Jiing-Chyuan Luo

Hepatic steatosis in chronic hepatitis C virus infection: Prevalence and clinical correlation

Background and Aims: Hepatic steatosis is a histological characteristic in patients with chronic hepatitis C virus (HCV) infection. The aim of this study was to evaluate the prevalence of hepatic steatosis in Chinese patients with chronic hepatitis C, and to look for possible correlation with various histopathological changes and to look for possible correlation with various clinical and pathologic variables.

Current patterns of irritable bowel syndrome in Taiwan: the Rome II questionnaire on a Chinese population

Background : Irritable bowel syndrome is a common condition seen in Western countries. In Asia, however, it is less known and even less studied.

Prevalence and health/social impacts of functional dyspepsia in Taiwan: A study based on the Rome Criteria Questionnaire Survey assisted by endoscopic exclusion among a physical check-up population

Objective Until now, the epidemiology of functional dyspepsia (FD) and its social impact on Asians have been rarely studied. The aims of this study were to determine the prevalence, social impact, and health-seeking behaviors of FD in an apparently healthy Chinese population in Taiwan. Material and methods Based on the questionnaire provided by the Rome II working team, a survey was administered to a Taiwanese population receiving paid physical check-up (n=2865). Esophagoduodenoscopy was performed in each subject to exclude organic dyspepsia. Finally, diagnoses of functional gastrointestinal disorders were obtained by means of a computer-generated algorithm. Results The FD prevalences were 23.8% and 11.8% according to the Rome I and -II criteria, respectively. Nearly 60% of Rome I-defined FD subjects and 18.9% of Rome II-defined FD subjects had overlapping irritable bowel syndrome (IBS). Irrespective of any Rome definition, FD subjects had excessive physician visits, absenteeism, and sleep disturbances compared to dyspepsia-free controls (p<0.01). Moreover, over half of the Rome II FD subjects were “consulters” showing excessive physician visits, absenteeism, and sleep disturbances than “non-consulters”. The dysmotility-like subgroup (74.5%) comprised the majority of FD subjects and showed no differences to their ulcer-like counterparts in terms of major demographic data and social and health impacts. Conclusions FD is a common complaint in Taiwan and also bears an obvious social and medical burden to society. Over half of our FD subjects sought medical help, which may be due to the readily accessible medical care in Taiwan. The newly defined Rome II criteria diminish the chance of co-existence of FD and IBS. Further FD classification by the main symptoms appears of limited clinical usefulness.

Incidence of bleeding from gastroduodenal ulcers in patients with end-stage renal disease receiving hemodialysis

Background: Few large population-based studies have compared the incidence of bleeding of gastroduodenal ulcers between patients with and without end-stage renal disease. We investigated the association between ulcer bleeding and end-stage renal disease in patients receiving hemodialysis, and we sought to identify risk factors for ulcer bleeding. Methods: We performed a nationwide seven-year population study using data from the National Health Insurance Research Database in Taiwan. We identified 36 474 patients with end-stage renal disease who were receiving hemodialysis, 6320 patients with chronic kidney disease and 36 034 controls matched for age, sex and medication use. We performed log-rank testing to analyze differences in survival time without ulcer bleeding among the three groups. We performed Cox proportional hazard regressions to evaluate the risk factors for ulcer bleeding among the three groups and to identify risk factors in patients receiving hemodialysis. Results: Patients receiving hemodialysis and those with chronic kidney disease had a significantly higher incidence of ulcer bleeding than controls had (p < 0.001). Hemodialysis (hazard ratio [HR] 5.24, 95% confidence interval [CI] 4.67–5.86) and chronic kidney disease (HR 1.95, 95% CI 1.62–2.35) were independently associated with an increased risk of ulcer bleeding. Diabetes mellitus, coronary artery disease, cirrhosis and use of nonsteroidal anti-inflammatory drugs were risk factors for ulcer bleeding in patients with end-stage renal disease who were receiving hemodialysis Interpretation: Patients with end-stage renal disease who are receiving hemodialysis had a high risk of ulcer bleeding. Diabetes mellitus, coronary artery disease, cirrhosis and the use of nonsteroidal anti-inflammatory drugs were important risk factors for ulcer bleeding in these patients.

Relationships between serum aminotransferase levels, liver histologies and virological status in patients with chronic hepatitis C in Taiwan

In patients with chronic hepatitis C, the relationships between serum alanine aminotransferase (ALT) levels, histological liver injury and serum hepatitis C virus (HCV) RNA titres remain controversial. To evaluate these relationships, 93 Chinese patients with histological diagnosis of chronic hepatitis C were enrolled for this study. Serum ALT levels, HCV‐RNA titres and HCV genotypes were examined. The histology was evaluated according to a modified histological activity score based on the degree of periportal necro‐inflammation, intralobular necro‐inflammation, portal inflammation, total necro‐inflammation and fibrosis. The mean serum ALT level was significantly higher in patients with severe intralobular necro‐inflammation activity than in patients with mild or no activity (P= 0.013). However, scores of intralobular activity were only weakly correlated with serum ALT levels (r= 0.27) and could not be used to adequately predict ALT values. Serum ALT levels showed no significant correlation with the scores of portal inflammation, periportal necro‐inflammation, total necro‐inflammation and fibrosis. Also, there was no significant difference in the mean serum ALT level among different serum HCV‐RNA levels and HCV genotypes. Serum HCV‐RNA titres and genotypes showed no significant correlation with liver histology and serum HCV‐RNA titres were only weakly correlated with the total necro‐inflammatory score (r= 0.27). In conclusion, although serum ALT levels were higher in patients with more severe intralobular necro‐inflammatory activity, the correlation was not strong enough to adequately predict ALT values. Serum HCV‐RNA titres and genotypes also showed no significant correlation with serum ALT levels and liver histologies.

Nonpeptic Ulcer, Nonvariceal Gastrointestinal Bleeding in Hemodialysis Patients

OBJECTIVES Hemodialysis patients carry a higher risk of peptic ulcer bleeding. Whether hemodialysis patients also have a higher occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding needs further evaluation. METHODS Using Taiwans National Health Insurance research database, the occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding was compared among the hemodialysis patients, chronic kidney disease patients, and controls using log-rank test. Risk factors were identified by Cox regression analysis. RESULTS A total of 20,830 patients were enrolled, including 8210 hemodialysis and 4190 chronic kidney disease patients and 8430 age- and sex-matched controls in a 2:1:2 ratio. In the 7-year follow-up period, hemodialysis patients had a significantly higher cumulative hazard of nonpeptic ulcer, nonvariceal gastrointestinal bleeding than chronic kidney disease patients and controls (P <.001, by log-rank test). The hazard also was significantly higher in the chronic kidney disease patients than in controls. Cox regression analysis revealed that older age, the comorbidities of diabetes mellitus, cirrhosis, and chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, chronic kidney disease (hazard ratio 5.17), hemodialysis (hazard ratio 9.43), and use of selective serotonin reuptake inhibitors were independent risk factors for nonpeptic ulcer, nonvariceal gastrointestinal bleeding in all study patients. Old age, diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, and use of selective serotonin reuptake inhibitors were independent risk factors in hemodialysis patients. CONCLUSIONS There is a higher risk of developing nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients after adjustments for age, sex, underlying comorbidities, and ulcerogenic medication. The risk has increased since patients had chronic kidney disease.

Cirrhotic patients at increased risk of peptic ulcer bleeding: a nationwide population‐based cohort study

Few large population‐based studies have compared the occurrence of peptic ulcer bleeding (PUB) in cirrhotic and noncirrhotic patients.

Gender difference on the symptoms, health-seeking behaviour, social impact and sleep quality in irritable bowel syndrome: a Rome II-based survey in an apparent healthy adult Chinese population in Taiwan.

Background : Little is known about the gender effect on irritable bowel syndrome in Asia.

Clinical significance of serum auto-antibodies in Chinese patients with chronic hepatitis C: Negative role of serum viral titre and genotype

Positive serum anti‐nuclear antibody (ANA) and anti‐smooth muscle antibody (SMA) have been reported in 10–66% of patients with chronic hepatitis C virus (HCV) infection from Western countries. However, the mechanism involved in this immunological disorder is still unknown. This study was carried out to evaluate the prevalence and clinical significance of positive serum auto‐antibodies in Chinese patients with chronic hepatitis C and to assess the role of serum HCV‐RNA titre and HCV genotype in the presence of serum auto‐antibodies. Serum ANA, SMA and anti‐mitochondrial antibody (AMA) were measured in 122 patients with chronic hepatitis C. Clinical, biochemical and virological data (serum HCV‐RNA titre and HCV genotype) were compared between patients with and without serum auto‐antibodies. Fifty‐eight (48%) patients were associated with positive serum autoantibodies: 42 (34%) positive for ANA, six (5%) positive for SMA, nine (7%) positive for both ANA and SMA and one (1%) positive for AMA. Clinical parameters (age, sex, blood transfusion history), liver biochemical tests, the presence of cryoglobulinaemia or cirrhosis, and the response to interferon treatment were not significantly different between patients with and without positive serum auto‐antibodies. Serum HCV‐RNA levels and HCV genotypes were also not significantly different between the two groups. Logistic regression analysis showed that none of the previously mentioned parameters were significant predictors to associate with serum auto‐antibodies in chronic hepatitis C. We concluded that 48% of Chinese patients with chronic hepatitis C were associated with positive serum auto‐antibodies. Hepatitis C virus genotypes and serum HCV‐RNA levels were not correlated to the presence of serum auto‐antibodies. The clinical significance and actual pathogenesis of this phenomenon remain to be clarified.

Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population-based study

Peptic ulcer bleeding remains a major healthcare problem despite decreasing prevalence of peptic ulcer disease. The role of chronic obstructive pulmonary disease (COPD) in the risk of peptic ulcer bleeding has not yet been established.