This syndrome is
most commonly seen in Yemenis. Sometimes it is
seen in patients coming from U.A.E. and rarely
from other Arab countries. So common is the
"combination" of the following
symptoms, that I have labelled it as a
"Syndrome" The complaints are :
- Severe
retrosternal burning and water brash or
vomiting.
- Epigastric
or high epigastric pain, often not
related to meals as in a case of typical
duodenal ulcer.
- Severe
constipation or obstipation and hard
stools requiring straining at the time of
defecation.
- Colonic
pains in different areas of the abdomen
- Abdominal
distension after meals and gases.
- Borborygmi.
- 'Piles'
or suspicion of having piles.
- Dryness
of mouth.
- Poor
appetite.
- Sexual
weakness.
- Low
backache, increased in the morning after
having marital relations the previous
night.
- Pain
over both the sacro-iliac joints at the
back
- Pain
over the scapular area at the upper back.
- Pain
in the knee joints.
- Pain
in both the loins.
- Burning
of urine off and on.
- Burning
of the arms and legs and often palms and
soles.
- Feeling
of cold over the arms and legs.
- Palpitations
after climbing steps or heavy exertion.
- Dyspnoea
on excessive exertion.
- Insomnia
or sleep disturbed by dreams.
- Pruritus
off and on.
- Excessive
weakness.
- Excessive
tiredness.
- Excessive
malaise.
- Increased
anger.
- Giddiness,
off and on with headache.
- Tension
and anxiety, especially of the job and
the imaginary illness.
- Ear,
nose and throat problems.
- Loss
of smell and taste.
 ALL THE ABOVE
SYMPTOMS ARE NARRATED BY THE PATIENTS, USING
THEIR HANDS AT THE SAME TIME AND ELICITING
ASSOCIATED "TENDERNESS". THEY MAKE
VIOLENT FACIAL GESTURES (see fig. alongside),
WHILE COMPLAINING OF PAIN.
Most of
them are smokers. Yemenis consume 'Qat' and many
of them have a past history of or are suspicious
of suffering from— either
- Bilharziasis—urinary
or colonic.
- Giardiasis
or
- Amoebiasis.
On
examination :
The patient is usually underweight, but there are
no signs of anaemia. Besides colonic, epigastric
and musculoskeletal tenderness, there are no
positive findings. The blood pressure, heart,
lungs and liver are usually normal.
Most of the
investigations including electrocardiogram,SMA
12/60, X-rays of G.l. tract, kidneys and
gali-bladder are normal.
 |
X-ray
chest often shows old, healed, calcified,
parenchymal lesions see fig. alongside).
Endoscopy of the upper G.l. tract may
show minimal congestion or erosions.
Minimal piles are often seen on
proctoscopy and/or sigmoidoscopy
examinations. |
Urine examination shows
presence of occasional pus cells. Stool
examination often shows presence of giardia or
Cysts of amoeba.
Finally, on
most of the occasions, the patient has consulted
a couple of specialists and has been investigated
and treated extensively without any relief.
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