Kok Ann Gwee

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gka@nus.edu.sg


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Now showing 1 - 10 of 27
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    In-practice predictors of response to proton pump inhibitor therapy in primary care patients with dyspepsia in an Asian population
    (2008-02) Gwee, K.-A.; Hwang, J.E.-H.; Ho, K.-Y.; Yeoh, K.-G.; Lum, C.-F.; Ang, P.-K.; MEDICINE
    BACKGROUND: Data on Asian patients who present to primary care physicians with dyspepsia are limited. AIM: To determine predictors of response to a trial of proton pump inhibitor therapy. METHOD: One hundred ninety patients presenting to their general practitioners with dyspeptic symptoms but without alarm symptoms, underwent endoscopy and were subsequently treated with 20 mg of esomeprazole twice a day for 2 weeks. Possible predictors of response were assessed before treatment. Dyspeptic symptoms were scored at baseline and at the end of treatment. Excellent response and poor response were defined as end of treatment score of ≤1 and failure to achieve ≥50% reduction in symptom scores. RESULTS: On bivariate analysis male sex and having ≤2 concurrent dyspeptic symptoms predicted excellent response, whereas bloating as most bothersome symptom, >2 dyspeptic symptoms, anxiety, and irritable bowel syndrome predicted poor response. On multivariate analysis, male sex and ≤2 dyspeptic symptoms, and bloating remained significant predictors of excellent and poor responses, respectively. CONCLUSIONS: Predictors of response to proton pump inhibitor trial that could be easily assessed in a primary care clinic were identified. In our population the response was not as favorable as suggested by clinical trials. Frequent overlap with irritable bowel syndrome seems to be an important factor. © 2008 Lippincott Williams & Wilkins, Inc.
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    Prevalence of Irritable Bowel Syndrome in Singapore and Its Association with Dietary, Lifestyle, and Environmental Factors
    (KOREAN SOC NEUROGASTROENTEROLOGY & MOTILITY, 2016-10-01) Siah, Kewin TH; Wong, Reuben K; Chan, Yiong H; Ho, Khek Y; Gweet, Kok-Ann; Dr Kewin Tien Ho Siah; MEDICINE
    Background/Aims The prevalence of irritable bowel syndrome (IBS) has risen considerably over the past decade in Singapore. We aim to explore the contribution of changes in diet, lifestyle and habits that may contribute to the increased prevalence and development of IBS. Methods This is a survey-based cross-sectional population study aimed to gather demographic, socio-economical, lifestyle, dietary, antibiotic usage and other related information. Subjects were adult male or female Singaporeans aged 21 years or above. Association of the factors gathered with the presence or absence of IBS (by Rome III criteria) was assessed using chi-square or Fisher's exact test. Variables with a level of statistical significance of 0.1 or less in the univariate analysis were entered into a stepwise logistic regression model. Results A total of 297 subjects participated in the study (female 60.3%). Overall, 20.9% subjects fulfilled the Rome III IBS criteria. Univariate analysis showed that IBS was associated with pet ownership, antibiotic usage, late dinner, (> 9 PM) and consumption of Western meals, coffee, and bread. The multivariate logistic regression analyses showed that IBS was independently associated with being a pet owner (P = 0.008; OR, 2.5; 95% CI, 1.278-5.037). Conclusions The prevalence of IBS was 20.9% using the Rome III criteria in our study. The association between IBS and pet ownership will need further investigation.
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    Is the constipated Asian male more common than we think?
    (2007) Gwee, K.-A.; Wong, R.-K.M.; MEDICINE
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    The response of Asian patients with functional dyspepsia to eradication of Helicobacter pylori infection
    (2009) Gwee, K.-A.; Teng, L.; Ho, K.-Y.; Yeoh, K.-G.; Wong, R.-K.M.; Sutedja, D.-S.; MEDICINE
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    The prevalence of isolated unconjugated hyperbilirubinaemia (Gilbert's syndrome) in subjects attending a health screening programme in Singapore.
    (1992-12) Gwee, K.A.; Koay, E.S.; Kang, J.Y.; PHARMACOLOGY
    We retrospectively studied the prevalence of hyperbilirubinaemia in 1,296 consecutive subjects attending a hospital health screening programme over an eighteen-month period. Sixty-four subjects (5%) had elevated bilirubin levels. Forty-one subjects (3.2%) had isolated unconjugated hyperbilirubinaemia. These subjects probably had Gilbert's syndrome. Recognition of this common benign condition is important to avoid unnecessary investigations.
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    The effects of melatonin on colonic transit time in normal controls and IBS patients
    (2009) Lu, W.-Z.; Song, G.-H.; Gwee, K.-A.; Ho, K.-Y.; MEDICINE
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    Rising prevalence of colonic diverticulosis in a westernized multi-ethnic Asian community
    (WILEY, 2020-07-09) Soh, Yu Sen Alex; Ooi, Shu Qin Delicia; Chan, Yiong Huak; Siah, Tien-Ho Kewin; Lee, Soh-Ee; Lee, Wei Jie Jonathan; Zhu, Feng; Yeoh, Khay Guan; Gwee, Kok-Ann; Dr Shu Qin Ooi; DEAN'S OFFICE (MEDICINE); MEDICINE; DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL); PAEDIATRICS
    Background and Aim: Singapore is a multi-ethnic country that has undergone rapid development over the last few decades, with increasing influence of western culture, and faces an aging population. Previously, a varying prevalence of colonic diverticulosis (CD) was reported by a few small studies. This study aims to evaluate the prevalence of CD in Singapore and identify associations with common gastrointestinal symptoms and risk factors. Methods: We reviewed retrospective data of 20 395 consecutive colonoscopies performed from 2006 to 2016 for presence of CD and indications of screening, diarrhea, constipation, and abdominal pain. Results: The prevalence of CD progressively increased from 2006 to 2016 (14.9% vs 23.9%, adjusted trend < 0.001), with an overall prevalence of 19.6%. Patients with CD were older and had higher body mass index (BMI). CD was significantly more prevalent in Chinese compared with Malay and Indian races (20.5% vs 18.9% vs 15.5%, P < 0.05), and in male patients compared with female patients (21.5% vs 17.6%, P < 0.05). Right-sided CD was more common than left-sided or pan diverticulosis (16.2% vs 8.3% vs 4.8%, P < 0.05). Age [odds ratio (OR), 1.060; 95% confidence interval (CI), 1.052–1.068], BMI (OR, 1.051; 95% CI, 1.028–1.075), male gender (OR, 1.317; 95% CI, 1.084–1.600), and abdominal pain (OR, 1.409; 95% CI, 1.168–1.699) were positively associated, while constipation (OR, 0.566; 95% CI, 0.452–0.709) was negatively associated with CD. Conclusion: The prevalence of CD in Singapore has progressively increased over the last decade and is associated with older age, higher BMI, and abdominal pain. These findings may provide insights for healthcare resource planning in the region.
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    Melatonin attenuates stress-induced defecation: Lesson from a rat model of stress-induced gut dysfunction
    (2005-10) Song, G.H.; Gwee, K.A.; Ho, K.Y.; Moochhala, S.M.; PHARMACOLOGY; MEDICINE
    Melatonin is known to alleviate stress and modulate gut motility. We investigated the modulating effects of melatonin on stress-induced gut dysfunction. One hundred Wistar rats were randomly assigned to five equal groups, receiving intraperitoneal injections of 0, 1, 10, 100 or 1000 μg kg-1 melatonin, respectively. Fifteen minutes later, each group was divided again into four subgroups receiving no treatment, 0.25 mg luzindole (a non-selective melatonin receptor antagonist) intraperitoneally, wrap-restraint stress, and 10 mg kg-1 serotonin intraperitoneally, respectively. Two hours later, serum serotonin, corticotropin-releasing factor (CRF) and melatonin levels, and faecal output were recorded. Results showed that intraperitoneal melatonin increased faecal output, but this effect was abolished by luzindole. In wrap-restraint group, prior intraperitoneal melatonin at doses of 100 or 1000 μg kg-1 significantly inhibited stress-induced defecation. This effect was associated with corresponding reductions in serum serotonin and CRF concentrations. In serotonin-treated group, serotonin-induced defecation was also inhibited by melatonin. In conclusion, melatonin exhibited an excitatory effect on bowel output in rats placed under resting state, while attenuated defecation in those subjected to wrap-restraint stress or serotonin treatment. The inhibitory effects of melatonin on stress-induced defecation may stem from its antagonistic effect on stress-induced enhancement of serotonin and CRF secretion. © 2005 Blackwell Publishing Ltd.
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    Herbal medicines in functional dyspepsia—Untapped opportunities not without risks
    (Blackwell Publishing Ltd, 2020-11-30) Gwee, Kok-Ann; Holtmann, Gerald; Tack, Jan; Suzuki, Hidekazu; Liu, Jinsong; Xiao, Yinglian; Chen, Min-Hu; Hou, Xiaohua; Wu, Deng-Chyang; Toh, Clarissa; Lu, Fang; Tang, Xu-Dong; MEDICINE
    Background: Contemporary treatments for functional dyspepsia have limitations. Herbal medicine has been suggested as adjunctive treatment. With growing scientific recognition and public interests, an in-depth review of this is timely. Aims/Purpose: To evaluate the therapeutic potential and problems that may be associated with the adoption of herbal medicines in functional dyspepsia. Methods: We reviewed the treatment landscape of functional dyspepsia and assessed the scientific community's interest in herbal medicine. Preclinical pharmacological and clinical trial data were reviewed for several herbal medicines available in the market. Challenges associated with adoption of herbal medicine in mainstream medicine were critically evaluated. Results: We found that herbal medicines frequently comprise a combination of herbs with multiple reported pharmacological effects on gastrointestinal motility and secretory functions, as well as cytoprotective and psychotropic properties. We identified a number of commercially available herbal products that have undergone rigorous clinical trials, involving large numbers of well-defined subjects, reporting both efficacy and safety for functional dyspepsia. Persisting concerns include lack of rigorous assessments for majority of products, toxicity, consistency of ingredients, dose standardizations, and quality control. We provide a quality framework for its evaluation. Conclusions: We commend herbal medicine as a viable future option in managing functional dyspepsia. An attractive appeal of herbal medicine is the prospect to simultaneously target multiple pathophysiological mechanisms. Wider adoption and acceptance of herbal medicines in treatment algorithms of functional dyspepsia will require the application of the scientific rigor expected of chemical therapies, to all stages of their development and evaluation. © 2020 John Wiley & Sons Ltd