Inflammatory Bowel disease in Saudi Arabia: Presentation and initial management

Non-specific Inflammatory Bowel disease (IBD) is infrequently seen in the Arabs of the Arabian Peninsula. This paper documents the presentation and initial management of 101 such Arabs treated for inflammatory bowel disease between 1976 and 1994. Medical records were examined and patients were classified according to the Organisation Mondiale de Gastroenterologie diagnostic scoring system. Sixty-seven patients had mucosal ulcerative colitis, 28 Crohn's disease (CD) and six indeterminate colitis; age range 2–71 years. Three patients had a family history of (IBD). The diagnosis was made by a combination of the patients' history, physical, radiological, endoscopic and histological examination; however, eight patients were not examined endoscopically and one in four patients was not biopsied at presentation. Thirty-nine patients did not receive any treatment prior to referral. One in three patients was first treated as inpatients. Giardia, Amoeba, Salmonella, Shigella or Schistosoma were detected in the stools of 36 patients at presentation. Following appropriate treatment, these infections were eliminated but the patients' symptoms persisted. Six patients who were thought to have gastrointestinal tuberculosis were subsequently diagnosed with CD. Ten patients had extraintestinal manifestations of their IBD and 11 had side effects (osteoporosis, Cushingoid features and growth retardation) from steroid treatment at other hospitals. Diagnosis was often delayed because infectious diarrhoea was common and awareness was low. Patients were referred late and some had developed complications of therapy.