Myanmar is the country where the prevalence of Helicobacter pylori (H. pylori) infection is high among Southeast Asia region. Many studies have demonstrated association of H. pylori infection with extraintestinal diseases as in pathogenic role.
Methods
This is narrative review article. Available studies regarding H. pylori and extraintestinal manifestations; both full texts and abstracts which appeared in the Union catalogue of Myanmar Health science link, were reviewed in this article.
Results
There were statistically significant association between H. pyloriinfection and autoimmune thrombocytopenia (P = .001), coronary artery disease (P = .001), Parkinson’s diseases (P = .001), chronic urticaria (P = .007) and psoriasis (P = .001). There were trend towards positive association with H. pylori infection and type 2 diabetes mellitus (0.544), ischemic stroke (P = .163) and pemphigus (58%) although statistically did not significant.
Conclusion
This is the first paper in Myanmar reviewing the prevalence of extraintestinal manifestation of H. pylori infection in Myanmar. Although the majority are descriptive in design and the results were heterogeneous , there are trend towards positive association of H. pylori infection and extraintestinal diseases in Myanmar.
{"title":"The status of Helicobacter pylori infection related extraintestinal diseases in Myanmar","authors":"Than Than Aye, Thet Mar Win, Myint Naychi Tun","doi":"10.1002/ygh2.472","DOIUrl":"https://doi.org/10.1002/ygh2.472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <h3> Background</h3> \u0000 <p>Myanmar is the country where the prevalence of <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection is high among Southeast Asia region. Many studies have demonstrated association of <i>H. pylori</i> infection with extraintestinal diseases as in pathogenic role.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is narrative review article. Available studies regarding <i>H. pylori</i> and extraintestinal manifestations; both full texts and abstracts which appeared in the Union catalogue of Myanmar Health science link, were reviewed in this article.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were statistically significant association between <i>H. pylori</i>infection and autoimmune thrombocytopenia (<i>P</i> = .001), coronary artery disease (<i>P</i> = .001), Parkinson’s diseases (<i>P</i> = .001), chronic urticaria (<i>P</i> = .007) and psoriasis (<i>P</i> = .001). There were trend towards positive association with <i>H. pylori</i> infection and type 2 diabetes mellitus (0.544), ischemic stroke (<i>P</i> = .163) and pemphigus (58%) although statistically did not significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first paper in Myanmar reviewing the prevalence of extraintestinal manifestation of <i>H. pylori</i> infection in Myanmar. Although the majority are descriptive in design and the results were heterogeneous , there are trend towards positive association of <i>H. pylori</i> infection and extraintestinal diseases in Myanmar.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 6","pages":"344-351"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71938725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ralley E. Prentice, Clarissa Rentsch, Aysha H. Al-Ani, Eva Zhang, Douglas Johnson, John Halliday, Robert Bryant, Jacob Begun, Mark G. Ward, Peter J. Lewindon, Susan J. Connor, Simon Ghaly, Britt Christensen
Background
The current COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has drastically impacted societies worldwide. Vaccination against SARS-CoV-2 is expected to play a key role in the management of this pandemic. Inflammatory conditions such as inflammatory bowel disease (IBD) often require chronic immunosuppression, which can influence vaccination decisions.
Aim
This review article aims to describe the most commonly available SARS-CoV-2 vaccination vectors globally, assess the potential benefits and concerns of vaccination in the setting of immunosuppression and provide medical practitioners with guidance regarding SARS-CoV-2 vaccination in patients with IBD.
Methods
All published Phase 1/2 and/or Phase 3 and 4 studies of SARS-CoV-2 vaccinations were reviewed. IBD international society position papers, safety registry data and media releases from pharmaceutical companies as well as administrative and medicines regulatory bodies were included. General vaccine evidence and recommendations in immunosuppressed patients were reviewed for context. Society position papers regarding special populations, including immunosuppressed, pregnant and breast-feeding individuals were also evaluated. Literature was critically analysed and summarised.
Results
Vaccination against SARS-CoV-2 is supported in all adult, non-pregnant individuals with IBD without contraindication. There is the potential that vaccine efficacy may be reduced in those who are immunosuppressed; however, medical therapies should not be withheld in order to undertake vaccination. SARS-CoV-2 vaccines are safe, but data specific to immunosuppressed patients remain limited.
Conclusions
SARS-CoV-2 vaccination is essential from both an individual patient and community perspective and should be encouraged in patients with IBD. Recommendations must be continually updated as real-world and trial-based evidence emerges.
{"title":"SARS-CoV-2 vaccination in patients with inflammatory bowel disease","authors":"Ralley E. Prentice, Clarissa Rentsch, Aysha H. Al-Ani, Eva Zhang, Douglas Johnson, John Halliday, Robert Bryant, Jacob Begun, Mark G. Ward, Peter J. Lewindon, Susan J. Connor, Simon Ghaly, Britt Christensen","doi":"10.1002/ygh2.473","DOIUrl":"10.1002/ygh2.473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The current COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has drastically impacted societies worldwide. Vaccination against SARS-CoV-2 is expected to play a key role in the management of this pandemic. Inflammatory conditions such as inflammatory bowel disease (IBD) often require chronic immunosuppression, which can influence vaccination decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This review article aims to describe the most commonly available SARS-CoV-2 vaccination vectors globally, assess the potential benefits and concerns of vaccination in the setting of immunosuppression and provide medical practitioners with guidance regarding SARS-CoV-2 vaccination in patients with IBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All published Phase 1/2 and/or Phase 3 and 4 studies of SARS-CoV-2 vaccinations were reviewed. IBD international society position papers, safety registry data and media releases from pharmaceutical companies as well as administrative and medicines regulatory bodies were included. General vaccine evidence and recommendations in immunosuppressed patients were reviewed for context. Society position papers regarding special populations, including immunosuppressed, pregnant and breast-feeding individuals were also evaluated. Literature was critically analysed and summarised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Vaccination against SARS-CoV-2 is supported in all adult, non-pregnant individuals with IBD without contraindication. There is the potential that vaccine efficacy may be reduced in those who are immunosuppressed; however, medical therapies should not be withheld in order to undertake vaccination. SARS-CoV-2 vaccines are safe, but data specific to immunosuppressed patients remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SARS-CoV-2 vaccination is essential from both an individual patient and community perspective and should be encouraged in patients with IBD. Recommendations must be continually updated as real-world and trial-based evidence emerges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 4","pages":"212-228"},"PeriodicalIF":0.0,"publicationDate":"2021-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39450364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lilian Yan Liang, Vincent Wai-Sun Wong, Vicki Wing-Ki Hui, Terry Cheuk-Fung Yip, Yee-Kit Tse, Grace Chung-Yan Lui, Henry Lik-Yuen Chan, Grace Lai-Hung Wong
Background
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a novel class of anti-diabetic drugs that lower the blood glucose level by inhibiting the renal glucose reabsorption. We aimed to evaluate the effect of SGLT2i on the risk of hepatic events in diabetic patients with chronic hepatitis B (CHB).
Methods
This is a retrospective territory-wide cohort study. Nucleos(t)ide analogue (NA)-treated diabetic patients with CHB were included. Patients who used SGLT2i for more than 90 days were classified as SGLT2i users and those who had never used SGLT2i were defined as non-SGLT2i users. The primary endpoint was the cumulative incidence of hepatic events.
Results
Among 5276 NA-treated diabetic patients with CHB, 393 (7.4%) patients were SGLT2i users and 4883 (92.6%) patients were non-users. Ten (2.5%) SGLT2i users and 739 (15.1%) non-users developed hepatic events during the mean follow-up of 25 and 63 months respectively. SGLT2i treatment was significantly associated with a lower risk of hepatic events in univariate analysis (subdistribution hazard ratio (SHR): 0.43, 95% CI: 0.22-0.84, P = 0.013) and log-rank test (P = 0.01) before propensity score (PS) weighting. This association was also observed in Fine-Gray subdistribution hazard regression after PS weighting (weighted SHR: 0.42, 95% CI: 0.19-0.90, P = 0.026).
Conclusions
Use of SGLT2i may be linked with a lower risk of hepatic events in NA-treated diabetic patients with CHB. Larger cohort studies or randomised trials are warranted.
{"title":"Sodium-glucose co-transporter 2 inhibitors reduce hepatic events in diabetic patients with chronic hepatitis B","authors":"Lilian Yan Liang, Vincent Wai-Sun Wong, Vicki Wing-Ki Hui, Terry Cheuk-Fung Yip, Yee-Kit Tse, Grace Chung-Yan Lui, Henry Lik-Yuen Chan, Grace Lai-Hung Wong","doi":"10.1002/ygh2.471","DOIUrl":"https://doi.org/10.1002/ygh2.471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a novel class of anti-diabetic drugs that lower the blood glucose level by inhibiting the renal glucose reabsorption. We aimed to evaluate the effect of SGLT2i on the risk of hepatic events in diabetic patients with chronic hepatitis B (CHB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective territory-wide cohort study. Nucleos(t)ide analogue (NA)-treated diabetic patients with CHB were included. Patients who used SGLT2i for more than 90 days were classified as SGLT2i users and those who had never used SGLT2i were defined as non-SGLT2i users. The primary endpoint was the cumulative incidence of hepatic events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5276 NA-treated diabetic patients with CHB, 393 (7.4%) patients were SGLT2i users and 4883 (92.6%) patients were non-users. Ten (2.5%) SGLT2i users and 739 (15.1%) non-users developed hepatic events during the mean follow-up of 25 and 63 months respectively. SGLT2i treatment was significantly associated with a lower risk of hepatic events in univariate analysis (subdistribution hazard ratio (SHR): 0.43, 95% CI: 0.22-0.84, <i>P</i> = 0.013) and log-rank test (<i>P</i> = 0.01) before propensity score (PS) weighting. This association was also observed in Fine-Gray subdistribution hazard regression after PS weighting (weighted SHR: 0.42, 95% CI: 0.19-0.90, <i>P</i> = 0.026).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Use of SGLT2i may be linked with a lower risk of hepatic events in NA-treated diabetic patients with CHB. Larger cohort studies or randomised trials are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 4","pages":"261-269"},"PeriodicalIF":0.0,"publicationDate":"2021-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71936001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To the Editor: The study by Lybeck et al1 focusing on riskassessment of extrahepatic cancer (EHC) in a nationwide Swedish cohort of hepatitis C virus (HCV) infected persons treated with direct acting antivirals (DAAs) provides critical insights in the patientfriendly, costeffective, timelinebased clinical management of HCVmediated EHC (eg nonHodgkin lymphoma/intrahepaticcholangiocarcinoma) for eventual design/development of novel immunomodulatory drugs and predictive/prognostic biomarkers in “atrisk” susceptible populations of varying genetic landscapes. Inclusion/exclusioncriteria were welldefined with a biasfree interpretation of complex statistical datasets; large sample size (N = 19 685 HCVpositive cases), a major study strength, added adequate statistical power (≥80%) reducing the possibility of potential selection bias in risk assessment amongst subgroups of HCVinfected persons: 4013 DAAtreated/3071 interferon (IFN)treated/12 601 untreated, with maximal 3 years’ clinical followup time. EHC risk was compared between treatment groups using Cox regression analyses, with adjustment for age/Charlson Comorbidity Index (CCI); matched case– control studyapproach wherein HCVinfected groups were stringently compared with matched cohorts without HCV from general Swedish population, reduced possibility of populationadmixture. Healthy/diseasefree, age/ethnicitymatched controls from random population significantly adds to statisticalpower of case– control association studies in “gastrohepatic diseaseweb”pathophysiology research2,3; Pandey has elegantly emphasized the significance of age/ethnicitymatched diseasefree controls from the general random population in multicentric epidemiology/ pharmacogenetics/genomics studies for demystifying the cellular/ molecular/genetic basis of inflammatory gastrohepatic ailments in susceptible cohorts.4 Overall, the findings of this study on HCVmediated EHC management in Swedish cohort(s) convincingly demonstrated that the HCVpositivity trend amongst 341 EHCs was appreciable: 84/43/214 EHC in DAA/IFN/untreatedgroup respectively; EHCrisk in DAAtreated compared with IFNtreated was doubled, but after adjustment for age/CCI, hazards ratio (HR) was 1.07 (95% CI 0.741.56). Cox regression analysis with controls revealed that EHCHR in DAAgroup = 1.45 (CI 1.131.86), with difference remaining statistically significant after adjusting for CCI. These findings may be successfully replicated in future multicentric large sample sizebased case– control prospective studies adhering to core tenets of good practice ethical research with longterm patient satisfaction trends. Interestingly, data from the HCVinfected EHCcohort and matched comparisoncohort were linked to national registers with prospectively collected data (National Board of Health and Welfare: PrescriptionRegister (PrR)/PatientRegister (PR)/CancerRegister (CR)/CauseofDeathRegister (DR)), adding authenticity to the selectioncriteria of eligible studysubjects of Swedish ethnic
{"title":"Re: Risk of extrahepatic cancer in a nationwide cohort of hepatitis C virus‐infected persons treated with direct‐acting antivirals: Public health impact amongst Swedish cohort in the Covid‐19 pandemic era","authors":"S. Pandey","doi":"10.1002/ygh2.470","DOIUrl":"https://doi.org/10.1002/ygh2.470","url":null,"abstract":"To the Editor: The study by Lybeck et al1 focusing on riskassessment of extrahepatic cancer (EHC) in a nationwide Swedish cohort of hepatitis C virus (HCV) infected persons treated with direct acting antivirals (DAAs) provides critical insights in the patientfriendly, costeffective, timelinebased clinical management of HCVmediated EHC (eg nonHodgkin lymphoma/intrahepaticcholangiocarcinoma) for eventual design/development of novel immunomodulatory drugs and predictive/prognostic biomarkers in “atrisk” susceptible populations of varying genetic landscapes. Inclusion/exclusioncriteria were welldefined with a biasfree interpretation of complex statistical datasets; large sample size (N = 19 685 HCVpositive cases), a major study strength, added adequate statistical power (≥80%) reducing the possibility of potential selection bias in risk assessment amongst subgroups of HCVinfected persons: 4013 DAAtreated/3071 interferon (IFN)treated/12 601 untreated, with maximal 3 years’ clinical followup time. EHC risk was compared between treatment groups using Cox regression analyses, with adjustment for age/Charlson Comorbidity Index (CCI); matched case– control studyapproach wherein HCVinfected groups were stringently compared with matched cohorts without HCV from general Swedish population, reduced possibility of populationadmixture. Healthy/diseasefree, age/ethnicitymatched controls from random population significantly adds to statisticalpower of case– control association studies in “gastrohepatic diseaseweb”pathophysiology research2,3; Pandey has elegantly emphasized the significance of age/ethnicitymatched diseasefree controls from the general random population in multicentric epidemiology/ pharmacogenetics/genomics studies for demystifying the cellular/ molecular/genetic basis of inflammatory gastrohepatic ailments in susceptible cohorts.4 Overall, the findings of this study on HCVmediated EHC management in Swedish cohort(s) convincingly demonstrated that the HCVpositivity trend amongst 341 EHCs was appreciable: 84/43/214 EHC in DAA/IFN/untreatedgroup respectively; EHCrisk in DAAtreated compared with IFNtreated was doubled, but after adjustment for age/CCI, hazards ratio (HR) was 1.07 (95% CI 0.741.56). Cox regression analysis with controls revealed that EHCHR in DAAgroup = 1.45 (CI 1.131.86), with difference remaining statistically significant after adjusting for CCI. These findings may be successfully replicated in future multicentric large sample sizebased case– control prospective studies adhering to core tenets of good practice ethical research with longterm patient satisfaction trends. Interestingly, data from the HCVinfected EHCcohort and matched comparisoncohort were linked to national registers with prospectively collected data (National Board of Health and Welfare: PrescriptionRegister (PrR)/PatientRegister (PR)/CancerRegister (CR)/CauseofDeathRegister (DR)), adding authenticity to the selectioncriteria of eligible studysubjects of Swedish ethnic","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82180937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Y. Liang, V. Wong, Vicki Wing-Ki Hui, T. Yip, Y. Tse, G. Lui, H. Chan, G. Wong
Sodium‐glucose co‐transporter 2 inhibitors (SGLT2i) are a novel class of anti‐diabetic drugs that lower the blood glucose level by inhibiting the renal glucose reabsorption. We aimed to evaluate the effect of SGLT2i on the risk of hepatic events in diabetic patients with chronic hepatitis B (CHB).
{"title":"Sodium‐glucose co‐transporter 2 inhibitors reduce hepatic events in diabetic patients with chronic hepatitis B","authors":"L. Y. Liang, V. Wong, Vicki Wing-Ki Hui, T. Yip, Y. Tse, G. Lui, H. Chan, G. Wong","doi":"10.1002/ygh2.471","DOIUrl":"https://doi.org/10.1002/ygh2.471","url":null,"abstract":"Sodium‐glucose co‐transporter 2 inhibitors (SGLT2i) are a novel class of anti‐diabetic drugs that lower the blood glucose level by inhibiting the renal glucose reabsorption. We aimed to evaluate the effect of SGLT2i on the risk of hepatic events in diabetic patients with chronic hepatitis B (CHB).","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"35 1","pages":"261 - 269"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72666136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer K. Maratt, Alison E. Freeman, Philip Schoenfeld, Sameer D. Saini, Grace L. Su, Andrew W. Tai, Anoop Prabhu, Joel H. Rubenstein, Akbar K. Waljee, Lisa Glass, Duyen Dang, Neehar D. Parikh, Shail M. Govani, Swati G. Patel, Stacy B. Menees
Background
Intraluminal bubbles may prevent the visualisation of mucosa during a colonoscopy. Simethicone minimises bubbles, but its impact on incomplete bowel preparation and optimal protocols for use are unclear.
Aim
To assess the impact of oral simethicone tablets when added to 2-litre, split-prep, polyethylene glycol electrolyte lavage solution + ascorbic acid on bubble score and frequency of incomplete bowel preparation.
Methods
This QA/QI project assessed outpatients who underwent colonoscopy at the Veterans Affairs Ann Arbor Healthcare System. After endoscopists were trained in intraluminal bubble scoring systems, data about bubble score, frequency of inadequate bowel preparation requiring early repeat colonoscopy, quality of bowel preparation using Boston Bowel Preparation Scale (BBPS), and patient tolerance were collected before and after addition of oral simethicone 160mg to each dose of 2-litre split-prep.
Results
There were no differences in patient characteristics between the baseline group (n = 348) and the simethicone group (n = 354). Simethicone improved the total mean intraluminal bubble score from 8.18 to 8.78 (P < 0.001). Early repeat colonoscopy due to inadequate bowel preparation was higher in the baseline group vs simethicone group: 8.7% vs 4.6%, P = 0.03 with an RRR = 0.5 (95% CI 0.26-0.95). Using BBPS, the frequency of having inadequate cleansing in any colon segment was higher in the baseline group vs simethicone group: 6.6% vs 3.1%; RRR = 0.55 (95% CI 0.21-0.94).
Conclusions
The addition of oral simethicone to each dose of 2-litre, split-prep of polyethylene glycol + ascorbic acid decreased intraluminal bubbles and reduced the frequency of inadequate bowel preparation.
{"title":"Oral simethicone tablets with PEG-ELS split-prep reduces frequency of inadequate bowel cleansing and decreases bubbles","authors":"Jennifer K. Maratt, Alison E. Freeman, Philip Schoenfeld, Sameer D. Saini, Grace L. Su, Andrew W. Tai, Anoop Prabhu, Joel H. Rubenstein, Akbar K. Waljee, Lisa Glass, Duyen Dang, Neehar D. Parikh, Shail M. Govani, Swati G. Patel, Stacy B. Menees","doi":"10.1002/ygh2.469","DOIUrl":"https://doi.org/10.1002/ygh2.469","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intraluminal bubbles may prevent the visualisation of mucosa during a colonoscopy. Simethicone minimises bubbles, but its impact on incomplete bowel preparation and optimal protocols for use are unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the impact of oral simethicone tablets when added to 2-litre, split-prep, polyethylene glycol electrolyte lavage solution + ascorbic acid on bubble score and frequency of incomplete bowel preparation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This QA/QI project assessed outpatients who underwent colonoscopy at the Veterans Affairs Ann Arbor Healthcare System. After endoscopists were trained in intraluminal bubble scoring systems, data about bubble score, frequency of inadequate bowel preparation requiring early repeat colonoscopy, quality of bowel preparation using Boston Bowel Preparation Scale (BBPS), and patient tolerance were collected before and after addition of oral simethicone 160mg to each dose of 2-litre split-prep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no differences in patient characteristics between the baseline group (n = 348) and the simethicone group (n = 354). Simethicone improved the total mean intraluminal bubble score from 8.18 to 8.78 (<i>P</i> < 0.001). Early repeat colonoscopy due to inadequate bowel preparation was higher in the baseline group vs simethicone group: 8.7% vs 4.6%, <i>P</i> = 0.03 with an RRR = 0.5 (95% CI 0.26-0.95). Using BBPS, the frequency of having inadequate cleansing in any colon segment was higher in the baseline group vs simethicone group: 6.6% vs 3.1%; RRR = 0.55 (95% CI 0.21-0.94).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The addition of oral simethicone to each dose of 2-litre, split-prep of polyethylene glycol + ascorbic acid decreased intraluminal bubbles and reduced the frequency of inadequate bowel preparation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 4","pages":"254-260"},"PeriodicalIF":0.0,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71976923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-09DOI: 10.1002/ygh2.477/v1/review2
A. Kulkarni, S. Fatima, Mithun Sharma, P. Kumar, Rajesh Gupta, N. Padaki, N. Reddy
The AsiaPacific region contributes to nearly 73% of global deaths due to hepatocellular carcinoma (HCC).1 The ageadjusted annual HCC incidence rate (per 100,000 persons) in India ranges between 0.7 and 7.5 for men and 0.2 and 2.2 for women.2 Most patients present in the advanced stage when definitive therapies are not possible.3 Lenvatinib was a breakthrough in the treatment of unresectable HCC (uHCC).4 However, there is no Indian data on lenvatinib therapy. In this report, we describe the outcomes of uHCC patients treated with lenvatinib. We retrospectively analysed the data of patients who were treated with lenvatinib as firstline systemic therapy at our tertiary care centre from January 2019 to February 2021. The data were analysed using SPSS software 25 version. Descriptive statistics have been expressed as mean (±SD) for continuous data. For categorical data, we have expressed the results as a percentage (n). KaplanMeier analysis was used to assess the median overall survival (OS) and progressionfree survival (PFS). A total of 63 patients received lenvatinib. The mean age was 60.24 ± 9.57 years. Males were predominant (93.7%). Viral hepatitis (50%) was the most common cause of liver disease, followed by nonalcoholic steatohepatitis (44.5%) and alcohol (6.3%). Twentytwo percent (14/63) of patients were noncirrhotic HCC. The mean αfetoprotein (AFP) before initiation of lenvatinib was 1120.71 ± 2369.55 ng/mL. All the patients had ≤1 Eastern Cooperative Oncology Group performance status. Thirtyfive percent of patients had received a prior radiological intervention (Table 1). Sixtytwo percent (39/63) of patients were initiated on 8 mg dose and the rest on 12 mg dose based on the weight. Fiftysix percent (35/63) of patients developed adverse events. The median tolerated dose was 8 mg/d in the whole cohort. The median duration of therapy was 4.1 months. Adverse events noted were hypertension (13/63, 21%), nausea (6/63, 10%), diarrheoa (5/63, 8%), palmarplantar erythrodysesthesia syndrome (4/63, 6.35%), fatigue (3/63, 5%), skin rash (2/63, 3.17%) and abdominal pain (1/63, 1.6%). One patient developed tumour rupture (size 10.3 × 7.1 cm) after 27 days of therapy. Treatment was discontinued in 20% (12/63) of patients due to adverse events. Seven patients were started on regorafenib, given the progressive disease. On KM analysis, the median PFS was 5 (95% CI, 4.275.72) months, and the median OS was 10.4 (95% CI, 8.2412.56) months. Fiftytwo patients were evaluated by modified Response Evaluation Criteria in Solid Tumors (mRECIST). While none of the patients achieved complete response, 27% (14/52) achieved partial response, 44.2% (23/52) had stable disease, and the disease progressed in 29% (15/52) of patients. Lenvatinib is a multikinase inhibitor which is now one of the firstline therapy recommended for uHCC. The first study by Kudo et al demonstrated noninferiority of lenvatinib compared to sorafenib.4 The median PFS was significantly better with lenva
{"title":"Lenvatinib for unresectable hepatocellular carcinoma: the first Indian experience","authors":"A. Kulkarni, S. Fatima, Mithun Sharma, P. Kumar, Rajesh Gupta, N. Padaki, N. Reddy","doi":"10.1002/ygh2.477/v1/review2","DOIUrl":"https://doi.org/10.1002/ygh2.477/v1/review2","url":null,"abstract":"The AsiaPacific region contributes to nearly 73% of global deaths due to hepatocellular carcinoma (HCC).1 The ageadjusted annual HCC incidence rate (per 100,000 persons) in India ranges between 0.7 and 7.5 for men and 0.2 and 2.2 for women.2 Most patients present in the advanced stage when definitive therapies are not possible.3 Lenvatinib was a breakthrough in the treatment of unresectable HCC (uHCC).4 However, there is no Indian data on lenvatinib therapy. In this report, we describe the outcomes of uHCC patients treated with lenvatinib. We retrospectively analysed the data of patients who were treated with lenvatinib as firstline systemic therapy at our tertiary care centre from January 2019 to February 2021. The data were analysed using SPSS software 25 version. Descriptive statistics have been expressed as mean (±SD) for continuous data. For categorical data, we have expressed the results as a percentage (n). KaplanMeier analysis was used to assess the median overall survival (OS) and progressionfree survival (PFS). A total of 63 patients received lenvatinib. The mean age was 60.24 ± 9.57 years. Males were predominant (93.7%). Viral hepatitis (50%) was the most common cause of liver disease, followed by nonalcoholic steatohepatitis (44.5%) and alcohol (6.3%). Twentytwo percent (14/63) of patients were noncirrhotic HCC. The mean αfetoprotein (AFP) before initiation of lenvatinib was 1120.71 ± 2369.55 ng/mL. All the patients had ≤1 Eastern Cooperative Oncology Group performance status. Thirtyfive percent of patients had received a prior radiological intervention (Table 1). Sixtytwo percent (39/63) of patients were initiated on 8 mg dose and the rest on 12 mg dose based on the weight. Fiftysix percent (35/63) of patients developed adverse events. The median tolerated dose was 8 mg/d in the whole cohort. The median duration of therapy was 4.1 months. Adverse events noted were hypertension (13/63, 21%), nausea (6/63, 10%), diarrheoa (5/63, 8%), palmarplantar erythrodysesthesia syndrome (4/63, 6.35%), fatigue (3/63, 5%), skin rash (2/63, 3.17%) and abdominal pain (1/63, 1.6%). One patient developed tumour rupture (size 10.3 × 7.1 cm) after 27 days of therapy. Treatment was discontinued in 20% (12/63) of patients due to adverse events. Seven patients were started on regorafenib, given the progressive disease. On KM analysis, the median PFS was 5 (95% CI, 4.275.72) months, and the median OS was 10.4 (95% CI, 8.2412.56) months. Fiftytwo patients were evaluated by modified Response Evaluation Criteria in Solid Tumors (mRECIST). While none of the patients achieved complete response, 27% (14/52) achieved partial response, 44.2% (23/52) had stable disease, and the disease progressed in 29% (15/52) of patients. Lenvatinib is a multikinase inhibitor which is now one of the firstline therapy recommended for uHCC. The first study by Kudo et al demonstrated noninferiority of lenvatinib compared to sorafenib.4 The median PFS was significantly better with lenva","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80428184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bunthen E, Ko Ko, Shintaro Nagashima, Serge Ouoba, Md Razeen Ashraf Hussain, Aya Sugiyama, Tomoyuki Akita, Masayuki Ohisa, Channarena Chuon, Bunsoth Mao, Md Shafiqul Hossain, Vichit Ork, Junko Tanaka
Aims
This study aims to examine the diagnostic accuracy of dried blood spot (DBS) samples contrast to serum samples for detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) sero-markers in large scale epidemiological study in the resource limited settings and then to determine the prevalence of each sero-marker from DBS samples collected during 2017 Cambodia nationwide study.
Methods
This study included 921 paired DBS and serum samples. HBsAg, HBsAg-HQ, anti-HBs, anti-HBc and anti-HCV were detected in all DBS/serum pairs but HBeAg and anti-HBe in 109 DBS/serum pairs using chemiluminescent enzyme immunoassay (CLEIA). Thereafter, the individual DBS's diagnostic accuracy was calculated. Additionally, the prevalence of each sero-marker was calculated in 4541 DBS samples from nationwide study in Cambodia.
Results
The sensitivity of DBS for detection of HBsAg, HBsAg-HQ, HBeAg and antiHBe were high (≥90%) with 100% specificity. Anti-HBc and anti-HBs showed low sensitivity (70.73% and 69.25% respectively) than other sero-markers, but their diagnostic accuracies were 94.58% and 89.32%. Therefore, the overall prevalence of HBsAg, HBsAg-HQ, anti-HBc, anti-HBs and anti-HCV using DBS samples in Cambodia were 2.38%, 2.53%, 14.27%, 31.84% and 0.15%, respectively. HBeAg and anti-HBe positivity among HBsAg positives were 31.48% and 53.7%.
Conclusion
Our study indicates that DBS has high diagnostic accuracy for HBsAg, HBsAg-HQ, HBeAg and anti-HBe. Having the benefit of simple procedure, easy and compact transportation and storage, it is considered as an alternative to serum samples in examining the serological profiles of HBV infection through a large-scale epidemiological study in the resource limited settings.
{"title":"Dried blood spot-based detection of serological profiles of hepatitis B and C infections and their prevalence in Cambodia","authors":"Bunthen E, Ko Ko, Shintaro Nagashima, Serge Ouoba, Md Razeen Ashraf Hussain, Aya Sugiyama, Tomoyuki Akita, Masayuki Ohisa, Channarena Chuon, Bunsoth Mao, Md Shafiqul Hossain, Vichit Ork, Junko Tanaka","doi":"10.1002/ygh2.468","DOIUrl":"https://doi.org/10.1002/ygh2.468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aims to examine the diagnostic accuracy of dried blood spot (DBS) samples contrast to serum samples for detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) sero-markers in large scale epidemiological study in the resource limited settings and then to determine the prevalence of each sero-marker from DBS samples collected during 2017 Cambodia nationwide study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 921 paired DBS and serum samples. HBsAg, HBsAg-HQ, anti-HBs, anti-HBc and anti-HCV were detected in all DBS/serum pairs but HBeAg and anti-HBe in 109 DBS/serum pairs using chemiluminescent enzyme immunoassay (CLEIA). Thereafter, the individual DBS's diagnostic accuracy was calculated. Additionally, the prevalence of each sero-marker was calculated in 4541 DBS samples from nationwide study in Cambodia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sensitivity of DBS for detection of HBsAg, HBsAg-HQ, HBeAg and antiHBe were high (≥90%) with 100% specificity. Anti-HBc and anti-HBs showed low sensitivity (70.73% and 69.25% respectively) than other sero-markers, but their diagnostic accuracies were 94.58% and 89.32%. Therefore, the overall prevalence of HBsAg, HBsAg-HQ, anti-HBc, anti-HBs and anti-HCV using DBS samples in Cambodia were 2.38%, 2.53%, 14.27%, 31.84% and 0.15%, respectively. HBeAg and anti-HBe positivity among HBsAg positives were 31.48% and 53.7%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study indicates that DBS has high diagnostic accuracy for HBsAg, HBsAg-HQ, HBeAg and anti-HBe. Having the benefit of simple procedure, easy and compact transportation and storage, it is considered as an alternative to serum samples in examining the serological profiles of HBV infection through a large-scale epidemiological study in the resource limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 4","pages":"247-253"},"PeriodicalIF":0.0,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71936433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victoria Tatiana Kronsten, Michael J. Colwill, Shadab Nayeemuddin, Jimmy K. Limdi, Christian Selinger, Glyn Scott, Lulia Al-Hillawi, Shayon Salehi, Paul Blaker, Guy Chung-Faye, Alexandra J. Kent, Patrick Dubois, Bu Hayee
Background
Anti-tumour necrosis factor therapy is an established treatment for moderate-to-severely active ulcerative colitis (UC). Recent network meta-analyses of controlled trial data have indicated a superiority of intravenous drugs (infliximab) over subcutaneous (adalimumab). We conducted a retrospective multi-centre cohort study to determine the comparative effectiveness of these two drugs.
Methods
Patients with UC administered infliximab or adalimumab as their first biologic, identified from the therapy databases of five UK hospitals, were included, if they had completed induction and were on maintenance treatment. Patients receiving infliximab as ‘rescue’ therapy for acute severe UC were excluded. The primary end-points for comparison were the number of patients remaining on initial therapy (infliximab or adalimumab) at 52 weeks and the number of patients in clinical remission at 52 weeks (Simple Clinical Colitis Activity [SCCAI] score ≤ 3).
Results
Seventy-eight infliximab and 63 adalimumab patients were analysed. At 52 weeks, 83% of infliximab patients and 59% of adalimumab patients remained on therapy (P = 0.001). At 52 weeks, 62% of the infliximab group were in clinical remission compared to 32% of the adalimumab group (P = 0.0004). Primary non-response was reported in 24% of adalimumab patients and 5% of infliximab patients (P = 0.001). There were no significant differences in colectomy rates or hospital admission for acute flares at 52 weeks.
Conclusions
Our real-world results affirm the findings of network meta-analyses of clinical trials, suggesting that infliximab is superior to adalimumab in the maintenance of remission in UC up to 52 weeks.
{"title":"A ‘real-world’ retrospective multi-centre cohort study comparing infliximab and adalimumab for the maintenance of remission in ulcerative colitis","authors":"Victoria Tatiana Kronsten, Michael J. Colwill, Shadab Nayeemuddin, Jimmy K. Limdi, Christian Selinger, Glyn Scott, Lulia Al-Hillawi, Shayon Salehi, Paul Blaker, Guy Chung-Faye, Alexandra J. Kent, Patrick Dubois, Bu Hayee","doi":"10.1002/ygh2.467","DOIUrl":"https://doi.org/10.1002/ygh2.467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anti-tumour necrosis factor therapy is an established treatment for moderate-to-severely active ulcerative colitis (UC). Recent network meta-analyses of controlled trial data have indicated a superiority of intravenous drugs (infliximab) over subcutaneous (adalimumab). We conducted a retrospective multi-centre cohort study to determine the comparative effectiveness of these two drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with UC administered infliximab or adalimumab as their first biologic, identified from the therapy databases of five UK hospitals, were included, if they had completed induction and were on maintenance treatment. Patients receiving infliximab as ‘rescue’ therapy for acute severe UC were excluded. The primary end-points for comparison were the number of patients remaining on initial therapy (infliximab or adalimumab) at 52 weeks and the number of patients in clinical remission at 52 weeks (Simple Clinical Colitis Activity [SCCAI] score ≤ 3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-eight infliximab and 63 adalimumab patients were analysed. At 52 weeks, 83% of infliximab patients and 59% of adalimumab patients remained on therapy (<i>P</i> = 0.001). At 52 weeks, 62% of the infliximab group were in clinical remission compared to 32% of the adalimumab group (<i>P</i> = 0.0004). Primary non-response was reported in 24% of adalimumab patients and 5% of infliximab patients (<i>P</i> = 0.001). There were no significant differences in colectomy rates or hospital admission for acute flares at 52 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our real-world results affirm the findings of network meta-analyses of clinical trials, suggesting that infliximab is superior to adalimumab in the maintenance of remission in UC up to 52 weeks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 4","pages":"229-235"},"PeriodicalIF":0.0,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.467","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71936436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Kronsten, M. Colwill, S. Nayeemuddin, J. Limdi, C. Selinger, G. Scott, L. Al‐Hillawi, S. Salehi, P. Blaker, G. Chung-Faye, A. Kent, P. Dubois, B. Hayee
Anti‐tumour necrosis factor therapy is an established treatment for moderate‐to‐severely active ulcerative colitis (UC). Recent network meta‐analyses of controlled trial data have indicated a superiority of intravenous drugs (infliximab) over subcutaneous (adalimumab). We conducted a retrospective multi‐centre cohort study to determine the comparative effectiveness of these two drugs.
{"title":"A ‘real‐world’ retrospective multi‐centre cohort study comparing infliximab and adalimumab for the maintenance of remission in ulcerative colitis","authors":"V. Kronsten, M. Colwill, S. Nayeemuddin, J. Limdi, C. Selinger, G. Scott, L. Al‐Hillawi, S. Salehi, P. Blaker, G. Chung-Faye, A. Kent, P. Dubois, B. Hayee","doi":"10.1002/ygh2.467","DOIUrl":"https://doi.org/10.1002/ygh2.467","url":null,"abstract":"Anti‐tumour necrosis factor therapy is an established treatment for moderate‐to‐severely active ulcerative colitis (UC). Recent network meta‐analyses of controlled trial data have indicated a superiority of intravenous drugs (infliximab) over subcutaneous (adalimumab). We conducted a retrospective multi‐centre cohort study to determine the comparative effectiveness of these two drugs.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"45 1","pages":"229 - 235"},"PeriodicalIF":0.0,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73318319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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