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Biomedical subjects

J Y Kang

Publications and source records attributed to J Y Kang.

At least 19 recordsLinked to original sources
PubMed1992

Chronic upper abdominal pain: site and radiation in various structural and functional disorders and the effect of various foods.

Pain site and radiation and the effect of various foods were studied prospectively in a consecutive series of patients with chronic upper abdominal pain. Patients followed for less than one year were excluded unless peptic ulcer or abdominal malignancy had been diagnosed or laparotomy had been carried out. A total of 632 patients were eligible for the first study and 431 for the second. Gastric ulcer pain was more likely to be left hypochondrial (17%) compared with pain from duodenal ulcer (4%) or from all other conditions (5%). It was less likely to be epigastric (54%) compared with duodenal ulcer pain (75%). Oesophageal pain was more likely to be both retrosternal and epigastric (25%) compared with non-oesophageal pain (2%). Radiation to the back was more common in peptic ulcer (31%) and biliary pain (35%) compared with functional pain (20%). Pain precipitation by fatty foods was commoner in biliary disease (40%) than in duodenal ulcer (11%), peptic ulcer (9%), or non-ulcer dyspepsia (19%). Orange, alcohol, and coffee precipitated pain more frequently in duodenal ulcer (41%, 50%, and 43% respectively) than in biliary disease (17%, 0%, and 14% respectively). Chilli precipitated pain in one quarter to one half of subjects regardless of diagnosis. Approximately one tenth of all subjects avoided chilli, curry, coffee, and tea because of medical or other advice.

Abdominal Pain↗
PubMed1992

Helicobacter pylori and gastric cancer: correlation with gastritis, intestinal metaplasia, and tumour histology.

This study aimed to examine the association between Helicobacter pylori, histological gastritis, and intestinal metaplasia in gastric cancers of different histological types. A total of 169 gastrectomy specimens received in one pathology department were studied. Altogether 156 were adenocarcinomas (intestinal type 87, diffuse type 50, mixed type 19). Gastritis occurred in 137 of 163 body specimens (84%) and in 126 of 131 antral specimens (96%). Its presence was unrelated to tumour histology. Atrophic gastritis was more common in both body and antral mucosa in intestinal type compared with diffuse type carcinoma. This was also true for intestinal metaplasia of the body, but not of the antral mucosa. H pylori was present in 101 of 163 (62%) body specimens and 56 of 131 (43%) antral specimens. In intestinal type carcinoma, H pylori was found in 52/84 (62%) body specimens and in 24/70 (34%) antral specimens, while the corresponding figures for diffuse type carcinoma were 29/48 (60%) and 17/38 (45%) respectively. Tumour histology therefore had no influence on the occurrence of H pylori. Tumour site had no effect on the presence or absence of gastritis, atrophic changes, intestinal metaplasia, or H pylori. While both H pylori and gastritis are associated with gastric cancer, the association is unrelated to tumour histology and may not be a causal one.

Adenocarcinoma↗
PubMed1992

Association of Helicobacter pylori with HLA-DR antigen expression in gastritis.

AIMS: To assess the association between Helicobacter pylori-associated gastritis and HLA-DR antigen (class II antigen) expression. METHODS: Fifty endoscopic gastric biopsy specimens were studied for the presence of H pylori, degree and type of inflammation, and for HLA-DR antigen expression in the epithelium. The cases were chosen to represent different categories: inflamed gastric mucosa with (n = 13) and without (n = 20) H pylori, and non-inflamed mucosa (n = 17). RESULTS: The antigen was aberrantly expressed in the antral mucosal epithelium in 11 of 12 cases (92%) with acute-on-chronic gastritis when H pylori was also present. It was present in the antrum in only seven of 18 H pylori negative cases (39%) with acute-on-chronic/chronic gastritis. One of three cases of acute gastritis and three of seven cases of chronic gastric erosions (non-inflamed category) showed positive staining. Generally, there was more staining in the antral than body mucosa and in the surface/foveolar epithelium than in the glands. No aberrant HLA-DR antigen expression was found in the 10 cases of normal gastric mucosa examined. CONCLUSIONS: These findings suggest that H pylori may have a role in the induction of class II HLA antigen expression in chronic gastritis and lend support to the view that these organisms may be responsible for part of the inflammatory response.

Acute Disease↗
PubMed1992

Some observations on the epidemiology of peptic ulcer disease in Singapore.

Several lines of evidence suggest that, of the three main races of Singapore, peptic ulcers are more common among the Chinese and Indians when compared to the Malays. These include studies on hospital series of patients with or without appropriate control groups, studies on the incidence of surgery for perforated ulcer as well as mortality statistics. A reduction in the Chinese:Malay difference in the incidence of perforated ulcer over three decades suggests that environmental factors are involved in producing these racial differences. However, we have to date been unable to determine the factor(s) responsible. The incidence of perforated ulcer in Singapore is increasing while ulcer mortality is declining. This is similar to the situation in Hong Kong but different from that in the western countries.

China↗
PubMed1992

The prevalence of isolated unconjugated hyperbilirubinaemia (Gilbert's syndrome) in subjects attending a health screening programme in Singapore.

We retrospectively studied the prevalence of hyperbilirubinaemia in 1,296 consecutive subjects attending a hospital health screening programme over an eighteen-month period. Sixty-four subjects (5%) had elevated bilirubin levels. Forty-one subjects (3.2%) had isolated unconjugated hyperbilirubinaemia. These subjects probably had Gilbert's syndrome. Recognition of this common benign condition is important to avoid unnecessary investigations.

Adolescent↗
PubMed1991

Helicobacter pylori and gastric acid output in peptic ulcer disease.

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association between Helicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%), Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence of Helicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence of Helicobacter pylori. However, gastric ulcer patients with Helicobacter had higher basal and maximal acid outputs when compared to patients without Helicobacter (mean basal output: 4.1 mmol/hr vs 2.4, P less than 0.05; mean maximal output 19.5 mmol/hr vs. 14.4, P less than 0.05). Although Helicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.

Duodenal Ulcer↗
PubMed1991

Acid and gastric ulcer pain.

We have shown previously that acid is one factor, although not the only one, in the pathogenesis of duodenal ulcer pain. In the present study patients with gastric ulcer were endoscoped without sedation or premedication. Under direct vision the ulcer craters were infused sequentially with 0.1 N HCl and normal saline, the sequence of infusion being randomized and double blind. Typical ulcer pain occurred in seven of 19 patients during acid infusion compared with one with saline (p = 0.023). Two patients who developed pain on acid were rechallenged after their pain disappeared, and typical pain recurred in both. Acid therefore has a definite role in the pathogenesis of gastric ulcer pain.

Female↗
PubMed1991

Seroprevalence of antibodies to the hepatitis C virus in Singapore.

The prevalence of antibodies to the hepatitis C virus (anti-HCV) in Singapore was assessed using a recombinant-based enzyme linked immunoassay system. 1004 serum samples were obtained from normal subjects (463), hemodialysis patients (112), hepatitis B virus (HBV) carriers (188), patients with hepatocellular carcinoma (HCC) (58) and patients with non-hepatitis B virus related liver diseases (183). Anti-HCV was found to be positive in 1.7% of healthy subjects, and in 20% of patients on regular hemodialysis. Three percent of HBV carriers were positive for anti-HCV. Twelve percent of patients with acute hepatitis with no known causes and 20% patients with chronic hepatitis with no known causes were positive for anti-HCV. Among patients with cirrhosis for which no known causes were found 33% were positive for anti-HCV. Thirty six percent of patients with HCC not associated with the presence of HBsAg were positive of anti-HCV. None of the patients with known causes of liver disease were positive for anti-HCV.

Adolescent↗
PubMed1991

Cost-effectiveness analysis of medical and surgical treatment for duodenal ulcer in Singapore.

A mathematical model involving transitions between possible states of duodenal ulcer was used to calculate the costs of various treatments, medical and surgical, which are available for the long-term management of duodenal ulcer. Costs of medical and surgical treatment were based on costs incurred at the National University Hospital, Singapore as at 1990. Elective surgery incurs a high cost, both financial and in terms of mortality, at the outset with minimal additional costs subsequently. The various medical options cost less initially but their costs are cumulative and eventually overtake the costs of surgical treatment. These calculations are based on the use of a proprietary preparation of a histamine-2-blocker. If a generic preparation is used, medical treatment becomes considerably cheaper over a 15 year period.

Cost-Benefit Analysis↗
PubMed1991

Investigation of rectal bleeding.

We studied a consecutive series of 115 patients presenting to one gastroenterologist with non-emergency rectal bleeding or positive faecal occult blood studies. When there is a clear history that the bleeding was perianal, 26 out of 33 patients (79%) were found to have haemorrhoids. In the absence of such a history (n = 82), 16 patients (20%) had colonic cancer or polyps, 20 (25%) colitis; 24 (29%) perianal disease while only 15 (18%) had no pathology demonstrated. Our experience coupled with a review of the literature on the investigation of rectal bleeding lead us to the following recommendations: (1) Total colonoscopy or flexible sigmoidoscopy plus double contrast barium enema should normally be performed; (2) when there is a clear history that the bleeding is perianal, flexible sigmoidoscopy may suffice.

Adolescent↗
PubMed1990

The site of recurrent duodenal ulcer.

The aim of this retrospective study was to determine the site of recurrent duodenal ulcer in relation to the site of the index ulcer. One hundred and thirty-five patients who had recurrent duodenal ulcer after documented healing of an index ulcer were studied. The recurrent ulcer was more likely to occur in the anterior bulb if the index ulcer was anterior (35 of 58 = 60%) than if the index ulcer was not anterior (29 of 77 = 38%, p less than 0.01). However, the likelihood of a recurrent ulcer on the posterior wall of the bulb was not significantly different whether the index ulcer was posterior (11 of 36 = 31%) or not (22 of 99 = 22%, p less than 0.24). Three of 20 patients (15%) who initially presented with bleeding bled again with their recurrent ulcers, compared with eight of 115 patients (7%) who first presented with dyspepsia only (p = 0.39). Thirteen patients were assessed independently by two endoscopists to determine ulcer site. Their assessments concurred for 12 (92%).

Adolescent↗
PubMed1990

Remission of Ménétrier's disease associated with ranitidine administration.

We describe a patient with Ménétrier's disease in whom acute administration of ranitidine reduced gastric protein loss more effectively than cimetidine or propantheline. This patient went into remission following a course of ranitidine. We reviewed the literature on remissions in Ménétrier's disease occurring without surgery. More detailed studies of various anti-secretory agents on individual patients are required to determine whether or not they are truly efficacious.

Adult↗
PubMed1990

The influence of dialect group on peptic ulcer frequency amongst the Chinese in Singapore.

In Singapore, peptic ulcer is more common amongst Chinese than amongst Malays or Indians. Earlier work has suggested that, amongst female Chinese, Cantonese women are more susceptible to ulcer disease when compared to females of other dialect groups. The aim of the present study was to confirm or refute this possibility. The dialect group distribution of 897 Chinese patients with peptic ulcer (duodenal ulcer 601, gastric ulcer 296) was compared with that of non-ulcer dyspepsia patients and 1602 general medical patients attending the same medical units. The proportion of various dialect groups (including Cantonese) was similar in all patient groups. The proportion of ulcer patients presenting with haemorrhage was also similar in the different dialect groups. We conclude that no major dialect differences exist in peptic ulcer frequency amongst the Chinese in Singapore.

China↗
PubMed1990

Gastroduodenal mucosa in uraemia: endoscopic and histological correlation and prevalence of helicobacter-like organisms.

This study aimed to determine the prevalence of endoscopic and histological gastroduodenitis as well as helicobacter-like organisms in patients with end stage renal failure undergoing maintenance dialysis treatment. A total of 322 out of 422 patients in our dialysis programme underwent endoscopy and gastroduodenal biopsy specimens were taken from 260. Endoscopic gastroduodenitis occurred in 158 (49%). Histological gastritis occurred in the gastric body or antrum in 134 patients (52%) and duodenitis in 52 (21%). There was no correlation between endoscopic and histological gastritis in contrast to a significant correlation for duodenitis. Helicobacter-like organisms occurred in the body or antrum in 81 (31%). Their presence was associated with gastritis--in particular acute and acute on chronic gastritis rather than chronic gastritis. Patients with gastritis were significantly older than those without (p less than 0.001) and had lower basal and peak acid outputs.

Acute Disease↗
PubMed1990

Effect of colloidal bismuth subcitrate on symptoms and gastric histology in non-ulcer dyspepsia. A double blind placebo controlled study.

The aim of this study was to determine the effect of colloidal bismuth subcitrate (De Nol) on symptoms and gastric histology in patients with non-ulcer dyspepsia. In a single centre trial, patients with food related upper abdominal pain not caused by ulcer disease were randomised to receive one tablet of colloidal bismuth subcitrate or matching placebo four times daily for eight weeks. Seventy three patients were entered and 51 completed the trial: 28 patients in the colloidal bismuth subcitrate group and 23 in the placebo group. Overall there was no difference between the two groups in terms of symptom relief. Among patients with histological gastritis (n = 23), however, those who took colloidal bismuth subcitrate used fewer antacid tablets (for three of four fortnightly periods) and were more likely to become asymptomatic (eight of 11 v three of 12, p less than 0.05); their gastritis was more likely to resolve (five of 10 v 0 of 12, p less than 0.025) and their gastric biopsies more likely to become negative for Helicobacter like organisms (eight of nine v 0 of 12, p less than 0.001) when compared with patients taking placebo. In contrast, patients who did not have gastritis in their index biopsies (n = 28) fared similarly whether they received colloidal bismuth subcitrate or placebo. Our results indicate that the administration of colloidal bismuth subcitrate benefited non-ulcer dyspepsia patients with gastritis but had no effect on those without.

Adult↗