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( Kok-ann Gwee ),( Paul Bergmans ),( Jinyong Kim ),( Bogdana Coudsy ),( Angelia Sim ),( Minhu Chen ),( Lin Lin ),( Xiaohua Hou ),( Huahong Wang ),( Khean-lee Goh ),( John A Pangilinan ),( Nayoung Kim 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.2
Background/Aims There is a need for a simple and practical tool adapted for the diagnosis of chronic constipation (CC) in the Asian population. This study compared the Asian Neurogastroenterology and Motility Association (ANMA) CC tool and Rome III criteria for the diagnosis of CC in Asian subjects. Methods This multicenter, cross-sectional study included subjects presenting at outpatient gastrointestinal clinics across Asia. Subjects with CC alert symptoms completed a combination Diagnosis Questionnaire to obtain a diagnosis based on 4 different diagnostic methods: self-defined, investigator`s judgment, ANMA CC tool, and Rome III criteria. The primary endpoint was the level of agreement/ disagreement between the ANMA CC diagnostic tool and Rome III criteria for the diagnosis of CC. Results The primary analysis comprised of 449 subjects, 414 of whom had a positive diagnosis according to the ANMA CC tool. Rome III positive/ANMA positive and Rome III negative/ANMA negative diagnoses were reported in 76.8% and 7.8% of subjects, respectively, resulting in an overall percentage agreement of 84.6% between the 2 diagnostic methods. The overall percentage disagreement between these 2 diagnostic methods was 15.4%. A higher level of agreement was seen between the ANMA CC tool and self-defined (374 subjects [90.3%]) or investigator`s judgment criteria (388 subjects [93.7%]) compared with the Rome III criteria. Conclusion This study demonstrates that the ANMA CC tool can be a useful for Asian patients with CC. (J Neurogastroenterol Motil 2017;23:262-272)
Inflammation and Functional Gastrointestinal Disorders IBS Lessons From Developing Countries
( Kok Ann Gwee ) 대한소화기학회 2007 SIDDS Vol.9 No.-
Recent research on the epidemiology of IBS in developing countries, alternative dietary mechanisms, and the role of infection provide exciting new ideas on the causation of IBS beyond traditional ideas pertaining to fibre and stress. Studies from recently affluent Asian countries suggest that there is a rising prevalence of IBS, particularly in the more privileged and better educated classes of society. This coupled with the promotion of dairy products and wholegrain cereals as healthier dietary choices could lead to greater exposure of the intestinal immune system to the common food antigens that have been implicated in an immune mediated food intolerance in IBS patients. While infection is now recognised to be a strong risk factor for the development of IBS in industrialised countries, early studies from endemic countries suggest that on the contrary early exposure to infections like amoeba could protect against IBS. These observations may be placed within an inflammatory model to support a role in the development of IBS. More research in developing countries could offer further lessons for our understanding of the pathogenesis.
( Kok Ann Gwee ) 대한소화기학회 2007 SIDDS Vol.9 No.-
A high prevalence of overlap between functional dyspepsia and irritable bowel syndrome has been consistently and universally reported. The prevalence of overlap is greater in patient series than community series. This together with some direct evidence suggest that patients with FD-IBS are more affected by their symptoms and are more likely to be referred for specialist attention. It is possible that some IBS patients with pain referred to the upper abdomen may be mislabelled as FD, and that this could pose a risk factor for unnecessary cholecystectomy. The FD-IBS overlap entity could also be attributed to the presence of a generalised rather than regional disorder of the gut. For example constipated IBS patients may exhibit both delayed gastric emptying and slow intestinal transit, while visceral hypersensitivity involving more than one region has also been demonstrated in FD and IBS subjects. IBS and FD could also arise from a common infectious trigger such as salmonella. Studies of symptom turnover report substantial flux between FD and IBS. Recent studies appear to suggest a declining incidence of FD, and this coupled with the recent recognition even by the Rome committee that there are very few patients with pure FD, raises questions regarding its relevance for the future.
( Kok-Ann Gwee ),( Uday C Ghoshal ),( Sutep Gonlachanvit ),( Andrew Seng Boon Chua ),( Seung-Jae Myung ),( Shaman Rajindrajith ),( Tanisa Patcharatrakul ),( Myung-Gyu Choi ),( Justin C Y Wu ),( Min-Hu 대한소화기기능성질환·운동학회 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.2
Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.
Second Asian Consensus on Irritable Bowel Syndrome
Kok-Ann Gwee,Sutep Gonlachanvit,Uday C Ghoshal,Andrew S B Chua,Hiroto Miwa,Justin Wu,Young-Tae Bak,Oh Young Lee,Ching-Liang Lu,Hyojin Park,Minhu Chen,Ari F Syam,Philip Abraham,Jose Sollano,Chi-Sen Cha 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.3
Background/AimsThere has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely toupdate the Asian IBS Consensus. MethodsKey opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology,pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process wascarried out by using a modified Delphi method. ResultsThirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-braininteraction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and uppergastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet,probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. ConclusionsOur consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view toholistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.
( Kok Ann Gwee ) 대한소화관운동학회 2010 Journal of Neurogastroenterology and Motility (JNM Vol.16 No.1
This review presents studies that support an inflammation-immunological model for the pathogenesis of post-infectious irritable bowel syndrome (IBS), and highlights recent studies that support a similar disease model in non-post-infectious IBS, in particular, diarrhoea-predominant IBS, as well as in post-infectious functional dyspepsia. These recent studies are highlighted to demonstrate that one Line of research in functional gastrointestinal disorders has moved away from the old psychosomatic concepts. It is hoped that this will encourage future students of this field to explore the role of immunological events.(J Neurogastroenterol Motil 2010;16:30-34)
( Wei Lu ),( Kok Ann Gwee ),( Kewin Tien Ho Siah ),( Jin Yong Kang ),( Ru Min Lee ),( Cecilia Cheng Lai Ngan ) 대한소화기기능성질환·운동학회 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.2
Background/AimsNon-celiac gluten sensitivity has been increasingly recognized as a predisposing factor for irritable bowel syndrome (IBS)-likesymptoms in Western populations where celiac disease (CD) is relatively common. In Asia where CD is rare, we wish to determinethe prevalence of gluten protein associated serology in IBS patients, which has not been formally studied, and its relationto histological and human leukocyte antigen (HLA) markers. MethodsWe reviewed a consecutive cohort of Asian patients with IBS, who had undergone serologic testing for IgA against deamidatedgliadin peptide antibodies (IgA DGP) and IgA anti-endomysium antibodies, and who also had duodenal biopsies during clinicalworkup. In addition, a subset of Chinese patients with positive serology was further tested for HLA-DQ2 and HLA-DQ8. ResultsOf 186 patients, 34 (18%) were positive for IgA DGP; bloating, abdominal pain, belching and diarrhea were the most com -monly reported symptoms but diarrhea as the most bothersome symptom was significantly more common in IgA DGP positivepatients. Mildly increased intra-epithelial lymphocytes on duodenal biopsy was also more common (29% vs. 9%, P = 0.001). Nine of 21 Chinese patients tested as IgA DGP positive undertook HLA-DQ2/DQ8 testing, with only 2 being positive forHLA-DQ8. All patients with positive IgA DGP reported symptom improvement with gluten withdrawal. ConclusionsWe have described a series of Asian, mainly Chinese, patients with IBS who were tested positive for IgA DGP, and improvedon a gluten exclusion diet. We believe this is the first report of non-celiac gluten sensitivity in Asia, a region where CD isuncommon