Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial ...Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.展开更多
Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance.However,the utility of these technological advancements remain dependent on the quality of bow...Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance.However,the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy.Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance,such as reduced cecal intubation rates,increased patient discomfort and lower adenoma detection.The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte,a non-absorbable solution,or aqueous sodium phosphate,a lowvolume hyperosmotic solution.Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar,although patients' compliance with these regimes may differ somewhat.Many studies have now shown that factors other than the type of bowel preparation regime used,can influence the quality of bowel preparation among adult patients undergoing colonoscopy.These factors can be broadly categorized as either patient-related or procedure-related.Studies from both Asia and the West have identified patient-related factors such as an increased age,male gender,presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy.Additionally,procedure-related factors such as adherence to bowel preparation instructions,timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing.Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly,such that the quality of colonoscopy performance and delivery of service to patients can be optimised.展开更多
AIM:To compare same-day whole-dose vs split-dose of 2-litre polyethylene glycol electrolyte lavage solution(PEG-ELS)plus bisacodyl for colon cleansing for morning colonoscopy.METHODS:Consecutive adult patients undergo...AIM:To compare same-day whole-dose vs split-dose of 2-litre polyethylene glycol electrolyte lavage solution(PEG-ELS)plus bisacodyl for colon cleansing for morning colonoscopy.METHODS:Consecutive adult patients undergoing morning colonoscopy were allocated into two groups i.e.,same-day whole-dose or split-dose of 2-litre PEGELS.Investigators and endoscopists were blinded to the allocation.All patients completed a questionnaire that was designed by Aronchick and colleagues to assess the tolerability of the bowel preparation regime used.In addition,patients answered an ordinal fivevalue Likert scale question on comfort level during bowel preparation.Endoscopists graded the quality of bowel preparation using the Boston bowel preparation scale(BBPS).In addition,endoscopists gave an overall grading of the quality of bowel preparation.Cecal intu-bation time,withdrawal time,total colonoscopy time,adenoma detection rate and number of adenomas detected for each patient were recorded.Sample size was calculated using an online calculator for binary outcome non-inferiority trial.Analyses was based upon intent-to-treat.Significance was assumed at P-value<0.05.RESULTS:Data for 295 patients were analysed.Mean age was 62.0±14.4 years old and consisted of 50.2%male.There were 143 and 152 patients in the split-dose and whole-dose group,respectively.Splitdose was as good as whole-dose for quality of bowel preparation.The total BBPS score was as good in the split-dose group compared to the whole-dose group[6(6-8)vs 6(6-7),P=0.038].There was no difference in cecal intubation rate,cecal intubation time,withdrawal time,total colonoscopy time and adenoma detection rate.Median number of adenoma detected was marginally higher in the split-dose group[2(1-3)vs 1(1-2),P=0.010].Patients in the whole-dose group had more nausea(37.5%vs 25.2%,P=0.023)and vomiting(16.4%vs 8.4%,P=0.037),and were less likely to complete the bowel preparation(94.1%vs 99.3%,P=0.020).Patients in the split-dose group were less likely to refuse the same bowel preparation regime(6.3%vs 13.8%,P=0.033)and less likely to want to try another bowel preparation regime(53.8%vs 78.9%,P<0.001).CONCLUSION:Splitting reduced-volume PEG-ELS for morning colonoscopy is as effective as taking the whole dose on the same morning but is better tolerated and preferred by patients.展开更多
Irritable bowel syndrome(IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical pr...Irritable bowel syndrome(IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psychosocial factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including:(1) large proportion of the population living in rural areas;(2) rapid development and associated lifestyle changes in urban areas; and(3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.展开更多
BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease(NAFLD)management.The fibrosis-8(FIB-8)score,recently developed by incorporating four additional variables into the fibrosis-4(FIB...BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease(NAFLD)management.The fibrosis-8(FIB-8)score,recently developed by incorporating four additional variables into the fibrosis-4(FIB-4)score,showed better performance in predicting significant fibrosis in NAFLD.AIM To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score(NFS)for predicting significant fibrosis.METHODS We collected the data of biopsy-proven NAFLD patients from three Asian centers in three countries.All the patients with available variables for the FIB-4 score(age,platelet count,and aspartate and alanine aminotransferase levels)and FIB-8 score(the FIB-4 variables plus 4 additional parameters:The body mass index(BMI),albumin to globulin ratio,gamma-glutamyl transferase level,and presence of diabetes mellitus)were included.The fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria,and significant fibrosis was defined as at least fibrosis stage 2.RESULTS A total of 511 patients with biopsy-proven NAFLD and complete data were included for validation.Of these 511 patients,271(53.0%)were female,with a median age of 51(interquartile range:41,58)years.The median BMI was 29(26.3,32.6)kg/m2,and 268(52.4%)had diabetes.Among the 511 NAFLD patients,157(30.7%)had significant fibrosis(≥F2).The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774,0.743,and 0.680,respectively.The FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS(P=0.001)and was also clinically superior to FIB-4,although statistical significance was not reached(P=0.073).The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36%sensitivity,and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.77 showed 67.51%specificity.CONCLUSION We demonstrated that the FIB-8 score had significantly better performance for predicting significant fibrosis in NAFLD patients than the NFS,as well as clinically superior performance vs the FIB-4 score in an Asian population.A novel simple fibrosis score comprising commonly accessible basic laboratories may be beneficial to use for an initial assessment in primary care units,excluding patients with significant liver fibrosis and aiding in patient selection for further hepatologist referral.展开更多
文摘Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.
文摘Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance.However,the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy.Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance,such as reduced cecal intubation rates,increased patient discomfort and lower adenoma detection.The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte,a non-absorbable solution,or aqueous sodium phosphate,a lowvolume hyperosmotic solution.Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar,although patients' compliance with these regimes may differ somewhat.Many studies have now shown that factors other than the type of bowel preparation regime used,can influence the quality of bowel preparation among adult patients undergoing colonoscopy.These factors can be broadly categorized as either patient-related or procedure-related.Studies from both Asia and the West have identified patient-related factors such as an increased age,male gender,presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy.Additionally,procedure-related factors such as adherence to bowel preparation instructions,timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing.Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly,such that the quality of colonoscopy performance and delivery of service to patients can be optimised.
基金Supported by University of Malaya Research Grant,Project No.RG536-13HTM
文摘AIM:To compare same-day whole-dose vs split-dose of 2-litre polyethylene glycol electrolyte lavage solution(PEG-ELS)plus bisacodyl for colon cleansing for morning colonoscopy.METHODS:Consecutive adult patients undergoing morning colonoscopy were allocated into two groups i.e.,same-day whole-dose or split-dose of 2-litre PEGELS.Investigators and endoscopists were blinded to the allocation.All patients completed a questionnaire that was designed by Aronchick and colleagues to assess the tolerability of the bowel preparation regime used.In addition,patients answered an ordinal fivevalue Likert scale question on comfort level during bowel preparation.Endoscopists graded the quality of bowel preparation using the Boston bowel preparation scale(BBPS).In addition,endoscopists gave an overall grading of the quality of bowel preparation.Cecal intu-bation time,withdrawal time,total colonoscopy time,adenoma detection rate and number of adenomas detected for each patient were recorded.Sample size was calculated using an online calculator for binary outcome non-inferiority trial.Analyses was based upon intent-to-treat.Significance was assumed at P-value<0.05.RESULTS:Data for 295 patients were analysed.Mean age was 62.0±14.4 years old and consisted of 50.2%male.There were 143 and 152 patients in the split-dose and whole-dose group,respectively.Splitdose was as good as whole-dose for quality of bowel preparation.The total BBPS score was as good in the split-dose group compared to the whole-dose group[6(6-8)vs 6(6-7),P=0.038].There was no difference in cecal intubation rate,cecal intubation time,withdrawal time,total colonoscopy time and adenoma detection rate.Median number of adenoma detected was marginally higher in the split-dose group[2(1-3)vs 1(1-2),P=0.010].Patients in the whole-dose group had more nausea(37.5%vs 25.2%,P=0.023)and vomiting(16.4%vs 8.4%,P=0.037),and were less likely to complete the bowel preparation(94.1%vs 99.3%,P=0.020).Patients in the split-dose group were less likely to refuse the same bowel preparation regime(6.3%vs 13.8%,P=0.033)and less likely to want to try another bowel preparation regime(53.8%vs 78.9%,P<0.001).CONCLUSION:Splitting reduced-volume PEG-ELS for morning colonoscopy is as effective as taking the whole dose on the same morning but is better tolerated and preferred by patients.
文摘Irritable bowel syndrome(IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psychosocial factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including:(1) large proportion of the population living in rural areas;(2) rapid development and associated lifestyle changes in urban areas; and(3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.
基金Supported by The Fatty Liver Research Fund,Faculty of Medicine Foundation,Chulalongkorn University。
文摘BACKGROUND Identifying hepatic fibrosis is crucial for nonalcoholic fatty liver disease(NAFLD)management.The fibrosis-8(FIB-8)score,recently developed by incorporating four additional variables into the fibrosis-4(FIB-4)score,showed better performance in predicting significant fibrosis in NAFLD.AIM To validate the FIB-8 score in a biopsy-proven NAFLD cohort and compare the diagnostic performance of the FIB-8 and FIB-4 scores and NAFLD fibrosis score(NFS)for predicting significant fibrosis.METHODS We collected the data of biopsy-proven NAFLD patients from three Asian centers in three countries.All the patients with available variables for the FIB-4 score(age,platelet count,and aspartate and alanine aminotransferase levels)and FIB-8 score(the FIB-4 variables plus 4 additional parameters:The body mass index(BMI),albumin to globulin ratio,gamma-glutamyl transferase level,and presence of diabetes mellitus)were included.The fibrosis stage was scored using nonalcoholic steatohepatitis CRN criteria,and significant fibrosis was defined as at least fibrosis stage 2.RESULTS A total of 511 patients with biopsy-proven NAFLD and complete data were included for validation.Of these 511 patients,271(53.0%)were female,with a median age of 51(interquartile range:41,58)years.The median BMI was 29(26.3,32.6)kg/m2,and 268(52.4%)had diabetes.Among the 511 NAFLD patients,157(30.7%)had significant fibrosis(≥F2).The areas under the receiver operating characteristic curves of the FIB-8 and FIB-4 scores and NFS for predicting significant fibrosis were 0.774,0.743,and 0.680,respectively.The FIB-8 score demonstrated significantly better performance for predicting significant fibrosis than the NFS(P=0.001)and was also clinically superior to FIB-4,although statistical significance was not reached(P=0.073).The low cutoff point of the FIB-8 score for predicting significant fibrosis of 0.88 showed 92.36%sensitivity,and the high cutoff point of the FIB-8 score for predicting significant fibrosis of 1.77 showed 67.51%specificity.CONCLUSION We demonstrated that the FIB-8 score had significantly better performance for predicting significant fibrosis in NAFLD patients than the NFS,as well as clinically superior performance vs the FIB-4 score in an Asian population.A novel simple fibrosis score comprising commonly accessible basic laboratories may be beneficial to use for an initial assessment in primary care units,excluding patients with significant liver fibrosis and aiding in patient selection for further hepatologist referral.
