Helicobacter pylori

• Case 1
  

  A 58-year-old gentleman had noticed on and off epigastric pain for 1 year and needed frequent medications. The pain got better with drugs but recurred later on. Doctor suggested gastroscopy to examine the oesophagus, stomach and duodenum which showed severe gastritis with H.pylori infection. A course of eradication therapy including proton pump inhibitors with 2 antibiotics for 10 days was given. He recovered completely after drugs and his urea breath test 6 weeks later showed that the bacteria were successfully eliminated.

• Case 2
  A 50-year-old gentleman complained of belching and bloating for 12 weeks. Doctor suggested gastroscopy which unfortunately showed a large tumour in the stomach and presence of H. pylori infection. He required surgery and subsequent chemotherapy. This might have been avoided if the H. pylori infection can be eliminated 10 years earlier.
  
  

Colorectal cancer

• Case 1
  

  Ms Lee planned to check her colon 2 years ago through a private colonoscopy appointment. She knew from the media that a university offered free colonoscopy if she was lucky in the draw. Unfortunately, she was not picked in the lucky draw, and she also deferred the check-up herself as she had no symptoms. After two years, she finally had a colonoscopy and a large tumour was found and immediate operation was needed. The operation lasted 12 hours, followed by chemotherapy and radiotherapy, and now she recovered. If Ms Lee had had a colonoscopy 2 years ago, she could have avoided the surgery.

• Case 2
  A 58﹣year﹣old doctor, who had saved many lives in his career, noticed gradual abdominal distension which he attributed to obesity. Unfortunately, colonoscopy showed a large tumour with liver metastasis. He did not respond to chemotherapy. If he had time for a checkup earlier, this could be avoided.
  
  

Liver cancer

• Case 1
  Mr Lee, now aged 48, was diagnosed as a hepatitis B carrier in 2007. However, he did not turn up at his doctor’s clinic for regular check up.
  One day, he was admitted to hospital after a severe bout of vomiting. The results of the diagnostic tests showed that his ALT level was 10 times higher than normal and his serum HBV DNA reading also rose alarmingly (>2x10⁵ IU/ mL). It was confirmed as acute hepatitis. Apart from that, his spleen was found enlarged due to early cirrhosis.
  
  His doctor then prescribed him entecavir. Shortly after starting the medication, his condition was improved and he was discharged 10 days later. In the following 3 years, he adhered to the same medication as advised. The levels of ALT and HBV DNA remained normal and the size of his spleen returned normal.
  
  Doctor’s comments:
  It is essential that hepatitis B carriers have a check up every 3-6 months. This helps prevent acute hepatitis flare which can lead to liver cirrhosis.
  In the case of Mr Lee, even if medication can bring the condition under control, 10 days of hospitalisation can be translated into tremendous financial loss and unexpected inconvenience caused, besides unnecessary worry for the patient, his family and friends.
  
  
• Case 2
  Mr Ho is a 51-year-old hepatitis B carrier. The results of his blood tests showed that his platelet count was much lower than normal (105 x 10⁹/L; with normal being above 150 x 10⁹/L). Ultrasound showed increased coarsening of liver parenchyma and splenomegaly. Knowing that this could be caused by cirrhosis, a fibroscan examination was arranged.
  The results showed that Mr Ho’s fibroscan score (12 kPa) was far higher than normal (<7kPa), indicating liver cirrhosis. Entecavir was prescribed in an attempt to prevent progression of the disease.
  Mr Ho’s fibroscan at the end of the three years of treatment showed that there was a dramatic improvement in his condition. His fibroscan score was reduced to 7.2 kPa, which was close to the normal level.
  
  Doctor’s comments:
  In the past, liver cirrhosis caused by hepatitis B was thought to be irreversible. However, recent advancement in medical science has brought effective drugs with a low genetic barrier to resistance for suppressing hepatitis B virus in a short period of time. This makes ‘irreversible’ liver cirrhosis now reversible.
  Patients are advised to have regular fibroscan examinations as early detection and treatment can greatly increase the chance of recovery.
  
  
• Case 3
  Mr Cheung is a 55-year-old alcoholic. Feeling unwell in 2008, he consulted doctors and underwent several tests. The results showed that his levels of ALT and HBV DNA level were abnormally high. He was diagnosed hepatitis B infection and was started on medication. After 3 months of treatment, his ALT and HBV DNA returned to normal. His doctor suggested he kept on taking medication and having an ultrasound examination every 6 months.
  Mr Cheung followed the medical advice. However, on an ultrasound examination in December 2009, a malignant tumour of early stage was found in his liver. Fortunately, the size of tumour was small and could be removed by surgery.
  Mr Cheung recovered soon after the operation. He kept on taking the medication and having an ultrasound examination twice a year. He remained healthy since then.
  
  Doctor’s comment:
  Hepatitis B patients are more prone to developing liver cancer than people without infection. Since there may be no obvious signs and symptoms shown in early-stage liver cancer, regular ultrasound examinations at least twice a year are particularly important for early detection. Without early detection and treatment, the tumour can grow and spread to other locations of the body, and the chance of recovery will become slim.