Clinical epidemiology and phenotypic characteristics of Crohn′s disease in the central region of Saudi Arabia

Aljebreen, Abdulrahman; Alharbi, Othman; Azzam, Nahla; Almalki, Ahmed; Alswat, Khalid; Almadi, Majid A

doi:10.4103/1319-3767.132993

Cited by 28 publications

(19 citation statements)

References 49 publications

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“…Studies conducted in Saudi Arabia have found that the most common EIMs found in UC patients are osteopenia, followed by EN, and then arthritis, with a prevalence of 30.5%, 23.8%, and 17.5%, respectively [ 19 ]. However, only 5% of CD patients have dermatological manifestations, 15.5% have arthritis or arthralgia, and 2.3% have deep vein thrombosis (DVT) [ 20 ]. A study in Riyadh showed that 32% of pediatric IBD patients have EIMs, most of them have indeterminate colitis [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Extraintestinal Manifestations of Inflammatory Bowel Disease in Middle Eastern Patients

Adam¹,

Alqassas²,

Saadah³

et al. 2020

JEGH

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Background and Aims: The Inflammatory Bowel Diseases (IBDs), Crohn's Disease (CD) and Ulcerative Colitis (UC), are gastrointestinal autoimmune disorders with many Extraintestinal Manifestations (EIMs). Previously reported incidences of EIMs in IBD patients have ranged from 10% to 50%. The large variation in occurrence of EIMs has been linked to genetic predisposition. Correlations between individual EIMs are unclear. Therefore, we aim to estimate the incidence of EIMs in a Middle Eastern cohort of patients with IBD and examine possible relationships with EIMs. Patients and Methods: We conducted a retrospective study involving all patients included in the King Abdulaziz University IBD information system registry between 2013 and 2018. Data on demographics, disease characteristics, and EIMs were extracted and analyzed using descriptive statistics: the standard Student's t-test and chi-squared test. Logistic regression analysis was used to examine associations using STATA software version 11.2 (StataCorp, TX, USA). Results: We reviewed the electronic medical files of 284 patients with confirmed IBD, of which 158 (55.6%) were females, the mean age was 27.8 (±15) years; 146 (51.4%) patients had CD and 138 (48.6%) UC. The overall incidence risk of EIMs was 138 (52.3%) over a mean duration of follow up of 7.3 (±3.9) years. The most common EIM was arthritis (33%), followed by aphthous ulcers (16%). Pyoderma gangrenosum occurred in 8% of patients and appeared to be specific for CD patients (p = 0.002), whereas Primary Sclerosing Cholangitis (PSC) was more specific for UC (p = 0.001). Certain EIMs appeared to occur together such as arthritis with PSC (p = 0.001). Regression analysis identified disease type (in favor of UC; odds ratio = 0.50, p = 0.03) and age at the time of diagnosis (odds ratio = 1.04, p = 0.001) as the only significant predictors of EIMs. Conclusion: Our results demonstrate that more than half of IBD patients have at least one EIM. Contrary to what has often been reported, we found that EIMs occur more commonly in UC than CD. A multidisciplinary assessment is recommended as part of IBD management to improve overall health outcomes.

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Section: Introductionmentioning

confidence: 99%

Extraintestinal Manifestations of Inflammatory Bowel Disease in Middle Eastern Patients

Adam¹,

Alqassas²,

Saadah³

et al. 2020

JEGH

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“…In another study that explored the epidemiologic, clinical, and phenotypic charactersitics of UC patients in four tertiary care hospital in three cities in Saudi Arabia, no significant difference in the percentages of male and female patients affected by UC was noted and the majority of UC patients were young (e.g., 17–40 years of age) [14]. Likewise, the majority of CD patients were young (e.g., 17–40 years of age) according to a multi-center study that explored the characteristics of CD patients in Saudi Arabia, however, the majority of patients were male [15].…”

Section: Introductionmentioning

confidence: 99%

Drug utilization and cost associated with inflammatory bowel disease management in Saudi Arabia

AlRuthia

Alharbi

Aljebreen

et al. 2019

Cost Eff Resour Alloc

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BackgroundThere has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries. Treatment costs are an essential component for healthcare planning and priority setting. The utilization patterns and annual administration and cost of IBD medications are largely unknown in countries with an increasing incidence of disease, Saudi Arabia being an example.AimTo evaluate the use of non-biologic and biologic agents and their associated annual administration costs in a sample of patients with Crohn’s disease (CD) and ulcerative colitis (UC) in Saudi Arabia.MethodsSingle-center retrospective chart review was performed to determine the use of biologic and non-biologic medications among IBD patients in a tertiary care hospital in Riyadh, Saudi Arabia. Daily and the annual acquisition cost of different IBD therapeutic agents was calculated. The utilization rates and cost of each type of medication by CD and UC patients were compared.ResultsData of 258 CD patients and 249 UC patients were analyzed. Infliximab and adalimumab were the most commonly prescribed biologics among the study sample, however, their utilization rates were significantly higher among CD than UC patients (36.82% vs. 11.24%, and 20.54% vs. 9.64%, respectively, P < 0. 01). Azathioprine utilization rate was also higher among CD patients compared to their UC counterparts (71.71% vs. 40.16%, respectively, P < 0.01). However, the utilization rate of mesalazine in the UC patients was significantly higher than their CD counterparts (85.53% vs. 14.34% for CD, P < 0.01). The annual cost of biologics (including administration and lab test cost) ranged from 5572 USD for ustekinumab to 18,424 USD for vedolizumab. On the other hand, the annual cost of non-biologics ranged from 16 USD for prednisone to 527 USD for methotrexate.ConclusionBiologics are extensively used in the management of IBD, particularly CD, and their utilization costs are significantly higher than non-biologics. Future studies should examine the cost effectiveness of IBD medications especially in countries with increasing incidence such as Saudi Arabia.

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“…[3] As such, IBD is no longer considered a rare disorder in several parts of the world, including areas where the disease prevalence was previously considered to be low, such as in Middle Eastern countries. [45] A study conducted in Bahrain in 2017 by Abdulla et al . estimated the incidence and prevalence of CD and UC among patients attending a particular primary healthcare (PHC) center.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and attitudes of primary healthcare physicians toward the diagnosis and management of inflammatory bowel disease following an educational intervention: A comparative analysis

Alharbi

Almahmudi

Makhdoom

et al. 2019

Saudi J Gastroenterol

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Background/Aims:Inflammatory bowel disease (IBD) is a chronic inflammatory condition that requires early diagnosis and proper management. Patients with early symptoms of IBD are typically evaluated first by primary healthcare (PHC) physicians, who in turn refer patients with suspected IBD to specialists. Therefore, we aimed to assess the knowledge and attitude of PHC physicians toward IBD.Materials and Methods:We conducted a comparative cross-sectional survey of PHC physicians practicing at the Ministry of Health PHC centers in Jeddah, KSA. Demographics and data on the knowledge and practices of physicians were collected through a predefined and tested questionnaire that included three domains (Eaden, Leong, and Sign/Symptom Awareness). A subgroup of the cohort was educated about IBD referral criteria (group A, n = 65) prior to study initiation and their responses were compared with those from the remaining group (group B, n = 135). Regression analysis was used to test associations with the significance threshold set at 5%.Results:A total of 211 PHC physicians were surveyed with a response rate of 95%. Female physicians comprised 66.5% of the cohort and the mean age was 32.26 ± 6.6 years. About 91% of physicians were Saudi nationals, and 75.5% were MBBS degree holders. The majority of the respondents (93%) reported seeing zero to five patients with IBD per month, and almost half of the physicians preferred to always refer patients to specialists (49.5%). Most of the respondents were uncomfortable (3.27 ± 1.4 to 4.35 ± 1.2) with initiating or managing specific medical therapies (maintenance therapy, therapy for acute flare, corticosteroids, immunomodulators, and biologics) for patients with IBD. With regard to knowledge, group A had higher scores in all three domains especially in the Sign/Symptom Awareness domain (mean score 6.17 ± 1.1 vs. 3.5 ± 1.01, P < 0.001). According to multivariate analyses, both groups’ knowledge showed no significant relationship with any of the medical therapies, except for the Sign/Symptom Awareness domain which was shown to be significantly affecting the comfort of doctors in managing maintenance therapy among patients with IBD [odds ratio (OR) =1.61, P = 0.008]. Gender, nationality, and qualifications were found to have a significant influence on the comfort in initiating specific medical therapies. Group A was identified as a significant factor in predicting comfort with managing corticosteroids (OR = 8.25, P = 0.006) and immunomodulators (OR = 6.03, P = 0.02) on patients with IBD.Conclusion:The knowledge and comfort of PHC physicians with IBD medication prescription appears to be higher when education is provided. This observation is important, since PHC physicians are responsible for early identification and referral of patients suspected of having IBD, to specialists.

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Clinical epidemiology and phenotypic characteristics of Crohn′s disease in the central region of Saudi Arabia

Cited by 28 publications

References 49 publications

Extraintestinal Manifestations of Inflammatory Bowel Disease in Middle Eastern Patients

Extraintestinal Manifestations of Inflammatory Bowel Disease in Middle Eastern Patients

Drug utilization and cost associated with inflammatory bowel disease management in Saudi Arabia

Knowledge and attitudes of primary healthcare physicians toward the diagnosis and management of inflammatory bowel disease following an educational intervention: A comparative analysis

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