Role of interventional endoscopic ultrasound in a developing country

Background/Aims@#Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience. @*Methods@#This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated. @*Results@#Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and five cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively. @*Conclusions@#EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.

Urease, Gastric Bacteria and Gastritis.

Urease is an enzyme produced by diverse bacterial species including normal flora, non pathogens, and pathogens such as Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella pneumonia, Citrobacter freundii, Enterobacter cloacae Helicobacter spp and Helicobacter pylori. Urease is central in Helicobacter pylori metabolism and virulence, important for colonization in the gastric mucosa. Urease catalyzes the hydrolysis of urea to ammonia and carbamate. This ammonia product can be examined by Urease biopsy test and Urea breath test such as 14C-Urea Breath Test or 13C-Urea Breath Test.Previously, the Urea breath test was intended to detect an increase in ammonia which is a urease product in the gastric mucosa produced by pathogenic gastric bacteria, such as Helicobacter pylori, etc.Acute and chronic gastritis caused by infection with these pathogenic bacteria infection turned out to be positive on Urea breath test. Indirectly, the results of the urea breath test are also related to the presence of inflammation in acute and chronic gastritis, regardless of whether the cause is Helicobacter pylori or other urease-producing pathogenic bacteria.The use of the urea breath test indirectly in diagnosing acute and chronic gastritis should be studied further. The use of the urea breath test is indeed very important to assist health services in countries and regions with limited endoscopic facilities, especially developing countries.We know that the prevalence of Helicobacter pylori infection in causing acute and chronic gastritis by examination of Urea breath test in Indonesia is not too high, ranging from 2-11.2%. So that is why more studies on non-Helicobacter pylori producing urease pathogens are needed, which can appear as a false positive urea breath test.

Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.

The association between new generation oral contraceptive pill and the development of inflammatory bowel diseases

BACKGROUND/AIMS: To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort. METHODS: A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD. RESULTS: Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77–3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049). CONCLUSIONS: In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.

Differences in the insulin resistance levels measured by HOMA-IR between patients with erosive and non-erosive gastroesophageal reflux disease / Journal of the ASEAN Federation of Endocrine Societies

Background@#Insulin resistance is the core of Metabolic Syndrome which carries a high risk for cardiovascular events. Insulin resistance had been reported to be higher in GERD patients than subjects without GERD, specifically in erosive esophagitis. @*Objective@#To compare the degree of insulin resistance, using HOMA-IR index, between erosive and non-erosive reflux disease. @*Methodology@#A cross-sectional study of 84 adult patients with GERD symptoms was conducted. The subjects were recruited consecutively between January 2017 and April 2017 at Cipto Mangunkusumo National Hospital in Jakarta. Gastroesophageal Reflux Disease Questionnaire (GERDQ) was used for subject recruitment. Homeostatic model assessment-insulin resistance (HOMA-IR) index was used to evaluate insulin sensitivity. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. Bivariate analysis was used to determine HOMA-IR difference between esophagitis and non-esophagitis group. @*Results@#The median of HOMA-IR in all subjects was 1.46 (0.32-13.85). Mann-Whitney test revealed that HOMA-IR index was higher in patients with erosive esophagitis [median 1.74 (0.35-13.85)] than those without erosive esophagitis [median 1.21 (0.32-10.78)] (p=0.05). @*Conclusion@#Insulin resistance is significantly higher in gastroesophageal reflux disease patients with esophageal erosions than in those without esophageal erosion.