Bulletin Autumn‧Winter 2004

patients w i t h H. pylori i n f ec t i on and a h i s t o ry of ulcer b l eed i ng. The result showed that one week of antibiotics was comparable to long-term acid suppressive t he r apy i n p r e v e n t i ng recurrent ulcer bleeding associated w i t h aspirin. These three studies have for the first time defined a novel and cost-effective strategy for the prevention of peptic ulcer disease in patients requiring NSAIDs and aspirin. Patients needing regular treatment w i t h NSAIDs or aspirin should be tested for H. pylori infection and, if it is present, should receive a course of antibiotics to eradicate the bacterium. This strategy not only reduces ulcer risk but also reduces the need for acid suppressive drugs, thereby decreasing healthcare expenditure. These research findings and their implications, wh i ch were initially v i ewed w i t h mu ch skepticism, have been formally adopted by both the European and Asia-Pacific expert panels on H. pylori infection as a strategy for the prevention of ulcers i n patients requiring NSAIDs. Redefining Treatment Guidelines for High-risk Arthritis Patients What methods of ulcer prevention are there f or p a t i e n ts w i t h o u t H. pylori infection who require NSAIDs? Prof. Chan says that current recommendations for high-risk arthritis patients include adding an acid suppressive d r ug to NSA I Ds or, recently, the substitution of NSAIDs w i t h a COX-2 selective inhibitor, a new class of NSA ID that is marketed as an effective painkiller without toxicity to the stomach. I n the US, the sales of this new class of painkillers exceeded US$6 b i l l i on each year. While there is strong evidence that this new class of drugs reduces ulcer risk i n low-risk patients, it is unknown whether it is as good as a combination of NSAIDs and acid suppressive drugs. I n the f ou r th study, arthritis patients w i t h o u t H. pylori i n f ec t i on w h o had a history of ulcer bleeding were randomly assigned to receive a COX-2 selective inhibitor (celecoxib) or a combination of a conventional NSAID (diclofenac SR) and an acid suppressive drug (omeprazole) for six months. The results showed that although the t wo strategies were comparable i n reducing the risk of recurrent ulcer bleeding to about five per cent in six months, neither treatment could totally eliminate the risk of recurrent bleeding i n these high-risk patients. This research f i n d i n g, w h i ch alarmed the international medical arena, has radically changed existing treatment guidelines for arthritis patients who are at risk for ulcer disease. Prof. Francis Chan obtained his M.B., Ch.B. with honours from The Chinese University of Hong Kong in 1988. After completing his residency training, he studied at the University of Calgary, Canada as a Croucher Foundation Research Fellow in 1993. He joined CUHK in 1997 as a lecturer. In 1998, he was awarded the degree of Doctor of Medicine. Prof. Chan's extensive research work has gained much recognition in the form of awards and invited lectures. He was appointed senior lecturer and reader in 2000 and 2003, respectively. Prof. Chan serves as an associate editor and an editorial board member in a number of international journals. He is a fellow of the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh, the Royal College of Physicians of Ireland, the American College of Gastroenterology, the Hong Kong College of Physicians, and the Hong Kong Academy of Medicine. Defining New Strategies for Ulcer Prevention 51