MyMedR

Letter: prompt endoscopy in Asians with uninvestigated dyspepsia

Mahadeva S, Goh KL

Aliment Pharmacol Ther, 2015 Apr;41(8):792.

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.

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.

Fulltext Idiopathic portal hypertension associated with autoimmune thyroiditis

Azian M, Goh KL

Med J Malaysia, 1993 Dec;48(4):443-5.

PMID: 8183170

We report a case of idiopathic portal hypertension (IPH) in association with autoimmune thyroiditis occurring in a 39 year old woman. Ultrasonography revealed a normal liver echotexture. Spleno-portogram confirmed portal hypertension and liver biopsy showed features in keeping with IPH. She was also found to be biochemically hypothyroid with markedly elevated thyroid autoantibodies. These findings may suggest an autoimmune link in the pathogenesis of IPH.

Fulltext Primary hyperparathyroidism--a clinical study

Goh KL, Wang F

Med J Malaysia, 1988 Sep;43(3):206-12.

PMID: 3241578

Clinically significant endoscopic findings in a multi-ethnic population with uninvestigated dyspepsia

Mahadeva S, Goh KL

Dig Dis Sci, 2012 Dec;57(12):3205-12.

PMID: 22688184 DOI: 10.1007/s10620-012-2256-7

INTRODUCTION: The proportion of clinically significant endoscopic findings (CSEF) in dyspepsia affects the initial management of this condition. With the changing epidemiology of organic upper gastrointestinal diseases in Asia, current data on CSEF remains uncertain.

METHODS: A cross-sectional study of consecutive adult patients attending an open access endoscopy list for the primary indication of dyspepsia was conducted. Independent epidemiological and clinical factors for CSEF were determined prospectively.

RESULTS: Data for 1167/1208 (96.6 %) adults (mean age 49.7 ± 15.9 years, 42.4 % males, ethnic distribution: 30.5 % Malays, 36.9 % Chinese and 30.8 % Indians) were analysed between January 2007 and August 2008. Three-hundred and eight (26.4 %) patients were found to have CSEF, most often those with age ≥45 years (30.3 vs 19 %, P < 0.0001), male gender (34.1 vs 20.7 % female, P < 0.0001), lower education levels (i.e. primary or no education), smoking (36.7 vs 24.9 %, P = 0.003), H. pylori infection (40.6 vs 21.8 %, P < 0.0001), and duration of dyspepsia ≤5 months (32.8 vs 24.4 %, P = 0.006). Age ≥ 45 years (OR 1.82, 95 % CI = 1.38-2.48), male gender (OR 1.84, 95 % CI = 1.53-2.59), H. pylori infection (OR 2.36, 95 % CI = 1.83-3.26), and duration of dyspepsia ≤5 months (OR 1.44, 95 % CI = 1.13-2.03) were subsequently identified as independent risk factors for CSEF.

CONCLUSION: CSEF are found in 26.4 % of Asian adults with uninvestigated dyspepsia. Duration of symptoms <5 months, among other recognised factors, is predictive of CSEF.

Fulltext Epidemiology of functional dyspepsia: a global perspective

Mahadeva S, Goh KL

World J Gastroenterol, 2006 May 07;12(17):2661-6.

PMID: 16718749 DOI: 10.3748/wjg.v12.i17.2661

Dyspepsia refers to group of upper gastrointestinal symptoms that occur commonly in adults. Dyspepsia is known to result from organic causes, but the majority of patients suffer from non-ulcer or functional dyspepsia. Epidemiological data from population-based studies of various geographical locations have been reviewed, as they provide more realistic information. Population-based studies on true functional dyspepsia (FD) are few, due to the logistic difficulties of excluding structural disease in large numbers of people. Globally, the prevalence of uninvestigated dyspepsia (UD) varies between 7%-45%, depending on definition used and geographical location, whilst the prevalence of FD has been noted to vary between 11%-29.2%. Risk factors for FD have been shown to include females and underlying psychological disturbances, whilst environmental/ lifestyle habits such as poor socio-economic status, smoking, increased caffeine intake and ingestion of non-steroidal anti-inflammatory drugs appear to be more relevant to UD. It is clear that dyspepsia and FD in particular are common conditions globally, affecting most populations, regardless of location.

Metronidazole resistance among Helicobacter pylori strains in Malaysia

Parasakthi N, Goh KL

Am J Gastroenterol, 1992 Jun;87(6):808.

PMID: 1590330

Primary and acquired resistance to clarithromycin among Helicobacter pylori strains in Malaysia

Parasakthi N, Goh KL

Am J Gastroenterol, 1995 Mar;90(3):519.

PMID: 7872306

Pediatric gastrointestinal endoscopy in malaysia

Boey CCM, Goh KL, Lee WS

Gastrointest Endosc, 1999 Feb;49(2):269-70.

PMID: 9925714

Retrieval of an impacted Dormia basket and stone in situ using a novel method

Ranjeev P, Goh Kl

Gastrointest Endosc, 2000 Apr;51(4 Pt 1):504-6.

PMID: 10744838

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.

The racial cohort phenomenon: seroepidemiology of Helicobacter pylori infection in a multiracial South-East Asian country

Goh KL, Parasakthi N

Eur J Gastroenterol Hepatol, 2001 Feb;13(2):177-83.

PMID: 11246618

BACKGROUND: Malaysia is a multiracial country where three major Asian races live together: Malay, Chinese and Indian. In addition, there are a number of native or indigenous races, particularly in East Malaysia. Differences in prevalence of gastric diseases between races have been noted, particularly with respect to peptic ulcer disease and gastric cancer. The aim of this study is to determine the prevalence rates and risk factors for Helicobacter pylori infection among various races in Malaysia.

METHODS: A large-scale prospective seroepidemiological study in West and East Malaysia using the HEL-p II commercial enzyme-linked immunosorbent assay kit (AMRAD, Melbourne, Australia) to detect H. pylori antibodies. Populations surveyed in West Malaysia were a rural community from Kuala Pilah, and blood donors from Kuala Lumpur and Kota Baru. Subjects studied in East Malaysia were volunteer blood donors from Kota Kinabalu, and blood donors and healthy volunteers from Sibu. Statistical analyses using multiple logistic regression analysis were carried out to identify independent risk factors for H. pylori infection

RESULTS: A total of 2,381 subjects were evaluated. H. pylori prevalence varied from different areas of study and ranged from a low of 26.4% in blood donors from Kota Baru to a high of 55.0% in Kota Kinabalu. The most striking differences, however, were noted in the prevalence rates among different racial groups. Prevalence rates among the Malays ranged from 11.9 to 29.2%, while the Chinese ranged from 26.7 to 57.5%, and those of Indians in two studies were 49.4 and 52.3%. In every location, Malays had a significantly lower prevalence compared with the other races. The highest prevalence rates were recorded among the indigenous races in Kota Kinabalu, East Malaysia. There was no difference between males and females in the studies. An increasing trend with age was noted in the majority of studies; however, no increase in prevalence rates was noted among the Malays.

CONCLUSIONS: The pattern of infection in a multiracial population in Malaysia points to a 'racial cohort' phenomenon. The infection appears to be confined to a racial group, with the Malays having consistently low prevalence rates. This observation may provide clues to the mode of transmission of infection.

Fulltext Burden of Dyspepsia in Rural and Urban Asia: Author's Reply

Mahadeva S, Goh KL

J Neurogastroenterol Motil, 2012 Apr;18(2):230.

PMID: 22523739 DOI: 10.5056/jnm.2012.18.2.230

Fulltext Commentary: changing aetiology of peptic ulcers

Goh KL, Chan WK

Aliment Pharmacol Ther, 2012 Aug;36(3):291-2; discussion 292-3.

PMID: 22747451 DOI: 10.1111/j.1365-2036.2012.05164.x

Fulltext Evaluation of patient satisfaction of an outpatient colonoscopy service in an asian tertiary care hospital

Chan WK, Goh KL

Gastroenterol Res Pract, 2012;2012:561893.

PMID: 22606201 DOI: 10.1155/2012/561893

Aim. To evaluate patient satisfaction towards an outpatient colonoscopy service and analyze areas of dissatisfaction for potential improvement. Method. Consecutive patients attending the outpatient diagnostic colonoscopy service in University of Malaya Medical Centre between 1st February and 31th July 2010 were interviewed using a questionnaire modified from the modified Group Health Association of America-9 (mGHAA-9) questionnaire. Favorable/unfavorable responses to each question, contribution of each question to unfavorable responses, and effect of waiting times on favorable/unfavorable response rates were analyzed. Results. Interview was carried out on 426 patients (52.1% men). Mean age ± standard deviation was 61.3 ± 12.9 years old. Mean waiting times for colonoscopy appointment and on colonoscopy day were 3.8 ± 2.7 months and 1.1 ± 0.8 hours, respectively. The main factors that contributed to unfavorable responses were bowel preparation followed by waiting times for colonoscopy appointment and on colonoscopy day (32.3%, 27.5%, and 19.6%, resp.). Favorable responses diminished to undesirable levels when waiting times for colonoscopy appointment and on colonoscopy day exceeded 1 month and 1 hour, respectively. Conclusion. Bowel preparation and waiting times were main factors for patient dissatisfaction. Waiting times for colonoscopy appointment and on colonoscopy day should not exceed 1 month and 1 hour, respectively, to maintain acceptable levels of patient satisfaction.
Study site: outpatient endoscopy, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Early detection of pancreatic cancer: a possibility in some cases but not a reality in most

Goh KL, Yoon BK

J Dig Dis, 2012 Aug;13(8):389-92.

PMID: 22788923 DOI: 10.1111/j.1751-2980.2012.00609.x

Pancreatic cancer is notoriously difficult to diagnose until a late stage when curative options are no longer available. Owing to its relatively low incidence and the lack of sensitivity of current diagnostic tool, screening of pancreatic cancer in the general population is not recommended. However, in high-risk individuals, especially those with well-described genetic syndromes and a strong family history of pancreatic cancer, screening can be carried out. Detection of a lesion of the diameter

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.

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.

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.

Appropriateness of colonoscopy using the ASGE guidelines: experience in a large Asian hospital

Chan TH, Goh KL

Chin J Dig Dis, 2006;7(1):24-32.

PMID: 16412034

The is currently a heavy burden on endoscopy services worldwide and although guidelines for the appropriate use of esophagogastroduodenoscopy (EGD) have been well studied, there are few such studies with respect to colonoscopy and none for the Asia-Pacific region. This study aimed, firstly, to determine the 'appropriateness of colonoscopy' for procedures performed in the endoscopy unit of a large Asian hospital using the American Society of Gastrointestinal Endoscopy (ASGE) 2000 guidelines, and secondly, to determine predictive factors including 'appropriateness of colonoscopy' for positive findings and colorectal cancer (CRC).

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