Chemokines and receptors in intestinal B lymphocytes.

Recent studies indicate that chemoattractant cytokines (chemokines) and their receptors modulate intestinal B lymphocytes in different ways, including regulating their maturity and differentiation in the bone marrow and homing to intestinal target tissues. Here, we review several important chemokine/chemokine receptor axes that guide intestinal B cells, focusing on the homing and migration of IgA antibody-secreting cells (IgA-ASCs) to intestinal-associated lymphoid tissues. We describe the selective regulation of these chemokine axes in coordinating the IgA-ASC trafficking in intestinal diseases.

Boceprevir early-access for advanced-fibrosis/cirrhosis in Asia-Pacific hepatitis C virus genotype 1 non-responders/relapsers.

Aim: To examined the efficacy and safety of treatment with boceprevir, PEGylated-interferon and ribavirin (PR) in hepatitis C virus genotype 1 (HCVGT1) PR treatment-failures in Asia.

Methods: The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures. Participating physicians were invited to contribute data from their patients: baseline characteristics, on-treatment responses, sustained virological response at week 12 (SVR12), and safety were collected and analysed.

Endoscopic biopsy features and diagnostic challenges of adult Crohn's disease at initial presentation.

Aims: Endoscopic biopsy diagnosis of Crohn's disease (CD) is problematic due to lack of specific microscopic features and patchy involvement. There is no documentation of the pattern and severity of microscopic features of CD at initial presentation in adults or children. We aimed to assess the initial mucosal biopsy features of CD in adults and to identify any specific features to confirm the diagnosis.

Patients' perception of transnasal gastroscopy.

Introduction: Gastroscopy is an excellent technique for investigation of upper gastrointestinal pathology. However, patients frequently request for conscious sedation as the procedure causes pain, pharyngeal reflex and nausea. Administration of conscious sedation incurs additional medical expenditure and risks.

Early experience with double balloon enteroscopy: a leap forward for the gastroenterologist.

Introduction: Double balloon enteroscopy (DBE) is a novel procedure that allows complete visualisation, biopsy and treatment of small intestinal disorders. We describe our early experience with the use of DBE, evaluating the indications, diagnostic rates and complications. A secondary aim of the study was to compare the findings from DBE with wireless capsule endoscopy (WCE).

Crohn's disease runs a more aggressive course in young Asian patients.

Background: Crohn's disease is a heterogeneous inflammatory bowel disease. The impact of age at diagnosis on the clinical course of patients varies widely as reported in the Western literature. Using the Vienna Classification, we seek to determine whether young Crohn's disease patients in an Asian population followed a different clinical course than old patients.

Dysphagia as a side effect of botulinum toxin injection.

Dysphagia is a known adverse effect of botulinum toxin injection into the cervical region for dystonia. We present an unusual case of dysphagia arising from injection into the orbicularis oculi muscle, which has hitherto not been described. We postulate that her dysphagia was caused by distant side effects of botulinum toxin due to repeated injections.

Appropriateness of the use of parenteral nutrition in a local tertiary-care hospital.

Introduction: Parenteral nutrition (PN) is an important supportive therapy for critically ill patients who have non-functioning gut. However, it is an expensive therapy and carries significant complications. The objective of our audit was to determine the appropriateness of prescription of PN in our hospital, based on the American Society for Parenteral and Enteral Nutrition (ASPEN) 2002 guidelines.

Audit of investigations in patients with iron deficiency anaemia.

Background: Patients with iron deficiency anaemia (IDA) are commonly referred to the gastroenterologists for exclusion of gastrointestinal (GI) pathologies. The British Society of Gastroenterology (BSG) has published a guideline for management of IDA. As recommended by this guideline, all patients should have examinations of both upper and lower GI tract with the exception of pre-menopausal women younger than 45 years old.

Gastrointestinal Cytomegalovirus infection in non-human immunodeficiency virus infected patients.

This is a retrospective study of fourteen patients who had proven Cytomegalovirus (CMV) infection of the gastrointestinal tract with no Human Immunodeficiency virus infection. The median age was 60.5 (Range 28 to 81) years.

Mathematical model for predicting biliary therapeutic endoscopic retrograde pancreatography (ERCP).

Introduction: Magnetic resonance cholangiopancreatography is as sensitive as endoscopic retrograde pancreatography in the evaluation of biliary tract diseases but does not offer therapeutic options. The aim of the present study was to develop a mathematical model to predict 'therapeutic endoscopic retrograde pancreatography' using clinical variables so that patients with low probability could be more appropriately investigated by magnetic resonance cholangiopancreatography in future.

Methods: Endoscopic retrograde pancreatography cases between January 1996 to December 1997 were retrospectively reviewed (before introduction of magnetic resonance cholangiopancreatography).

Clinical characteristics of ulcerative colitis in Singapore, a multiracial city-state.

Background: Ulcerative colitis (UC) is rare in Asia. Singapore is an ethnically heterogeneous city-state with a population made up of Chinese (77%), Indians (7.5%), and Malays (14%).

Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition.

Introduction: The prevalence of deranged liver function tests (LFT) in patients on long-term home parenteral nutrition (HPN) is poorly documented. The aim of our study was to document the prevalence of this complication and possible associated factors.

Method: Retrospective analysis of case notes of 107 patients on HPN was performed.

Helicobacter pylori infection is unlikely to be transmitted between partners: evidence from genotypic study in partners of infected patients.

Introduction: We postulated that the oro-oral route of transmission between spouses could be an important route of transmission of Helicobacter pylori.

Aims: To estimate the prevalence of different genotypes of H. pylori as distinguished by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in our local population, and to compare the genotypes of H.

Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease.

Aim: Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated.

Methods: Physical and psychological well-being were assessed using questionnaires administered to 100 out-patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis.

Percutaneous endoscopic gastrostomy--indications and outcome of our experience at the Singapore General Hospital.

Introduction: Percutaneous endoscopic gastrostomy (PEG) is widely used for patients with dysphagia from neurological causes and head and neck malignancy. We examined the indications, complication rates and long term outcome of PEG inserted in our department.

Methods: We performed a study of PEG inserted in our department between January 1995 to March 2000.

Gastrointestinal manifestations of systemic lupus erythematosus.

Gastrointestinal symptoms are common in patients with systemic lupus erythematosus (SLE) and can be due to primary gastrointestinal disorders, complications of therapy or SLE itself. In this case report, we describe three different presentations and causes of gastrointestinal complaints in patients with SLE. Diagnostic and management problems are discussed.

Efficacy of a nitroimidazole containing tripletherapy regime in Singapore.

Background: There has been a gradual increase in the proportion of Singapore patients with metronidazole resistant strains of Helicobacter pylori. We studied the efficacy of a nitroimidazole containing regime in eradicating H. pylori.

Survey of dyspepsia management in community.

Introduction: Dyspepsia is a common complaint and represents an important health problem in the community. The aim of the study was to survey the diagnostic approach and management of dyspepsia and Helicobacter pylori (H. pylori) infection by primary care physicians.

One week triple therapy for Helicobacter pylori associated duodenal ulcer disease.

Introduction: Eradication of Helicobacter pylori (H. pylori) cures and prevents the relapse of duodenal ulceration. Different treatment regimes for the eradication of H.

A combination of ciprofloxacin and Rowachol does not prevent biliary stent occlusion.

Background: Endoscopic insertion of biliary prostheses is now an established palliative treatment for frail and elderly patients with distal extrahepatic malignant biliary strictures who are unable to tolerate major surgery. The major limitation to long-term biliary stenting is late stent occlusion caused by bacterial adherence followed by encrustation with amorphous bacterial products. We studied the effect on the duration of stent patency of combination therapy with ciprofloxacin and Rowachol, a choleretic agent, in a group of patients who underwent stent insertion for extrahepatic malignant biliary strictures.

Nitric oxide and gall-bladder motor function.

Background: The L-arginine: nitric oxide (NO) pathway has been shown to be important in the regulation of intestinal motility and NO may be the mediator for nonadrenergic noncholinergic (NANC) neurotransmission.

Aim: To determine the role of the L-arginine: NO pathway in gall-bladder motor function.

Methods: Strips of fresh bovine and human gall-bladders were stimulated with cholecystokinin (CCK).

Influence of cholecystectomy on sphincter of Oddi motility.

Background: Gall bladder and sphincter of Oddi (SO) function are coordinated by hormonal and neuronal mechanisms. Nerve fibres pass between the gall bladder and the SO via the cystic duct. It is therefore possible that cholecystectomy may alter SO motility.