INFLAMMATORY BOWEL-DISEASE IN SAUDI-ARABIA - NONOPERATIVE AND OPERATIVE MANAGEMENT AT KING-FAISAL-SPECIALIST-HOSPITAL

Background: Non-specific inflammatory bowel disease (IBD) is said to b e infrequently seen in the Arabs of the Arabian Peninsula. This study documents the non-operative and operative managment of 101 such Arabs treated for IBD between 1976 and 1994. Methods: Medical records were e xamined and patients were classified according to the OMGE diagnostic scoring system. Results: One hundred and one patients were treated dur ing the study period (mean follow-up 4.35 yr.). Sixty seven patients h ad mucosal ulcerative colitis (MUG), 28 Crohn's disease (CD) and 6 ind eterminate colitis (ND). The average age of patients with MUC was 29.6 yr., CD 32.5 yr. and IND 25.7 yr. Fifty three MUC patients were manag ed non-opertively and 13 underwent staged restorative proctocolectomy. Eight CD patients were actively treated for tuberculosis before a dia gnosis of CD was made and anti-tuberculous treatment was abandoned. Ei ght CD patients did not require surgery, 18 underwent resection of the diseased bowel and 2 underwent minor anal surgery. Two presently have recurrent disease. Post-operatively 7 developed enteric fistulae, one an anastomotic sinus and 21 perianal problems. Patients with CD tende d to be hospitalized more frequently than MUC patients. Two IND patien ts had staged restorative proctocolectomy. Both are well. Nine patient s underwent 7 or more colonoscopies. Serial biopsy revealed severe dys plasia in 4 patients. Re-biopsy failed to confirm the finding in one p atient. No cancer was found the remaining 3 patients who underwent res ection. Overall 26 patients were either lost to follow up or discharge d, 12 remained unchanged, 50 were improved, and 13 were symptom-free. Seven developed serious long-term side effects from their non operativ e management. Conclusion: The majority of patients with MUG, in contra st to patients with CD, were improved by non-operative management prot ocols and a great awareness of the presence of CD in the Peninsula cou ld result in fewer patients being treated inappropriately.