P = 0.61).
Conclusions:
Although the majority of patients with CD-related intra-abdominal collections underwent surgical resection in this cohort, no obvious predictors of surgical intervention could be identified. The decision to perform early surgery appeared to be influenced by the findings observed on cross-sectional imaging during the follow-up of these collections.
... ширеність захворювань раніше вважалася низькою, наприклад, країни Середнього Сходу [5,6]. У США, за даними 2015 року, діагноз запального захворювання кишечника (виразкового коліту або хвороби Крона) був встановлений у 3 млн осіб (1,3% населення). ...
Іnflammatory bowel diseases are among various chronic processes, which, in the case of inadequate diagnosis and irrational treatment, eventually lead to highly unfavorable consequences. Thus, the timely establishment of the diagnosis, as well as the prescription of effective therapy and the subsequent careful follow-up of patients with inflammatory bowel diseases is the key to prolongation of the patients’ wellbeing and prevention of the occurrence of severe complications. Due to the possible increase in the prevalence of these pathologies in the future, close and effective cooperation between specialists and primary care physicians is extremely important nowadays. Unfortunately, there are currently no tools that can be used by primary care physicians to improve the routing of patients with inflammatory bowel disease. However, close and clear communication between primary and secondary healthcare specialists should become an integral part of health care systems, including that in our country.
