The authors studied the relationship of endoscopic esophagitis and gastroesophageal flap valve (GEFV) in patients with symptomatic gastroesophageal reflux (GER). On endoscopy, the GEFV was graded as I to IV in 138 patients with acid regurgitation and heartburn relieved by antacids, and in 54 control subjects without symptoms suggestive of GER. Grade of GEFV was correlated with the grade of esophagitis, response to medical treatment, duration of symptoms, obesity, smoking, sex, and age of the patient. Abnormal GEFV (grades III and IV) was more frequent in patients with symptomatic GER, both with and without esophagitis, compared with control subjects (p = 0.000001. p = 0.03). Abnormal GEFV was significantly more common in patients with GER with esophagitis compared with those without (p < 0.00001). There was no significant difference in the distribution of normal and abnormal GEFV in patients with grade I esophagitis. However, grade 2 and grade 3 esophagitis were associated more commonly with an abnormal GEFV (p < 0.00001, p < 0.02 respectively). Hiatal hernia is always associated with an abnormal GEFV. Abnormal GEFV correlated significantly with age (more frequent when older than 40 years). Sex, duration of symptoms (>3 years), response to medical therapy, smoking, and obesity (body mass index > 30 kg/m2) did not correlate significantly with abnormal GEFV. We conclude that endoscopic esophagitis is usually associated with abnormal GEFV. It is more frequent in grades 2 and 3 but not grade 1 esophagitis. It is also encountered more commonly after the age of 40 years.

The role of endoscopic therapy after laparoscopic cholecystectomy (LC) was assessed in 62 patients referred for endoscopic retrograde cholangiopancreatography (ERCP). Patients were referred because of persistent biliary pain, jaundice, abnormal liver function tests, elevated serum amylase, abnormal ultrasound of the biliary system, or abnormal laparoscopic cholangiogram. Diagnostic imaging of the biliary system was abnormal in 47 of 62 (76%) cases. Sonographic abnormalities were seen in 33 of 57 (58%) patients: common bile duct (CBD) stones were present in 10 of 58 (17%); CBD >7 mm, in 22 of 58 (38%); and subhepatic fluid collection, in 10 of 58 (17%). Laparoscopic cholangiogram was done in nine cases, and CBD calculi were detected in eight. Magnetic resonance cholangiogram was abnormal in six of seven patients: CBD stones were seen in two cases; subhepatic fluid collection, in two; and clip-on CBD, in two. Endoscopic therapy was carried out in 46 of 62 (74%) patients: 40 of 47 (85%) had abnormal imaging (p = 0.0003); 29 of 33 (88%), abnormal sonography (p = 0.002); 10 of 10 (100%), CBD stones on sonography (p = 0.03); and 31 of 46 (67%), abnormal liver function tests before ERCP (p = 0.04). Twenty-five patients had a CBD stone extracted at ERCP. Bile leaks were treated successfully with papillotomy alone in 12 of 13 cases; a stent was necessary in 1 case. Endoscopic papillotomy was done in two patients with biliary pancreatitis, in one patient with recurrent idiopathic pancreatitis, and in five with suspected biliary dyskinesia. Surgery was necessary in four patients with a CBD transection. We conclude that most patients referred for ERCP after LC need endoscopic intervention. Abnormal imaging correlates best with the need for endoscopic therapy.

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Crohn's disease occurs more commonly in young Saudi females. Patients are symptomatic for almost a year prior to diagnosis. The presentation is variable and response to therapy is satisfactory. Surgery is necessary in a high number of patients.