Background/Aims:Solitary rectal ulcer syndrome (SRUS) is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted.Materials and Methods:All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin (SMA) was performed. The clinical files were reviewed for clinical features and endoscopic findings.Results:Thirteen cases were identified: 8 males and 5 females. The age range was 15–85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of the 13 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts' distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases.Conclusion:SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts' distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature.

Objective: To determine the prevalence and histological features of endoscopic nodular gastritis (NG) in adult dyspeptic patients and its relation to Helicobacter pylori infection. Subjects and Methods: A retrospective endoscopic report review of 2,142 patients identified 67 patients with NG during the period from 1 September 2006 to 31 August 2007. A subset of 32 NG patients (group 1) who had had gastric biopsies during upper gastrointestinal endoscopy and had been evaluated for H. pylori infection were compared to 32 age- and gender-matched dyspeptic patients. They had undergone endoscopy during the same period, which yielded normal results, and had available biopsies that were similarly evaluated for H. pylori infection (controls, group 2). Pertinent clinical data were obtained from the patients’ records. An experienced pathologist assessed the biopsies for the presence and grade of inflammation, activity, glandular atrophy, intestinal metaplasia, presence and density of H. pylori and presence of lymphoid follicles or aggregates. Results: NG was identified in 67 (3.1%) patients. On histological examination, group 1 had a significantly higher grade of gastritis (p < 0.001). The presence and density of H. pylori infection was significantly higher in group 1 (p < 0.001). The H. pylori density correlated significantly with the severity of gastritis (r = 0.57, p < 0.001). The endoscopic performance of NG on H. pylori infection had high specificity (96.8%) and positive predictive value (93.3%). Conclusion: This study outlined the clinicopathological features of NG identified among a cohort of dyspeptic patients in Kuwait and confirmed the close association with H. pylori infection. However, our study has a limitation in that histopathologic assessment of all NG patients was not feasible.

Background/Aim:Adenomatous colorectal polyps (ACPs) are known to be the precursor lesions for colorectal cancer. The aim of the study was to determine the prevalence, endoscopic and pathological features of ACPs in patients referred for colonoscopy.Patients and Methods:The endoscopic and histological reports of adult patients who underwent complete colonoscopy in the gastroenterology unit of a regional Kuwaiti hospital between January 2008 and December 2008 were retrospectively studied. The specimens of polyps were reviewed by an experienced pathologist who was blinded to the clinical or endoscopic information. Non-neoplastic polyps were not included in the analysis.Results:Of 530 eligible patients (mean age, 45 years; male-female ratio, 2:1), 54 (10%) had 103 ACPs. Of the patients with ACPs (mean age, 57 years), 43 (80%) were males and 36 (67%) were Kuwaitis. Histopathological examination of the most significant polyp in each patient revealed that 40 (74%) polyps were tubular adenomas (TAs); 11 (20%), tubulovillous (TV) adenomas; and 3 (6%), villous adenomas. High-grade dysplasia was noticed in 4 (10%) adenomas. Fifteen (2.8%) of the 530 patients had advanced ACPs. Logistic regression analysis of some variables and their association with ACPs found that age (P<0.001; OR, 1.9; CI, 1.5-2.3), history of adenoma (P=0.001; OR, 6.4; CI, .2.1-19.4) and being Kuwaitis (P=0.029; OR, 2.1; CI, 1.1-4.1) to be independently associated with ACPs.Conclusion:The most common histological type of ACPs was tubular adenoma. Advancing age, being Kuwaiti nationals and prior removal of ACPs were significantly associated with the occurrence of ACPs.

Few studies have been conducted in the Eastern Mediterranean region on chronic hepatitis C virus (HCV) infection with reference to genotypes. We investigated the response to standard combination therapy (pegylated interferon/ribavirin) of different genotypes of HCV in Kuwaiti patients and factors that could be associated with sustained virological response (SVR). The records of all Kuwaiti patients treated for chronic HCV between January 2003 and May 2009 were retrospectively identified and reviewed. Of 108 patients studied, 27.8% were infected with genotype 1, 25.0% with genotype 3 and 47.2% with genotype 4. Overall, 64.8% of patients achieved SVR, 25.9%, were non-responders and 9.3% were relapsers. Baseline viral load and alanine aminotransferase level in addition to early virological response to pegylated interferon-based therapy may serve as a decision tool for clinicians to identify patients who are unlikely to achieve SVR. Traitement par peginterféron alfa-2b et ribavirine chez des patients koweïtiens atteints d'infection chronique par le virus de l'hépatite CRÉSUMÉ Peu d'études ont été conduites dans la région de la Méditerranée orientale sur l'infection chronique par le virus de l'hépatite C rapportée aux différents génotypes. Nous avons étudié la réponse à une association médicamenteuse classique (interféron pégylé/ribavirine), de différents génotypes du virus de l'hépatite C chez des patients koweïtiens, et les facteurs qui pourraient être associés à une réponse virologique prolongée. Les dossiers de tous les patients koweïtiens traités pour une infection par le virus de l'hépatite C entre janvier 2003 et mai 2009 ont été recherchés et examinés. Parmi 108 patients étudiés sur dossier, 27,8 % d'entre eux étaient infectés par le génotype 1, 25,0 % par le génotype 3, et 47,2 % par le génotype 4. Globalement, 64,8 % des patients ont présenté une réponse virologique prolongée, 25,9 % étaient non-répondeurs et 9,3 % ont rechuté. La charge virale de référence et le taux d'alanine aminotransférase, associés à une réponse virologique précoce au traitement à base d'interféron pégylé sont des critères qui pourraient servir d'aide à la décision pour les cliniciens afin d'identifier les patients qui ne sont pas susceptibles de présenter une réponse virologique prolongée.