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Background: REAP‐HP study (Real‐world practice and Expectation of Asia‐Pacific physicians and patients in Helicobacter Pylori eradication) was the pioneer study investigating the expectation and preference of physicians across Asia‐Pacific in H. pylori eradication in 2015. This study is the first follow‐up study of REAP‐HP in Taiwan. Aims: (1) To investigate the preference in regimens for the first‐line anti‐H. pylori therapy of Taiwanese gastroenterologist in 2020, (2) To survey the factor that cause the most concern when prescribing anti‐H. pylori regimens in clinical practice, and (3) to compare REAP‐HP survey data in 2020 and those surveyed in 2015 regarding the abovementioned end‐points. Methods: A questionnaire for H. pylori eradication survey of physicians was distributed to the gastroenterologists who attended the Taiwan Digestive Disease Week 2020. Data of most commonly used first‐line anti‐H. pylori regimens and concerned factors when prescribing anti‐H. pylori regimens between 2015 and 2020 were compared. Results: A total of 258 physicians from different districts of Taiwan participated in the REAP‐HP Survey in 2020. The top three most commonly used anti‐H. pylori regimens in Taiwan in 2020 were 14‐day standard triple therapy (36.8%; 95% confidence interval [CI]: 30.9%–42.7%), 7‐day standard triple therapy (17.8%; 95% CI: 13.1%–22.5%) and 14‐day reverse hybrid therapy (14.7%; 95% CI: 10.4%–19.0%) respectively. The top two factors that cause the most concern during prescribing anti‐H. pylori therapy were eradication rate (82.3%; 95% CI: 77.6%–87.0%) and side effect (10.4%; 95% CI: 6.7%–15.1%). In 2015, the top three most commonly used regimens in Taiwan were 7‐day standard triple therapy (62%; 95% CI: 56.2%–67.8%), 14‐day standard triple therapy (21%; 95% CI: 16.1%–25.9%) and 10‐day sequential therapy (7%; 95% CI: 4%–10%). A remarkable difference of the most commonly used anti‐H. pylori regimens between 2015 and 2020 existed (p <.001). The top two factors that cause the most concern during prescribing anti‐H. pylori therapy in 2015 were eradication rate (84.1%) and side effect (7.0%). There were no differences in the factors that cause the most concern during prescribing anti‐H. pylori regimens between 2015 and 2020. Conclusion: 14‐day standard triple therapy has replaced 7‐day standard triple therapy as the most commonly used first‐line anti‐H. pylori therapy among Taiwanese gastroenterologists in 2020. 14‐day reverse hybrid therapy is on rise to the third place as the most commonly used anti‐H. pylori regimen in Taiwan. [ABSTRACT FROM AUTHOR]

Summary: Background: Mac‐2 binding protein glycosylation isomer (M2BPGi) is an emerging biomarker for risk prediction of liver disease, but data remain sparse for patients with chronic hepatitis B (CHB) who are treated with nucleos(t)ide analogues (NA). Aim: To clarify serial changes in M2BPGi and its association with subsequent hepatocellular carcinoma (HCC) development in NA‐treated CHB patients. Methods: We enrolled 384 previously untreated CHB patients who received NAs. Among them, 195 had baseline cirrhosis (n = 142:48:5 for Child A:B:C). Sera were collected at NA initiation, and after 1 and 2 years. Serum M2BPGi levels were measured and expressed as cut‐off index (COI) at different time points. The association between M2BPGi and HCC was evaluated by the Cox proportional hazard model. Results: The median M2BPGi levels significantly decreased from 1.68 COI at baseline, to 1.0 at year 1, and 0.88 at year 2. During median follow‐up of 72.7 months, HCC occurred in 37 patients, 36 of whom had cirrhosis. In patients with cirrhosis, baseline M2BPGi level was associated with HCC risk (adjusted hazard ratio, 1.07 per COI; 95% CI, 1.01‐1.14) on the multivariable Cox analysis, whereas levels at year 1 or 2 were not independently predictive. A risk score for HCC was developed using baseline M2BPGi, age and body mass index with c statistics of 0.77, 0.79 and 0.87 at 3, 5 and 10 years, respectively. Conclusions: Serum M2BPGi level significantly decreases after NA treatment in CHB patients. Baseline level can be factored into the risk prediction of HCC in NA‐treated patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Diclofenac-induced adverse drug reactions and hyperbilirubinemia caused by a variant gene In addition, GI bleeding exacerbates bilirubin metabolism by supplying excess unconjugated bilirubin to the liver. A 76 years old man with a history of hyperbilirubinemia associated with diclofenac use was referred to our laboratory for genetic study. [Extracted from the article]

Many reports have shown the beneficial effects of consumption of pine seeds and pine seed oil. However, few studies have examined the biological effect of pinolenic acid (PNA; ∆5,9,12–18:3), the main fatty acid in pine seed oil. In this study, using murine macrophage RAW264.7 cells as a model, we examined the effect of PNA on polyunsaturated fatty acid (PUFA) metabolism, prostaglandin (PG) biosynthesis and cyclooxygenase-2 (COX-2) expression. Results showed that PNA was readily taken up, incorporated and elongated to form eicosatrienoic acid (ETrA, ∆7,11,14–20:3) in macrophage cells. A small portion of this elongated metabolite was further elongated to form ∆9,13,16–22:3. The degree of incorporation of PNA and its metabolites into cellular phospholipids varied with the length of incubation time and the concentration of PNA in the medium. Incubation of PNA also modified the fatty acid profile of phospholipids: the levels of 18- and 20-carbon PUFA were significantly decreased, whereas those of 22-carbon fatty acids increased. This finding suggests that PNA enhances the elongation of 20-carbon fatty acids to 22-carbon fatty acids. The syntheses of PGE1 from dihomo-γ-linolenic acid (DGLA, ∆8,11,14–20:4) and PGE2 from arachidonic acid (ARA, ∆5,8,11,14–20:4) were also suppressed by the presence of PNA and its metabolite. As the expression of COX-2 was not suppressed, the inhibitory effect of PNA on PG activity was attributed in part to substrate competition between the PNA metabolite (i.e., ∆7,11,14–20:3) and DGLA (or ARA). [ABSTRACT FROM AUTHOR]

Background and Aim: Endoluminal gastroplication (ELGP) offers a minimally invasive option for the treatment of gastroesophageal reflux disease (GERD) in Western countries. However, long-term outcomes of ELGP in Asian populations have not been investigated. The aim of this prospective study was to evaluate the long-term benefits of ELGP in Asian patients with GERD. Methods: Taiwanese patients diagnosed with GERD were enrolled and had the procedure performed with EndoCinch. The assessment included symptom scoring, validated GERD questionnaires, esophagogastroduodenoscopy, esophageal manometry and 24-h pH monitoring before and after the procedure over a 2-year period. Results: Twenty-one consecutive patients were recruited and underwent ELGP. Patients reported improved heartburn symptom score (mean 64.0 vs 21.1, P < 0.001), regurgitation frequency score (mean 2.4 vs 1.3, P < 0.001), and GERD health-related quality of life (mean 23.1 vs 10.1, P < 0.001) at 24 months. The mean total time of pH < 4 reduced from 121.7 min to 67.1 min ( P = 0.008) and mean DeMeester score reduced from 32.9 to 17.6 ( P = 0.011) at 3 months. Antisecretory drug discontinuation rate was 81%, 57%, 52% and 48% at 1, 6, 12 and 24 months, respectively. Of the patients who had a favorable initial response to ELGP at 1 month, 41% resumed antisecretory medications at 24 months follow-up. All adverse events were mild and transient. Conclusions: Endoluminal gastroplication is a safe and modestly effective endotherapy for patients with GERD. It significantly improved symptoms in an Asian population. Approximately one in two patients continues to be off medication at 24 months follow-up. However, the long-term efficacy and durability are still to be determined. [ABSTRACT FROM AUTHOR]