No abstract

The prevalence of antibody to hepatitis C virus (HCV) was determined in 139 patients with chronic liver disease (CLD) and 42 patients with hepatocellular carcinoma (HCC) during one year at the Riyadh Military Hospital, Saudi Arabia. The anti-HCV was detected in 36 of 96 (37.5%) HBsAg-negative patients with chronic liver disease and six of 43 (13.9%) HBsAg-positive patients with chronic liver disease. In addition, 11 (42.3%) HBsAg-negative hepatocellular carcinoma patients and two of 16 (12.5%) HBsAg-positive hepatocellular patients had antibody to HCV. The anti-HCV prevalence was 1.5% in 4818 healthy blood donors and 1% in 385 antenatal patients. The overall HCV seropositivity of 30.4% in 181 liver disease patients (CLD and HCC) in Saudi Arabia is lower than that reported from European countries.

At the Riyadh Armed Forces Hospital (RAFH), 352 patients had gastroscopy and from each, antral gastric biopsies were taken for identification of Helicobacter pylori, by urease test and histopathology. In 217 (61.64%) of these 352 patients, the histology specimens showed Helicobacter pylori in 73.68% of patients with duodenal ulcer, 70% of patients with gastric ulcers and gastric erosions, 61% of patients with duodenitis and 52% of patients with gastritis. Helicobacter pylori, previously known as Campylobacter, was first isolated in the human gastric mucosa by Warren and Marshall in 1983. 1 Helicobacter pylori has an etiological role in peptic ulcer disease and nonulcer dyspepsia.2-4 Helicobacter pylori secrete substances that mediate inflammation, cause tissue damage, and affect gastric secretory function.5 Helicobacter pylori infection is associated with alterations in surface mucous cells and with a marked inflammatory response consisting mainly of polymorphonuclear leukocyte infiltration. 6Helicobacter pylori colonization is now believed to be the major cause of type B gastritis.7 Helicobacter pylori is strongly associated with duodenal ulcer and the association varies between 80% to 100% from published reports. 8There are a few reports on Helicobacter pylori published from Saudi Arabia. [9][10][11][12][13] This study on the prevalence of Helicobacter pylori shows our experience at the Riyadh Armed Forces Hospital (RAFH), Riyadh. Patients and MethodsA total of 352 consecutive patients with dyspepsia (excluding patients with bleeding, tumors and those taking nonsteroidal anti-inflammatory drugs) had gastroscopy at the Gastroenterology Department, Riyadh Armed Forces Hospital, between January and June 1991G. The age of these patients range between 17 and 69 years (mean 48.2 years). The endoscopic diagnosis of gastritis or duodenitis was made if the mucosa was hyperemic, erythematous, congested or friable. A gastric or duodenal ulcer was diagnosed when an ulcer crater was noted.To determine the prevalence of Helicobacter pylori in these patients, three endoscopic biopsies (0.2 to 0.5 cm in size) were taken from the gastric antrum. One biopsy was placed immediately in the rapid urease test, 14Campylobacter-like organism (CLO or gel test) and examined at 10 minute intervals for the next six hours. If a definite pink color developed in the urease test, a positive result was recorded. The other two biopsies were placed in a buffered formalin saline and sent for histology, where paraffin sections were stained with hematoxylin and eosin for grading gastritis and with a May-Grünwald Giemsa method for showing bacteria according to the method of Whitehead et al 15 as modified by Marshall and Warren. 16 A positive Helicobacter pylori was recorded when a typical gram negative spiral bacteria was seen in the biopsy. In specimens where histology shows evidence of gastritis without Helicobacter, organisms are recorded as negative.

We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy (ECDT) at Riyadh Armed Forces Hospital (RAFH).The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy (ECDT). This approach provides an access to the common bile duct thus allowing appropriate therapeutic procedures on the biliary system to be performed. Endoscopic removal of common bile duct (CBD) stones is an established, effective, and safe procedure, particularly in the very sick and elderly [1][2][3]. However, cannulating the papilla is not always successful and even in experienced hands, there is a failure rate of 10% to 15% [4]. This is particularly the case when gallstones are impacted in the para-papillary region or there are occluding tumors rendering cannulation of the papillary orifice impossible.Endoscopic choledochoduodenostomy (ECDT) was introduced as an alternative procedure for these sort of cases [5,6] and the results have so far been encouraging. Its indications include both impacted papillary stones and palliative treatment for bile duct and ampullary cancer [7].Between 1984 and 1989, we treated seven patients; five with impacted papillary stones and two with ampullary carcinoma using ECDT at the Gastroenterology Unit in Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. This report describes the procedure in these seven patients and discusses its indications, morbidity, and outcome. Patients and MethodsA total of seven cases (five men and two women) age group 32 to 86 years (mean 59 years) with cholestatic jaundice were managed by the ECDT at the Gastroenterology Unit, Riyadh Armed Forces Hospital.Prior to treatment, all patients were admitted to the hospital, clinically examined, and the relevant blood tests and abdominal ultrasound examinations were performed. At endoscopy, routine premedication with midazolam and buscopan were given intravenously. A side-view duodenoscope (Videoscope JFX IT or IT10) was used.At endoscopy, the papilla was swollen (Figure 1a). After several unsuccessful attempts to cannulate the papilla with a conventional sphincterotome, this was removed and replaced by a needle knife (5 mm wire papillotome). A small incision was then carefully made on the roof of the papilla 1 to 1.5 cm proximal to the assumed site of the orifice and below the transverse duodenal fold (Figures lb and 1c). The flow of bile indicated the establishment of a communication between the common bile duct and duodenal lumen (Figure 1d). The conventional sphincterotome was then reintroduced and contrast was injected to visualize the biliary tree, and the cut further extended superiorly

Forty-two patients with hepatocellular carcinoma (HCC) were seen during two years at Riyadh Armed Forces Hospital (RAFH), Saudi Arabia. As viral hepatitis is common in this country, serological markers for hepatitis B virus (HBV) and the newly identified hepatitis C virus (HCV) were also studied in these patients. Fourteen (33.3%) patients were HBsAg positive, 11 (26.2%) were anti-HCV positive, two (4.8%) were positive for both HBsAg and anti-HCV and five (11.9%) were anti-HBc and anti-HBs positive. The remaining ten patients all were negative for markers. Serological markers were also studied in 1472 blood donors (control group) during the same period. Twenty-two (1.5%) were positive for anti-HCV, 59 (4%) for HBsAg and two (0.1%) for both markers. Our results are in accordance with previous studies carried out elsewhere, and it is suggested that hepatitis C virus like hepatitis B, may play an important etiological role in hepatocellular carcinoma in Saudi Arabia. However, the actual mechanism for oncogenic effect of anti-HCV has not been established.In view of the high incidence of HCC [9], the endemicity of HBV [10] and the recent report on HCV infection in Saudi Arabia [11], we carried out a retrospective study to evaluate the prevalence of HBV markers and anti-HCV in Saudi patients with HCC.