Background and Aim:The gut microbiota in irritable bowel syndrome (IBS) is known to vary with diet. We aim to (i) analyze the gut microbiota composition of IBS patients from a multi-ethnic population and (ii) explore the impact of a low FODMAP diet on gastrointestinal symptoms and gut microbiota composition among IBS patients. Methods: A multi-center study of multi-ethnic Asian patients with IBS was conducted in two phases: (i) an initial cross-sectional gut microbiota composition study of IBS patients and healthy controls, followed by (ii) a single-arm 6-week dietary interventional study of the IBS patients alone, exploring clinical and gut microbiota changes. Results: A total of 34 adult IBS patients (IBS sub-types of IBS-D 44.1%, IBS-C 32.4%, and IBS-M 23.5%) and 15 healthy controls were recruited. A greater abundance of Parabacteroides species with lower levels of bacterial fermenters and short-chain fatty acids producers were found among IBS patients compared with healthy controls. Age and ethnicity were found to be associated with gut microbiota composition. Following a low FODMAP dietary intervention, symptom and quality of life improvement were observed in 24 (70.6%) IBS patients. Symptom improvement was associated with adherence to the low FODMAP diet (46.7% poor adherence vs 92.9% good adherence, P = 0.014), and gut microbiota patterns, particularly with a greater abundance of Bifidobacterium longum, Anaerotignum propionicum, and Blautia species post-intervention. Conclusion: Gut microbiota variation in multi-ethnic IBS patients may be related to dietary intake and may be helpful to identify patients who are likely to respond to a low FODMAP diet.
Background Inflammatory bowel disease is an uncommon disease in developing nations whereby patient’s knowledge on the disease may be limited. The CCKNOW questionnaire, a widely known questionnaire to assess patient’s knowledge on the disease, may be too complex to comprehend for patients in developing countries. The aim of this study is to develop a new tool known as AIBDKQ questionnaire to evaluate the local inflammatory bowel disease patient’s knowledge. Methods This was a prospective study carried out in four phases. In phase 1, three gastroenterologists with expertise in IBD generated a total of 21 questions related to the general knowledge of the disease in the English language. Phase 2 involved content and face validity whereby the questions were further validated by other gastroenterologists. In phase 3, the validated questions were translated into three languages namely Malay, Mandarin and Tamil which are commonly used in Malaysia. In phase 4 (statistical validity), administration of the questionnaires to patients and hospital staff were conducted to assess the construct validity, discriminative ability, predictive validity and reliability of the questionnaires. Results A total of 21 questions were generated initially. Further evaluation indicated that 20 items had adequate kappa and content validity index for relevance (CVI: 0.714 to 1, Kapp: 0.645 to 1) and clarity (CVI: 0.714 to 1, Kapp: 0.645 to 1). The questionnaires in four languages were administered to 213 patients to assess the construct validity. Six items were removed (three for low communality, one for small loading factors, two for cross loading), resulting in 16 final questions. Assessment with 34 hospital staff involving nurses, doctors and clerks showed significant differences in knowledge between the groups (F = 14.007, p < 0.001) and were able to discriminate doctors from nurses and clerks. Another group of 18 hospital staff administered with AIBDKQ and CCKNOW questionnaires showed a Pearson’s correlation coefficient of 0.8 indicating strong correlation and concurrent predictive validity between the two questionnaires. Final assessment with 38 patients for reliability assessment revealed high intraclass correlation of the questionnaire among the four languages. Conclusions The AIBDKQ has an excellent discriminant ability and internal consistency with a strong correlation when compared to the standard CCKNOW questionnaire.
Background: The differentiation between intestinal tuberculosis from Crohn's disease remains a challenge, particularly in areas where tuberculosis is highly prevalent. Previous studies have identified features that favor one diagnosis over the other. To determine the accuracy of a standardized protocol in the initial diagnosis of Crohn’s disease versus intestinal tuberculosis. Methods: All patients with suspected intestinal tuberculosis or Crohn’s disease were prospectively recruited. A standardized protocol was applied and the diagnosis was made accordingly. The protocol consists of; history and examination, ileocolonoscopy with biopsies, and tuberculosis workup. The diagnosis of probable intestinal tuberculosis was made based on at least one positive finding. All other patients were diagnosed as probable Crohn’s disease. Patients were treated either with anti-tubercular therapy or steroids. Reassessment was then carried out clinically, biochemically and endoscopically. In patients with suboptimal response, the treatment was either switched or escalated depending on the reassessment. Results: 164 patients were recruited with final diagnosis of 30 (18.3%) intestinal tuberculosis and 134 (81.7%) Crohn’s disease. 1 (3.3%) out of 30 patients with intestinal tuberculosis was initially treated as Crohn’s disease. 16 (11.9%) out of 134 patients with Crohn’s disease were initially treated as intestinal tuberculosis. The initial overall accuracy for the protocol was 147/164 (89.6%). All patients received the correct diagnosis by 12 weeks after reassessment. Conclusion: In our population, most patients had CD rather than ITB. The standardized protocol had a high accuracy in differentiating CD from ITB.
Background and AimsThiopurines, which are immunosuppressive drugs for maintaining remission for inflammatory bowel disease, are known to cause myelotoxicity in patients with Nudix Hydroxylase 15 (NUDT15) genetic variants in some Asian countries with monoethnic populations. We aimed to investigate the association of NUDT15 variants with leukopenia in a multiethnic population in Southeast Asia.MethodsPatients with a confirmed diagnosis of inflammatory bowel disease were recruited. We collected demographic and clinical characteristics and whole blood counts before and after initiating thiopurines. Thiopurine S-methyltransferase (TPMT) and NUDT15 genotypes were analyzed with the single nucleotide polymorphisms (SNPs) genotyping assay. Leukopenia was defined as a white blood cell (WBC) count < 3,000/μl.ResultsIn this study, 19 (18.6%) of the 102 patients who had adequate thiopurine therapy experienced leukopenia, 11 patients (57.9%) had NUDT15 c.415C > T variants, 2 patients (10.5%) had NUDT15 c.52G > A variants while one (5.3%) had a TPMT variation. Individually, NUDT15 c.415C > T had a sensitivity and specificity of 57.9% and 94.0% (odds ratio [OR] = 21.45, 95% CI 5.94–77.41, p < 0.001), respectively, for predicting thiopurine-induced leukopenia, while NUDT15 c.52G > A was only observed in patients with leukopenia. As compared with patients with wild-type NUDT15, both NUDT15 variations had a combined sensitivity and specificity of 68.4% and 94%, respectively (OR = 33.80, 95% CI 8.99–127.05, p < 0.001), for predicting thiopurine-induced leukopenia as well as a shorter onset to leukopenia (median onset [months] 2.0 vs. 5.5; p = 0.045). Sub-group analysis showed that both NUDT15 variations were strongly associated with leukopenia among the Chinese and Indians but not among the Malays.ConclusionNudix Hydroxylase 15 variants strongly predicted thiopurine-induced leukopenia across a multiethnic Southeast Asian population, particularly among the Chinese and Indians.
Introduction Clinical practice guidelines recommend periodic colonoscopy surveillance following colorectal adenoma excision. Inappropriate use of post polypectomy surveillance is common and lead to improper resource utilisation.The aim of this review is to identify structured interventions which can affect post polypectomy surveillance practices and to evaluate the effectiveness of these various interventions in improving clinician adherence to post polypectomy surveillance guidelines. Methods A computerised search was performed to identify relevant studies between 1997 to November 2020. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the Newcastle-Ottawa risk of assessment scoring system. Results The search identified 5602 citations. Forty-one articles were retrieved for full text analysis and seven studies met the inclusion criteria. Compliance to PPS guidelines were higher following interventions which included medical education, specialist nurse coordinators facilitation, continuous quality improvement and clinical decision support systems. Conclusion This study demonstrates that medical education, specialist nurse coordinators, continuous quality improvement and clinical decision support systems are effective in improving clinicians’ compliance to post polypectomy surveillance guidelines and is associated with reduction in over- and underutilisation of colonoscopy surveillance resources.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.