Publications by authors named "Ratha-Korn Vilaichone"

89 Publications

Serum Helicobacter pylori antibody reactivity in seven Asian countries using an automated latex aggregation turbidity assay.

J Gastroenterol Hepatol 2021 Feb 20. Epub 2021 Feb 20.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Oita, Japan.

Background And Aim: To determine the application range of diagnostic kits utilizing anti-Helicobacter pylori antibody, we tested a newly developed latex aggregation turbidity assay (Latex) and a conventional enzyme-linked immunosorbent assay (ELISA; E-plate), both containing Japanese H. pylori protein lysates as antigens, using sera from 7 Asian countries.

Methods: Serum samples (1,797) were obtained, and standard H. pylori infection status and atrophy status were determined by culture and histology (immunohistochemistry) using gastric biopsy samples from the same individuals. The two tests (ELISA and Latex) were applied, and receiver operating characteristics (ROC) analysis was performed.

Results: Area under the curve (AUC) from the ROC of E-plate and Latex curves were almost the same and the highest in Vietnam. The Latex AUC was slightly lower than the E-plate AUC in other counties, and the difference became statistically significant in Myanmar and then Bangladesh as the lowest. To consider past infection cases, atrophy was additionally evaluated. Most of the AUCs decreased using this atrophy-evaluated status; however, the difference between the two kits was not significant each country but the Latex AUC was better using all samples. Practical cut-off values were 3.0 U/mL in the E-test and 3.5 U/mL in the Latex test, to avoid missing gastric cancer patients to the greatest extent possible.

Conclusions: The kits were applicable in all countries, but new kits using regional H. pylori strains are recommended for Myanmar and Bangladesh. Use of a cut-off value lower than the best cut-off value is essential for screening gastric cancer patients.
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http://dx.doi.org/10.1111/jgh.15467DOI Listing
February 2021

Gastrointestinal manifestation as clinical predictor of severe COVID-19: A retrospective experience and literature review of COVID-19 in Association of Southeast Asian Nations (ASEAN).

JGH Open 2020 Dec 12;4(6):1096-1101. Epub 2020 Sep 12.

Gastroenterology Unit, Department of Medicine, Faculty of Medicine Thammasat University Hospital Khlong Nueng Thailand.

Background And Aim: Coronavirus disease 19 (COVID-19) has caused over 200 000 deaths worldwide. Thailand announced the first confirmed case outside mainland China in January 2020. The disease also spread widely across Association of Southeast Asian Nations (ASEAN). Gastrointestinal manifestations could be presenting symptoms of COVID-19. This study aimed to determine the prevalence of gastrointestinal manifestations of COVID-19 patients in Thailand and review important aspects of this disease in ASEAN.

Methods: Thai patients diagnosed with COVID-19 at Thammasat University Hospital, Thailand, were evaluated between 1 January 2020 and 30 April 2020. Patients' data, clinical presentation, exposure risk, past medical history, laboratory results, and treatment outcomes were extensively reviewed.

Results: A total of 352 COVID-19 tests were performed, and 40 patients with positive tests were studied. The mean age was 30.5 years, and 55% were female. Most (82.5%) had no underlying diseases. Comorbidities were associated with severe COVID-19 (odds ratio [OR] 29.93; 95% confidence interval [CI] 2.31-388.40, = 0.009). Gastrointestinal symptoms were present in 12 patients (30%). The most common presenting symptoms were anorexia (17.5%) and diarrhea (15%). Gastrointestinal symptoms developed before (9.1%), concurrent with (63.6%), and after (27.3%) respiratory symptoms. Diarrhea was significantly associated with severe COVID-19 (OR 38.52; 95% CI 3.11-476.70, = 0.004). Twenty-four patients (60%) received antiviral drugs; 40% had only supportive care. Only one patient required intensive care. No patient died.

Conclusions: Gastrointestinal manifestations in COVID-19 patients are common symptoms and can occur anytime during the disease course. Patients presenting with only gastrointestinal symptoms should raise clinical suspicion for COVID-19 in areas with high disease incidence. Clinically severe COVID-19 was associated with comorbidities and diarrhea.
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http://dx.doi.org/10.1002/jgh3.12394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731825PMC
December 2020

Prognostic factors for survival in patients with gastric adenocarcinoma.

Cancer Rep (Hoboken) 2021 Feb 19;4(1):e1305. Epub 2020 Oct 19.

Gastroenterology Unit, Thammasat University Hospital, Pathumthani, Thailand.

Background: Gastric cancer ranks as a leading cause of cancer deaths worldwide. Information of prognostic factors related to gastric cancer are limited.

Aim: This study aimed to gather clinical data and prevalence of prognostic factors related to gastric adenocarcinoma in Thailand.

Methods And Results: This retrospective cohort study was conducted at Thammasat University Hospital, Thailand between January 2010 and July 2018. Gastric adenocarcinoma patients were enrolled and followed up for at least 5 years. Total of 210 gastric tumor patients were enrolled. One hundred patients were diagnosed with gastric adenocarcinomas (57 men and 43 women, mean age = 61.1 years). The leading presenting symptoms were weight loss (65%), followed by dyspepsia (54%) and UGI bleeding. Common clinical manifestations were thrombocytosis (26%), followed by syndrome of inappropriate antidiuretic hormone (SIADH; 15%). Eosinophilia was present in early cancer (25.0% vs 6.5%, P = .123), while SIADH and thrombocytosis were more common in advanced stages (16.3% vs 0%, P = .602, and 28.3% vs 0%, P = .108, respectively). SIADH was significantly related to reduced 1-year survival rate compared to normal serum sodium levels (21.4% vs 71.4%, OR 0.109, 95% CI 0.024-0.497, P = .004). Five-year survival rates were worse in patients with SIADH, but better in patients with eosinophilia compared to patients without these conditions (0% vs 27.8%, P = .058 and 20.0% vs 7.8%, P = .375, respectively).

Conclusion: Thrombocytosis and SIADH were common in gastric cancer. SIADH was significantly correlated with poor 1-year survival. These clinical manifestations might be useful for predicting gastric cancer prognosis.
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http://dx.doi.org/10.1002/cnr2.1305DOI Listing
February 2021

Predictors for development of complete and incomplete intestinal metaplasia (IM) associated with H. pylori infection: A large-scale study from low prevalence area of gastric cancer (IM-HP trial).

PLoS One 2020 1;15(10):e0239434. Epub 2020 Oct 1.

Digestive Diseases Research Center (DRC), Thammasat University Hospital, Pathumthani, Thailand.

Background: Gastric intestinal metaplasia (IM) is precancerous lesion of gastric cancer related to H. pylori infection. There has been limited data about IM and associated risk factors. This study aimed to determine risk factors related to development of IM to guide proper management.

Methods: 1,370 patients undergoing UGI endoscopy at Thammasat University Hospital, Thailand were included between January 2018-August 2019. Patients' data including baseline characteristics, laboratory results, and histopathology from medical database were extensively reviewed. Immunohistochemical staining for p53 expression from gastric biopsies was also performed.

Results: Overall H. pylori prevalence was 43.8%. Mean age was 60.7 years and 45% of whom were males. Chronic gastritis was observed in 1,064(77.7%) patients, while 223(16.3%) had IM. Of 223 patients with IM, 194(87%) patients had complete IM, while 29 (13%) had incomplete IM. In groups of complete and incomplete IM, current H. pylori infection rates were 66.5% and 58.6%, respectively. The BMI of incomplete IM group(27.4) was significantly higher than BMI of complete IM group (23.6). Overweight and obese patients (BMI ≥23 kg/m2) were significantly associated with higher risk for the development of incomplete IM (OR 3.25; 95%CI 1.14-9.27, p = 0.027). Males, age >50 years, and current H. pylori infection were significantly higher in IM than chronic gastritis group with OR 1.43 (95%CI 1.01-2.03, p = 0.048), OR 1.67 (95% CI 1.08-2.57, p = 0.021), and OR 3.14 (95% CI 2.29-4.30, p<0.001), respectively. During 20 months of study, there were 15 patients (1.1%) diagnosed with gastric cancer and 1-year survival rate was only 60%.

Conclusions: Males, age >50 years, and current H. pylori infection are significant predictors for the presence of intestinal metaplasia. BMI might be beneficial for using as a predictive risk factor to reduce the development of incomplete intestinal metaplasia. H. pylori eradication could be an effective way to prevent the development of gastric precancerous lesions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239434PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529201PMC
November 2020

Population-based study of Helicobacter pylori infection and antibiotic resistance in Bhutan.

Int J Infect Dis 2020 Aug 29;97:102-107. Epub 2020 May 29.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.

Objectives: Bhutan suffers from a high prevalence of Helicobacter pylori (H. pylori) infection and gastric cancer-related mortality. In preparation for a countrywide H. pylori eradication program, the antibiotic resistance patterns of H. pylori infection were surveyed in different geographical regions.

Methods: Dyspeptic patients in 6 districts including Thimphu, Punakha, Wangdue, Trongsa, Bumthang, and Haa underwent upper gastrointestinal endoscopy during GASTROCAMP and were enrolled between December 2010 and April 2015. Gastric biopsies were obtained for rapid urease test, histopathology, and H. pylori culture. Antimicrobial susceptibility testing was later performed if the culture was positive.

Results: A total of 1178 patients were surveyed. The overall H. pylori infection in Bhutan was 66.2%. Punakha had the highest prevalence of H. pylori infection (85.6%). Thimphu and Punakha (city areas) had higher prevalence of H. pylori infection than rural districts (73.5% vs 63.3%, OR=1.61, 95% CI 1.22-2.13, p=0.0008). There were 357 patients (30.3%) with positive H. pylori culture completed antimicrobial susceptibility testing. The mean age was 40.5 years with female predominance (57.1%). No amoxicillin resistant strains were found. Metronidazole resistance was 81% followed by levofloxacin resistance (8.1%). Clarithromycin (2%) and tetracycline (0.6%) resistance was rare except in Thimphu, the capital city (10%) vs 0% in rural areas, p<0.001. The metronidazole resistance rate remained stable at approximately 80% during the past 5 years of study. Levofloxacin-resistant strains gradually rose from 5.3% in 2010 to 9.9% in 2015.

Conclusions: Bhutan had a high prevalence of H. pylori infection. Metronidazole resistance was extremely high, whereas clarithromycin resistance was quite low in this specific area. Antibiotic resistance pattern could be good evidence for guiding a proper treatment regimen for H. pylori infection in Bhutan.
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http://dx.doi.org/10.1016/j.ijid.2020.05.077DOI Listing
August 2020

Prevalence and Antibiotic Resistance Patterns of Helicobacter pylori Infection in Koh Kong, Cambodia.

Asian Pac J Cancer Prev 2020 May 1;21(5):1409-1413. Epub 2020 May 1.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.

Background: Gastric cancer, which is the leading cause of cancer mortality in Cambodia, can be prevented by Helicobacter pylori (H. pylori) eradication. There is limited data about H. pylori strains in Cambodia. This study aimed to evaluate H. pylori prevalence and antibiotic resistance in Koh Kong, Cambodia.

Methods: 118 Cambodian dyspeptic patients were scheduled to enter this study and 58 were enrolled between July and September 2019. All patients underwent upper GI endoscopy. 3 gastric biopsies were obtained for rapid urease test, H. pylori culture with E-test and GenoType® HelicoDr (Hain Lifescience factory, Germany). 3-mL blood sample was collected for CYP2C19 genotyping.

Results: 58 subjects were enrolled (40 females, 18 males, mean age 43.8 years). Overall H. pylori prevalence was 31.0%. Antibiotic resistance rates were 78.6% for metronidazole, 50.0% for fluoroquinolones, and 27.8% for clarithromycin. There was no amoxicillin and tetracycline resistance. More than half of H. pylori strains (57.1%) were multidrug-resistant. Most (35.7%) were resistant to metronidazole and quinolone. Poor, intermediate and rapid metabolizers were 5.5%, 38.9% and 55.6%, respectively.

Conclusions: H. pylori infection remains common infection in Cambodia. High prevalence of clarithromycin, metronidazole, levofloxacin and multidrug-resistant H. pylori is still major problems in Cambodia. Treatment regimens without clarithromycin and quinolone such as 14-day bismuth-based quadruple therapy might be an appropriate choice for H. pylori eradication in this particular area.
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http://dx.doi.org/10.31557/APJCP.2020.21.5.1409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541852PMC
May 2020

Efficacy of Omeprazole, Tetracycline, and 4 Times Daily Dosing of Amoxicillin in Helicobacter pylori Eradication in Limited Resource Area in Bhutan: A Prospective Randomized Trial (BHUTAN Study).

Asian Pac J Cancer Prev 2020 Apr 1;21(4):1109-1114. Epub 2020 Apr 1.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.

Backgrourd: H. pylori-associated gastric cancer is the first cancer-related death in Bhutan. Effective regimen for H. pylori eradication is essential to reduce risk of developing gastric cancer. Clarithromycin is not widely used in this limited resource country. Aim of this study was to evaluate proper regimen and prevalence of antibiotic resistance pattern for H. pylori eradication in Bhutan.

Methods: Five hundred and forty-six patients underwent gastroscopy during GASTROCAMP between October 2014 and April 2015 in Bhutan and 77 patients were enrolled. Four gastric biopsies were obtained for rapid urease test, histopathology, H. pylori culture with Epsilometer test. All H. pylori-positive patients were randomized to receive either 7-day or 14-day of 500 mg amoxicillin four times daily, 500 mg tetracycline four times daily, and 20 mg omeprazole twice daily.

Results: Seventy-seven subjects were enrolled (54 females, 23 males, mean age = 45.4 years). Of 77 patients, 52 (67.5%) received 7-day regimen while 25 (32.5%) had 14-day regimen. Prevalence of H. pylori was 38.2%. Antibiotic resistance was 80.0% for metronidazole, 11.1% for levofloxacin and no resistance seen in amoxicillin, tetracycline and clarithromycin. Overall eradication rates of 7-day and 14-day regimens were 51.9% and 80.0%, p = 0.02. Female and age ≥40 years had significantly higher eradication rate when receiving 14-day compared to 7-day regimen (94.1% vs. 45.9%, OR = 18.82; 95% CI 2.26-157.02, p = 0.0007 and 86.7% vs. 50.0%, OR = 6.50; 95% CI 1.25-33.91, p = 0.02, respectively).

Conclusions: Fourteen-day regimen might be an acceptable regimen for H. pylori eradication in limited resource area such as Bhutan. Female and age ≥40 years should receive longer duration of treatment. This 14-day regimen could at least reduce the risk of developing H. pylori-associated diseases especially peptic ulcer with complications and gastric cancer which lead to many deaths in Bhutan.
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http://dx.doi.org/10.31557/APJCP.2020.21.4.1109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445957PMC
April 2020

Anti-, Anti-Inflammatory, Cytotoxic, and Antioxidant Activities of Mace Extracts from .

Evid Based Complement Alternat Med 2020 29;2020:7576818. Epub 2020 Mar 29.

Division of Applied Thai Traditional Medicine, Faculty of Public Health, Naresuan University, Phitsanulok 65000, Thailand.

The aril (mace) of , known as Dok-Chan, is a spice that has long been used for treating stomach discomfort, peptic ulcer, and nausea. It is an ingredient in many remedies in Thai traditional medicine, e.g., Ya-Hom-Thep-Bha-Jit, Ya-Hom-Nao-Wa-Kot, and Ya-That-Bun-Job, which are used to treat dyspepsia and other gastrointestinal tract symptoms. The aqueous and ethanolic extracts of mace were used for all tests. Anti activities were determined by the disc diffusion method and agar dilution. Anti-inflammatory activity was determined by the LPS-induced nitric oxide (NO) inhibition in a RAW264.7 cell line, and cytotoxicity was determined against gastric cancer cell lines (Kato III) using the sulphorhodamine B (SRB) assay. The DPPH radical scavenging and ABTS radical cation decolorization assays were used to determine the antioxidant activities. The result found that the ethanolic extract of mace exhibited antimicrobial activity against ATCC 43504 and six clinical strains with MIC values of 125-250 g/ml. The aqueous extract MICs against ATCC reference strain and six clinical strains were 500 g/ml compared with 0.5 g/ml for the positive control, clarithromycin. The inhibitory effect of LPS-induced NO release and cytotoxic activity of the ethanolic extract had IC values of 82.19 g/ml and 26.06 g/ml, respectively, and the EC values for the DPPH and ABTS antioxidant assays were 13.41 g/ml and 12.44 g/ml, respectively. The mace extract also had anticancer properties. In conclusion, the ethanolic mace extract had anti-, anti-inflammatory, antioxidant, and anticancer activities. These data support further preclinical and clinical investigation to see if the mace extract could have a role in treating patients with dyspepsia, peptic ulcers, and possibly gastric cancer.
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http://dx.doi.org/10.1155/2020/7576818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146089PMC
March 2020

Serum pepsinogens as a gastric cancer and gastritis biomarker in South and Southeast Asian populations.

PLoS One 2020 9;15(4):e0230064. Epub 2020 Apr 9.

Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia.

Serum pepsinogens have been widely acknowledged as gastric mucosal biomarkers; however, a multicountry report on the benefits of pepsinogens as biomarkers has not yet been published. We analyzed 1,206 sera and gastric mucosal samples collected from Bangladesh, Bhutan, Indonesia, Myanmar, Nepal and Thailand then assessed the association between gastric mucosal changes and Helicobacter pylori infection. The new cutoff values for serum pepsinogen values were evaluated using a receiver operating characteristic analysis. The participants with H. pylori infection had significantly lower pepsinogen I and higher pepsinogen II values, but a lower pepsinogen I/II ratio than participants without the infection (all P < .001). The pepsinogen I and pepsinogen I/II values were significantly higher and lower, respectively, in individuals with atrophic gastritis than in those without (both P < .001). Among uninfected individuals, only the pepsinogen I/II ratio was significantly lower in atrophic individuals. Pepsinogen I/II ratio also were significantly different between disease among H. pylori-positive and H. pylori-negative individuals, suggesting the pepsinogen I/II ratio is a robust biomarker for determining both chronic and atrophic gastritis. The cutoffs for detecting chronic and atrophic gastritis for the pepsinogen I/II ratio were 4.65 and 4.95, respectively. In conclusion, pepsinogen levels are useful biomarker for both chronic gastritis and atrophic gastritis, but they should be used with caution. Population-based validation is necessary to determine the best cutoff values. Among all pepsinogen values, the pepsinogen I/II ratio was the most reliable gastric mucosal-change biomarker.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230064PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145115PMC
July 2020

High Effective of 14-Day High-Dose PPI- Bismuth-Containing Quadruple Therapy with Probiotics Supplement for Helicobacter Pylori Eradication: A Double Blinded-Randomized Placebo-Controlled Study.

Asian Pac J Cancer Prev 2019 09 1;20(9):2859-2864. Epub 2019 Sep 1.

Gastroenterology Unit, Thammasat University Hospital, Pathumthani, Thailand.

Background: Helicobacter pylori (H. pylori) infection is important risk factors for chronic gastritis, peptic ulcer and gastric cancer. Bismuth-containing quadruple therapy has recently been the first-line regimen recommended in many European countries but has limited efficacy in ASEAN especially Thailand. This study was aim to evaluate efficacy of high dose PPI Bismuth-containing quadruple therapy with probiotics supplement for H. pylori eradication. Methods: In this double-blind randomized placebo-controlled study, H. pylori infected patients were randomized to receive 7-or 14-day high dose PPI- bismuth-containing quadruple therapy with or without probiotics supplement. Probiotic was 37.5 mg Lactobacillus reuteri (Biogaia®) in tablet twice daily. CYP2C19 genotyping and antibiotic susceptibility tests were also done. H. pylori eradication was defined as a negative 13C-urea breath test at least 4 weeks after treatment. Results: 100 subjects were enrolled (72 females, 28 males, mean age=54 years). Antibiotic resistance was 15.6% for clarithromycin, 34.1% for metronidazole. CYP2C19 genotyping was performed in both group and revealed 13%, 50% and 37% for poor, intermediate and rapid metabolizers, respectively. Overall eradication rates of 7-day and 14-day regimens with probiotic were 68% and 96%; P value=0.027. The eradication rate for all patients with poor and rapid metabolizers were 100% with 14-day regimen. 14-day regimen with probiotics can provide 100% eradication with clarithromycin resistance, metronidazole resistance or dual clarithromycin and metronidazole resistance group. Furthermore, the incidence of nausea and vomiting, abdominal discomfort, and bitter taste were significantly lower in patients with probiotics group compared with placebo (6%vs.26%, P=0.002,OR=0.126,95% CI=0.03-0.53; 4%vs.18.0%, P=0.017, OR= 0.155,95% CI=0.03-0.81 and 4%vs.26%, P= 0.001,OR= 0.08, 95%CI= 0.016-0.41, respectively). Conclusions: The 14-day high dose PPI- bismuth-containing quadruple therapy with probiotic can provide an excellent cure rate for H. pylori infection as first line treatment irrespective of CYP2C19 and antibiotic resistance pattern. Adding probiotic also significantly reduced treatment-related adverse events and improve the patients’ compliance.
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http://dx.doi.org/10.31557/APJCP.2019.20.9.2859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976817PMC
September 2019

Characterization of a novel Helicobacter pylori East Asian-type CagA ELISA for detecting patients infected with various cagA genotypes.

Med Microbiol Immunol 2020 Feb 23;209(1):29-40. Epub 2019 Sep 23.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, 879-5593, Japan.

Currently, Western-type CagA is used in most commercial Helicobacter pylori CagA ELISA kits for CagA detection rather than East Asian-type CagA. We evaluated the ability of the East Asian-type CagA ELISA developed by our group to detect anti-CagA antibody in patients infected with different cagA genotypes of H. pylori from four different countries in South Asia and Southeast Asia. The recombinant CagA protein was expressed and later purified using GST-tag affinity chromatography. The East Asian-type CagA-immobilized ELISA was used to measure the levels of anti-CagA antibody in 750 serum samples from Bhutan, Indonesia, Myanmar, and Bangladesh. The cutoff value of the serum antibody in each country was determined via Receiver-Operating Characteristic (ROC) analysis. The cutoff values were different among the four countries studied (Bhutan, 18.16 U/mL; Indonesia, 6.01 U/mL; Myanmar, 10.57 U/mL; and Bangladesh, 6.19 U/mL). Our ELISA had better sensitivity, specificity, and accuracy of anti-CagA antibody detection in subjects predominantly infected with East Asian-type CagA H. pylori (Bhutan and Indonesia) than in those infected with Western-type CagA H. pylori predominant (Myanmar and Bangladesh). We found positive correlations between the anti-CagA antibody and antral monocyte infiltration in subjects from all four countries. There was no significant association between bacterial density and the anti-CagA antibody in the antrum or the corpus. The East Asian-type CagA ELISA had improved detection of the anti-CagA antibody in subjects infected with East Asian-type CagA H. pylori. The East Asian-type CagA ELISA should, therefore, be used in populations predominantly infected with East Asian-type CagA.
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http://dx.doi.org/10.1007/s00430-019-00634-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6983352PMC
February 2020

Once-daily rabeprazole, levofloxacin, clarithromycin-MR, and bismuth for Helicobacter pylori eradication: A randomized study of 7 or 14 days (ONCE study).

Helicobacter 2019 Oct 7;24(5):e12615. Epub 2019 Jul 7.

National Digestive Diseases Research Center (NDRC), Pathumthani, Thailand.

Objective: Most therapies for Helicobacter pylori eradication utilize multiple drugs given 2-4 times daily. Patient adherence has been an impediment to reliably achieving high success. This study evaluated a once-daily dosing H pylori eradication regimen.

Methods: A prospective randomized pilot study of H pylori eradication compared once-daily treatment regimen containing levofloxacin (750 mg), clarithromycin-MR (1 g), rabeprazole (60 mg), and bismuth subsalicylate (1,048 mg) for a 7 or 14 days. CYP2C19 genotype and antibiotic susceptibility tests were performed. Successful eradication was defined as negative 13C-urea breath test at least 4 weeks after completion of treatment.

Results: 100 subjects were randomized (40 men, 60 women with mean age =54 years). The eradication rates were as follows: 94% (47/50; 95%CI 0.87-1.01) and 84% (42/50; 95%CI 0.73-0.95) with 14-day and 7-day therapy (OR 0.34; 95%CI 0.08-1.35, P = 0.06), respectively. Resistance rates were as follows: 13.0% for clarithromycin, 26.0% for fluoroquinolone, 2.9% for dual clarithromycin-fluoroquinolone resistance, and 62.8% for metronidazole. The 14-day regimen provided 100% eradication in patients with levofloxacin susceptible strain irrespective of the presence of clarithromycin resistance. CYP2C19 genotypes had no effect on cure rates.

Conclusions: The once-daily 14-day rabeprazole-, levofloxacin-, clarithromycin-MR-, and bismuth-containing therapy provided high eradication rate suggested that triple therapies with a PPI, bismuth, and clarithromycin-MR or levofloxacin would be highly effective for once-a-day tailored therapy or as empiric therapy for first-line regimen.
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http://dx.doi.org/10.1111/hel.12615DOI Listing
October 2019

High Efficacy of Rapid Urine Test for Diagnosis of Helicobacter pylori Infection in Thai People

Asian Pac J Cancer Prev 2019 May 25;20(5):1525-1529. Epub 2019 May 25.

Digestive Diseases Research Center of Thailand, Pathumthani, Thailand.

Background: Accurate diagnosis of Helicobacter pylori (H. pylori) infection plays an important role in further effective treatment. Rapid urine test (RAPIRUN) is a test developed for qualitative detection of urine H. Pylori antibody and use for determine the sensitivity, specificity and accuracy. However, the test needs validation in Thai population before using in clinical practice. Objective: This study aimed to compare performance of different diagnostic tests on H. pylori detection in Thai population. Methods: Total of 94 patients with dyspepsia who referred to Thammasat University Hospital, Pathumthani, Thailand, between December 2012 and April 2013 were enrolled in this study. All patients underwent gastroscopy. Then, 3 biopsies at antrum were taken for H. pylori diagnosis. including rapid urease test (Pronto Dry, Eisai, Thailand), H. pylori culture, and histopathology. Urine samples were also collected at the same time for rapid urine test (RAPIRUN H. pylori Antibody, Otsuka Pharmaceutical Co., Ltd.). Patients were diagnosed with H. pylori-positive if their culture or rapid urease tests plus histopathology yielded positive results. Results: Total of 29 patients (30.9%) were infected with H. pylori. Prevalence of H. pylori infection by rapid urease test, histopathology, culture and rapid urine test were 25.5%, 28.7%, 29.8%, and 32.9% respectively. We observed that rapid urease test, histopathology, culture, and rapid urine test had sensitivity of 82.8%, 93.1%, 93.1% and 86.2%; specificity of 100%, 100%, 100%, and 90.8%; and accuracy of 95.7%, 97.9%, 97.9%, and 89.4%, respectively. Conclusion: Rapid urine test (RAPIRUN) provided a reliable result for diagnosis of H. pylori infection. Furthermore, this rapid urine test demonstrated high accuracy, reliable, safe handle and easy to use. We suggested rapid urine test for diagnosis of H. pylori infection in Thai population since we found it less invasive and with higher reliable efficacy.
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http://dx.doi.org/10.31557/APJCP.2019.20.5.1525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857864PMC
May 2019

N-Acetylcysteine Prevents Post-embolization Syndrome in Patients with Hepatocellular Carcinoma Following Transarterial Chemoembolization.

Dig Dis Sci 2019 11 9;64(11):3337-3345. Epub 2019 May 9.

Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.

Background: Post-embolization syndrome is a common complication after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). N-acetylcysteine (NAC) is known to ameliorate liver damage from several causes.

Aim: To determine the efficacy of intravenous NAC in the prevention of post-embolization syndrome in HCC patients following TACE.

Methods: In this study, patients with HCC admitted for TACE were prospectively enrolled. All patients were randomized stratified by Child A or B to receive NAC or placebo. The NAC group received intravenous NAC 24 h prior to TACE (150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h, then continuous infusion 6.25 mg/h for 48 h after the procedure). The placebo group received an infusion of 5% glucose solution until 48 h after procedure. The post-embolization syndrome was defined as: T ≥ 38.5 c and serum ALT > 3 times of pretreatment value.

Results: In total, 111 HCC patients were enrolled; 57 were randomly assigned to NAC group and 54 to placebo group. The incidence of post-embolization syndrome was lower in NAC group (24.6%) compared to placebo group (48.2%); P = 0.01. On multivariate analysis, receiving IV NAC (P = 0.03) and HCC diameter (P < 0.01) were associated with developing post-embolization syndrome. Post-TACE liver decompensation was documented in 26/111 (23.4%) patients. There was no difference in the incidence of post-TACE liver decompensation between NAC and placebo group.

Conclusions: In this study, intravenous NAC administration reduces the incidence of post-embolization syndrome after TACE in patients with HCC. However, it does not prevent post-TACE liver decompensation.

Trial Registration Number: This study was registered with Thai Clinical Trial Registry (TCTR20150313002).
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http://dx.doi.org/10.1007/s10620-019-05652-0DOI Listing
November 2019

CYP2C19 Genotype, CagA Genotype and Antibiotic Resistant Strain of Helicobacter pylori Infection

Asian Pac J Cancer Prev 2019 Apr 29;20(4):1243-1247. Epub 2019 Apr 29.

Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand. Email:

Background: H. pylori is a class I carcinogen and major cause of gastric cancer. Few previous studies reported relationship between H. pylori infection, CYP2C19 genotype and functional dyspepsia (FD) subtype. The aim of this study was to determine relationship between CYP2C19 genotype and FD subtype patients(host factor) with antibiotic resistant strains of H. pylori infection and CagA genotype(bacterial factor). Methods: FD patients who were investigated with gastroscopy at Thammasat University Hospital, Thailand during March 2017-November 2017 were enrolled. Two antral gastric biopsies were obtained for rapid urease test, E-test and cultures. CagA genotypes (CagA1a and CagA2a) were determined by PCR and CYP2C19 genotype was determined by PCR-RFLP. FD patients were categorized as epigastric pain syndrome(EPS) and postprandial distress syndrome (PDS). Results: 93 FD patients with H. pylori infection were enrolled (37 male, 56 female, mean age 54.5 years). There were 33 patients with EPS and 60 patients with PDS. CYP2C19 genotype revealed 55.9% rapid metabolizer (RM), 40.9% intermediate metabolizer (IM) and 3.2% poor metabolizer (PM) genotypes. Antibiotics susceptibility tests demonstrated 62.8% resistant to metronidazole, 12.9% resistant to clarithromycin and 27.1% resistant to fluoroquinolone. CagA 1a and CagA 2a were demonstrated in 6 patients(11.5%) and 46 patients(88.5%). CagA2a genotype was more prevalent in PDS than EPS patients (94.3%vs.76.5%; P =0.08) without significance. In intermediate metabolizer (IM), CagA2a genotype was significant higher in PDS than EPS(100% vs.25%; P=0.004). Conclusions: PDS, CYP2C19 RM genotype and CagA 2a gene of H. pylori infection were the predominant type of FD in Thailand. Metronidazole remain the most common antibiotic resistant strain of H. pylori infection in FD patients. PDS (host factor) was significantly related to CagA2a genotype (bacterial factors) only in patients with intermediate metabolizer. Appropriate dose of proton pump inhibitor (PPI) and correct regimens for H. pylori eradication in FD patients should be consider to improve clinical outcomes.
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http://dx.doi.org/10.31557/APJCP.2019.20.4.1243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948911PMC
April 2019

Risk Factors and Prognosis of Spontaneously Ruptured Hepatocellular Carcinoma in Thailand

Asian Pac J Cancer Prev 2018 Dec 25;19(12):3629-3634. Epub 2018 Dec 25.

Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand. Email:

Objective: Hepatocellular carcinoma (HCC) is the fatal cancer worldwide. Spontaneously Rupture remains important complication of HCC. The incidence of spontaneous HCC rupture was high in ASEAN but limited studies were reported. The aim of this study was to evaluate predictors and overall survival of ruptured HCC in tertiary care center in Thailand. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years old during January 2012-January 2016 and followed up through June 2016 at Thammasat University Hospital, Thailand. All clinical information, laboratory and radiologic findings were collected from reviewing computer data base of medical records. Results: 333 patients had completely retrievable information. Of which, 51patients (15.3%) had spontaneous ruptured HCC. Clinical symptoms with abdominal discomfort and anemic symptoms were significantly higher in ruptured than non-ruptured HCC groups. (76.47% vs.39.36%: p<0.001, 13.73vs.0.71%, p<0.001). Furthermore, size of tumors, presences of metastasis and serum AFP>200 ng/mL were significantly higher in ruptured than non-ruptured HCC groups (10.29cm. vs. 6.47cm. p<0.001, 17.65% vs. 8.16%, p=0.034, 60.78% vs. 36.88%, p=0.001, respectively). In multivariate analysis, age, abdominal discomfort, anemic symptoms, Child-Pugh score>6 were independent risk factors of HCC rupture (OR=0.96, 95%CI=0.93-0.99, p=0.02; OR=3.47, 95%CI=1.26-9.6, p=0.016; OR=54.51, 95%CI=7.09-418.89, p<0.001; OR=2.62, 95%CI=1.09-6.31, p=0.031, respectively). 1-year and 2-year survival rates of ruptured HCC were 66.9% and 44.6% respectively. Conclusions: Age, abdominal discomfort, anemic symptoms and Child-Pugh score>6 might be predictive factors of spontaneous ruptured HCC. Ruptures of HCC remained a fatal disease with poor survival rate in Thailand. Appropriate treatment in early stage could be effective tool to improve the treatment outcomes.
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http://dx.doi.org/10.31557/APJCP.2018.19.12.3629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428545PMC
December 2018

Helicobacter pylori Infection and Related Gastrointestinal Diseases in Southeast Asian Countries: An Expert Opinion Survey

Asian Pac J Cancer Prev 2018 Dec 25;19(12):3565-3569. Epub 2018 Dec 25.

Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Hochiminh, Vietnam.

Background: Helicobacter pylori (H. pylori) infection is currently considered as an infectious disease irrespective of symptoms and stage of disease. This study aimed to survey the impact of H. pylori infection and the current management approaches in Southeast Asian countries. Materials and methods: This is a survey among 26 experts from 9 Southeast Asian countries (Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam), who attended a meeting to develop the ASEAN consensus on H. pylori management in November 2015. Results: The prevalence of H. pylori varied significantly from 20% to 69% among countries, highest in Myanmar and lowest in Malaysia. The rate of H. pylori infection in patients with gastritis, peptic ulcer disease and gastric cancer (GC) also varied significantly, not only among countries but also among regions within the same country. The most common method for H. pylori diagnosis before treatment was rapid urease test, followed by urea breath test. In multi-ethnic countries, some ethnic groups including Chinese, Batak and Minahasanese were considered as having higher risk of GC. There have been no national screening programs for GC in all countries, and a majority of patients with GC were diagnosed in advanced stages with very poor 5-year survival. Conclusions: The prevalence of H. pylori infection and its infection rates in related gastrointestinal diseases were significantly different among Southeast Asian countries. The prognosis of patients with GC in the region was very poor. The result of this survey is a platform for future international and regional research collaboration.
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http://dx.doi.org/10.31557/APJCP.2018.19.12.3565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428556PMC
December 2018

Thailand Dyspepsia Guidelines: 2018.

J Neurogastroenterol Motil 2019 Jan;25(1):15-26

Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.

The management of dyspepsia in limited-resource areas has not been established. In 2017, key opinion leaders throughout Thailand gathered to review and evaluate the current clinical evidence regarding dyspepsia and to develop consensus statements, rationales, levels of evidence, and grades of recommendation for dyspepsia management in daily clinical practice based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This guideline is mainly focused on the following 4 topics: (1) evaluation of patients with dyspepsia, (2) management, (3) special issues (overlapping gastroesophageal reflux disease/irritable bowel syndrome and non-steroidal anti-inflammatory drug/aspirin use), and (4) long-term follow-up and management to provide guidance for physicians in Thailand and other limited-resource areas managing such patients.
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http://dx.doi.org/10.5056/jnm18081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326203PMC
January 2019

Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand

Asian Pac J Cancer Prev 2018 Nov 29;19(11):3301-3305. Epub 2018 Nov 29.

Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand. Email:

Objective: Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study was to evaluate overall survival rate and predictors of VB in HCC patients. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing computer database of medical records. Results: 333 patients had completely retrievable information. Of which, 27 patients (8.1%) had documented with VB. Clinical presentations with weight loss and jaundice were higher in VB than non-VB groups (40.74% vs. 34.64%, p=0.525 and 7.41% vs. 2.29%, p=0.116) but the differences were not significant. The most common causes of cirrhosis in HCC patients with VB were chronic HBV infection (55.56%). In multivariate analysis; presence of ascites, Child-Pugh score>6, presence of varices were independent risk factors of having VB in HCC patients (OR=7.59, 95%CI=1.13-50.88, p=0.037; OR=5.07, 95%CI=1.08-23.76, p=0.039; OR=23.51, 95%CI=4.71-117.35, p<0.001, respectively). In HCC patients with VB, 1-year and 2.5-year survival rates were 56.6% and 28.3%. Conclusions: HCC patients with ascites, Child-Pugh score>6 and presence of varices might be important predictive factors of VB. Having VB were greatly impact to the survival rate of HCC patients. Clinical suspicion and regular surveillance of VB in HCC patients at risk could improve treatment outcomes.
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http://dx.doi.org/10.31557/APJCP.2018.19.11.3301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318381PMC
November 2018

Prevalence and Pattern of Antibiotic Resistant Strains of Helicobacter Pylori Infection in ASEAN

Asian Pac J Cancer Prev 2018 May 26;19(5):1411-1413. Epub 2018 May 26.

Division of Gastroenterology, Department of Medicine, Thammasat University Hospital, Pathumthani, Thailand.

Objective: Antibiotic resistance has significantly impact on eradication rates for H. pylori infection and remains important cause of treatment failure worldwide including ASEAN countries. The aim of this study was to survey the prevalence and antibiotic resistant pattern of H. pylori infection in ASEAN. Methods: This study was a survey among 26 experts from 9 ASEAN countries including Thailand, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore and Vietnam whom attended a meeting to develop the ASEAN consensus on H. pylori management in Bangkok in November 2015. A questionnaire was sent to each member of the consensus meeting. The detail of the questionnaire included information about prevalence of H. pylori infection, facilities to perform H. pylori culture, molecular testing for antibiotic resistance and antibiotic resistance rate in their countries. Results: H. pylori infection remain common in ASEAN ranging from 20% in Malaysia, 21-54% in Thailand and 69% in Myanmar. Most of ASEAN countries can perform H. pylori cultures and antibiotic susceptibility tests except Laos and Cambodia. In ASEAN countries, metronidazole resistant H pylori is quite common whereas amoxicillin resistance remain rare. Clarithromycin resistance results in a significant decrease in H. pylori eradication rate with clarithromycin-containing regimens. The prevalence of clarithromycin resistance varies in ASEAN countries being high in Vietnam (30%) and Cambodia (43%), moderate to high in Singapore (17%) and low in Malaysia (6.8%), Philippine (2%) and Myanmar (0%). In Thailand, clarithromycin resistance tends to higher in large cities (14%) than in rural areas (~3.7%). Conclusion: ASEAN countries should develop a standard protocol for regular susceptibility testing of H. pylori so that clinicians would be better able to choose reliably effective empiric therapies. The wide range of antibiotic resistance in ASEAN countries suggests that the preferred first line regimen should be depend on the local antibiotic resistance other than single recommendation.
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http://dx.doi.org/10.22034/APJCP.2018.19.5.1411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031816PMC
May 2018

Characterization and Antibacterial Activity Against Helicobacter pylori of Lactic Acid Bacteria Isolated from Thai Fermented Rice Noodle.

Probiotics Antimicrob Proteins 2019 03;11(1):92-102

Department of Biochemistry and Microbiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, 10330, Thailand.

A total of 32 lactic acid bacteria (LAB) were isolated from Khanom-jeen, a Thai traditional fermented rice noodle. They belonged to the genus Leuconostoc (Ln), Lactobacillus (Lb), Enterococcus (E), Lactococcus (Lc), and Weissella (W), based on their phenotypic characteristics and 16S rRNA gene sequence analyses. The strains were identified as Ln. pseudomesenteroides (group 1, two strains), Ln. citreum (group 2, three strains), Ln. lactis (group 3, three strains), Lb. paracasei subsp. tolerans (group 4, two strains), E. faecium (group 5, three strains), Lc. lactis subsp. lactis (group 6, one strain), W. confusa (group 7, six strains), Lb. fermentum (group 8, seven strains), and Lb. plantarum subsp. plantarum and Lb. pentosus (group 9, five strains). Fifteen strains exhibited the inhibitory activity against Helicobacter pylori clinical isolates by spot-on-lawn method. Lb. fermentum P43-01 resisted to bile acids showed the broad spectrum of antimicrobial activity against H. pylori strains MS83 and BK364. These antagonistic effects were associated with proteinaceous compounds which are sensitive to α-chymotrypsin and pepsin. Results indicated that production of bacteriocin-like substances of selected strain might be the significant mechanism that exerted the inhibition on H. pylori. A potential strain could be used as probiotics in alternative or adjunctive therapy for a patient suffering from H. pylori infection.
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http://dx.doi.org/10.1007/s12602-018-9385-zDOI Listing
March 2019

Feasibility of the unilateral-flange stent for the treatment of benign pancreatic duct stricture: a pilot study.

Nagoya J Med Sci 2017 11;79(4):453-458

Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.

Endoscopic placement of the plastic stent has been adopted as an initial treatment for chronic pancreatitis with pancreatic duct stricture. Stent fracture while attempting removal is one of the complications of stent exchange. The use of the unilateral-flange stent in these patients has never been reported. We investigated the outcomes associated with the use of this stent with regard to stent exchange and stent-related adverse events. From 2011 to 2015, 9 patients with chronic pancreatitis and main pancreatic duct (MPD) stricture treated with the unilateral-flange stent were included. Eleven endoscopic treatment sessions, 53 endoscopic stent deployments or exchange procedures were analyzed. Technical success rate was 100%. Forty-eight stents were exchanged on a regular basis in 1 to 6-month intervals. Another 5 stent exchange procedures were urgently performed due to stent obstruction and caused pancreatitis (n=2), symptomatic external stent migration (n=2), and concurrent cholangitis (n=1). The rate of symptomatic migration was 3.7%. The mean duration for stent exchange was 29 minutes and no stent fracture occurred during the procedure. Of 11 endoscopic treatment sessions, 7 were successful, 3 were changed to the metallic stents, and 1 was lost to follow-up. According to this study, unilateral-flange stent placement for benign MPD stricture is technically feasible and effective. Stent removal during the exchange period is unchallenging and without stent fracture.
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http://dx.doi.org/10.18999/nagjms.79.4.453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719204PMC
November 2017

Helicobacter pylori bab characterization in clinical isolates from Bhutan, Myanmar, Nepal and Bangladesh.

PLoS One 2017 6;12(11):e0187225. Epub 2017 Nov 6.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.

Background: Helicobacter pylori BabA is an important outer membrane protein that involves in the attachment to the gastric mucosa and enhances the virulence property of the bacterium. This study was aimed to characterize the bab genotypes, to evaluate its association with cagA, vacA and clinical diseases as well as degree of gastric inflammation.

Methods: H. pylori isolates from four countries were subjected for the characterization of bab. The locus specific forward and bab specific reverse primers were used to get the specific products by PCR, which could distinguish the three locus (A, B and C). The histological activities were evaluated according to the Updated Sydney system.

Result: In patients from high risk countries (Bhutan and Myanmar) relatively higher frequencies of strains with babA-positivity (91.8% and 90.7%, respectively), babA at locus A (98% and 91.2%, respectively) and with single babA (96.8% and 91.2%, respectively) were found. Strains with two loci occupied were the most prevalent in Bhutan (84.6%), Myanmar (74.7%), Nepal (58.3%) and Bangladesh (56.9%). The genotype babA at locus A/babB at locus B/bab-negative at locus C (babA/babB/-) was the most common genotype isolated from Bhutan (82.7%), Myanmar (58.7%), Nepal (32%) and Bangladesh (31.4%) among all genotypes assessed. This genotype was also associated with the peptic ulcer disease (P = 0.013) when compared to gastritis. babA-positive characteristics and the genotype babA/babB/- exhibited the enhanced histological activities.

Conclusions: The higher prevalence of virulence associated babA-positive characteristics and enhanced histological activities in Bhutan than in Myanmar, Nepal and Bangladesh might partly explain why the peoples in Bhutan are at higher risk for developing severe gastric complications.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187225PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673166PMC
November 2017

Prevalence, risk factors, and virulence genes of Helicobacter pylori among dyspeptic patients in two different gastric cancer risk regions of Thailand.

PLoS One 2017 30;12(10):e0187113. Epub 2017 Oct 30.

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.

Gastric cancer risk is varied among different regions of Thailand. We examined the characteristics of Helicobacter pylori infection in two regions of Thailand. The H. pylori status of 273 dyspeptic patients (136 from the South and 137 from the North; a low and high incidence of gastric cancer region, respectively) was evaluated, and virulence genotypes (cagA, vacA, hrgA and jhp0562-positive/β-(1,3)galT) were determined. The overall H. pylori infection rate was 34.1% (93/273). The prevalence was higher in the North than in the South (50.4% vs. 17.6%, P <0.001) and was significantly higher among individuals with the following characteristics: low income, birthplace in the Northeast or North regions, agricultural employment, or consumption of alcohol or unboiling water. Among these socio-demographic determinants, region was an independent risk factor for H. pylori infection (odds ratio = 6.37). Patients including both H. pylori infected and uninfected cases who lived in the North had significantly more severe histological scores than those in the South. In contrast, among H. pylori-positive cases, patients in the South had significantly more severe histological scores than those in the North. Of the 74 strains cultured, 56.8% carried Western-type cagA, with a higher proportion in the South than in the North (76.2% vs. 49.1%, P = 0.05). In disagreement with the current consensus, patients infected with the Western-type cagA strains had more severe inflammation scores in the antrum than those infected with the East Asian-type cagA strains (P = 0.027). Moreover, Western-type cagA strains induced more severe histological scores in patients from the South than those of either genotype from the North. Other virulence genes had no influence on histological scores. The incidence of gastric cancer in Thailand was different among regions and corresponded to differences in the prevalence of H. pylori infection. More careful follow-up for patients in the South will be required, even if they are infected with H. pylori carrying Western-type cagA.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187113PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662176PMC
November 2017

Effectiveness of 7-Day and 14-Day Moxifloxacin-Dexlansoprazole Based Triple Therapy and Probiotic Supplement for Helicobacter Pylori Eradication in Thai Patients with Non-Ulcer Dyspepsia: A Double-Blind Randomized Placebo-Controlled Study

Asian Pac J Cancer Prev 2017 10 26;18(10):2839-2843. Epub 2017 Oct 26.

Gastroenterology Unit, Thammasat University Hospital, Pathumthani,, Thailand.

Background: Helicobacter pylori (H. pylori) is important cause of peptic ulcer and gastric cancer. Moxifloxacin is effective antibiotic for treatment for H. pylori. However, there were limited studies as first line therapy. Probiotics had been shown to decrease therapy-related side-effect and increase eradication rate. Aim of this study was to evaluate the efficacy of moxifloxacin-dexlansoprazole based triple therapy with probiotic for H. pylori treatment in Thailand. Methods: Patients with H. pylori infected gastritis were randomized to receive 7- or 14-day moxifloxacin-dexlansoprazole based triple therapy with probiotic or placebo. Regimen consisted of 60 mg dexlansoprazole twice daily, 400mg moxifloxacin once daily, 1g clarithromycin MR once daily. Probiotic used in this study was 282.5mg Saccharomyces boulardii (S. boulardii) in capsule prescribed twice daily. CYP2C19 genotyping, antibiotic susceptibility tests, and CagA genotyping were also done. Successful eradication was defined as a negative 13C-urea breath test at least 4 weeks after treatment. Results: Total of 108 subjects was enrolled (27 each to 7-and 14-day regimens with probiotic or placebo). Antibiotic susceptibility tests showed 29% fluoroquinolone, 19% metronidazole and 4% clarithromycin resistance. CYP2C19 genotyping demonstrated 43%, 47% and 11% were rapid, intermediate and poor metabolizers, respectively. CagA genes were positive in all patients. Eradication rates of 7-day and 14-day regimens with probiotic were 100%, and 93% respectively. There were no significant differences between eradication rate of 7-day and 14-day regimen with or without probiotics. Regarding side-effects, incidence of nausea, abdominal discomfort, bitter taste, and diarrhea were significantly lower in regimen with probiotic group compared with placebo(7.4%vs. 22.2%; p=0.028, 0.00%vs.14.8%; p=0.003, 35.2%vs.70.4%; p=0.0002, and 0.00%vs.9.3%; p=0.028, respectively). Conclusions: 7-day moxifloxacindexlansoprazole therapy plus S. boulardii provide an reliable cure rate of H. pylori in non-ulcer dyspeptic patients in Thailand, independent of CYP2C19 genotype. Probiotic adding also decreased side effects during the treatment.
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http://dx.doi.org/10.22034/APJCP.2017.18.10.2839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747412PMC
October 2017

Characterizing in Myanmar.

Gut Liver 2018 Jan;12(1):51-57

Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.

Background/aims: Differences in the infection rate are not sufficient to clarify the dissimilarity of gastric cancer incidence between Myanmar and its neighboring countries. To better understand this trend, the virulence gene was characterized in Myanmar.

Methods: Glutamate-proline-isoleucine-tyrosine-alanine (EPIYA) patterns and CagA multimerization (CM) motifs of genotypes were examined by performing polymerase chain reactions and DNA sequencing.

Results: Of 69 tested strains, -positive patients had significantly more severe histological scores in their antrum than -negative patients. Sequence analysis revealed that 94.1% of strains had Western-type containing an EPIYA motif (92.6%) or EPIYT motif (6.4%). The intestinal metaplasia scores in the antral of patients infected with the ABC and ABCC types of were significantly higher than those of patients with AB-type . Interestingly, in patients infected with , 46.3% of strains with three EPIYA motifs contained two identical Western-typical CM motifs, and these patients showed significantly higher antrum inflammation scores than patients infected with two identical nontypical-CM motif strains (p=0.02).

Conclusions: In Myanmarese strains, Western-type was predominant. The presence of CM motifs and the proportion of multiple EPIYA-C segments might partially explain the intermediate gastric cancer risk found in Myanmar.
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http://dx.doi.org/10.5009/gnl17053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753684PMC
January 2018

virulence genes of minor ethnic groups in North Thailand.

Gut Pathog 2017 11;9:56. Epub 2017 Oct 11.

Department of Environment and Preventive Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593 Japan.

Background: There are few studies analyzed concurrently the prevalence and genotypes of infection with the ancestor origins from different ethnics, especially with including minority groups. We recruited a total of 289 patients in MaeSot, Thailand (154 Thai, 14 Thai-Chinese, 29 Karen and 92 Hmong ethnics). The virulence genes and genealogy of the strains were determined by PCR-based sequencing.

Results: Based on culture and histology/immunohistochemistry, the prevalence of infection was 54.5% (158/289). Among 152 isolates cultured, the East-Asian-type was predominant genotype among strains from Hmong, Thai-Chinese and Thai (96.0% [48/50], 85.7% [6/7] and 62.7% [47/75], respectively), whilst majority of strains from Karen had Western-type (73.3% [11/15]). Patients infected with the East-Asian-type strains had significantly higher activity and intestinal metaplasia in the antrum and activity in the corpus than those with Western-type ( = 0.024, 0.006 and 0.005, respectively). The multilocus sequencing typing analysis discriminated that most strains from Hmong and Thai-Chinese belonged to hspEAsia (92.0 and 85.7%, respectively), whereas strains from Karen predominantly possessed hpAsia2 (86.7%) and strains from Thai were classified into hspEAsia (45.2%) and hpAsia2 (31.1%).

Conclusions: genotypes were relatively different among ethnic groups in Thailand and were associated with the source of ancestor even living in a small rural town. Caution and careful check-up are required especially on Hmong ethnic associated with high prevalence of virulence genotypes of .
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http://dx.doi.org/10.1186/s13099-017-0205-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637267PMC
October 2017

Colorectal Cancer and Precancerous Lesions Associated with Ulcerative Colitis in Thailand

Asian Pac J Cancer Prev 2017 08 27;18(8):2123-2126. Epub 2017 Aug 27.

Gastroenterology Unit, Thammasat University Hospital, Pathumthani, Thailand.

Background: Ulcerative colitis(UC) is important risk factor of colorectal cancer. Many evidences from western countries confirmed this relationship but limited studies were reported in ASEAN. This study was aimed to investigate prevalence, clinical presentations, endoscopic findings, histopathology, disease progression and risk for colorectal cancer(CRC) of UC patients in Thailand. Methods: We conducted a retrospective cohort study using computer data base from Thammasat University Hospital, Pathumthani, Thailand between September 2011 and December 2015, follow-up through May 2016. Diagnosis of UC was confirmed by histopathology and whole clinical course. Results: We identified 6,082 patients who diagnosed with colitis during the study period. Of whom, only 22 patients(<1%) was confirmed of UC. Male to female ratio was 13:9 (mean age of 47.2 years). Clinical presentations were bloody diarrhea in 86.4%, watery diarrhea in 31.8% and abdominal pain in 59.1%. According to Montreal classification, disease extensions were ulcerative proctitis in 22.7%, distal UC in 50%, and pancolitis in 27.3%. Disease grading was mild in 31.8%, moderate in 9.1%, and severe in 59.1%. The prevalence of precancerous lesions were 2/22 patients(9.1%). There was no definite invasive colorectal cancer patient during study period. However, history of malnutrition was significantly higher in patients with dysplasia than those without dysplastic lesions(50%vs.0%, P-value=0.045). There was no difference in duration and disease extension between 2 groups. Interestingly, subgroup analysis demonstrated that pancolitis was significantly more common in female than male (55.6%vs.7.7%,P-value=0.02,OR=15.0, 95%CI=1.3- 169.9). Furthermore, patients’ age> 35 years had significantly more severe colitis than younger group (81.25%vs.0%, P-value=0.0006) Conclusions: Although UC is rare disease in ASEAN, precancerous lesions for CRC were not uncommon. UC with pancolitis was common in female whereas severe colitis was common in elderly patients. Proper screening program and careful surveillance for precancerous lesions in patients at risk might be appropriate approach for early detection and improvement the treatment outcome.
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http://dx.doi.org/10.22034/APJCP.2017.18.8.2123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697470PMC
August 2017

Helicobacter pylori management in ASEAN: The Bangkok consensus report.

J Gastroenterol Hepatol 2018 Jan;33(1):37-56

Department of Medicine, Gastroenterology Section, Baylor College of Medicine and Michael E. DeBakey VA Medicine Center, Houston, Texas, USA.

Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. H. pylori management in ASEAN: the Bangkok consensus report gathered key opinion leaders for the region to review and evaluate clinical aspects of H. pylori infection and to develop consensus statements, rationales, and grades of recommendation for the management of H. pylori infection in clinical practice in ASEAN countries. This ASEAN Consensus consisted of 34 international experts from 10 ASEAN countries, Japan, Taiwan, and the United States. The meeting mainly focused on four issues: (i) epidemiology and disease association; (ii) diagnostic tests; (iii) management; and (iv) follow-up after eradication. The final results of each workshop were presented for consensus voting by all participants. Statements, rationale, and recommendations were developed from the available current evidence to help clinicians in the diagnosis and treatment of H. pylori and its clinical diseases.
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http://dx.doi.org/10.1111/jgh.13911DOI Listing
January 2018

Interleukin-17C in Human Helicobacter pylori Gastritis.

Infect Immun 2017 10 20;85(10). Epub 2017 Sep 20.

Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA

The interleukin-17 (IL-17) family of cytokines (IL-17A to IL-17F) is involved in many inflammatory diseases. Although IL-17A is recognized as being involved in the pathophysiology of -associated diseases, the role of other IL-17 cytokine family members remains unclear. Microarray analysis of IL-17 family cytokines was performed in -infected and uninfected gastric biopsy specimens. mRNA was upregulated approximately 4.5-fold in -infected gastric biopsy specimens. This was confirmed by quantitative reverse transcriptase PCR in infected and uninfected gastric mucosa obtained from Bhutan and from the Dominican Republic. Immunohistochemical analysis showed that IL-17C expression in -infected gastric biopsy specimens was predominantly localized to epithelial and chromogranin A-positive endocrine cells. mRNA levels were also significantly greater among -positive than -negative infections ( = 0.012). studies confirmed an increase in mRNA and protein levels in cells infected with -positive infections compared to cells infected with either -negative or pathogenicity island (PAI) mutant. Chemical inhibition of IκB kinase (IKK), mitogen-activated protein extracellular signal-regulated kinase (MEK), and Jun N-terminal kinase (JNK) inhibited induction of IL-17C proteins in infected cells, whereas p38 inhibition had no effect on IL-17C protein secretion. In conclusion, infection was associated with a significant increase in IL-17C expression in human gastric mucosa. The role of IL-17C in the pathogenesis of -induced diseases remains to be determined.
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http://dx.doi.org/10.1128/IAI.00389-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607407PMC
October 2017