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Evaluation of the string test for the detection of Helicobacter pylori

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World Journal of Gastroenterology 2003年第2期9卷 309-311页

作者： Rupert WL Leong Ching C Lee Thomas KW Ling WaiK Leung Joseph JY Sung Department of Gastroenterology University of New South WalesBankstown HospitalSydneyAustralia Department of Microbiology Chinese University of Hong Kong Prince of Wales HospitalShatinHong KongChina Department of Medicine & Therapeutics Chinese University of Hong KongPrince of Wales HospitalShatinHone KongChina

AIM: Helicobacter pylori can be diagnosed by invasive ornon-invasive tests but to obtain bacteria for culture andantibiotic susceptibility testing, an upper GI endoscopy isoften required. The string test may be a minimally-invasivealternative method of obtaining H. pylori samples. This studyevaluates the sensitivity and specificity of the string test inthe diagnosis of H. pylori in comparison with endoscopicmeans of diagnosis.METHODS: This was a prospective open comparative studyof patients with dyspepsia with endoscopy-based tests asgold standard (defined as a positive CLO test and antralhistology). Fasting patients swallowed the encapsulated-string(Entero-test Hp), which was withdrawn after 1 hour. Thegastric juice from the string was plated onto H. pylori-selectivemedia for culture. Helicobacter pylori was identified by typicalcolony morphology, gram stain and biochemical test results.RESULTS: Thirty dyspeptic patients were recruited of whom21 (70 %) were positive for H. pylori according to the goldstandard. The sensitivity, specificity, positive predictive value,and negative predictive value for the string test were 38 %,100 %, 100 % and 41% respectively, and for endoscopicbiopsies 81%, 100 %, 100 %, 69 % respectively (P=0.004).Logistic regression showed that only abundant growthdensity from endoscopic biopsy cultures to be a predictor ofa positive string test (P=0.018).CONCLUSION: The string test is an alternative method toendoscopy in obtaining H. pylori but has a low sensitivitycompared to endoscopic biopsies.

关键词：幽门螺杆菌活组织检查消化道溃疡细菌培养内窥镜无创性检查

Gastroenterologist perceptions of faecal microbiota transplantation

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World Journal of Gastroenterology 2015年第38期21卷 10907-10914页

作者： Sudarshan Paramsothy Alissa J Walsh Thomas Borody Douglas Samuel Johan van den Bogaerde Rupert WL Leong Susan Connor Watson Ng Hazel M Mitchell Nadeem O Kaakoush Michael A Kamm Gastroenterology and Hepatology Department St Vincent’s Hospital Centre for Digestive Diseases Gastroenterology and Hepatology Department Bankstown-Lidcombe Hospital Gastroenterology and Hepatology Department Nambour General Hospital Gastroenterology and Hepatology Department Liverpool Hospital University of New South Wales School of Biotechnology and Biomolecular Sciences Departments of Gastroenterology and Medicine St Vincent's Hospital and University of Melbourne

AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.

关键词： Perceptions Gastroenterologist Clostridium diffici

Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases

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World Journal of Gastroenterology 2014年第5期20卷 1238-1247页

作者： Yanna Ko Rhys Butcher rupert W leong Concord Hospital Gastroenterology and Liver Services and The University of New South Wales

Inflammatory bowel diseases(IBD)are idiopathic chronic diseases of the gastrointestinal tract well known to be associated with both genetic and environmental risk factors.Permissive genotypes may manifest into clinical phenotypes under certain environmental influences and these may be best studied from migratory studies.Exploring differences between first and second generation migrants may further highlight the contribution of environmental factors towards the development of IBD.There are few opportunities that have been offered so far.We aim to review the available migration studies on IBD,evaluate the known environmental factors associated with IBD,and explore modern migration patterns to identify new opportunities and candidate migrant groups in IBD migration research.

关键词： Inflammatory bowel disease Crohn’s dis-ease Ulcera

Dual biologic therapy with ocrelizumab for multiple sclerosis and vedolizumab for Crohn's disease:A case report and review of literature

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World Journal of Clinical Cases 2022年第8期10卷 2569-2576页

作者： Michael Au Nikola Mitrev rupert W leong Viraj Kariyawasam Department of Gastroenterology and Hepatology Blacktown and Mt Druitt HospitalsWestern Sydney Local Health DistrictSydney 2148New South WalesAustralia Blacktown Clinical School Western Sydney UniversityBlacktown 2148New South WalesAustralia Department of Gastroenterology and Hepatology Blacktown HospitalWestern Sydney Local Health DistrictBlacktown 2148New South WalesAustralia Endoscopy Department and Inflammatory Bowel Disease Service Concord HospitalSydney 2137New South WalesAustralia Concord Clinical School University of SydneySydney 2137New South WalesAustralia Inflammatory Bowel Disease Service Blacktown HospitalWestern Sydney Local Health DistrictBlacktown 2148New South WalesAustria

BACKGROUND Little is known about the safety and efficacy of using two or more biologics for the treatment of immune-mediated diseases,including Crohn’s disease(CD).CASE SUMMARY This case report and narrative review demonstrate the potential safety of dual biologic therapy(DBT)in a 45-year-old female with two separate immunemediated diseases.She had a history of multiple sclerosis for which she was receiving treatment with ocrelizumab,and she had been recently diagnosed with CD after presenting with diarrhoea.The CD diagnosis was confirmed radiologically,endoscopically,histologically,and biochemically.The patient received treatment with vedolizumab,a gut-specific inhibitor of theα4β7 integrin on leukocytes.No adverse reactions were observed for the duration of treatment.The safety of ocrelizumab and vedolizumab for the treatment of different immune-mediated diseases was demonstrated.CONCLUSION DBT may be a safe and effective option for the treatment of refractory disease or multiple immunemediated diseases.Newer biologics,which have improved safety profiles and gut specificity,may provide promising avenues for treatment.However,caution must be exercised in the appropriate selection of biologics given their inherent immunosuppressive properties,side effects,and efficacy profiles.Current evidence suggests that biologic therapy is not associated with a worse prognosis in patients with coronavirus disease 2019,but treatment decisions should be made in a multidisciplinary setting.Further research from controlled trials is needed to better understand the safety profile of DBT in CD.The immunopathological mechanisms underlying DBT also remain to be clarified.

关键词： Dual biologic therapy Combination Immunosuppression Safety Autoimmune Case report

Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: A review of the literature

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World Journal of Gastroenterology 2014年第27期20卷 8783-8789页

作者： Rosy Wang rupert leong Gastroenterology and Liver Services Concord Hospital

To examine and evaluate recent evidence regarding the epidemiology, pathogenesis and management of colorectal cancer(CRC) development in inflammatory bowel disease(IBD)-primary sclerosing cholangitis(PSC) patients. Using the PubMed database, a literature search was conducted for relevant articles in English from the past 10 years. Relevant studies investigating PSC as a risk factor for CRC in IBD in the context of incidence and prevalence, pathogenesis, prevention and prognosis were included in this review. Recent evidence increasingly points to PSC as a significant risk factor in the development of CRC in patients with concomitant IBD. PSC may be an important risk factor for CRC in different populations worldwide. The mechanism for this increase in risk is still unclear. The efficacy of UDCA as a chemopreventive agent remains controversial. Liver transplantation does not halt the development of CRC, although there is not enough evidence to suggest that it is associated with increased incidence of CRC. While routine colonoscopic surveillance should be performed in patients with concurrent PSC and IBD, more high-level evidence is required to support the benefits of the procedure. While many new developments have taken place in the last decade, the pathogenesis and optimal management of CRC development in IBD-PSC patients remain unclear.

关键词： Primary sclerosing cholangitis Ulcerative colitis

Knowledge and attitudes towards the use of histological assessments in ulcerative colitis by gastroenterologists vs pathologists

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World Journal of Gastroenterology 2023年第2期29卷 378-389页

作者： Aviv Pudipeddi Caroline Fung Britt Christensen Robert V Bryant Kavitha Subramaniam John Chetwood Sudarshan Paramsothy rupert W leong Gastroenterology and Liver Services Concord Repatriation General HospitalSydney 2139Australia Faculty of Medicine and Health Concord Clinical SchoolUniversity of SydneySydney 2138Australia Department of Anatomical Pathology Concord Repatriation General HospitalSydney 2139Australia Department of Gastroenterology Royal Melbourne HospitalMelbourne 3050Australia Department of Medicine University of MelbourneMelbourne 3052Australia Department of Gastroenterology and Hepatology The Queen Elizabeth HospitalAdelaide 5011Australia Gastroenterology and Hepatology Unit Canberra HospitalCanberra 2605Australia Australian National University Medical School Australian National UniversityCanberra 2601Australia Faculty of Medicine and Health Sciences Macquarie University HospitalSydney 2109Australia

BACKGROUND Histological remission is increasingly accepted as a treatment endpoint in the management of ulcerative colitis(UC).However,the knowledge of histology guidelines and the attitudes towards their use in clinical practice by gastroenterologists and pathologists is unknown.AIM To evaluate the knowledge of histology guidelines and attitudes towards the use of histology in UC by gastroenterologists and pathologists.METHODS A prospective,cross-sectional nationwide survey of gastroenterologists and pathologists who analyse UC specimens was conducted.The survey consisted of 34 questions to assess gastroenterologists’and pathologists’knowledge(score out of 19)and attitudes towards histological assessment in UC.Survey questions were formulated using the European Crohn’s and Colitis position paper on histopathology and the British Society of Gastroenterology biopsy reporting guidelines.It included knowledge of histological assessment of disease activity and dysplasia,knowledge of histological scoring systems for ulcerative colitis,uptake of histology scoring systems in routine practice,attitudes towards the role of histological activity,and the use of histological activity in clinical scenarios.RESULTS Of 89 responders(77 gastroenterologists,12 pathologists),there was almost universal acceptance that histological assessment should form part of UC evaluation[95%gastroenterologists,92%pathologists].However,gastroenterologists reported that 92%of their pathologists do not use a histological scoring system.Utilisation of a formal histological scoring system was preferred by 77%of gastroenterologists and 58%of pathologists.Both groups lacked awareness of the Geboes Score,Nancy Index and Robarts Histopathological Index scoring systems with 91%,87%,and 92%of gastroenterologists respectively;and 83%,83%,and 92%pathologists respectively,being uncertain of scoring systems’remission definitions.Histology knowledge score was not significantly different between gastroenterologists and pathologists[9/19(IQR:8-11)vs 8/19(IQR:7-1

关键词： Histology Scoring system Ulcerative colitis Survey

Epidemiology of inflammatory bowel disease in South America: A systematic review

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World Journal of Gastroenterology 2019年第47期25卷 6866-6875页

作者： Sriharan Selvaratnam Santiago Gullino Lisa Shim Eric Lee Alice Lee Sudarshan Paramsothy rupert W leong Department of Gastroenterology and Hepatology Macquarie University Hospital

BACKGROUND The worldwide epidemiology of inflammatory bowel disease(IBD)is rapidly changing.Increasing Crohn’s disease(CD)and ulcerative colitis(UC)incidence and prevalence have been recorded in developing regions such as Asia,Africa and Eastern Europe where it was previously thought to be uncommon.Whether this is also the case in South America is not well known.Demonstration that developing regions worldwide have increasing IBD incidence would indicate that environmental change plays a significant role in the development of IBD.AIM To report the incidence,prevalence and disease characteristics of CD and UC within the South American continent.METHODS A systematic review was conducted by searching published studies in major international and regional databases(MEDLINE,EMBASE and Scopus)between January 1990 and December 2018.Outcomes considered were incidence,prevalence,phenotype,environmental and genetic factors,ethnicity and gender.A pair of independent reviewers screened and reviewed all identified articles.RESULTS One hundred and sixty two citations were initially retrieved with 18 studies included in this systematic review.The majority of included studies were from Brazil(n=13,72%).The incidence of UC ranged from 4.3-5.3/100000 personyears whilst the incidence of CD ranged from 0.74-3.5/100000 person-years.Prevalence ranged from 15.0-24.1/100000 inhabitants for UC and from 2.4-14.1/100000 inhabitants for CD.The incidence and prevalence of both UC and CD has increased significantly in Brazil over the past 21 years.Pancolitis was the most common disease distribution in patients with UC whilst colonic involvement was the most common distribution in CD.People residing in urban areas were at higher risk of developing both CD and UC.CONCLUSION The IBD burden in South America is increasing at a rate possibly even greater than other developing regions around the world.There is a paucity of highquality epidemiological studies and further robust and representative data are required to further explore modifiable risk fac

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis South America Epidemiology

Faecal microbiota transplantation as an elixir of youth

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Hepatobiliary Surgery and Nutrition 2020年第4期9卷 488-489页

作者： Craig Haifer Sudarshan Paramsothy rupert W.leong Concord Clinical School The University of SydneySydneyAustralia Gastroenterology and Liver Services Concord Repatriation General HospitalSydneyAustralia South Western Clinical School UNSWSydneyAustralia

The intestinal microbiota has been increasingly seen to be responsible for various gastrointestinal disorders such as inflammatory bowel diseases(1).However,their effects on systemic physiological processes unrelated ... 详细信息

关键词： diseases gastrointestinal unrelated

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

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World Journal of Gastroenterology 2016年第40期22卷 8892-8904页

作者： James WT Toh Peter Stewart Matthew JFX Rickard rupert leong Nelson Wang Christopher J Young Department of Colorectal Surgery Concord Repatriation General Hospital South Western Sydney Clinical School University of New South Wales Liverpool Hospital School of Medicine Western Sydney University Liverpool Hospital Ingham Institute of Applied Research Liverpool Hospital Discipline of Surgery Sydney Medical School the University of Sydney Department of Gastroenterology Concord Repatriation General Hospital Department of Colorectal Surgery Royal Prince Alfred Hospital

Despite advancements in medical therapy of Crohn's disease(CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD(and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

关键词：外科 Crohn’ s 疾病主要腹的外科 Perianal 煽动性的肠疾病结肠癌