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The development of alcohol‐associated diseases is multifactorial, mechanism of which involves metabolic alteration, dysregulated immune response, and a perturbed intestinal host‐environment interface. Emerging evidence has pinpointed the critical role of the intestinal host–microbiota interaction in alcohol‐induced injuries, suggesting its contribution to disease initiation and development. To maintain homeostasis in the gut, the intestinal mucosa serves as the first‐line defense against exogenous factors in the gastrointestinal tract, including dietary contents and the commensal microbiota. The gut‐epithelial barrier comprises a physical barrier lined with a single layer of intestinal epithelial cells and a chemical barrier with mucus trapping host regulatory factors and gut commensal bacteria. In this article, we review recent studies pertaining to the disrupted gut‐epithelial barrier upon alcohol exposure and examine how alcohol and its metabolism can affect the regulatory ability of intestinal epithelium. [ABSTRACT FROM AUTHOR]

Background: Vonoprazan, a potassium‐competitive acid blocker, has demonstrated greater potency and a longer duration of acid suppression when compared to the proton pump inhibitors. However, data regarding the comparison between vonoprazan‐based triple therapy with standard treatment for first‐line Helicobacter pylori treatment are limited. This study aimed to compare the efficacy between 7‐day vonoprazan‐based triple therapy with high‐dose amoxicillin (VAC‐7) and 14‐day extended sequential therapy (S‐14). Materials and Methods: This was a single‐center prospective randomized controlled trial following a noninferiority design. Subjects over 20 years old with confirmed H. pylori infection were enrolled prospectively from Fu Jen Catholic University Hospital. They were randomly assigned to the VAC‐7 or S‐14 group. The primary endpoint was the eradication rate in first‐line treatment, evaluated by urea breath test, with noninferiority determined using the Farrington–Manning method. The secondary outcome included adverse effect rates and compliance, assessed through self‐administered questionnaires. Results: Between December 2021 and June 2023, a total of 628 patients were recruited. The eradication rates by per‐protocol analysis and intention‐to‐treat analysis were 88.6%/81.8% for VAC‐7 and 90.3%/81.4% for S‐14, respectively. The VAC‐7 was non‐inferior to S‐14 in terms of ITT analysis. Subjects experienced fewer incidences of nausea, anorexia, dizziness, fatigue, and any severe adverse events in the VAC‐7 group. Compliance was higher in the VAC‐7 group, with 94% taking all the pills correctly. Conclusions: Our findings supported the use of 7‐day vonoprazan triple therapy with high‐dose amoxicillin as the standard first‐line treatment for H. pylori infection. Trial Registration:ClinicalTrials.gov identifier: NCT05371249 [ABSTRACT FROM AUTHOR]

Psoriasis can affect individuals of all age groups. While the epidemiology of psoriasis in adults has been extensively studied, there is limited research specifically investigating pediatric cases. This study aimed to investigate the prevalence and incidence of skin psoriasis (PsO) and psoriatic arthritis (PsA) among pediatric patients in Taiwan. A nationwide cohort of 17 535 patients with psoriatic diseases under the age of 18 was enrolled from the National Health Insurance Research Database for the period 2000–2013, including 16 129 PsO patients and 2022 PsA patients. The age‐ and sex‐standardized prevalence and incidence of pediatric PsO and PsA were calculated. The 2007 yearly reports of age‐ and sex‐specific distribution of the general population was adopted as a standard. The results showed that between 2000 and 2013, the prevalence for pediatric PsO increased from 0.03% to 0.07%, and from 0.003% to 0.014% for pediatric PsA. During the same period, the incidence slightly decreased from 19.81 to 17.55 per 100 000 for pediatric PsO but increased from 1.02 to 5.06 per 100 000 for pediatric PsA. Adolescents (12 to <18 years) had higher prevalence and incidence rates of PsO and PsA than children (aged ≤ 12 years), with no sex difference observed in either age group. PsA preceding PsO was more common among children than adolescents (27.07% vs. 13.46%). This study provides important insights into the prevalence and incidence of psoriatic diseases in the pediatric population. Further research is needed to identify risk factors for pediatric psoriasis and to investigate its long‐term health outcomes. [ABSTRACT FROM AUTHOR]

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Summary: Background: Studies have shown that bullous pemphigoid (BP) occurs in patients with chronic kidney disease (CKD). However, the risk of developing BP in patients with CKD remains inconclusive. Objective: To investigate whether CKD increases the risk of BP. Methods: Participants were recruited from the National Health Insurance Database of Taiwan between 2007 and 2018. Overall, 637,664 newly diagnosed patients with CKD and 637,664 age‐, sex‐, and comorbidity‐matched non‐CKD participants were selected. A competing risk model was used to evaluate the risk of development of BP. Results: After adjusting for age, sex, and comorbid diseases in the multivariate model, CKD was a significant risk factor for BP (adjusted hazard ratio [aHR]: 1.29; 95% confidence interval [CI]: 1.17–1.42; p < 0.001). CKD patients were classified into the dialytic or non‐dialytic groups and compared to non‐CKD participants, and this revealed that patients with dialysis‐dependent CKD had the highest risk of BP (aHR 1.75; 95% CI 1.51–2.03), followed by patients with non‐dialysis‐dependent CKD (aHR 1.20; 95% CI 1.08–1.32). Limitations: We lacked detailed laboratory data on the severity of CKD. Conclusions: Compared with individuals without CKD, those with CKD had a 1.3‐fold increased risk of BP. Patients with dialysis‐dependent CKD had an even higher BP risk (1.8‐fold). [ABSTRACT FROM AUTHOR]

Summary: Background: Finite nucleos(t)ide analogue (NUC) therapy has been proposed as an alternative treatment strategy for chronic hepatitis B (CHB). Aim: To quantify the incidence of severe hepatitis flares following NUC cessation in everyday clinical practice. Methods: This population‐based cohort study enrolled 10,192 patients (male 71.7%, median age 50.9 years, cirrhosis 10.7%) who had received first‐line NUCs for at least 1 year before discontinuing treatment. The primary outcome was severe flare with hepatic decompensation. We used competing risk analyses to assess event incidences and associated risk factors. Results: During a median follow‐up of 2.2 years, 132 patients developed severe flares with hepatic decompensation, yielding a 4‐year cumulative incidence of 1.8% (95% confidence interval [CI], 1.5%–2.2%). Significant risk factors were cirrhosis (adjusted sub‐distributional hazard ratio [aSHR], 2.74; 95% CI, 1.82–4.12), manifestations of portal hypertension (aSHR, 2.46; 95% CI, 1.45–4.18), age (aSHR, 1.21 per 10 years; 95% CI, 1.03–1.42) and male sex (aSHR, 1.58; 95% CI, 1.04–2.38). In patients without cirrhosis or portal hypertension (n = 8863), the 4‐year cumulative incidence of severe withdrawal flares stood at 1.3% (95% CI, 1.0%–1.7%). For those patients with available data confirming adherence to the standard stopping rules (n = 1274), the incidence was 1.1% (95% CI, 0.6%–2.0%). Conclusions: Severe flares with hepatic decompensation were observed in 1%–2% of patients with CHB after stopping NUC therapy in daily practice. Risk factors included older age, cirrhosis, portal hypertension and male sex. Our findings argue against NUC cessation as part of routine clinical care. [ABSTRACT FROM AUTHOR]

Figure 1 presents the cumulative incidence rate of MACE, which showed no significant difference between the vitiligo and non-vitiligo cohorts in 5 years (2.75%; 95% confidence interval [CI], 2.49-3.01 for vitiligo vs. 2.41%; 95% CI, 2.29-2.53 for control, I p i = 0.08). Vitiligo is a common skin depigmentation disorder drawing disturbances in quality of life and psychological concerns.[1] Several mechanisms have been postulated for the development of vitiligo, including T cell-mediated inflammation, oxidative stress impairment and generation of pro-inflammatory cytokines, which may be associated with the risk of major adverse cardiovascular events (MACE).[[2]] Studies have explored the relationship between MACE and other skin inflammatory conditions such as psoriasis, atopic dermatitis and alopecia areata,[[4], [6]] but the association between vitiligo and MACE remains obscure. No significant differences were found between vitiligo and MACE in patients with different age groups, sex and multiple comorbidities. [Extracted from the article]

Bullous pemphigoid (BP) has been reported to be associated with an increased risk of venous thromboembolism (VTE). However, the exact time course is unclear, and no previous studies have been reported in the Asian population. This nationwide population‐based cohort study examined the risk of VTE among BP patients in Taiwan between 2007 and 2018. A total of 12 692 BP patients were 1:2 matched with non‐BP patients by age, sex, and propensity score of comorbidities. Cumulative incidence and Cox proportional hazards models were used to investigate the risk of VTE. The BP cohort had a significantly higher VTE rate than the non‐BP cohort (0.17% vs. 0.08%, p = 0.015) in 1 year; the finding was more prominent within the first 6 months after diagnosis. BP was a significant risk factor for VTE (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.01–4.06); the association mildly diminished but remained significant after extending the follow‐up period to 2 years (HR, 1.73; 95% CI, 1.06–2.81). Other significant risk factors for VTE included cancer, chronic liver disease and cirrhosis, and female sex. In conclusion, this study revealed a 2.02‐fold increased risk of VTE in patients with BP in Taiwan. [ABSTRACT FROM AUTHOR]

Coexistence of inflammatory bowel disease (IBD) in atopic dermatitis (AD) patients has been reported. The long‐term risk of IBD in AD patients remains unclear. Our aim for the study is to examine the long‐term risk of IBD in AD patients. This is a nationwide cohort study. From the National Health Insurance Research Database of Taiwan (1997–2013), a total of 36 400 AD patients were identified and matched with 364 000 reference subjects without AD by age, sex and number of hospital visits. Demographic characteristics and comorbidities were compared. Cox proportional hazards regression analysis was conducted to examine the risk of IBD. The 16‐year cumulative incidences of IBD were 0.047% (95% confidence interval [CI], 0.040–0.054) and 0.047% (95% CI, 0.025–0.096) in non‐AD and AD cohorts, respectively (P = 0.973). There were 17 cases of IBD (0.05%), including 10 ulcerative colitis and seven Crohn's disease, among AD patients compared with 169 IBD cases (0.05%) among controls (P > 0.999). Infections (adjusted hazard ratio [HR], 2.71; 95% CI, 1.96–3.95; P < 0.001) and age (adjusted HR, 1.03; 95% CI, 1.02–1.03; P < 0.001) were independently associated with IBD, after adjusting for major comorbidities and conducting multivariate analyses. AD was not associated with IBD development. In conclusion, AD is not independently associated with IBD development. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Hsu et al papers. To view these articles, visit https://doi.org/10.1111/apt.17614 and https://doi.org/10.1111/apt.17657 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Hsu et al papers. To view these articles, visit https://doi.org/10.1111/apt.17614 and https://doi.org/10.1111/apt.17630 [ABSTRACT FROM AUTHOR]

Taiwanese identity is distinct from and juxtaposed against the Chinese identity. What explains the emergence of a Taiwanese identity – specifically in the south? This identity formation is surprising considering the multiple decades of authoritarian rule where the government championed a Chinese identity. In this article, weargue that the Taiwanese identity manifested from a linguistic tension betweenHokloand Mandarinspeakers.And while the Kuomintang adopted a strict Mandarin monolingual policy, thehomogeneity of theHoklo speakers in the south – i.e., they constituted a minimal winningsizeand they were regionally concentrated –ensured the survival of theHoklovernacular. This vernacular would become the instrument for the formation of a Taiwanese identity. In contrast,we see initial push back from the Hakka speakers who were excluded from the narrative of Taiwanese identity. Likewise,in the north where there weregreater linguistic heterogeneity and increasing interethnic marriages, Taiwanese identity was not as coherent. [ABSTRACT FROM AUTHOR]

Summary: Background: Narrowband ultraviolet B (NB‐UVB) phototherapy is a widely used treatment for various dermatoses. The risk of skin cancer following long‐term NB‐UVB phototherapy has rarely been explored in skin phototypes III‐V. Methods: We conducted a nationwide‐matched cohort study and identified a total of 22 891 psoriasis patients starting NB‐UVB phototherapy from the Taiwan National Health Insurance Database during the period 2000‐2013. Cumulative incidences of skin cancers were compared between subjects receiving less than 90 UVB treatments (S‐cohort, N = 13 260) and age‐ as well as propensity score‐matched subjects receiving more than or equal to 90 UVB treatments (L‐cohort, N = 3315). Results: There were no significant differences in the overall cumulative incidences of skin cancers between the two cohorts (log‐rank t test, P = 0.691) during the follow‐up periods. The S‐cohort had a significantly lower prevalence of actinic keratosis when compared with the L‐cohort (0.54% vs 1.00%, P = 0.005). Conclusion: Long‐term NB‐UVB phototherapy does not increase skin cancer risk compared with short‐term NB‐UVB phototherapy in psoriasis patients with skin phototypes III‐V. [ABSTRACT FROM AUTHOR]

Background and Aim: The eradication rate of Helicobacter pylori (H. pylori) has been declining over the past decades. A rescue plan is needed for increasing populations with treatment failure. However, the optimum second‐line eradication regimen remains inconclusive. We conducted a network meta‐analysis to assess the comparative effectiveness of second‐line H. pylori eradication therapies and determine the optimum regimen. Methods: We searched electronic databases from January 2005 to February 2018 for randomized controlled trials assessing the effectiveness of second‐line regimens in patients with persistent H. pylori infection after first‐line treatment. Bayesian network meta‐analysis was performed to combine the direct and indirect evidence and to investigate the rank order of second‐line therapies. We also appraised the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation guidance. Results: Twenty‐six trials with 3628 participants who received second‐line eradication therapy were identified. All regimens showed pooled eradication rates < 90%. Compared with 7‐day triple therapy, quinolone‐based (odds ratio [OR] 4.29, 95% credible interval [CrI] 1.67–12.12, surface under the cumulative ranking [SUCRA] 0.95), non‐quinolone‐based bismuth‐containing quadruple therapies for 10 days or more (OR 2.25, 95% CrI 1.10–4.62, SUCRA 0.78), and sequential therapy (OR 2.91, 95% CrI 1.16–7.65, SUCRA 0.66) showed significantly higher effectiveness. Overall, regimens with longer duration demonstrated higher eradication rates but higher rates of adverse events. More adverse events were reported in those patients treated with concomitant therapy. Conclusions: Quinolone‐based bismuth‐containing quadruple therapies for 10 days or more are the optimum second‐line regimens for H. pylori eradication. [ABSTRACT FROM AUTHOR]

Summary: Background: There remains an unmet need for convenient biomarkers to assess the risks of discontinuing nucleos(t)ide analogues (NAs) in chronic hepatitis B (CHB). Aim: To investigate if hepatitis B core‐related antigen (HBcrAg) is an independent of surface antigen (HBsAg) for risk prediction of NA cessation. Methods: This prospective multicentre study enrolled 135 CHB patients who stopped entecavir or tenofovir after achieving viral remission for a median of 25.2 months. All patients stopped NA with negative HBeAg and undetectable viral DNA, and were then observed for clinical relapse and HBsAg loss. Predictors including HBsAg and HBcrAg levels were explored using Cox proportional hazard model and weighted to develop a risk score. Results: During a median follow‐up of 25.9 months, clinical relapse and HBsAg loss occurred in 66 and eight patients, respectively, with a 5‐year cumulative incidence of 56.1% (95% CI 46.7‐66.0%) and 8.8% (95% CI 4.3‐17.4%), respectively. HBcrAg was an independent relapse predictor, as well as HBsAg, age, ALT and tenofovir use. A score (SCALE‐B) was calculated by the equation of 35*HBsAg (log IU/mL) + 20*HBcrAg (log U/mL) + 2*age (year) + ALT (U/L) + 40 for tenofovir use. The concordance rates for clinical relapse were 0.87, 0.88, 0.87, 0.85 and 0.90 at 1, 2, 3, 4 and 5 years, respectively. Moreover, HBsAg loss occurred exclusively in low‐risk patients predicted by the score. Conclusions: Serum HBcrAg and HBsAg levels were independent predictors of off‐NA relapse and can be factored into a risk score to guide treatment cessation in patients with CHB. [ABSTRACT FROM AUTHOR]

Objectives: The intestinal microbiota has been known to involve in obesity and host immune response. We aimed to investigate the intestinal microbiota and potential genetic function in relation to clinical presentation in psoriasis patients. Methods: Faecal microbiota and predicted genetic function inferred from high‐throughput 16S ribosomal RNA sequencing were analysed between psoriasis (n = 32) and age‐, gender‐ and body mass index (BMI)‐matched non‐psoriasis subjects (n = 64), from a referral medical centre. The correlation between altered microbiota and disease activity, arthritis and systemic anti‐psoriatic drugs was also investigated. Results: We observed a distinct faecal microbial community structure in psoriasis patients, with an increased abundance of phylum Firmicutes and decreased abundance of phylum Bacteroidetes, across different subgroup of subjects. Ruminococcus and Megasphaera, of the phylum Firmicutes, were the top‐two genera of discriminant abundance in psoriasis. A number of functional genes and metabolic pathways involving bacterial chemotaxis and carbohydrate transport were predicted over‐represented, whereas genes related to cobalamin and iron transport were predicted under‐represented in faecal microbiota of psoriasis patients. Conclusions: The distinct faecal microbial composition in psoriasis might be associated with altered transport of carbohydrate, cobalamin and iron, as well as chemotaxis. [ABSTRACT FROM AUTHOR]

Abstract: Background: A consensus on the management of Helicobacter pylori has been developed. We aimed to assess whether dissemination through continuing medical education (CME) could enhance the adoption of this consensus among clinicians and to explore potential barriers to acceptance. Materials and methods: Four CME courses were held to disseminate the consensus. Adoption surveys were performed to evaluate participants’ behavior in the past and their commitment to adopt the consensus in future clinical practice after CME. The gaps and barriers to adoption were also surveyed. Results: A total of 240 physicians had attended the CME courses and received surveys with the 22 statements/substatements of the consensus. Before CME, adoption was good in six, fair in ten, and poor in six. After CME, 21 statements had either an initial >90% adoption or improvement to good or fair (P < 0.001), but one still had poor even though it showed improvement (P = 0.02). Although commitment was good or fair after CME, there was a >20% gap between “commitment” and “no barrier” to adoption for 11 statements, ten of which had a main barrier of financial incentives. Among the statements with fair or poor commitment after CME, less commitment to adoption and more barriers related to financial incentives were pronounced in clinicians serving in regional/district hospitals or clinics compared to those serving in medical centers. Conclusions: Continuing medical education may improve the adoption of the H. pylori consensus. The financial incentives were shown to be a main barrier to adoption of the consensus and should be improved. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to elucidate the temporal change and determinants for the risk of HCC in patients with chronic hepatitis B continuously receiving NUC. Through analysis of the national healthcare database in Taiwan, we screened a total of 65 426 infected patients receiving entecavir or tenofovir for at least 3 months and excluded those with lamivudine, adefovir or telbivudine exposure, malignancy, end‐stage renal failure or a diagnosis of HCC within 3 months of starting treatment. Eligible patients (N = 27 820) were followed until HCC occurrence, completion of the allowed 3‐year regimen or 31 December 2013. During a median follow‐up of 25.1 (12.1‐35.6) months, 802 patients developed HCC, with 1‐, 2‐ and 3‐year cumulative incidence of 1.82% (95% CI, 1.66‐1.99%), 3.05% (95% CI, 2.82‐3.28%) and 4.06% (95% CI, 3.77‐4.36%), respectively. HCC annual incidence decreased with an adjusted IRR of 0.73 (95% CI, 0.66‐0.80) per yearly interval and was associated with cirrhosis (IRR, 10.07; 95% CI, 6.00‐16.90 in age <40 years; 4.69; 95% CI, 3.94‐5.59 in age ≧40 years), age (IRR, 3.38; 95% CI, 2.10‐5.47 for 40‐50 years; 6.92; 95% CI, 4.27‐11.21 for 50‐60 years; 12.50; 95% CI, 7.71‐20.25 for ≧60 years; <40 years as reference), male sex (IRR, 1.71; 95% CI, 1.44‐2.04), HCV coinfection (IRR, 1.27; 95% CI, 1.02‐1.58) and diabetes (IRR, 1.24; 95% CI, 1.05‐1.45). In conclusion, the risk of HCC in patients with chronic hepatitis B receiving entecavir or tenofovir declines over time and is determined by cirrhosis, age, male sex, HCV coinfection and diabetes. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) may be a cause of hepatocellular carcinoma (HCC), but its high prevalence challenges current surveillance strategies. We aimed to evaluate HCC incidences in different risk stratifications for noncirrhotic NAFLD. Using Taiwan's National Health Insurance Research Database, we located 31,571 patients with NAFLD between the years 1998 and 2012. After excluding other causes of hepatitis, underlying cirrhosis or malignancy, 18,080 patients were recruited for final analysis. Cumulative incidences of HCC were analyzed after adjusting for competing mortality. With a median follow-up duration of 6.32 years in the study cohort, the 10-year cumulative incidence of HCC was 2.73% [95% confidence interval (CI): 1.69-3.76%]. Hepatoprotectant was used as a surrogate marker for elevated serum alanine transaminase (ALT). After adjusting for age, gender, hypertension, hypercholesterolemia, diabetes mellitus, gout, statin use, metformin use and aspirin use, elevated ALT was independently associated with an increased HCC risk [hazard ratio (HR) 6.80, 95% CI: 3.00-15.42; p < 0.001]. Multivariate stratified analysis verified this association in all subgroups (HR> 1.0). Moreover, increased age (HR 1.08 per year, 95% CI: 1.05-1.11) and statin use (HR 0.29, 95% CI: 0.12-0.68) were also identified as independent risk factors. The 10-year cumulative HCC incidence was highest in older (age >55 years) patients with ALT elevation (12.41%, 95% CI: 5.99-18.83%), but lowest in younger patients without ALT elevation (0.36%, 95% CI: 0-1.08%). The incidence of HCC was relatively low in patients with clinically noncirrhotic NAFLD, however, HCC risk was significantly increased in older patients experiencing an elevated serum ALT. [ABSTRACT FROM AUTHOR]

Background and Aim Therapeutic duration of nucleos(t)ide analogues for chronic hepatitis B (CHB) is not indefinite in many parts of the world. Viral reactivation is common off therapy, but the risk of subsequent clinical outcome remains unclear and unpredictable. We aimed to quantify the incidence of and explore the predictors for clinical flare following virological relapse in CHB patients who discontinue entecavir therapy. Methods This multicenter cohort study prospectively monitored 133 CHB patients who were HBeAg-negative and viral DNA-undetectable when discontinuing entecavir after at least 3 years on therapy. Following virological relapse (viral DNA >2,000 IU/mL) that occurred in 92 patients, the incidences of subsequent clinical flare and persistent (unremittent for 3 months) or severe hepatitis (with jaundice or coagulopathy) were determined, and risk factors were explored. Patients did not resume antiviral therapy until occurrence of persistent or severe hepatitis. Results The cumulative incidence of clinical hepatitis 2 years after virological relapse was 61.0% (95% confidence interval [CI], 49.9-72.3%) and that of persistent or severe hepatitis was 53.0% (95% CI, 40.9-66.2%). Serum viral load at the virological relapse was associated with both clinical hepatitis (adjusted hazard ratio [HR], 1.31 per log IU/mL; 95% CI, 1.07-1.60) and persistent or severe hepatitis (adjusted HR, 1.63 per log IU/mL; 95% CI, 1.27-2.10), after adjustment for serum aminotransferase and alfa-fetoprotein levels in the multivariate analysis. Viral DNA >100 000 IU/mL predicted a nearly inevitable occurrence of clinical flare ( P < 0.0001). Conclusions A high viral load at the virological relapse predicts subsequent clinical hepatitis in CHB patients who discontinue entecavir. [ABSTRACT FROM AUTHOR]

Background Previous international consensus statements provided general policies for the management of Helicobacter pylori infection. However, there are geographic differences in the prevalence and antimicrobial resistance of H. pylori, and in the availability of medications and endoscopy. Thus, nationwide or regional consensus statements are needed to improve control of H. pylori infection and gastric cancer. Materials and Methods This consensus statement for management of H. pylori in Taiwan has three major sections: (1) optimal diagnosis and indications; (2) current treatment strategies; and (3) screening-to-treat and surveillance for control of gastric cancer. The literature review emphasized recent data for development of draft statements and determination of levels of evidence. Twenty-five Taiwan experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. Consensus, defined as an agreement of least 80% of the experts, and recommendation grade were determined by anonymous voting. Results There were 24 consensus statements. Section 1 has seven statements on recommendations for the diagnosis and indications for treatment of H. pylori infection. Section 2 has 10 statements that provide an updated treatment algorithm for first-line, second-line, and third-line regimens. Section 3 has seven statements regarding H. pylori eradication for reducing the risk of gastric cancer, with a cost-benefit analysis. After H. pylori eradication, the consensus highlights the use of endoscopic surveillance and/or chemoprevention to further reduce the burden of gastric cancer. Conclusions This consensus statement has updated recommendations for improving the clinical management of H. pylori infection in areas such as Taiwan, which have high prevalence of H. pylori infection and gastric cancer. [ABSTRACT FROM AUTHOR]

Background and Aim The role of serum hepatitis B surface antigen ( HBs Ag) level in determining virological breakthrough ( VB) for patients with hepatitis B virus ( HBV) infection receiving lamivudine remains unclear. The study aimed to evaluate the impact of serum HBs Ag levels on VB among patients receiving lamivudine therapy, especially in a setting of low HBV viral load. Methods Two hundred sixty-eight consecutive treatment-naïve patients who underwent lamivudine therapy for chronic hepatitis B were enrolled. Factors in terms of VB were analyzed by multivariate analysis. Results After a median treatment duration of 67.1 weeks, 102 patients had VB. Multivariate analysis showed that positive hepatitis B e antigen ( HBe Ag) (hazard ratio 2.165, P = 0.026) and HBV DNA levels ≥ 2000 IU/m L after 6 months of lamivudine therapy (hazard ratio 5.236, P = 0.001) were independent risk factors predicting VB. The cumulative VB rates stratified by HBe Ag-positive and -negative at 3 years were 44.7% and 26.3%, respectively. At 3 years, the cumulative VB rates stratified by the HBV DNA < 2000 and ≥ 2000 IU/m L after 6 months of therapy were 25.5% and 79.4%, respectively. For HBe Ag-positive patients with serum HBV DNA < 2000 IU/m L after 6 months of therapy, baseline HBs Ag levels ≥ 20 000 IU/m L was the only risk factor associated with VB. Conclusions For chronic hepatitis B patients treated with lamivudine, serum HBV DNA level > 2000 IU/m L after 6 months of therapy could predict subsequent VB. In patients with lower on-treatment viral load, baseline serum HBs Ag level is associated with the emergence of VB, especially for those with serum positive HBe Ag. [ABSTRACT FROM AUTHOR]

Background: The association between uremia and survival outcomes of patients undergoing hepatic resection for hepatocellular carcinoma (HCC) has not been well investigated, particularly for perioperative complications. This nationwide cohort study aimed to compare survival outcomes as well as perioperative mortality and complications between uremia-HCC patients and non-uremia-HCC patients who underwent hepatic resection. Methods: Using Taiwan's National Health Institute Research Database, 149 uremia-HCC patients who underwent hepatic resection between 1996 and 2008 were enrolled. The control group comprised 596 HCC patients who also received hepatic resection during the same time period. The two groups were matched for age, gender, viral hepatitis status, and underlying liver cirrhosis. Disease-free survival, overall survival, and perioperative complications were compared between the two groups. Results: For the uremia-HCC cohort, the 1-, 5-, and 10-year overall and disease-free survival rates were 86, 52, and 38 %, as well as 77, 27, and 18 %, respectively. The survival outcomes were comparable between uremia-HCC cohort and the HCC cohort, regardless of extent of hepatic resection. As for perioperative complications, the uremia-HCC cohort had a higher risk of postoperative infections requiring invasive interventions as well as an increased risk of life-threatening heart-associated complications, compared to the HCC cohort. Conclusions: Uremia did not influence survival outcomes between the uremia-HCC and the HCC cohorts, irrespective of extent of hepatic resection. This study urges a better perioperative care strategy to avoid potential cardiac and infectious complications in uremia-HCC patients. [ABSTRACT FROM AUTHOR]

The association between schizophrenia and cancer risk is contentious in the clinical and epidemiological literature. Studies from different populations, tumor sites, or health care systems have provided inconsistent findings. In the present study, we examined a less well-investigated hypothesis that age plays a crucial role in cancer risk in schizophrenia. We conducted a nationwide cohort study using Taiwan's National Health Insurance Research Database ( NHIRD) between 1995 and 2007. Overall, gender-, and age-stratified standardized incidence ratios ( SIR) were used to investigate the pattern of cancer risk by age. Of the 102 202 schizophrenic patients, 1738 developed cancer after a diagnosis of schizophrenia ( SIR = 0.92; 95% confidence interval [ CI] 0.90-0.96). However, the age-stratified SIR declined with age (e.g. SIR [95% CI] = 1.97 [1.85-2.33], 0.68 [0.65-0.78], and 0.36 [0.34-0.45] for those aged 20-29, 60-69, and ≥70 years, respectively) in both genders and for major cancers. Cancer risks in schizophrenic patients were lower for cancers that are more likely to develop at an older age in the general population (e.g. stomach cancer [ SIR = 0.62; 95% CI 0.57-0.80], pancreatic cancer [ SIR = 0.49; 95% CI 0.39-0.84], and prostate cancer [ SIR = 0.35; 95% CI 0.29-0.58]). In contrast, cancer risks were higher for cancers that have a younger age of onset, such as cancers of the nasopharynx ( SIR = 1.18; 95% CI 1.08-1.49), breast ( SIR = 1.50; 95% CI 1.44-1.66) and uterine corpus ( SIR = 2.15; 95% CI 1.98-2.74). The unique age structures and early aging potential of schizophrenia populations may contribute to the observed inverse relationship between age and cancer risk. Higher cancer comorbidity in young schizophrenic patients deserves more attention. [ABSTRACT FROM AUTHOR]

Objective Psoriasis is associated with ischemic heart disease (IHD). Results of prior studies have suggested that methotrexate (MTX) may improve vascular disease in patients with psoriasis and rheumatoid arthritis. The aim of this study was to assess the risk of new-onset IHDs in psoriasis patients, comparing those taking MTX with those taking other nonbiologic antipsoriatic drugs. Methods In this retrospective cohort study, we utilized claims data from the National Health Insurance Research Database of Taiwan to identify 179,200 subjects who had received a diagnosis of psoriasis, with or without psoriatic arthritis, on at least 3 visits. The risk of hospitalization for new-onset IHD was compared between psoriasis patients taking MTX monotherapy (n = 6,578; MTX case cohort) and psoriasis patients taking other nonbiologic antipsoriatic drugs (n = 5,471; reference control cohort) between January 1996 and December 2008. Additional adjustments were made for cardiovascular risk factors, number of hospital visits, Charlson comorbidity score, and use of other antiinflammatory drugs. Results The incidence rates of IHD were 666 cases per 100,000 person-years in the MTX case cohort and 830 cases per 100,000 person-years in the reference control cohort (unadjusted P = 0.027). Increasing age, male sex, presence of hypertension, presence of diabetes, Charlson comorbidity score, and use of phototherapies were independent risk factors for hospitalization related to a new IHD in the study cohorts. However, the multivariate-adjusted hazard ratio for IHD-related hospitalizations among patients receiving MTX, in comparison with those receiving other nonbiologic antipsoriatic drugs, was 0.97 (95% confidence interval 0.79-1.19), after adjustment for age, sex, comorbidity score, number of hospital visits, and other antiinflammatory treatments for psoriasis. Conclusion In patients with psoriasis with or without coexisting psoriatic arthritis, the adjusted risk of hospitalization for an IHD among individuals receiving MTX was comparable with that among individuals receiving other nonbiologic antipsoriatic drugs. [ABSTRACT FROM AUTHOR]

Colon adenoma resection by polypectomy stops the adenoma-carcinoma pathway to CRC development. However, whether colon adenoma resection alters colon microbiota and changes colon carcinogenesis remains unknown. The three types of adenoma, i.e., tubular adenoma, villous adenoma and mixed type adenoma have different malignant potentials. [Extracted from the article]

Large-scale, real-world studies on the side effects of systemic therapies (including biologics) in patients with psoriasis are limited. We aimed to calculate the risk of malignancy in patients with psoriasis who were treated with systemic medications. Nested case-control analyses were performed among psoriasis patients without a history of malignancy. We recruited 4188 patients with newly diagnosed psoriasis and successive malignancies, and 8376 matched controls from the National Health Insurance Research Database in Taiwan. The therapy duration was within 5 years before malignancy onset and further stratified into two groups according to the duration of medication usage. Multivariate conditional logistic regression adjusted for potential confounders was used to estimate malignancy risk associated with systemic treatments. Among psoriasis patients, long-term (> 12 months) treatment with cyclosporine increased the risk of malignancy compared with no exposure (odds ratio, 1.57; p = 0.01). Short-term (≤ 12 months) or long-term (> 12 months) use of other systemic treatments, including methotrexate, azathioprine, systemic retinoids, mycophenolate mofetil, sulfasalazine, etanercept, adalimumab, and ustekinumab, was not associated with an increased risk of malignancy in patients with psoriasis. Long-term treatment with cyclosporine increased the risk of malignancy in patients with psoriasis by 1.57-fold., (© 2022 Wiley Periodicals LLC.)

Objective: The association of rheumatoid arthritis (RA) and malignancy has rarely been explored in Asian populations. The aim of this study was to investigate the relative risk of cancer in Taiwanese patients with RA and to identify groups of patients with a high risk of cancer., Methods: We conducted a nationwide cohort study of the risk of cancer among 23,644 patients with RA who had no history of malignancies, using the National Health Insurance database of Taiwan from 1996 to 2007. Standardized incidence ratios (SIRs) for various cancers were analyzed., Results: Among the patients with RA, 935 cancers were observed. Patients with RA had an increased risk of cancer (SIR 1.23, 95% confidence interval [95% CI] 1.22-1.23), especially hematologic cancers (SIR 2.74, 95% CI 2.68-2.81). The relative risk of cancer was higher among younger patients. Most cancer cases were detected within the first year following the diagnosis of RA. The relative risk of cancer decreased as the duration of observation increased. Among hematologic cancers, the risk of non-Hodgkin's lymphoma was greatest (SIR 3.54, 95% CI 3.45-3.63). Among solid tumors, the risk of cancers of the kidney and vagina/vulva was highest. A decreased risk of cancers of the cervix and nonmelanoma skin cancer in patients with RA was also observed., Conclusion: Patients with RA have an increased risk of cancer, especially hematologic and kidney cancers. The relative risk of cancer in patients with RA decreased with long-term followup. Cancer screening with continued vigilance is recommended for patients with RA., (Copyright © 2011 by the American College of Rheumatology.)