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Chen C.-H.,Digestive Disease Center | Chen C.-H.,Hungkuang University | Chen C.-H.,Meiho University of Technology | Lin C.-L.,Data Management | And 3 more authors.
Medicine (United States) | Year: 2016

Duodenal diversion can ameliorate lipid and glucose metabolism. We assessed the risk of stroke after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) in peptic ulcer disease (PUD). We identified 6425 patients who received SGBIIA for PUD between 1998 and 2010 from the Taiwan National Health Insurance Research Database as the study cohort; we frequency-matched them with 25,602 randomly selected controls from the PUD population who did not receive SGBIIA according to age, sex, index year, and comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and obesity. All patients were followed until the end of 2011 to determine the incidence of stroke. The incidence of stroke was lower in patients in the SGBIIA cohort than in those in the non-SGBIIA cohort (18.9 vs 22.9 per 1000 personyears, adjusted hazard ratio [aHR] 0.80, 95% confidence interval [CI] 0.72-0.89, P<0.001). The risk of ischemic stroke (aHR 0.77, 95% CI 0.69-0.86, P<0.001), rather than hemorrhagic stroke (aHR 1.00, 95% CI 0.78-1.28), was lower for the SGBIIA cohort than for the non-SGBIIA cohort according to the multivariable Cox proportional hazard regression analysis. The relative risk of ischemic stroke after SGBIIA was lower in men (aHR 0.77, 95% CI 0.69-0.86) than in women (aHR 0.80, 95% CI 0.65-0.99) and in patients aged ≥365 years (aHR 0.72, 95% CI 0.63-0.81) than in those of other age groups (-49 years, aHR 0.82, 95% CI 0.48-1.39; 50-64 years, aHR 1.01, 95% CI 0.79-1.28). The relative risk of ischemic stroke after SGBIIA was also reduced in patients with comorbidities (aHR 0.84, 5% CI 0.75-0.95) rather than in those without comorbidities (aHR 0.81, 95% CI 0.59-1.12). SGBIIA is associated with a low risk of ischemic stroke for PUD patients, and its protective effect is prominent in men, patients aged 65 years, and those with comorbidities. © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Chen C.-H.,Digestive Disease Center | Chen C.-H.,Hungkuang University | Chen C.-H.,Meiho University of Technology | Lin C.-L.,Data Management | And 2 more authors.
Osteoporosis International | Year: 2016

Summary: Gastroesophageal reflux disease (GERD) with proton pump inhibitor (PPI) use is associated with an increased risk of osteoporosis. The risk of hip fracture is not increased in GERD patients with PPI use. Introduction: The relationship between GERD with PPI treatment and the risk of osteoporosis is unclear. We aimed to determine the risk of developing osteoporosis in patients diagnosed with GERD. Methods: Patients diagnosed with GERD and received PPI treatment between 2000 and 2010 were identified from the Longitudinal Health Insurance Database as the study cohort (n = 10,620), which was frequency matched with the comparison cohort (n = 20,738) sampled from the general population according to age, sex, index year, and comorbidities. Both cohorts were followed until the end of 2011. The risk of osteoporosis was evaluated in both groups by using Cox proportional hazards regression models. Results: The GERD patients with PPI treatment had a greater incidence (31.4 vs 20.7 per 1000 person-year; crude hazard ratio [cHR] 1.51; 95 % confidence interval [CI] 1.40–1.63) and a higher risk (adjusted HR [aHR] 1.50; 95 % CI 1.39–1.62) of osteoporosis than that of the comparison cohort. However, the overall incidence of hip fracture was not different between the GERD with PPI use and the control cohorts (aHR 0.79; 95 % CI 0.53–1.18). Conclusion: GERD with PPI use is associated with an increased risk of osteoporosis. The findings of our study do not support an increased risk of hip fracture in GERD patients treated with a PPI. © 2016, International Osteoporosis Foundation and National Osteoporosis Foundation.


Chen C.-H.,Digestive Disease Center | Chen C.-H.,Hungkuang University | Chen C.-H.,Meiho University of Technology | Lin C.-L.,Data Management | And 2 more authors.
PLoS ONE | Year: 2016

Purpose: Abnormal interaction in the brain-gut axis has emerged as one of the relevant pathophysiological mechanisms for the development of irritable bowel syndrome (IBS). Moreover, the brain-gut axis has recently been demonstrated to be crucial for the maintenance of cognitive performance. Therefore, we assessed the risk of dementia following diagnosis of IBS. Methods: Using the Taiwan National Health Insurance Research Database (NHIRD) to obtain medical claims data from 2000 to 2011, we employed a random sampling method to enroll32 298 adult patients with IBS and frequency-matched them according to sex, age, and baseline year with 129 192 patients without IBS. Results: The patients with IBS exhibited an increased risk of dementia [adjusted hazard ratio (aHR) = 1.26, 95% confidence interval (CI) = 1.17-1.35]after adjustment for age, sex, diabetes, hypertension, stroke, coronary artery disease (CAD), head injury, depression, and epilepsy, and the overall incidence of dementia for the cohorts with and without IBS was 4.86 and 3.41 per 1000 person-years, respectively. IBS was associated with an increased risk of dementia in patients older than 50 years in both male and female, and in those with comorbidity or without comorbidity. After adjustment for age, sex, and comorbidity, patients with IBS were also more likely to develop either non- Alzheimer's disease (AD) dementia (aHR = 1.24, 95% CI = 1.15-1.33) or AD (aHR = 1.76, 95% CI = 1.28-2.43). Conclusions: IBS is associated with an increased risk of dementia, and this effect is obvious only in patients who are ≥ 50 years old. © 2016 Chen et al.


Chen C.-H.,Digestive Disease Center | Chen C.-H.,Hungkuang University | Chen C.-H.,Meiho University of Technology | Lin C.-L.,Data Management | And 2 more authors.
Medicine (United States) | Year: 2015

An abnormal interaction in the brain-gut axis is regarded as the cause of irritable bowel syndrome (IBS). We attempted to determine the association between IBS and subsequent development of epilepsy. A total of 32,122 patients diagnosed with IBS between 2000 and 2011 were identified from the Longitudinal Health Insurance Database as the study cohort, and 63,295 controls were randomly selected from the insurants without IBS and frequency-matched according to age, sex, and index year as the comparison cohort. Both cohorts were followed up until the end of 2011 to measure the incidence of epilepsy.We analyzed the risks of epilepsy using Cox proportional hazards regression models. The IBS patients had greater cumulative incidence of epilepsy than the cohort without IBS (log-rank test, P<0.001 and 2.54 versus 1.86 per 1000 person-years). The IBS cohort had a higher risk of epilepsy after adjusting for age, sex, diabetes, hypertension, stroke, coronary artery disease, head injury, depression, systemic lupus erythematosus, brain tumor, and antidepressants usage (adjusted hazard ratio [aHR]: 1.30, 95% confidence interval [CI]: 1.17-1.45). Stratified by the presence of other risk factors, the relative risk was also greater for patients with (aHR: 1.25, 95% CI: 1.10-1.41) or without other risk factors (aHR: 1.68, 95% CI: 1.35-2.10) in the IBS cohort than for those in the non-IBS cohort. The age-specific relative risk of epilepsy in the IBS cohort was greater than that in the non-IBS cohort for both 35 to 49 age group and 50 to 64 age group (age - 34, aHR:1.31, 95% CI: 0.93-1.85; age 35- 49, aHR: 1.43, 95% CI: 1.12-1.83; age 50-64, aHR: 1.56, 95% CI: 1.27-1.91). However, there was no difference between patients > 65 years with IBS and those without IBS (aHR: 1.11, 95% CI: 0.94-1.31). This population-based cohort study revealed that IBS increases the risk of developing epilepsy. However, IBS may be less influential than other risk factors. Further study is necessary to clarify whether IBS is a risk factor or an epiphenomenon for epilepsy development. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Chen C.-H.,Digestive Disease Center | Chen C.-H.,Hungkuang University | Chen C.-H.,Meiho University of Technology | Lin C.-L.,China Medical University at Heping | And 2 more authors.
Medicine (United States) | Year: 2015

Gallbladder polyp (GP) and stroke share several metabolic disorders as risk factors. We assessed the association between GP and subsequent stroke risk. From 2000 to 2011, patients with GP aged >20 years were identified from the Longitudinal Health Insurance Database 2000. Of the 15, 975 examined patients, 12, 780 and 3195 were categorized into the non-GP and GP cohorts, respectively. The relative risks of stroke were estimated using the Cox proportional hazard model after adjusting for age, sex, and comorbidities. The overall incidence of stroke was higher in the GP cohort than in the non-GP cohort (6.66 vs 5.20/1000 person-yr), with an incidence rate ratio (IRR) of 1.28 (95% confidence interval [CI]=1.15-1.42). The risk of stroke was 1.32-fold (95% CI=1.06-1.63) in patients with GP compared with patients without GP after adjusting for age, sex, income level, urbanization level, occupation and comorbidities of gallstone, alcohol-related illness, diabetes, hyperlipidemia, hypertension, obesity, COPD, coronary heart disease, and asthma. Furthermore, the stroke risk was higher among elderly patients (with 1-yr intervals; adjusted HR [aHR]=1.06, 95% CI=1.05-1.07), the male sex (aHR=1.62, 95% CI=1.35-1.96), lower income level (aHR=1.37, 95% CI=1.02-1.85 for level I; aHR=1.62, 95% CI=1.25-2.10 for level II), living in second urbanized areas (aHR=1.28, 95% CI=1.00-1.63), alcoholrelated illness (aHR=1.56, 95% CI=1.07-2.28), diabetes (aHR=1.78, 95% CI=1.41-2.24), and hypertension (aHR=2.74, 95% CI=2.19-3.42). GP is associated with stroke; however, GP may be less influential than other risk factors are, such as male sex, lower income level, alcohol-related illness, diabetes, and hypertension, on stroke development. Additional studies are required to clarify whether GP is a risk factor for or an epiphenomenon of stroke development. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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