MyMedR

Fulltext Absence of Helicobacter pylori is not protective against peptic ulcer bleeding in elderly on offending agents: lessons from an exceptionally low prevalence population

Lee YY, Noridah N, Syed Hassan SA, Menon J

PeerJ, 2014;2:e257.

PMID: 24688841 DOI: 10.7717/peerj.257

Aim. Helicobacter pylori (H. pylori) infection is exceptionally rare in population from the north-eastern region of Peninsular Malaysia. This provides us an opportunity to contemplate the future without H. pylori in acute non-variceal upper gastrointestinal (GI) bleeding. Methods. All cases in the GI registry with GI bleeding between 2003 and 2006 were reviewed. Cases with confirmed non-variceal aetiology were analysed. Rockall score > 5 was considered high risk for bleeding and primary outcomes studied were in-hospital mortality, recurrent bleeding and need for surgery. Results. The incidence of non-variceal upper GI bleeding was 2.2/100,000 person-years. Peptic ulcer bleeding was the most common aetiology (1.8/100,000 person-years). In-hospital mortality (3.6%), recurrent bleeding (9.6%) and need for surgery (4.0%) were uncommon in this population with a largely low risk score (85.2% with score ≤5). Elderly were at greater risk for bleeding (mean 68.5 years, P = 0.01) especially in the presence of duodenal ulcers (P = 0.04) despite gastric ulcers being more common. NSAIDs, aspirin and co-morbidities were the main risk factors. Conclusions. The absence of H. pylori infection may not reduce the risk of peptic ulcer bleeding in the presence of risk factors especially offending drugs in the elderly.

Fulltext An open-label pilot study to assess the efficacy and safety of virgin coconut oil in reducing visceral adiposity

Liau KM, Lee YY, Chen CK, Rasool AH

ISRN Pharmacol, 2011;2011:949686.

PMID: 22164340 DOI: 10.5402/2011/949686

Introduction. This is an open-label pilot study on four weeks of virgin coconut oil (VCO) to investigate its efficacy in weight reduction and its safety of use in 20 obese but healthy Malay volunteers. Methodology. Efficacy was assessed by measuring weight and associated anthropometric parameters and lipid profile one week before and one week after VCO intake. Safety was assessed by comparing organ function tests one week before and one week after intake of VCO. Paired t-test was used to analyse any differences in all the measurable variables. Results. Only waist circumference (WC) was significantly reduced with a mean reduction of 2.86 cm or 0.97% from initial measurement (P = .02). WC reduction was only seen in males (P < .05). There was no change in the lipid profile. There was a small reduction in creatinine and alanine transferase levels. Conclusion. VCO is efficacious for WC reduction especially in males and it is safe for use in humans.

Fulltext Food Allergy and Helicobacter pylori Infection: A Systematic Review

Ma ZF, Majid NA, Yamaoka Y, Lee YY

Front Microbiol, 2016;7:368.

PMID: 27047479 DOI: 10.3389/fmicb.2016.00368

Based on the hygiene hypothesis, a low prevalence of Helicobacter pylori (H. pylori) infection may explain the recent high prevalence of allergic diseases including food allergy. However, there are very few studies that investigate the relationship between H. pylori and food allergy.

Diagnosis and management of fatty liver

Tan PO, Mustaffa N, Tan SS, Lee YY

J R Coll Physicians Edinb, 2020 Sep;50(3):256-261.

PMID: 32936098 DOI: 10.4997/JRCPE.2020.308

Globally, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing rapidly and constitutes a significant healthcare burden due to associated complications including hepatic (cirrhosis and hepatocellular cancer) and non-hepatic (cardiovascular deaths) disorders. It is closely linked to insulin resistance and metabolic syndrome but moderate alcohol consumption frequently coexists. Recently, genetic polymorphisms were implicated in the development of non-obese NAFLD. Apart from liver biopsy, in order to assess for steatosis, fibrosis and non-alcoholic steatohepatitis (NASH), advances in non-invasive serum tests and elastography have provided similarly accurate, more accessible and safer alternatives for risk stratification. As for treatment in 2020, weight loss and lifestyle modification remain the central strategy. Unfortunately, no pharmacological agents have been approved thus far, but there are a number of potential therapies in the pipeline for fibrosis and NASH. Treatment of underlying metabolic disorders is important. While the term NAFLD was coined in the 1980s, more recent understanding may support a change in nomenclature highlighting its strong metabolic roots.

Fulltext Editorial: simultaneous, prolonged monitoring of the acid pocket and oesophageal reflux. Authors' reply

Ma ZF, Deraman MA, Coyle C, Lee YY

Aliment Pharmacol Ther, 2020 07;52(2):398-399.

PMID: 32592257 DOI: 10.1111/apt.15835

Value of CT pulmonary arteriography and venography in the evaluation of venous thromboembolism in a multiracial Asian population

Lee YJ, Zakaria R, Manaf ZA, Mohamed Z, Lee YY

Chin Med J (Engl), 2013;126(11):2049-53.

PMID: 23769556

There is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis (DVT) in suspected acute pulmonary embolism (PE). The aim was to investigate the value for using such an approach in a multiracial Asian population.

Corrigendum: Food Allergy and Helicobacter pylori Infection: A Systematic Review

Ma ZF, Abdul Majid N, Yamaoka Y, Lee YY

Front Microbiol, 2016;7:1232.

PMID: 27512393 DOI: 10.3389/fmicb.2016.01232

[This corrects the article on p. 368 in vol. 7, PMID: 27047479.].

Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place

Abdul Rani R, Raja Ali RA, Lee YY

Intest Res, 2016 Oct;14(4):297-304.

PMID: 27799880

Irritable bowel syndrome (IBS), a common gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. We examined the similarities and differences in IBS and IBD, and offer new thoughts and approaches to the disease paradigm.

Fulltext Epidemiological differences of common liver conditions between Asia and the West

Jayaraman T, Lee YY, Chan WK, Mahadeva S

JGH Open, 2020 Jun;4(3):332-339.

PMID: 32514433 DOI: 10.1002/jgh3.12275

Liver diseases form a heterogenous group of acute and chronic disorders of varying etiologies. Not only do they result in significant morbidity and mortality, but they also lead to a marked reduction in quality of life, together with a high socioeconomic burden globally. A better understanding of their global distribution is necessary to curb the massive health-care and socioeconomic burden that they entail. Notable differences and similarities have been described between common liver disease conditions occurring in Asia and the West (Europe and North America), giving rise to the need for an updated collective appraisal of this subject. In this review, the epidemiological differences of common liver conditions, specifically acute liver failure, drug-induced liver injury, acute-on-chronic liver failure, hepatocellular carcinoma, and non-alcoholic fatty liver disease, between Asia and the West are discussed.

Management of refractory heartburn: are we convinced that surgery is better than medical treatment?

Jalil MABM, Wong Z, Ali RAR, Lee YY

J R Coll Physicians Edinb, 2020 Mar;50(1):51-53.

PMID: 32539039 DOI: 10.4997/JRCPE.2020.114

Have we found the panacea to COVID-19 with remdesivir, an old but newly packaged drug?

Thalha AMM, Lee YY, Besari A, Omar SFS

J R Coll Physicians Edinb, 2020 06;50(2):159-161.

PMID: 32568289 DOI: 10.4997/JRCPE.2020.217

Fulltext Anorectal Manometry in Defecatory Disorders: A Comparative Analysis of High-resolution Pressure Topography and Waveform Manometry

Lee YY, Erdogan A, Yu S, Dewitt A, Rao SSC

J Neurogastroenterol Motil, 2018 Jul 30;24(3):460-468.

PMID: 29879762 DOI: 10.5056/jnm17081

Background/Aims: Whether high-resolution anorectal pressure topography (HRPT), having better fidelity and spatio-temporal resolution is comparable to waveform manometry (WM) in the diagnosis and characterization of defecatory disorders (DD) is not known.

Methods: Patients with chronic constipation (Rome III) were evaluated for DD with HRPT and WM during bearing-down "on-bed" without inflated rectal balloon and "on-commode (toilet)" with 60-mL inflated rectal balloon. Eleven healthy volunteers were also evaluated.

Results: Ninety-three of 117 screened participants (F/M = 77/16) were included. Balloon expulsion time was abnormal (＞ 60 seconds) in 56% (mean 214.4 seconds). A modest correlation between HRPT and WM was observed for sphincter length (R = 0.4) and likewise agreement between dyssynergic subtypes (κ = 0.4). During bearing down, 2 or more anal pressure-segments (distal and proximal) could be appreciated and their expansion measured with HRPT but not WM. In constipated vs healthy participants, the proximal segment was more expanded (2.0 cm vs 1.0 cm, P = 0.003) and of greater pressure (94.8 mmHg vs 54.0 mmHg, P = 0.010) during bearing down on-commode but not on-bed.

Conclusions: Because of its better resolution, HRPT may identify more structural and functional abnormalities including puborectal dysfunction (proximal expansion) than WM. Bearing down on-commode with an inflated rectal balloon may provide additional dimension in characterizing DD.

Fulltext The deadly ebola threat in the midst of an overwhelming dengue epidemic

Besari AM, Md Noor SS, Lee YY

Malays J Med Sci, 2014 Nov-Dec;21(6):9-13.

PMID: 25897277 MyJurnal

The recent death tolls and morbidities associated with two deadly viral haemorrhagic fevers (VHFs), i.e., Ebola and dengue, are simply shocking. By the end of August 2014, 65 672 people were afflicted with dengue fever (DF) in Malaysia, with 9505 from Kelantan, and there were 128 reported deaths. More astounding are the death tolls associated with Ebola: 3091 deaths from 6574 reported cases so far. It is not difficult to imagine the potential disaster if Ebola spreads beyond Africa. VHFs are characterised by an acute onset of fever, vascular disruption and a rapid progression to shock and death. The revised World Health Organization (WHO) 2012 classification (dengue with and without warning signs and severe dengue) is more clinically relevant and allows more streamlined admission. With good administrative support and public health and governmental efforts, the dengue epidemic in Malaysia is now more contained. However, there should be no laxity with the imminent lethal Ebola threat. Human-to-human transmission is an important mechanism for the spread of Ebola, and this calls for strict precautions regarding contact with any suspected cases. In contrast, the control and elimination of dengue would require successful control of the vectors and their breeding sites.

Fulltext A Rome III survey of functional dyspepsia among the ethnic Malays in a primary care setting

Lee YY, Wahab N, Mustaffa N, Daud N, Mohd Noor N, Shaaban J, et al.

BMC Gastroenterol, 2013;13:84.

PMID: 23672671 DOI: 10.1186/1471-230X-13-84

Backgrounds: The study aimed to survey for FD in a primary care setting in a population known to have an extremely low prevalence of Helicobacter pylori (H. pylori) infection, with the hypothesis that in such a population, dyspepsia should have been relatively less common.
Methods: The Rome III FD Diagnostic Questionnaire was translated into the Malay language and later tested for reliability. A prospective cross-sectional survey was then performed involving 160 Malay patients attending primary care clinic after informed consent. Patients positive for symptoms of FD were subjected to upper endoscopy and exclusion of H. pylori infection. Univariable and multivariable analyses were used to test for associated risk factors.
Results: The back-translated questionnaire was similar to the original English version and was reliable (Cronbach Alpha-coefficient 0.85). Of the 160 surveyed subjects, 19 of them (11.9%) had symptoms of FD. With exclusion of erosive diseases (3/160 or 1.9%) from endoscopy, 16 subjects or 10% had FD. None of the 19 subjects were positive for H. pylori infection. Epigastric pain syndrome was present in 11/16 (68.8%) and the rest, overlap with postprandial distress syndrome. With multivariable analysis, a married status (OR = 8.1; 95% CI 1.0-36.5) and positive psychosocial alarm symptoms (OR = 3.8; 95% CI 1.0-14.0) were associated with FD. Of those married subjects, females were more likely to have FD and psychosocial symptoms than men (6.3% vs. 1.9%), P = 0.04.
Conclusions: FD was more common than one had expected among Malays attending primary care clinic in an area with low prevalence of H. pylori.
Keywords: Functional dyspepsia, Malays, Rome III, Females, Marriage, Psychosocial alarm
Questionnaire: Rome III Functional Dyspepsia Diagnostic questionnaire; Red Flag Questionnaire; Psychosocial Alarm Questionnaire; Hospital Anxiety Depression Scale; HADS

Study site: primary care clinic within the university hospital of Universiti Sains Malaysia (USM)

Growth reduction among primary schoolchildren with light trichuriasis in Malaysia treated with albendazole

Tee MH, Lee YY, Majid NA, Noori NM, Raj SM

Southeast Asian J. Trop. Med. Public Health, 2013 Jan;44(1):19-24.

PMID: 23682433

We studied asymptomatic primary schoolchildren in northeastern Malaysia with light to moderate trichuriasis to determine the effect of albendazole treatment on growth rates and TNF-alpha levels. Thirty-seven schoolchildren aged 6-7 years with stool samples positive for Trichuris trichiura and negative for other geohelminths and protozoa were randomized to receive albendazole 400 mg or a placebo daily for 2 days. Anthropometric parameters at baseline, 3, 6 and 12 months were compared between the 2 groups. The placebo group had a significantly greater increase in height (p = 0.04) than the albendazole treatment group. There were no significant differences in urinary TNF-alpha levels (p = 0.8) between the 2 groups and no significant changes between baseline and 1 month post-treatment levels. Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.

Deleted in Colorectal Cancer (DCC) gene polymorphism is associated with H. pylori infection among susceptible Malays from the north-eastern region of Peninsular Malaysia

Maran S, Lee YY, Xu S, Rajab NS, Hasan N, Mustaffa N, et al.

Hepatogastroenterology, 2013 Jan-Feb;60(121):124-8.

PMID: 22829558

Using genome-wide case-control association approach, the current study aimed to determine whether genetic polymorphism(s) is/are associated with H. pylori infection among ethnic Malays from the north-eastern region of Peninsular Malaysia, a region with an exceptionally low prevalence for H. pylori infection and gastric cancer.

Validity and reliability of the Malay-language translation of the Rome III Diagnostic Questionnaire for irritable bowel syndrome

Lee YY, Waid A, Tan HJ, Chua SB, Whitehead WE

J Gastroenterol Hepatol, 2012 Apr;27(4):746-50.

PMID: 22004172 DOI: 10.1111/j.1440-1746.2011.06943.x

The Malay language is widely used within the "Malay Archipelago" particularly in Malaysia, Indonesia, Philippines, Singapore and Brunei with a combined population of 300 million. There are no reliable data on the epidemiology of irritable bowel syndrome (IBS) in the Malay speaking population because the Rome Diagnostic Questionnaire has not been translated and validated for the Malay language. The current study aimed to translate and validate the Rome III IBS Diagnostic Questionnaire, Red Flag and Psychosocial Alarm questionnaires into the Malay language.

Fulltext Barrett's Esophagus in an Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection

Lee YY, Tuan Sharif SE, Syed Abd Aziz SH, Raj SM

ISRN Gastroenterol, 2011;2011:394734.

PMID: 21991505 DOI: 10.5402/2011/394734

Objective. This study was undertaken to gain an insight into the relationship between Helicobacter pylori (H. pylori) infection, Barrett's esophagus and reflux esophagitis in an area of exceptionally low prevalence of H. pylori infection. Methods. A total of 1895 consecutive upper endoscopies performed between January 2005 and July 2007 were reviewed. 120 cases of columnar-lined esophagus and endoscopic esophagitis were evaluated. H. pylori infection was determined using the urease test and/or histology. Results. The rate of endoscopic esophagitis was 5.49% (80 Malays, 24 non-Malays) while histological reflux esophagitis was found in 3.75% (56 Malays, 15 non-Malays). Barrett's esophagus was present in 0.79% (11 Malays, 4 non-Malays). H. pylori infection was present in 8/120 or 6.67% subjects. Conclusion. The low rate of Barrett's esophagus in this population does not support the hypothesis that the absence of H. pylori infection is more than a minor risk factor for Barrett's esophagus.

Fulltext Helicobacter pylori infection among Aborigines (the Orang Asli) in the northeastern region of Peninsular Malaysia

Rahim AA, Lee YY, Majid NA, Choo KE, Raj SM, Derakhshan MH, et al.

Am J Trop Med Hyg, 2010 Nov;83(5):1119-22.

PMID: 21036849 DOI: 10.4269/ajtmh.2010.10-0226

Whether the exceptionally low prevalence of Helicobacter pylori (HP) infection reported among Malays is also present among aborigines (the Orang Asli) living in northeastern Peninsular Malaysia is unknown. We studied asymptomatic Orang Asli from settlements situated 210 km from the city of Kota Bharu. The HP infection status was confirmed by a validated serology test. Nineteen percent of 480 Orang Asli tested positive for HP infection. The prevalence was 40.6% in the birth cohort of the 1940s and declined steadily in later cohorts to under 10% among 12-30 year olds. This may be related to the phases of relocation from the jungles into resettlement camps and ultimately into designated villages near rivers. The low prevalence pattern after the 1970s was probably partly a result of improvement in sanitation and hygiene practice in these villages but other unidentified factors may also be operating.

Fulltext Diagnostic accuracy of reused Pronto Drytest and CLOtest in the detection of Helicobacter pylori infection

Jamaludin S, Mustaffa N, Che Hamzah NA, Syed Abdul Aziz SH, Lee YY

BMC Gastroenterol, 2015;15:101.

PMID: 26264957 DOI: 10.1186/s12876-015-0332-0

Unchanged substrate in a negative rapid urease test may be reused to detect Helicobacter pylori (H. pylori). This could potentially reduce costs and wastage in low prevalence and resource-poor settings. We thus aimed to investigate the diagnostic accuracy of reused Pronto Dry and CLOtest kits, comparing this to the use of new Pronto Dry test kits and histopathological evaluation of gastric mucosal biopsies.

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