A State Scientific & Technological Progress second-class award has been conferred upon Chinese University's Gastrointestinal Research Group for its achievement in revolutionising the treatment of bleeding peptic ulcers.

Peptic-ulcer disease is a major threat to human health. About 20% to 25% of patients with bleeding ulcers require surgery to control the bleeding. Of them, 20% to 25% die from the surgery.

The research work of the Prince of Wales Hospital team led by Prof Joseph Sung has led to major advancements in the disease's management.

Other members of the team include Prof James Lau, Prof Francis Chan, Prof Enders Ng, Associate Prof Philip Chiu, Hon Clinical Associate Prof Lee Yuk-tong, and former Chinese University Dean of Medicine Prof Sydney Chung.

Healing hands: Prof Joseph Sung says the breakthrough in the treatment of bleeding peptic ulcers has led to a significant drop in mortality from the disease. Prof Enders Ng, Prof Sung, Associate Prof Philip Chiu and Hon Clinical Associate Prof Lee Yuk-tong are pleased their efforts have been recognised by the nation.

Major breakthrough

In an interview with news.gov.hk, Prof Sung said the project, entitled "Innovative Non-surgical Treatments of Peptic Ulcer Bleeding", has made major medical breakthroughs in the following areas:

* the development of novel endoscopic treatment of ulcer bleeding;

* the development of a novel endoscopic suturing device, known as the 'Eagle-claw', for the control of large blood-vessel bleeding that cannot be stopped by a conventional endoscopic device;

* use of anti-bacterial therapy in the treatment of peptic ulcers;

* development of a supplemental drug therapy to enhance the outcome of endoscopic therapy for acute bleeding ulcers; and

* the formulation of novel strategies for the prevention of non-steroidal anti-inflammatory drug-associated ulcer complications.

The team pioneered endoscopic injection therapy for the control of active ulcer bleeding without the use of surgery, and pioneered the combined use of endoscopic injection and thermo-coagulation - using heat produced by high-frequency electric current to produce a thermal sealing of the bleeding vessel.

Since the discovery of H. pylori infection - a bacterium that causes chronic inflammation of the inner lining of the stomach, or gastritis - by two Australian doctors in the early '80s, the team was the first group to show that one week of antibiotics without acid-suppressing drugs effectively healed gastric and duodenal ulcers.

The research group also showed that recurrent ulcer bleeding is rare after successful eradication of H. pylori. Since then, the use of antibiotics has eliminated the need for life-long treatment of expensive acid-suppressive agents.

Mortality falls

With these advancements in treatment strategies, Hong Kong's peptic-ulcer bleeding mortality fell from 10% in the '80s to 4.7% in 1998. The figure has recently dropped further, to 4.4%.

The research work has led to the revision of international treatment guidelines for peptic-ulcer disease and contributed to reducing the need for surgery, blood transfusions and hospital stays, and reduced ulcer occurrence and relapses.

Overcoming challenges

Prof Lee said the research involved complicated co-ordination work because they needed to ask many patients to return to the hospital for new treatment so doctors could follow up their long-term progress.

Another team member, Prof Ng, said it was difficult to come up with innovative ideas as the use of surgery was widely considered as a conventional treatment for peptic-ulcer disease two decades ago.

However, the team, with its unfailing eagerness to find a safer treatment strategy, eventually made a research breakthrough, leading to the formulation of new medical standards.

Prof Chiu said it was a great opportunity for physicians and surgeons to get together to do research. However, due to their diverse training backgrounds, much effort was needed to ensure all doctors participating in the research followed the same protocol.

Other challenges

In the early stages, there was conflict among team members as some had doubt in the efficacy of endoscopic therapy compared to surgery, Prof Sung said.

"We had to convince them that we had no intention to jeopardise patients' health, and the research aimed to prove the new treatment's effectiveness."

Insufficient funding support was another challenge, he said, noting that clinical research requires random sampling, data collection and analysis - so having a dedicated research team like his is important.

Clinical research, he noted, is a kind of translational research which attempts to more directly connect basic research to patient care. He hoped other research teams would not face the difficulties his team had.

Prof Sung is pleased the nation has recognised his team's efforts over the past two decades. Team members are proud of their work, and excited to see their knowledge and experience widely hailed in the international medical field.