JGH Open: An Open Access Journal of Gastroenterology and Hepatology, 2020
The COVID‐19 pandemic, secondary to SARS‐CoV‐2, has resulted in high mortality and morbidity worl... more The COVID‐19 pandemic, secondary to SARS‐CoV‐2, has resulted in high mortality and morbidity worldwide. As inflammatory bowel disease (IBD) is a chronic disease, and most patients are on long‐term immunosuppressive agents, there is understandable concern, particularly in terms of therapy. In view of this, experts in IBD across the Asia Pacific region were invited to put together recommendations based on their experience and the currently available data. In general, most IBD therapies (with a few exceptions) can be continued safely, and the general consensus is that maintaining disease control should remain the main principle of management. In addition, social distancing measures and the appropriate use of personal protective equipment should be strictly adhered to. During the current pandemic, face‐to‐face clinic follow ups and non‐urgent procedures should be kept to a minimum.
Background and Aims Asian patients have traditionally been considered to respond poorly to interf... more Background and Aims Asian patients have traditionally been considered to respond poorly to interferon-based treatment. We explored the effect of peginterferon alfa-2a (PEGASYS) in Asian patients with HBeAg-negative CHB enrolled in a large randomized clinical trial investigating the response to PEGASYS +/− lamivudine versus lamivudine (Marcellin et al. NEJM 2004). Patients and Methods 177 patients with HBeAg-negative CHB received 48 weeks of PEGASYS (180 μg once-weekly) + placebo. Patients were assessed 24 weeks post-treatment. Results Of the 177 patients, 108 (61%) were of Asian origin. Almost all the Asian patients (97%) were infected with genotypes B or C (42 patients with B, 63 with C, one with D and two other).The rate of combined response (ALT normalization and HBV DNA <20,000cp/ml) in Asian patients treated with PEGASYS was 45% (49/108), which was higher than that observed in the overall ITT population (36%). Response to PEGASYS was equally good in Asian patients infected with HBV genotype B (43%) and genotype C (49%). HBV DNA suppression of <400cp/ml was achieved in 26% of Asian patients compared with 19% in the overall ITT population. A total of three (3%) Asian patients treated with PEGASYS achieved HBsAg seroconversion after only 6 months of follow-up. Conclusions Asian patients responded favorably to PEGASYS treatment; 45% of Asian patients had a virological and biochemical response which was sustained 24 weeks after the end of treatment. Response rates were similar in patients infected with genotypes B or C.
Background and Aims Persons with inflammatory bowel disease (IBD) may be particularly vulnerable ... more Background and Aims Persons with inflammatory bowel disease (IBD) may be particularly vulnerable to COVID-19 either because of their underlying disease or its management. Guidance has been presented on the management of persons with IBD in the time of this pandemic by different groups. We aimed to determine how gastroenterologists around the world were approaching the management of IBD. Methods Members of the World Gastroenterology Organization (WGO) IBD Task Force contacted colleagues in countries largely beyond North America and Europe, inviting them to review the WGO website for IBD and COVID-19 introduction, with links to guideline documents, and then to respond to 9 ancillary open-ended management questions. Results Fifty-two gastroenterologists from 33 countries across 6 continents completed the survey (April 14 to May 16, 2020). They were all adhering for the most part to published guidelines on IBD management in the COVID-19 era. Some differences and reductions in services r...
In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virolog... more In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virological response (SVR) is very high, but close attention must be paid to the possible occurrence of hepatocellular carcinoma (HCC) and reactivation of hepatitis B virus (HBV) in patients with co-infection who achieved SVR in short term. HCC occurrence was more often observed in patients with previous HCC history. We found occurrence of HCC in 178 (29.6%) of 602 patients with previous HCC history (15.4 months mean follow-up post-DAA initiation) but, in contrast, in only 604 (1.3%) of 45,870 patients without previous HCC history (18.2 months mean follow-up). Thus, in these guidelines, we recommend the following: in patients with previous HCC history, surveillance at 4-month intervals for HCC by ultrasonography (US) and tumor markers should be performed. In patients without previous HCC history, surveillance at 6- to 12-month intervals for HCC including US is recommended until the long-term DA...
The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in A... more The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in Asia is characterized by specific distribution of genotypes, lack of access to specific therapeutic agents, relatively high cost of treatment, and lack of experienced healthcare providers. Clear consensus on the diagnosis, management, and monitoring of HCV infection specific to the Asian region is a major unmet need. The consensus guidelines documents that have been published to date by major medical societies presume access to an array of direct acting antiviral agents and diagnostic tests that are not broadly applicable to resource limited settings, including Asia. To address the lack of an Asia-specific set of HCV treatment guidelines, we assembled a panel of 15 HCV experts in the field of hepatology from India, Indonesia, Myanmar, Vietnam, Pakistan, Philippines, and Mongolia convened in April 2017 to review the updated literature and provide recommendations on the diagnosis and manage...
Autoimmune hepatitis (AIH) is considered less common in the Asian-pacific region. Due to this, AI... more Autoimmune hepatitis (AIH) is considered less common in the Asian-pacific region. Due to this, AIH flare as a cause of acute on chronic liver failure(ACLF) is often overlooked and treatment is delayed. We aimed at defining clinical, histopathological spectrum and role of steroid therapy in AIH-ACLF. Patients with AIH-ACLF, prospectively recruited and followed between 2012-2017, were analyzed from the APASL ACLF Research Consortium (AARC) data base. Diagnosis of AIH was confirmed using International Autoimmune Hepatitis Group (IAIHG) score or simplified AIH score with histopathological evidence. Of 2,825 ACLF patients, 82(2.9%) fulfilled criteria of AIH (age 42.1±18.1yr, 70%females). At baseline, mean bilirubin was 18.6±8.2mg/dl, CTP score 11.7±1.4 and MELD score 27.6±6.5. Mean IgG was 21.61±7.32 g/dl and was elevated ≥1.1 times in 97%; 49% were seronegative. Liver histology was available in 90%, with median HAI of 10[IQR:7-12]; 90%with moderate to severe interface activity; 56% show...
Journal of gastroenterology and hepatology, Jan 26, 2018
The concept of consuming microorganisms in the treatment of a medical condition and in health mai... more The concept of consuming microorganisms in the treatment of a medical condition and in health maintenance has gained much traction, giving rise to an abundance of medical claims, and of health supplements. We identified relevant clinical questions on the therapeutic use of probiotics and reviewed the literature in irritable bowel syndrome, inflammatory bowel disease, impaired intestinal immunity, liver disease, intestinal infections and common childhood digestive disorders. Statements were developed to address these clinical questions. A panel of experienced clinicians was tasked to critically evaluate and debate the available data. Both consensus and contentious statements are presented to provide to clinicians a perspective on the potential of probiotics, and importantly their limitations.
Guidelines on the management of antithrombotic therapy for endoscopic procedures vary among count... more Guidelines on the management of antithrombotic therapy for endoscopic procedures vary among countries. Differences in the management of antithrombotic agents for endoscopic procedures between Western and Eastern countries have already been reported. However, no study has investigated the differences among Asian countries. The aim of this study was to examine the differences in the etiology of gastrointestinal bleeding and management of antithrombotic agents during endoscopic procedures between Japan and other Asian countries (OAC). Questionnaires regarding gastrointestinal bleeding in clinical practice and management of antithrombotic agents during endoscopy were distributed to members of the International Gastroenterology Consensus Symposium Study Group. We analyzed the questionnaire answers and compared the results between Japan and OAC. The cause of and treatment methods for gastrointestinal bleeding differed between Japan and OAC. In Japan, the trend was to continue drugs at the...
Colorectal cancer, fourth leading form of cancer worldwide and is increasing in alarming rate in ... more Colorectal cancer, fourth leading form of cancer worldwide and is increasing in alarming rate in the developing countries. Treating colorectal cancer has become a big challenge worldwide and several antibody therapies such as bevacizumab, panitumumab and cetuximab are being used with limited success. Moreover, mutation ingene which is linked with the colorectal cancer initiation and progression further interferes with the antibody therapies. Considering median progression free survival and overall survival in account, this review focuses to identify the most efficient antibody therapy in combination with chemotherapy (FOLFOX-4) inmutated colorectal cancer patients. The bevacizumab plus FOLFOX-4 therapy shows about 9.3 months and 8.7 months of progression free survival forwild and mutant type, respectively. The overall survival is about 34.8 months for wild type whereas for the mutant it is inconclusive for the same therapy. In comparison, panitumumab results in better progression-fr...
Journal of gastroenterology and hepatology, Jan 31, 2017
Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastro... more 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 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: 1) Epidemiology and Disease Association; 2) Diagnostic tests; 3) Management; and 4) 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...
In 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific gathered leading hepatitis ex... more In 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific gathered leading hepatitis experts from Bangladesh, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand to discuss common challenges to the burden posed by hepatitis B virus (HBV) and hepatitis C virus (HCV), to learn from each other&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s experience, and identify sustainable approaches. In this report, we summarise these discussions. Countries differ in their policy responses to HBV and HCV; however, substantial systemic, cultural, and financial barriers to achievement of elimination of these infections persist in all countries. Common challenges to elimination include limited availability of reliable epidemiological data; insufficient public awareness of risk factors and modes of transmission, leading to underdiagnosis; high rates of transmission through infected blood products, including in medical settings; limited access to care for people who inject drugs; prevailing stigma and discrimination against people infected with viral hepatitis; and financial barriers to treatment and care. Despite these challenges, promising examples of effective programmes, public-private initiatives, and other innovative approaches are evident in all countries we studied in Asia Pacific. The draft WHO Global Health Sector Strategy on Viral Hepatitis 2016-21 provides a solid framework upon which governments can build their local strategies towards viral hepatitis. However, greater recognition by national governments and the international community of the urgency to comprehensively tackle both HBV and HCV are still needed. In all countries, strategic plans and policy goals need to be translated into resources and concrete actions, with national governments at the helm, to enable a sustainable response to the rising burden of hepatitis B and C in all countries.
Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any i... more Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its…
JGH Open: An Open Access Journal of Gastroenterology and Hepatology, 2020
The COVID‐19 pandemic, secondary to SARS‐CoV‐2, has resulted in high mortality and morbidity worl... more The COVID‐19 pandemic, secondary to SARS‐CoV‐2, has resulted in high mortality and morbidity worldwide. As inflammatory bowel disease (IBD) is a chronic disease, and most patients are on long‐term immunosuppressive agents, there is understandable concern, particularly in terms of therapy. In view of this, experts in IBD across the Asia Pacific region were invited to put together recommendations based on their experience and the currently available data. In general, most IBD therapies (with a few exceptions) can be continued safely, and the general consensus is that maintaining disease control should remain the main principle of management. In addition, social distancing measures and the appropriate use of personal protective equipment should be strictly adhered to. During the current pandemic, face‐to‐face clinic follow ups and non‐urgent procedures should be kept to a minimum.
Background and Aims Asian patients have traditionally been considered to respond poorly to interf... more Background and Aims Asian patients have traditionally been considered to respond poorly to interferon-based treatment. We explored the effect of peginterferon alfa-2a (PEGASYS) in Asian patients with HBeAg-negative CHB enrolled in a large randomized clinical trial investigating the response to PEGASYS +/− lamivudine versus lamivudine (Marcellin et al. NEJM 2004). Patients and Methods 177 patients with HBeAg-negative CHB received 48 weeks of PEGASYS (180 μg once-weekly) + placebo. Patients were assessed 24 weeks post-treatment. Results Of the 177 patients, 108 (61%) were of Asian origin. Almost all the Asian patients (97%) were infected with genotypes B or C (42 patients with B, 63 with C, one with D and two other).The rate of combined response (ALT normalization and HBV DNA <20,000cp/ml) in Asian patients treated with PEGASYS was 45% (49/108), which was higher than that observed in the overall ITT population (36%). Response to PEGASYS was equally good in Asian patients infected with HBV genotype B (43%) and genotype C (49%). HBV DNA suppression of <400cp/ml was achieved in 26% of Asian patients compared with 19% in the overall ITT population. A total of three (3%) Asian patients treated with PEGASYS achieved HBsAg seroconversion after only 6 months of follow-up. Conclusions Asian patients responded favorably to PEGASYS treatment; 45% of Asian patients had a virological and biochemical response which was sustained 24 weeks after the end of treatment. Response rates were similar in patients infected with genotypes B or C.
Background and Aims Persons with inflammatory bowel disease (IBD) may be particularly vulnerable ... more Background and Aims Persons with inflammatory bowel disease (IBD) may be particularly vulnerable to COVID-19 either because of their underlying disease or its management. Guidance has been presented on the management of persons with IBD in the time of this pandemic by different groups. We aimed to determine how gastroenterologists around the world were approaching the management of IBD. Methods Members of the World Gastroenterology Organization (WGO) IBD Task Force contacted colleagues in countries largely beyond North America and Europe, inviting them to review the WGO website for IBD and COVID-19 introduction, with links to guideline documents, and then to respond to 9 ancillary open-ended management questions. Results Fifty-two gastroenterologists from 33 countries across 6 continents completed the survey (April 14 to May 16, 2020). They were all adhering for the most part to published guidelines on IBD management in the COVID-19 era. Some differences and reductions in services r...
In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virolog... more In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virological response (SVR) is very high, but close attention must be paid to the possible occurrence of hepatocellular carcinoma (HCC) and reactivation of hepatitis B virus (HBV) in patients with co-infection who achieved SVR in short term. HCC occurrence was more often observed in patients with previous HCC history. We found occurrence of HCC in 178 (29.6%) of 602 patients with previous HCC history (15.4 months mean follow-up post-DAA initiation) but, in contrast, in only 604 (1.3%) of 45,870 patients without previous HCC history (18.2 months mean follow-up). Thus, in these guidelines, we recommend the following: in patients with previous HCC history, surveillance at 4-month intervals for HCC by ultrasonography (US) and tumor markers should be performed. In patients without previous HCC history, surveillance at 6- to 12-month intervals for HCC including US is recommended until the long-term DA...
The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in A... more The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in Asia is characterized by specific distribution of genotypes, lack of access to specific therapeutic agents, relatively high cost of treatment, and lack of experienced healthcare providers. Clear consensus on the diagnosis, management, and monitoring of HCV infection specific to the Asian region is a major unmet need. The consensus guidelines documents that have been published to date by major medical societies presume access to an array of direct acting antiviral agents and diagnostic tests that are not broadly applicable to resource limited settings, including Asia. To address the lack of an Asia-specific set of HCV treatment guidelines, we assembled a panel of 15 HCV experts in the field of hepatology from India, Indonesia, Myanmar, Vietnam, Pakistan, Philippines, and Mongolia convened in April 2017 to review the updated literature and provide recommendations on the diagnosis and manage...
Autoimmune hepatitis (AIH) is considered less common in the Asian-pacific region. Due to this, AI... more Autoimmune hepatitis (AIH) is considered less common in the Asian-pacific region. Due to this, AIH flare as a cause of acute on chronic liver failure(ACLF) is often overlooked and treatment is delayed. We aimed at defining clinical, histopathological spectrum and role of steroid therapy in AIH-ACLF. Patients with AIH-ACLF, prospectively recruited and followed between 2012-2017, were analyzed from the APASL ACLF Research Consortium (AARC) data base. Diagnosis of AIH was confirmed using International Autoimmune Hepatitis Group (IAIHG) score or simplified AIH score with histopathological evidence. Of 2,825 ACLF patients, 82(2.9%) fulfilled criteria of AIH (age 42.1±18.1yr, 70%females). At baseline, mean bilirubin was 18.6±8.2mg/dl, CTP score 11.7±1.4 and MELD score 27.6±6.5. Mean IgG was 21.61±7.32 g/dl and was elevated ≥1.1 times in 97%; 49% were seronegative. Liver histology was available in 90%, with median HAI of 10[IQR:7-12]; 90%with moderate to severe interface activity; 56% show...
Journal of gastroenterology and hepatology, Jan 26, 2018
The concept of consuming microorganisms in the treatment of a medical condition and in health mai... more The concept of consuming microorganisms in the treatment of a medical condition and in health maintenance has gained much traction, giving rise to an abundance of medical claims, and of health supplements. We identified relevant clinical questions on the therapeutic use of probiotics and reviewed the literature in irritable bowel syndrome, inflammatory bowel disease, impaired intestinal immunity, liver disease, intestinal infections and common childhood digestive disorders. Statements were developed to address these clinical questions. A panel of experienced clinicians was tasked to critically evaluate and debate the available data. Both consensus and contentious statements are presented to provide to clinicians a perspective on the potential of probiotics, and importantly their limitations.
Guidelines on the management of antithrombotic therapy for endoscopic procedures vary among count... more Guidelines on the management of antithrombotic therapy for endoscopic procedures vary among countries. Differences in the management of antithrombotic agents for endoscopic procedures between Western and Eastern countries have already been reported. However, no study has investigated the differences among Asian countries. The aim of this study was to examine the differences in the etiology of gastrointestinal bleeding and management of antithrombotic agents during endoscopic procedures between Japan and other Asian countries (OAC). Questionnaires regarding gastrointestinal bleeding in clinical practice and management of antithrombotic agents during endoscopy were distributed to members of the International Gastroenterology Consensus Symposium Study Group. We analyzed the questionnaire answers and compared the results between Japan and OAC. The cause of and treatment methods for gastrointestinal bleeding differed between Japan and OAC. In Japan, the trend was to continue drugs at the...
Colorectal cancer, fourth leading form of cancer worldwide and is increasing in alarming rate in ... more Colorectal cancer, fourth leading form of cancer worldwide and is increasing in alarming rate in the developing countries. Treating colorectal cancer has become a big challenge worldwide and several antibody therapies such as bevacizumab, panitumumab and cetuximab are being used with limited success. Moreover, mutation ingene which is linked with the colorectal cancer initiation and progression further interferes with the antibody therapies. Considering median progression free survival and overall survival in account, this review focuses to identify the most efficient antibody therapy in combination with chemotherapy (FOLFOX-4) inmutated colorectal cancer patients. The bevacizumab plus FOLFOX-4 therapy shows about 9.3 months and 8.7 months of progression free survival forwild and mutant type, respectively. The overall survival is about 34.8 months for wild type whereas for the mutant it is inconclusive for the same therapy. In comparison, panitumumab results in better progression-fr...
Journal of gastroenterology and hepatology, Jan 31, 2017
Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastro... more 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 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: 1) Epidemiology and Disease Association; 2) Diagnostic tests; 3) Management; and 4) 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...
In 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific gathered leading hepatitis ex... more In 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific gathered leading hepatitis experts from Bangladesh, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand to discuss common challenges to the burden posed by hepatitis B virus (HBV) and hepatitis C virus (HCV), to learn from each other&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s experience, and identify sustainable approaches. In this report, we summarise these discussions. Countries differ in their policy responses to HBV and HCV; however, substantial systemic, cultural, and financial barriers to achievement of elimination of these infections persist in all countries. Common challenges to elimination include limited availability of reliable epidemiological data; insufficient public awareness of risk factors and modes of transmission, leading to underdiagnosis; high rates of transmission through infected blood products, including in medical settings; limited access to care for people who inject drugs; prevailing stigma and discrimination against people infected with viral hepatitis; and financial barriers to treatment and care. Despite these challenges, promising examples of effective programmes, public-private initiatives, and other innovative approaches are evident in all countries we studied in Asia Pacific. The draft WHO Global Health Sector Strategy on Viral Hepatitis 2016-21 provides a solid framework upon which governments can build their local strategies towards viral hepatitis. However, greater recognition by national governments and the international community of the urgency to comprehensively tackle both HBV and HCV are still needed. In all countries, strategic plans and policy goals need to be translated into resources and concrete actions, with national governments at the helm, to enable a sustainable response to the rising burden of hepatitis B and C in all countries.
Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any i... more Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its…
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Papers by Jose Sollano