Eng Kiong Teo

Racial differences in the prevalence of ulcerative colitis and Crohn's disease in Singapore.

Background : The aim of this study was to determine the prevalence rates of inflammatory bowel disease in the different races in Singapore.

Clinical profile of primary sclerosing cholangitis in Singapore

Abstract Background and Aim: Primary sclerosing cholangitis (PSC) is a rare chronic disease in Singapore and its epidemiological profile has not been described previously. The present study aimed to define the demographic and clinical profile of patients with PSC in Singapore.

The Utility of Narrow Band Imaging in Improving the Endoscopic Diagnosis of Gastroesophageal Reflux Disease

BACKGROUND & AIMS Narrow band imaging (NBI) facilitates mucosal surface evaluation and may improve the endoscopic diagnosis of gastroesophageal reflux disease (GERD). We investigated the utility of NBI in improving the endoscopic diagnosis of GERD when compared with conventional endoscopy. METHODS A total of 107 subjects (nonerosive reflux disease [NERD], 36; erosive reflux disease [ERD], 41; controls, 30) were recruited prospectively. The mucosal morphology at the squamocolumnar junction (SCJ) in GERD and controls was visualized using conventional endoscopy and NBI. The main outcome measurements were as follows: (1) The differences in mucosal morphology at the SCJ between conventional endoscopy and NBI; and (2) the differences in mucosal morphology at the SCJ between GERD and controls with NBI. RESULTS Micro-erosions, increased vascularity, and pit patterns at the SCJ not seen on conventional endoscopy were well seen with NBI. Compared with controls, ERD and NERD had a significantly higher prevalence of micro-erosions (ERD, 100%; NERD, 52.8%; controls, 23.3%), and increased vascularity (ERD, 95.1%; NERD, 91.7%; controls, 36.7%), but a lower prevalence of round pit pattern (ERD, 4.9%; NERD, 5.6%; controls, 70%). ERD and NERD were similar in terms of increased vascularity and pit patterns. Increased vascularity with absence of round pit pattern was useful to distinguish NERD from controls (sensitivity, 86.1%; specificity, 83.3%). Interobserver agreement was good for increased vascularity (kappa = 0.95) and micro-erosions (kappa = 0.89), but lower for pit pattern (kappa = 0.59). CONCLUSIONS NBI enhanced mucosal morphology at the SCJ and appeared useful for improving the endoscopic diagnosis of GERD.

Racial differences in Helicobacter pylori, serum pepsinogen and gastric cancer incidence in an urban Asian population

Background:  In Singapore, the highest incidence of gastric cancer occurs in the Chinese (C), with lower rates among Malay (M) and Indian (I) subjects. The purpose of the present paper was to examine whether racial differences in the prevalence of Helicobacter pylori and serum pepsinogen (PG) could account for this difference.

A comparison of surgery versus transcatheter angiographic embolization in the treatment of nonvariceal upper gastrointestinal bleeding uncontrolled by endoscopy.

Background Patients with recurrent nonvariceal upper gastrointestinal bleeding who have failed endoscopic therapy pose a challenge. Percutaneous transcatheter angiographic embolization (TAE) is an alternative to surgery but remains controversial. This study compares the treatment outcomes in patients with recurrent nonvariceal upper gastrointestinal bleeding. Methods A retrospective single-centre study of consecutive patients who underwent TAE (January 2007–December 2010) compared with patients treated surgically (January 2004–December 2010) was conducted. Patient demographics, comorbidities, rebleeding rates, length of stay and mortality were compared. Results Thirty [23 men; age (SD) 66.5±15.6 years] and 63 [41 men; age (SD) 68.2±15.0 years, NS] patients underwent TAE and surgery after a mean (SD) of 1.7±1.0 and 2.1±1.1 (NS) gastroscopies, respectively, for gastric ulcers (n=28), duodenal ulcers (n=53), small-bowel diverticuli (n=7), jejunal ulcer (n=1) and gastric Dieulafoy’s lesions (n=2). Ten (33.3%) and 44 (69.8%) patients who underwent TAE and surgery, respectively, had an American Society of Anesthesiologists status of at least 2 (P=0.001). Higher rebleeding rates were observed after TAE compared with surgery [n=14 (46.7%) vs. 8 (12.7%), P=0.001]; however, there were no significant differences in 30-day mortality (16.7 vs. 19.0%, NS), complication rates (46.7 vs. 60.3%, NS) and length of stay (45.1±9.8 vs. 25.5±18.1 days, P=0.06). Twenty-four out of 30 patients (80%) who underwent TAE achieved haemostasis after a median (SD) of 2.0 (1.2) TAE procedures. Rebleeding occurred in five out of seven patients (71%) who underwent TAE for small-bowel diverticular bleeding. Conclusion TAE averted the need for surgery in high-risk patients. Its role in low surgical risk patients or patients with small-bowel diverticular bleeding requires further study.

Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy

BACKGROUND The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market. METHODS Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm. RESULTS In the US and Germany, costs of the reference arms were US

Autoimmune hepatitis in Singapore: a rare syndrome affecting middle-aged women.

14,486 and US

Helicobacter pylori eradication versus prokinetics in the treatment of functional dyspepsia: a randomized, double-blind study

9,998 for hepatitis B e antigen (HBeAg)-positive and US

An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital.

11,398 and US

An analysis of the efficacy and safety of a strategy of early precut for biliary access during difficult endoscopic retrograde cholangiopancreatography in a general hospital.

7,531 for HBeAg-negative patients, respectively. In HBeAg-positive patients, the lamivudine roadmap was most cost-effective (ICER US