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Alfa-interferon is the standard treatment of chronic hepatitis B. However, the response rate varies widely in patients from different parts of the world, reflecting differences in the natural history of the disease and the immune reactivity of the population studied. The aim of this study is to assess the efficacy of alfa-interferon in the treatment of Kuwaiti patients with chronic replicative hepatitis B infection. Twenty-two adult Kuwaiti patients with biopsy-proven chronic hepatitis B were treated with alfa-interferon after an observation period of six months. All patients had abnormal transaminase levels and were HBeAg and HBV-DNA positive. Alfainterferon-2b, 5 million units, was administered five days a week for 16 weeks. Patients were followed for at least 12 months after completing therapy. One of the 22 patients dropped out of the study after a single dose of interferon, because of side effects. Of the remaining 21 patients, three (14%) had a sustained loss of HBV-DNA and HBeAg. None of the patients lost HBsAg. There were no episodes of hepatic decompensation or deaths during the study. One patient developed hepatocellular carcinoma 28 months after completing treatment with interferon. Overall, Kuwaiti patients with chronic replicative hepatitis B responded poorly to interferon therapy. Ann Saudi Med 1997;17(3):279-282. The World Health Organization estimates that 300 million people are chronically infected by the hepatitis B virus (HBV). Many infected patients are at considerable risk of developing cirrhosis and hepatocellular carcinoma. The majority of infected individuals reside in Southeast Asia and Africa, where prevalence rates of 10%-20% have been

The authors report here the results of endoscopic cystogastrostomy performed on 3 children aged 11, 3, and 2.5 years with nonresolving pancreatic pseudocyst (PP) of 12, 9.5, and 7 cm in diameter. The etiology of PP was abdominal trauma in 2 and idiopathic acute pancreatitis in 1 case. Ultrasound and computed tomography scans confirmed the diagnosis and suitability for gastric drainage. After the puncture of cyst, a double pig-tail stent was placed for the permanent drainage of cystogastrostomy. Complete regression was confirmed by follow-up ultrasonography at 8, 6, and 7 weeks, respectively. There were no procedure-related complications, nor was there a recurrence of cyst during the 2 years of follow-up. This report suggests that children with nonresolving PP, that are anatomically accessible, can be treated successfully and safely by endoscopic drainage.

BACKGROUND: Colonoscopic procedure is an accepted modality for the evaluation of colonic disease. Open-access versus restricted-access colonoscopy has been argued over in the recent literature. The aim of this retrospective analysis is to identify the yield of the major indications for the procedure, and the pattern of colon pathology in our community. PATIENTS AND METHODS: We retrospectively analyzed our experience in 3000 colonoscopies over a five-year period. The patients comprised 1145 females (38%) and 1855 males (62%), and their ages ranged from 9 months to 95 years (mean 39.2). There were 2283 patients (76%) who were aged less than 55 years. Complete examination to the cecum was possible in 2850 cases (95%). RESULTS: Pathological findings were identified in 640 patients (21%). The diagnostic yield of patients referred for lower abdominal pain and surveillance was low, at 7% and 17%, respectively. The yield was high for those with lower gastrointestinal bleeding (47%), non-bloody diarrhea (35%), iron deficiency anemia (30%), mass lesions identified by radiology (53%), and polyps identified by radiology (70%). Inflammatory bowel disease was diagnosed in 220 patients, carcinoma in 64 patients, and colonic polyps in 139 patients. CONCLUSION: Colonic diseases are not uncommon in our part of the world. Colonoscopy is a rewarding procedure in those patients referred with lower gastrointestinal bleeding, mass lesions, polyps and diarrhea. The procedure is less rewarding in patients with lower abdominal pain and in those undergoing surveillance colonoscopy. Patient selection on the basis of the presenting complaint may help to utilize the limited resources available to gastroenterologists. About 63% of the procedures were done for indications found to have a low yield. Inflammatory bowel disease is seen with increasing frequency in our population.

Background: Chronic ulcerative colitis is a disease of unknown etiology. Its incidence is on the rise in various developing countries as has been reported in studies from South-East Asia and the Middle East. There seems to be significant differences in the pattern and the clinical course of this disease in our patient population. The aim of our study is to assess the incidence and the clinical course of the disease in Kuwait. Methods: This is a retrospective study of cases identified over a period of 14 years (1985–1999). Three hundred forty-six patients were identified to have chronic ulcerative colitis. Ninety patients were interviewed for this study. Results: Chronic ulcerative colitis is being identified with increasing frequency. Our local incidence was 2.8 per 100,000 persons per year. The disease was seen in both sexes with equal frequency. It peaks at the third decade of life, with no second peak observed in the sixth decade. The disease was of mild to moderate severity in 93% of the cases. The distribution of the disease in the colon showed pancolitis in 45%, left-sided colitis in 14%, proctosigmoiditis in 21% and proctitis in 20%. Arthritis and arthralgia were the most frequent extraintestinal manifestation seen in 31%. Perianal disease, although rare in ulcerative colitis, was seen in 8%. Of interest is the fact that over 14 years of follow-up, none of our patients developed high-grade dysplasia or colorectal cancer. Four patients required total colectomy mainly due to failure of medical therapy. Conclusions: Chronic ulcerative colitis is occurring with increasing frequency similar to that seen in Western countries. The disease observed in our patient population was of mild to moderate severity, with fewer complications than reported in Western countries. It peaks in the third decade with no second peak. None of our patients developed high-grade dysplasia or colorectal carcinoma.