1
|
Zhang J, Chen T, Wen Y, Siah KTH, Tang X. Insights and future prospects of traditional Chinese medicine in the treatment of functional dyspepsia. Phytomedicine 2024; 127:155481. [PMID: 38452693 DOI: 10.1016/j.phymed.2024.155481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/20/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Functional dyspepsia (FD) is a prevalent and challenging gastrointestinal disorder. Conventional medicine often faces limitations in providing effective treatment for FD, thus indicating the need to explore alternative approaches. Traditional Chinese medicine (TCM), which is rooted in ancient Chinese traditions and has evolved over thousands of years, offers a holistic approach to well-being. TCM incorporates herbal remedies, acupuncture, and other therapies while shaping the future of complementary and alternative medicine. PURPOSE To review the existing literature on the current status and future prospects of using TCM to treat FD. METHODS We extensively searched the PubMed, Google Scholar, Embase, an China National Knowledge Internet databases from inception to May 31, 2023 to identify relevant literature. We also searched the reference lists of the included articles. RESULTS Clinical evidence-based research has explored the efficacy of TCM in treating FD. Recent research has illuminated the multifaceted mechanisms through which TCM interventions affect FD. TCM is a promising alternative, as it emphasizes a holistic approach and holds potential advantages in addressing the complex nature of FD. CONCLUSIONS The integration of TCM and Western medicine offers a comprehensive approach to understanding and managing FD by bridging traditional wisdom with modern scientific understanding. This paper highlights the practical implications of this integration, the challenges to be addressed, and the potential for international collaboration to further elucidate the efficacy of TCM. However, continued research and dialog are needed to advance the modern development of TCM and to improve the quality of life of FD patients.
Collapse
Affiliation(s)
- Jiaqi Zhang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ting Chen
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongtian Wen
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Xudong Tang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| |
Collapse
|
2
|
Ng CYJ, Lai NPY, Ng WM, Siah KTH, Gan RY, Zhong LLD. Chemical structures, extraction and analysis technologies, and bioactivities of edible fungal polysaccharides from Poria cocos: An updated review. Int J Biol Macromol 2024; 261:129555. [PMID: 38278384 DOI: 10.1016/j.ijbiomac.2024.129555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Poria cocos is a popular medicinal food. Polysaccharides are the key component of Poria cocos, forming 70-90 % of the dry sclerotia mass. Recent studies indicate that Poria cocos polysaccharides (PCP-Cs) have multiple beneficial functions and applications. A literature search was conducted using the Web of Science Core Collection and PubMed databases. For this review, we provided an updated research progress in chemical structures, various extraction and analysis technologies, bioactivities of PCP-Cs, and insights into the directions for future research. The main polysaccharides identified in Poria cocos are water-soluble polysaccharides and acidic polysaccharides. Hot water, alkali, supercritical fluid, ultrasonic, enzyme, and deep eutectic solvent-based methods are the most common methods for PCP-Cs extraction. Technologies such as near-infrared spectroscopy, high-performance liquid chromatography, and ultraviolet-visible spectrophotometry, are commonly used to evaluate the qualities of PCP-Cs. In addition, PCP-Cs have antioxidant, immunomodulatory, neuroregulatory, anticancer, hepatoprotective, and gut microbiota regulatory properties. Future research is needed to focus on scaling up extraction, enhancing quality control, elucidating mechanisms of bioactivities, and the utilisation of PCP-Cs in food industries. Overall, Poria cocos is a good source of edible fungi polysaccharides, which can be developed into functional foods with potential health benefits.
Collapse
Affiliation(s)
- Chester Yan Jie Ng
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
| | - Nicole Poh Yee Lai
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
| | - Wen Min Ng
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
| | - Kewin Tien Ho Siah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore; Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore.
| | - Ren-You Gan
- Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), 31 Biopolis Way, Singapore 138669, Singapore; Department of Food Science and Technology, Faculty of Science, National University of Singapore, 2 Science Drive 2, Singapore 117542, Singapore.
| | - Linda L D Zhong
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
| |
Collapse
|
3
|
Wong ZY, Koh JH, Muthiah M, Koh B, Ong EYH, Ong CEY, Ou KQ, Lim WH, Tan DJH, Chee D, Siah KTH, Wong Y, Kaewdech A, Wijarnpreecha K, Kulkarni AV, Nah B, Huang DQ, Noureddin M, Ng CH, Teng M. Proton Pump Inhibitors Increases Longitudinal Risk of Mortality, Decompensation, and Infection in Cirrhosis: A Meta-Analysis. Dig Dis Sci 2024; 69:289-297. [PMID: 37968557 DOI: 10.1007/s10620-023-08150-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND/AIMS Proton pump inhibitors (PPIs) are frequently prescribed to cirrhotic patients, but there is limited longitudinal evidence regarding their effects. This study aimed to assess the impact of PPIs on adverse events in cirrhotic patients. METHODS A comprehensive search was conducted using the Medline and Embase databases to identify relevant articles. Pooled hazard ratios (HRs) using DerSimonian and Laird random-effects model were calculated to evaluate the risk of adverse events such as long-term mortality, hepatic decompensation, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and overall infection in cirrhotic patients with PPI use. RESULTS The analysis included 28 studies with 260,854 cirrhotic patients. The prevalence of PPI use among cirrhotic patients was 55.93%. The use of PPIs was not significantly associated with short-term mortality in cirrhotic patients. However, long-term mortality (HR 1.321, 95% CI 1.103-1.581, P = 0.002), decompensation (HR 1.646, 95% CI 1.477-1.835, P < 0.001), HE (HR 1.968, 95% CI 1.372-2.822, P < 0.001), SBP (HR 1.751, 95% CI 1.649-1.859, P < 0.001), and infection (HR 1.370, 95% CI 1.148-1.634, P < 0.001) were significantly associated with PPI use. Sensitivity analysis with prospective studies yielded similar results. CONCLUSION PPIs should be reserved for appropriate indications at lowest effective dose for cirrhotic patients due to the potential harm.
Collapse
Affiliation(s)
- Zhen Yu Wong
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jia Hong Koh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Benjamin Koh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Elden Yen Hng Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Christen En Ya Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Kai Qi Ou
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Yujun Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Apichat Kaewdech
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Benjamin Nah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | | | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Margaret Teng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| |
Collapse
|
4
|
Yoshida N, Draganov PV, John S, Neumann H, Rani RA, Hsu WH, Fernandopulle N, Siah KTH, Morgenstern R, Tomita Y, Inoue K, Dohi O, Hirose R, Itoh Y, Murakami T, Inagaki Y, Inada Y, Arantes V. Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study. Dig Dis Sci 2023; 68:3943-3952. [PMID: 37558800 DOI: 10.1007/s10620-023-08057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION In light-emitting diode (LED) and LASER colonoscopy, linked color imaging (LCI) and blue light/laser imaging (BLI) are used for lesion detection and characterization worldwide. We analyzed the difference of LCI and BLI images of colorectal lesions between LED and LASER in a multinational study. METHODS We prospectively observed lesions with white light imaging (WLI), LCI, and BLI using both LED and LASER colonoscopies from January 2020 to August 2021. Images were graded by 27 endoscopists from nine countries using the polyp visibility score: 4 (excellent), 3 (good), 2 (fair), and 1 (poor) and the comparison score (LED better/similar/LASER better) for WLI/LCI/BLI images of each lesion. RESULTS Finally, 32 lesions (polyp size: 20.0 ± 15.2 mm) including 9 serrated lesions, 13 adenomas, and 10 T1 cancers were evaluated. The polyp visibility scores of LCI/WLI for international and Japan-expert endoscopists were 3.17 ± 0.73/3.17 ± 0.79 (p = 0.92) and 3.34 ± 0.78/2.84 ± 1.22 (p < 0.01) for LED and 3.30 ± 0.71/3.12 ± 0.77 (p < 0.01) and 3.31 ± 0.82/2.78 ± 1.23 (p < 0.01) for LASER. Regarding the comparison of lesion visibility about between LED and LASER colonoscopy in international endoscopists, a significant difference was achieved not for WLI, but for LCI. The rates of LED better/similar/LASER better for brightness under WLI were 54.5%/31.6%/13.9% (International) and 75.0%/21.9%/3.1% (Japan expert). Those under LCI were 39.2%/35.4%/25.3% (International) and 31.3%/53.1%/15.6% (Japan expert). There were no significant differences in the diagnostic accuracy and the comparison score of BLI images between LED and LASER. CONCLUSIONS The differences of lesion visibility for WLI/LCI/BLI between LED and LASER in international endoscopists could be compared to those in Japanese endoscopists.
Collapse
Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Peter V Draganov
- Endoscopy Department, University of Florida, Gainesville, FL, USA
| | - Sneha John
- Department of Gastroenterology, Gold Coast University, Gold Coast, Australia
| | - Helmut Neumann
- First Medical Department, Interdisciplinary Endoscopy, University Medical Center Mainz, Mainz, Germany
| | - Rafiz Abdul Rani
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Wen-Hsin Hsu
- Division of Gastroenterology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | | | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ricardo Morgenstern
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | | | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Vitor Arantes
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
5
|
Futagami S, Kessoku T, Kasai Y, Higurashi T, Nakajima A, Agawa S, Yamawaki H, Nakamura K, Habiro M, Kawawa R, Ueki N, Higashida S, Watanabe Y, Yamato H, Yamamoto T, Takasaki Y, Ito K, Hojo M, Isayama H, Motoda N, Ohashi R, Siah KTH, Ng CK, Gwee KA. Comparison of pancreatic enzyme abnormalities and protease-activated receptor-2-positive eosinophils in the duodenum of patients with functional dyspepsia-irritable bowel syndrome overlap with functional dyspepsia alone in Asian populations. J Gastroenterol Hepatol 2023; 38:1778-1786. [PMID: 37278449 DOI: 10.1111/jgh.16250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/19/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIM Some patients with functional gastrointestinal disorders exhibit pancreatic dysfunctions and pancreatic enzyme abnormalities. Thus, we aimed to clarify whether significant differences in clinical characteristics, prevalence of pancreatic enzyme abnormalities, duodenal inflammation, and protease-activated receptor 2 (PAR2) expression levels related to hypersensitivity exist between functional dyspepsia (FD) alone and FD-irritable bowel syndrome (IBS) overlap group. METHODS Ninety-three patients based on the Rome IV criteria, FD alone (n = 44) and FD overlapped with IBS (n = 49) group were enrolled. The patients scored their own clinical symptoms after consuming high-fat meals. Serum trypsin, PLA2, lipase, p-amylase, and elastase-1 levels were measured. PAR2, eotaxin-3, and TRPV4 mRNA levels in duodenum were determined using real-time polymerase chain reaction methods. PRG2- and PAR2 in the duodenum were evaluated using immunostaining. RESULTS FD score and global GSRS in patients with FD-IBS overlap were significantly higher than FD alone. Although the prevalence of pancreatic enzyme abnormalities in patients with FD alone was significantly (P < 0.01) higher than that in FD-IBS overlap, the ratio of aggravation of clinical symptoms following high-fat intake in patients with FD-IBS overlap was significantly higher (P = 0.007) than that in patients with FD alone. PAR2- and PRG2-double positive cells were localized in the degranulated eosinophils in the duodenum of patients with FD-IBS overlap. The number of PAR2- and PRG2-double positive cells in FD-IBS overlap was significantly (P < 0.01) higher than FD alone. CONCLUSIONS Pancreatic enzyme abnormalities and PAR2 expression on degranulated eosinophils infiltrations in the duodenum may be associated with the pathophysiology of patients with FD-IBS overlap in Asian populations.
Collapse
Affiliation(s)
- Seiji Futagami
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
- Department of Palliative Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Yuki Kasai
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
| | - Shuhei Agawa
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Yamawaki
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Ken Nakamura
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Mayu Habiro
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Rie Kawawa
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Nobue Ueki
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Sakura Higashida
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Yoshiyuki Watanabe
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
- Division of Gastroenterology, Kawasaki Rinko General Hospital, Kawasaki, Japan
| | - Hiroshi Yamato
- Department of Medicine, Division of Gastroenterology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takatsugu Yamamoto
- Department of Medicine, Division of Gastroenterology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Koichi Ito
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Norio Motoda
- Department of Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Kewin Tien Ho Siah
- Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Stomach, Liver and Bowel Clinic, Gleneagles Hospital, Singapore
- The Gastroenterology Group, Gleneagles Hospital, Singapore
| |
Collapse
|
6
|
Lee VV, Lau NY, Blasiak A, Siah KTH, Ho D. Involving patients in the process: Development of a constipation patient-reported outcome measure for symptoms and quality of life. Comput Struct Biotechnol J 2023; 22:41-49. [PMID: 37822352 PMCID: PMC10563011 DOI: 10.1016/j.csbj.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
Objective Patient-reported outcome measures (PROMs) are useful standardized tools to measure current patient health status and well-being. While there are existing constipation-related PROMs, the majority of PROMs were not developed with adequate patient involvement and few examined content validity. Accordingly, the current study aimed to develop a constipation PROM with multiple phases of patient and clinician involvement. Methods To generate PROM items, 15 patients with chronic constipation (age range =28-79 years, 10 females) underwent a qualitative interview exploring their experiences with chronic constipation. Following that, eight clinical experts completed the content validity index (CVI) ratings of all the items generated to assess content validity. Based on results of the content validity assessment, relevant items were maintained and 12 participants with chronic constipation were re-interviewed to obtain feedback about comprehensibility, comprehensiveness and relevance. Results Six themes and 25 sub-themes emerged from the qualitative interview, and an initial list of 33 symptom items and 18 quality of life (QoL) items were generated. Based on the CVIs calculated, 11 symptom items and nine QoL items were maintained with the scale-content validity index indicating excellent content validity. Overall, participants indicated the PROM to be relevant, comprehensive and easy to understand however, minor amendments were made to improve the three qualities of interest. Conclusion The current study developed a constipation PROM that measures both symptom severity and constipation-related QoL, with supporting evidence for relevance, comprehensiveness and comprehensibility. Further prioritization should be given to validating and exploring new digital modalities of PROM administration.
Collapse
Affiliation(s)
- V Vien Lee
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ni Yin Lau
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Agata Blasiak
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- The N.1 Institute for Health, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Bia-Echo Asia Centre for Reproductivity Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
7
|
Tan CQL, Loh GYW, Benjamin TWR, Koh CJ, Mok JSR, Hartono JL, Chua KTC, Tan HH, Siah KTH. Dental trauma in endoscopy: A systematic review and experience of a tertiary endoscopy centre. World J Gastrointest Endosc 2023; 15:518-527. [PMID: 37663114 PMCID: PMC10473904 DOI: 10.4253/wjge.v15.i8.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy. AIM To determine frequency and effects of dental injury in endoscopy, we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature. METHODS Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284% of procedures. Review of literature identified a similar rate of 0.33%. RESULTS Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay. Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management. CONCLUSION Dental complications occur in approximately 1 in 300 of upper endoscopy cases. These are easily preventable by pre-endoscopy screening. Protocols to mitigate dental injury are also suggested.
Collapse
Affiliation(s)
- Chelsea Qiu Lin Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117594, Singapore
| | - Gabrielle Yi Wen Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117594, Singapore
| | - Tay Wei Rong Benjamin
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - John Shao Rong Mok
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - Juanda Leo Hartono
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | | | - Hee Hon Tan
- Division of Prosthodontics, National University Centre for Oral Health, Singapore 119074, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| |
Collapse
|
8
|
Ng JJJ, Loo WM, Siah KTH. Associations between irritable bowel syndrome and non-alcoholic fatty liver disease: A systematic review. World J Hepatol 2023; 15:925-938. [PMID: 37547029 PMCID: PMC10401413 DOI: 10.4254/wjh.v15.i7.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is associated with obesity and metabolic syndrome. IBS and non-alcoholic fatty liver disease (NAFLD) are highly prevalent entities worldwide and may share similar mechanisms including gut dysbiosis, impaired intestinal mucosal barrier and immune system activation.
AIM To systematically review their association according to the Preferred Reporting Items for Systemic Review and Meta-analyses guidelines.
METHODS PubMed, EMBASE and Cochrane Database of Systematic Reviews were searched for relevant papers. Manual searches were also performed.
RESULTS Six studies were included. Both IBS and NAFLD subjects had significantly more metabolic risk factors like hypertension, obesity, dyslipidaemia and diabetes. Our review showed that 23.2% to 29.4% of NAFLD patients had IBS. IBS was significantly higher in NAFLD patients compared with patients without NAFLD (23.2% vs 12.5%, P < 0.01). A higher proportion of IBS patients had NAFLD (65.8% to 74.0%). IBS patients were three times more likely to have NAFLD compared with non-IBS patients (P < 0.001). Two studies showed a significant correlation between the severity of IBS and NAFLD. The proportion of NAFLD subjects with IBS increased with NAFLD severity.
CONCLUSION Further prospective studies are warranted to evaluate the relationship and shared pathways between IBS and NAFLD, potentially leading to the development of future therapeutics.
Collapse
Affiliation(s)
- Jareth Jun Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Wai Mun Loo
- AliveoMedical, Mount Alvernia and Mount Elizabeth Hospitals, Singapore 574623, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore 119228, Singapore
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| |
Collapse
|
9
|
Zhang VRY, Ramachandran GK, Loo EXL, Soh AYS, Yong WP, Siah KTH. Volatile organic compounds as potential biomarkers of irritable bowel syndrome: A systematic review. Neurogastroenterol Motil 2023:e14536. [PMID: 36780514 DOI: 10.1111/nmo.14536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disease characterized by intermittent abdominal pain with altered bowel habits. Due to the condition's chronicity, patients suffer from poor quality of life, while the healthcare burden continues to grow. There is currently no reliable biomarker for the diagnosis of IBS, and the current approach depends on ruling-out organic diseases such as inflammatory bowel disease (IBD) and colorectal cancer by markers of inflammation like fecal calprotectin and C-reactive protein, or invasive procedures like a colonoscopy. Volatile organic compounds (VOCs) are growing in popularity as a biomarker due to its accuracy and ease of use. PURPOSE This systematic review of Medline and Cochrane's databases aimed to identify VOCs in the diagnosis of IBS. 57% of the studies proved that VOCs could identify IBS patients from healthy controls with AUC ranging from 0.83 to 0.99. Studies that distinguished IBS from IBD patients had slightly higher AUC of 0.87-0.98. Combining VOC into panels allowed the creation of discriminative algorithms. Though current research is limited by areas of heterogeneity in VOC sampling and small sample sizes, our review shows that VOC analysis has the potential to be a noninvasive point-of-care test that differentiates IBS from other organic gastrointestinal diseases.
Collapse
Affiliation(s)
| | | | - Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Paediatrics and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Wei Peng Yong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| |
Collapse
|
10
|
Gwee KA, Lee YY, Suzuki H, Ghoshal UC, Holtmann G, Bai T, Barbara G, Chen MH, Chua ASB, Gibson PR, Hou X, Liu J, Nakajima A, Pratap N, Sachdeva S, Siah KTH, Soh AYS, Sugano K, Tack J, Tan VPY, Tang X, Walker M, Wu DC, Xiao YL, Zulkifli KK, Toh C. Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms. J Gastroenterol Hepatol 2023; 38:197-209. [PMID: 36321167 DOI: 10.1111/jgh.16046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.
Collapse
Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Giovanni Barbara
- Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy
| | - Min-Hu Chen
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsong Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nitesh Pratap
- Krishna Institute of Medical Sciences, Secunderabad, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Victoria Ping Yi Tan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Xudong Tang
- Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Marjorie Walker
- Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Lian Xiao
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khairil Khuzaini Zulkifli
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Clarissa Toh
- Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore
| |
Collapse
|
11
|
Futagami S, Kessoku T, Kasai Y, Higurashi T, Nakajima A, Agawa S, Yamawaki H, Habiro M, Ueki N, Sanada I, Yamamoto M, Watanabe Y, Yamato H, Yamamoto T, Takasaki Y, Ito K, Hojo M, Isayama H, Siah KTH, Gwee KA. Comparison of clinical characteristics, eating behaviors, and clinical symptoms following fat intake in functional dyspepsia with functional dyspepsia with pancreatic enzyme abnormalities between Singapore and Japan. J Gastroenterol Hepatol 2022; 37:1525-1533. [PMID: 35501294 DOI: 10.1111/jgh.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 04/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM To clarify whether there were any significant differences in clinical symptoms and eating patterns between functional dyspepsia (FD) patients and FD with pancreatic enzyme abnormalities (FD-P) patients as refractory FD, we compared these factors in multicenter studies in Singapore and Japan. METHODS One hundred ninety-eight consecutive patients presenting with FD (n = 88), FD-P patients (n = 81) based on Rome III classification and controlled group (n = 39) recruited from six institutions in Singapore and Japan. Clinical characteristics, clinical symptoms for dietary fat intake, and eating behaviors were estimated using questionnaires. Anxiety and health-related quality of life were determined by STAI-state/-trait and SF-8, respectively. RESULTS There were no significant differences in age, sex, BMI, smoking, alcohol intake, past medical history, and history of allergy in FD and FD-P patients between Singapore and Japan. There were no significant differences in FD subtypes, gastrointestinal symptom rating scale score, severity of FD symptoms, and eating pattern in Singapore and Japan. Moreover, there were significant differences in certain eating behaviors between FD and FD-P patients in Singapore and Japan. Interestingly, epigastric pain and early satiety following fat meals in FD-P patients were significantly (P = 0.003 and P = 0.008, respectively) higher compared with those in FD patients in Japan. Physical component score in FD-P patients was significantly (P = 0.019) disturbed compared with those in FD patients in Japan. CONCLUSIONS Epigastric pain and early satiety following fat meals in FD-P patients may be useful tools to differentiate FD-P patients from FD patients in Japan.
Collapse
Affiliation(s)
- Seiji Futagami
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan.,Department of Palliative Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Yuki Kasai
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City Univeristy, Yokohama, Japan
| | - Shuhei Agawa
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Yamawaki
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Mayu Habiro
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Nobue Ueki
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Iori Sanada
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Mariko Yamamoto
- Division of Gastroenterology, Nippon Medical School, Tokyo, Japan
| | - Yoshiyuki Watanabe
- Division of Gastroenterology, Kawasaki Rinko General Hospital, Kawasaki, Japan
| | - Hiroshi Yamato
- Division of Gastroenterology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takatsugu Yamamoto
- Division of Gastroenterology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Koichi Ito
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok-Ann Gwee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,The Gastroenterology Group, Gleneagles Hospital, Singapore
| |
Collapse
|
12
|
Bek S, Teo YN, Tan XH, Fan KHR, Siah KTH. Association between irritable bowel syndrome and micronutrients: A systematic review. J Gastroenterol Hepatol 2022; 37:1485-1497. [PMID: 35581170 DOI: 10.1111/jgh.15891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut brain interaction with a multifactorial etiology. Food trigger avoidance is common among individuals with IBS and exclusion diets are gaining popularity. However, recent guidelines on IBS management cautioned regarding the use of unsupervised dietary therapy with concerns of development of poor eating habits and even nutritional deficiencies. We aimed to review the available literature on the effect of habitual and exclusion diets on micronutrient status as well as the role of micronutrient supplementation in alleviating IBS symptoms. METHODS Four electronic databases (PubMed, Embase, Cochrane, Web of Science) were searched for articles that reported micronutrient data in patients with IBS. Serum micronutrient levels and dietary intake of micronutrients in patients with IBS were collected. The extracted data were tabulated and organized by micronutrient type to observe for trends. RESULTS Twenty-six articles were included in this systematic review (12 interventional and 14 observational studies). Studies showed that generally IBS subjects had lower levels of vitamin B2, vitamin D, calcium, and iron at baseline compared with non-IBS subjects. Studies also found that exclusion diets were associated with lower intake of micronutrients especially vitamin B1, B2, calcium, iron, and zinc. There was a lack of interventional studies on micronutrients. CONCLUSION Irritable bowel syndrome patients are at risk of developing multiple micronutrient deficiencies that may have both localized gastrointestinal as well as systemic effects. Dietary management of IBS patients should include a proper dietitian review to ensure nutritional adequacy where possible.
Collapse
Affiliation(s)
- Schin Bek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin-Hui Tan
- Department of Dietetics, National University Hospital, Singapore
| | - Kristie H R Fan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,FAST and Chronic Programmes, Alexandra Hospital, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| |
Collapse
|
13
|
Siah KTH, Mahadeva S. Hypnotherapy and
IBS
: Time to take control of the Asian gut. JGH Open 2022; 6:445-446. [PMID: 35822116 PMCID: PMC9260201 DOI: 10.1002/jgh3.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology University Medicine Cluster, National University Hospital Singapore
- Department of Internal Medicine Yong Loo Lin School of Medicine, National University of Singapore Singapore
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine Faculty of Medicine, University of Malaya Kuala Lumpur Malaysia
| |
Collapse
|
14
|
Quek SXZ, Tan EXX, Ren YP, Muthiah M, Loo EXL, Tham EH, Siah KTH. Factors early in life associated with hepatic steatosis. World J Hepatol 2022; 14:1235-1247. [PMID: 35978672 PMCID: PMC9258263 DOI: 10.4254/wjh.v14.i6.1235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rise in prevalence of non-alcoholic fatty liver disease (NAFLD) mirrors the obesity epidemic. NAFLD is insidious but may gradually progress from simple steatosis to steatohepatitis, fibrosis and cirrhosis and/or hepatocellular carcinoma. Intervention strategies to ameliorate developmental programming of NAFLD may be more efficacious during critical windows of developmental plasticity.
AIM To review the early developmental factors associated with NAFLD.
METHODS Databases MEDLINE via PubMed, and EMBASE and Reference Citation Analysis were searched and relevant publications up to April 30, 2021 were assessed. Original research studies that included risk factors associated with early development of NAFLD in human subjects were included. These factors include: Maternal factors, intrauterine and prenatal factors, post-natal factors, genetic and ethnic predisposition, childhood and adolescence environmental factors. Studies were excluded if they were review articles or animal studies, case reports or conference abstracts, or if NAFLD was not clearly defined and assessed radiologically.
RESULTS Of 1530 citations identified by electronic search, 420 duplicates were removed. Of the 1110 citations screened from title and abstract, 80 articles were included in the final analysis. Genetic polymorphisms such as patatin-like phospholipase domain-containing protein 3 (PNPLA3) and membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) were associated with increased risk of NAFLD. Familial factors such as maternal obesogenic environment and parental history of hepatic steatosis was associated with offspring NAFLD. Longer duration of exclusive breastfeeding in infancy was associated with a lower risk of developing NAFLD later in life while metabolic dysfunction and/or obesity in adolescence was associated with increased risk of NAFLD. Studies relating to socioeconomic factors and its association with NAFLD reported confounding results.
CONCLUSION Maternal metabolic dysfunction during pregnancy, being exclusively breastfed for a longer time postnatally, diet and physical activity in childhood and adolescence are potential areas of intervention to decrease risk of NAFLD.
Collapse
Affiliation(s)
- Sabrina Xin Zi Quek
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Eunice Xiang-Xuan Tan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yi Ping Ren
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Mark Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore 119228, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore 119228, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| |
Collapse
|
15
|
Siah KTH, Mahadeva S. Post-COVID-19 functional gastrointestinal disorders: Prepare for a GI aftershock. J Gastroenterol Hepatol 2022; 37:413-414. [PMID: 35258135 PMCID: PMC9115068 DOI: 10.1111/jgh.15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine ClusterNational University HospitalSingapore,Department of Internal Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| |
Collapse
|
16
|
Lee VV, Vijayakumar S, Lau NY, Blasiak A, Siah KTH, Ho D. Understanding the user: Patients’ perception, needs, and concerns of health apps for chronic constipation. Digit Health 2022; 8:20552076221104673. [PMID: 35663236 PMCID: PMC9158402 DOI: 10.1177/20552076221104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Chronic constipation is a prevalent gastrointestinal disorder that requires long-term management and treatment adherence. With increasing smartphone usage, health app adoption represents an opportunity to incorporate personalized, patient-led care into chronic constipation management. Despite the number of apps available targeting patients with constipation, studies have not yet examined user needs and barriers towards successful app adoption and sustained usage. Accordingly, the current study explored user perception, needs, and concerns of health apps in patients with chronic constipation. Methods Fifteen participants with chronic constipation (age range = 28–79 years, 10 females) in Singapore completed a 60 min semi-structured qualitative interview exploring participant's experiences with and attitudes towards chronic constipation and health apps. Participants also completed two questionnaires regarding their constipation symptoms and general technology usage. Interviews were audio-recorded, transcribed verbatim, and coded using NVivo. Results Four themes and 10 sub-themes were identified using inductive thematic analysis. Themes and sub-themes cover importance of patient identity, disease-based expectations of health apps, barriers towards adoption and sustained usage of health apps, necessary conditions when adopting health apps (including perception of supportive benefits, clear understanding of app intention, personalized technology, and trusted sources), and push factor expectations which includes creative engagement and incentivization embedded within the app. Conclusion The findings captured barriers and key elements necessary for successful health app adoption and continued usage by patients with chronic constipation. Identified elements that matter to patients can provide app developers with user-focused insights and recommendations to develop effective health apps that sustain user engagement.
Collapse
Affiliation(s)
- V Vien Lee
- The N.1 Institute for Health, National University of Singapore, Singapore
| | | | - Ni Yin Lau
- The N.1 Institute for Health, National University of Singapore, Singapore
| | - Agata Blasiak
- The N.1 Institute for Health, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pharmacology; Singapore’s Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- The N.1 Institute for Health, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pharmacology; Singapore’s Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
17
|
Teh R, Tee WD, Tan E, Fan K, Koh CJ, Tambyah PA, Oon J, Tee N, Soh AYS, Siah KTH. Review of the role of gastrointestinal multiplex polymerase chain reaction in the management of diarrheal illness. J Gastroenterol Hepatol 2021; 36:3286-3297. [PMID: 34129249 DOI: 10.1111/jgh.15581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/19/2021] [Accepted: 06/13/2021] [Indexed: 01/25/2023]
Abstract
Acute and chronic diarrheal illness secondary to gastrointestinal infection is a significant cause of morbidity and mortality around the world. A cornerstone of management includes prompt diagnosis and appropriate treatment of culprit pathogens. Timely diagnosis can improve patient care, assist in infection control, and prevent disease outbreaks. Historical methods of diagnosis include traditional culture methods and stool analysis. These are limited by long turnaround time and inability to simultaneously assess multiple pathogens. The advent of multiplexed nucleic acid amplification tests first began with the Food and Drug Administration-approved respiratory virus multiplex polymerase chain reaction (PCR) panel in 2009, followed by gastrointestinal infections in 2013, and neurological infections in 2014. We conducted a review of current literature pertaining to the clinical utility of a gastrointestinal multiplex PCR in management of acute and chronic diarrhea in patients. To date, seven platforms approved by the US Food and Drug Administration are used in detection of various bacterial, viral, and parasitic causative organisms for diagnosis of gastrointestinal infections. The sensitivity and specificity of each assay vary depending on the tested organism. Interpretation of a positive result has to be tailored to the clinical context. Further studies are required to establish the utility of gastrointestinal multiplex PCR from a cost-based perspective, whether specific enteropathogens such as Clostridioides difficile are better assessed with toxin gene detection and whether new parameters such as cycle threshold values can improve clinical application of test results.
Collapse
Affiliation(s)
- Readon Teh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Wei De Tee
- Division of Gastroenterology and Hepatology, Ng Teng Fong General Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eunice Tan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kristie Fan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Ananth Tambyah
- Division of Infectious Diseases, National University Hospital, Singapore.,Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jolene Oon
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Nancy Tee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW In recent years, landmark clinical trials investigating the role of early oral exposure to food antigens for food allergy (FA) prevention have highlighted the importance of immunoregulatory pathways in the 'gut-skin axis'. This review highlights recent literature on the mechanisms of the immune system and microbiome involved in the gut-skin axis, contributing to the development of atopic dermatitis (AD), FA, allergic rhinitis (AR) and asthma. Therapeutic interventions harnessing the gut-skin axis are also discussed. RECENT FINDINGS Epicutaneous sensitization in the presence of AD is capable of inducing Th2 allergic inflammation in the intestinal tract and lower respiratory airways, predisposing one to the development of AR and asthma. Probiotics have demonstrated positive effects in preventing and treating AD, though there is no evident relationship of its beneficial effects on other allergic diseases. Prophylactic skin emollients use has not shown consistent protection against AD, whereas there is some evidence for the role of dietary changes in alleviating AD and airway inflammation. More randomized controlled trials are needed to clarify the potential of epicutaneous immunotherapy as a therapeutic strategy for patients with FA. SUMMARY The growing understanding of the gut-skin interactions on allergic disease pathogenesis presents novel avenues for therapeutic interventions which target modulation of the gut and/or skin.
Collapse
Affiliation(s)
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital
- Department of Medicine, Yong Loo Lin School of Medicine
| | - Elizabeth Huiwen Tham
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A STAR)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS)
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS)
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
19
|
Du H, Siah KTH, Ru-Yan VZ, Teh R, En Tan CY, Yeung W, Scaduto C, Bolongaita S, Cruz MTK, Liu M, Lin X, Tan YY, Feng M. Prediction of in-hospital mortality of Clostriodiodes difficile infection using critical care database: a big data-driven, machine learning approach. BMJ Open Gastroenterol 2021; 8:e000761. [PMID: 34789472 PMCID: PMC8601086 DOI: 10.1136/bmjgast-2021-000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/05/2021] [Indexed: 11/15/2022] Open
Abstract
RESEARCH OBJECTIVES Clostriodiodes difficile infection (CDI) is a major cause of healthcare-associated diarrhoea with high mortality. There is a lack of validated predictors for severe outcomes in CDI. The aim of this study is to derive and validate a clinical prediction tool for CDI in-hospital mortality using a large critical care database. METHODOLOGY The demographics, clinical parameters, laboratory results and mortality of CDI were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. We subsequently trained three machine learning models: logistic regression (LR), random forest (RF) and gradient boosting machine (GBM) to predict in-hospital mortality. The individual performances of the models were compared against current severity scores (Clostridiodes difficile Associated Risk of Death Score (CARDS) and ATLAS (Age, Treatment with systemic antibiotics, leukocyte count, Albumin and Serum creatinine as a measure of renal function) by calculating area under receiver operating curve (AUROC). We identified factors associated with higher mortality risk in each model. SUMMARY OF RESULTS From 61 532 intensive care unit stays in the MIMIC-III database, there were 1315 CDI cases. The mortality rate for CDI in the study cohort was 18.33%. AUROC was 0.69 (95% CI, 0.60 to 0.76) for LR, 0.71 (95% CI, 0.62 to 0.77) for RF and 0.72 (95% CI, 0.64 to 0.78) for GBM, while previously AUROC was 0.57 (95% CI, 0.51 to 0.65) for CARDS and 0.63 (95% CI, 0.54 to 0.70) for ATLAS. Albumin, lactate and bicarbonate were significant mortality factors for all the models. Free calcium, potassium, white blood cell, urea, platelet and mean blood pressure were present in at least two of the three models. CONCLUSION Our machine learning derived CDI in-hospital mortality prediction model identified pertinent factors that can assist critical care clinicians in identifying patients at high risk of dying from CDI.
Collapse
Affiliation(s)
- Hao Du
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University Medicine Cluster, National University Hospital, Singapore
| | | | - Readon Teh
- University Medicine Cluster, National University Hospital, Singapore
| | - Christopher Yu En Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wesley Yeung
- University Medicine Cluster, National University Hospital, Singapore
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Christina Scaduto
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Mengru Liu
- School of Computing and Information Systems, Singapore Management University, Singapore
| | - Xiaohao Lin
- Machine Intellection Department, Institute for Infocomm Research, Agency for Science Technology and Research, Singapore
| | | | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore
| |
Collapse
|
20
|
Koo CS, Siah KTH, Koh CJ. Endoscopy training in COVID-19: Challenges and hope for a better age. J Gastroenterol Hepatol 2021; 36:2715-2719. [PMID: 33871079 PMCID: PMC8251278 DOI: 10.1111/jgh.15524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic is a unique challenge that has disrupted endoscopy training. Initial infection control measures aimed at protecting patients and staff meant nonessential endoscopic activity was suspended in many countries. The decrease in elective caseload from the pandemic also reduced training numbers during this period. While hands-on training took a backseat, more efforts were directed to didactic training of cognitive competencies. We review the literature describing the impact of COVID-19 on endoscopy training and summarize key measures aimed at mitigating this effect. These include leveraging on web-based didactic material and video-conferences, increased use of simulation and models to hone technical competencies, and a shift in focus from numbers-based accreditation to competency-based accreditation. While COVID-19 was hoped to be short-lived, it is clear the impact is long-lasting. Hence, it is crucial for training programs to take stock of how endoscopy training is evolving and use this opportunity to implement new paradigms into their endoscopic training curricula. COVID-19 might just be the catalyst that transforms endoscopy training into a new digital era.
Collapse
Affiliation(s)
- Chieh Sian Koo
- Division of Gastroenterology and HepatologyNational University HospitalSingapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and HepatologyNational University HospitalSingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and HepatologyNational University HospitalSingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| |
Collapse
|
21
|
Chua CE, Kew GS, Demutska A, Quek S, Loo EXL, Gui H, Wong S, Lau HX, Low EXS, Loh TL, Ooi SL, Hung ECW, Rahman MM, Ghoshal U, Wong H, Cheung CKY, Syam AF, Tan N, Xiao Y, Liu JS, Lu F, Chen CL, Lee YY, Maralit RM, Kim YS, Oshima T, Miwa H, Pang J, Siah KTH. Factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic: a cross-sectional study in 12 Asian countries. BMJ Open 2021; 11:e046310. [PMID: 34373296 PMCID: PMC8354757 DOI: 10.1136/bmjopen-2020-046310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Regardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic. OBJECTIVES In our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic. METHODS A multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail. RESULTS Among the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance. CONCLUSIONS We found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.
Collapse
Affiliation(s)
- Chun En Chua
- Department of Medicine, Yong Loo Lin School of Medicine, National University Hospital, Singapore
| | - Guan Sen Kew
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Alla Demutska
- Department of Clinical Psychology, James Cook University, Singapore
| | - Sabrina Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hao Gui
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Scott Wong
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Hui Xing Lau
- Singapore Institute for Clinical Sciences (SICS), Agency for Science Technology and Research, Singapore
| | | | - Tze Liang Loh
- Department of Otorhinolarygology, Head and Neck Surgery, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Shien Lung Ooi
- Department of Anaesthesiology, Columbia Asia Hospitals Pvt Ltd, Sarawak, Malaysia
| | | | - M Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Uday Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute Medical Science, India, India
| | - Hei Wong
- Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong
| | - Cynthia K Y Cheung
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, University of Indonesia, Depok, Jawa Barat, Indonesia
| | - Niandi Tan
- Departments of Gastroenterology and Hepatology, the First Affiliated Hospital, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yinglian Xiao
- Department of Gastroenterology, Wuhan Union Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Jin-Song Liu
- China Academy of Chinese Medical Sciences, Xiyuan Hospital, Beijing, China
| | - Fang Lu
- Department of Medicine, Buddhist Tzu Chi Hospital and University School of Medicine, Hualien, Taiwan
| | - Chien-Lin Chen
- Department of Medicine, Buddhist Tzu Chi Hospital and University School of Medicine, Hualien, Taiwan
| | - Yeong Yeh Lee
- Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Ruter M Maralit
- Department of Medicine, The Medical City, Pasig City, Manila, Philippines
| | - Yong-Sung Kim
- Wonkwang Digestive Disease Research Institute, Gut and Food Healthcare, Wonkwang University School of Medicine Hospital, Iksan, Jeollabuk-do, Korea (the Republic of)
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore
| |
Collapse
|
22
|
Quek SXZ, Loo EXL, Demutska A, Chua CE, Kew GS, Wong S, Lau HX, Low EXS, Loh TL, Lung OS, Hung ECW, Rahman MM, Ghoshal UC, Wong SH, Cheung CKY, Syam AF, Tan N, Xiao Y, Liu J, Lu F, Chen C, Lee YY, Maralit RM, Kim Y, Oshima T, Miwa H, Pang J, Siah KTH. Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome. J Gastroenterol Hepatol 2021; 36:2187-2197. [PMID: 33615534 PMCID: PMC8014795 DOI: 10.1111/jgh.15466] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/18/2021] [Accepted: 02/14/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Gastrointestinal manifestations of the coronavirus disease 2019 (COVID-19) pandemic may mimic irritable bowel syndrome (IBS), and social distancing measures may affect IBS patients negatively. We aimed to study the impact of COVID-19 on respondents with self-reported IBS. METHODS We conducted an anonymized survey from May to June 2020 in 33 countries. Knowledge, attitudes, and practices on personal hygiene and social distancing as well as psychological impact of COVID-19 were assessed. Statistical analysis was performed to determine differences in well-being and compliance to social distancing measures between respondents with and without self-reported IBS. Factors associated with improvement or worsening of IBS symptoms were evaluated. RESULTS Out of 2704 respondents, 2024 (74.9%) did not have IBS, 305 (11.3%) had self-reported IBS, and 374 (13.8%) did not know what IBS was. Self-reported IBS respondents reported significantly worse emotional, social, and psychological well-being compared with non-IBS respondents and were less compliant to social distancing measures (28.2% vs 35.3%, P = 0.029); 61.6% reported no change, 26.6% reported improvement, and 11.8% reported worsening IBS symptoms. Higher proportion of respondents with no change in IBS symptoms were willing to practice social distancing indefinitely versus those who deteriorated (74.9% vs 51.4%, P = 0.016). In multivariate analysis, willingness to continue social distancing for another 2-3 weeks (vs longer period) was significantly associated with higher odds of worsening IBS. CONCLUSION Our study showed that self-reported IBS respondents had worse well-being and compliance to social distancing measures than non-IBS respondents. Future research will focus on occupational stress and dietary changes during COVID-19 that may influence IBS.
Collapse
Affiliation(s)
- Sabrina Xin Zi Quek
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
| | - Alla Demutska
- Department of Clinical PsychologyJames Cook UniversitySingapore
| | - Chun En Chua
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore
| | - Guan Sen Kew
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore,Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Scott Wong
- Department of MedicineNg Teng Fong General HospitalSingapore
| | - Hui Xing Lau
- Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
| | | | - Tze Liang Loh
- Department of Otorhinolarygology, Head and Neck SurgeryUniversiti Putra MalaysiaSeri KembanganMalaysia
| | - Ooi Shien Lung
- Department of AnaesthesiologyColumbia Asia HospitalMiriSarawakMalaysia
| | | | - M. Masudur Rahman
- Department of GastroenterologySheikh Russel National Gastroliver Institute and HospitalDhakaBangladesh
| | - Uday C Ghoshal
- Department of GastroenterologySanjay Gandhi Postgraduate Institute Medical ScienceLucknowIndia
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of MedicineThe Chinese University of Hong KongShatinHong Kong
| | - Cynthia K Y Cheung
- State Key Laboratory of Pharmaceutical BiotechnologyThe University of Hong KongHong Kong,Department of MedicineThe University of Hong KongHong Kong
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineUniversity of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | - Niandi Tan
- Departments of Gastroenterology and HepatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yinglian Xiao
- Departments of Gastroenterology and HepatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Jin‐Song Liu
- Department of GastroenterologyWuhan Union Hospital of Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Fang Lu
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Chien‐Lin Chen
- Department of MedicineBuddhist Tzu Chi Hospital and University School of MedicineHualienTaiwan
| | - Yeong Yeh Lee
- St George and Sutherland Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia,Gut Research Group, Faculty of MedicineUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | | | - Yong‐Sung Kim
- Wonkwang Digestive Disease Research Institute, Gut and Food HealthcareWonkwang University School of MedicineIksanSouth Korea
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaHyogoJapan
| | - Hiroto Miwa
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | - Junxiong Pang
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore,Centre for Infectious Disease Epidemiology and ResearchNational University of SingaporeSingapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore,Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| |
Collapse
|
23
|
Oshima T, Siah KTH, Yoshimoto T, Miura K, Tomita T, Fukui H, Miwa H. Impacts of the COVID-19 pandemic on functional dyspepsia and irritable bowel syndrome: A population-based survey. J Gastroenterol Hepatol 2021; 36:1820-1827. [PMID: 33197076 PMCID: PMC7753727 DOI: 10.1111/jgh.15346;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/22/2020] [Accepted: 11/07/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIM Functional gastrointestinal disorders are a group of stress-sensitive gut-brain disorders. The COVID-19 outbreak has caused immense stress and anxiety among the general public. Strict measures to counter COVID-19 emergency, including physical distancing, have also taken a toll on physical and mental health. We investigated the impact of the COVID-19 pandemic on the gastrointestinal and psychological symptoms of functional dyspepsia (FD) and irritable bowel syndrome (IBS). METHODS An online survey was conducted in Japan for a group of randomly assigned panelists from May 26 to 27, 2020. Each respondent answered a questionnaire on stress, physical distancing, and worries about COVID-19. Gastrointestinal symptoms were assessed to diagnose FD and IBS (Rome III), and psychological symptoms were assessed using the Hospital Anxiety and Depression Scale. RESULTS A total of 5157 subjects were finally enrolled, with FD in 8.5%, IBS in 16.6%, and FD-IBS overlap in 4.0%. For both gastrointestinal and psychological symptoms, respondents with FD-IBS overlap showed the worst scores, followed by IBS-alone, then FD-alone respondents. During the COVID-19 pandemic, 11.9% of respondents reported deterioration and 2.8% reported improvement of gastrointestinal symptoms. FD-IBS overlap, psychological disease comorbidity, and stress at work/school were significantly associated with symptom deterioration. Younger age, commuting by public transport, and work/study from home were associated with symptom improvement. CONCLUSIONS The COVID-19 pandemic negatively affected FD/IBS subjects, with respondents showing FD-IBS overlap syndrome as the most important independent factor associated with deterioration in gastrointestinal symptoms. Physicians need to take extra care of FD/IBS patients in the post-COVID period.
Collapse
Affiliation(s)
- Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Takanori Yoshimoto
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Ko Miura
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Hirokazu Fukui
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| |
Collapse
|
24
|
Oshima T, Siah KTH, Yoshimoto T, Miura K, Tomita T, Fukui H, Miwa H. Impacts of the COVID-19 pandemic on functional dyspepsia and irritable bowel syndrome: A population-based survey. J Gastroenterol Hepatol 2021; 36:1820-1827. [PMID: 33197076 PMCID: PMC7753727 DOI: 10.1111/jgh.15346] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/22/2020] [Accepted: 11/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Functional gastrointestinal disorders are a group of stress-sensitive gut-brain disorders. The COVID-19 outbreak has caused immense stress and anxiety among the general public. Strict measures to counter COVID-19 emergency, including physical distancing, have also taken a toll on physical and mental health. We investigated the impact of the COVID-19 pandemic on the gastrointestinal and psychological symptoms of functional dyspepsia (FD) and irritable bowel syndrome (IBS). METHODS An online survey was conducted in Japan for a group of randomly assigned panelists from May 26 to 27, 2020. Each respondent answered a questionnaire on stress, physical distancing, and worries about COVID-19. Gastrointestinal symptoms were assessed to diagnose FD and IBS (Rome III), and psychological symptoms were assessed using the Hospital Anxiety and Depression Scale. RESULTS A total of 5157 subjects were finally enrolled, with FD in 8.5%, IBS in 16.6%, and FD-IBS overlap in 4.0%. For both gastrointestinal and psychological symptoms, respondents with FD-IBS overlap showed the worst scores, followed by IBS-alone, then FD-alone respondents. During the COVID-19 pandemic, 11.9% of respondents reported deterioration and 2.8% reported improvement of gastrointestinal symptoms. FD-IBS overlap, psychological disease comorbidity, and stress at work/school were significantly associated with symptom deterioration. Younger age, commuting by public transport, and work/study from home were associated with symptom improvement. CONCLUSIONS The COVID-19 pandemic negatively affected FD/IBS subjects, with respondents showing FD-IBS overlap syndrome as the most important independent factor associated with deterioration in gastrointestinal symptoms. Physicians need to take extra care of FD/IBS patients in the post-COVID period.
Collapse
Affiliation(s)
- Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Takanori Yoshimoto
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Ko Miura
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Hirokazu Fukui
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
| |
Collapse
|
25
|
Shah SU, Xiu Ling Loo E, En Chua C, Sen Kew G, Demutska A, Quek S, Wong S, Lau HX, Low EXS, Loh TL, Lung OS, Hung ECW, Rahman MM, Ghoshal UC, Wong SH, Cheung CKY, Syam AF, Tan N, Xiao Y, Liu JS, Lu F, Chen CL, Lee YY, Maralit RM, Kim YS, Oshima T, Miwa H, Siah KTH, Pang J. Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study. PLoS One 2021; 16:e0252835. [PMID: 34097719 PMCID: PMC8183980 DOI: 10.1371/journal.pone.0252835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Knowledge and attitude influence compliance and individuals' practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness. OBJECTIVE This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals. DESIGN Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020. SETTING Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail. PARTICIPANTS Participants ≥21 years working in healthcare and non-healthcare related professions. MAIN OUTCOME Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP. RESULTS HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59-2.85) well-being. CONCLUSION AND RELEVANCE While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.
Collapse
Affiliation(s)
- Shimoni Urvish Shah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Chun En Chua
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Guan Sen Kew
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Alla Demutska
- Department of Clinical Psychology, James Cook University, Singapore, Singapore
| | - Sabrina Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Scott Wong
- Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Hui Xing Lau
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - En Xian Sarah Low
- Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Tze Liang Loh
- Department of Otorhinolarygology, Head and Neck Surgery, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ooi Shien Lung
- Department of Anaesthesiology, Columbia Asia Hospital, Miri, Sarawak, Malaysia
| | | | - M. Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute Medical Science, Lucknow, India
| | - Sunny H. Wong
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cynthia K. Y. Cheung
- Department of Medicine, State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China
| | - Ari F. Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Niandi Tan
- Departments of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinglian Xiao
- Departments of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin-Song Liu
- Department of Gastroenterology, Wuhan Union Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fang Lu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chien-Lin Chen
- Department of Medicine, Buddhist Tzu Chi Hospital and University School of Medicine, Hualien, Taiwan
| | - Yeong Yeh Lee
- St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia
- Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Yong-Sung Kim
- Wonkwang Digestive Disease Research Institute, Gut and Food Healthcare, Wonkwang University School of Medicine, Iksan, South Korea
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kewin Tien Ho Siah
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, Singapore
| |
Collapse
|
26
|
Kew GS, Soh AYS, Lee YY, Gotoda T, Li YQ, Zhang Y, Chan YH, Siah KTH, Tong D, Law SYK, Ruszkiewicz A, Tseng PH, Lee YC, Chang CY, Quach DT, Kusano C, Bhatia S, Wu JCY, Singh R, Sharma P, Ho KY. Multinational survey on the preferred approach to management of Barrett’s esophagus in the Asia-Pacific region. World J Gastrointest Oncol 2021; 13:279-294. [PMID: 33889279 PMCID: PMC8040063 DOI: 10.4251/wjgo.v13.i4.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/31/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major societies provide differing guidance on management of Barrett’s esophagus (BE), making standardization challenging.
AIM To evaluate the preferred diagnosis and management practices of BE among Asian endoscopists.
METHODS Endoscopists from across Asia were invited to participate in an online questionnaire comprising eleven questions regarding diagnosis, surveillance and management of BE.
RESULTS Five hundred sixty-nine of 1016 (56.0%) respondents completed the survey, with most respondents from Japan (n = 310, 54.5%) and China (n = 129, 22.7%). Overall, the preferred endoscopic landmark of the esophagogastric junction was squamo-columnar junction (42.0%). Distal palisade vessels was preferred in Japan (59.0% vs 10.0%, P < 0.001) while outside Japan, squamo-columnar junction was preferred (59.5% vs 27.4%, P < 0.001). Only 16.3% of respondents used Prague C and M criteria all the time. It was never used by 46.1% of Japanese, whereas 84.2% outside Japan, endoscopists used it to varying extents (P < 0.001). Most Asian endoscopists (70.8%) would survey long-segment BE without dysplasia every two years. Adherence to Seattle protocol was poor with only 6.3% always performing it. 73.2% of Japanese never did it, compared to 19.3% outside Japan (P < 0.001). The most preferred (74.0%) treatment of non-dysplastic BE was proton pump inhibitor only when the patient was symptomatic or had esophagitis. For BE with low-grade dysplasia, 6-monthly surveillance was preferred in 61.9% within Japan vs 47.9% outside Japan (P < 0.001).
CONCLUSION Diagnosis and management of BE varied within Asia, with stark contrast between Japan and outside Japan. Most Asian endoscopists chose squamo-columnar junction to be the landmark for esophagogastric junction, which is incorrect. Most also did not consistently use Prague criteria, and Seattle protocol. Lack of standardization, education and research are possible reasons.
Collapse
Affiliation(s)
- Guan Sen Kew
- Department of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore
| | - Alex Yu Sen Soh
- Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yan-Qing Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yan Zhang
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Kewin Tien Ho Siah
- Department of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore
| | - Daniel Tong
- Department of Surgery, The University of Hong Kong, Hong Kong Pokfulam, Hong Kong, China
| | - Simon Ying Kit Law
- Department of Surgery, The University of Hong Kong, Hong Kong Pokfulam, Hong Kong, China
| | | | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Taipei 24352, Taiwan
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Vietnam, Hochiminh 70000, Viet Nam
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shobna Bhatia
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai 400012, India
| | - Justin Che-Yuen Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, University of Adelaide, Adelaide 64128, Australia
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, KS 64128, United States
| | - Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
| |
Collapse
|
27
|
Chua RXY, Tay MJY, Ooi DSQ, Siah KTH, Tham EH, Shek LPC, Meaney MJ, Broekman BFP, Loo EXL. Understanding the Link Between Allergy and Neurodevelopmental Disorders: A Current Review of Factors and Mechanisms. Front Neurol 2021; 11:603571. [PMID: 33658968 PMCID: PMC7917177 DOI: 10.3389/fneur.2020.603571] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
Both allergic diseases and neurodevelopmental disorders are non-communicable diseases (NCDs) that not only impact on the quality of life and but also result in substantial economic burden. Immune dysregulation and inflammation are typical hallmarks in both allergic and neurodevelopmental disorders, suggesting converging pathophysiology. Epidemiological studies provided convincing evidence for the link between allergy and neurodevelopmental diseases such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Possible factors influencing the development of these disorders include maternal depression and anxiety, gestational diabetes mellitus, maternal allergic status, diet, exposure to environmental pollutants, microbiome dysbiosis, and sleep disturbances that occur early in life. Moreover, apart from inflammation, epigenetics, gene expression, and mitochondrial dysfunction have emerged as possible underlying mechanisms in the pathogenesis of these conditions. The exploration and understanding of these shared factors and possible mechanisms may enable us to elucidate the link in the comorbidity.
Collapse
Affiliation(s)
- Regena Xin Yi Chua
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michelle Jia Yu Tay
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Delicia Shu Qin Ooi
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Michael J Meaney
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore.,Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Birit F P Broekman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore.,Department of Psychiatry, Onze Lieve Vrouwe Gasthuis and Amsterdam University Medical Centre, VU University Medical Center, Amsterdam, Netherlands
| | - Evelyn Xiu Ling Loo
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| |
Collapse
|
28
|
Shorey S, Demutska A, Chan V, Siah KTH. Adults living with irritable bowel syndrome (IBS): A qualitative systematic review. J Psychosom Res 2021; 140:110289. [PMID: 33227554 DOI: 10.1016/j.jpsychores.2020.110289] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To consolidate existing qualitative studies which examined the experiences and needs of adults living with IBS, and to gather a holistic insight for future directions and avenues to support these adults. METHODS A qualitative systematic review was conducted and six databases were searched for qualitative studies, beginning from each database's inception to July 2020. The qualitative data were meta-synthesised and thematic analysis was adopted. Any discrepancies that arose were discussed between the reviewers until a consensus was reached throughout the process of data screening, selection, critical appraisal and synthesis. RESULTS Seventeen studies with a total of 299 adults diagnosed with IBS were included. Four themes were identified: (1) physical, psychological, and social consequences; (2) impact of IBS on working adults; (3) dealing with IBS; and (4) sources of support and support needs. CONCLUSION Future research across geographically diverse locations are needed to gather a thorough perspective of the experiences and needs of adults living with IBS. The development and evaluation of technology-based, trained peer-led volunteers, and interventions that adopt mindfulness, active coping strategies, cognitive behavioural therapy and acceptance, and commitment therapy are needed. Ultimately, the collaboration between the relevant stakeholders is essential for standardised instruments and materials for accurate testing, diagnosis, assessment, treatment and management of IBS.
Collapse
Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, 117597, Singapore.
| | - Alla Demutska
- James Cook University, 149 Sims Drive, 387380, Singapore
| | - Valerie Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, 117597, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Level 10 Tower Block, 1 E Kent Ridge Road, 119228, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore
| |
Collapse
|
29
|
Zhang VRY, Woo ASJ, Scaduto C, Cruz MTK, Tan YY, Du H, Feng M, Siah KTH. Systematic review on the definition and predictors of severe Clostridiodes difficile infection. J Gastroenterol Hepatol 2021; 36:89-104. [PMID: 32424877 DOI: 10.1111/jgh.15102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Clostridiodes difficile infection (CDI) is one of the most common hospital-acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty-three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non-mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi-center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.
Collapse
Affiliation(s)
- Valencia Ru Yan Zhang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aaron Shu Jeng Woo
- Gastroenterology and Hepatology Service, Sengkang General Hospital, Singapore
| | - Christina Scaduto
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria Teresa Kasunuran Cruz
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Yan Yuan Tan
- Alliance Healthcare Group, Singapore.,Babylon Health, Singapore
| | - Hao Du
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore
| |
Collapse
|
30
|
Affiliation(s)
- Chieh Sian Koo
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore
| | - How Cheng Low
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore
| |
Collapse
|
31
|
Loo EXL, Wang DY, Siah KTH. Association between Irritable Bowel Syndrome and Allergic Diseases: To Make a Case for Aeroallergen. Int Arch Allergy Immunol 2019; 181:31-42. [PMID: 31694023 DOI: 10.1159/000503629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disease and the most common cause of prolonged abdominal pain and bowel disturbances in the developed world. While initially thought to be functional or psychosomatic in nature, IBS is now recognized as a heterogeneous group of conditions. A subset of IBS patients and patients with allergic diseases share some characteristic inflammatory features. In fact, atopic children show an increased likelihood of developing IBS as adults. Given these findings, a subset of IBS may be suffering from allergy-related gut diseases. In this review, we present the allergy-related comorbidities of IBS, including genetic, environmental, and immunologic factors. We discuss studies demonstrating an increased sensitization of IBS patients to aeroallergens compared to food allergens. We then postulate potential pathophysiological mechanisms underlying both IBS and aeroallergens in the gut, followed by potential implications in the screening and treatment of allergies in IBS patients.
Collapse
Affiliation(s)
- Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Pediatrics, Yong Loo School of Medicine, National University of Singapore, Singapore, Singapore
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore, .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
| |
Collapse
|
32
|
Siah KTH, Gwee KA. Rome IV Exploratory Model Closely Resemble Asian Functional Gastrointestinal Disorder Symptom Clusters. Clin Gastroenterol Hepatol 2019; 17:1002. [PMID: 30902227 DOI: 10.1016/j.cgh.2018.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok-Ann Gwee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
33
|
Chan Y, So SHW, Mak ADP, Siah KTH, Chan W, Wu JCY. The temporal relationship of daily life stress, emotions, and bowel symptoms in irritable bowel syndrome-Diarrhea subtype: A smartphone-based experience sampling study. Neurogastroenterol Motil 2019; 31:e13514. [PMID: 30450780 DOI: 10.1111/nmo.13514] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The current study aimed to model the moment-to-moment relationship between daily life stress, emotions, and bowel symptoms among patients with irritable bowel syndrome-diarrhea subtype (IBS-D) in the flow of daily life using a smartphone-based experience sampling method (ESM). METHODS Patients with IBS-D (N = 27) and healthy controls (HC; N = 30) completed ESM ratings of their real-time daily life stress, which was defined as subjective stress related to daily activities, both positive and negative emotions, as well as bowel symptoms eight times a day for 14 consecutive days, following a baseline interview measuring bowel and mood symptoms. Moment-to-moment association between ESM variables was tested within and between groups using multilevel regression modeling. KEY RESULTS Patients with IBS-D reported more severe bowel symptoms and lower positive affect than HCs, but levels of daily life stress and negative affect were comparable between groups. Time-lagged analysis of ESM data revealed that, among patients with IBS-D, daily life stress predicted a decrease in abdominal pain and urgency to defecation at a subsequent time point, whereas severity of bowel symptoms and occurrence of diarrhea predicted a subsequent increase in negative affect and daily life stress. The above associations were not found among HCs. CONCLUSIONS AND INFERENCES ESM unveiled the dynamic relationship between bowel symptoms, stress, and emotionality. Patients with IBS-D responded to bowel symptoms with more stress and distress momentarily. Counter-intuitively, daily life activity stress appeared to ameliorate bowel symptoms, although a more rigorous study design is required to testify this claim. Psychological understanding of IBS-D is discussed.
Collapse
Affiliation(s)
- Yawen Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Arthur Dun Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore City, Singapore
| | - Wai Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
34
|
Siah KTH. Airborne allergen, allergy & atopic IBS. Neurogastroenterol Motil 2019; 31:e13517. [PMID: 30793844 DOI: 10.1111/nmo.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
35
|
Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, Pratap N, Ghoshal UC, Syam AF, Abdullah M, Choi MG, Bak YT, Lu CL, Gonlachanvit S, Boon CS, Fang F, Cheong PK, Wu JCY, Gwee KA. Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters. Gut 2018; 67:1071-1077. [PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/29/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID. DESIGN 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters. RESULTS Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence). CONCLUSION We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.
Collapse
Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiaorong Gong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Xi Jessie Yang
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - William E Whitehead
- Centre for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Xiaohua Hou
- Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nitesh Pratap
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Myung-Gyu Choi
- Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Tae Bak
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, South Korea
| | - Ching-Liang Lu
- Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taiwan National Yang-Ming University Taipei, Taipei, Taiwan
| | - Sutep Gonlachanvit
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | | | - Fan Fang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Pui Kuan Cheong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Kok-Ann Gwee
- Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
36
|
Soh AYS, Kang JY, Siah KTH, Scarpignato C, Gwee KA. Searching for a definition for pharmacologically refractory constipation: A systematic review. J Gastroenterol Hepatol 2018; 33:564-575. [PMID: 28960557 DOI: 10.1111/jgh.13998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/24/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Surgery and other non-pharmacological treatments such as sacral nerve stimulation are used for the treatment of difficult-to-treat chronic constipation. Novel pharmacological therapeutic agents are also being introduced. To evaluate the efficacy of these treatments, it is imperative to have a consistent definition of pharmacologically refractory constipation. A systematic review of studies on refractory, difficult-to-treat or surgically treated constipation was carried out to determine the criteria that various authors used to define this group of patients. METHODS A systematic review was performed for literature published from June 2005 to June 2015 using PubMed, Cochrane, and Scopus databases, as well as manual searches. Studies on patients with refractory or intractable constipation were extracted. Criteria used for defining refractory constipation, as well as pharmacological agents tried including dosage, frequency, and duration, were reviewed. RESULTS Sixty-one studies were included in this review. Forty-eight involved surgical treatment of constipation, while 13 examined non-surgical therapies for refractory constipation. There is no generally accepted definition of refractory constipation. Authors consider constipation to be refractory when response to management is suboptimal, but there is no consensus on the choice of drug, order of usage, and dosage or treatment duration. Prior medical therapy was not mentioned at all in five studies. CONCLUSIONS There is need for a detailed definition of pharmacologically refractory constipation before submitting patients to invasive treatments and to evaluate new pharmacological agents.
Collapse
Affiliation(s)
- Alex Yu Sen Soh
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Jin-Yong Kang
- Department of Gastroenterology, St George's Hospital, London, UK.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Carmelo Scarpignato
- Clinical Pharmacology and Digestive Pathophysiology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
37
|
Yoshida N, Naito Y, Murakami T, Hirose R, Ogiso K, Inada Y, Dohi O, Kamada K, Uchiyama K, Handa O, Konishi H, Siah KTH, Yagi N, Fujita Y, Kishimoto M, Yanagisawa A, Itoh Y. Linked color imaging improves the visibility of colorectal polyps: a video study. Endosc Int Open 2017; 5:E518-E525. [PMID: 28596985 PMCID: PMC5462607 DOI: 10.1055/s-0043-105495] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/13/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/STUDY AIM Linked color imaging (LCI) by a laser endoscope (Fujifilm Co, Tokyo, Japan) is a novel narrow band light observation. In this study, we aimed to investigate whether LCI could improve the visibility of colorectal polyps using endoscopic videos. PATIENTS AND METHODS We prospectively recorded videos of consecutive polyps 2 - 20 mm in size diagnosed as neoplastic polyps. Three videos, white light (WL), blue laser imaging (BLI)-bright, and LCI, were recorded for each polyp by one expert. After excluding inappropriate videos, all videos were evaluated in random order by two experts and two non-experts according to a published polyp visibility score from four (excellent visibility) to one (poor visibility). Additionally, the relationship between polyp visibility scores in LCI and various clinical characteristics including location, size, histology, morphology, and preparation were analyzed compared to WL and BLI-bright. RESULTS We analyzed 101 colorectal polyps (94 neoplastic) in 66 patients (303 videos). The mean polyp size was 9.0 ± 8.1 mm and 54 polyps were non-polypoid. The mean polyp visibility scores for LCI (2.86 ± 1.08) were significantly higher than for WL and BLI-bright (2.53 ± 1.15, P < 0.001; 2.73 ± 1.47, P < 0.041). The ratio of poor visibility (score 1 and 2) was significantly lower in LCI for experts and non-experts (35.6 %, 33.6 %) compared with WL (49.6 %, P = 0.015, 50.5 %, P = 0.046). The polyp visibility scores for LCI were significantly higher than those for WL for all of the factors. With respect to the comparison between BLI-bright and WL, the polyp visibility scores for BLI-bright were not higher than WL for right-sided location, < 10 mm size, sessile serrated adenoma and polyp histology, and poor preparation. For those characteristics, LCI improved the lesions with right-sided location, SSA/P histology, and poor preparation significantly better than BLI. CONCLUSIONS LCI improved polyp visibility compared to WL for both expert and non-expert endoscopists. It is useful for improving polyp visibility in any location, any size, any morphology, any histology, and any preparation level.
Collapse
Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan,Corresponding author Naohisa Yoshida, MD PhD Department of Molecular Gastroenterology and HepatologyKyoto Prefectural University of MedicineGraduate School of Medical Science465 Kajii-choKawaramachi-HirokojiKamigyo-kuKyoto 602-8566Japan+81-75-2510710
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takaaki Murakami
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore
| | - Nobuaki Yagi
- Department of Gastroenterology, Murakami Memorial Hospital, Gifu, Japan
| | - Yasuko Fujita
- Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| |
Collapse
|
38
|
Yoshida N, Naito Y, Murakami T, Hirose R, Ogiso K, Inada Y, Dohi O, Okayama T, Kamada K, Uchiyama K, Ishikawa T, Handa O, Konishi H, Siah KTH, Yagi N, Itoh Y. Safety and Efficacy of a Same-Day Low-Volume 1 L PEG Bowel Preparation in Colonoscopy for the Elderly People and People with Renal Dysfunction. Dig Dis Sci 2016; 61:3229-3235. [PMID: 27487795 DOI: 10.1007/s10620-016-4262-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/20/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A same-day low-volume 1 L polyethylene glycol (PEG) for bowel preparation before colonoscopy was developed to improve patients' compliance. We aimed to evaluate the efficacy and safety of this regimen especially for the elderly and patients with renal dysfunction. METHODS All consecutive patients who underwent colonoscopy in our center from November 2014 to September 2015 were included. Patients undertook a low-residue diet with 10 mL sodium picosulfate 1 day before colonoscopy. Subsequently, they had 1 L low-volume PEG (MoviPrep) and 0.5 L water 4 h before the examination. Clinical outcomes, including cleansing level using the Boston bowel preparation score (BBPS), in the elderly and special-elderly (65-79 and ≥80 years old) were analyzed and compared with the non-elderly (18-64 years old). Additionally, patients with renal dysfunction were analyzed with respect to both complications and changes in blood parameters. RESULTS A total of 5427 patients (mean age: 64.5 ± 13.8) were analyzed. The rate of BBPS ≥ 6 in the elderly (2761 patients), special-elderly (565 patients), and non-elderly (2101 patients) was 94.1, 91.8, and 94.6 %, respectively. In the special-elderly, the rate of renal dysfunction was 14.8 %, and no severe complications were detected after colonoscopy. Additionally, there were no severe complications in 86 patients with renal dysfunction, though elevation of hematocrit was shown after intake of 1 L PEG (before, 36.7 ± 6.1 vs. after, 39.0 ± 5.7, P = 0.006). CONCLUSIONS Our study shows the safety and efficacy of same-day low-volume 1 L PEG bowel preparation in colonoscopy for the elderly and patients with renal dysfunction.
Collapse
Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takaaki Murakami
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuya Okayama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Nobuaki Yagi
- Department of Gastroenterology, Murakami Memorial Hospital, Gifu, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
39
|
Ogiso K, Yoshida N, Siah KTH, Kitae H, Murakami T, Hirose R, Inada Y, Dohi O, Okayama T, Kamada K, Uchiyama K, Ishikawa T, Handa O, Konishi H, Naito Y, Yanagisawa A, Itoh Y. New-generation narrow band imaging improves visibility of polyps: a colonoscopy video evaluation study. J Gastroenterol 2016; 51:883-90. [PMID: 26810569 DOI: 10.1007/s00535-016-1167-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/07/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The benefits of narrow band imaging (NBI) in colorectal polyp detection remain questionable. Previous NBI has poorer brightness and resolution than white light (WL). However, recently these factors were improved by the new-generation video processor system (EVIS LUCERA ELITE) in comparison with the previous system (EVIS LUCERA SPECTRUM). The aim of this study was to investigate whether NBI with EVIS LUCERA ELITE could improve the visibility of colorectal polyps compared to WL. METHODS We analyzed prospectively 240 colorectal polyps (group 1: ELITE with CF-HQ290 scope, 80 polyps; group 2: ELITE with PCF-Q260AZI scope, 80 polyps; group 3: SPECTRUM with PCF-Q260AZI scope, 80 polyps) whose videos were recorded using NBI and WL at Kyoto Prefectural University of Medicine. The videos were evaluated in a randomized order by three experts and three non-experts. Each polyp was assigned a polyp visibility score from 4 (excellent visibility) to 1 (poor visibility). The polyp visibility scores in each mode and their relationship to the clinical characteristics were analyzed. RESULTS The mean polyp visibility scores of NBI with ELITE system were significantly higher than those of WL (ELITE with CF-HQ290: 3.14 ± 0.87 vs. 2.75 ± 0.98, p < 0.0001, ELITE with PCF-Q260AZI: 3.03 ± 0.92 vs. 2.83 ± 0.93, p = 0.0006). Conversely, the mean polyp visibility score of NBI using SPECTRUM system with PCF-Q260AZI was significantly lower than WL (2.75 ± 1.06 vs. 3.05 ± 0.92, p < 0.0001). CONCLUSIONS Our study showed that NBI using EVIS LUCERA ELITE improved polyp visibility.
Collapse
Affiliation(s)
- Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kewin Tien Ho Siah
- Division of Molecular Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Hiroaki Kitae
- Department of Gastroenterology, Asahi University Murakami Memorial Hospital, Gifu, Japan
| | - Takaaki Murakami
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuya Okayama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Akio Yanagisawa
- Department of Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
40
|
Yoshida N, Naito Y, Murakami T, Hirose R, Ogiso K, Siah KTH, Inada Y, Yagi N, Itoh Y. High incidence of postoperative hemorrhage in colorectal endoscopic submucosal dissection during anticoagulant therapy. Int J Colorectal Dis 2016; 31:1487-8. [PMID: 26951182 DOI: 10.1007/s00384-016-2540-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takaaki Murakami
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kewin Tien Ho Siah
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Murakami Memorial Hospital, Gifu, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
41
|
Yoshida N, Naito Y, Siah KTH, Murakami T, Ogiso K, Hirose R, Inada Y, Inoue K, Konishi H, Kugai M, Morimoto Y, Hasegawa D, Kanemasa K, Wakabayashi N, Yagi N, Yanagisawa A, Itoh Y. High incidence of metachronous advanced adenoma and cancer after endoscopic resection of colon polyps ≥20 mm in size. Dig Endosc 2016; 28:194-202. [PMID: 26422700 DOI: 10.1111/den.12551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/16/2015] [Accepted: 09/25/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM There are limited studies on incidence rates of metachronous neoplastic lesions after resecting large colorectal polyps. In the present study, we analyzed metachronous lesions after endoscopic resection of colorectal polyps ≥20 mm in size. METHODS We retrospectively analyzed consecutive patients who underwent endoscopic resection of polyps from 2006 to 2013 at two affiliated hospitals. All patients underwent at least two total colonoscopies before follow up to ensure minimal missed polyps. Only patients who had follow-up colonoscopy annually after resection were recruited. We separated patients according to size of polyp resected; there were 239 patients in the ≥20-mm group and 330 patients in the <20-mm group. Clinical characteristics and cumulative rates of metachronous advanced adenoma and cancer in both groups were analyzed. Advanced adenoma was defined as a neoplastic lesion ≥10 mm in size and adenoma with a villous component. RESULTS Cumulative rate of development of metachronous advanced adenoma and cancer in the ≥20-mm group was significantly higher than in the <20-mm group (22.9% vs. 9.5%, P < 0.001) at 36 months. There was also more development of small polyps 5-9 mm in the ≥20-mm group than in the <20-mm group (45.2% vs. 28.8%, P < 0.001). With respect to metachronous lesions, there were more right-sided colonic lesions in the ≥20-mm group than in the <20-mm group (78.8% vs. 50.0%, P = 0.015). CONCLUSION High incidence rates of development of metachronous neoplastic lesions were detected after resection of colorectal polyps ≥20 mm in size.
Collapse
Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Kewin Tien Ho Siah
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore.,Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore
| | - Takaaki Murakami
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| | - Munehiro Kugai
- Department of Gastroenterology, Maizuru Medical Center, Kyoto, Japan
| | - Yasutaka Morimoto
- Department of Gastroenterology, Matsushita Memorial Hospital, Osaka, Japan
| | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Osaka, Japan
| | | | | | - Nobuaki Yagi
- Department of Gastroenterology, Murakami Memorial Hospital, Gifu, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Singapore
| |
Collapse
|
42
|
Yoshida N, Naito Y, Hirose R, Ogiso K, Siah KTH, Inada Y, Dohi O, Kamada K, Katada K, Uchiyama K, Handa O, Takagi T, Konishi H, Yagi N, Itoh Y. Risk of lens cloudiness during colorectal endoscopic submucosal dissection and ability of a novel lens cleaner to maintain and restore endoscopic view. Dig Endosc 2015; 27:609-17. [PMID: 25613857 DOI: 10.1111/den.12442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Generally, colorectal endoscopic submucosal dissection (ESD) cannot be carried out with severe lens cloudiness. We examined the occurrence of lens cloudiness during ESD as well as the efficacy of a novel cleaner for it. METHODS This study was a prospective study compared to historical control. First, we analyzed 103 ESD cases using standard cleaner at the Kyoto Prefectural University of Medicine in 2012. Relationship between lens cloudiness and clinical characteristics of lesions was analyzed. Lens cloudiness was recorded as grade 0 (clear) to grade 2 (very unclear). Then, we recruited 92 consecutive patients who underwent colorectal ESD using the novel cleaner from August 2013 to July 2014. The cleaner was applied on top of the lens before procedure and ability to prevent lens cloudiness was tested. Additionally, the novel cleaner was injected from endoscopic channel into a space created by endoscopic hood and colonic wall in seven cases with grade 1 or 2 of lens cloudiness and the ability to clean lens cloudiness inside the colon was tested. RESULTS Rate of severe lens cloudiness was 8.7%. Multivariate analysis showed that severe lens cloudiness was related with severe submucosal fatty tissue (P < 0.001). The novel cleaner had significantly less cloudiness cases compared to the standard cleaner (14.1% vs 33.0%, P = 0.002). Additionally, the novel cleaner enabled us to clean lens cloudiness in all seven cases. CONCLUSION Lens cloudiness during ESD was associated with submucosal fatty tissue. Effective lens cleaner should be used to prevent and clean lens cloudiness.
Collapse
Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kewin Tien Ho Siah
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Katada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Murakami Memorial Hospital, Gifu, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
43
|
Lu W, Gwee KA, Siah KTH, Kang JY, Lee R, Ngan CCL. Prevalence of Anti-deamidated Gliadin Peptide Antibodies in Asian Patients With Irritable Bowel Syndrome. J Neurogastroenterol Motil 2014; 20:236-41. [PMID: 24840376 PMCID: PMC4015193 DOI: 10.5056/jnm.2014.20.2.236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/27/2013] [Accepted: 01/08/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND/AIMS Non-celiac gluten sensitivity has been increasingly recognized as a predisposing factor for irritable bowel syndrome (IBS)-like symptoms in Western populations where celiac disease (CD) is relatively common. In Asia where CD is rare, we wish to de-termine the prevalence of gluten protein associated serology in IBS patients, which has not been formally studied, and its rela-tion to histological and human leukocyte antigen (HLA) markers. METHODS We reviewed a consecutive cohort of Asian patients with IBS, who had undergone serologic testing for IgA against deamidated gliadin peptide antibodies (IgA DGP) and IgA anti-endomysium antibodies, and who also had duodenal biopsies during clinical workup. In addition, a subset of Chinese patients with positive serology was further tested for HLA-DQ2 and HLA-DQ8. RESULTS Of 186 patients, 34 (18%) were positive for IgA DGP; bloating, abdominal pain, belching and diarrhea were the most com-monly reported symptoms but diarrhea as the most bothersome symptom was significantly more common in IgA DGP positive patients. Mildly increased intra-epithelial lymphocytes on duodenal biopsy was also more common (29% vs. 9%, P = 0.001). Nine of 21 Chinese patients tested as IgA DGP positive undertook HLA-DQ2/DQ8 testing, with only 2 being positive for HLA-DQ8. All patients with positive IgA DGP reported symptom improvement with gluten withdrawal. CONCLUSIONS We have described a series of Asian, mainly Chinese, patients with IBS who were tested positive for IgA DGP, and improved on a gluten exclusion diet. We believe this is the first report of non-celiac gluten sensitivity in Asia, a region where CD is uncommon.
Collapse
Affiliation(s)
- Wei Lu
- Department of Gastroenterolgy and Hepatology, National University Health System, Singapore
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Gastroenterolgy and Hepatology, National University Health System, Singapore
| | - Jin Yong Kang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rumin Lee
- Stomach, Liver and Bowel Center, Gleneagles Hospital, Singapore
| | | |
Collapse
|
44
|
Abstract
Irritable bowel syndrome (IBS) is a common disorder characterized by recurrent abdominal pain or discomfort, in combination with disturbed bowel habits in the absence of identifiable organic cause. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced by the pineal gland and also large number by enterochromaffin cells of the digestive mucosa. Melatonin plays an important part in gastrointestinal physiology which includes regulation of gastrointestinal motility, local anti-inflammatory reaction as well as moderation of visceral sensation. Melatonin is commonly given orally. It is categorized by the United States Food and Drug Administration as a dietary supplement. Melatonin treatment has an extremely wide margin of safety though it may cause minor adverse effects, such as headache, rash and nightmares. Melatonin was touted as a potential effective candidate for IBS treatment. Putative role of melatonin in IBS treatment include analgesic effects, regulator of gastrointestinal motility and sensation to sleep promoter. Placebo-controlled studies in melatonin suffered from heterogeneity in methodology. Most studies utilized 3 mg at bedtime as the standard dose of trial. However, all studies had consistently showed improvement in abdominal pain, some showed improvement in quality of life of IBS patients. Melatonin is a relatively safe drug that possesses potential in treating IBS. Future studies should focus on melatonin effect on gut mobility as well as its central nervous system effect to elucidate its role in IBS patients.
Collapse
|
45
|
Yang X, Park T, Wickens CD, Siah KTH, Fong L, Yin SQ. The effect of information access cost and overconfidence bias on junior doctors’ pre-handover performance. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1541931213571391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper examined the effect of information access cost and overconfidence bias on doctors’ information retrieval strategies and performances during pre-handover. Sixteen medical residents participated in a simulated experiment, where they studied four patient cases and later on completed recall and recognition questions. The results showed that an increase in information access cost led to less information access attempts and poorer pre-handover performance. Further, there was an interaction between information access cost and overconfidence on pre-handover performance. When information access cost was high, overconfidence contributed to poor pre-handover performance.
Collapse
Affiliation(s)
- Xi Yang
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore
| | - Taezoon Park
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore
| | | | | | - Liesel Fong
- Department of Medicine, National University Hospital System, Singapore
| | - Shan Qing Yin
- Clinical Service Department, Changi General Hospital, Singapore
| |
Collapse
|
46
|
Gwee KA, Siah KTH, Wong RK, Wee S, Wong ML, Png DJC. Prevalence of disturbed bowel functions and its association with disturbed bladder and sexual functions in the male population. J Gastroenterol Hepatol 2012; 27:1738-44. [PMID: 22849306 DOI: 10.1111/j.1440-1746.2012.07243.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Chronic constipation is usually associated with young women, and urinary and sexual dysfunction has been reported as co-morbidity. Elderly men also appear to suffer from chronic constipation, as well as lower urinary tract symptoms and erectile dysfunction, but their association as co-morbidity has not been studied in the community. The aim of the present study was to determine the prevalence of bowel symptoms in our community with particular reference to the association with urinary and sexual dysfunction in the male population. METHODS A population-based cross-sectional survey involving 2276 subjects (1143 male, 1133 female) representative of the Singapore population demographics was conducted to evaluate the prevalence of chronic bowel disturbances, lower urinary tract symptoms (LUTS), and erectile dysfunction (ED). RESULTS The prevalence of chronic constipation was 25.1% overall, with the highest in men aged ≥ 70 years (35.8%) followed by women aged 20-29 years (30.5%). The commonest symptoms reported in chronic constipation were hard stool (95.1%), straining (90.9%) and incomplete evacuation (53.8%). Bloating was often experienced by 25.5% of the community, among whom 61.1% had some form of bowel disturbance. In men aged ≥ 30 years, LUTS (7.8% v 3.1%) and ED (60.5% v 48.6%) were more common in men with than without chronic constipation; constipation was an independent predictor of ED. CONCLUSIONS In this Asian urban community, chronic constipation was more common than previously suspected, and urinary and erectile dysfunction were found to be co-morbidity in men.
Collapse
Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore.
| | | | | | | | | | | |
Collapse
|