الفهرس 
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Abstract
Dysentery is a clinical description of the triad of diarrhoea, tenesmus, and pathological stool which contains mucus, blood & pus. It arises as a result of pathological conditions affecting the colon. Dyserltery is referred to as acute or chronic when it lasts for less or more than two weeks respectively. Numerous infectious and non-infectious causes have been reported to elicit dysentery. Parasitic diseases (e.g. schistosomiasis, amoebiasis, balantidiasis, trichuriasis etc) are the main causes of infectious dysentery that might become chronic and develop complications. Bacterial (shigellosis, yersiniasis... etc) and viral infections usually induce acute infectious dysentery. Inflammatory bowel disease (ulcerative colitis and crohn’s disease), diverticulosis, cancer colon, ... etc are the main causes of non-infectious dysentery. Infectious dysentery is the predominanting type in the developing countries including Egypt. Schistosoma mansoni and Entamoeba histolytica are the main causative agents implicated in this concern. No age, sex, race, or class level is immune against dysentery. In addition several risk factors such as smoking, spicy food consumption, coffee drinking, and drug abuse have been reported to affect the course and outcome of dysentery. The present study was carried out in order to: 1- Detect the different causes of chronic dysentery among patients of the study. 2-Discuss the related factors associated with its occurrence among the studied group. 3- Find out the possible correlation of parasitic infections to various colonic lesions encountered in the study. One hundred patients with chronic dysentery attending AI-Moassat Hospital Endoscopic unit at Alexandria were recruited for the study. Also 100 idividuals with neither history nor medications for dysentery in the last 6 months were involved in the study as a control group. To achieve objectives of the study we proceeded in testing both patients and controls into a predesigned system of serial investigations. All studied participants were submitted to the followings: 1- Filling a predesigned questionnaire including demographic, socioeconomic, habitual and dietary data. 2- Thorough history taking about: a- Dysenteric complaints & associated manifestations. b- Associated diseases. c- Medications. l1li 3- Full clinical examination; general & systemic. a 4- Laboratory investigations including: a- Complete blood picture to detect anaemia, leucocytosis, easinophilia ... etc. b- Stool analysis: Two techniques were used to detect various parasitic infections. These are DWMT & FECT. 5- Colonoscopic examination using Olympus fiberoptic lower endoscope for: a- Scoping various colonic mucosal lesions. b- Colonic snipping: Three rectal and I or colonic snips were taken from the abnormal as well as the adjacent normal mucosa. They were examined microscopically for presence of protozoae (vegetative forms) as well as schistosoma eggs. Data collected were coded, tabulated, and analysed using different statistical methods including chi-square (X2) and odds ratio (OR) with 95 confidence interval (Cl). Analyses of data showed the following results: 1.lnfectious dysentery was more prevailing (73 ) than the non infectious one (22 ) while 5 of the studied dysentery remained undetermined. 2. Parasitic infections were responsible for all cases (1000/0) of the studied chronic infectious dysentery. Amoebiasis (370/0), followed by schistosomiasis (190/0) were the main parasites incriminated. 3. The principal aetiologic illnesses of the non-infectious dysentery were as follows: Cancer colon (7 ), ulcerative colitis (6 ), pseudomembranous colitis (60/0), and diverticulosis (3 ). 4. The highest percentage of the studied ~ysentery whether parasitic or non-infectious prevailed above the age of 30 years. . This is due to increase in the frequency of both chronic parasitic infections and causes of non-infectious dysentery by age. 5. Most our patients were males (82 ) than the non infectious one (22 ) while 5 of the studied dysentery remained undetermined. 2. Parasitic infections were responsible for all cases (1000/0) of the studied chronic infectious dysentery. Amoebiasis (370/0), followed by schistosomiasis (190/0) were the main parasites incriminated. 3. The principal aetiologic illnesses of the non-infectious dysentery were as follows: Cancer colon (7 ), ulcerative colitis (6 ), pseudomembranous colitis (60/0), and diverticulosis (3 ). 4. The highest percentage of the studied ~ysentery whether parasitic or non-infectious prevailed above the age of 30 years. . This is due to increase in the frequency of both chronic parasitic infections and causes of non-infectious dysentery by age. 5. Most our patients were males (82 ) of lower socioeconomic level (62 ) living in unsanitary urban areas (70 ) and practicising themselves domestic plumbing activities. This might explain the predominance of infectious dysentery among them. 6.Smoking, spicy foods, and coffee drinking have been found to affect the course as well as the clinical presentation of chronic dysentery particularly the parasitic type. On the other hand, neither antibiotics, corticosteroids, nor NSAIDs utilization proved to affect either form of the studied dysentery. 7. Clinically gradual onset was common feature in all types of chronic dysentery. Except for pallor, other clinical findings of dyspepsia, wasting... etc. were less common in chronic amoebic dysentery. Bleeding per rectum, bloody diarrhoea, pallor, abdominal pain, vitamin deficiency, and tender palpable colon were closely related to chronic schistosomal dysentery. Abdominal pain and passage of mucoid bloody or watery stools were prevalent in chronic dysentery caused by other parasitic infections. On the other hand pallor, wasting, and severe abdominal pain were almost pathognomonic of chronic noninfectious dysentery. 8. from the haematological point of view, microcytic hypochromic anaemia appeared closely related to chronic dysentery in the following order; schistosomiasis, other parasitic infections, amoebiaisis, and non-infectious dysentery. Meanwhile eosinophilia appeared confined to chronic schistosomal dysentery . 9. Stool examination using FECT proved to be better than DWMT in identifying faecal parasites in general, and Trichuris trichiura in particular. Offensive odour and presence of pus in the stool seemed to be peculiar to chronic amoebic dysentery while detection of RBCs looked a common finding in all forms of chronic dysentery. 10.Colonoscopy presented congestion, erosion, ulceration, localized haemorrhage, and polyposis as usual findings in chronic dysentery. Congestion of colonic mucosa was the commonest feature in all forms particularly the amoebic one. Colonic polyposis yielded a striking association with chronic. schistosomiasis. 11.Colonic snipping appeared to be the best technique in diagnosing chronic schistosomiasis. In the light of the present study, parasitic infections especially amoebiasis and schistosomiasis are the principal causes of chronic dysentery which commonly affect males of middle and older ages and lower standards of living. Smoking, consumption of spices and drinking of coffee are prominent risk factors having remarkable impact on the clinical course and outcome of dysentery. In addition, non-infectious dysentery has considerable frequency and. emerging as a prominent health problem. Detailed inquiry about dysentery, clinical examination, stool analysis using different techniques, haematological examination,colonoscopy and colonic snipping represent. collectively the key instrument for diagnostic approach to chronic dysentery.