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Follow up of serial urea breath test results in patients after consumption of antibiotics for non-gastric infections

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World Journal of Gastroenterology 2002年第4期8卷 703-706页

作者： Wai-Keung Leung Lawrence Cheung-Tsui Hung Carrie Ka-Li Kwok rupert wing-loong leong Daniel Kwok-Keung Ng Joseph Jao-Yiu Sung Department of Medicine & Therapeutics Prince of Wales Hospitalthe Chinese University of Hong KongShatinHong KongChina Department of Paediatrics Kwong Wah HospitalKowloonHong KongChina

AIM: The widespread use of antibacterial therapy hasbeen suggested to be the cause for the decline in theprevalence of Helicobacter pyloriinfection. This studyexamine the serial changes of urea breath test resultsin a group of hospitalized patients who were givenantibacterial therapy for non-gastric ***: Thirty-five hospitalized patients who weregiven antibacterial therapy for clinical infections,predominantly chest and urinary infections, werestudied. Most (91%) patients were given singleantibiotic of either a penicillin or cephalosporin *** 13C-urea breath tests were performed within 24hours of initiation of antibiotics, at one-week and atsix-week post-therapy. H. pylori infection wasdiagnosed when one or more urea breath tests ***: All 35 patients completed three serial ureabreath tests and 26 (74 %) were H. pylori-positive. Ten(38 %) H. pylori-infected patients had at least onenegative breath test results during the study *** medium delta 13C values were significantly lowerat baseline (8.8) than at one-week (20.3) and six-week(24.5) post-treatment in H. pylori-positive individuals(P=0.022). Clearance of H. pyloriat six-week was onlyseen in one patient who had received anti-helicobactertherapy from another ***: Our results suggested that one-third ofH. pylori-infected individuals had transient false-negative urea breath test results during treatment withantibacterial agent. However, clearance of H. pyloriinfection by regular antibiotic consumption is rare.

关键词：抗生素 HP感染连续尿素呼吸试验耐药

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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 Crohn's Inflammatory bowel disease Colorectal cancer Liver transplantation Ursodeoxycholic acid

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World Journal of Gastroenterology 2012年第21期18卷 2600-2608页

作者： Christian P Selinger rupert WL leong Simon Lal Department of Gastroenterology Salford Royal HospitalSalford M6 8HD United Kingdom Gastroenterology and Liver Services Sydney Local Health Network Concord HospitalNSW 2139 Sydney Australia Faculty of Medicine The University of New South WalesNSW 2052 Sydney Australia

Inflammatory bowel disease (IBD) affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Women with IBD need to consider the possible course of disease during pregnancy, the benefits and risks associated with medications required for disease management during pregnancy and breastfeeding and the effects of mode of delivery on their disease. When indicated, aminosalicylates and thiopurines can be safely used during pregnancy. Infliximab and Adalimumab are considered probably safe during the first two trimesters. During the third trimester the placenta can be crossed and caution should be applied. Methotrexate is associated with severe teratogenicity due to its folate antagonism and is strictly contraindicated. Women with IBD tend to deliver earlier than healthy women, but can have a vaginal delivery in most cases. Caesarean sections are generally recommended for women with active perianal disease or after ileo-anal pouch surgery. While the impact of disease activity and medication has been addressed in several studies, there are minimal studies evaluating patients' perspective on these issues. Women's attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients' views on this subject.

关键词： Pregnancy Breast-feeding Nursing Inflammatory bowel disease Crohn’s disease Ulcerative colitis

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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 *** genotypes may manifest into clinical phenotypes under certain environmental influences and these may be best studied from migratory *** differences between first and second generation migrants may further highlight the contribution of environmental factors towards the development of *** are few opportunities that have been offered so *** 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 disease, Ulcerative colitis, Epidemiology, Risk factor, Environment, Hygiene hypothesis

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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 *** 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 *** CD diagnosis was confirmed radiologically,endoscopically,histologically,and *** patient received treatment with vedolizumab,a gut-specific inhibitor of theα4β7 integrin on *** adverse reactions were observed for the duration of *** safety of ocrelizumab and vedolizumab for the treatment of different immune-mediated diseases was *** DBT may be a safe and effective option for the treatment of refractory disease or multiple immunemediated *** biologics,which have improved safety profiles and gut specificity,may provide promising avenues for ***,caution must be exercised in the appropriate selection of biologics given their inherent immunosuppressive properties,side effects,and efficacy *** 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 *** research from controlled trials is needed to better understand the safety profile of DBT in *** immunopathological mechanisms underlying DBT also remain to be clarified.

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

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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

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Vedolizumab serum trough concentrations with and without thiopurines in ulcerative colitis: The prospective VIEWS pharmacokinetics study

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World Journal of Gastroenterology 2025年第2期31卷 102-112页

作者： Thanaboon Chaemsupaphan Aviv Pudipeddi Hui-Yu Lin Sudarshan Paramsothy Viraj C Kariyawasam Melissa Kermeen rupert W leong Department of Gastroenterology and Liver Services Concord Repatriation General HospitalSydney 2139New South WalesAustralia Faculty of Medicine Siriraj HospitalMahidol UniversityBangkok 10700Thailand Faculty of Medicine and Health University of SydneySydney 2139New South WalesAustralia Department of Gastroenterology Tan Tock Seng HospitalSingapore 308433Singapore Faculty of Medicine and Health Sciences Macquarie UniversitySydney 2139New South WalesAustralia Department of Gastroenterology and Hepatology Blacktown HospitalSydney 2148New South WalesAustralia Blacktown Clinical School Western Sydney UniversitySydney 2148New South WalesAustralia

BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and *** is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thiopurines on vedolizumab trough concentrations is *** To investigate the exposure-response relationship of vedolizumab and the impact of thiopurine withdrawal in UC patients who have achieved sustained clinical and endoscopic remission during maintenance *** This is a post-hoc analysis of prospective randomized clinical trial(VIEWS)involving UC patients across 8 centers in Australia from 2018 to *** in clinical and endoscopic remission were randomized to continue or withdraw thiopurine while receiving *** evaluated vedolizumab serum trough concentrations,presence of anti-vedolizumab antibodies,and clinical outcomes over 48 weeks to assess exposure-response asso-ciation and impact of thiopurine *** There were 62 UC participants with mean age of 43.4 years and 42%were *** participants received vedolizumab as maintenance therapy with 67.7%withdrew *** serum trough concentrations remained stable over 48 weeks regardless of thiopurine use,with no anti-vedolizumab antibodies ***-tients with clinical remission had higher trough concentrations at week *** quartile analysis,a threshold of>11.3μg/mL was associated with sustained clinical remission,showing a sensitivity of 82.4%,specificity of 60.0%,and an area of receiver operating characteristic of 0.71(95%CI:0.49-0.93).Patients discontinuing thiopurine required higher vedolizumab concentrations for achieving *** A positive exposure-response relationship between vedolizumab trough concentrations and UC outcomes suggests that monitoring drug levels may be *** thiopurine did not influence vedolizumab levels,its with-drawal may necessitate higher vedolizumab trough concentrations to maintain remi

关键词： Pharmacokinetic Vedolizumab Thiopurine Ulcerative colitis Trough concentration Antibody Inflammatory bowel diseases

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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 ***: 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 ***: 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

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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 *** 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 *** this is also the case in South America is not well *** that developing regions worldwide have increasing IBD incidence would indicate that environmental change plays a significant role in the development of *** To report the incidence,prevalence and disease characteristics of CD and UC within the South American *** A systematic review was conducted by searching published studies in major international and regional databases(MEDLINE,EMBASE and Scopus)between January 1990 and December *** considered were incidence,prevalence,phenotype,environmental and genetic factors,ethnicity and gender.A pair of independent reviewers screened and reviewed all identified *** One hundred and sixty two citations were initially retrieved with 18 studies included in this systematic *** 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 *** ranged from 15.0-24.1/100000 inhabitants for UC and from 2.4-14.1/100000 inhabitants for *** incidence and prevalence of both UC and CD has increased significantly in Brazil over the past 21 *** was the most common disease distribution in patients with UC whilst colonic involvement was the most common distribution in *** residing in urban areas were at higher risk of developing both CD and *** The IBD burden in South America is increasing at a rate possibly even greater than other developing regions around the *** is a paucity of highquality epidemiological studies and further robust and representative data are

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

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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： Surgery Crohn’s disease Major abdominal surgery Perianal Inflammatory bowel disease Colon cancer

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