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Background/Aims: Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore. Methods: In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013-2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types. Results: A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P

BACKGROUND AND AIM Gastrointestinal (GI) lesions may have subtle morphological changes. Linked color imaging (LCI) combines narrow-band wavelength light and white light imaging (WLI) in appropriate balance to enhance lesion detection. We compared the detection rates of upper GI lesions using LCI and WLI. METHOD Patients were randomized in a 1:1 ratio to receive tandem gastroscopy with WLI inspection followed by LCI, or vice versa. Endoscopic examination was performed using the EG-L590ZW gastroscope and the LASEREO endoscope system (Fujifilm Co., Tokyo, Japan). Histology was reported by a specialist GI pathologist blinded to the technique of lesion detection and was used as the gold standard for diagnosis. RESULTS Ninety patients (mean age 66.8 years, 51.5% male patients) were randomized to either LCI examination first followed by WLI (LCI-WLI), or vice versa (WLI-LCI). An 18.9% of gastroscopies in the study were for surveillance of previously known gastric cancer precursors. Ten patients (11.1%) had a history of Helicobacter pylori infection. There was no significant difference in the time taken for examination under LCI (311 ± 96 s) and WLI (342 ± 86 s) (P = 0.700). LCI detection rates were higher than WLI detection rates for gastric cancer precursors such as atrophic gastritis (2.19% vs 0.55%) (P

BACKGROUND AND AIM Real-world data on sofosbuvir/velpatasvir with and without ribavirin (SOF/VEL ± RBV), particularly among patients with genotype 3 (GT3) decompensated cirrhosis, prior treatment, coinfection, and hepatocellular carcinoma (HCC), are scarce. We aimed to assess the efficacy and safety of SOF/VEL ± RBV in a real-world setting that included both community and incarcerated GT3 hepatitis C virus (HCV) patients. METHODS We included all GT3 HCV patients treated with SOF/VEL ± RBV in our institution. The primary outcome measure was the overall sustained virological response 12 weeks after treatment (SVR12), reported in both intention-to-treat (ITT) and per-protocol analyses. The secondary outcome measures were SVR12 stratified by the presence of decompensated cirrhosis, prior treatment, HCC, and HIV/hepatitis C virus coinfection and the occurrence rate of serious adverse events requiring treatment cessation or hospitalization. RESULTS A total of 779 HCV patients were treated with 12 weeks of SOF/VEL ± RBV, of which 85% were treated during incarceration. Among the 530 GT3 HCV patients, 31% had liver cirrhosis, and 6% were treatment-experienced. The overall SVR12 for GT3 was 98.7% (95% confidence interval: 97.3%, 99.5%) and 99.2% (95% confidence interval: 98.1%, 99.8%) in ITT and per-protocol analyses, respectively. High SVR12 was also seen in ITT analysis among GT3 HCV patients with decompensated cirrhosis (88%), prior treatment (100%), HCC (100%), and HIV/hepatitis B virus coinfection (100%). Apart from one patient who developed myositis, no other serious adverse events were observed. CONCLUSION The SOF/VEL ± RBV is a safe and efficacious treatment option for GT3 HCV patients in a real-world setting. SOF/VEL with RBV may be considered for decompensated GT3 HCV patients.

Background and Aim Perturbance in the composition of human gut microbiota has been associated with metabolic disorders such as obesity, diabetes mellitus, and insulin resistance. The objectives of this study are to examine the effects of ethnicity, central obesity, and recorded dietary components on potentially influencing the human gut microbiome. We hypothesize that these factors have an influence on the composition of the gut microbiome. Methods Subjects of Chinese (n = 14), Malay (n = 10), and Indian (n = 11) ancestry, with a median age of 39 years (range: 22–70 years old), provided stool samples for gut microbiome profiling using 16S rRNA sequencing and completed a dietary questionnaire. The serum samples were assayed for a panel of biomarkers (interleukin‐6, tumor necrosis factor alpha, adiponectin, cleaved cytokeratin 18, lipopolysaccharide‐binding protein, and limulus amebocyte lysate). Central obesity was defined by waist circumference cut‐off values for Asians. Results There were no significant differences in Shannon alpha diversity for ethnicity and central obesity and no associations between levels of inflammatory cytokines and obesity. The relative abundances of Anaerofilum (P = 0.02), Gemellaceae (P = 0.02), Streptococcaceae (P = 0.03), and Rikenellaceae (P = 0.04) were significantly lower in the obese group. From principle coordinate analysis, the effects of the intake of fiber and fat/saturated fat were in contrast with each other, with clustering of obese individuals leaning toward fiber. Conclusion The study demonstrated that there were differences in the gut microbiome in obese individuals. Certain bacterial taxa were present in lower abundance in the group with central obesity. Fiber and fat/saturated fat diets were not the key determinants of central obesity., The objectives of this study are to examine the effects of ethnicity, central obesity, and dietary components on the human gut microbiome. Asian subjects (n = 35) provided stool samples for gut microbiome profiling using 16S rRNA sequencing and completed a dietary questionnaire. The relative abundances of Anaerofilum (P = 0.02), Gemellaceae (P = 0.02), Streptococcaceae (P = 0.03), and Rikenellaceae (P = 0.04) were significantly lower in the obese group.

Background Preliminary studies on a new topical hemostatic agent TC-325 show its safety and effectiveness in the treatment of active upper GI bleeding. However, to date, there are no randomized trials comparing Hemospray with the combined conventional technique (CCT). Our pilot study aimed to compare the efficacy and safety of Hemospray with that of the CCT in treating peptic ulcers with active bleeding or high-risk stigmata. Method This was a randomized comparative study of patients with upper GI bleeding symptoms and had Forrest class I, IIA or IIB ulcers. Results 20 patients were recruited; mean age was 70 years; range 23–87. There were 16 males. Mean hemoglobin was 9.7 g/dL. We had successful initial hemostasis in 19 patients (95%); 90% (9/10) in TC-325 group and 100% (10/10) in CCT group. TC-325 monotherapy failed to stop bleeding in a patient with a Forrest IB posterior duodenal wall ulcer. Rebleeding was seen in 4 patients (21.1%; 4/19); 3 patients (33.3%; 3/9) in TC-325 group and 1 patient (10%; 1/10) in CCT group. One patient required angio-embolization therapy while 3 patients had successful conventional endotherapy. Two patients from the TC-325 group had serious adverse events which were not procedure or therapy related; 1 death and 1 acute myocardial infarction. In patients with Forrest IIA or IIB ulcers, five patients received TC-325 monotherapy; none had rebleeding. Conclusion Our pilot study showed that TC-325 has a trend towards higher rebleeding rate than CCT, when treating actively bleeding ulcers. Larger trials are necessary for definitive results. Copyright © 2017 John Wiley & Sons, Ltd.

BACKGROUND & AIMS We compared the effects of weight loss induced with the glucagon-like peptide-1 agonist liraglutide, with that of lifestyle modification, followed by weight maintenance after discontinuing intervention, in obese adults with non-alcoholic fatty liver disease (NAFLD). METHODS Thirty obese (mean age 40.7 ± 9.1 years, BMI 33.2 ± 3.6 kg/m2 , 90% male) adults with NAFLD defined as liver fat fraction (LFF) > 5% on magnetic resonance imaging without other causes of hepatic steatosis were randomized to a supervised programme of energy restriction plus moderate-intensity exercise to induce ≥ 5% weight loss (DE group, n = 15), or liraglutide 3 mg daily (LI group, n = 15) for 26 weeks, followed by 26 weeks with only advice to prevent weight regain. RESULTS Diet and exercise and LI groups had significant (P

We compared the effects of weight loss induced by the glucagon-like peptide 1-agonist liraglutide with a structured lifestyle intervention in obese adults with non-alcoholic fatty liver disease (NAFLD). Obese (body mass index ≥30 kg/m2 , mean weight 96.0 ± 16.3 kg) non-diabetic Asian adults, with NAFLD diagnosed by liver fat fraction (LFF) ≥ 5.5% on magnetic resonance imaging without other causes of hepatic steatosis, were randomized to a supervised program of dieting (restriction by 400 kilocalories/d) plus moderate-intensity aerobic exercise (~200 min/wk; DE group, n = 12), or liraglutide at the 3 mg daily dose approved for weight loss (LI group, n = 12), for 26 weeks. Both DE and LI groups had significant (P < .01) and similar reductions in weight (-3.5 ± 3.3 vs -3.5 ± 2.1 kg, respectively, P = .72), LFF (-8.9 ± 13.4 vs -7.2% ± 7.1%, P = .70), serum alanine aminotransferase (-42 ± 46 vs -34 ± 27 U/L, P = .52) and aspartate aminotransferase (-23 ± 24 vs -18 ± 15 U/L, P = .53). In this first randomized study comparing the 2 weight-loss modalities for improving NAFLD, liraglutide was as effective as structured lifestyle modification.

Preliminary studies on a new topical hemostatic agent, TC-325, have shown its safety and effectiveness in treating active upper gastrointestinal (GI) bleeding. However, to date there have been no randomized trials comparing TC-325 with the conventional combined technique (CCT). Our pilot study aimed to compare the efficacy and safety of TC-325 with those of CCT in treating peptic ulcers with active bleeding or high-risk stigmata.This was a comparative randomized study of patients with upper GI bleeding who had Forrest class I, IIA or IIB ulcers.Altogether 20 patients with a mean age of 70 years (range 23-87 years) were recruited, including 16 men, with a mean hemoglobin of 97 g/L. Initial hemostasis was successful in 19 (95.0%) patients, including 90.0% (9/10) in the TC-325 group and 100% (10/10) in the CCT group. TC-325 monotherapy failed to stop bleeding in a patient with Forrest IB posterior duodenal wall ulcer. Rebleeding was seen in 33.3% (3/9) of the patients in the TC-325 group and 10.0% (1/10) in the CCT group. One patient required angio-embolization therapy while three had successful conventional endotherapy. Two patients from the TC-325 group had serious adverse events that were not procedure- or therapy-related. In patients with Forrest IIA or IIB ulcers, five received TC-325 monotherapy; none had rebleeding.Our pilot study showed that TC-325 has a tendency towards a higher rebleeding rate than CCT, when treating actively bleeding ulcers. Larger trials are necessary for definitive results.

The cholinesterase inhibitor neostigmine indirectly stimulates muscarinic M1/M2/M3 receptors, thereby reducing colonic distension in acute colonic pseudo-obstruction. We investigated the dose-response profile for the colonic sensorimotor effects of neostigmine and bethanechol, a direct muscarinic M2/M3 agonist in humans. A barostat-manometric assembly recorded phasic pressures, tone, and pressure-volume relationships (compliance) in the descending colon and rectum of 30 healthy subjects who received intravenous neostigmine (0.25, 0.75, or 1.5 mg; n = 15) or subcutaneous bethanechol (2.5, 5, or 10 mg; n = 15). Sensation to luminal distension was also assessed. Thereafter, the effects of neostigmine and bethanechol on colonic transit (geometric center) were compared with those of saline by scintigraphy in 21 subjects. Both drugs increased colonic phasic pressure activity, reduced rectal compliance, and enhanced urgency during rectal distension. Neostigmine also reduced colonic and rectal balloon volumes, reflecting increased tone by an average of 12% and 25% for the highest dose, respectively. Only neostigmine reduced colonic compliance, accelerated colonic transit [mean geometric center at 90 min 2.5 vs. 1.0 (placebo)], and increased pain perception during colonic distension. We conclude that neostigmine has more prominent colonic motor and sensory effects than bethanechol. Moreover, neostigmine induces coordinated colonic propulsion, perhaps by stimulating muscarinic M1 receptors in the myenteric plexus.

Magnesium alloy has been widely investigated as biodegradable cardiovascular stent and bone implant. Its application for biodegradable esophageal stenting remains unexplored. This paper reports the biodegradation behaviors of AZ31 magnesium alloy in artificial saliva and various types of beverage in vitro. Results show that the magnesium ion release rate of AZ31 in artificial saliva for a stent (2cm diameter, 10cm length at 50% stent surface coverage) is 43 times lower than the daily allowance of human body magnesium intakes. The degradation rates of AZ31 in different beverages could also be significantly different. These results suggest that the esophagus in nature is a less aggressive chemical environment for degradation of magnesium alloys. The significant difference in degradation rates of AZ31 in different beverages opens new opportunities for development of degradation controllable esophageal stent through customizing ingested beverages., {"references":["","J. L. Tokar, S. Banerjee, B. A. Barth, D. J. Desilets, V. Kual, S.R. Kethi\net al., Drug-eluting/biodegradable stents. Gastrointestinal Endoscopy,\n2011. 74(5): p. 954-958.","S. Irani. and R. Kozarek, Esophageal stents: past, present, and future.\n2010. 12(4): p. 178-190.","P. Sharma and R. Kozarek, Role of esophageal stents in benign and\nmalignant Diseases. Am J Gastroenterol, 2009. 105(2): p. 258-273","X. Gu, Y. Zheng, Y. Cheng, S. Zhong, T. Xi, In vitro corrosion and\nbiocompatibility of binary magnesium alloys. Biomaterials, 2009. 30(4):\np. 484-498.","S. Schumacher, J. Stahl, W. Bäumer, J. M. Seitz, F. W Bach, L. J.\nPetersen, Ex vivo examination of the biocompatibility of biodegradable\nmagnesium via microdialysis in the isolated perfused bovine udder\nmodel. International Journal of Artificial Organs, 2011. 34(1): p. 34-43.","G. L. Diamond, P.E. Goodrum, S.P. Felter, W. L. Ruoff, Gastrointestinal\nabsorption of metals. Drug and Chemical Toxicology, 1997. 20(4): p.\n345-368.","F. Witte, N. Hort, C. Vogt, S. Cohen, K.U. Kainer, R. Willumeit, et al.,\nDegradable biomaterials based on magnesium corrosion. Current\nOpinion in Solid State and Materials Science, 2009. 12(5-6): p. 63-72.","R. C. Orlando, Esophageal mucosal defense mechanisms. GI Mobility\nonline, 2006.","J-Y. Gal, Y. Fovet, and M. Adib-Yadzi, About a synthetic saliva for in\nvitro studies. Talanta, 2001. 53(6): p. 1103-1115.\n[10] A. Loos, R. Rohde, A. Haverich and S. Barlach, In vitro and in vivo\nbiocompatibility testing of absorbable metal stents. Macromolecular\nSymposia, 2007. 253: p. 103-108.\n[11] H. Sigel and A. Sigel, Bioinorganic Chemistry of Metal toxicity, in\nMetal ions in biological systems: concepts on metal ion toxicity, 1986,\nCRC Press. p. 25.\n[12] G.S. Duffó and S.B. Farina, Corrosion behaviour of a dental alloy in\nsome beverages and drinks. Materials Chemistry and Physics, 2009.\n115(1): p. 235-238.\n[13] J.E. Moore Jr, J.S. Soares, and K.R. Rajagopal, Biodegradable stents:\nbiomechanical modeling challenges and opportunities. Cardiovascular\nEngineering and Technology, 2010. 1(1): p. 52-65.\n[14] G.P. Talwar and L.M. Srivastava, Gastrointestinal tract, in Textbook of\nBiochemistry and Human Biologiy. 2003. p. 599-602\n[15] M. Mobin, M.A. Khan, and M. Parveen, Inhibition of mild steel\ncorrosion in acidic medium using starch and surfactants additives.\nJournal of Applied Polymer Science, 2011. 121(3): p. 1558-1565.\n[16] E.S. Ferreira, C. Giacomelli, F.C. Giacomelli, A. Spinelli., Evaluation of\nthe inhibitor effect of l-ascorbic acid on the corrosion of mild steel.\nMaterials Chemistry and Physics, 2004. 83(1): p. 129-134.\n[17] M.S.S. Morad and A.A.A. Hermas, Influence of some amino acids and\nvitamin C on the anodic dissolution of tin in sodium chloride solution.\nJournal of Chemical Technology & Biotechnology, 2001. 76(4): p. 401-\n410.\n[18] A. Yamamoto and S. Hiromoto, Effect of inorganic salts, amino acids\nand proteins on the degradation of pure magnesium in vitro. Materials\nScience and Engineering C, 2009. 29(5): p. 1559-1568.\n[19] N.H. Helal and W.A. Badawy, Environmentally safe corrosion inhibition\nof Mg–Al–Zn alloy in chloride free neutral solutions by amino acids.\nElectrochimica Acta, 2011. 56(19): p. 6581-6587.\n[20] L. Ramalingam, L.B. Messer, and E.C. Reynolds, Adding casein\nphosphopeptide-amorphous calcium phosphate to sports drinks to\neliminate in vitro erosion. Pediatric Dentistry, 2005. 27(1): p. 61-67."]}

Wireless oesophageal (Bravo) readings in healthy European and American subjects show varied results. Values in Asians remain unstudied.We performed Bravo studies in healthy Asians to determine if values differed from previously published and identified reflux parameters to differentiate healthy volunteers from patients.Fifty healthy volunteers were recruited between August 2009 and August 2011 to undergo 48 h wireless pH monitoring. Bravo capsule was introduced transorally and placed 6 cm above the squamocolumnar junction. Acid reflux parameters were compared against 41 patients previously evaluated for non-erosive reflux disease.Five volunteers were excluded. Capsule dislodgement occurred in four and three volunteers on study days 1 and 2 respectively. Forty and 37 volunteers (73% male, mean age 33.0 ± 7.6 years) had interpretable readings at 24 and 48 h, respectively. Percentage of time oesophageal pH4 in 37 volunteers who completed 48 h recordings was 1.6% (7.5%), 1.5% (6.3%) and 1.9% (5.8%) on days 1, 2 and overall study duration, respectively.Bravo readings in Asians differed from previously published. Percentage of time oesophageal pH4 on day 2 and DeMeester score on day 2 (95th percentile 22.9) best discriminated healthy volunteers from patients.

Background & Aims Narrow band imaging (NBI) facilitates mucosal surface evaluation and may improve the endoscopic diagnosis of gastroesophageal reflux disease (GERD). We investigated the utility of NBI in improving the endoscopic diagnosis of GERD when compared with conventional endoscopy. Methods A total of 107 subjects (nonerosive reflux disease [NERD], 36; erosive reflux disease [ERD], 41; controls, 30) were recruited prospectively. The mucosal morphology at the squamocolumnar junction (SCJ) in GERD and controls was visualized using conventional endoscopy and NBI. The main outcome measurements were as follows: (1) The differences in mucosal morphology at the SCJ between conventional endoscopy and NBI; and (2) the differences in mucosal morphology at the SCJ between GERD and controls with NBI. Results Micro-erosions, increased vascularity, and pit patterns at the SCJ not seen on conventional endoscopy were well seen with NBI. Compared with controls, ERD and NERD had a significantly higher prevalence of micro-erosions (ERD, 100%; NERD, 52.8%; controls, 23.3%), and increased vascularity (ERD, 95.1%; NERD, 91.7%; controls, 36.7%), but a lower prevalence of round pit pattern (ERD, 4.9%; NERD, 5.6%; controls, 70%). ERD and NERD were similar in terms of increased vascularity and pit patterns. Increased vascularity with absence of round pit pattern was useful to distinguish NERD from controls (sensitivity, 86.1%; specificity, 83.3%). Interobserver agreement was good for increased vascularity (κ = 0.95) and micro-erosions (κ = 0.89), but lower for pit pattern (κ = 0.59). Conclusions NBI enhanced mucosal morphology at the SCJ and appeared useful for improving the endoscopic diagnosis of GERD.

Crohn's disease (CD) is rare in the Chinese population, but lately there seems to be an increasing trend of CD in the Singapore Chinese population. We carried out a retrospective study of all Chinese patients with CD seen from 1987 to 1993 at the Singapore General Hospital. All patients were regularly followed up and treated. Disease activity was defined by the Organisation Mondiale de Gastroenterologie index. We also compared our series with our first series reported in 1987 and a Western series. There were 32 patients (20 men, 12 women) giving a hospital prevalence of 26.7 per 100,000 patients compared with 3.5 per 100,000 patients in 1986. The mean age was 37.1 years (range, 19-80 years). Twelve patients had small intestinal disease, 9 had colonic disease, and 11 had both. The common presenting symptoms were bloody diarrhea (67%), abdominal pain (53%), loss of weight (47%), and fever (34%). Extraintestinal manifestations were rare. Six patients had no relapse during the follow-up period, whereas the remaining 26 patients had an average of two relapses (range, 1-5). These relapses were complicated by fistulas in 8 patients and strictures in 11 patients. Response to steroids and sulfasalazine was good in most patients. Four patients required repeated surgery despite medical treatment. The prevalence of CD appears to be increasing among the Singapore Chinese population. The clinical features are similar to those of the Western population. Most of our patients responded to standard medical therapy, but further follow-up is needed to assess their long-term clinical outcome.

Acute pancreatitis is a common disease with a relatively high morbidity and mortality. In contrast, chronic pancreatitis is a recurrent disease with multiple potential complications that occasionally require urgent intervention. This article focuses on the emergency complications of acute and chronic pancreatitis that require urgent intervention. Recent developments in the diagnosis and management of such complications are discussed.

Purpose: More than 80% of hepatocellular carcinomas (HCCs) worldwide occur in developing countries, especially in Asia. It often presents at an advanced stage beyond treatment. In this circumstance, a simple prognostic model is useful. Previous prognostic models require radiologic and laboratory investigations that are not readily available in developing countries. Our aim is to formulate and then validate a simple clinical prognostic model for HCC in an Asian population using only clinical parameters and with serum alpha-fetoprotein (AFP) as the sole laboratory test. Patients and Methods: Cox regression modeling was performed on several clinical parameters and serum AFP level in 397 patients with HCC who received only supportive care in Singapore. A later group of 324 HCC patients from an Asia-Pacific–wide randomized trial was then used to validate the model. Results: Ascites, physical performance status, and serum AFP were independently predictive of survival. Cox analysis yielded a simple score based on these three variables that categorizes patients into low-, medium-, and high-risk groups with 6-month survivals of 43%, 21%, and 5%, respectively. The prospective validation data provided corresponding estimates of 33%, 15%, and 3% and give confirmation of the utility of the simple model. Conclusion: We have formulated and prospectively validated a simple prognostic score for untreated HCC that only requires a clinical evaluation for ascites and physical performance status and measurement of serum AFP. This simple model is particularly apt for developing country circumstances and can also be used to select patients for treatment trials.

Background: It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria. Methods: A modified English version of Talley's bowel disease questionnaire was developed in collaboration with various research teams in accordance with the Rome II criteria. This instrument was translated into the local languages of the following nine Asian regions: China, Hong Kong, Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam. From September to December 2001, newly enrolled outpatients attending 14 GI or medical clinics in these regions were invited to complete the questionnaire. From these respondents, patients with functional gastrointestinal disorders fulfilling the ‘12 weeks out of 12 months’ criteria were separated for further analysis. Principal component factor analysis with varimax rotation was used to identify symptom clusters or factors. These factors were compared with the existing classification of functional GI diseases derived from the Rome II criteria. Results: Factor analysis of symptoms from 1012 functional GI patients supported the Rome II classification of the following groups of functional GI disorders: diarrhea-predominant irritable bowel syndrome, functional constipation, functional dyspepsia, functional abdominal pain syndrome, functional heartburn, and functional vomiting. Functional diarrhea was combined with functional anorectal disorders, and globus merged with functional dysphagia into one factor. Some of the functional dyspepsia, abdominal bloating and belching symptoms were loaded into one factor. Conclusions: Factor analysis of symptoms from a sample of Asian patients with functional GI disorders partially supported the use of the Rome II classification. © 2003 Blackwell Publishing Asia Pty Ltd

Colonic transit is slowed in patients with disordered rectal evacuation, but the mechanism of this phenomenon is unclear. Our objective was to investigate rectocolonic inhibitory reflexes in humans to provide potential insight into patients with obstructed defecation. In 30 healthy subjects, a barostat-manometric assembly recorded colonic tone and phasic activity in the descending colon during rectal distension and recorded rectal tone during colonic distension. Phasic distensions were 8, 16, and 32 mmHg above balloon operating pressure, and staircase inflations were comprised of balloon inflation then deflation in 2-mmHg increments at 30-s intervals from 0 to 36 mmHg. Colonic balloon volumes increased to a similar extent during phasic rectal distensions 8, 16, and 32 mmHg above operating pressure, reflecting reduced colonic tone; balloon volumes also increased and phasic pressure activity decreased during staircase rectal distensions. In contrast, rectal balloon volume declined, reflecting increased tone during phasic and staircase colonic distensions. Thus rectal distension inhibited colonic motor activity, indicative of a viscerovisceral inhibitory reflex.

Background: Malignant obstructive jaundice is a common management problem encountered in tertiary care center. Advanced age of the patients, late stage of diagnosis and preexisting medical illnesses favor endoscopic stenting via Endoscopic Retrograde Cholangiopancreatography (ERCP). However, due to financial limitation and short period of survival, polyethylene stents may be good enough to achieve drainage in these patients. Our aim was to study the effectiveness of polyethylene stents in the management of malignant biliary strictures. Methods: ERCP was done in all patients with suspected malignant obstructive jaundice based on clinical features, liver function tests, tumour markers and imaging studies. Following demonstration of biliary strictures, brushings were done for histology. Endoscopic stenting was done with 1 or more 10 French polyethylene stents by the conventional method. All patients were on regular follow up after successful stenting. Repeat procedures or stent exchanges were performed based on clinical and biochemical parameters suggestive of stent occlusion. Results: 55 consecutive patients (31 female, 24 male), mean age: 61 years (Range: 32-86) were included in the study. The types of malignancies included periampullary carcinoma (N=18), pancreatic carcinoma (N=22), cholangiocarcinoma (N=12) and porta hepatis secondaries (N=3). Nineteen patients had histological confirmation of tumours. Stenting was successful in 45 patients on first attempt giving an initial success rate of 82%. Seven patients were stented by the combined percutaneous-endoscopic method. The overall success rate of stenting was thus 95%. The mean duration of stent patency was 3.6 months. Repeated stent exchange was done for 16 patients. There was no procedure related mortality. Stent migration was seen in 2 patients and recurrent cholangitis in 1 patient. Four patients underwent palliative bypass surgery subsequently with a mean survival of 4.3 months. Sixteen stented patients later died from advanced malignancies during the study period with a mean survival of 5.7 months. Conclusions: Endoscopic stenting with economical polyethylene stents was an effective palliative treatment for malignant obstructive jaundice. It is the treatment of choice for patients with advanced disease, high surgical risk and limited life expectancy.

Neurogastroenterology and motility disorders of the gastrointestinal (GI) tract encompass a broad spectrum of diseases involving the GI tract and central nervous system. They have varied pathophysiology, clinical presentation and management, and make up a substantial proportion of outpatient clinic visits. Typically, patients experience persistent symptoms referable to the GI tract despite normal endoscopic and radiologic findings. An appropriate evaluation is thus important in the patient's care. Advances in technology and understanding of the disease pathophysiology have provided better insight into the physiological basis of disease and a more rational approach to patient management. While technological advances serve to explain patients' persistent symptoms, they should be balanced against the costs of diagnostic tests. This review highlights the GI investigative modalities employed to evaluate patients with persistent GI symptoms in the absence of a structural lesion, with particular emphasis on investigative modalities available locally and the clinical impact of such tools.