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Dive into the research topics where Jyh-Ming Liou is active.

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Featured researches published by Jyh-Ming Liou.


Journal of Gastroenterology and Hepatology | 2008

Asia-Pacific consensus guidelines on gastric cancer prevention

Kwong Ming Fock; Nicholas J. Talley; Paul Moayyedi; Richard H. 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 M. Mitchell; Abdul Aziz Rani; Jyh-Ming Liou; Ratha Korn Vilaichone; Jose D. Sollano

Background and Aim:  Gastric cancer is a major health burden in the Asia–Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer.


The Lancet | 2013

Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial

Jyh-Ming Liou; Chieh-Chang Chen; Mei-Jyh Chen; Chien-Chuan Chen; Chi-Yang Chang; Yu-Jen Fang; Ji Yuh Lee; Shih-Jer Hsu; Jiing-Chyuan Luo; Wen-Hsiung Chang; Yao-Chun Hsu; Cheng-Hao Tseng; Ping-Huei Tseng; Hsiu-Po Wang; Ueng-Cheng Yang; Chia-Tung Shun; Jaw-Town Lin; Yi-Chia Lee; Ming-Shiang Wu

BACKGROUND Whether sequential treatment can replace triple therapy as the standard treatment for Helicobacter pylori infection is unknown. We compared the efficacy of sequential treatment for 10 days and 14 days with triple therapy for 14 days in first-line treatment. METHODS For this multicentre, open-label, randomised trial, we recruited patients (≥20 years of age) with H pylori infection from six centres in Taiwan. Using a computer-generated randomisation sequence, we randomly allocated patients (1:1:1; block sizes of six) to either sequential treatment (lansoprazole 30 mg and amoxicillin 1 g for the first 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg for another 7 days; with all drugs given twice daily) for either 10 days (S-10) or 14 days (S-14), of 14 days of triple therapy (T-14; lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg for 14 days; with all drugs given twice daily). Investigators were masked to treatment allocation. Our primary outcome was the eradication rate in first-line treatment by intention-to-treat (ITT) and per-protocol (PP) analyses. This trial is registered with ClinicalTrials.gov, number NCT01042184. FINDINGS Between Dec 28, 2009, and Sept 24, 2011, we enrolled 900 patients: 300 to each group. The eradication rate was 90·7% (95% CI 87·4-94·0; 272 of 300 patients) in the S-14 group, 87·0% (83·2-90·8; 261 of 300 patients) in the S-10 group, and 82·3% (78·0-86·6; 247 of 300 patients) in the T-14 group. Treatment efficacy was better in the S-14 group than it was in the T-14 group in both the ITT analysis (number needed to treat of 12·0 [95% CI 7·2-34·5]; p=0·003) and PP analyses (13·7 [8·3-40], p=0·003). We recorded no significant difference in the occurrence of adverse effects or in compliance between the three groups. INTERPRETATION Our findings lend support to the use of sequential treatment as the standard first-line treatment for H pylori infection. FUNDING National Taiwan University Hospital and National Science Council.


Gut | 2010

Levofloxacin-based and clarithromycin-based triple therapies as first-line and second-line treatments for Helicobacter pylori infection: a randomised comparative trial with crossover design

Jyh-Ming Liou; Jaw-Town Lin; Chi-Yang Chang; Mei-Jyh Chen; Tsu-Yao Cheng; Yi-Chia Lee; Chien-Chuan Chen; Wang-Huei Sheng; Hsiu-Po Wang; Ming-Shiang Wu

Background The efficacy of a levofloxacin-based regimen as the first-line treatment and a clarithromycin-based regimen as the second-line treatment for Helicobacter pylori infection remains unknown. The aim of this study was to assess the eradication rates of these two regimens using different administration sequences. Methods Eligible patients were randomised to receive LAL: levofloxacin (750 mg once a day), amoxicillin (1000 mg twice a day) and lansoprazole (30 mg twice a day) for 7 days, or CAL: clarithromycin (500 mg twice a day), amoxicillin (1000 mg twice a day) and lansoprazole (30 mg twice a day) for 7 days. Patients with positive [13C]urea breath test after treatment were retreated with the rescue regimen in a crossover manner for 10 days. Result When used as first-line treatment (n=432), the eradication rates of LAL (n=217) and CAL (n=215) were 74.2 and 83.7% (p=0.015) in the intent-to-treat (ITT) analysis, and 80.1 and 87.4% (p=0.046) in the per-protocol (PP) analysis, respectively. When used as second-line treatment, the eradication rates of LAL (n=26) and CAL (n=40) were 76.9 and 60% (p=0.154) in the ITT analysis, and 80 and 61.5% (p=0.120) in the PP analysis, respectively. The overall eradication rates of CAL followed by LAL were better than the reverse sequence in both the ITT analysis (93% vs 85.3%, p=0.01) and the PP analysis (97.6% vs 92.5%, p=0.019). The eradication rate was significantly lower in the presence of levofloxacin resistance in the LAL group (50% vs 84.4%, p=0.018) and clarithromycin resistance in the CAL group (44.4% vs 90.7%, p=0.002). Conclusion CAL achieved a higher eradication rate than LAL as the first-line treatment, but not as the second-line treatment. The strategy of using CAL as the initial treatment and LAL as the rescue regimen achieved higher eradication rates than the reverse sequence. Clinical trial number NCT00816140.


Journal of Antimicrobial Chemotherapy | 2013

Efficacy of genotypic resistance-guided sequential therapy in the third-line treatment of refractory Helicobacter pylori infection: a multicentre clinical trial

Jyh-Ming Liou; Chieh-Chang Chen; Chi-Yang Chang; Mei-Jyh Chen; Yu-Jen Fang; Ji-Yuh Lee; Chien-Chuan Chen; Shih-Jer Hsu; Yao-Chun Hsu; Cheng-Hao Tseng; Ping-Huei Tseng; Lawrence Chang; Wen-Hsiung Chang; Hsiu-Po Wang; Chia-Tung Shun; Jeng-Yih Wu; Yi-Chia Lee; Jaw-Town Lin; Ming-Shiang Wu

OBJECTIVES The efficacy of sequential therapy and the applicability of genotypic resistance to guide the selection of antibiotics in the third-line treatment of Helicobacter pylori have not been reported. We aimed to assess the efficacy of genotypic resistance-guided sequential therapy in third-line treatment. METHODS Genotypic and phenotypic resistances were determined in patients who failed at least two eradication therapies by PCR with direct sequencing and agar dilution test, respectively. The patients were retreated with sequential therapy containing esomeprazole and amoxicillin for the first 7 days, followed by esomeprazole and metronidazole plus clarithromycin, levofloxacin or tetracycline for another 7 days (all twice daily), according to genotypic resistance determined using gastric biopsy specimens. Eradication status was determined by the (13)C-urea breath test. Trial registered at clinicaltrials.gov (identifier: NCT01032655). RESULTS The overall eradication rate was 80.7% (109/135, 95% CI 73.3%-86.5%) in the intention-to-treat analysis. The presence of amoxicillin resistance (OR 6.83, 95% CI 1.62-28.86, P = 0.009) and prior sequential therapy (OR 4.77, 95% CI 1.315-17.3, P = 0.017), but not tetracycline resistance (tetracycline group), were associated with treatment failure. The eradication rates in patients who received clarithromycin-, levofloxacin- and tetracycline-based sequential therapies were 78.9% (15/19), 92.2% (47/51) and 71.4% (25/35) in strains susceptible to clarithromycin, levofloxacin and tetracycline, respectively. CONCLUSIONS A simple molecular method guiding sequential therapy can achieve a high eradication rate in the third-line treatment of refractory H. pylori infection.


The Journal of Clinical Endocrinology and Metabolism | 2010

Plasma Insulin-Like Growth Factor-Binding Protein-2 Levels as Diagnostic and Prognostic Biomarker of Colorectal Cancer

Jyh-Ming Liou; Chia-Tung Shun; Jin-Tung Liang; Han-Mo Chiu; Mei-Jyh Chen; Chien–Chuan Chen; Hsiu-Po Wang; Ming-Shiang Wu; Jaw-Town Lin

CONTEXT Overexpression of IGF-II and IGF-binding protein (IGFBP)-2 has been reported in several cancers. OBJECTIVE We aimed to assess the roles of plasma IGF-II and IGFBP-2 levels as diagnostic and prognostic biomarkers and the impact of loss of imprinting (LOI) of IGF-II on the survival of colorectal cancer (CRC). DESIGN We conducted a case control and prospective cohort study for diagnostic and prognostic values, respectively. PATIENTS AND SETTING Plasma levels of IGF-II and IGFBP-2 were measured in 162 patients with CRC before surgery, in paired 15 patients after curative surgery, in 24 patients with advanced colon polyps, and in 114 healthy controls between 2003 and 2006 in National Taiwan University Hospital. RESULTS The area under the curve values of using IGFBP-2 as a diagnostic marker for advanced colon polyp and CRC were 0.654 [95% confidence interval (CI) = 0.547-0.76; P = 0.017] and 0.815 (95% CI = 0.766-0.864; P < 0.001), respectively. The sensitivity and specificity for diagnosing CRC were 80.2 and 64%, respectively, if the cutoff value of IGFBP-2 was 377 ng/ml. In the multivariate Cox proportional hazards regression model, higher IGFBP-2 levels were associated with increased risk of mortality [hazard ratio (HR) = 2.46; P = 0.017], whereas higher IGF-II levels were associated with reduced risk of mortality (HR = 0.42; P = 0.044). LOI of IGF-II was associated with increased risk of mortality (HR = 7.91; P = 0.014) in patients with stage IV disease. CONCLUSIONS IGFBP-2 is a potential diagnostic and prognostic biomarker of CRC. LOI of IGF-II is significantly associated with poor prognosis in patients with stage IV disease.


Journal of Gastroenterology and Hepatology | 2009

Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage

Yao-Chun Hsu; Chen-Shuan Chung; Cheng-Hao Tseng; Tzu-Ling Lin; Jyh-Ming Liou; Ming-Shiang Wu; Fu-Chang Hu; Hsiu-Po Wang

Background and Aims:  Risk factors for mortality in acute variceal hemorrhage remain incompletely understood. Whether endoscopy timing is associated with risk of mortality has not been investigated. We aimed to investigate risk factors for in‐hospital mortality in cirrhotic patients with acute variceal hemorrhage, with emphasis on endoscopy timing.


PLOS ONE | 2015

The Primary Resistance of Helicobacter pylori in Taiwan after the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors—A Nationwide Study

Jyh-Ming Liou; Chi-Yang Chang; Mei-Jyh Chen; Chieh-Chang Chen; Yu-Jen Fang; Ji-Yuh Lee; Jeng-Yih Wu; Jiing-Chyuan Luo; Tai-Cherng Liou; Wen-Hsiung Chang; Cheng-Hao Tseng; Chun-Ying Wu; Tsung-Hua Yang; Chun-Chao Chang; Hsiu-Po Wang; Bor-Shyang Sheu; Jaw-Town Lin; Ming-Jong Bair; Ming-Shiang Wu; Taiwan Gastrointestinal Disease

Objective The Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance. Methods The defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method. Results The DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000–2007 to 8.3% in 2008–2010 and 13.4% in 2011–2012 (p=0.001). The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p<0.001), which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance. Conclusions The low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan might be attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance.


Antimicrobial Agents and Chemotherapy | 2011

Genotypic Resistance in Helicobacter pylori Strains Correlates with Susceptibility Test and Treatment Outcomes after Levofloxacin- and Clarithromycin-Based Therapies

Jyh-Ming Liou; Chi-Yang Chang; Wang-Huei Sheng; Yu-Chi Wang; Mei-Jyh Chen; Yi-Chia Lee; Hsu-Wei Hung; Hung Chian; San-Chun Chang; Ming-Shiang Wu; Jaw-Town Lin

ABSTRACT The accuracy of genotypic resistance to levofloxacin (gyrA mutations) and its agreement with treatment outcomes after levofloxacin-based therapy have not been reported. We aimed to assess the correlation. Helicobacter pylori strains isolated from patients who received levofloxacin-based and clarithromycin-based triple therapies in a previous randomized trial were analyzed for point mutations in gyrA and 23S rRNA. PCR followed by direct sequencing was used to assess the gyrA and 23S rRNA mutations. An agar dilution test was used to determine the MICs of clarithromycin and levofloxacin. We found that the agreement between genotypic and phenotypic resistance to levofloxacin was best when the MIC breakpoint was >1 μg/ml (kappa coefficient, 0.754). The eradication rates in patients with and without gyrA mutations were 41.7% and 82.7%, respectively (P = 0.003). The agreement between genotypic and phenotypic resistance to clarithromycin was best when the MIC breakpoint was >2 μg/ml (kappa, 0.694). The eradication rates in patients with and without 23S rRNA mutations were 7.7% and 93.5%, respectively (P < 0.001). The agreements (kappa coefficient) between therapeutic outcomes after clarithromycin-based triple therapy and genotypic and phenotypic resistance were 0.671 and 0.356, respectively. The agreements (kappa coefficient) between therapeutic outcomes after levofloxacin-based triple therapy and genotypic and phenotypic resistance were 0.244 and 0.190, respectively. In conclusion, gyrA and 23S rRNA mutations in H. pylori strains appeared to be better markers than phenotypic resistance in the prediction of treatment outcomes. The optimal breakpoints for levofloxacin and clarithromycin resistance appeared to be >1 μg/ml and >2 μg/ml, respectively.


Journal of The Formosan Medical Association | 2005

Natural course and treatment of dual hepatitis B virus and hepatitis C virus infections

Chun-Jen Liu; Jyh-Ming Liou; Ding-Shinn Chen; Pei-Jer Chen

In areas where hepatitis B virus (HBV) infection is endemic such as Southeast Asia, the Far East and southern Europe, a substantial number of patients are infected with both hepatitis C and B. Moreover, patients who are dually infected with hepatitis C virus (HCV) and HBV have been reported to carry a significantly higher risk of developing fulminant hepatic failure, liver cirrhosis and hepatocellular carcinoma than those with HCV or HBV infection alone. Such dually infected patients need careful medical attention and effective treatment. Dually infected hepatitis patients can be classified into 2 groups according to the dominant viral activity: the first in which hepatitis C dominates over hepatitis B (hepatitis C/B) and the second in which hepatitis B dominates over hepatitis C (hepatitis B/C). Their natural histories may differ and require distinct treatments. For hepatitis C/B, conventional interferon (IFN) alone has not been shown to be effective in the clearance of HCV RNA. IFN in combination with ribavirin for 6 months has been used to treat hepatitis C/B patients in a few pilot studies and a sustained HCV clearance rate could be achieved to an extent comparable to that in simple hepatitis C. Nevertheless, the treatment outcomes in those infected with HCV genotype 1 remain unsatisfactory. Systematic trials of treatment for hepatitis B/C patients have not yet been reported. In this article, we review recent updates in the natural history and treatment of dual HBV and HCV infections, and draw attention to several unresolved issues requiring further study. These efforts may culminate in better treatment for patients co-infected with HCV and HBV.


Expert Review of Gastroenterology & Hepatology | 2014

Evidence-based recommendations for successful Helicobacter pylori treatment

Jeng-Yih Wu; Jyh-Ming Liou; David Y. Graham

An effective Helicobacter pylori therapy reliably provides high cure rates in infections with susceptible strains. It is possible to predict the efficacy of any regimen if one knows the prevalence of antibiotic resistance for a regimen or for a specific patient. We show how to predict the outcome for current regimens and discuss the factors that undermine different regimens (i.e., their Achilles heel). In general, in Western countries, clarithromycin-containing triple and sequential therapy should be considered obsolete as empiric therapies. Preferred regimens are 14-day concomitant or bismuth-containing quadruple therapy. We provide details of how to identify a regimen for a patient or region that will reliably cure 90% or more as well as those that will reliably fail.

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Ming-Shiang Wu

National Taiwan University

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Jaw-Town Lin

Fu Jen Catholic University

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Hsiu-Po Wang

National Taiwan University

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Yi-Chia Lee

National Taiwan University

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Chieh-Chang Chen

National Taiwan University

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Mei-Jyh Chen

National Taiwan University

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Chia-Tung Shun

National Taiwan University

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Chun-Ying Wu

National Yang-Ming University

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Jeng-Yih Wu

Kaohsiung Medical University

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