MyMedR

Fulltext The challenges of implementing evidence-based therapy for irritable bowel syndrome in Asia

Chuah KH, Mahadeva S

JGH Open, 2021 Nov;5(11):1225-1226.

PMID: 34816007 DOI: 10.1002/jgh3.12665

Fulltext Telemedicine in routine gastroenterology practice: A boost during the COVID-19 pandemic

Leow AH, Mahadeva S

JGH Open, 2021 May;5(5):533-534.

PMID: 34013051 DOI: 10.1002/jgh3.12545

Letter: Post-COVID-19 disorders of gut-brain interaction (DGBI)-Just post-infectious or a multi-faceted entity?

Siah KTH, Mahadeva S

Aliment Pharmacol Ther, 2023 Jul;58(1):130-131.

PMID: 37307548 DOI: 10.1111/apt.17549

The influence of cultural habits on the changing pattern of functional dyspepsia

Yap P, Mahadeva S, Goh KL

Dig Dis, 2014;32(3):217-21.

PMID: 24732186 DOI: 10.1159/000357853

Dyspepsia is a common gastroenterological problem with an estimated global prevalence between 7 and 40%. Functional dyspepsia (FD) is a major economic burden to patients and healthcare systems and significantly affects patient quality of life. The ROME III definition of FD divides it into two subgroups, epigastric pain syndrome and postprandial distress syndrome, the former being more associated with reflux disease and the latter with gastric dysmotility. The global incidence and prevalence of FD continues to rise, but the reason for this is not clear. Rising global obesity and gastroesophageal reflux disease rates may be contributing to the rise in FD. Socioeconomic and cultural demographic changes such as changing dietary habits and rapid urbanization, particularly in the developing countries, are likely to be influencing the course of FD and the way it presents.

Controlled attenuation parameter for the detection and quantification of hepatic steatosis in nonalcoholic fatty liver disease

Chan WK, Nik Mustapha NR, Mahadeva S

J Gastroenterol Hepatol, 2014;29(7):1470-6.

PMID: 24548002 DOI: 10.1111/jgh.12557

Controlled attenuation parameter (CAP) has been suggested as a noninvasive method for detection and quantification of hepatic steatosis. We aim to study the diagnostic performance of CAP in nonalcoholic fatty liver disease (NAFLD) patients.

Fulltext Commentary: rabeprazole improves symptoms in patients with functional dyspepsia in Japan

Yap PR, Mahadeva S, Goh KL

Aliment Pharmacol Ther, 2013 Nov;38(10):1321-2.

PMID: 24134501 DOI: 10.1111/apt.12497

Anxiety and depression in various functional gastrointestinal disorders: do differences exist?

Hartono JL, Mahadeva S, Goh KL

J Dig Dis, 2012 May;13(5):252-7.

PMID: 22500787 DOI: 10.1111/j.1751-2980.2012.00581.x

To examine the differences in the prevalence and severity of anxiety and depression in patients with functional dyspepsia (FD), nonerosive reflux disease (NERD), irritable bowel syndrome (IBS) and healthy controls.

Fulltext Low rates of hepatotoxicity among Asian patients with paracetamol overdose: a review of 1024 cases

Marzilawati AR, Ngau YY, Mahadeva S

BMC Pharmacol Toxicol, 2012;13:8.

PMID: 23021009 DOI: 10.1186/2050-6511-13-8

The metabolism of paracetamol in Asians is thought to differ from Westerners. Detailed clinical features of paracetamol -induced hepatotoxicity among Asians remains largely unreported.

Fulltext Successful management of intussusception with total polyp clearance in Peutz-Jeghers syndrome using a combined endoscopic and surgical approach

Kong SS, Taib NA, Mahadeva S

BMJ Case Rep, 2009;2009.

PMID: 21686715 DOI: 10.1136/bcr.08.2008.0628

Intussusception due to small intestinal polyps in Peutz-Jeghers syndrome represents a significant clinical challenge. Neither pure surgical nor endoscopic approaches alone are effective in the long-term management of this problem. We describe a combined approach using both surgery and small bowel endoscopy in the management of this condition, which resulted in both immediate and long-term success. Although not new, we believe this approach remains relevant despite recent technological advancements in this area.

A novel 2-step approach combining the NAFLD fibrosis score and liver stiffness measurement for predicting advanced fibrosis

Chan WK, Nik Mustapha NR, Mahadeva S

Hepatol Int, 2015 Oct;9(4):594-602.

PMID: 25788185 DOI: 10.1007/s12072-014-9596-7

BACKGROUND: The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) is indeterminate in a proportion of NAFLD patients. Combining the NFS with liver stiffness measurement (LSM) may improve prediction of advanced fibrosis. We aim to evaluate the NFS and LSM in predicting advanced fibrosis in NAFLD patients.

METHODS: The NFS was calculated and LSM obtained for consecutive adult NAFLD patients scheduled for liver biopsy. The accuracy of predicting advanced fibrosis using either modality and in combination were assessed. An algorithm combining the NFS and LSM was developed from a training cohort and subsequently tested in a validation cohort.

RESULTS: There were 101 and 46 patients in the training and validation cohort, respectively. In the training cohort, the percentages of misclassifications using the NFS alone, LSM alone, LSM alone (with grey zone), both tests for all patients and a 2-step approach using LSM only for patients with indeterminate and high NFS were 5.0, 28.7, 2.0, 2.0 and 4.0 %, respectively. The percentages of patients requiring liver biopsy were 30.7, 0, 36.6, 36.6 and 18.8 %, respectively. In the validation cohort, the percentages of misclassifications were 8.7, 28.3, 2.2, 2.2 and 8.7 %, respectively. The percentages of patients requiring liver biopsy were 28.3, 0, 41.3, 43.5 and 19.6 %, respectively.

CONCLUSIONS: The novel 2-step approach further reduced the number of patients requiring a liver biopsy whilst maintaining the accuracy to predict advanced fibrosis. The combination of NFS and LSM for all patients provided no apparent advantage over using either of the tests alone.

Repeat endoscopy for recurrent iron deficiency anemia: an (un)expected finding from southeast Asia

Mahadeva S, Qua CS, Yusoff W, Sulaiman W

Dig Dis Sci, 2007 Feb;52(2):523-5.

PMID: 17219070

Fulltext Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding

Lee YY, Tee HP, Mahadeva S

World J Gastroenterol, 2014 Feb 21;20(7):1790-6.

PMID: 24587656 DOI: 10.3748/wjg.v20.i7.1790

Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis.

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

Hepaticogastric fistulation from a proximally migrated biliary stent

Mahadeva S, Ranjeev P, Goh KL

Gastrointest Endosc, 2003 Aug;58(2):295-7.

PMID: 12872109

Endoscopic intervention for hepatolithiasis associated with sharp angulation of right intrahepatic ducts

Mahadeva S, Prabakharan R, Goh KL

Gastrointest Endosc, 2003 Aug;58(2):279-82.

PMID: 12872105

Hepatolithiasis (intrahepatic stones) is common in Asian patients. Hepatolithiasis with intrahepatic strictures and sharp ductal angulation poses a particularly difficult management problem.

Ethnicity influences pain after ultrasound-guided percutaneous liver biopsy

Mahadeva S, Mahfudz AS, Vijayananthan A

Eur J Gastroenterol Hepatol, 2015 Dec;27(12):1378-81.

PMID: 26340164 DOI: 10.1097/MEG.0000000000000465

The influence of ethnicity on pain complicating ultrasound-guided percutaneous liver biopsy (US-guided PLB) and its clinical impact has not been reported to date.

Fulltext Factors influencing dyspepsia-related consultation: differences between a rural and an urban population

Mahadeva S, Yadav H, Everett SM, Goh KL

Neurogastroenterol Motil, 2011 Sep;23(9):846-53.

PMID: 21740483 DOI: 10.1111/j.1365-2982.2011.01746.x

BACKGROUND:
Dyspepsia is a common, chronic condition but medical consultation rates for symptoms remain variable. We aimed to examine two populations with varied health-care provision to determine predictive factors for dyspepsia-related consultation.

METHODS:
A cross-sectional, population-based study in both an urban and a rural community within a single Asian country was conducted. Details on dyspepsia-related consultation rates over a fixed period and independent factors influencing them were identified.

KEY RESULTS:
A total of 4039/5370 (75.2%) adults from representative rural and urban areas in this country agreed to participate in the study. Although mean ages of respondents were similar (40.4years), the demographics of both populations varied in terms of gender (62.7% female, rural vs 55.7% female, urban, P<0.0001), marital status (75.4% rural vs 70.5% urban, P=0.002), ethnicity, (79% Malay rural vs 45.3% Malays urban, P<0.0001) and socio-economic status (professional occupation 7.1% rural vs 47.3% urban, P<0.0001). Dyspepsia-related consultation rates were found to be higher among rural compared to urban adults (41.4%vs 28.7%, P<0.0001). Over-the-counter medication consumption was higher among urban compared to rural dyspepsia sufferers (n=157 vs n=35, P<0.0001). Following logistic regression, rural population (OR 3.14, 95% CI=1.65-6.0), low quality of life (OR 1.90, 95% CI=1.17-3.10), and self-medication (OR 0.40, 95% CI=0.25-0.62) were found to independently predict dyspepsia-related consultation.

CONCLUSIONS & INFERENCES:
Dyspepsia-related consultation varied significantly between urban and rural communities. Factors within the rural population, self-medication practices, and a low quality of life independently influenced dyspepsia-related consultation.

Fulltext Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Rahman MM, Mahadeva S, Ghoshal UC

World J Gastroenterol, 2017 Oct 07;23(37):6788-6801.

PMID: 29085223 DOI: 10.3748/wjg.v23.i37.6788

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psycho-social factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including: (1) large proportion of the population living in rural areas; (2) rapid development and associated lifestyle changes in urban areas; and (3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.

Perceptions of Healthcare Professionals on the Usage of Percutaneous Endoscopic Gastrostomy in a Teaching Hospital from a Middle-Income South East Asian Country

Jaafar MH, Mahadeva S, Subramanian P, Tan MP

J Nutr Health Aging, 2017;21(4):473-479.

PMID: 28346575 DOI: 10.1007/s12603-016-0774-2

OBJECTIVE: To explore the perceptions of healthcare professionals' (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.

DESIGN: Semi-structured, qualitative interviews.

SETTINGS: A teaching hospital in Kuala Lumpur, Malaysia.

PARTICIPANTS: A total of 17 healthcare professionals aged 23-43 years, 82% women.

RESULTS: Thematic analysis revealed five themes that represent HCPs' perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.

CONCLUSION: The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.

Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: a systematic review

Jaafar MH, Mahadeva S, Morgan K, Tan MP

J Nutr Health Aging, 2015 Feb;19(2):190-7.

PMID: 25651445 DOI: 10.1007/s12603-014-0527-z

OBJECTIVE: The objective of this systematic review was to evaluate existing studies on the effectiveness of percutaneous endoscopic gastrostomy (PEG) feeding compared to nasogastric (NG) feeding for patients with non-stroke related dysphagia.

METHODS: We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and PubMed databases through to December 2013 using the terms "percutaneous endoscopic gastrostomy", "gastrostomy", "PEG", "nasogastric", "nasogastric tube", "nasogastric feeding" and "intubation". We included randomized controlled trials (RCTs) and non-RCTs which compared PEG with NG feeding in individuals with non-stroke dysphagia.

RESULTS: 9 studies involving 847 participants were included in the final analysis, including two randomized trials. Pooled analysis indicated no significant difference in the risk of pneumonia [relative risk (RR) = 1.18, 95% confidence interval (CI) = 0.87-1.60] and overall complications [relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.63-1.02] between PEG and NG feeding. A meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective.

CONCLUSIONS: Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.

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