Khean-Lee Goh's research while affiliated with University of Kuala Lumpur and other places
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Publications (68)
Objective
An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occu...
Introduction:
The Malaysian Society of Gastroenterology and Hepatology saw the need for a consensus statement on metabolic dysfunction-associated fatty liver disease (MAFLD).
Methods:
The consensus panel consisted of experts in the field of gastroenterology/hepatology, endocrinology, bariatric surgery, family medicine and public health. A modifi...
A 32‐year‐old Malay male was referred to our hospital for a second opinion. An abdominal and pelvic CT scan at the previous medical facility showed a large retroperitoneal tumor, which was subjected to ultrasound‐guided fine‐needle aspiration cytology (FNAC) with a provisional diagnosis of malignant lymphoma. However, after reviewing the existing r...
Background:
A significant proportion of the non-alcoholic fatty liver disease (NAFLD) population is non-obese. Prior studies reporting the severity of NAFLD amongst non-obese patients were heterogenous. Our study, using data from the largest biopsy-proven NAFLD international registry within Asia, aims to characterize the demographic, metabolic and...
This paper reports the proceedings from the first consensus meeting on the management of mild‐to‐moderate gastroesophageal reflux disease (GERD) in the Southeast Asian (SEA) region. Seventeen statements were drawn up by a steering committee that focused on epidemiology, mechanism of action, diagnostic investigations, and treatment. Voting on the re...
Background
Resistance to clarithromycin and levofloxacin in Helicobacter pylori which resulted in treatment failures has become a major challenge for physicians worldwide. The resistance is mainly mediated by mutations in a specific domain of the 23S rRNA, gyrA and gyrB genes for clarithromycin and levofloxacin respectively. Hence in this study, we...
A 54-year-old Chinese man presented with ascites for 2 weeks. He had a preceding 2-year history of intermittent dysphagia, lethargy and general malaise. Blood investigations revealed leucocytosis with eosinophilia of 26.5%, whereas paracentesis showed turbid fluid with high protein content (45 g/L) and a high white blood cell count of 5580/µL, pred...
Purpose of the review
Idiopathic peptic ulcer disease (IPUD) is an ulcer with no identifiable etiology. The major causes of peptic ulceration are Helicobacter pylori infection and ingestion of non-steroidal anti-inflammatory drugs. Is this a truly idiopathic disease or simply a misdiagnosis?
Recent findings
The diagnosis of H. pylori infection can...
Probiotics comprise a large group of microorganisms, which have different properties and thus confer different benefits. The use of probiotics has shown promising results in the management of diarrheal diseases. While the availability of probiotic products has flourished in the marketplace, there is limited guidance on the selection of probiotics f...
Objective:
A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC).
Methods:
28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method,...
Background & Aims
H. pylori treatment failures are difficult to treat. We aimed to test the efficacy of 2 different high dose dual therapy regimens with or without bismuth for 2 weeks as a rescue therapy for treatment failures.
Methods
H. pylori positive patients were randomly assigned to either a Dexlansoprazole (Dexilant) 60 mg b.i.d, amoxicilli...
Background & Aims
We compared a high‐dose dual therapy (HDDT) with rabeprazole and amoxicillin and compared it with a standard triple therapy (STT) with rabeprazole, amoxicillin, and clarithromycin for 2 weeks for H pylori eradication in treatment naïve patients.
Methods
H pylori‐positive patients were randomly assigned to either a rabeparzole (Pa...
Background:
Gamma-glutamyl transferase (GGT) is associated with the risk of cardiovascular disease (CVD) in the general population.
Aim:
To identify the association of baseline GGT level and QRISK2 score among patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD).
Methods:
This was a retrospective study involving 1535 biopsy-pro...
Background:
We developed a novel oblique-tip papillotome (OT-papillotome) to facilitate biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate the utility of the OT-papillotome for contrast-guided cannulation (CGC) and wire-guided cannulation (WGC) during ERCP, compared with standard...
Coronavirus-19 (COVID-19) caused by SARS-CoV-2 has become a global pandemic. Risk of transmission may occur during endoscopy and the goal is to prevent infection among healthcare professionals while providing essential services to patients. Asia was the first continent to have a COVID-19 outbreak, and this position statement of the Asian Pacific So...
Objective
To establish the non-inferior efficacy of vonoprazan versus lansoprazole in the treatment of Asian patients with erosive oesophagitis (EO).
Design
In this phase III, double-blind, multicentre study, patients with endoscopically confirmed EO were randomised 1:1 to receive vonoprazan 20 mg or lansoprazole 30 mg, once daily for up to 8 week...
Wireless capsule endoscopy (WCE) is an effective technology that can be used to make a gastrointestinal (GI) tract diagnosis of various lesions and abnormalities. Due to a long time required to pass through the GI tract, the resulting WCE data stream contains a large number of frames which leads to a tedious job for clinical experts to perform a vi...
The landscape of liver diseases in Malaysia has changed dramatically since the time of Professor Balasegaram Manickavasagar-an eminent surgeon in the 1960s. The most significant discoveries in hepatology have been that of hepatitis B virus in 1963 and hepatitis C virus in 1989, which have both been shown to be predominantly blood borne diseases. He...
Background & Aims
Measuring liver stiffness only in patients with indeterminate or high nonalcoholic fatty liver disease (NAFLD) fibrosis scores (called a 2-step approach) was reported to reduce indeterminate or discordant results while maintaining the accuracy to identify patients with advanced fibrosis. We aimed to validate this approach using da...
Objective
The 7‐day standard triple therapy (STT) gives unacceptable low eradication rates. We sought to determine if extending the STT from 7 days to 14 days or adding a bismuth compound to the one week STT would result in a better eradication rates.
Methods
H. pylori positive patients were assigned to: Group A‐ (7‐day STT) rabeprazole(Pariet) 20...
Background and Aims
There have been few reports on lactase deficiency (LD) and lactose intolerance (LI) in Malaysia, which has a peculiar mix of three distinct major Asian races—Malay, Chinese, and Indian. The aim of this study was to determine the prevalence of LD and LI in a young multiethnic Malaysian population.
Methods
Lactase activity was me...
Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our review seeks to identify potential risk factors, modalities for early diagnosis, and novel interventions that may ameliorate the potential adverse effects of these surgical complica...
Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publi...
The study of Helicobacter pylori in Malaysia has given several important insights into the epidemiology of the infection and pathogenesis of disease. Malaysia has a multiracial Asian population with three major Asian races living together- Malay, Chinese and Indian. Races remain fairly distinct because of a paucity of inter-racial marriages. The “R...
This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia....
OBJECTIVE
Whether the human papillomavirus (HPV) is associated with esophageal cancer has been controversial and there has been no report to date on this in Malaysians or other South East Asian populations. With an age‐standardized incidence rate (ASR) of 2 per 100,000, esophageal cancers are not common amongst Malaysians, but are nevertheless impo...
Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing and display technology and the...
Wireless capsule endoscopy (WCE) is a technology developed to inspect the whole
gastrointestinal tract (especially the small bowel area that is unreachable using the traditional
endoscopy procedure) for various abnormalities in a non-invasive manner. However, visualization
of a massive number of images is a very time-consuming and tedious task for...
Outer Inflammatory Protein A (OipA) is an important virulence factor associated with gastric cancer and ulcer development, however the results has not been well-established and turned out to be controversial. This study aims to elucidate the role of OipA in H. pylori infection using clinical strains harboring oipA “on” and “off” motifs. Proteomics...
Colorectal cancer (CRC), gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), and nonalcoholic fatty liver disease are considered important emerging diseases in the Asia Pacific (AP) region. The incidence rate of CRC is the highest among gastrointestinal cancers in the region surpassing that of gastric cancer. However, populati...
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 (MALT) lymphoma. H. pylori management in ASEAN: the Bangkok consensus report gathered key opinion leaders for the region to review...
AIM
To compare high definition white light endoscopy and bright narrow band imaging for colon polyps’ detection rates.
METHODS
Patients were randomised to high definition white light endoscopy (HD-WLE) or the bright narrow band imaging (bNBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using bNBI with...
Data underlying the results presented in this paper.
(SAV)
Boxplot showing the cut-off index according to hepatocyte ballooning grades (p < 0.001 across groups).
p value across groups was calculated using Kruskal-Wallis test and between groups was calculated using Mann-Whitney test.
(TIF)
Boxplot showing the cut-off index according to lobular inflammation grades (p < 0.001 across groups).
p value across groups was calculated using Kruskal-Wallis test and between groups was calculated using Mann-Whitney test.
(TIF)
Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA⁺-M2BP) has been suggested to be useful for the assessment of disease severity in non-alcoholic fatty liver disease (NAFLD). Consecutive adult NAFLD patients who had a liver biopsy were included. Serum WFA⁺-M2BP level was measured using a lectin-antibody sandwich immunoassay using a...
Boxplot showing the cut-off index according to steatosis grades (p = 0.007 across groups).
p value across groups was calculated using Kruskal-Wallis test and between groups was calculated using Mann-Whitney test.
(TIF)
Background and study aims An Endoscopic Club E-conference (ECE) was set up in May 2014 to cater to increased demand for gastrointestinal endoscopy-related teleconferences in the Asia-Pacific region which were traditionally organized by the medical working group (MWG) of Asia-Pacific Advanced Network. This study describes how the ECE meeting was run...
Typical LC-ESI-TOF total ion chromatogram of plasma metabolite extract from (A) Baseline, (B) 6 months, (C) 12 months, and (D) 18 months post-eradication group, acquired under ESI positive ionization.
Global characterization of the fecal lipidomics data.
Global characterization of the plasma metabolomics data.
Typical LC-ESI-TOF total ion chromatogram of plasma metabolite extract from (A) Baseline, (B) 6 months, (C) 12 months, and (D) 18 months post-eradication group, acquired under ESI negative ionization.
Summary of the differentially expressed plasma metabolites.
Significantly changed fecal lipid profiles when Baseline compared with post-H. pylori eradication groups.
Mixture of Avanti Polar Lipids glycerophospholipid standards.
Proteobacteria hopanoids detected in the plasma metabolite profiles.
Typical LC-ESI-TOF total ion chromatogram of fecal lipid extract from (A) Baseline, (B) 6 months, (C) 12 months, and (D) 18 months post-eradication group, acquired under ESI positive ionization.
Typical LC-ESI-TOF total ion chromatogram of fecal lipid extract from (A) Baseline, (B) 6 months, (C) 12 months, and (D) 18 months post-eradication group, acquired under ESI negative ionization.
Summary of the differentially expressed fecal lipids.
Characteristics of the pooled fecal and plasma sample groups.
Significantly changed plasma metabolite profiles when Baseline compared with post-H. pylori eradication groups.
X-ray repair cross-complementing group 1 (XRCC1) is one of the key components in the base excision repair pathway that repairs erroneous DNA lesions and removes nonbulky base adducts for the maintenance of genome integrity. Studies have revealed that differences in individual DNA repair capacity can impact the interindividual variation in cancer su...
Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia‐Pacific population. PPIs are the mainstay therapeutic agents for prophylaxis against aspirin gastropathy and for acid‐related disorders including gastroesophageal reflux disease. They are also co‐prescribed with oral anticoagulant agents and with dual‐antiplatelet...
Citations
... The proximal end of gastric folds defines the EGJ in some guidelines [76,77,[79][80][81]; however, the distal end of palisade vessels defines the EGJ in other guidelines [78]. Recently, an international consensus report on the anatomy, pathophysiology and clinical significance of the EGJ has been published [82]. The consensus report recommends that the length of BE and the presence of intestinal metaplasia should not be required for diagnosing BE. ...
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... Fourth, confounders were adjusted based on knowledge of their associations with MAFLD and subclinical atherosclerosis. Lifestyle modification, such as smoking, alcohol drinking, physical activity and body weight management, remains the cornerstone for MAFLD treatment [45]. Additionally, improving cardiovascular health has been a target for prevention of MAFLD as well as subclinical atherosclerosis and cardiovascular disease [15,46]. ...
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... [13] A recent multicenter study in Asia showed that coexisting metabolic comorbidities were prevalent in non-obese individuals with NAFLD, including diabetes or prediabetes (71.1%), dyslipidemia (70.1%), and hypertension (43.4%). [37] In our study, the only difference was that, in comparison with metabolic parameters alone, only FPG was statistically different between the 2 groups. However, when >2 abnormal metabolic indices were used as the metabolic abnormality standards, the metabolic abnormality rate in the NAFLD group was 36.84%, which was higher than that in the healthy control group. ...
... The overall prevalence of GERD in adults is 13.3%, with a higher rate of 19.6% in Central America and 22.1% in South Asia. [3] GERD can result in diminished health-related quality of life, and potential long-term treatment can consume substantial health care resources. ...
... Resistance to levofloxacin relates to mutations in these genes, resulting in amino acid changes and rendering enzymes unaffected by the antibiotic. The most common mutations occur on the quinolone resistance-determining region (QRDR) of gyrA affecting codons 91 and 87 of the gyrA product, more specifically D91 to G [149,159,165,168], N [150,165,168,169,200] or Y [150,165,168] and N87K [150,159,165,168,201]. Despite this, changes in other codons of both gyrA, and, less frequently, gyrB products were, and continue to be, frequently reported, although the impact of some of them on antibiotic resistance is not yet well established [168,171,200]. ...
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... Probiotics are live microorganisms that confer health benefits on the host when administered in adequate amounts [14][15][16][17] . It is reported that Saccharomyces cerevisiae var. ...
... Further, besides NAFLD, there are so many diseases that have prefix of "non" like non-Hodgkin's lymphoma, noncirrhotic portal fibrosis, noncommunicable diseases, and so on, and the prefix "non" does not trivialize these diseases. 28 Similarly, the word "nonalcoholic" in NAFLD does not seem to be stigmatizing. In fact, patients may feel happier when they learn that their liver disease is not related to alcohol. ...
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... 13,14 The solution to the 'whom to test' question is predicated on the presumption that all those infected can be cured. 11,12,15 The recommendations for whom to test have greatly expanded and now include all first-degree relatives of those with H. pylori infections, those with active or a history of peptic ulcer disease or gastric cancer and all those living in the same household as a patient discovered to have an H. pylori infection 11,14,15 (Table 2). ...
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... Clarithromycin is a key antibiotic that we continue to recommend as first-line therapy. A recently published paper from our centre has shown a high success rate with 2-week STT incorporating clarithromycin which is reflective of the susceptibility of our local strains to clarithromycin (Hwong-Ruey Leow, Chang & Goh, 2020). However, with the rise in resistance rates as shown in this present study, success rates of this therapy will drop in the future. ...
... 6 There are abundant viral receptor expressions on gastrointestinal epithelial cells, and recent studies have suggested possible fecal-oral transmission. [7][8][9] It has been suggested that preventive measures against fecal contamination should be implemented owing to prolonged duration of viral shedding in stool up to 16 days from symptom onset. 10 The Association of Southeast Asian Nations (ASEAN) is composed of 11 countries with a total population of more than 655 million people, ranking third among all subregions in the world. ...
