MyMedR

Crohn's disease in adults: observations in a multiracial Asian population

Hilmi I, Tan YM, Goh KL

World J Gastroenterol, 2006 Mar 07;12(9):1435-8.

AIM: To determine the demography and clinical presentation of CD and secondly to determine any differences in the prevalence between the different ethnic groups in a multiracial Asian population.

METHODS: Patients with CD who were seen in 2001-2003 in the University of Malaya Medical Centre (UMMC) were enrolled in this study. Prevalence of disease was calculated for the group as a whole and by race with hospital admissions per ethnic group as the denominator.

RESULTS: Thirty-four patients were diagnosed to have CD. Basic demographic data of patients; male:female 17:17; mean age 29.1 years (+/-13.5 years); ethnic group: Malays 5 (14.7%), Chinese 12 (35.3%) and Indians 17 (50%).Twenty-six (76.5%) were diagnosed under the age of 40 and 8 (23.5%) were diagnosed over the age of 40. Location of the disease was as follows:ileocolonic 13 (38.2%), terminal ileum only 9 (26.5%), colon only 8 (23.5%), and upper gastrointestinal 4 (11.8%). Sixteen (47.1%) had penetrating disease, 9 (26.5%) had stricturing disease and 9 (26.5%) had non-penetrating and non-stricturing disease. The hospital admission prevalence of CD was 26.0 overall, Indians 52.6, Chinese 6.9, and Malays 9.3 per 10(5) admissions per ethnic group. The difference between Indians and Malays: [OR 5.67 (1.97, 17.53) P<0.001] was statistically significant but not between the Indians and the Chinese [OR 1.95 (0.89, 4.35) P=0.700]. The difference between the Chinese and the Malays was also not statistically significant. [OR 2.90 (0.95, 9.42) P=0.063].

CONCLUSION: The clinical presentation of CD is similar to the Western experience. Although the overall prevalence is low,there appears to be a clear racial predominance among the Indians.

Fulltext Gastro-oesophageal reflux disease in 'difficult-to-control' asthma: prevalence and response to treatment with acid suppressive therapy

Wong CH, Chua CJ, Liam CK, Goh KL

Aliment Pharmacol Ther, 2006 May 1;23(9):1321-7.

PMID: 16629937 DOI: 10.1111/j.1365-2036.2006.02888.x

BACKGROUND: The causal association between gastro-oesophageal reflux disease (GERD) and difficult-to-control asthma is unclear.
AIM: To determine the prevalence of GERD and response to proton pump inhibitor therapy in patients with difficult-to-control asthma.
METHODS: Consecutive patients with difficult-to-control asthma as defined by persistent and recurrent symptoms despite on optimal asthmatic medications were recruited for the study. GERD was diagnosed by symptoms, gastroscopy and 24-h oesophageal pH monitoring. All patients were prescribed a course of lansoprazole 30 mg daily for 8 weeks. Improvement to treatment was assessed by a change in pulmonary symptom score and also by patient's subjective assessment of improvement.
RESULTS: Seventeen of 30 (56.7%) patients with difficult-to-control asthma were diagnosed with GERD. Pulmonary symptom score improved significantly only in patients with GERD (35.0 to 21.0; P = 0.002). Twelve of 16 (75%) patients with GERD reported an improvement in asthma symptoms; 1 of 11 (9.1%) without GERD reported mild symptom improvement. There was no significant change in peak expiratory flow rate and forced expiratory volume.
CONCLUSIONS: More than half of patients with difficult-to-control asthma were diagnosed with GERD. In these patients the severity of asthma improved significantly with potent acid suppression therapy. This underlines the critical role of acid reflux in this subset of patients with difficult-to-control asthma.
Study site: Respiratory clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

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.

Fulltext Chronic hepatitis B infection and liver cancer

Wong Ch, Goh K

Biomed Imaging Interv J, 2006 Jul;2(3):e7.

PMID: 21614253 MyJurnal DOI: 10.2349/biij.2.3.e7

Hepatitis B virus (HBV) is one of the most well recognised human carcinogens. Since its discovery about 40 years ago, HBV has been studied extensively. This article summarises the evidence derived from various studies including epidemiological, animal model, histopathology studies and molecular genetics studies leading to the establishment of HBV as the main aetiological agent for hepatocellular carcinoma (HCC). The reduction in the incidence of childhood HCC due to mass hepatitis B vaccination in Taiwan is a dramatic demonstration of the critical aetiological role of hepatitis B in HCC. Thus it is essential for interventionalists to understand the epidemiological and pathogenesis of HCC to ensure optimal patient care.

Fulltext A second case of diphyllobothriasis in Malaysia

Rohela M, Jamaiah I, Goh KL, Nissapatorn V

Southeast Asian J. Trop. Med. Public Health, 2006 Sep;37(5):896-8.

PMID: 17333730

Diphyllobothriasis was first reported in Malaysia in 2002. We are reporting a second case of diphyllobothriasis in Malaysia. The patient was a 37-year-old Chinese male seen at the outpatient clinic with a complaint of passing strands of white color flat worm in his stool. He had no other abdominal complaints. Laboratory and physical examinations were normal. Diphyllobothrium latum was confirmed by examination of the gravid proglottids passed out and the typical operculated eggs expelled from the ruptured proglottids. The patient had a history of eating raw fish. He was treated with a single dose of praziquantel.
Study site: Outpatient clinic, University Malaya Specialist Center (UMSC), Kuala Lumpur, Malaysia

Chemoprevention of colorectal cancer with nonsteroidal anti-inflammatory drugs

Hilmi I, Goh KL

Chin J Dig Dis, 2006;7(1):1-6.

PMID: 16412030 DOI: 10.1111/j.1443-9573.2006.00236.x

Colorectal carcinoma is one of the commonest solid organ tumors in the world and its prevalence appears to be increasing in Asia. Recently, there has been much interest in various chemotherapeutic agents for the management of this condition, in particular nonsteroidal anti-inflammatory drugs (NSAIDs). There is a large amount of data that suggest traditional NSAIDs, as well as the new cyclooxygenase (COX)-2 selective inhibitors such as rofecoxib and celecoxib, have a role in the setting of primary and secondary prevention, and adjuvant therapy of both sporadic colorectal carcinoma and familial adenomatous polyposis. This review examines some of this data, as well as the potential problems and limitations of using these agents, particularly in light of the recent withdrawal of rofecoxib.

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).

Ethnicity and H. pylori as risk factors for gastric cancer in Malaysia: A prospective case control study

Goh KL, Cheah PL, Md N, Quek KF, Parasakthi N

Am J Gastroenterol, 2007 Jan;102(1):40-5.

PMID: 17100981

To determine the risk factors for gastric cancer (GCA), with particular emphasis on ethnicity in our multiracial population.

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.

Gastro-oesophageal reflux disease in chronic laryngitis: prevalence and response to acid-suppressive therapy

Qua CS, Wong CH, Gopala K, Goh KL

Aliment Pharmacol Ther, 2007 Feb 1;25(3):287-95.

PMID: 17269990

Gastro-oesophageal reflux is thought to cause chronic laryngitis through laryngopharyngeal reflux. Response of laryngitis to treatment with acid-suppressive therapy supports this causal link.

Efficacy of pantoprazole 20 mg daily compared with esomeprazole 20 mg daily in the maintenance of healed gastroesophageal reflux disease: a randomized, double-blind comparative trial - the EMANCIPATE study

Goh KL, Benamouzig R, Sander P, Schwan T, EMANCIPATE

Eur J Gastroenterol Hepatol, 2007 Mar;19(3):205-11.

PMID: 17301646

To compare the efficacy and tolerability of pantoprazole 20 mg once daily with that of esomeprazole 20 mg once daily for 6 months as maintenance therapy in patients with previously healed gastroesophageal reflux disease.

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.

HUITAI rapid urease test: a new ultra-rapid biopsy urease test for the diagnosis of Helicobacter pylori infection

Goh KL, Cheah PL, Navaratnam P, Chin SC, Xiao SD

J Dig Dis, 2007 Aug;8(3):139-42.

PMID: 17650225

The gastric biopsy urease test is an accurate and robust diagnostic test for Helicobacter pylori infection. Large endoscopy units use their own homemade unbuffered ultra-rapid urease test for diagnosis of H. pylori infection but several commercial rapid urease tests are available.

Fulltext Tolerance and safety to colonoscopy with conscious sedation in Malaysian adults

Ma WT, Mahadeva S, Quek KF, Goh KL

Med J Malaysia, 2007 Oct;62(4):313-8.

PMID: 18551936 MyJurnal

Tolerance to colonoscopy varies between populations and data from the South East Asian region is lacking. We aimed to determine tolerance and safety with to colonoscopy; conscious sedation and identify risk factors for complications in Malaysian adults. Consecutive outpatients undergoing colonoscopy were enrolled prospectively. A combination of pethidine and midazolam were used and tolerance to colonoscopy assessed three hours post-procedure using a validated scale. All patients were monitored for cardiorespiratory depression and risk factors for complications were identified. Two hundred and eight patients (mean age 57.2 +/- 14.8 years, 48% female) were enrolled. The population ethnicity consisted of 45 (21.63%) Malays, 101 (48.56%) Chinese and 56 (26.92%) Indians. Conscious sedation was achieved with 5.0 +/- 1.1 mg of midazolam and 43.3 +/- 14.0 mg of pethidine. Thirty (14.4%) patients tolerated the procedure poorly and independent predictors included female gender (OR 2.93, 95% CI = 1.22 to 7.01) and a prolonged duration of procedure (OR 2.85, 95% CI = 1.08 to 7.48). Hypotension occurred in 13 (6.25%) patients, with age > 65 years as the only risk factor (OR 13.17, 95% CI = 1.28 to 137.92). A prolonged duration was the main cause of hypoxia (OR 5.49, 95% CI = 1.54 to 19.49), which occurred in 6 (2.88%) patients. No major complications occurred during the study period. The current practice of conscious sedation is safe and tolerated well by most adults in our population. However, poor tolerance in a notable minority may have significant clinical implications.

Study site: Division of Gastroenterology, Department of Medicine, University Malaya Medical Centre (UMMC)

Evaluation of the monoclonal stool antigen test for Helicobacter pylori in an Asian population with dyspepsia

Bhewa Y, Hilmi I, Cheah PL, Navaratnam P, Goh KL

J Dig Dis, 2007 Nov;8(4):207-10.

PMID: 17970878

Although well established in the West, stool antigen tests (SAT) are not widely used in Asia. Data on the accuracy of this test in Asia is sparse and, to date, there have been no studies looking at the more refined monoclonal SAT. The aim of this study is to validate the diagnostic accuracy of a stool antigen test, Hp STAR, for the detection of Helicobacter pylori.

Changing trends in gastrointestinal disease in the Asia-Pacific region

Goh KL

J Dig Dis, 2007 Nov;8(4):179-85.

PMID: 17970873

The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asia-Pacific region. These changes are important as more than half of the world's population come from the region and therefore impact significantly on the global disease burden. The highest incidence of gastric cancer (GCA) has been reported from Asia and GCA remains a very important cancer. However time-trend studies have shown a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer has been steadily increasing in Asia with age-standardized incidence rates of some countries approaching that of the West. The pattern of acid-related diseases has also changed. Gastroesophageal reflux disease is a fast emerging disease with an increasing prevalence of reflux esophagitis and reflux symptoms. The prevalence of peptic ulcer disease has at the same time declined in step with a decrease in H. pylori infection. Many of the changes taking place mirror the Western experience of several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientific work will allow a clearer understanding of the key processes underlying these changes. With rapid modernization, lifestyle changes have been blamed for an increase in several diseases including gastroesophageal reflux disease, nonalcoholic fatty liver disease and colorectal cancer. A worrying trend has been the increase in obesity among Asians, which has been associated with an increase in metabolic diseases and various gastrointestinal cancers. Conversely, an improvement in living conditions has been closely linked to the decrease in GCA and H. pylori prevalence.

Fulltext Evaluation and management of dyspepsia - current perspectives

Goh KL

Malays Fam Physician, 2007;2(1):2-7.

PMID: 25606069

Fulltext Tumour seeding following percutaneous needle biopsy of hepatocellular carcinoma

Qua CS, Wong CH, Goh KL

Singapore Med J, 2008 Jan;49(1):e8-11.

PMID: 18204759

We report a hepatocellular carcinoma seeding following needle biopsy in a 57-year-old man who first presented with a focal hepatic lesion at another hospital. The patient had been a hepatitis B carrier for 20 years. Initial surveillance ultrasonography showed a lesion in segment IV, in the background of non-cirrhotic liver and normal serum alpha-foetoprotein level (8 ng/ml). A percutaneous needle biopsy was done and histopathology confirmed well-differentiated hepatocellular carcinoma. The patient had refused surgery and preferred to try traditional medicine. He presented to us four months after the initial biopsy with epigastric swelling. This was found to be due to a tumour seeding along the previous biopsy tract. He was given radiofrequency ablation (RFA) of tumour along the needle tract, in addition to the primary tumour. We conclude that the need for percutaneous needle biopsy should be critically evaluated in patients presenting with focal hepatic lesions and the role of RFA in treating tumour seeding needs further evaluation.

Observations of the Indian enigma is valid

Quek KF, Goh KL

Am J Gastroenterol, 2008 Jun;103(6):1575.

PMID: 18510600 DOI: 10.1111/j.1572-0241.2008.01850.x

Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat" strategy compared with prompt endoscopy in young Asians with dyspepsia

Mahadeva S, Chia YC, Vinothini A, Mohazmi M, Goh KL

Gut, 2008 Sep;57(9):1214-20.

PMID: 18441005 DOI: 10.1136/gut.2007.147728

To compare a Helicobacter pylori "test and treat" strategy with prompt endoscopy in young Asians with dyspepsia.

Displaying publications 81 - 100 of 333 in total