Antimicrobial eradication rates for Helicobacter pylori have been decreasing and the reason for treatment failure was found to be resistance to one or more of the antibiotics. Clarithromycin resistance to H pylori was associated with point mutations in the 23S rRNA gene and the PCR-RFLP method can detect these point mutations. The aim of this study was to determine the molecular detection of genotypic clarithromycin-resistant strains and its effect on the eradication rate of concomitant therapy in H pylori infection. The presence of H pylori DNA was confirmed by amplifying the UreC gene by polymerase chain reaction (PCR) and point mutations on 23S rRNA (A2142G and A2143G) were detected by PCR-RFLP. A total of 98 H pylori-infected patients were involved and among them, genotypic clarithromycin-sensitive strain was 93.9% and clarithromycin-resistant strain was 6.1%. All patients were found to have the A2143G point mutation but A2142G was not detected. Successful eradication rate of concomitant therapy was found to be 89.8% and unsuccessful rate was 10.2%. Among patients with the clarithromycin-resistant gene, only 16.7% had successful eradication and 83.3% had unsuccessful eradication. There was a statistically significant association between failure rate of concomitant therapy and detection of clarithromycin-resistant genes (P < 0.01). The presence of A2143G point mutation in the clarithromycin-resistant strain has a negative effect on the eradication rate of H pylori infection.
{"title":"Molecular detection of genotypic clarithromycin-resistant strains and its effect on the eradication rate of concomitant therapy in Helicobacter pylori infection","authors":"Khun Nyi Nyi, Aye Min Soe, Zaw Min Htut","doi":"10.1002/ygh2.476","DOIUrl":"https://doi.org/10.1002/ygh2.476","url":null,"abstract":"<p>Antimicrobial eradication rates for <i>Helicobacter pylori</i> have been decreasing and the reason for treatment failure was found to be resistance to one or more of the antibiotics. Clarithromycin resistance to <i>H pylori</i> was associated with point mutations in the 23S rRNA gene and the PCR-RFLP method can detect these point mutations. The aim of this study was to determine the molecular detection of genotypic clarithromycin-resistant strains and its effect on the eradication rate of concomitant therapy in <i>H pylori</i> infection. The presence of <i>H pylori</i> DNA was confirmed by amplifying the UreC gene by polymerase chain reaction (PCR) and point mutations on 23S rRNA (A2142G and A2143G) were detected by PCR-RFLP. A total of 98 <i>H pylori</i>-infected patients were involved and among them, genotypic clarithromycin-sensitive strain was 93.9% and clarithromycin-resistant strain was 6.1%. All patients were found to have the A2143G point mutation but A2142G was not detected. Successful eradication rate of concomitant therapy was found to be 89.8% and unsuccessful rate was 10.2%. Among patients with the clarithromycin-resistant gene, only 16.7% had successful eradication and 83.3% had unsuccessful eradication. There was a statistically significant association between failure rate of concomitant therapy and detection of clarithromycin-resistant genes (<i>P</i> < 0.01). The presence of A2143G point mutation in the clarithromycin-resistant strain has a negative effect on the eradication rate of <i>H pylori</i> infection.</p>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 6","pages":"372-378"},"PeriodicalIF":0.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71955820","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}
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.
缅甸是东南亚地区幽门螺杆菌感染率较高的国家。许多研究表明，幽门螺杆菌感染与肠外疾病有关。
{"title":"The status of Helicobacter pylori infection related extraintestinal diseases in Myanmar","authors":"T. Aye, T. Win, M. Tun","doi":"10.1002/ygh2.472","DOIUrl":"https://doi.org/10.1002/ygh2.472","url":null,"abstract":"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.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"16 1","pages":"344 - 351"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84519352","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}
Grace Y. Zhang, Krupa Patel, Olufunso Agbalajobi, Wheytnie Alexandre, Andrea Reid, Marina Serper, Linda Calgaro, Susan Zickmund, Tami Coppler, Margaret Mizah, Obaid Shaikh, Shari Rogal
Background
Treatment adherence remains a potential barrier to achieving population-level hepatitis C virus (HCV) elimination by 2030. We aimed to understand barriers to and facilitators of HCV treatment adherence pre- and post-direct-acting antiviral (DAA) treatment.
Methods
A cohort of US Veterans who were initiating DAA treatment completed pre- and post-treatment surveys assessing demographic information, psychological symptoms and perceived barriers to adherence. DAA adherence was assessed through self-report and pharmacy records. Sustained virologic response (SVR) was evaluated using the medical record. Mann-Whitney U, Fisher's exact tests, and logistic regression were employed to evaluate associations of patient characteristics and survey responses with adherence and SVR.
Results
Of 97 participants, the majority were male (98%), white (62%), low-income (less than 35 000/y; 82%), and had a history of self-reported prior substance use (93%). The most common anticipated adherence barrier prior to treatment was having side effects (21%). Over follow-up, 62% of participants missed doses and 84% achieved SVR. Decreased pain (OR 0.32, 95% CI 1.06-1.72), agreeing with ‘the medication will improve my health’ (OR 4, 95% CI 1.22-15.8) and disagreeing with being ‘worried about my liver disease getting worse’ (OR 0.2, 95% CI 0.05, 0.59) predicted successfully achieving SVR. After treatment, the most commonly reported barriers to adherence were being busy (13%) and being away from home (13%). Veterans reported non-significantly decreased substance use after treatment (38% vs 28%, P = .18).
Conclusion
In this population of Veterans with high rates of substance use, most participants missed doses but still achieved SVR. HCV treatment may also serve as an opportunity for substance use treatment.
{"title":"Patient perceptions of successful hepatitis C virus treatment adherence in Veterans","authors":"Grace Y. Zhang, Krupa Patel, Olufunso Agbalajobi, Wheytnie Alexandre, Andrea Reid, Marina Serper, Linda Calgaro, Susan Zickmund, Tami Coppler, Margaret Mizah, Obaid Shaikh, Shari Rogal","doi":"10.1002/ygh2.474","DOIUrl":"https://doi.org/10.1002/ygh2.474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Treatment adherence remains a potential barrier to achieving population-level hepatitis C virus (HCV) elimination by 2030. We aimed to understand barriers to and facilitators of HCV treatment adherence pre- and post-direct-acting antiviral (DAA) treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort of US Veterans who were initiating DAA treatment completed pre- and post-treatment surveys assessing demographic information, psychological symptoms and perceived barriers to adherence. DAA adherence was assessed through self-report and pharmacy records. Sustained virologic response (SVR) was evaluated using the medical record. Mann-Whitney <i>U</i>, Fisher's exact tests, and logistic regression were employed to evaluate associations of patient characteristics and survey responses with adherence and SVR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 97 participants, the majority were male (98%), white (62%), low-income (less than 35 000/y; 82%), and had a history of self-reported prior substance use (93%). The most common anticipated adherence barrier prior to treatment was having side effects (21%). Over follow-up, 62% of participants missed doses and 84% achieved SVR. Decreased pain (OR 0.32, 95% CI 1.06-1.72), agreeing with ‘the medication will improve my health’ (OR 4, 95% CI 1.22-15.8) and disagreeing with being ‘worried about my liver disease getting worse’ (OR 0.2, 95% CI 0.05, 0.59) predicted successfully achieving SVR. After treatment, the most commonly reported barriers to adherence were being busy (13%) and being away from home (13%). Veterans reported non-significantly decreased substance use after treatment (38% vs 28%, <i>P</i> = .18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this population of Veterans with high rates of substance use, most participants missed doses but still achieved SVR. HCV treatment may also serve as an opportunity for substance use treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"3 5","pages":"307-325"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ygh2.474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71941516","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}
Cholangiocarcinoma has a poor prognosis because of the poor early detection rate and limited treatment options. Therefore, it is important to understand the symptoms of paraneoplastic syndromes in order to detect occult malignancy early, when it is still at a highly treatable stage. Here, we report an extremely rare case of cholangiocarcinoma with paraneoplastic syndrome related to a clinical diagnosis of dermatomyositis (DM) sine dermatitis. A 74‐year‐old Caucasian man experienced 3 weeks of painless jaundice, progressive proximal muscle weakness and renal failure with rhabdomyolysis. Based on the results of laboratory tests and imaging (magnetic resonance cholangiopancreatography, endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography) and histological examination, the diagnosis was cholangiocarcinoma. The diagnosis was consistent with cholangiocarcinoma with paraneoplastic syndrome provoked by DM sine dermatitis. He was successfully treated with biliary stent insertion and supportive management. Eventually, Whipple surgery was successfully performed. Paraneoplastic syndrome is very rare in patients with cholangiocarcinoma, and it is extremely uncommon in the setting of DM. This is the first case in New Zealand.
{"title":"A rare case of cholangiocarcinoma presenting with paraneoplastic syndrome","authors":"Stephanie L. Yung, M. Arendse, F. Weilert, B. Ko","doi":"10.1002/ygh2.479","DOIUrl":"https://doi.org/10.1002/ygh2.479","url":null,"abstract":"Cholangiocarcinoma has a poor prognosis because of the poor early detection rate and limited treatment options. Therefore, it is important to understand the symptoms of paraneoplastic syndromes in order to detect occult malignancy early, when it is still at a highly treatable stage. Here, we report an extremely rare case of cholangiocarcinoma with paraneoplastic syndrome related to a clinical diagnosis of dermatomyositis (DM) sine dermatitis. A 74‐year‐old Caucasian man experienced 3 weeks of painless jaundice, progressive proximal muscle weakness and renal failure with rhabdomyolysis. Based on the results of laboratory tests and imaging (magnetic resonance cholangiopancreatography, endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography) and histological examination, the diagnosis was cholangiocarcinoma. The diagnosis was consistent with cholangiocarcinoma with paraneoplastic syndrome provoked by DM sine dermatitis. He was successfully treated with biliary stent insertion and supportive management. Eventually, Whipple surgery was successfully performed. Paraneoplastic syndrome is very rare in patients with cholangiocarcinoma, and it is extremely uncommon in the setting of DM. This is the first case in New Zealand.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"1 1","pages":"326 - 330"},"PeriodicalIF":0.0,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88759037","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}
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}
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