Background: Inflammatory bowel disease (IBD) represents a growing health challenge in regions undergoing socioeconomic transition. This study characterized IBD epidemiology across Gulf Cooperation Council (GCC) countries, forecasted future burden, and identified country-specific determinants to inform targeted health policy interventions. Methods: IBD data from the Global Burden of Disease study (1990–2021) were analyzed for all six GCC countries using descriptive epidemiology, temporal trend analysis, three forecasting models (Age-Period-Cohort, Joinpoint regression, Bayesian age-standardized rate modeling), and regression analyses to identify socioeconomic, environmental, gender-specific, and healthcare system factors associated with IBD burden variation. Results: Age-standardized IBD prevalence rates varied across GCC countries (28.92–42.93 per 100,000), with Qatar and the United Arab Emirates (UAE) showing the highest rates and fastest increases (967% and 898% since 1990). Kuwait uniquely demonstrated stable or slightly declining trends. Significant female predominance emerged in most countries (male ratio 0.70–0.91) with strong birth cohort effects (1970s cohorts showing 18–48% higher risk than 1950s cohorts). IBD manifested primarily as disability rather than a mortality burden. Projections indicate continued increases through 2030, potentially reaching 55–59 per 100,000 in Qatar and the UAE. Fast food outlet density, processed food imports, antibiotic consumption, and female vitamin D deficiency were the most significant modifiable risk factors. Conclusions: The GCC region faces a growing IBD epidemiological profile characterized by rising burden, female predominance, and generational differences in risk observations. Identification of modifiable determinants provides actionable targets for intervention, while country-specific projections offer a foundation for healthcare planning to address this challenge.

Background/Objectives: Azathioprine (AZA) is widely used for maintaining remission in inflammatory bowel disease (IBD), but the implications of its withdrawal remain unclear. This study evaluates relapse rates after AZA discontinuation in adult IBD patients in remission and identifies predictors of relapse. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251016594). Databases were searched from inception to 4 January 2025, including RCTs and cohort studies involving adult IBD patients who discontinued AZA in clinical remission. The main outcome assessed was relapse incidence, with additional outcomes covering time until relapse, predictors of relapse, and management following relapse. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed. Results: Twenty-two studies comprising 3057 patients were included. The pooled relapse rate after AZA withdrawal was 32.5% (95% CI: 28.2–37.2%; I² = 94.2%). UC patients exhibited higher relapse rates (41.3%) than CD patients (24.7%, p = 0.003). Shorter AZA duration, elevated CRP, and absence of mucosal healing were associated with increased relapse risk. Meta-regression identified AZA duration as a significant predictor (β = −0.18, p = 0.009). Post-relapse management often involved AZA reintroduction or escalation to biologics, with low surgery rates. The GRADE assessment revealed that the certainty of evidence for the majority of primary outcomes was classified as low to very low. Conclusions: While this meta-analysis suggests that relapse after AZA withdrawal occurs frequently in IBD patients, the low to very low certainty of evidence limits definitive recommendations. The significant heterogeneity indicates that relapse risk varies across different patient populations and different settings.

Gastric cancer traditionally affects older adults, and its precursor lesions and risk factors are well-documented in this population. Helicobacter pylori (H. pylori) infection remains highly prevalent in Saudi Arabia and contributes to gastric pathology. However, early-onset gastric cancer (EOGC), diagnosed in individuals aged ≤ 45 years, presents unique challenges and remains poorly understood in young populations. Therefore, we conducted an observational cohort study using a prospective longitudinal design (2021–2024) involving 1823 Saudi nationals aged 18–45 years who underwent zoom high-definition chromoendoscopy to evaluate the prevalence of premalignant gastric lesions (PGLs) and EOGC. We found a high H. pylori prevalence (78.0%) with PGLs in 1.9% of participants and EOGC-adenocarcinoma in 0.7% of patients. All EOGC cases arose from dysplasia, with most PGLs being classified as OLGA/OLGIM stage II/III. Multiple risk factorswere significantly associated with PGLs and EOGC, including H. pylori infection (p = 0.022), increasing age (p < 0.001), a family history of gastric cancer (p < 0.001), poor dietary habits (p < 0.001), obesity (p < 0.001), and smoking (p < 0.001). Additional EOGC risk factors include dage of 36–45 years (p = 0.018), EBV infection (p = 0.016), and diabetes mellitus (p = 0.001). These findings demonstrate the notable presence of PGLs and EOGC in young Saudi adults and emphasize the importance of early detection and risk factor management in this vulnerable population.

Catheter-associated urinary tract infections (CAUTIs) cause serious complications among hospitalized patients due to biofilm-forming microorganisms which make treatment ineffective by forming antibiotic-resistant strains. As most CAUTI-causing bacterial pathogens have already developed multidrug resistance, there is an urgent need for alternative antibacterial agents to prevent biofilms on catheter surfaces. As a trial to find out such a potential agent of natural origin, the bark of Tamarix ericoides Rottl., a little-known plant from the Tamaricaceae family, was examined for its antibacterial and antibiofilm activities against one of the major, virulent, CAUTI-causing bacterial pathogens: Enterococcus faecalis. The methanolic T. ericoides bark extract was analyzed for its antibacterial activity using the well diffusion method and microdilution method. Killing kinetics were calculated using time–kill assay, and the ability of biofilm formation and its eradication upon treatment with the T. ericoides bark extract was studied by crystal violet assay. GC-MS analysis was performed to understand the phytochemical presence in the extract. A in vitro bladder model study was performed using extract-coated catheters against E. faecalis, and the effect was visualized using CLSM. The changes in the cell morphology of the bacterium after treatment with the T. ericoides bark extract were observed using SEM. The biocompatibility of the extract towards L₉₂₉ cells was studied by MTT assay. The anti-E. faecalis activity of the extract-coated catheter tube was quantified by viable cell count method, which exposed 20% of growth after five days of contact with E. faecalis. The anti-adhesive property of the T. ericoides bark extract was studied using CLSM. The extract showed potential antibacterial activity, and the lowest inhibitory concentration needed to inhibit the growth of E. faecalis was found to be 2 mg/mL. The GC-MS analysis of the methanolic fractions of the T. ericoides bark extract revealed the presence of major phytochemicals, such as diethyl phthalate, pentadecanoic acid, methyl 6,11-octadecadienoate, cyclopropaneoctanoic acid, 2-[(2-pentylcyclopropyl) methyl]-, methyl ester, erythro-7,8-bromochlorodisparlure, etc., that could be responsible for the antibacterial activity against E. faecalis. The killing kinetics of the extract against E. faecalis was calculated and the extract showed promising antibiofilm activity on polystyrene surfaces. The T. ericoides bark extract effectively reduced the E. faecalis mature biofilms by 75%, 82%, and 83% after treatment with 1X MIC (2 mg/mL), 2X MIC (4 mg/mL), and 3X MIC (6 mg/mL) concentrations, respectively, which was further confirmed by SEM analysis. The anti-adhesive property of the T. ericoides bark extract studied using CLSM revealed a reduction in the biofilm thickness, and the FDA and PI combination revealed the death of 80% of the cells on the extract-coated catheter tube. In addition, SEM analysis showed extensive damage to the E. faecalis cells after the T. ericoides bark extract treatment, and it was not cytotoxic. Hence, after further studies, T. ericoides bark extract with potential antibacterial, antibiofilm, and anti-adhesive activities can be developed as an alternative agent for treating CAUTIs.