MyMedR

Statements of the Malaysian Society of Gastroenterology & Hepatology and the National Heart Association of Malaysia task force 2012 working party on the use of antiplatelet therapy and proton pump inhibitors in the prevention of gastrointestinal bleeding

Tan HJ, Mahadeva S, Menon J, Ng WK, Zainal Abidin I, Chan FK, et al.

J Dig Dis, 2013 Jan;14(1):1-10.

PMID: 23134105 DOI: 10.1111/1751-2980.12000

The working party statements aim to provide evidence and guidelines to practising doctors on the use of antiplatelet therapy and proton pump inhibitors (PPIs) in patients with cardiovascular risk as well as those at risk of gastrointestinal (GI) bleeding. Balancing the GI and cardiovascular risk and benefits of antiplatelet therapy and PPIs may sometimes pose a significant challenge to doctors. Concomitant use of anti-secretory medications has been shown to reduce the risk of GI bleeding but concerns have been raised on the potential interaction of PPIs and clopidogrel. Many new data have emerged on this topic but some can be confusing and at times controversial. These statements examined the supporting evidence in four main areas: rationale for antiplatelet therapy, risk factors of GI bleeding, PPI-clopidogrel interactions and timing for recommencing antiplatelet therapy after GI bleeding, and made appropriate recommendations.

Extragastrointestinal manifestations of Helicobacter pylori infection: facts or myth? A critical review

Tan HJ, Goh KL

J Dig Dis, 2012 Jul;13(7):342-9.

PMID: 22713083 DOI: 10.1111/j.1751-2980.2012.00599.x

Helicobacter pylori (H. pylori) infection is reported to be associated with many extragastrointestinal manifestations, such as hematological diseases [idiopathic thrombocytopenic purpura (ITP) and unexplained iron deficiency anemia (IDA)], cardiovascular diseases (ischemic heart diseases), neurological disorders (stroke, Parkinson's disease, Alzheimer's disease), obesity and skin disorders. Among these, the best evidence so far is in ITP and unexplained IDA, with high-quality studies showing the improvement of IDA and ITP after H. pylori eradication. The evidence of its association with coronary artery disease is weak and many of the results may be erroneous. The role of H. pylori infection in affecting serum leptin and ghrelin levels has attracted a lot of attention recently and available data to date have been conflicting. There have also been many uncontrolled, small sample studies suggesting an association between H. pylori infection and neurological disorders or chronic urticaria. However, more studies are required to clarify such proposed causal links.

Controversy of proton pump inhibitor and clopidogrel interaction: a review

Tan HJ

J Dig Dis, 2010 Dec;11(6):334-42.

PMID: 21091895 DOI: 10.1111/j.1751-2980.2010.00466.x

A proton pump inhibitor (PPI) is often co-prescribed with clopidogrel to reduce the gastrointestinal risk of bleeding ulcers in patients following acute coronary syndrome or a stent implant. However, the safety issue of such practice has been scrutinized after some studies reporting an increased incidence of cardiovascular events and mortality, although there have also been contrary research reports. This has lead to a warning statement from the US Food and Drug Administration cautioning the concomitant use of PPI and clopidogrel. This review examines the evidence of PPI as gastroprotective agent, histamine H(2) antagonists as an alternative therapy, the influence of PPI on the antiplatelet effect of clopidogrel, and the controversies of various studies.

Changing epidemiology of Helicobacter pylori in Asia

Tan HJ, Goh KL

J Dig Dis, 2008 Nov;9(4):186-9.

PMID: 18959588 DOI: 10.1111/j.1751-2980.2008.00344.x

As in developed societies, the prevalence of Helicobacter pylori has declined rapidly in Asia. This has been shown in both seroprevalence-based and endoscopy-based studies. While the decline in the incidence of gastric cancer has now been observed, a decrease in peptic ulcer disease has not been so clearly evident. This apparent paradox can be explained by an increase in non-H. pylori associated ulcers - such as those related to non-steroidal anti-inflammatory drugs or idiopathic ulcers. The increase of gastroesophageal reflux disease in Asia has been widely observed and commented on and its relationship to the decline in H. pylori speculated upon. However there have been few conclusive studies from Asia on this subject. While the improved diagnosis and elimination of H. pylori has contributed to its decline, a more basic change involving large segments of the Asian population must be responsible. An improvement in hygiene and living conditions that results from more affluent Asian societies is thought to be a possible cause.

Efficacy of 1-week proton pump inhibitor triple therapy as first-line Helicobacter pylori eradication regime in Asian patients: is it still effective 10 years on?

Qua CS, Manikam J, Goh KL

J Dig Dis, 2010 Aug;11(4):244-8.

PMID: 20649738 DOI: 10.1111/j.1751-2980.2010.00445.x

OBJECTIVE:
To re-examine the efficacy and tolerability of 1-week proton pump inhibitor triple therapy as a first-line Helicobacter pylori (H. pylori) eradication therapy.

METHODS:
Consecutive participants with a positive rapid urease test during an outpatient upper endoscopy were included. All participants were given pantoprazole 40 mg b.i.d., amoxycillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. for 1 week. They were asked to return after 1 week to report any side effects related to the medications and to check for compliance. Successful eradication was defined by negative (13)C-urea breath test at least 4 weeks after the completion of therapy.

RESULTS:
A total of 191 patients were recruited into the study, of whom 81 were male (42.4%) and 110 female (57.6%), with a mean age of 55.6 (range 21-88) years. Overall 26 patients (13.6%) defaulted follow up and five patients were not compliant (taking less than 85%) with the medications. Per-protocol and intention-to-treat eradication rates were 84.4% (95% CI: 78.6-89.9%) and 71.2% (95% CI: 64.5-77.6%), respectively. Overall 68 participants (42.5%) reported no side effects, followed by 58 (36.3%) with a taste disturbance, 16 (10.0%) with epigastric pain, 15 (9.4%) with diarrhea, 13 (8.1%) with nausea or vomiting, 12 (7.5%) with loss of appetite, nine (5.6%) with dizziness and two (1.3%) with an allergic skin rash, none of which was severe.

CONCLUSION:
The current regime using pantoprazole, amoxycillin and clarithromycin is highly tolerable and effective and should continue to be recommended as a first-line therapy for H. pylori eradication in our setting.

Towards understanding the low prevalence of Helicobacter pylori in Malays: genetic variants among Helicobacter pylori-negative ethnic Malays in the north-eastern region of Peninsular Malaysia and Han Chinese and South Indians

Maran S, Lee YY, Xu SH, Raj MS, Abdul Majid N, Choo KE, et al.

J Dig Dis, 2013 Apr;14(4):196-202.

PMID: 23241512 DOI: 10.1111/1751-2980.12023

To identify gene polymorphisms that differ between Malays, Han Chinese and South Indians, and to identify candidate genes for the investigation of their role in protecting Malays from Helicobacter pylori (H. pylori) infection.

Non-alcoholic fatty liver disease in Malaysia: a demographic, anthropometric, metabolic and histological study

Malik A, Cheah PL, Hilmi IN, Chan SP, Goh KL

J Dig Dis, 2007 Feb;8(1):58-64.

PMID: 17261137

Nonalcoholic fatty liver disease (NAFLD) is increasing rapidly in the Asia-Pacific region. There has been a paucity of studies from the region. The aims of this study were to define the demographic, anthropometric, metabolic and histological characteristics of patients with NAFLD in our local population and to determine independent predictors of severe liver fibrosis.

Performance of transient elastography (TE) and factors associated with discordance in non-alcoholic fatty liver disease

Mahadeva S, Mahfudz AS, Vijayanathan A, Goh KL, Kulenthran A, Cheah PL

J Dig Dis, 2013 Nov;14(11):604-10.

PMID: 23859493 DOI: 10.1111/1751-2980.12088

To determine the accuracy of transient elastography (TE) and factors associated with discordance between TE and liver histology in patients with non-alcoholic fatty liver disease (NAFLD).

Colonoscopy in elderly Asians: a prospective evaluation in routine clinical practice

Ma WT, Mahadeva S, Kunanayagam S, Poi PJ, Goh KL

J Dig Dis, 2007 May;8(2):77-81.

PMID: 17532819

Colonoscopy is believed to be more complicated in elderly patients in Western countries. It is uncertain if the situation holds true among Asians. This study is to determine differences in colonoscopy performance and sedation complications between patients aged<65 years and those>or=65 years of age in an Asian population.

Endoscopic sleeve gastroplasty: Case report, technique and literature review

Loo H, Chan WK, Galvao Neto M

J Dig Dis, 2017 Oct;18(10):598-603.

PMID: 28960864 DOI: 10.1111/1751-2980.12548

Mandarin version of the Leeds Dyspepsia Questionnaire: A valid instrument for assessing symptoms in Asians

Leow HR, Ching SM, Sujarita R, Yap CF, Chia YC, Ho SH, et al.

J Dig Dis, 2014 Nov;15(11):591-6.

PMID: 25139629 DOI: 10.1111/1751-2980.12183

OBJECTIVE:
To develop and validate a Mandarin version of the Leeds Dyspepsia Questionnaire (M-LDQ) in Asian patients with dyspepsia.

METHODS:
The M-LDQ was developed according to standardized methods. The validity, internal consistency, test-retest reliability and responsiveness of the instrument were evaluated in both primary and secondary care patients.

RESULTS:
A total of 184 patients (mean age 54.0 ± 15.8 years, of whom 59% were women and 72.3% of whom had at least secondary level education) were recruited between August 2012 and March 2013, from both primary (n = 100) and secondary care clinics (n = 84). Both the internal consistency of all components of the M-LDQ (Cronbach's α 0.79) and test-retest reliability (Spearman's correlation coefficient 0.78) were good. The M-LDQ was valid in diagnosing dyspepsia in primary care (area under the receiver operating characteristics curve 0.84) and was able to discriminate between secondary and primary care patients (median cumulative LDQ score 13.0 vs 3.0, P < 0.0001). Among eight patients with organic dyspepsia, the median M-LDQ score reduced significantly from 21.0 (pretreatment) to 9.5 (4 weeks post-treatment) (P < 0.0001).

CONCLUSION:
The M-LDQ is a valid and responsive instrument for assessing ethnic Chinese adults with dyspepsia.

KEYWORDS:
Mandarin; ethnic Chinese; functional dyspepsia; outcome measure; questionnaire; validation

Optimizing first line 7-day standard triple therapy for Helicobacter pylori eradication: Prolonging treatment or adding bismuth: which is better?

Leow AH, Azmi AN, Loke MF, Vadivelu J, Graham DY, Goh KL

J Dig Dis, 2018 Nov;19(11):674-677.

PMID: 30307122 DOI: 10.1111/1751-2980.12679

OBJECTIVE: The 7-day standard triple therapy (STT) gives unacceptablly low eradication rates of Helicobacter pylori (H. pylori). We aimed to examine whether extending STT from 7 days to 14 days or adding a bismuth compound to a 7-day STT would result in better eradication rates.

METHODS: H. pylori-positive patients were assigned to Group A (7-day STT; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, for 7 days), Group B (7-day STT with bismuth; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily and bismuth subcitrate 240 mg twice daily, for 7 days) and Group C (14-day STT; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily for 14 days). Eradication was tested using 13 C-UBT at least 4 weeks after the completion of therapy.

RESULTS: A total of 364 patients were recruited. In the intention-to-treat analysis, eradication rates were 79.3% (96/121; 95% confidence interval [CI] 71.3-85.6%) for 7-day STT, 81.7% (98/120; 95% CI 73.8-87.6%) for 7-day STT with bismuth, and 88.6% (109/123; 95% CI 81.8-93.1%) for 14-day STT, respectively. Statistical significance was achieved between the 7-day and the 14-day STT treatment (P = 0.048).

CONCLUSIONS: Adding bismuth to the 7-day STT did not result in an increase in the eradication rate. Extending the STT to 14 days, however, achieved a significantly higher eradication rate. Nevertheless, this did not achieve the targeted 90% eradication rate on intention-to-treat analysis.

Dyspepsia in non-steroidal anti-inflammatory drug users and the effect of preventive measures

Lee HL, Chua SS, Mahadeva S

J Dig Dis, 2018 Jun;19(6):342-349.

PMID: 29732728 DOI: 10.1111/1751-2980.12607

OBJECTIVE: To evaluate regular non-steroidal anti-inflammatory drug (NSAID) users for dyspepsia, as well as to assess the effect of preventive measures, and the reasons for non-adherence to gastroprotective agents (GPA) from a real-world perspective.
METHODS: A prospective longitudinal study was conducted among outpatients with regular NSAID usage. The presence of dyspepsia was assessed by locally validated versions of the Leeds dyspepsia questionnaire (LDQ), GPA and the participants' adherence to the drugs were assessed at recruitment and 2 weeks later. GPA was defined as the use of antisecretory medications or cyclooxygenase-2 inhibitors.
RESULTS: Initially, 409 participants (mean age 52.3 ± 14.6 years, 60.6% females, 48.4% treated for musculoskeletal pain) were recruited. At recruitment, 50.9% of the participants had at least one upper gastrointestinal symptom. Complete data for follow-up analysis were collected from 158 participants who were naive NSAID users, had no prior gastrointestinal medication and who could be contacted. At 2-week follow-up there was no significant difference in the LDQ score change between NSAID users treated with GPA and those did not. However, there was a greater reduction in abdominal pain/discomfort (8.8% vs 5.0%, P

Massive subcapsular air collection in the liver: a rare life-threatening complication following ERCP rendezvous procedure

Koh PS, Ho SH, Yoong BK, Abdullah BJ, Goh KL

J Dig Dis, 2013 Jun;14(6):337-9.

PMID: 23279747 DOI: 10.1111/1751-2980.12030

Jaundice and life-threatening hemobilia: an uncommon presentation of choledochal cyst

Koh PS, Yoong BK, Vijayananthan A, Nawawi O, Mahadeva S

J Dig Dis, 2013 Aug;14(8):451-4.

PMID: 23324023 DOI: 10.1111/1751-2980.12036

Hemobilia with jaundice as a result of cholestasis and bleeding from choledochal cyst is uncommon. Ascertaining the diagnosis is often challenging and delayed diagnosis can lead to significant consequences due to hemodynamic instability, particularly in elderly patients. Although surgery remains the definitive treatment modality, interventional radiology for hemostasis has been increasingly recognized as an option. In this manuscript, we described two Malaysian cases of jaundice and hemobilia associated with choledochal cysts and the challenges related with clinical diagnosis and management.

Genetic polymorphisms of ATG16L1 and IRGM genes in Malaysian patients with Crohn's disease

Kee BP, Ng JG, Ng CC, Hilmi I, Goh KL, Chua KH

J Dig Dis, 2020 Jan;21(1):29-37.

PMID: 31654602 DOI: 10.1111/1751-2980.12829

OBJECTIVE: To investigate the association between genetic polymorphisms in ATG16L1 and IRGM genes and the development of Crohn's disease (CD) in Malaysian patients.

METHODS: Altogether 335 participants were recruited, including 85 patients with CD and 250 unrelated healthy controls, and their informed consent was obtained. Genomic DNA was extracted via a conventional phenol-chloroform extraction method. Six single nucleotide polymorphisms (SNPs) in ATG16L1 and IRGM genes were genotyped using TaqMan SNP genotyping assays. Associations between SNP and CD were determined using Fisher's exact test, odds ratio, and 95% confidence interval. Statistical power and the Hardy-Weinberg equilibrium were also calculated.

RESULTS: Two SNPs (rs2241880 and rs6754677) in the ATG16L1 gene were significantly associated with the onset of CD in the Malaysian population. The A allele and homozygous A/A genotype of the rs2241880 A/G polymorphism were protective against CD in the overall Malaysian and Malay population. The G allele and homozygous G/G genotype of the rs6754677 G/A polymorphism were protective in the Indian population, whereas the homozygous A/A genotype showed a risk of developing CD. The homozygous G/G genotype of IRGM rs11747270 was significantly present in the controls. However, this significance was not observed in a race-stratified analysis. All three ATG16L1 SNPs were associated with inflamed terminal ileum. IRGM rs4958847 and rs11747270 increased the risk of developing arthritis in patients with CD.

CONCLUSION: We found a significant association between SNP, which are located in autophagy-related genes, and CD in a Malaysian population.

Impact of Klebsiella pneumoniae in lower gastrointestinal tract diseases

Kaur CP, Vadivelu J, Chandramathi S

J Dig Dis, 2018 May;19(5):262-271.

PMID: 29573336 DOI: 10.1111/1751-2980.12595

The 2016 Global Burden of Disease report by WHO revealed that diseases of the gastrointestinal tract (GIT) had one of the highest incidence rates worldwide. The plethora of factors that contribute to the development of GIT-related illnesses can be divided into genetic, environmental and lifestyle factors. Apart from that, the role that infectious agents play in the development of GIT diseases has piqued the interest of researchers worldwide. The human gut harbors approximately 1014 bacteria in it with increasing concentration toward the lower GIT. Among the various microbiota that colonize the human gut, Gram-negative bacteria have been most notoriously linked to GIT-related diseases such as inflammatory bowel disease (IBD) including Crohn's disease and ulcerative colitis and colorectal cancer (CRC). Some of the notable culprits that have been attributed to these diseases are Bacteroides fragilis, Fusobacterium nucleatum, Escherichia coli and Helicobacter pylori. However, studies in recent years are beginning to recognize a new player, Klebsiella pneumoniae (K. pneumoniae) in the causation and progression of GIT diseases. Once synonymous with infections and diseases of the upper respiratory tract, K. pneumoniae has now emerged as one of the pathogens commonly isolated from patients with GIT diseases. However, extensive studies attributing K. pneumoniae to GIT diseases, particularly that of CRC are scanty. Therefore, this review intends to shed light on the association of K. pneumoniae in gastrointestinal diseases such as Crohn's disease, ulcerative colitis as well as CRC.

Collagenous colitis presenting with skip lesions mimicking Crohn's disease and complicated by intestinal obstruction

Hui CK, Hui NK

J Dig Dis, 2017 Aug;18(8):487-491.

PMID: 28682012 DOI: 10.1111/1751-2980.12507

Eosinophilic gastroenteritis complicating acute calculus eosinophilic cholecystitis 6 months after cholecystectomy

Hui CK

J Dig Dis, 2018 Nov;19(11):693-695.

PMID: 30370999 DOI: 10.1111/1751-2980.12683

Clarithromycin resistance and point mutations in the 23S rRNA gene in Helicobacter pylori isolates from Malaysia

Ho SL, Tan EL, Sam CK, Goh KL

J Dig Dis, 2010 Apr;11(2):101-5.

PMID: 20402836 DOI: 10.1111/j.1751-2980.2010.00423.x

To determine the prevalence of primary clarithromycin resistance amongst Helicobacter pylori (H. pylori) strains in Malaysian patients with gastroduodenal diseases, by using restriction fragment length polymorphism (RFLP) in domain V of 23S rRNA.

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