Issue No.: NL 9 /2013 Date: April 2013 Newsletter Editor: Dr. Nahla Azzam

In this issue: 1. SGA LATEST SCIENTIFIC PARTICIPATIONS:

A. THE 12TH SAUDI GASTROENTEROLOGY ASSOCIATION CONFERENCE

1. FIRST SGA EDUCATIONAL VIDEO CLIP

2. SGA STATEMENT ON COLORECTAL CANCER SCREENING

B. 12TH INTERNATIONAL ENDOSCOPY COURSE & WORKSHOP

C.SGA 5TH ENDOSCOPY GUIDE WORKSHOP

2. HOT TOPICS IN GASTROENTEROLOGY..

3. UPCOMING SCIENTIFIC EVENTS

6th ENDOSCOPY GUIDE WORKSHOP

IBD AWARENESS CAMPAIGN

UPDATE IN GASTROENTEROLOGY & HEPATOLOGY

SYMPOSIUM

4. GUT CLUB Schedule for 2013

SGA Monthly GUT Club Meeting in Riyadh.

SCHEDULE FOR THE ACADEMIC MEETINGS IN EASTERN

PROVINCE

For More Information, please contact SGA

Office at:

TEL/FAX: 01-4679130

EMAIL: sga@saudigastro.com

SGA Website: www.saudigastro.com

SGA journal: www.saudijgastro.com

Our Vision:

SGA aims to be a leading organization in the field of

gastroenterology with a significant positive impact on

patient care in the Middle East .

Our Mission:

To advance the science and practice of Gastroenterology

and Endoscopy in Saudi Arabia.

Current SGA Board of directors:

Dr. Abdulrahman AlJebreen, SGA President

Dr. Abdulllah Al-Ghamdi SGA Vice President

Dr. Ayman A. Abdo, SGA Treasure

Dr. Fahad AL Sohaibani SGA Board Secretary

Dr Faisal Sanai, SGA Board Member

Dr. Faisal Batwa, SGA Board Member

Dr. Mohamed AL Shumrany, SGA Board Member

Dr. Nahla Azzam, SGA Board Member

Dr. Hanan AL Ghamdi, SGA Board Member

1. SGA Latest Scientific Participations:

A. THE 12TH SAUDI GASTROENTEROLOGY ASSOCIATION CONFERENCE

For the first time, the SGA has held several other

activities around the main event. The first

postgraduate course for primary health physicians

was held on the 28th of January 2013. This was held

by the collaboration of the GI section and department

of community and family health care at KAMC. The

title of “GI Challenges in primary care” reflects the

content of this interactive course, which was highly

cited by our colleagues at primary care and family

Medicine.

Also, with collaboration with the nursing department

at KAMC, the first Saudi Nursing Endoscopy course

entitled “contemporary issues for endoscopy nursing

at Saudi Arabia” was held in parallel with the primary

care program.

This project has gained wide success with significantly

positive feedback from participants. Addressing

endoscopy and GI nursing needs was a empty space

and this meeting has started to fill the gap.

The Gala dinner was held on the 29th January 2013 at

Kanz Ubhor Resort at the shores of the red Sea. With

local spectacular show and Folklore dancing, the

pleasant weather and the beautiful friendly

atmosphere have added ambience and warmth to the

dinner. The Red sea diving trip and old Jeddah tour

was a unique experience for our special guests. The

meeting was a special time for colleagues and SGA

members to meet and exchange expertise and discuss

issues of concern to GI practice in Saudi Arabia.

The 12th Saudi Gastroenterology association held on

28-30 January 2013 meeting was a success. The

meeting hosted by the Gastroenterology section and

academic affairs at King Abdul-Aziz Medical city of

National Guard Health affairs at Jeddah was held in

Jeddah at the Hilton hotel, the most luxuries hotel

on the west coast of Saudi Arabia. With its large and

prestigious conference facilities, the meeting

attendee exceeded 1200 attendees and participant.

The meeting focused on luminal GI issues with major

emphasis on Inflammatory bowel disease, choosing

the title of the meeting “ Update on IBD and

challenges in Gastroenterology”. With Expert

international faculty from Europe and North

America, the program related issues in the diagnosis

and management of GI problems to current trends

of practice in Saudi Arabia and the Middle East

region. Bridges of connections were built for further

international collaboration. New generation of Saudi

Gastroenterologists took the driving wheel of the

conference presentations. Hand in hand with their

older peers, the program final success was geared

for their contribution.

Major GI and liver companies has participated

actively in the meeting with well-received exhibition

area.

The first SGA public activity in Arabic was another

success. More than 450 attendees have participated

actively in the meeting with open discussion with

national experts. With partnership with UTURN

Media Corporation, the SGA was able to receive

wide public acceptance with coverage in local and

national newspapers, Radio and TV stations. All

trendy social media channels were used to promote

SGA presence. In collaboration with Fun Media

Corporation, the activity started by an arabic

lectures followed by an open discussion with the

audience and the panelist.

We thank ALLAH for his blessing and we praise him.

The SGA would like to acknowledge and thank the

contribution of every single member and individual

who contributed to the success of this event. The

meeting was adjourned on 30th January 2013 with

the hope to meet again on 2014 at the east coast in

the beautiful city of Dammam.

Dr. Faisal Batwa

Chairman of organizing committee of

The 12th SGA meeting.

SGA is pleased to announce its public awareness initiative, in form of high definition simple to understand Arabic language, animated video clips. These clips will be posted regularly on our Facebook & Twitter pages, for general public to get to know more about Gastrointestinal diseases, and certain Gastrointestinal procedures.

The 1st video clip was launched during our regular SGA meeting. As of now, our viewer-ship is reaching up to approx eight thousand views.

Future brings more terse and catchy clips, bringing awareness for various Gastrointestinal diseases, diagnostic and therapeutic imaging procedures.

Please visit the link:

http://youtu.be/YMhR6qcMGjM

1. FIRST SGA EDUCATIONAL

VIDEO CLIP

B. 12TH INTERNATIONAL

ENDOSCOPY COURSE & WORKSHOP

Gastroenterology, Hepatology and Endoscopy

Department has already conducted 12 endoscopy

courses and Workshops successfully in the past.

The 12th

Endoscopy Workshop was held on the

13 & 14 March 2013 which was a great

successful.

We were delighted to see with us excellent

endoscopists from many countries such as USA,

Belgium, France, Japan, India, Egypt and

Lebanon.

During our Workshop the cases were carefully

selected and the experts were given enough time

to do the procedures and explain the cases. The

large audiences were very interactive. The

standards were high including audio video

projections. Our work shop would certainly

count as a very important education endeavor in

the Kingdom of Saudi Arabia.

Maj. Gen. Dr. Malfi AlOtaibi

Chairman of organizing committee of

12th international endoscopy workshop

2. SGA ADDRESSES GUIDANCE STATEMENT

ON COLORECTAL CANCER SCREENING

Colorectal cancer (CRC) ranks first in males and

third in females among all the cancers in Saudi

Arabia. CRC incidence and related mortalities

have been steadily increasing in the country over

the past twenty years. There is established

evidence that approximately 10% of colorectal

cancers are due to genetic causes, however, about

90% of the causes are associated with

environmental factors, particularly diet. In light

of this, a special session about colorectal cancer

in Saudi Arabia was held during the 12th Annual

SGA Meeting, which attracted special attention

from the audience during the conference. It

ignited a lot of debate, stimulating audience

interaction with our expert panel to address this

national health care concern. SGA stated the

importance of establishing awareness about CRC

and need for national screening programs in

KSA.

On the more, formation of two focus groups was

announced in this meeting. IBD and Endoscopy

Focus Groups will serve as a nucleus for further

National programs and guidelines.

C.SGA 5TH ENDOSCOPY GUIDE WORKSHOP

King Khalid University Hospital GI Unit has always pride itself in being updated with the latest trends in the field of Endoscopy. With the continued support and collaboration of physicians, nurses and staff, the Unit aims to be one of the finest in the field of Gastroenterology Procedures.

One of the newest technologies to emerge is the Scope Guide from Olympus. This device is designed to provide a real-time 3D image of the shape and configuration of the colonoscope inside the body. Scope Guide assists with finding the optimal location to apply abdominal pressure, easier, more confident scope insertion, and early loop identification. The use of Scope Guide during colonoscopies may lead to less patient discomfort.

KKUH Endoscopy Unit, in collaboration with the Saudi Gastroenterology Association (SGA), conducts training workshops five (5) times per year for physicians who are interested in learning how to use a Scope Guide for a more effective and successful approach in performing colonoscopy with no X-ray radiation exposure risk. With the assistance and leadership of capable and experienced physicians, trainees not only witness how to use a Scope Guide but also have the opportunity to participate through hands-on practical training in the KKUH Skills Simulation Laboratory, as well as, real patients .

The workshop was conducted February 4-5, 2013 and supervised by four (4) senior gastroenterologist namely Dr. Othman Al Harbi (KKUH) and Dr. Abdullah Al Mutawa (KFMC) who took charge of the training during the first day and Dr.Ahmed Al Malki and Dr. Nahla Azzam from (KKUH) who took the ranks on the second day. The five (6) chosen participants were from different fellowship training program hospitals in Riyadh.

The workshop started with lecture given by Dr. AlHarbi on the general roles and principles of safe colonoscopy, after which then all the candidates had hands on training on how to perform colonoscopy with help of scope guide. The trainees were also given vital information, instructions and guidelines regarding the principles of pre-colonoscopy preparation, the quality of colon prep, consent, different conscious sedation medications and the indications/contraindications for colonoscopy.

Future Scope Guide Training Workshops will be April 29-30, 2013. Interested participants (Registrars/Fellows) are required to fill out a Registration Form and forward it to webmaster@gi-ksu.med.sa. Only four (6) trainees are accepted per workshop for optimum learning experience. Upon completion of the practicum, each participant will be given a certificate for his/her involvement, and is eligible for 10 CME Hours (Saudi Council Approved).

The American College of Gastroenterology has

published new guidelines for diagnosing and

managing gastroesophageal reflux disease

(GERD). Overall, the guidelines include a

recommendation for establishing the diagnosis,

managements, and the rule of surgery in GERD,

the following highlights some of these

recommendations:

1) Weight loss, in addition to head of bed

elevation (for patients with nocturnal GERD

symptoms), is an effective lifestyle measure for

GERD.

2) Avoidance of foods thought to provoke

reflux is not routinely advised for most GERD

patients.

3) Routine screening and treatment for H.

pylori infection are not recommended because

there isn't enough evidence that testing and

treatment will affect GERD symptoms

4) Biopsies of the distal and mid-esophagus

should be obtained to rule out eosinophilic

esophagitis (EoE),particularly in patients with

GERD and dysphagia or patients with

refractory GERD.

5) Many concerns regarding the long-term

safety of PPIs. PPI therapy does appear to be a

risk factor for the development of Clostridium

difficile infection an increased risk of

osteoporosis, in patients with other risk factors

for hip fracture and does not appear to be an

increased risk of cardiovascular events in

patients using concomitant clopidogrel.

6) GERD can be considered to be a co-factor for

patients with extra-esophageal symptoms

including cough, laryngitis, and asthma. While a

PPI trial can be recommended in patients who

also have typical GERD symptoms, reflux

monitoring should be considered before a PPI

trial in patients without GERD symptoms.

Evaluation for non-GERD causes should occur in

all patients.

7) PPIs are highly effective for treatment of GERD,

they should be administered in the lowest

effective dose for patients requiring long-term

therapy. The efficacy of the currently available

PPIs appears to be equivalent. Maintenance PPI

therapy should be continued for patients with

GERD-associated complications.

8) Endoscopic therapy is not recommended as

therapy for GERD. Obese patients with GERD

should consider gastric bypass surgery as

treatment for heartburn symptoms.

9) In patients who are refractory to PPI therapy

despite optimization of timing and dose

escalation, should undergo upper endoscopy and

ambulatory pH monitoring and consider surgical

options.

2. HOT TOPICS IN GASTROENTEROLOGY

New Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease The American Journal of Gastroenterology 108(March 2013), 308-328

Associations of Recreational Physical Activity and Leisure Time Spent Sitting With Colorectal Cancer Survival

J Clin Oncol. 2013;31:876-885

This cohort study examined the associations of

prediagnosis and postdiagnosis recreational

physical activity and leisure time spent sitting

with mortality among patients with colorectal

cancer.

They include a 2,293 participants who were

diagnosed with invasive, nonmetastatic

colorectal cancer up to mid-2007. At baseline,

before their cancer diagnosis, and again after

their cancer diagnosis, participants completed

detailed questionnaires that included

information concerning recreational physical

activity and leisure time spent sitting.During a

maximum follow-up of 16.1 years after

colorectal cancer diagnosis, 846 patients with

colorectal cancer died, 379 of them from

colorectal cancer. Engaging in 8.75 or more

metabolic equivalent (MET) hours per week of

recreational physical activity (equivalent to

approximately 150 minutes per week of

walking) compared with fewer than 3.5 MET

hours per week.

The study showed that increased activity (≥

8.75 MET hours vs < 3.5 MET hours per week)

was associated with increased survival was

associated with lower all-cause mortality

(prediagnosis physical activity: relative risk

[RR], 0.72; 95% CI, 0.58 to 0.89; postdiagnosis

physical activity: RR, 0.58; 95% CI, 0.47 to

0.71). Spending 6 or more hours per day of

leisure time sitting compared with fewer than 3

hours per day was associated with higher all-

cause mortality (prediagnosis sitting time: RR,

1.36; 95% CI, 1.10 to 1.68; postdiagnosis

sitting time: RR, 1.27; 95% CI, 0.99 to 1.64).

The authors conclude that more recreational

physical activity before and after colorectal

cancer diagnosis was associated with lower

mortality, whereas longer leisure time spent

sitting was associated with higher risk of death

Viral hepatitis reactivation has been widely

reported in patients undergoing

immunosuppressive therapy; however, few data

are available about the risk of HBV and HCV

reactivation in patients with inflammatory

bowel disease, receiving immunosuppressive

drugs. This study assesses the prevalence of

HBV and HCV infection in a consecutive series

of patients with inflammatory bowel disease

and evaluate the effects of immunosuppressive

therapy during the course of the infection. It is

a retrospective observational multicenter study

included all consecutive patients with

inflammatory bowel disease who have attended

seven Italian tertiary referral hospitals in the

last decade. A total of 5096 patients were

consecutively included: 2485 Crohn's disease

and 2611 Ulcerative Colitis. 30.5% and 29.7%

of the patients were investigated for HBV and

HCV infection. A total of 30 HBsAg positive,

17 isolated anti-HBc and 60 anti-HCV-positive

patients were identified. In 20 patients with

HBV or HCV infection received

immunosuppressive therapy (six HBsAg+; four

isolated anti-HBc+ and 10 anti-HCV+). One of

six patients showed HBsAg+ and one of four

isolated anti-HBc+ experienced reactivation of

hepatitis. Two of six HBsAg patients received

prophylactic therapy with lamivudine. Only one

of 10 anti-HCV+ patients showed mild increase

in viral load and ALT elevation.

Effect of Immunosuppressive Therapy on Patients With Inflammatory Bowel Diseases and Hepatitis B or C Virus Infection

J Viral Hepat. 2013;20(3):200-208.

Effect of Immunosuppressive Therapy on Patients With J Viral Hepat. 2013;20(3):200-208.

Efficacy of tenofovir disoproxil fumarate at 240 weeks in patients with chronic hepatitis B with high baseline viral load (≥ 9 log10 copies/mL).

Hepatology. 2013 Jan 30

The authors conclude that screening procedures

for HBV and HCV infection at diagnosis have

been underused in patients with inflammatory

bowel disease,immunosuppressive therapy have

a role in HBV reactivation, but the impact on

clinical course seems to be less relevant than

previous reported.

The study evaluated the antiviral response of

patients with chronic hepatitis B who had

baseline high viral load (HVL), defined as

having hepatitis B virus (HBV) DNA = 9

log(10) copies/mL, following 240 weeks of

tenofovir disoproxil fumarate (TDF) treatment.

A total of 641 HBeAg-negative and HBeAg-

positive patients (129 with HVL) received 48

weeks of TDF 300 mg (HVL n=82) or adefovir

dipivoxil (ADV) 10 mg (HVL n=47), followed

by open-label TDF for an additional 192 weeks.

Patients with confirmed HBV DNA = 400

copies/mL on or after Week 72 had the option

of adding emtricitabine (FTC).

The study showed that by Week 240, 98.3% of

HVL and 99.2% of non-HVL patients on

treatment achieved HBV DNA <400

copies/mL. Both groups had similar rates of

histologic regression between baseline and

Week 240. Patients with HVL generally took

longer to achieve HBV DNA <400 copies/mL

than non-HVL patients, but by Week 96 the

percentages of patients with HBV DNA <400

copies/mL were similar in both groups. No

patient with baseline HVL had persistent

viremia at Week 240 or amino acid

substitutions associated with TDF resistance.

The study concludes that chronic hepatitis B

patients with HVL can achieve HBV DNA

negativity with long-term TDF treatment.

3. Upcoming Scientific Events:

6th

ENDOSCOPY GUIDE

WORKSHOP

Will hold be on the 29-30 April, 2013

/ 19-20 Jumada II, 1434 (Monday-

Tuesday).

Interested participants may email

webmaster@gi-ksu.med.sa for

application and request for

Registration Forms

IBD AWARENESS CAMPAIGN

(YES, I CAN…….)

This is a public activities in Arabic

which will be conducted throughout

the whole year .Our target is IBD

patients as well as the public to get to

know more about the disease.

DAY DATE LOCATION TIME

Monday 8/4/2013 King Khalid university hospital 8am-2pm.

Thursday 11/4/2013 Khozama Hotel 6pm-9pm.

Wednesday 19/6/2013 Riyadh Gallery Mall 6pm-9pm.

Wednesday- Thursday 25-26/9/2013 Sahara Mall from 6pm-9pm.

Wednesday- Thursday 13-14/11/2013 Gurnadah Mall 6pm-9pm.

Wednesday- Thursday 25-26/12/2013 Salam Mall 6pm-9pm.

IBD AWARENESS CAMPAIGN ACTVITIS

UPDATE IN GASTROENTEROLOGY & HEPATOLOGY SYMPOSIUM

HOSPITAL TIME DATE DAY

RKH 8:30 pm 12/01/1434

(26. 11.2012) Monday

KFSH&RC 8:30 pm 11/02/1434

(24.12.2012) Monday

KSMC 8:30 pm 02/03/1434

(14.01.2013) Monday

KFMC 8:30 pm 01/04/1434

(11.02.2013) Monday

KKHU 8:30 pm

06/05/1434

(18.03.2013)

Monday

SFH 8:30 pm

05/06/1434

(15.04.2013)

Monday

KFNGH

8:30 pm

03/07/1434

(13.05.2013)

Monday

RKH

8:30 pm

26/10/1434

(02.09.2013) Monday

KFSH&RC

8:30 pm

24/11/1434

(30.09.2013) Monday

KSMC

8:30 pm

23/12/1434

(28.10.2013) Monday

DATE NAME OF SPEAKER 26 September

2012 Dr. Raid Al-Sulaiman Consultant Gastroenterologist & Assistant Professor, Department of Internal Medicine, King Fahd Hospital of the University (KFHU), Al-Khobar

7 November 2012

Prof. Abdulaziz Al-Quorain Consultant Gastroenterologist & Professor, Dept. of Internal Medicine, KFHU

5th

December 2012

Dr. Hamouda Abdullatif Consultant Gastroenterologist Dammam Medical Complex, Dammam

26 December 2012

Dr. Mohd Al-Ghamdi Consultant Gastroenterologist, King Fahad Military Medical Complex (KFMMC), Dhahran

30 January 2013

Dr. Naeem M.F. Ali Consultant Transplant Hepatologist King Fahad Specialist Hospital (KFSH), Dammam

27 February 2013

Dr. Ahmed Ourfali Consultant Gastroenterologist, KFSH, Dammam

27 March 2013 Dr. Nawaf Zakary Consultant Gastroenterologist, KFMMC, Dhahran

24 April 2013 Dr. Mohd Yasawy Consultant Gastroenterologist & Associate Professor, Dept. of Internal Medicine, KFHU, Al-Khobar

29 May 2013 Dr. Sami Al-Momen Consultant Gastroenterologist King Fahad Specialist Hospital, Dammam

26 June 2013 Dr. Mona Ismail Consultant Hepatologist & Assistant Professor, Department of Internal Medicine, KFHU, Al-Khobar

SCHEDULE FOR THE ACADEMIC

MEETINGS IN EASTERN PROVINCE

VENUE: KFHU TIME: 8:00 – 10:00 PM

.

4. GUT CLUB Schedule for 2013

SGA MONTHLY GUT CLUB

MEETING IN RIYADH.

VENUE: KFHU TIME: 8:00 – 10:00 PM

Thank You,

Greetings from SGA

Team