Journal/Magazine Articles

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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine

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    The Association between new generation oral contraceptive pill and the development of inflammatory bowel diseases
    (Korean Association for the Study of Intestinal Diseases, 2018) Sanagapalli, S.; Ko, Y.; Kariyawasam, V.; Ng, S.C.; Tang, W.; de Silva, H.J.; Chen, M.; Wu, K.; Aniwan, S.; Ng, K.K.; Ong, D.; Ouyang, Q.; Hilmi, I.; Simadibrata, M.; Pisespongsa, P.; Gopikrishna, S.; Leong, R.W.; IBD Sydney Organization and the asia-Pacific Crohn's Epidemiology Study (ACCESS) Group
    BACKGROUND/AIMS: To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort. METHODS: A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD. RESULTS: Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77-3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049). CONCLUSIONS: In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.
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    Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents.
    (Springer-Verlag, 2018) Zaghiyan, K.; Warusavitarne, J.; Spinelli, A.; Chandrasinghe, P.; Di Candido, F.; Fleshner, P.
    PURPOSE: Initial reports of transanal ileal pouch-anal anastomosis (taIPAA) suggest safety and feasibility compared with transabdominal IPAA. The purpose of this study was to evaluate differences in technique and results of taIPAA in three centers performing taIPAA across two continents. METHODS: Prospective IPAA registries from three institutions in the US and Europe were queried for patients undergoing taIPAA. Demographic, preoperative, intraoperative, and postoperative data were compiled into a single database and evaluated. RESULTS: Sixty-two patients (median age 38 years; range 16-68 years, 43 (69%) male) underwent taIPAA in the three centers (USA 24, UK 23, Italy 15). Most patients had had a subtotal colectomy before taIPAA [n = 55 (89%)]. Median surgical time was 266 min (range 180-576 min) and blood loss 100 ml (range 10-500 ml). Technical variations across the three institutions included proctectomy plane of dissection (intramesorectal or total mesorectal excision plane), specimen extraction site (future ileostomy site vs. anus), ileo-anal anastomosis technique (stapled vs. hand sewn) and use of fluorescence angiography. Despite technical differences, anastomotic leak rates (5/62; 8%) and overall complications (18/62; 29%) were acceptable across the three centers. CONCLUSIONS: This is the first collaborative report showing safety and feasibility of taIPAA. Despite technical variations, outcomes are similar across centers. A large multi-institutional, international IPAA collaborative is needed to compare technical factors and outcomes.
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    Asia Pacific Consensus Statements on Crohn's Disease Part 1: definition, diagnosis and epidemiology (Asia Pacific Crohn’s Disease Consensus Part 1)
    (Wiley-Blackwell, 2016) Ooi, C.J.; Hilmi, I.; Makharia, G.K.; Gibson, P.R.; Fock, K.M.; Ahuja, V.; Ling, K.L.; Lim, W.C.; Thia, K.T.; Wei, S.C.; Leung, W.K.; Koh, P.K.; Gearry, R.B.; Goh, K.L.; Ouyang, Q.; Sollano, J.; Manatsathit, S.; de Silva, H.J.; Rerknimitr, R.; Pisespongsa, P.; Abu Hassan, M.R.; Sung, J.; Hibi, T.; Boey, C.C.; Moran, N.; Leong, R. W.; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel Disease
    Inflammatory bowel disease (IBD) was previously thought to be rare in Asia, but emerging data indicate rising incidence and prevalence of IBD in the region. The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region.1 The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field. This article is protected by copyright. All rights reserved.
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    The Asia Pacific Consensus Statements on Crohn's Disease Part 2: Management
    (Wiley-Blackwell, 2016) Ooi, C.J.; Hilmi, I.; Makharia, G.K.; Gibson, P.R.; Fock, K.M.; Ahuja, V.; Ling, K.L.; Lim, W.C.; Thia, K.T.; Wei, S.C.; Leung, W.K.; Koh, P.K.; Gearry, R.B.; Goh, K.L.; Ouyang, Q.; Sollano, J.; Manatsathit, S.; de Silva, H.J.; Rerknimitr, R.; Pisespongsa, P.; Abu Hassan, M.R.; Sung, J.; Hibi, T.; Boey, C.C.; Moran, N.; Leong, R.W.; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel Disease
    Inflammatory bowel disease (IBD) was previously thought to be rare in Asia, but emerging data indicate rising incidence and prevalence of IBD in the region. The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region.1 The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field. This article is protected by copyright. All rights reserved.
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    Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study
    (Elsevier-W.B. Saunders, 2013) Ng, S.C.; Tang, W.; Ching, J.Y.; Wong, M.; Chow, C.M.; Hui, A.J.; Wong, T.C.; Leung, V.K.; Tsang, S.W.; Yu, H.H.; Li, M.F.; Ng, K.K.; Kamm, M.A.; Studd, C.; Bell, S.; Leong, R.; de Silva, H.J.; Kasturiratne, A.; Mufeena, M.N.; Ling, K.L.; Ooi, C.J.; Tan, P.S.; Ong, D.; Goh, K.L.; Hilmi, I.; Pisespongsa, P.; Manatsathit, S.; Rerknimitr, R.; Aniwan, S.; Wang, Y.F.; Ouyang, Q.; Zeng, Z.; Zhu, Z.; Chen, M.H.; Hu, P.J.; Wu, K.; Wang, X.; Simadibrata, M.; Abdullah, M.; Wu, J.C.; Sung, J.J.; Chan, F.K.; Asia-Pacific Crohn's and Colitis Epidemiologic Study (ACCESS) Study Group
    BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. METHODS: We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. RESULTS: We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). CONCLUSIONS: We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations.
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    Asia Pacific Association of Gastroenterology Working Group on Inflammatory Bowel Disease.The Asia-Pacific consensus on ulcerative colitis.
    (Wiley-Blackwell, 2010) Ooi, C.J.; Fock, K.M.; Makharia, G.K.; Goh, K.L.; Ling, K.L.; Hilmi, I.; Lim, W.C.; Kelvin, T.; Gibson, P.R.; Gearry, R.B.; Ouyang, Q.; Sollano, J.; Manatsathit, S.; Rerknimitr, R.; Wei, S.C.; Leung, W.K.; de Silva, H.J.; Leong, R.W.
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    Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey
    (BioMed Central, 2010) Niriella, M.A.; de Silva, A.P.; Dayaratne, A.H.G.K.; Ariyasinghe, M.H.A.D.P.; Navarathne, M.M.N.; Peiris, R.S.K.; Samarasekara, D.; Satarasinghe, R.L.; Rajindrajith, S.; Dassanayake, A.S.; Wickremasinghe, A.R.; de Silva, H.J.
    BACKGROUND: Inflammatory bowel disease (IBD) is being increasingly diagnosed in Asia. However there are few epidemiological data from the region. METHODS: To determine prevalence and clinical characteristics of IBD, a hospital-based survey was performed in the Colombo and Gampaha districts (combined population 4.5 million) in Sri Lanka. Patients with established ulcerative colitis (UC) and Crohn's disease (CD), who were permanent residents of these adjoining districts, were recruited from hospital registries and out-patient clinics. Clinical information was obtained from medical records and patient interviews. RESULTS: There were 295 cases of IBD (UC = 240, CD = 55), of which 34 (UC = 30, CD = 4) were newly diagnosed during the study year. The prevalence rate for UC was 5.3/100,000 (95% CI 5.0-5.6/100,000), and CD was 1.2/100,000 (95% CI 1.0-1.4/100,000). The incidence rates were 0.69/100,000 (95% CI 0.44-0.94/100,000) for UC and 0.09/100,000 (95% CI 0.002-0.18/100,000) for CD. Female:male ratios were 1.5 for UC and 1.0 for CD. Mean age at diagnosis was (males and females) 36.6 and 38.1y for UC and 33.4 and 36.2y for CD. Among UC patients, 51.1% had proctitis and at presentation 58.4% had mild disease. 80% of CD patients had only large bowel involvement. Few patients had undergone surgery. CONCLUSIONS: The prevalence of IBD in this population was low compared to Western populations, but similar to some in Asia. There was a female preponderance for UC. UC was mainly mild, distal or left-sided, while CD mainly involved the large bowel.
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    The Association of autoimmune disorders with inflammatory bowel disease
    (Oxford University Press, 1989) Snook, J.A.; de Silva, H.J.; Jewell, D.P.
    Medical records of patients with ulcerative colitis (n = 858), Crohn's disease (n = 378) and coeliac disease (n = 148) were examined to determine the prevalence of associated autoimmune disorders. Of outpatient controls (n = 300), 2 per cent had at least one autoimmune disorder, compared to 7 per cent with ulcerative colitis, 2 per cent with Crohn's disease and 6 per cent with coeliac disease. Inclusion of primary sclerosing cholangitis with the autoimmune disorders increased the overall prevalence in ulcerative colitis to over 9 per cent. The results provide further indirect evidence of involvement of autoimmune mechanisms in the pathogenesis of ulcerative colitis