Research

Chuah YY, Lee YY, Tzeng WS, Shiue YL Inguinal ecchymosis, known as Stabler sign, is classically associated with retroperitoneal hemorrhage. However, imaging confirmation of the underlying mechanism is rarely demonstrated. We report a 33-year-old woman who developed progressive right inguinal ecchymosis one week after excisional surgery for fibrocystic breast nodules. Physical examination revealed extensive bruising over the right breast and a separate ecchymotic area in the r

Tagiling N, Simadibrata DM, Makharia GK, Sadgehi A, Moreira L, Leung WK, Kaplan GG, Leddin D, Metz G, Barkun AN, Lee YY Background And Aims Gastrointestinal (GI) and liver diseases are common and remain major contributors to global morbidity and mortality, with disease patterns increasingly shifting toward metabolic and functional etiologies. Anticipating these evolving challenges, the World Gastroenterology Organization (WGO), comprising 121 national and regional societies,

Simadibrata DM, Utari AP, Andarini L, Wijaya J, Hasanah NH, Cheng KY, Palsson OS, Sperber AD, Bangdiwala SI, Lee YY, Syam AF Background And Aims Disorders of gut-brain interaction (DGBI) significantly impact quality of life (QoL), healthcare utilization, and work productivity globally, yet data from Indonesia remain limited. This household face-to-face survey study aimed to investigate the prevalence and impact of DGBI on psychological distress, dietary habits, QoL, and healt

Tengku Alang TAI, Lee YY, Tan TS, Mokhtar AM Digital twins (DT) technology has shown considerable growth in recent years. Previous studies have examined technologies in a variety of areas, including health care. However, limited studies have attempted to provide a thorough discussion of strategies for the seamless integration of DT into health care, particularly in the context of interoperability of heterogeneous medical data. This review examines the underlying concept of DT

Siboni S, Sozzi M, Visaggi P, Kristo I, De Bortoli N, Tolone S, Marabotto E, Bernardi D, Schoppmann SF, Penagini R, Rogers B, Hobson A, Haworth J, Louie B, Lee YY, Tee V, Masuda T, Theodorou D, Triantafyllou T, Barcella B, Cusmai L, Puricelli M, Coletta M, Annese V, Savarino EV, Asti ELG, Gyawali CP Introduction According to Lyon 2.0, laryngopharyngeal symptoms (LPS) should undergo upfront pathophysiologic tests. The novel Milan score integrates esophagogastric junction (EGJ)

Hod K, Marasco G, Colecchia L, Cremon C, Barbaro MR, Cacciari G, Falangone F, Kagramanova A, Bordin D, Drug V, Miftode E, Fusaroli P, Mohamed SY, Ricci C, Bellini M, Rahman MM, Melcarne L, Santos J, Lobo B, Bor S, Yapali S, Akyol D, Sapmaz FP, Urun YY, Eskazan T, Celebi A, Kacmaz H, Ebik B, Binicier HC, Bugdayci MS, Yağcı MB, Pullukcu H, Kaya BY, Tureyen A, Hatemi İ, Koc ES, Sirin G, Calıskan AR, Bengi G, Alıs EE, Lukic S, Trajkovska M, Dumitrascu D, Pietrangelo A, Corradini

Simadibrata DM, Butt MF, Liu BD, Al-Fakhouri Z, Alomari L, Cheng KY, Palsson OS, Sperber AD, Bangdiwala SI, Lembo A, Lee YY Introduction Individuals with underweight or obesity may have altered gut-brain signaling. This study investigated the association between body mass index (BMI) and the prevalence and burden of disorders of gut-brain interaction (DGBI). Methods This cross-sectional analysis used the internet-based data from the Rome Foundation Global Epidemiology Study,

Chee D, Ya Ong CE, Tan DJH, Schattenberg JM, Ioannou GN, Huang DQ, HCC Policy Study Group No abstract available.

Wong RK, Fang X, Ghoshal UC, Kashyap PC, Mulak A, Lee YY, Sperber AD, Holtmann G Sociocultural determinants such as cultural norms, diet, and environmental factors, along with their effects on the gastrointestinal microbiome, can modify the risk to develop disorders of gut-brain interaction (DGBI). These factors also shape symptom perception and health care-seeking behaviors, and how society and health care providers respond to patients with DGBI. This document summarizes the

Leelakusolvong S, Chua TS, Quach DT, Ong AM, Syam AF, Galang AJG, Cheah WK, Dao HV, Sollano JD, Khaira KS, Kijdamrongthum P, Ambaras Khan R, Chirapongsathorn S, Lee YY Background And Aim Proton pump inhibitors (PPIs) are integral to managing many gastrointestinal conditions. However, the prevalent inappropriate PPI prescription across Southeast Asia (SEA) is concerning. Given the absence of locally tailored recommendations to inform clinical practice, this consensus document

Quach DT, Huynh TM, Galang AJG, Dao HV, Chirapongsathorn S, Kijdamrongthum P, Khan RA, Ong AM, Cheah WK, Khaira KS, Tan SF, Sollano J, Syam AF, Chua TS, Leelakusolvong S, Lee YY Despite widespread use, real-world evidence regarding proton pump inhibitor (PPI) prescribing and rationalization practices in Southeast Asia (SEA) remains limited; therefore, we aimed to characterize current prescribing behaviors and rationalization strategies among healthcare professionals in the re

GBD 2023 Diarrhoeal Disease and Enteric Infectious Diseases Collaborators Background Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions,

Chuah YY, Ooi SW, Hsieh SP, Tzeng WS, Lee YY, Shiue YL, Tu CM, Liao CY Adult intussusception is an uncommon condition that usually indicates an underlying pathological lead point. Ileal perineurioma is an exceptionally rare benign peripheral nerve sheath tumor with limited gastrointestinal reports. We describe a 59-year-old woman presenting with acute severe abdominal pain, vomiting, and distension. Contrast-enhanced computed tomography demonstrated ileal intussusception with

Ayad ME, Yu S, El Shennawy S, Al Mowafy EA, Sahran NF, Elwalid-Jad R, Lee YY Background And Aim Postbiotics, preparations of inanimate microorganisms and/or their components with health benefits, may offer potential advantages in the management of IBS, but evidence remains limited. We conducted the first systematic review and meta-analysis to assess the efficacy and safety of postbiotics in adults with IBS. Methods PubMed, Scopus, Embase, and Web of Science were searched from

Sozzi M, Siboni S, Latorre-Rodriguez AR, Mittal SK, Marabotto E, Pasta A, Calabrese F, Andreatta E, Aldinio G, Coletta M, Penagini R, Lee YY, Ehab SAM, Tee V, Lee RH, Alcala-Gonzalez LG, Rogers B, Hennen MS, Haworth J, Patel A, Patel P, Masuda T, Coss-Adame E, Salvador R, Provenzano L, Nicoletti L, Piccirelli S, Pezzuto E, Tolone S, Asti E, Savarino EV, Gyawali CP Background High-resolution manometry (HRM) is increasingly used to assess risk of gastroesophageal reflux disease

Zheng F, Yang Y, Zhan Y, Zhang ZW, Lu G, Xie D, Zhang SM, Mageswary U, Lee YY, Liong MT Background Functional constipation is a common disorder of gut-brain interaction that substantially affects bowel function, psychological well-being, and quality of life. Probiotic supplementation represents a microbiota-targeted nutritional strategy for functional constipation, but associated host-response signals remain incompletely understood. Methods This single-center, randomized, dou

Quach DT, Liou JM, Gisbert JP, Leung WK, Moss SF, Fallone CA, Katelaris P, Schulz C, Kayamba V, Zhou L, Vu NTH, Vilaichone RK, Miftahussurur M, Setshedi M, Riquelme A, Yadegar A, Lee YY, Ishibashi F, Jung HY, Coelho LG, Suzuki H, Lee YC, Megraud F, Mahachai V, Sugano K, Malfertheiner P Background Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real-world outcomes of Helicobacter pylori management remain variable. Antimicrobial re

Patcharatrakul T, Siah KTH, Syam AF, Nakajima A, Suzuki H, Lee YY, Hojo M, Rattanachaisit P, Pitisuttithum P, Quek S, Bai T, Ren YP, Nagahara A, Ong AM, Chen CL, Lu CL, Quach DT, Makharia GK, Wu JCY, Jung KW, Chuah KH, Zhong L, Rahman MM, Lee TH, Ghoshal UC, Hou X, Fang X, Xiao YL, Gonlachanvit S Background/Aims Chronic constipation is a common gastrointestinal (GI) disorder in Asia, characterized by heterogeneous symptom presentation, frequent overlap with other GI symptoms,

Xu X, Shi Y, Tacke F, Wai-Sun Wong V, Li W, Sebastiani G, Newsome PN, Romero-Gomez M, Pan C, Castera L, Chai J, Kim W, Valenti L, Yilmaz Y, Win KM, Xu X, Ocama P, Ghazinyan H, Al Mahtab M, Hamid S, Lesmana CRA, Romeo S, Castellanos Fernandez MI, Yu X, Luukkonen PK, Takahashi H, Charatcharoenwitthaya P, Boursier J, Cua IH, Dao HV, Spearman CW, Bandara Dassanayake SU, Ayurzana M, Aghayeva G, Muthiah MD, Mendez-Sanchez N, Stedman CA, Alswat K, Sharara AI, Debzi N, Leite NC, Alkh

Lau SY, Kok VS, Tan SS, Adnan SD, Ng WL, Ang BH, Yaacob NY, Lee YY, Kaur S, Mohamed R, Wong PF, Lim LL, Letchumanan M, Vethakkan SR, Noor NM, Tan SF, Low TL, Kiew LB, Chan WK Background Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related deaths in Malaysia. Early detection increases the likelihood of curative treatment and improves survival. This consensus document aims to provide evidence-based, locally relevant recommendations for the preventi

Aim To assess the association of the expression of apolipoprotein B (apoB) and 4-hydroxynonenal (4HNE) with the clinicopathological data of patients with colorectal cancer (CRC). Methods We obtained 80 CRC histopathological specimens sent to the Pathology Laboratory of Hospital Universiti Sains Malaysia from 2015 to 2019. Data on demographic factors, body mass index (BMI), and clinicopathological characteristics were also collected. Formalin-fixed paraffin-embedded tissues w

Background The gut microbiota in irritable bowel syndrome (IBS) is known to vary with diet. Aims i) To analyse the gut microbiota composition of IBS patients from a multi-ethnic population and ii) explore the impact of a low FODMAP diet on gastrointestinal symptoms and gut microbiota composition amongst IBS patients. Methods A multi-centre study of multi-ethnic Asian patients with IBS was conducted in two phases: i) an initial cross-sectional gut microbiota composition stud

Abstract ​Helicobacter pylori is one of the most common chronic bacterial infections in humans and responsible for 90% of duodenal ulcers and 70–90% of gastric ulcers. Despite this, many misconceptions regarding the appropriate diagnostic method and treatment strategies still exist in the Malaysian clinical practice. Under the initiative of the steering committee, an expert panel consisting of nine key opinion leaders in the field of gastroenterology convened to develop a set

Implications for population-based research Background and aims The Rome Foundation Global Epidemiology Study (RFGES) assessed the prevalence, burden, and associated factors of Disorders of Gut-Brain Interaction (DGBI) in 33 countries around the world. Achieving worldwide sampling necessitated use of two different surveying methods: In-person household interviews (9 countries) and Internet surveys (26 countries). Two countries, China and Turkey, were surveyed with both methods

Background & Aims Fatty liver disease is highly prevalent, resulting in overarching wellbeing and economic costs. Addressing it requires comprehensive and coordinated multisectoral action. We developed a fatty liver disease-Sustainable Development Goal (SDG) country score to provide insights into country-level preparedness to address fatty liver disease through a whole-of-society lens. Approach & Results We developed two fatty liver disease-SDG score sets. The first included

Background Rome criteria differentiate distinct types of disorders of gut-brain interaction (DGBI); also known as functional gastrointestinal disorders. Overlap of symptom categories frequently occurs. This systematic review and meta-analysis aimed to define the prevalence of DGBI overlap and compare overlap in population-based, primary care or tertiary care health settings. Furthermore, we aimed to compare symptom severity of psychological comorbidities in DGBI with and with

Normative Values For Standard Egg-white Meal & Highcalorie Nutrient Drink, And Its Association With Retentionderived Metrics

Elevated liver enzyme levels are a frequent incidental finding in primary care, and non-alcoholic fatty liver disease is the main cause of incidental elevation of liver enzymes worldwide. The features of the disease vary from simple steatosis, characterized by a benign prognosis, to non-alcoholic steatohepatitis and cirrhosis, increasing morbidity and mortality. In this case report, abnormal liver activity was incidentally detected during other medical assessments. The patien

Background Systematic reviews and meta-analyses of randomized clinical trials (RCTs) have reported the benefits of ketogenic diets (KD) in various participants such as patients with epilepsy and adults with overweight or obesity. Nevertheless, there has been little synthesis of the strength and quality of this evidence in aggregate. Methods To grade the evidence from published meta-analyses of RCTs that assessed the association of KD, ketogenic low-carbohydrate high-fat diet

Background The prevalence of irritable bowel syndrome (IBS) is now known to be similar in various geographical regions, but there has been no study directly comparing characteristics of patients with IBS between populations. Aims To evaluate clinical and psychological differences between adults with IBS seen in secondary care in the United Kingdom (UK) and Malaysia. Methods Age‐ and sex‐matched patients with IBS from a single centre in the UK (Leeds) and two centres in Mala

Objectives To grade the evidence from published meta-analyses of randomized clinical trials (RCTs) that assessed the association of ketogenic diets (KD), ketogenic low-carbohydrate high-fat diet (K-LCHF), and very low-calorie KD (VLCKD) with health outcomes. Methods PubMed, EMBASE, Epistemonikos, and Cochrane database of systematic reviews were searched up to May 20, 2022. Meta-analyses of RCTs of KD were included. Meta-analyses were re-performed using a random-effects mod

Tuberculosis (TB) is a chronic infection of global-health concern because of its high incidence, costly medical treatment, drug resistance and risk of co-infections. Anti-TB treatment involves a combination of drugs with high degree of liver toxicity, leading to drug-induced liver injury in 2–28% of patients who receive anti-TB treatment. In this case report, a patient with TB experienced drug-induced liver injury, and the initiation of treatment with silymarin 140 mg three-t

Non-alcoholic fatty liver disease is one of the main causes of elevated liver enzymes and chronic liver disease worldwide. It ranges from steatosis to steatohepatitis, leading to cirrhosis and related liver dysfunction. Silymarin is a herbal medicine, mostly used for liver disorders owing to its supposed hepatoprotective action. This report recommends silymarin in a patient with diabetes and grade II non-alcoholic steatohepatitis, confirming significant hepatoprotective effec

Neurogastroenterology and motility is a new but advanced subspecialty within gasteroenterology that cater to difficult, persistent and refractory gut-brain symptoms. Hospital USM has the country’s first and new state-of-the art motility lab that was recently launched on the 25 May 2023, and is covered in nationwide media. Another first is the Brain-Gut Clinic, established on the 16 November 2022. The clinic is a new concept that builds on unique multiple disciplines in relati

This review aimed to map current evidence on the association between dietary factors and colorectal cancer (CRC) risk in Asia. This review was conducted based on Arksey and O’Malley methodological framework. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram was used to record the review process. For the purpose of searching for articles, three electronic databases namely PubMed, EBSCOHost and ScienceDire

Background Mirikizumab, a p19-directed antibody against interleukin-23, showed efficacy in the treatment of ulcerative colitis in a phase 2 trial. Methods We conducted two phase 3, randomized, double-blind, placebo-controlled trials of mirikizumab in adults with moderately to severely active ulcerative colitis. In the induction trial, patients were randomly assigned in a 3:1 ratio to receive mirikizumab (300 mg) or placebo, administered intravenously, every 4 weeks for 12 w

Background JNJ-73763989 (JNJ-3989), a small interfering RNA, targets all hepatitis B virus (HBV) RNAs, reducing all HBV proteins. JNJ-56136379 (JNJ-6379; also known as bersacapavir), a capsid assembly modulator, inhibits HBV replication. We aimed to evaluate the efficacy (ie, antiviral activity) and safety of these therapeutics in combination with nucleos(t)ide analogues in patients with chronic hepatitis B. Methods The REEF-1 multicentre, double-blind, active-controlled, r

We thank Dr Ghoshal for his interest in our study, examining differences in IBS between patients in the UK and Malaysia in secondary care, and his acknowledgement of the regional variations in the profile of IBS. IBS does not contribute to mortality, but it has a substantial impact on quality of life, which has been reported to be worse than some severe chronic organic diseases. Although patients with IBS in a primary care study from Malaysia were also shown to have impaired

Background Multidrug-resistant Helicobacter pylori strains are emerging in Southeast Asia. This study evaluates the region's real-world practice in H. pylori management. Materials and methods Physicians who managed H. pylori eradication in daily practice across 10 Southeast Asian countries were invited to participate in an online questionnaire, which included questions about the local availability of antimicrobial susceptibility tests (ASTs) and their preferred eradication

Purpose of Review Esophageal disorders, including gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and esophageal cancer, may be affected by climate change. Our review describes the impact of climate change on risk factors associated with esophageal diseases and speculates how these climate-related factors impacted esophageal disorders and their management. Recent Findings Climate change is responsible for extreme weather conditions (shifts in rainfal

Background The significance of the current study was to determine normative levels of PIVKA-II and AFP in patients with unresectable HCC and healthy participants. The second goal was to assess the roles of PIVKA-II and AFP in predicting radiological response after loco-regional therapy. Methods This prospective cohort study enrolled consecutive samples of HCC patients and healthy controls. Venous blood samples were obtained at baseline and after interventions to determine ser

Background Nab-paclitaxel is formulated to address several limitations of paclitaxel. Methods A systematic review was done of several databases and a meta-analysis with a random-effects model was conducted to assess the efficacy and safety of nab-paclitaxel in metastatic gastric cancer (MGC). Results Included studies revealed that nab-paclitaxel provides a 30.4% overall response rate and 65.7% disease control rate in MGC patients. The overall survival was 9.65 months and prog

Disorders of esophagogastric junction (EGJ) outflow, including achalasia and EGJ outflow obstruction, are motility disorders characterized by inadequate relaxation of lower esophageal sphincter with or without impaired esophageal peristalsis. Current guidelines are technical and less practical in the Asia–Pacific region, and there are still massive challenges in timely diagnosis and managing these disorders effectively. Therefore, a Malaysian joint societies' task force has d

Background Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades. Methods The age, sex and year-wise estimates of incidence, mortality, and disability-adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 s

Background The precise estimation of cases with significant fibrosis (SF) is an unmet goal in non‐alcoholic fatty liver disease (NAFLD/MASLD). Aims We evaluated the performance of machine learning (ML) and non‐patented scores for ruling out SF among NAFLD/MASLD patients. Methods Twenty‐one ML models were trained (N = 1153), tested (N = 283), and validated (N = 220) on clinical and biochemical parameters of histologically‐proven NAFLD/MASLD patients (N = 1656) collected across

A Newly Developed Metric, PSDrest Predicts the Presence of Defecatory Disorders and Highly Correlates with the Balloon Expulsion Test Tengku Ahmad Iskandar Tengku Alang1,2, Lee Yeong Yeh1,2, Khairil Khuzaini Zulkifli3, Mung Seong Wong1,2, Nor Aslina Abd Samat1,2, Siti Norhasliza Muhamad1,2, Azliani Abd Aziz1,2, 1 School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia. 2 Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysi

Development and Validation of A Novel User-Friendly Prototypic Stool Device with Power Spectral Density Feature to Measure the Bowel Continence Function in Constipation Executive summary A balloon expulsion device is very simple to set. This just requires the use of latex balloon attached to a catheter with water-filled syringe attached to inflate the balloon. However, there is no standardization in methodology utilized in any laboratories which more or less could produce con

Gastric Accommodation & Mucosal Uptake Study using Quantitative Hybrid SPECT/CT in Healthy Volunteers and Functional Dyspepsia Patients Functional dyspepsia (FD) is a collection of clinical syndromes characterized by recurrent epigastric pain, postprandial fullness, early satiety, and/or bloating without any structurally abnormal upper gastrointestinal endoscopy. The pathophysiology of FD is multifactorial, and the suggested pathways include dysfunctional gastric accommodatio

Ami D Sperber, Shrikant I Bangdiwala, Douglas A Drossman, Uday C Ghoshal, Jan Tack, William E Whitehead, Dan L Dumitrascu, Xuicai Fang, Shin Fukudo, John Kellow, Edith Okeke, Eamonn MM Quigley, Max Schmulson, Peter Whorwell, Timothy Archampong, Payman Adibi, Viola Andresen, Marc A Benninga, Bruno Bonaz, Serhat Bor, Luis Bustos Fernandez, Suck Chei Choi, Enrico S Corazziari, Carlos Francisconi, Albis Hani, Leonid Lazebnik, Yeong Yeh Lee, Agata Mulak, M Masudur Rahman, Javier S

Kai Ming Liau, Yeong Yeh Lee, Chee Keong Chen, Aida Hanum G Rasool Introduction This is an open-label pilot study on four weeks of virgin coconut oil (VCO) to investigate its efficacy in weight reduction and its safety of use in 20 obese but healthy Malay volunteers. Methodology Efficacy was assessed by measuring weight and associated anthropometric parameters and lipid profile one week before and one week after VCO intake. Safety was assessed by comparing organ function test