ACE (Angiotensin-Converting Enzyme) Inhibitors/Angiotensin Receptor Blockers Are Associated With Lower Colorectal Cancer Risk: A Territory-Wide Study With Propensity Score Analysis

Whether ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers modify colorectal cancer risk remains controversial. We aimed to determine association between their use and colorectal cancer risk after a negative baseline colonoscopy. This is a territory-wide retrospective cohort study recruiting patients aged ≥40 who had undergone colonoscopy between 2005 and 2013. Exclusion criteria included colorectal cancer detected 3years (adjusted hazard ratio, 1.18 [95% CI, 0.88-1.57]); every single year increase in the drug use was associated with 5% reduction in adjusted hazard ratio risk. ACE inhibitors/angiotensin receptor blocker were associated with a lower colorectal cancer risk in a duration-response manner

Tenofovir disoproxil fumarate for the treatment of chronic hepatitis B monoinfection

Introduction: Resistance in nucleoside/nucleotide analog (NA) therapy has always been a challenge in the management of chronic hepatitis B (CHB). Clinical studies: Initially developed for the treatment of HIV infection, early in vitro and clinical observational studies had shown tenofovir disoproxil fumarate (TDF) to be also active against CHB. Recent data from various multicenter phase 3 and 4 clinical trials have confirmed TDF being able to achieve a high viral suppression in both NA-naive and -experienced CHB patients. There are also emerging data on the efficacy of TDF in decompensated CHB. Although there are in vitro studies identifying certain mutation loci associated with a reduced susceptibility to TDF, there have so far been no reports of virologic resistance to TDF in clinical studies. TDF has a favorable safety profile, although more long-term data would be needed. Conclusions: TDF has the makings of an 'ideal' first-line drug for the treatment of CHB. © 2011 Asian Pacific Association for the Study of the Liver.postprin

Future prevention and treatment of chronic hepatitis B infection

Vaccination for hepatitis B virus (HBV) infection and treatment for chronic hepatitis B, while effective for primary prevention and control of the disease, still have their limitations. Global coverage of HBV immunization needs improvement. Several patient populations are noted to have suboptimal seroprotective rates after HBV vaccination. There are currently several potential new vaccines undergoing animal and human studies, most notably vaccines containing immunostimulatory DNA sequences. Long-term nucleoside analogue therapy is necessary in achieving permanent virologic suppression. Potential new treatments explore new mechanisms of action, including the inhibition of hepatitis B surface antigen release, targeting antifibrotic mechanism, and immunomodulation through novel interferons and therapeutic vaccines. The clinical application of potential new vaccines and therapies would enhance the prevention of HBV infection and treatment of chronic hepatitis B. © 2012 by Lippincott Williams & Wilkins.postprin

Evaluating the sterility of disposable wall oxygen humidifiers, during and between use on patients.

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New high-definition narrow band imaging versus conventional high-definition white light colonoscopy for detection of colorectal adenomas: a randomised controlled trial with tandem colonoscopy

This journal suppl. entitled: 19th Medical Research Conference; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongPoster PresentationINTRODUCTION: Adenoma detection is important in colonoscopy as polypectomy has been shown to reduce the subsequent incidence and mortality of colorectal cancer. Narrow band imaging (NBI), an image-enhanced imaging system of the endoscopy, is developed to improve the diagnostic performance of the endoscopy. We tested whether the new generation of NBI colonoscopy would improve detection of colorectal adenoma when compared with high-definition white light (HD-WL) in a randomised tandem colonoscopy study ...postprin

Metformin Use and Gastric Cancer Risk in Diabetic Patients After Helicobacter pylori Eradication

Background: Although prior studies showed metformin could reduce gastric cancer (GC) risk in patients with diabetes mellitus (DM), they failed to adjust for Helicobacter pylori infection and glycemic control. We aimed to investigate whether metformin reduced GC risk in H. pylori -eradicated diabetic patients and its association with glycemic control. Methods: This was a territory-wide cohort study using hospital registry database, recruiting all diabetic patients who were prescribed clarithromycin-based triple therapy for H. pylori infection from 2003 to 2012. Subjects were observed from H. pylori therapy prescription until GC diagnosis, death or end of study (December 2015). Exclusion criteria included GC diagnosed within first year of H. pylori therapy, prior history of GC or gastrectomy, and failure of H. pylori eradication. The hazard ratio (HR) of GC with metformin (defined as at least 180-day use) was estimated by Cox model with propensity score adjustment for covariates (age, sex, comorbidities, medications [including insulin], and time-weighted average hemoglobin A1c [HbA1c]). All statistical tests were two-sided. Results: During a median follow-up of 7.1 years (IQR:4.7–9.8), 37 (0.51%) of 7,266 diabetic patients developed GC at a median age of 76.4 years (IQR: 64.8–81.5 years). Metformin use was associated with a reduced GC risk (adjusted HR:0.49; 95% CI:0.24–0.98). There was a trend towards a lower GC risk with increasing duration (ptrend =0.01) and dose of metformin (ptrend=0.02) HbA1c level was not an independent risk factor for GC. Conclusions: Metformin use was associated with a lower GC risk among H. pylori -eradicated diabetic patients in a duration- and dose-response manner, which was independent of HbA1c level

Ten days quadruple versus sequential therapy as empirical first- and second-line treatment for Helicobacter pylori eradication: a randomised crossover trial

This journal suppl. entitled: 18th Medical Research Conference; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongOral PresentationINTRODUCTION: Helicobacter pylori (HP) is one of the commonest bacterial infections worldwide. The eradication rate of clarithromycin-based and bismuth-based therapy has been declining in the western world. The aim of the study was to compare the efficacy and tolerability of HP eradication with a 10-day sequential therapy versus quadruple therapy as empirical first- and second-line ...postprin

Levels of HBV DNA and not HBsAg are associated with biochemical flares after HBeAg seroconversion

BACKGROUND: The role of HBsAg levels in predicting subsequent flares in chronic hepatitis B patients after HBeAg seroconversion is not known METHODS: Serum HBsAg and HBV DNA levels were determined in 224 CHB patients at 6-12 months after spontaneous HBeAg seroconversion. Serum HBV DNA levels were performed using Cobas Taqman assay. HBsAg titers were determined using Roche Elecsys HBsAg II ...postprin

Effect of nucleos(t)ide analogues therapy on HBsAg, intrahepatic HBV DNA and covalently closed circular DNA levels

BACKGROUND: We aimed to study 1) the effects of 1-year nucleos(t)ide analogue (NA) therapy on HBsAg and covalently closed circular DNA (cccDNA) levels; and 2) the possible use of HBsAg reduction as a marker for cccDNA reduction. METHODS: We recruited 124 NA-treated patients with ...postprin

Prevalence of past or current Hepatitis B infection and factors for non-vaccination in Chinese patients with inflammatory bowel diseases

The Conference program's website is located at http://jsibd.jp/1staocc/program.htmlPoster Oral: PO-46Information on the prevalence and natural history of chronic hepatitis B (HBV) among Asian IBD patients are scarce. Moreover, the prevalence of HBV vaccination coverage in Asian IBD patients remains unknown. AIM: We determined the prevalence and clinical course of current and past HBV infection among Chinese IBD patients. We also determined the proportion of Chinese IBD patients without protective antibody against HBV and factors associated with non-vaccination. METHODS: All patients attending our IBD Clinic had blood tests for viral hepatitis B markers. The prevalence of current and past infection with HBV, and effective HBV vaccination were determined. We also identified for risk factors associated with non-vaccination. RESULTS: A total of 267 Chinese IBD (166 ulcerative colitis and 101 Crohn’s disease) patients were studied. The mean follow up was 10.5 years. Current HBV infection was detected in 6.7% patients whereas 28.5% had evidence of past HBV infection. One hundred and two (38.2%) patients had no detectable anti-HBs antibodies. Multivariate analysis found that young age of diagnosis (OR 1.021; 95% CI 1.00 – 1.04) and the use of thiopurines (OR 0.51; 95%CI 0.29 – 0.91) were associated with absence of anti-HBs. Deranged liver function was detected in 27 (10.1%) IBD patients including three (16.7%) HBsAg-positive patients. The corresponding proportion of patients with liver derangement was 7.9% in patients with past HBV infection, 8.9% in HBsAg-negative patients without anti-HBs and 11.2% in patients with effective HBV vaccination (P = 0.71). CONCLUSION: Current and past infection with HBV was detected in about one-third of Chinese IBD patients. Approximately 40% of IBD patients lacked protective antibody against HBV. The use of thiopurines and young age of diagnosis was associated with non-vaccination among Chinese IBD patients. A more intensive HBV vaccination program with regular monitoring of anti-HBs may be needed in this group of patients.published_or_final_versio