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Background The risk factors for gastrointestinal bleeding (GIB) in clopidogrel users have not been identified. Aim To clarify whether clopidogrel use is a risk factor for upper GIB (UGIB) and lower GIB (LGIB) and identify the risk factors in clopidogrel users. Methods Using the National Health Insurance Research Database of Taiwan, 3238 clopidogrel users and 12 952 age-, sex-, and enrolment time-matched controls in a 1:4 ratio were extracted for comparison from a cohort dataset of 1 000 000 randomly sampled subjects. Cox proportional hazard regression models were used to identify the independent risk factors for UGIB and LGIB in all enrollees and clopidogrel users after adjustments for age, gender, comorbidity [i.e., coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease (CKD), cirrhosis, uncomplicated peptic ulcer disease, and peptic ulcer bleeding (PUB)], and medications [e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors, aspirin, steroids, selective serotonin reuptake inhibitors (SSRIs), warfarin and alendronate]. Results Cox proportional hazard regression analysis showed that use of clopidogrel increased the risk of UGIB [hazard ratio (HR): 3.66; 95% confidence interval (CI): 2.96-4.51] and LGIB [HR: 3.52, 95% CI: 2.74-4.52]. Age, CKD, PUB history, use of aspirin and NSAIDs were independent risk factors for UGIB in the clopidogrel users. Age, CKD, PUB history, use of aspirin and SSRIs were independent risk factors for LGIB. Conclusions In clopidogrel users, age, CKD, PUB history, use of aspirin and NSAIDs are independent risk factors for UGIB; age, CKD, PUB history, use of aspirin and SSRIs are independent risk factors for LGIB. [ABSTRACT FROM AUTHOR]

Background Few large population-based studies have compared the occurrence of peptic ulcer bleeding ( PUB) in cirrhotic and noncirrhotic patients. Aims To investigate if cirrhotic patients have higher risk of PUB than the general population and to identify possible risk factors of PUB in cirrhotic patients. Methods Using the National Health Insurance Research Database, a nationwide population-based dataset in Taiwan and matching age, gender, comorbidities and ulcerogenic medication by propensity score, 4013 cirrhotic patients, 8013 chronic hepatitis patients and 7793 normal controls were compared. The log-rank test was used to analyse differences in accumulated PUB-free survival rates between the groups. Cox proportional hazard regressions were performed to evaluate independent risk factors for PUB in all patients and identified risk factors of PUB in cirrhotic patients. Results During the 7-year follow-up, cirrhotic patients had significantly higher incidences of PUB than chronic hepatitis patients and controls, respectively ( P < 0.001 by log-rank test). By Cox proportional hazard regression analysis, cirrhosis was independently associated with increased risk of PUB (hazard ratio: 4.22; 95% CI 3.37-5.29, P < 0.001) after adjusting for age, gender, economic status, underlying comorbidities and ulcerogenic medication. Age, male, diabetes, chronic renal disease, history of gastro-oesophageal variceal bleeding and use of nonsteroidal anti-inflammatory drugs were risk factors for PUB in cirrhotic patients. Conclusion Cirrhotic patients have a significantly higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like age, gender, economic status, underlying comorbidities and ulcerogenic medication. [ABSTRACT FROM AUTHOR]

Summary Background 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. Aim To determine if COPD patients have a higher risk of peptic ulcer bleeding than the general population and to identify the risk factors of peptic ulcer bleeding in COPD patients. Methods From Taiwan's National Health Insurance research database, 62 876 patients, including 32 682 COPD and 30 194 age-gender-matched non- COPD controls, were recruited. Cox proportional hazard regression was performed to evaluate independent risk factors for ulcer bleeding in all patients and to identify risk factors in COPD patients. Results During the 8-year follow-up, COPD patients had a significant higher rate of peptic ulcer bleeding than the control group ( P < 0.001, by log-rank test). By Cox proportional hazard regression analysis, COPD [hazard ratio ( HR) 1.93, 95% CI 1.73-2.17] was an independent risk factor after adjusting for age, gender, underlying comorbidities and ulcerogenic medication. Age > 65 years, male, comorbidities of hypertension, diabetes, heart failure, history of peptic ulcer disease, and chronic renal disease and use of nonsteroidal anti-inflammatory drugs were risk factors of ulcer bleeding in COPD patients. Conclusion Patients with chronic obstructive pulmonary disease have a higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like underlying comorbidities and ulcerogenic medication. [ABSTRACT FROM AUTHOR]

>Background The epidemiology and impact of functional constipation on Asians remain unclear. >Aim To determine the prevalence of functional constipation, its social/medical impact, and its distinction from constipation-predominant irritable bowel syndrome (C-IBS) in Taiwan. >Methods A Rome II questionnaire was administered to an apparently healthy adult Chinese population ( n = 2865). >Results The prevalence of functional constipation was 8.5% and it was 2.7% for C-IBS. The functional constipation subjects were predominantly female and had excessive gastrointestinal-related doctor visits, absenteeism and sleep disturbance compared with controls ( P < 0.01). Among functional constipation subjects, approximately 40% were ‘consulters’ with excessive doctor consultations, absenteeism and sleep disturbance. Female gender, the presence of sleep difficulty and higher constipation symptom scores were predictive of their consultation behaviour ( P < 0.05). No differences existed in demographic variables, doctor consultations and absenteeism between 172 functional constipation and 54 C-IBS subjects. However, the C-IBS subjects experienced more severe constipation symptoms and sleep disturbance than functional constipation subjects. >Conclusions Functional constipation in Taiwan is comparable with that in other countries. The clinical presentation of constipation-predominant irritable bowel syndrome differ somewhat from that of functional constipation. [ABSTRACT FROM AUTHOR]

Background : Little is known about the social and medical burdens of heartburn in Asia. Aim : To assess the impact of heartburn in Taiwan. Methods : We applied a questionnaire to 2018 apparently healthy adult Chinese receiving a routine health maintenance programme. Costs of heartburn-related prescriptions were obtained from the Bureau of National Health Insurance of Taiwan. Results : Heartburn prevalence (>1 episode/week) was 7%. Smoking and increased body mass index were associated with heartburn occurrence. Heartburn sufferers reported more atypical gastro-oesophageal reflux disease symptoms, e.g. chest pain, dysphagia and globus. They were more likely to consult physicians, and have an increased frequency and number of days of absenteeism, irrespective of upper gastrointestinal or nongastrointestinal-related illnesses. They experienced sleep disturbances more frequently. The 62 heartburn consulters (48%) were more likely to have co-existing globus, visited physicians more, had more absenteeism, suffered from more sleep disturbances and had higher costs for antacids, proton pump inhibitors, hypnotic/sedatives, tranquilizers and antidepressants than nonconsulters. Conclusions : Heartburn prevalence in Taiwan is lower than in Western countries. Nevertheless, heartburn in Taiwanese creates a significant burden in terms of social impact, health resource utilization, sleep quality and pharmaceutical costs. The increased costs of psychoactive drugs in consulters suggest that anxiety/depression affects their health-seeking behaviour. [ABSTRACT FROM AUTHOR]

: Little is known about the gender effect on irritable bowel syndrome in Asia. : To assess the gender difference in Chinese subjects with irritable bowel syndrome meeting Rome II criteria. : Irritable bowel syndrome was identified from an apparently healthy adult population receiving a routine health maintenance program ( n = 2018). : Female gender is not a factor associated with irritable bowel syndrome or irritable bowel syndrome-related health care-seeking behaviour. Female irritable bowel syndrome subjects, irrespective of consulting behaviour for irritable bowel syndrome, are likely to have<3 bowel movements/week, hard/lumpy stools and abdominal fullness/bloating ( P < 0.05). Female irritable bowel syndrome subjects are prone to be absent from school/work with more days of absenteeism, irrespective of consultation status ( P < 0.05). Only female irritable bowel syndrome consulters have more absenteeism for their irritable bowel syndrome-related symptoms, reporting more sleep disturbances than their male counterparts ( P < 0.001). : In an apparent healthy adult population in Taiwan, gender difference is present in Rome II defined Chinese subjects with irritable bowel syndrome as regards bowel symptoms, social impact and sleep quality. Female predominance was not found in irritable bowel syndrome subjects and irritable bowel syndrome-related health care-seeking behaviour in the current population. Both irritable bowel syndrome non-consulters and consulters have similar gender difference profiles in presenting symptoms, suggesting that bowel symptoms per se may not be the only factor leading to health care-seeking behaviour. The gender differences in sleep problems were observed solely in irritable bowel syndrome consulter. [ABSTRACT FROM AUTHOR]

: Irritable bowel syndrome is a common condition seen in Western countries. In Asia, however, it is less known and even less studied. : To determine the prevalence and social impact of irritable bowel syndrome as well as the health-seeking behaviour of irritable bowel syndrome patients in Taiwan : Using the modified Rome II questionnaire, a survey was carried out in a population receiving physical check-up ( n = 2865). : The prevalence of irritable bowel syndrome in Taiwan was 22.1% and 17.5% (κ = 0.73) according to the Rome II and I criteria, respectively. No gender difference was found between subjects with and without irritable bowel syndrome symptoms. Irritable bowel syndrome subjects were likely to undertake an excessive number of physician-visits ( P < 0.01). Such subjects were often absent from work/school, with more days of absenteeism than irritable bowel syndrome-free subjects ( P < 0.01). They also suffered obvious sleep disturbance ( P < 0.01). Nearly half of the irritable bowel syndrome subjects were ‘consulters’, and they were more likely to have frequent physician-visits, suffer from work/school absenteeism, and endure sleep disturbance and bowel symptoms than irritable bowel syndrome nonconsulters ( P < 0.05). : Irritable bowel syndrome is common in a Chinese population of Taiwan. Similar to irritable bowel syndrome in the West, it also involves significant social and medical burdens. However, in the irritable bowel syndrome subjects of Taiwan there is no gender difference, and more irritable bowel syndrome subjects will seek physician consultations, which may be due to Taiwan's easily accessible and affordable heath care facilities. [ABSTRACT FROM AUTHOR]