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Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

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World Journal of Gastroenterology 2005年第7期11卷 1044-1047页

作者： Tju-Siang Chua kwong-ming fock Tay-Meng Ng Eng-Kiong Teo Jessica Yi-Lyn Tan Tiing-Leong Ang Division of Gastroenterology

AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection ***: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures ***: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly ***: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.

关键词： Bleeding peptic ulcer Epinephrine Endoscopic hemoclip Combination therapy

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Clinical utility,safety and tolerability of capsule endoscopy in urban Southeast Asian population

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World Journal of Gastroenterology 2003年第10期9卷 2313-2316页

作者： Tiing-Leong Ang kwong-ming fock Tay-Meng Ng Eng-Kiong Teo Yi-Lyn Tan Division of Gastroenterology Changi General HospitalSingapore

AIM:Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western *** this prospective study,we aimed to determine the clinical utility,safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population. METHODS:We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel *** 9 patients the indication was obscure gastrointestinal bleeding,while in 6 patients it was to determine the extent of small bowel involvement in Crohn's *** patient underwent capsule endoscopy for evaluation of chronic abdominal ***'s tolerability to the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events. RESULTS:Abnormal findings were present in 8 patients (50%).The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 *** included 2 cases of angiodysplasia,2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal *** patient had small bowel erosions and loci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn's *** endoscopy was well tolerated by all *** patient with Crohn's disease had a complication of capsule retention due to terminal ileum *** capsule eventually passed out spontaneously after i month. CONCLUSION:Our study,which represented the first Asian series,further confirms the diagnostic utility,safety and tolerability of wireless capsule endoscopy.

关键词： Endoscopes Adult Aged Endoscopy, Digestive System Female Humans Intestinal Diseases Intestine, Small Male Middle Aged Patient Satisfaction Prospective Studies Singapore

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A comparison of the clinical, demographic and psychiatric profiles among patients with erosive and non-erosive reflux disease in a multi-ethnic Asian country

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World Journal of Gastroenterology 2005年第23期11卷 3558-3561页

作者： Tiing-Leong Ang kwong-ming fock Tay-Meng Ng Eng-Kiong Teo Tju-Siang Chua Jessica Tan Division of Gastroenterology

AIM:To examine the clinical spectrum of gastroesophageal reflux disease (GERD) and compare erosive (ERD) with non-erosive (NERD) in terms of clinical, demographic and psychiatric profiles. METHODS: Patients with reflux symptoms were enrolled and stratified to NERD and ERD after endoscopy (LA classification). Patients with ERD presenting with dyspepsia were included. Patients on proton pump inhibitors (PPI) or H2 receptor antagonists before endoscopy were excluded. Demographic data, Helicobacter pylori(H pylori) status and presence of minor psychiatric morbidity (based on General Health Questionnaire-28) were analyzed. RESULTS: Among 690 patients screened, 533 were eligible for analysis (male to female ratio: 3:2; Chinese: 75.4%; Malay: 9.8%; Indian: 14.8%). Clinical spectrum of GERD: N: 40.5%; A: 46%; B: 9.2%; C: 2.1%; D: 0.6%; Barrett's esophagus: 1.7%. Compared to patients with NERD, patients with ERD were significantly older (45 vs 39.4 years), more likely to be male (64.4% vs 53.7%), tended to smoke (19.6% vs 9.7%), less likely to have minor psychiatric morbidity (26.4 vs 46.7%) and were more likely to respond to PPI (79.7 vs 66.8%). There was also a trend towards a higher BMI (24.5 vs 23.5). Race, alcohol consumption and H pylori status were not significant. On multivariate analysis, age and presence of minor psychiatric morbidity remained with significant differences. CONCLUSION: The majority of patients who have typical symptoms of GERD have NERD or mild erosive reflux disease. Compared to patients with erosive reflux disease, patients with NERD were younger and had a higher prevalence of minor psychiatric morbidity.

关键词： Reflux disease Clinical spectrum Psychiatric morbidity

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胃癌预防亚太地区共识指南

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胃肠病学 2008年第4期13卷 231-240页

作者： kwong ming fock Nick Talley Paul Moayyedi Richard Hunt Takeshi Azuma Kentaro Sugano Shu Dong Xiao Shiu Kum Lam Khean Lee Goh Tsutomu Chiba Naomi Uemura Jae G Kim Nayoung Kim Tiing Leong Ang Varocha Mahachai Hazel Mitchell Abdul Aziz Rani Jyh ming Liou Ratha-korn Vilaichone Jose Sollanor 钱本余 Changi General Hospital Singapore Mayo Clinic College of Medicine Rochester USA McMaster University Medical Center Ontario Canada University of Fukui Fukui Jichi Medical University Tochigi Shanghai Institrte of Digestive Disease Shanghai University of Hong Kong Hong Kong University of Malaya Kuala Lumpur Malaysia Kyoto University Kyoto Kure Kyousai General Hospital Kure Japan Chung Ang University College of Medicine Seoul National University College of Medicine Seoul Korea Chulalongkorn University Hospital Bangkok University of New South Wales Sydney New South Wales Australia University of Indonesia Jakarta Indonesia National Taiwan University Hospital Taipei China Thammasat University Hospital Pathumthani Thailand University of Santo Tomas Manila Philippines

背景与目的:胃癌是亚太地区的主要健康负担之一,但对其预防策略尚缺乏共识。本共识会议旨在评价预防胃癌的策略。方法:多学科专家组应用德尔菲(Delphi)法制订共识条文,提呈相关数据,对证据等级、推荐强度以及共识水平予以分级。结果:幽... 详细信息

背景与目的:胃癌是亚太地区的主要健康负担之一,但对其预防策略尚缺乏共识。本共识会议旨在评价预防胃癌的策略。方法:多学科专家组应用德尔菲(Delphi)法制订共识条文,提呈相关数据,对证据等级、推荐强度以及共识水平予以分级。结果:幽门螺杆菌(***)感染是非贲门胃腺癌必要但非充分的致病因子。盐的高摄入与胃癌强烈相关。新鲜果蔬对胃癌具有预防作用,但维生素和其他饮食补充并不能预防胃癌。***感染中的宿主-细菌相互作用导致不同类型的胃炎和胃酸分泌,从而决定疾病结局。胃癌阳性家族史是一个重要的危险因素。低血清胃蛋白酶原反映胃萎缩程度,可作为检出胃癌高危人群的标志物。***筛查和治疗被推荐作为减少高危人群胃癌危险性的一种策略,该策略在萎缩性胃炎发生前实施最为有效,但并不排除对胃癌高危人群的内镜监测。对胃癌低危人群不推荐行***筛查。***感染的一线治疗应遵循国家治疗指南。结论:高危人群中***筛查和根除策略可能会减少胃癌的发生率,本共识根据现有证据予以推荐。

关键词：癌指南幽门螺杆菌预防

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亚太地区胃食管反流病的处理共识:更新版

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胃肠病学 2008年第7期13卷 421-436页

作者： kwong ming fock Nicholas J Talley Ronnie Fass Khean Lee Goh Peter Katelaris Richard Hunt Michio Hongo Tiing Leong Ang Gerald Holtmann Sanjay Nandurkar San Ren Lin Benjamin CY Wong Francis KL Chan Abdul Aziz Rani Young-Tae Bak Jose Sollano Khek Yu Ho Sathoporn Manatsathit 钱本余 Changi General Hospital Mayo Clinic College of Medicine Rochester University of Arizona Health Sciences Center University of Malaya University of Sydney McMaster University Medical Center Tohoku University Hospital Royal Adelaide Hospital Monash University The Third Hospital Peking University Queen Mary Hospital Prince of Wales Hospital University of Indonesia Korea University College of Medicine University of Santo Tomas National University Hospital Siriraj Hospital

背景与目的:自从2004年亚太地区胃食管反流病(GERD)共识发表以来,更多关于GERD流行病学和处理的文献资料相继出现。有必要对这些资料进行循证综述,对共识作出更新。方法:由多学科专家组应用德尔菲(Delphi)法制定共识条文,提呈相关资料,... 详细信息

背景与目的:自从2004年亚太地区胃食管反流病(GERD)共识发表以来,更多关于GERD流行病学和处理的文献资料相继出现。有必要对这些资料进行循证综述,对共识作出更新。方法:由多学科专家组应用德尔菲(Delphi)法制定共识条文,提呈相关资料,并对证据质量、推荐力度和共识水平进行分级。结果:亚洲GERD发生率日益增加。其危险因素包括老年、男性、种族、家族史、社会经济地位高、体重指数增加和吸烟。对于有典型症状而无报警症状的患者,对质子泵抑制剂(PPI)试验有症状应答具有诊断意义。如PPI试验失败,停止治疗后pH监测结果阴性可排除GERD。窄带成像、胶囊内镜检查和无线pH监测的作用尚未明确。亚洲诊断策略的制定须考虑到并存的胃癌和消化性溃疡。减轻体质量和抬高床头可改善反流症状。PPIs是最有效的内科治疗手段。对于非糜烂性反流病(NERD)患者,按需治疗较为适宜。有慢性咳嗽、喉炎和典型GERD症状的患者在排除非GERD病因后,应予PPI每天两次治疗。如有经验丰富的外科医师,GERD患者可行胃底折叠术。除临床试验外,GERD不应采用内镜治疗。结论:新的诊断方法和内镜治疗的作用有待进一步研究阐明。亚洲GERD诊断策略的制定须考虑到并存的胃癌和消化性溃疡。PPIs仍为治疗的基石。

关键词：共识糜烂性食管炎非糜烂性反流病

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