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Background and Aims: Patients with inflammatory bowel disease (IBD) are subjected to a large amount of ionizing radiation during the course of their illness. This may increase their risk of malignancy to a greater level than that due to the disease itself. In Caucasian patients with Crohn’s disease, this has been well documented and recommendations are in place to avoid high radiation imaging protocols. However, there are limited data available on radiation exposure in Asian IBD patients. We therefore sought to identify total radiation exposure and any differences between ethnically diverse ulcerative colitis (UC) and Crohn’s disease (CD) patients at our centre along with determining factors that may contribute to any variation. Methods: The cumulative effective dose (CED) was calculated retrospectively from 2000 to 2014 using data from our online radiology database and patients’ medical records. Total CED in the IBD population was measured. High exposure was defined as a radiation dose of greater than 0.2mSv (equivalent to slightly less than ½ a year of background radiation). Results: A total of 112 cases of IBD (36 CD and 76 UC) were reviewed. Our CD patients were diagnosed at an earlier age than our UC cases (mean age 26.1 vs 45.7). The total CED in our IBD population was 8.53 (95% CI: 4.53-12.52). Patients with CD were exposed to significantly higher radiation compared to those with UC. The mean CED was 18.6 (7.30-29.87) and 3.65 (1.74-5.56, p=0.01) for CD and UC patients respectively. 2 patients were diagnosed as having a malignancy during follow up with respective CED values of 1.76mSv and 10mSv. Conclusions: CD patients, particularly those with complicated disease, received a higher frequency of diagnostic imaging over a shorter period when compared to UC patients. Usage of low radiation imaging protocols should be encouraged in IBD patients to reduce their risk of consequent malignancy.

Background Coronary artery disease (CAD), which clinically manifested as an acute coronary syndrome (ACS) is an important extrahepatic cardiovascular complication of non-alcoholic fatty liver disease (NAFLD). To date, little is known about the correlation between young patients with ACS and NAFLD. Aim to assess the correlation between NAFLD and severity of CAD in young ACS patients and determine the prevalence of NAFLD in this cohort. Methods This cross-sectional study included young (45 years and less) ACS patients. Coronary angiogram was performed to assess CAD severity, and complexity determined by SYNTAX score. CAD severity was classified into: no apparent CAD, mild CAD, single vessel disease (SVD) and multi-vessel disease (MVD). Liver ultrasound was used to diagnose and grade the NAFLD (grade 1–3). NAFLD fibrosis score (NFS) was calculated, and patients were stratified to low, indeterminate, and high probability for advanced liver fibrosis. Results Total of 85 patients with median age of 40 years (IQR 35–43) and predominated by males (84.7%). Thirty-three (38.9%) had ST elevation myocardial infarction (STEMI), 32 (37.6%) had Non-STEMI and 20 (23.5%) had unstable angina. MVD was demonstrated in 36.5%, SVD in 24.7%, mild CAD in 31.8%, and no apparent CAD in 7.1% of the patients. Median Syntax score was 16 (IQR 9.0–22.3). NAFLD was diagnosed in all, 85 (100%) patients, with 13 (15.2%), 36 (42.4%) and 36 (42.2%) patients had grade 1, 2 and 3 liver steatosis respectively. NFS detected low advanced fibrosis probability in 60 (70.6%) patients, indeterminate probability in 24 (28.2%) patients and high probability in only 1 (1.2%) patient. No significant correlation between grades of NAFLD with ACS subtypes (p=0.72), severity of CAD (p=0.882) and SYNTAX score (p=0.982). No significant association between NFS and ACS subtypes (p=0.232), severity of CAD (p=0.445) and SYNTAX score (p=0.624, r=0.07). Conclusions NAFLD is highly prevalent in young patients presented with ACS, and it should be routinely screened in our clinical practice. However, in a small cohort, we observed no significant correlation between severity of NAFLD and severity of CAD among young ACS patients.

Backgrounds. The aim of this study was to appraise the relationship between serum fragmented cytokeratin-18(CK-18), controlled attenuation parameter (CAP), and liver steatosis assessed by ultrasound (US) in nonalcoholic fatty liver disease (NAFLD) patients. Methods. Patients who underwent abdominal US were recruited, followed with measurement of CAP using Fibroscan® and serum fragmented CK-18 using enzyme-linked immunosorbent assay. The degree of liver steatosis assessed by US was categorized into mild (S1), moderate (S2), and severe (S3). Results. A total of 109 patients were included in our study. CAP and fragmented CK-18 level were significantly correlated with liver steatosis grade with rs = 0.56 and 0.68, p=0.001, respectively. NAFLD Fibrosis Score was poorly correlated with liver steatosis grade (rs=-0.096, p=0.318). Using fragmented CK-18 level, area under receiver operating characteristic (AUROC) curves for S≥2 and S≥3 were excellent (0.82 and 0.84, respectively). Using CAP, AUROC curves for detection of S≥2 and S≥3 were good (0.76, 0.77, respectively). We also proposed cut-off value of CAP to detect S≥2 and S≥3 to be 263 and 319db/m, respectively, and fragmented CK-18 level to detect S≥2 and S≥3 (194 and 294 U/L, respectively). Conclusions. Both the fragmented CK-18 level and the CAP, but not NAFLD Fibrosis Score, were well correlated with hepatic steatosis grade as assessed by US.

There is a lack of non-invasive screening modalities to diagnose chronic atrophic gastritis (CAG) and intestinal metaplasia (IM). Thus, the aim of the present study was to determine the sensitivity and specificity of serum pepsinogen I (PGI), PGI:II, the PGI:II ratio and gastrin-17 (G-17) in diagnosing CAG and IM, and the correlations between these serum biomarkers and pre-malignant gastric lesions. A cross-sectional study of 72 patients (82% of the calculated sample size) who underwent oesophageal-gastro-duodenoscopy for dyspepsia was performed in the present study. The mean age of the participants was 56.2±16.2 years. Serum PGI:I, PGI:II, G-17 and Helicobacter pylori antibody levels were measured by enzyme-linked immunosorbent assay. Median levels of PGI:I, PGI:II, the PGI:II ratio and G-17 for were 129.9 µg/l, 10.3 µg/l, 14.7 and 4.4 pmol/l, respectively. Subjects with corpus CAG/IM exhibited a significantly lower PGI:II ratio (7.2) compared with the control group (15.7; P

Introduction: Camurati-Engelmann disease (CED) is a rare autosomal dominant disease with various phenotypic expressions. The symptoms usually develop during childhood. The hallmark of the disease is bilateral symmetric diaphyseal hyperostosis of the long bones with progressive involvement of the metaphysis. The epiphysis is strictly spared. The common clinical symptoms are pain of the extremities, muscle wasting, waddling gait, and lethargy. CED is rarely seen in conjunction with hypogonadism. CED-associated hypothyroidism has not been reported yet. Clinical assessment and skeletal survey are important to make the diagnosis. Case Presentation: Hereby we reported a case of CED with concomitant hypogonadism and hypothyroidism. Serial plain radiographs of the patient showed classic and progressive diaphyseal cortical hyperostosis of the long bone. Conclusions: Hyperostosis of the skull was observed in the present case. The characteristic osseous changes of CED were highlighted and the differential diagnoses were discussed.