Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    Best practices on immunomodulators and biological agents for ulcerative colitis and Crohn's disease in Asia.
    (Taehan Chang Yŏn'gu Hakhoe, 2019) Ooi, C.J.; Hilmi, I.; Banerjee, R.; Chuah, S.W.; Ng, S.C.; Wei, S.C.; Makharia, G.K.; Pisespongsa, P.; Chen, M.H.; Ran, Z.H.; Ye, B.D.; Park, D.I.; Ling, K.L.; Ong, D.; Ahuja, V.; Goh, K.L.; Sollano, J.; K.Lim, W.C.; Leung, W.; Raja Ali, R.A.; Wu, D.C.; Ong, E.; Mustaffa, N.; Limsrivilai, J.; Hisamatsu, T.; Yang, S.K.; Ouyang, Q.; Geary, R.; de Silva, H.J.; Rerknimitr, R.; Simadibrata, M.; Abdullah, M.; Leong, R.W.L.; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel Disease and Asian Organization for Crohn's and Colitis
    ABSTRACT: The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.
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    Incidence and Phenotype of Inflammatory Bowel Disease From 13 Countries in Asia-Pacific: Results From the Asia-Pacific Crohn's and Colitis Epidemiologic Study 2011-2013
    (American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2016) Ng, S.C.; Kaplan, G.; Banerjee, R.; Wei, Shu-Chen; Tang, Whitney; Zeng, Z.; Chen, Min-hu; Yang, H.; de Silva, H.J.; Niriella, M.A.; Ong, D.E.; Ling, Khoon-Lin; Hilmi, I; Pisespongsa, P.; Aniwan, S.; Limsrivilai, J.; Abdullah, M.; Chong, V.H.; Cao, Q.; Miao, Y.; Ong-Go, A.K.; Bell, S.; Niewiadomski, O.; Kamm, M.A.; Ng, K.K.; Yu, H.H.; Wang, Yu-Fang; Ouyang, Q.; Goh, K.L.; Lin, Hung-Hsin; Lin, Wei-Chen; Wu, K.; Simadibrata, M.; Chan, F.K.; Sung, J.
    Background: The Asia-Pacific Crohn's and Colitis Epidemiology Study, initiated in 2011, aimed to determine the incidence and phenotype of inflammatory bowel disease (IBD) in Asia-Pacific. We herein present incidence and phenotype data from 2011 through 2013 for 12 countries or areas in Asia (Brunei, China, Hong Kong, India, Indonesia, Macau, Malaysia, Philippines, Singapore, Sri Lanka, Taiwan, Thailand) and Australia. Methods: We performed a prospective, population-based study of IBD incidence in predefined catchment areas using a web-based database. New cases were diagnosed based on standard criteria and ascertained from multiple sources. Endoscopy, pathology, and pharmacy records were searched for completeness of case capture. Age-standardized incidence was calculated with 95% confidence interval (CI). Crude incidence in different regions within Asia was pooled together using a random effect model. Results: We identified 1,572 new IBD patients (2011-2012, n=419; 2012-2013, n=1,153; 131 from Australia) including 1,057 (67%) ulcerative colitis (UC) and 515 (33%) Crohn's disease (CD). The mean annual incidence for IBD per 100,000 was 1.68 (95% CI, 1.59-1.77) in Asia and 22.28 (95% CI, 18.48-26.71) in Australia. The three countries within Asia with the highest incidence per 100,000 was India (9.31; 95% CI, 8.38-10.31), China (Guangzhou) (3.30; 95% CI, 2.68-4.06) and Hong Kong (2.58; 95% CI, 2.20-3.03). Within five regions of China, IBD incidence varied from 0.49 to 3.30 per 100,000. Pooled incidence of UC and CD within East Asia (China, Macau, Hong Kong, Taiwan) was 1.12 (95% CI, 0.77-1.48) and 0.33 (95% CI, 0.17-0.49), respectively. Pooled incidence of UC and CD within South East Asia (Brunei, Malaysia, Singapore, Indonesia, Thailand, Philippines) was 0.38 (0.21-0.55) and 0.30 (95% CI, 0.22-0.38), respectively. Ratio of UC:CD was 2.21 in Asia and 0.64 in Australia. Median time from symptom onset to diagnosis was 3 months [interquartile range (IQR), 2-10] for UC and 7 months (IQR 2-19) for CD. Stricturing, penetrating and perianal CD at diagnosis was common (21%, 10% and 17%, respectively) in Asia. Conclusion: Robust large-scale comparative epidemiologic IBD data from newly industrialized countries are emerging. Incidence of IBD varies throughout Asia with a higher incidence in East than South-East Asia. Complicated CD at diagnosis remains prevalent in Asia. Emergence of IBD in Asia will result in the need for specific health-care resources.
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    Best practices on immunomodulators and biological agents for ulcerative colitis and Crohn's disease in Asia.
    (Blackwell Scientific Publications, 2019) Ooi, C. J.; Hilmi, I.; Banerjee, R.; Chuah, S.W.; Ng, S.C; Wei, S.C.; Makharia, G.K.; Pisespongsa, P.; Chen, M.H.; Ran, Z.H.; Ye, B.D.; Park, D. I.; Ling, K. L.; Ong, D.; Ahuja, V.; Goh, K.L.; Sollano, J.; K.Lim, W.C.; Leung, W.; Raja Ali, R.A.; Wu, D.C.; Ong, E; Mustaffa, N.; Limsrivilai, J.; Hisamatsu, T.; Yang, S. K.; Ouyang, Q.; Geary, R.; de Silva, H.J.; Rerknimitr, R.; Simadibrata, M.; Abdullah, M.; Leong, R.W.L.; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel Disease and Asian Organization for Crohn's and Colitis
    The Asia Pacific Working Group on Inflammatory Bowel Disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis (AOCC). With biological agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biological agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible Hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.
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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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    Natural history of inflammatory bowel disease in Asia: A follow-up population-based cohort study
    (American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2014) Ng, S.C.; Tang, W.; de Silva, H.J.; Niriella, M.A.; Senanayake, Y.U.; Ooi, C.J.; Ling, K-L; Ong, D.E.; Goh, K.L.; Hilmi, I.; Ouyang, Q.; Wang, Y-F.; Hu, P.; Chen, M.; Zeng, Z.; Zhu, Z.; Wu, K.; Wang, X.; Pisespongsa, P.; Manatsathit, S.; Aniwan, S.; Simadibrata, M.; Abdullah, M.; Tsang, S.; Wong, T.; Leung, V.; Lo, F.H.; Hui, A.R.; Chow, C.M.; Yu, H.H.; Li, M.F.; Ng, K.K.; Ching, J.; Sung, J.J.Y.; Chan, F.K.L.
    BACKGROUND AND AIM: Data on the natural history of inflammatory bowel disease (IBD) in population-based setting in Asia are scarce. It is not clear if IBD disease course differs between Asian and Western cohorts. METHODS: In a population-based incident cohort from eight countries in Asia, we identified 259 IBD patients diagnosed between 2011 and 2013, including 158 ulcerative colitis (UC) and 101 Crohn's disease (CD) with a median follow up of 15 months (range, 12-31 months). The risk of disease extent and behaviour change according to the Montreal classification, and probability of medical or surgical therapy were prospectively assessed. RESULTS: Median age at diagnosis was 29 years (Interquartile range, IQR, 20-44) for CD, and 41 years (IQR, 30-54) for UC. At diagnosis, in CD, ileo-colonic disease (51%) and inflammatory behaviour (67%) were the most frequent phenotype. At one year, cumulative probability of behavior change from inflammatory to stricturing or penetrating disease was 18%, and cumulative rate of colectomy was 8%. In CD cumulative probabilities of receiving 5-aminosalicylic acid (5-ASA), corticosteroids, immune-suppressants and anti-tumor necrosis factor therapy were 61%, 43%, 66% and 10%, respectively, at one year. In UC, disease extent at diagnosis was evenly distributed including 31% with proctitis, 37% with left sided disease and 32% with extensive colitis. Disease extension occurred during follow-up in 19% of patients. Cumulative rate of colectomy at one year was 1%. In UC cumulative probabilities of receiving 5-ASA, corticosteroids and immunesuppressants were 91%, 28% and 13%, respectively at one year. There were two mortalities at maximal follow-up from lung carcinoma and severe sepsis. CONCLUSION: In this populationbased follow-up study, clinical presentation and early disease course in Asian IBD patients appear comparable to that of Western patients. Progression to complicated behavior and accelerated use of immunesuppressants is common in CD. Early surgical rate for UC in Asia remains low. Understanding the natural history of IBD in our population can help optimize therapeutic interventions. Reference: SC Ng, et al. Incidence and Phenotype of Inflammatory Bowel Disease, Based on Results from the Asia-Pacific Crohn's and Colitis Epidemiologic Study. Gastroenterology 2013; 145(1):158-165
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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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