Background: The association between restless leg syndrome (RLS) and inflammatory bowel disease (IBD) has often been an under-investigated and clinically misdiagnosed entity. An emphasis should be made on the severity and associated factors, as the prevalence of both entities is on the rise globally. In this study we aimed to investigate the prevalence, severity and associated risk factors of RLS in patients with IBD. Methods: A multi-center, prospective cross-sectional study was conducted with age and gender matched controls in the ratio of 1:3. Cases of IBD were confirmed according to European Crohns and Colitis Organization guidelines. The study recruited 377 cases and 1131 age and gender-matched controls. RLS severity and prevalence was determined using a validated International Restless Legs Syndrome Study Group questionnaire. The anthropometric and blood biochemical measurements were retrieved from the patient's medical records. Associated factors were analyzed by regression analysis. Results: The prevalence of RLS in patients with IBD and non-IBD control groups was 21.5% and 9.7%, respectively ( P = 0.001). The severity index of RLS symptoms in all the three categories of mild, moderate and severe RLS was higher in the IBD group ( P = 0.001). Obesity (BMI >30 Kg/m 2 ) was more prevalent in patients with IBD with RLS than without RLS (21.9%: 10.3%, P = 0.009). Ages between 46 and 59 years (OR = 18.7 [2.6–29.4], P = 0.008), obesity (OR = 22 [2.6–29.4], P = 0.005), higher TSH levels (OR = 1.7 [1.0–3.0], P = 0.033), and lower hemoglobin levels ( P = 0.028) showed a greater risk associated with RLS. Conclusion: Prevalence and severity of RLS was higher in patients with IBD. The risk factors for RLS in IBD include increasing age, obesity, higher TSH, and lower hemoglobin.

Background The Ulcerative Colitis (UC) and Chron’s Disease (CD) are two debilitating Inflammatory Bowel Diseases (IBD) with an immense negative impact on patients’ health-related quality of life (HRQoL). Although several studies have examined the efficacy of different drugs in the management of IBD, none of these studies has assessed their impact on HRQoL among IBD patients in low incidence areas, such as Saudi Arabia. Therefore, the aim of this study was to examine the impact of Azathioprine, which is one of the commonly utilised immunosuppressive drugs, on HRQoL among a sample of IBD patients in Saudi Arabia. Methods This was a single-centre retrospective cohort study in which adult patients (≥18 years) with a confirmed diagnosis of UC or CD and no malignancies were identified in the hospital IBD registry. Patients’ HRQoL was assessed using the EuroQol five-dimensions- 3-level (EQ5D) at baseline as well as six months after initiation of therapy. The overall HRQoL was assessed using the Visual Analogue Scale (VAS) of the EQ5D. Multiple linear regression analysis was conducted to examine the impact of Azathioprine on patients’ EQ5D VAS scores at the six-month follow-up visit controlling for their baseline EQ5D VAS scores, duration of illness, sex, diagnosis (CD or UC), comorbidities, number of prescription medications, and the use of biologics (e.g., infliximab, adalimumab), 5-aminosalicylic acid (5-ASA), and steroids. Results Out of 220 IBD patients who were recruited, 160 patients met the inclusion criteria and were included in the study. About 56% of the patients had CD and 44% had UC. The mean age of the patients was 27 years and 54% of them were female. The majority of the patients (77%) did not have any comorbidities. Approximately 63% of the patients were on Azathioprine, and only 4% of them were on Azathioprine monotherapy. The majority of those on Azathioprine were on combination therapy with 5-ASA (78%), steroids (80%), and biologics (69%). Patients on Azathioprine were more likely to report higher overall HRQoL scores at the six-month follow-up visit compared with their counterparts on other therapies (β = 9.35; 95% CI: 0.486–18.22; p = 0.003). Conclusion The use of Azathioprine was associated with a positive impact on IBD patients’ HRQoL controlling for their baseline overall HRQoL scores as well as a myriad of covariates. Future studies should examine the cost-effectiveness of Azathioprine in comparison to other therapeutic agents in the management of IBD.

Background Patients with long-standing Ulcerative Colitis (UC) are at high risk of getting colorectal cancer (CRC). Therefore, surveillance colonoscopy is recommended to minimize that risk. Aim To examine the rate of dysplasia alongside the clinical, biochemical and endoscopic variables associated with dysplasia among patients with long-standing UC in a university-affiliated tertiary care center. Methods This was a retrospective medical chart review was conducted. UC patients with a disease history of ≥ 8 years or had primary sclerosing cholangitis (PSC) and underwent colonoscopy surveillance between 2010 and 2021 were included. Patients’ endoscopic and histopathological characteristics as well as their adherence to annual surveillance colonoscopy were assessed. Results Two-hundred and sixty patients were included with a mean age and duration of illness of 45 years and 15 years, respectively. Most of the patients were females (55%) and did not adhere to the annual surveillance (56%). About 59% of the patients were in remission, and 48% of them had pancolitis, 35% had left-sided UC, and 17% had proctitis. The percentage of treated patients with monoclonal antibody (mAb) among those who adhered to the annual surveillance colonoscopy was twice that among those who did not adhere to the annual surveillance colonoscopy (34% vs. 17%). The odds of detecting dysplasia among those who adhered to regular annual colonoscopy was 78% lower in comparison to their counterparts who did not adhere to the annual colonoscopy (OR= 0.153, 95% CI= 0.026 – 0.90, p-value=0.0379) controlling for the presence of PSC, disease duration, history of colectomy, and baseline albumin level. On the other hand, patients with longer disease duration had higher odds of dysplasia detection in comparison to their counterparts with shorter disease duration (OR= 1.136, 95% CI= 1.038 – 1.243, p-value=0.0055). 5). . Conclusion Adherence to the annual colonoscopy among high-risk UC patients was associated with lower rates of dysplasia detection. However, the rates of dysplasia detection among patients with poor adherence to the annual colonoscopy were lower that the ones reported in the literature. Future studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

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