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.

Issue No.: NL13 /2014 April – July

Newsletter Editor: Dr. Nahla Azzam

Current SGA Board of directors:

Dr. Majid Al-Madi SGA President

Dr. Faisal Batwa SGA Vice President

Dr. Nahla Azzam SGA Treasurer

Dr. Fahad Al Sohaibani SGA Board Secretary

Dr. Mohamed Al Shumrany SGA Board Member

Dr. Abed Alehibi SGA Board Member

Dr. Hani Jawa SGA Board Member

Dr. Mutaz Hashim SGA Board Memebr

For More Information, please contact

SGA Office at:

Mobile: +966 564 412 595

EMAIL: sga@saudigastro.com

SGA Website: www.saudigastro.com

SGA journal: www.saudijgastro.com

Dear Colleagues, The last few years have seen a dramatic change in the activities as well as the impact that the SGA has achieved at multiple levels. On the scientific side, the last annual meeting in Jeddah was a great success and has gained the attention as well as admiration at both a national and international level especially from our guests from our neighboring gulf states. The SGA has also either facilitated or indorsed a number of activities all throughout the Kingdome. Furthermore, our flagship, the Saudi Journal of Gastroenterology (SJG) has been receiving numerous high quality manuscripts and we are expecting our first impact factor very soon. On a community level the SGA has made a great effort that reached out to the community and embraced their concerns as well as their needs, this issue of the newsletter exhibits this in a clear manner. All of this is by the Grace of Allah and then due to the hard work and exceptional dedication from our colleagues in the past SGA board. All our thanks and sincere appreciation goes out to the past President Dr. Abdulrahman Aljebreen, or Past Vice President Dr. Abdullah Alghamdi, as well as our past Board members Dr. Hanan Alghamdi, Dr. Ayman Abdo and Dr. Faisal Sanai. We would like also to thank both the editors as well as the associated editors of the SJG.

Our appreciation is mostly to our members of the society that made all these accomplishments happen and without their ideas, communication and their participation none of this would have happened. We have assembled a team for the upcoming SGA board cycle and we have thankfully retained experienced physicians form the prior board and I believe they are an invaluable asset to the SGA as well some enthusiastic new members. Our mission will be to sustain what our predecessors have achieved and expand on it. We aim to build long term partnerships with the industry for the greater benefit of our association as well as trying to outreach to neighboring societies in the gulf region and internationally. The aim of this would be to enrich our educational resources as well as make visible internationally what we have provided and the great potential and impact our members can make in their professional fields as well as to our communities. Our board members, as well as myself, believe that the upcoming few years will be exciting with new partnerships, the formation of interest groups in IBD as well as endoscopy and Celiac disease, the establishment of a steering scientific subcommittee for the SGA and much more. We urge all members to participate with us and share their achievements with us, it is only fair, as it is our passion and mission. Majid Almadi

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HOT TOPICS IN GASTROENTEROLOGY AND HEPATOLOGY

UPCOMING SCIENTIFIC EVENTS: i. The 13th Saudi Gastroenterology Association Annual

Meeting, Dammam. ii. The the 9th Pan Arab meeting, Tunis . iii. 1st International Conference Live Endoscopic Ultrasound in

Saudi Arabia.

GUT CLUB SCHEDULE FOR 1435: i. SGA Monthly GUT Club Meeting in Riyadh.

SGA LATEST SCIENTIFIC PARTICIPATIONS i. The Fourth Meeting Of Saudi Celiac Patients’ Support Group. ii. Second Celiac Disease Awareness Day at 141 girls school. iii. The Third IBD Clinical Observation Program ICOP. iv. Celiac disease awareness Campaign closing event at Sahara Mall.

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4. FORMING IBD & ENDOSCOPY INTREST GROUP

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NEW BOARD MEMBERS FOR SGA

SGA AWARDED FROM KING SAUD UNIVERSITY

The Saudi Gastroenterology Association Board of Directors members were elected electronically for three -years term. The election was held under the supervision of Administration Department of International Cooperation and Scientific Societies ,King Saud University on 22nd of May 2014 .Congratulation for the New SGA board members.

1. New Board Members for SGA

Riyadh KSA, 16-17 March 2014 - The Third meeting of Administration Department of International Cooperation and Scientific Societies was recently held in King Saud University. The event entitled “Social Responsibility of Scientific Societies” was lead by the Director of King Saud University, Dr. Badran Abdulrahman Othman Al-omar

During the event, the Saudi Gastroenterology Association was rated for the second time in the list of scientific Rector of Honor for its outstanding scientific associations (Rank A), for the year 1433/1434 H. This grading is among more than 50 societies affiliated to KSU which represents the top quarter of the associations affiliated to the University. Special thanks to the previous chairman of the SGA, Dr. Abdulrahman Aljebreen , all previous Board members and to everybody who participated, shared, or contributed to all the work and efforts related to SGA activities or programs. It should be noted that all these achievements were made possible only because of the high level of dedication and professionalism demonstrated by all SGA members.

2. SGA awarded from King Saud University .

The event was held on Thursday, 17 \ 6 \ 1435,

corresponding to 17 \ 4 \ 2014 in Al Hayat Mall

,Riyadh.

The event was attended by the following :

• Volunteers from health educators and

students from the Faculty of Medicine, King

Saud University.

• Dr. Nahla Azzam, consultant

gastroenterologist , member of the Saudi

Celiac Patients’ Support Group and

supervisor of the event in the Al Hayat Mall.

• Dr. Othman Alharbi, consultant

gastroenterologist , member of the Saudi

Celiac Patients’ Support Group and

supervisor of public relations team.

• Therapeutic dietician ,Arwa Ajaji, who is also

a group member.

• Therapeutic dietitian ,Saleh Al amri , who is

also a group member.

• The exhibition included the following :

• Educational power point presentations

about the disease.

• Nutritional corner , which provided free

food samples specific for celiac patients .

• Distribution of the first version of the

group’s Journal and brochures identifying

the disease and different recipes for gluten

free diet . Visitors have expressed their

gratitude to the members of the group.

• Dr. Badr Al-sleem ,consultant pediatric

gastroenterologist King Fahad Medical City ,

member of the Saudi Celiac Patients’

Support Group and supervisor of the group's

media team have showed his appreciation to

all his colleagues and the volunteers for their

remarkable efforts.

3.i. The Fourth Meeting Of Saudi Celiac Patients’ Support Group

He mentioned that our responsibility in every

meeting is to increase the awareness of the disease

among the population until they become fully

acquainted about the disease and we are dedicated

in supporting any celiac patient to bypass all the

difficulties. A major obstacle which faces any celiac

patient is getting gluten free products because of

their high price, and he stated that many efforts are

running by Saudi Celiac Patients’ Support Group and

SGA through the Ministry of Health to provide the

celiac patients with the gluten free products free

from any charges.

At Special thanks to Seera Company for their

support and providing gluten free samples.

The meeting was held in 141 Girls’ School on Wednesday 8th Rajab 1435 H, corresponding to 30th April 2014 from 8:00 am until 11:00 am in collaboration with a number of volunteer students from the Faculty of Medicine, King Saud University and under the supervision of Dr.. Fahad Al-Sohaibani,gastrointestinal consultant and a member of the Saudi Celiac Patients’ Support Group. Dr. Abeer Algemah and Dr. Falwa Al Harthy’s provided the school students and staff with a lecture about the disease prevalence, symptoms ,diagnosis and managements . School staff were extremely cooperative with the group. As a result, the event was well organized and very successful.

3.ii. Second Celiac Disease Awareness Day at 141 Girls School

The third sequel of the IBD Clinical Observation Program was held on the 07th – 08th of June 2014 at King Khalid University Hospital, Medical Education Center. The two-day event was successful, as expected, by the virtue of our honored Speakers and Organizers: * Dr. Othman Al Harbi and Dr. Nahla Azzam from King Khalid University Hospital. * Guest Speakers Dr. Ahmad Al Malki from King Saud Medical Complex and Dr. Samar Al Homoud from King Faisal Specialist Hospital and Research Center. Almost 20 Junior Gastroenterologists, Fellows, Registrars and Consultants from all over Saudi Arabia attended the two-day event which have included the following activities: 1. Lectures 2.Interactive discussions of the Speakers and attendees 3. Question and Answer Portion 4.Case discussion using voting system 5. Daycare Tour With the assistance of the feedback and suggestions of the previous attendees, we were able to make the Program more interactive and educational for the attendees that have participated in this event. The primary goal of the program was to provide the gastroenterologist fellows and juniors with a multidisciplinary broad base of knowledge in inflammatory bowel diseases

3.iii. The Third IBD Clinical Observation Program ICOP

Our aim in the next phase is to continue the next sequel of this Program and we are expecting more Gastroenterologists to come and join us.

After more or less than a year of continuous drive in raising the public awareness on celiac Disease, the event has come to it’s final ceremony .The closing of campaign events for the year 2014 was held at Sahara Mall on the 12th of June . It was organized by the Saudi Celiac Patients’ Support Group under the umbrella of the Saudi Gastroenterology Association. We would like to acknowledge the Event Organizers and Medical Students for the never-ending support and presence in the event which definitely made this Campaign a success! And so as to SABIC Company for their sponsorship. The exhibition was a success by all means with overwhelming positive feedback from the visitors who praised the efforts of The SGA and Saudi Celiac Patients’ Support Group.

3.iv. Celiac disease awareness Campaign closing event at Sahara Mall.

4.Forming IBD & Endoscopy interest group

The SGA is excited to announce about the formation of IBD and endoscopy interested groups .One of the strategic goals of SGA is to promotes the formation of subgroups of members who are experts in GI domains that would help in the advancement of practice and science related to their interests. We proposed to start with 2 groups (IBD and endoscopy interest groups) for the upcoming period. They will function independently aiming to create /support national data bases in IBD and endoscopy in Saudi Arabia, promote research , recommend clinical national practical guidelines, and exchange knowledge with international expertise . Authority of the groups will be defined by the objectives of SGA board ,and will be monitored and evaluated by the Board of SGA. The Terms of Reference of the interest group will be emailed to all SGA members.

5.Hot topics in Gastroenterology & hepatology

The Saudi FDA has posted a circulation on its website and the SGA endorsed its recommendations to restrict the use of domperidone-containing antiemetics because of concerns about adverse cardiac effects. The SGA stated that these medicines should only be used with caution under the care of a health care professional. A review of the evidence confirms a "small increased risk" for serious adverse cardiac events with domperidone use, including QTc prolongation, torsade de pointes, serious ventricular arrhythmia, and sudden cardiac death. The risk increased in patients older than 60 years. In addition, it should pay attention to drug-drug interactions in particular CYP3A4 inhibitors with domperidone. The position statement will be published in the September issue of the Saudi Journal of Gastroenterology.

Domperidone Position Statement by SGA due to its cardiac risks

The FDA approved Vedolizumab for Ulcerative Colitis and Crohn’s disease

The US Food and Drug Administration (FDA) approved vedolizumab (Entyvio, Takeda Pharmaceuticals USA, Inc) injection for treatment of adults with moderate to severe ulcerative colitis and adults with moderate to severe Crohn's disease. It is a humanized immunoglobulin G1 monoclonal antibody that is given intravenously. Vedolizumab binds exclusively to the α4β7 integrin,It lessens inflammation in the gastrointestinal tract by selectively inhibiting the entry of inflammation-stimulating lymphocytes into the gastrointestinal tract Vedolizumab is approved to treat those conditions when 1 or more standard therapies (corticosteroids, immunomodulators, or tumor necrosis factor [TNF] blocker medications) have been inadequate(1). Vedolizumab's safety and effectiveness for Crohn's disease were established in 3 clinical trials in approximately 1500 patients who had failed to respond adequately to corticosteroids, immunomodulators, or TNF blocker medications. More than fifty percentage of participants treated with vedolizumab achieved clinical response, clinical remission, and corticosteroid-free clinical remission compared with a placebo(2). 1. Sands BE, Feagan BG, Rutgeerts P, et al. Effects of vedolizumab

induction therapy for patients with Crohn's disease in whom tumor necrosis factor antagonist treatment had failed. Gastroenterology. 2014 May 21 2. Feagan BG, Rutgeerts P, Sands BE, et al; GEMINI 1 Study Group. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013;369:699-710

http://www.takeda.com/news/2014/20140521_6573.html

FODMAP diet improves the symptoms and quality of life of Irritable bowel disease patients

The study looked at the effect of low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD) on IBS symptoms and OoL .the authors report on changes in irritable bowel syndrome-severity scoring system (IBS-SSS) and irritable bowel syndrome-quality of life (IBS-QoL) in 19 IBS patients, aged 18 to 74 years (F/M: 14/5), During a control period of the first 6-weeks patients were asked to register their IBS-SSS and IBS-QoL on the web-application weekly without receiving any intervention. A low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD,) was introduced for the next 6 weeks while continuing the registration. A significant improvement in severity (IBS-SSS) was observed during both the control period, median: 278 (range: 122-377), P = 0.02, and subsequently during the LFD period, median: 151 (range: 29-334), P < 0.01. The IBS-QoL solely changed significantly during the LFD period, median: 67 (37-120), P < 0.01. The authors concluded that the results are promising however larger scale trials are needed.

World J Gastroenterol. 2014 Jun 7;20(21):6680-4.

Resolution in Obesity-Related Diseases After Laparoscopic Sleeve Gastrectomy

The study evaluated the changes in obesity-related diseases and micronutrients after laparoscopic sleeve gastrectomy (LSG).117 patients over a period from May 2007, to December 2011, evaluated for a two year follow-up. Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index (BMI), obesity-related diseases and micronutrients. Major complications included bleeding requiring transfusion at 5.1%, leak at 1.7% and abscess without a visible leak at 0.9%. Mean BMI was reduced from 46.6 (standard deviation (SD) 6.0) kg/m2 to 30.6 (SD 5.6) kg/m2 at two years, and resolution occurred for 80.7% of patients with type 2 diabetes, 63.9% with hypertension, 75.8% with hyperlipidemia, 93.0% with sleep apnea, 31.4% with musculoskeletal pain, 85.4% with snoring and 73.3% with urinary incontinence. Amenorrhea resolved in all premenopausal females. The proportion of patients with symptomatic gastroesophageal reflux disease increased from 12.8% to 27.4%. The prevalence of patients with low ferritin-levels increased, while 25-hydroxyvitamin D (25(OH)D) deficiency decreased postoperatively. The authors concluded that LSG is an effective procedure for morbid obesity and obesity-related diseases, however the technique should be further explored particularly to avoid gastroesophageal reflux. BMC Surg. 2014;14(8)

Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Adherence to the American Association for the Study of Liver Disease (AASLD) guidelines for the management of chronic hepatitis B (CHB) has not been systematically assessed. This current study comprehensively evaluate the adherence to five key areas of ASSLAD guidelines (i) timely alanine aminotransferase (ALT)/hepatitis B virus DNA level checks needed to monitor inactive carrier and immune-tolerant phases; (ii) liver biopsy to guide decisions on initiating treatment; (iii) treatment initiation when indicated; (iv) hepatocellular carcinoma (HCC) screening; (v) testing for hepatitis A virus (HAV) immunity, HIV, and hepatitis C virus (HCV) co-infections. The study evaluated physician and patient factors underlying nonadherence, and they looked at the predictors of nonadherence such as physician type, patient demographic factors, and phase of CHB infection. Nine hundred and sixty-two adult patients were retrospectively identified. Each patient chart was reviewed in detail. The authors found that Sixty percent did not undergo clinically indicated liver biopsies, largely owing to physician nonadherence. Eighty-nine percent of these missed biopsies were needed to further assess possible e-antigen-negative CHB. A high treatment initiation rate was found for the treatment eligible, but 121 patients had unclear treatment eligibility as they warranted, but did not undergo, liver biopsy.

Forty-five percent did not have timely HCC screening, although gastroenterology physicians had the highest odds of adherence, and 29% did not have timely CHB lab assessment; patients seen by gastroenterologists had twice the odds compared with primary care physicians of undergoing timely lab monitoring. Thirty-five, 24, and 54% were not tested for HAV, HCV, and HIV co-infections. The authors concluded a remarkably poor adherence to AASLD guidelines, particularly in the areas of liver biopsy, timely HCC and ALT monitoring, and testing for co-infection. These findings call for greater efforts to meet physician knowledge gaps, incorporation of decision support tools, and improved communication among providers.

Am J Gastroenterol. 2014;9(6):867-875.

Recommended topics to read Management of Celiac Disease: Beyond

the Gluten-Free Diet. Gastroenterology. 2014 Jun;146.

Hepatic Encephalopathy in Chronic Liver Disease : 2014 practical guideline by the European Association for the Study of the Liver and The American Association for The Study Of the Liver Disease.

Journal Of Hepatology ,July 7,2014. Microscopic Colitis or Functional Bowel

Disease With Diarrhea: A French Prospective Multicenter Study.

Am J Gastroenterol. 2014 Jul 8.

i. The 13th Saudi Gastroenterology Association Annual Meeting

6-UPCOMING SCIENTIFIC EVENTS

ii. 9th Pan Arab Congress of Gastroenterology

iii. 1st International Conference Live Endoscopic Ultrasound in Saudi Arabia

Riyadh GUT Club meeting Schedule for 1435 H

TUESDAY 07/11/1435 (02.09.2014)

سعود الملك مدينة الطبية

KSMC

TUESDAY 06/12/1435 (30.09.2014)

الطبية فهد الملك مدينةKFMC

TUESDAY 27/12/1435 (21.10.2014)

خالد الملك مستشفى الجامعيKKHU

Thank you,

Greetings from SGA

team