Displaying publications 21 - 40 of 111 in total

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  1. Metabolic fatty liver syndromes: where do we stand in 2024?
    Chan WK, George J
    J Gastroenterol Hepatol, 2024 Apr;39(4):613-614.
    PMID: 38357837 DOI: 10.1111/jgh.16507
  2. Education and imaging: Gastrointestinal: An unusual cause of gastric outlet obstruction
    Hasmoni MH, Hilmi I, Goh KL
    J Gastroenterol Hepatol, 2013 Mar;28(3):585.
    PMID: 23565549
  3. Liver cirrhosis in Malaysia: peculiar epidemiology in a multiracial Asian country
    Qua CS, Goh KL
    J Gastroenterol Hepatol, 2011 Aug;26(8):1333-7.
    PMID: 21443669 DOI: 10.1111/j.1440-1746.2011.06732.x
    To determine the etiology of liver cirrhosis and risk factors for hepatocellular carcinoma (HCC) in a multiracial Asian population.
  4. Clinical and epidemiological perspectives of dyspepsia in a multiracial Malaysian population
    Goh KL
    J Gastroenterol Hepatol, 2011 Apr;26 Suppl 3:35-8.
    PMID: 21443706 DOI: 10.1111/j.1440-1746.2011.06648.x
    Dyspepsia is perhaps the most common gastrointestinal disease universally. The prevalence of dyspepsia ranges from 7-40% in population based studies worldwide. These figures vary with definition of dyspepsia used and also with the survey methodology. As with Western studies, functional dyspepsia (FD) predominates in Asia. With a decline in peptic ulcer disease and gastric cancer, the proportion of FD is set to increase further. Studies have shown FD to account for 50-70% of cases of uninvestigated dyspepsia. In Malaysia dyspepsia has been reported in up to 15% of a rural and 25% of an urban population. No racial differences were seen in the rural survey. In the urban survey, Malays and Indians were found to have significantly more dyspepsia than Chinese. No clear explanation can be found for these racial differences. In clinical practice, Malays seem to complain a lot of wind and bloating in the "stomach." This is interesting to note when you compare it with the prevalence of H. pylori which is distinctly less common amongst Malays compared to the Indians and Chinese. As with many Asian populations, many Malaysians do not consult for complains of dyspepsia. Many will self medicate and others may even bear with their complains. This is probably true in the rural population. Traditional medications are often used and these are often ethnic based. Different types of lotions for example are used for massaging the putative area in the abdomen by Malay, Chinese and Indian patients. Moxibustion and acupuncture is still practiced by Chinese traditional physicians for treatment of dyspepsia. The notion that mood disorders may underlies dyspepsia is still poorly accepted by a less educated or rural population who consider a psychiatric consultation a taboo. Amongst urban dwellers where Westernized medical care is readily available and the awareness of potential serious disease like cancer is higher, consultation for dyspepsia is certainly higher. Indeed a higher education level has been identified as independent risk factors for dyspepsia in both an urban and rural population survey in Malaysia. With greater consultation for dyspepsia, there has also been a higher demand and utilization of endoscopy services for investigation of gastrointestinal diseases in the country.
  5. Anxiety, depression and quality of life differences between functional and organic dyspepsia
    Mahadeva S, Goh KL
    J Gastroenterol Hepatol, 2011 Apr;26 Suppl 3:49-52.
    PMID: 21443710 DOI: 10.1111/j.1440-1746.2011.06656.x
    OBJECTIVE AND BACKGROUND:
    The role of psychological disturbance in the pathogenesis of functional dyspepsia is uncertain. We aimed to examine for differences in anxiety, depression and health-related quality of life (HRQOL) between adults with organic (OD) and functional dyspepsia (FD).

    METHODOLOGY:
    A prospective, cross-sectional study of Malaysian adults undergoing oesophago-gastro-duodenoscopy (OGDS) for the primary indication of dyspepsia was conducted. Prior to OGDS, locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS), Nepean Dyspepsia Index (NDI) and Leeds Dyspepsia Questionnaire (LDQ) were administered.

    RESULTS:
    839 patients (mean age 49.6 ± 15.8 years, 55.7% female, ethnic division: Malays 30.5% , Chinese 38.4%, Indians 29.4%) were studied between June 2008 and March 2009. 472 (56.3%) and 367 (43.7%) patients had FD and OD respectively. There was no difference in the mean LDQ score between FD and OD patients (18.6 vs 18.1, P = 0.4). Moderate/severe anxiety was more prevalent in FD compared to OD patients (28.5% vs 23.1%, P = 0.05) but there was no significant difference in depression. Summary scores for the NDI revealed a lower mean value in FD patients compared to OD patients (68.6 ± 19.5 vs 71.4 ± 19.6, P = 0.04).

    CONCLUSION:
    Patients with FD have a lower HRQOL compared to those with OD, but this could not be attributed to differences in anxiety nor depression between both groups.
  6. Validation study of the Leeds Dyspepsia Questionnaire in a multi-ethnic Asian population
    Mahadeva S, Chan WK, Mohazmi M, Sujarita R, Goh KL
    J Gastroenterol Hepatol, 2011 Nov;26(11):1669-76.
    PMID: 21649731 DOI: 10.1111/j.1440-1746.2011.06806.x
    BACKGROUND AND AIM:
    Outcome measures for clinical trials in dyspepsia require an assessment of symptom response. There is a lack of validated instruments assessing dyspepsia symptoms in the Asian region. We aimed to translate and validate the Leeds Dyspepsia Questionnaire (LDQ) in a multi-ethnic Asian population.

    METHODS:
    A Malay and culturally adapted English version of the LDQ were developed according to established protocols. Psychometric evaluation was performed by assessing the validity, internal consistency, test-retest reliability and responsiveness of the instruments in both primary and secondary care patients.

    RESULTS:
    Between April and September 2010, both Malay (n=166) and Malaysian English (n=154) versions were assessed in primary and secondary care patients. Both language versions were found to be reliable (internal consistency was 0.80 and 0.74 (Cronbach's α) for Malay and English, respectively; spearman's correlation coefficient for test-retest reliability was 0.98 for both versions), valid (area under receiver operating curve for accuracy of diagnosing dyspepsia was 0.71 and 0.77 for Malay and English versions, respectively), discriminative (median LDQ score discriminated between primary and secondary care patients in Malay (11.0 vs 20.0, P<0.0001) and English (10.0 vs 14.0, P=0.001), and responsive (median LDQ score reduced after treatment in Malay (17.0 to 14.0, P=0.08) and English (18.0 to 11.0, P=0.008) to dyspepsia.

    CONCLUSIONS:
    The Malaysian versions of the LDQ are valid, reliable and responsive instruments for assessing symptoms in a multi-ethnic Asian population with dyspepsia.
  7. Gastroesophageal reflux disease in Asia: A historical perspective and present challenges
    Goh KL
    J Gastroenterol Hepatol, 2011 Jan;26 Suppl 1:2-10.
    PMID: 21199509 DOI: 10.1111/j.1440-1746.2010.06534.x
    Gastroesophageal reflux disease (GERD), previously uncommon in Asia, has now become an important disease in the region. Although much variability exists between studies, most endoscopy-based studies show a prevalence of erosive esophagitis of more than 10%. Symptom-based studies also show a prevalence of 6-10%. Two longitudinal follow-up studies on GERD symptoms have shown an increase with time, and several endoscopy-based time trend studies have also shown a significant increase in erosive reflux esophagitis. Studies on Barrett's esophagus have been confounded by the description of short (SSBE) and long segment (LSBE) Barrett's esophagus. Great variation in prevalence rates has been reported. SSBE vary from 0.1% to more than 20% while LSBE vary from 1-2%. Of the putative causative factors, obesity has been the most important. Many studies have linked GERD-esophagitis as well as occurrence of reflux symptoms with an increase in body mass index (BMI), obesity, especially visceral or central obesity, and metabolic syndrome. A decline in Helicobacter pylori infection with growing affluence in Asia has been broadly thought to result in healthier stomachs and a higher gastric acid output resulting in reflux disease. However, variable results have been obtained from association and H. pylori eradication studies.
  8. Non-cardiac chest pain: prevalence of reflux disease and response to acid suppression in an Asian population
    Mohd H, Qua CS, Wong CH, Azman W, Goh KL
    J Gastroenterol Hepatol, 2009 Feb;24(2):288-93.
    PMID: 19054255 DOI: 10.1111/j.1440-1746.2008.05702.x
    Gastroesophageal reflux disease is thought to be the commonest cause of 'non-cardiac chest pain'. The use of proton-pump inhibitors resulting in improvement in the chest pain symptom would support this causal association.
  9. Role of Helicobacter pylori virulence factor and genotypes in non-ulcer dyspepsia
    Tan HJ, Rizal AM, Rosmadi MY, Goh KL
    J Gastroenterol Hepatol, 2006 Jan;21(1 Pt 1):110-5.
    PMID: 16706821
    The role of Helicobacter pylori (HP) in non-ulcer dyspepsia is debatable. Eradicating HP will help a small group of non-ulcer dyspeptic patients. However, it is unclear which subgroup of patients will benefit from eradication therapy. The aim of the present study was to compare the cagA and cagE status, as well as vacA genotypes, of HP in non-ulcer dyspeptic patients who responded successfully to eradication therapy compared with those patients who did not.
  10. Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview
    Goh KL
    J Gastroenterol Hepatol, 2004 Sep;19 Suppl 3:S22-5.
    PMID: 15324378
    Gastroesophageal reflux disease (GERD) is a common disease in the West, which now appears to be also increasing in prevalence in the Asian Pacific region. The reasons for this changing epidemiology are two-fold: an increased awareness among doctors and patients, and/or a true increase in the prevalence of the disease. Prevalence rates of reflux esophagitis (RE) of up to 16% and prevalence of GERD symptoms of up to 9% have been reported in the Asian population. However, the frequency of strictures and Barrett's esophagus remain very low. Non-erosive reflux disease (NERD) appears to be the most common form of GERD among Asian patients accounting for 50-70% of cases with GERD. Among Asian patients differences can also be discerned among different ethnic groups. For example, in Malaysia where a multiracial society exists, RE is significantly more common among Indians compared to Chinese and Malays whereas NERD is more frequently seen in the Indian and Malays compared to the Chinese. The reasons for these differences are not known but may indicate both genetic factors and environmental factors peculiar to the particular racial group. GERD has also been increasing in the region demonstrating a time-lag phenomenon compared to the West. Differing predisposition to GERD among different ethnic groups would mean that such an increase would be more prominent among certain racial groups.
  11. Effects of a probiotic fermented milk on functional constipation: a randomized, double-blind, placebo-controlled study
    Mazlyn MM, Nagarajah LH, Fatimah A, Norimah AK, Goh KL
    J Gastroenterol Hepatol, 2013 Jul;28(7):1141-7.
    PMID: 23432408 DOI: 10.1111/jgh.12168
    Evidence suggests that probiotics reduce certain constipation-related symptoms. Lactobacillus casei strain Shirota has never been tested as treatment for functional constipation in otherwise-healthy subjects. To evaluate the efficacy of this probiotic among adults with functional constipation was aimed.
  12. Distribution of Helicobacter pylori cagA, cagE and vacA in different ethnic groups in Kuala Lumpur, Malaysia
    Tan HJ, Rizal AM, Rosmadi MY, Goh KL
    J Gastroenterol Hepatol, 2005 Apr;20(4):589-94.
    PMID: 15836708
    There is a geographic variation in Helicobacter pylori (HP) genotypes and virulence factors. Cytotoxin associated genes A (cagA) and E (cagE), and certain vacuolating cytotoxin (vacA) genotypes are associated with peptic ulcer disease (PUD). There is also a different prevalence of PUD among different ethnic groups in Malaysia. The present study compared the distribution of vacA alleles and cagA and cagE status in three ethnic groups residing in Kuala Lumpur, Malaysia, and their association with clinical outcome.
  13. Predictors of health-care consultation for recurrent abdominal pain among urban schoolchildren in Malaysia
    Boey CC, Goh KL
    J Gastroenterol Hepatol, 2001 Feb;16(2):154-9.
    PMID: 11207895
    AIM: To look at the predictors of health-care consultation for recurrent abdominal pain among urban schoolchildren in Malaysia.

    METHODS: Recurrent abdominal pain was defined as at least three episodes of abdominal pain, severe enough to affect a child's activities over a period longer than 3 months. A health-care consulter was defined as a child who had been brought to see a doctor regarding recurrent abdominal pain at least once in the past year. Children aged between 9 and 15 years were randomly chosen from schools in the city of Petaling Jaya, given questionnaires to fill in and interviewed to determine whether they fulfilled the above criteria for having symptoms of recurrent abdominal pain and for being a consulter. Bivariate analysis and multiple logistic regression analysis were performed on the data obtained.

    RESULTS: One hundred and forty-three (9.61%) children fulfilled the criteria for recurrent abdominal pain out of a total of 1488 schoolchildren interviewed. There were 65 (45.5%) consulters and 78 (54.5%) non-consulters. Among the consulters, the male to female ratio was 1:1.4, while among the non-consulters, the ratio was 1:1.1. On bivariate analysis, the Chinese had a significantly lower likelihood to consult a doctor (P = 0.02), while the other two races did not show any increase in consultation (Malays, P = 0.08; Indians, P = 0.21). Among those with severe pain, there was a significantly higher prevalence of consulters (P < 0.01). Furthermore, those whose sleep was interrupted by abdominal pain were more likely to consult (P < 0.01). Children who had consulted a doctor were more likely to be missing school because of abdominal pain (P < 0.01). Following multiple logistic regression analysis, ethnicity was no longer a significant predictor.

    CONCLUSIONS: Approximately 45.5% of schoolchildren with recurrent abdominal pain in an urban setting were brought to see a doctor. Predictors of recent health-care consultation were school absence, pain severity and interruption of sleep caused by abdominal pain.

  14. Can a non-invasive strategy for managing young dyspeptics be safely implemented in Asia?
    Mahadeva S, Goh KL
    J Gastroenterol Hepatol, 2003 Apr;18(4):359-62.
    PMID: 12653882
    Dyspepsia is a common problem in the Asia-Pacific region, with a prevalence rate ranging from 10-20%. It constitutes 2-5% of consultations with primary-care physicians and forms a major part of the gastroenterologists' workload. Although upper gastrointestinal endoscopy (UGIE) is the investigation of choice, no serious disease is present in the majority of patients and various other ways have been suggested, mainly in the West, to reduce the demand on the finite resources of UGIE services. The alternative methods to UGIE have been based on non-invasive detection of Helicobacter pylori in patients with dyspepsia, as the organism has been shown to be associated with most peptic ulcers and even gastric cancer. A positive H. pylori test in a patient with dyspepsia may not necessarily indicate serious disease, but H. pylori eradication eliminates the propensity for developing peptic ulcers and perhaps even cancer (not proven). In high-risk populations, non-invasive screening for H. pylori can even be considered a 'cancer test', as it can help target investigations in a selected group of patients.
  15. Psychosocial factors and childhood recurrent abdominal pain
    Boey CC, Goh KL
    J Gastroenterol Hepatol, 2002 Dec;17(12):1250-3.
    PMID: 12423267
    Recurrent abdominal pain in children is not a single condition but a description of a wide spectrum of clinical manifestations, some of which fit into a definite pattern, such as the irritable bowel syndrome, while others do not. Organic disorders may be present, but in the majority of children they cannot be detected. Although children with recurrent abdominal pain do not generally have psychological or psychiatric illness, there is a growing body of evidence to suggest that psychosocial stress plays an important role in this condition. This review will look into some of this evidence. The precise pathophysiology that results in abdominal pain is still not clearly understood, but the current belief is that visceral hypersensitivity or hyperalgesia and changes in the brain-gut axis linking the central and enteric nervous systems are important mechanisms.
  16. Update on the management of Helicobacter pylori infection, including drug-resistant organisms
    Goh KL
    J Gastroenterol Hepatol, 2002 Apr;17(4):482-7.
    PMID: 11982731
    Helicobacter pylori infection has many different clinical outcomes. Not all infected persons need to be treated. Therefore, indications for treatment have to be clear, and several consensus guidelines have been formulated to aid the medical practitioner in this decision-making process. Triple therapy with a proton pump inhibitor (PPI), in combination with amoxicillin and clarithromycin is the established treatment of choice. For patients with penicillin hypersensitivity, metronidazole can be substituted for amoxicillin. Bacterial resistance to antibiotics is a major factor adversely affecting treatment success. Resistance to metronidazole has been reported in up to 80%, and resistance to clarithromycin in 2-10% of strains cultured. Resistance to either one of the antibiotics has been reported to result in a drop in efficacy of up to 50%. Emergence of resistance to both metronidazole and clarithromycin following failed therapy is a cause for concern; this underlines the need to use the best available first-line therapy. To avoid the emergence of resistance to both key antibiotics, the combination of metronidazole and clarithromycin should be avoided where possible. For failed treatment, several strategies can be employed. These include ensuring better compliance with repeat therapy, and maximizing the efficacy of repeat treatment by increasing dosage and duration of treatment, as well as altering the choice of drugs. Quadruple therapy incorporating a bismuth compound with a PPI, tetracycline and metronidazole has been a popular choice as a "rescue" therapy. Ranitidine bismuth citrate has been shown to be able to overcome metronidazole and clarithromycin resistance; it may be a useful compound drug to use in place of a PPI in "rescue" therapies. In the case of persistent treatment failures, it is useful to consider repeating gastroscopy and obtaining tissue for culture, and then prescribe antibiotics according to bacterial susceptibility patterns. It is also important in refractory cases to review the original indication for treatment and determine the importance of the indication.
  17. Predictive factors by multivariate analysis for colorectal cancer in Malaysian patients undergoing colonoscopy
    Tan YM, Rosmawati M, Ranjeev P, Goh KL
    J Gastroenterol Hepatol, 2002 Mar;17(3):281-4.
    PMID: 11982698
    BACKGROUND: The majority of colorectal cancers are still diagnosed in patients who present with symptoms especially in countries where colorectal screening programs are not practised. The aim of our study was to determine the predictive factors for colorectal cancer in patients referred for colonoscopy.

    METHODS: A prospective study of 485 consecutive patients who underwent colonoscopy during a 22-month period was performed. All patients answered a detailed questionnaire. Indications for colonoscopy and the findings were recorded.

    RESULTS: The mean age of the study population was 55.7 +/- 14.7 years. There were 221 (45.6%) males and 264 (54.4%) females. Sixty-five (13.4%) were Malays, 298 (61.4%) were Chinese and 112 (23.1%) were Indians. Multiple backward stepwise regression analysis revealed that independent predictors for colorectal cancer (odds ratio [95% CI]) were the presence of rectal bleeding (4.3 [4.0-8.0]) and iron deficiency anemia (4.0 [3.6-10.2]). In those aged 50 and over, male gender (4.5 [2.2-9.3]) and abdominal pain (3.1 [1.4-6.7]) were also significant positive predictors of cancer.

    CONCLUSIONS: With the ever-increasing demand for gastrointestinal endoscopy, the appropriate utilization of colonoscopy is essential to afford prompt patient evaluation. Our study supports the need to prioritize the use of colonoscopy in patients with rectal bleeding and iron deficiency anemia. In the older patient where the background prevalence of colorectal cancer is higher, referral for colonoscopy is also justified.

  18. Prevalence of and risk factors for Helicobacter pylori infection in a multi-racial dyspeptic Malaysian population undergoing endoscopy
    Goh KL
    J Gastroenterol Hepatol, 1997 Jun;12(6):S29-35.
    PMID: 9195409
    The aim of the present study was to determine the risk factors for Helicobacter pylori in a dyspeptic Malaysian population. A cross-sectional survey of 1060 consecutive patients presenting with dyspepsia at the Endoscopic Unit, University Hospital, Kuala Lumpur, Malaysia from January 1994 to July 1995 was undertaken. All patients answered a detailed questionnaire and underwent endoscopy, with two antral biopsies taken for diagnosis of H. pylori using a rapid urease test. An overall H. pylori prevalence of 49.0% was recorded. Helicobacter pylori prevalence in relation to the major endoscopic diagnoses were as follows: non-ulcer dyspepsia (NUD) 31.2%; duodenal ulcer (DU) 91.4%; and gastric ulcer (GU) 74.1%. The prevalence among the races were as follows: Malay 16.4%; Chinese 48.5%; and Indians 61.8%. Multiple logistic regression analysis identified the following as independent risk factors: > 45 years old 1.5 (1.1,2.0); male gender 1.6 (1.2,2.1); ethnic group: Chinese 2.5 (1.7,3.7); Indians 4.9 (3.2,7.5); level of education: low 2.3 (1.5,3.5); middle 1.7 (1.1,2.6); and smoking 1.6 (1.2,2.3). Analysis was also performed on DU, GU and non-UD patients separately; in both DU and GU patients, H. pylori prevalence was high regardless of age, sex, race or level of education. However, in DU patients, Indian race had an independent risk factor (Odds ratio = 7.8 (1.2,48.4)). The findings in the NUD group reflected the findings in the ¿all patients' group; > 45 years old, male gender, Indian and Chinese race, and low level of education were also significant, independent risk factors. The overall differences in H. pylori prevalence between the different subgroups were mainly due to differences in the NUD group. The increased risk of H. pylori infection in Chinese and Indians points to either an inherent ethnic genetic predisposition or to socio-cultural practices peculiar to the particular race which may be responsible for transmission of the infection.
  19. Non-alcoholic fatty liver disease in diabetics--prevalence and predictive factors in a multiracial hospital clinic population in Malaysia
    Chan WK, Tan AT, Vethakkan SR, Tah PC, Vijayananthan A, Goh KL
    J Gastroenterol Hepatol, 2013 Aug;28(8):1375-83.
    PMID: 23517307 DOI: 10.1111/jgh.12204
    BACKGROUND AND AIM:
    There is currently no published study comparing prevalence of non-alcoholic fatty liver disease (NAFLD) and associated factors among diabetics of different ethnicity in the Asia-Pacific region.

    METHODS:
    Cross-sectional study of consecutive patients in the Diabetic Clinic in University of Malaya Medical Centre. The Global Physical Activity Questionnaire and a semiquantitative food-frequency questionnaire were used to assess physical activity and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake.

    RESULTS:
    Data for 399 patients were analyzed (mean age 62.3 ± 10.5 years, 43.1% men). The racial distribution was Chinese 43.6%, Indian 33.1%, Malay 22.3%, and others 1.0%. The prevalence of NAFLD was 49.6%. On univariate analysis, factors associated with NAFLD were age < 65 years, race, obesity, central obesity, glycated hemoglobin ≥ 7.0%, and elevated serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels. Patients with low physical activity were more likely to have NAFLD (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.06-2.63, P = 0.020). The prevalence of NAFLD was highest among Malays (60.7%), followed by Indians (51.5%), and lowest among Chinese (42.0%) consistent with higher prevalence of central obesity and higher percentage calorie intake from fat in the former groups of patients. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR = 2.20, 95% CI = 1.29-3.75, P = 0.004) and elevated serum ALT level (OR = 1.98, 95% CI = 1.21-3.25, P = 0.007).

    CONCLUSIONS:
    NAFLD was seen in half of a cohort of diabetic patients and was independently associated with central obesity and elevated serum ALT level. Prevalence of NAFLD was different and paralleled the difference in prevalence of central obesity and in percentage calorie intake from fat among the different ethnic groups.

    © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

    KEYWORDS:
    diabetes mellitus; dietary intake; epidemiology; ethnicity; non-alcoholic fatty liver disease; physical activity
    Study site: Diabetic clinic, University Malaya Medical Centre (UMMC)
  20. East Asian perspective on the interaction between proton pump inhibitors and clopidogrel
    Zou D, Goh KL
    J Gastroenterol Hepatol, 2017 Jun;32(6):1152-1159.
    PMID: 28024166 DOI: 10.1111/jgh.13712
    Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia-Pacific population. PPIs are the mainstay therapeutic agents for prophylaxis against aspirin gastropathy and for acid-related disorders including gastroesophageal reflux disease. They are also co-prescribed with oral anticoagulant agents and with dual-antiplatelet therapy for the treatment and prevention of gastrointestinal bleeding. Clopidogrel belongs to the drug class of thienopyridines and is currently the most widely prescribed oral anticoagulant agent either alone or in combination with aspirin. Platelet inhibition by clopidogrel is prone to significant inter-individual variability and is believed to be affected by several factors such as genetics and drug-drug interactions. Since it was first reported in 2009, the potential for drug-drug interactions between PPIs and clopidogrel has remained headline news, and its significance in clinical practice is the subject of an ongoing debate. For East Asian patients in particular, the clinical relevance of the interaction between PPIs and clopidogrel remains unclear because of conflicting data, as well as underrepresentation of East Asian subjects in landmark trials. Increased CYP2C19 genetic polymorphisms in individuals from Asia-Pacific countries only fuel the confusion. Recent studies in East Asian cohorts suggests that the potential of PPIs to attenuate the efficacy of clopidogrel could be minimized by the use of newer PPIs with weaker affinity for the CYP2C19 isoenzyme, namely, pantoprazole, dexlansoprazole, and rabeprazole. This review aims to help clinicians choose the most appropriate PPI for co-prescription with clopidogrel in patients from Asia-Pacific countries.
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