Pathologically different features and fibrosis scores in chronic hepatitis C genotypes 3 and 1.

BACKGROUND: Chronic hepatitis C genotypes 3 and 1 are the two most common genotypes in Thailand. OBJECTIVE: Identify the pathologically different features between genotypes 3 and land to compare the fibrosis score of Knodell HAI and Ishak modified HAI. MATERIAL AND METHOD: The pathological features of 114 liver biopsies were evaluated. RESULTS: Steatosis was more commonly found in genotype 3 than in genotype 1 (97.1% vs. 77.8%, p = 0.001). Portal lymphoid follicles were commonly found, but bile duct damage was uncommon. The majority of portal tracts showed partial involvement. The majority of patients had Knodell fibrosis 1 and Ishak fibrosis 3. CONCLUSION: Steatosis is significantly more common in genotype 3, while other features do not show any differences. The portal tracts show partial involvement because inflammatory cells tend to aggregate and form lymphoid follicles. The most comparable fibrosis scores are Knodell fibrosis 1 and Ishak fibrosis 3.

Effect of botulinum toxin injection for achalasia in Thai patients.

BACKGROUND: Achalasia is a disorder of the esophagus. The lower esophageal sphincter fails to relax and increases the loss of body peristalsis. It is an uncommon disease worldwide. Data regarding its treatment are derived mostly from North America and European countries. Few data regarding this treatment were available in Asia and no data about using botulinum toxin injection for this disease was available in Thailand. OBJECTIVE: To evaluate the efficacy of botulinum toxin in achalasia in Thai patients. MATERIAL AND METHOD: Eleven achalasia adult Thai patients with a mean age of 56.5 +/- 16.9 were studied. There are nine females and two males. The duration of symptom before treatment was 27.5 +/- 34.5 months. All patients receiving botulinum toxin injection at Siriraj hospital between 2001 and 2006 were retrospectively reviewed. Pretreatment of baseline lower esophageal sphincter, symptom score and body weight were compared. Time to second botulinum toxin injection or the need to receive treatment for recurrence was recorded to evaluate the time of recurrence. Adverse events from this procedure were collected. RESULTS: Eleven patients were involved in this study. One patient that received 40 units of botulinum toxin showed no response after a six months follow up. The other ten patients received botulinum toxin 80 units for each session and were enrolled in this study. All ten patients demonstrated good response to the first botulinum toxin injection and subsequent injections. Four patients received only one session of botulinum toxin injection during study period. Meanwhile, five patients received two sessions and only one patient required four sessions. Symptom score of all ten patients improved significantly compared with pretreatment score (7.3 +/- 1.3 for pretreatment and 0.4 +/- 0.5, 0.9 +/- 0.7 and 1.6 +/- 1.3 after 2 weeks, 3 months and 6 months, respectively). Body weight increased significantly when compared with pretreatment (47.7 +/- 6.5 Kg for pretreatment and 49.2 +/- 5.8, 50.5 +/- 6.4, and 50.7 +/- 5.8 Kg after 2 weeks, 3 months, and 6 months, respectively). Previous treatments prior botulinum toxin injection do not seem to influence the effect of this treatment. Mean time of recurrence is 444 +/- 132 days (270-718 days). Minor adverse events such as chest pain and reflux symptoms were seen in this therapy. CONCLUSION: Botulinum toxin injection in Thai achalasia patients is an effective, simple, and safe treatment. These results showed the similar outcomes as in Caucasian patients.

Risk factors of hepatitis C virus infection in blood donors in Thailand: a multicenter case-control study.

OBJECTIVE: To investigate the risk of hepatitis C virus (HCV) infection in healthy blood donors in Thailand MATERIAL AND METHOD: We performed a case-control study of 435 HCV-seropositive blood donors and 894 HCV-seronegative blood donors as controls. The study was done with direct interview regarding demographic characteristics and risk factors. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated by using conditional logistic regression. RESULTS: The final multivariable model included only the following independent HCVrisk factors: intravenous drug user (IDU) (OR = 61.5; 95%CI, 26.6-142.5), previous blood or blood products transfusion (OR = 12.3; 95%CI, 7.6 -19.9), sharing of razors (OR = 2.3, 95%CI, 1.6-3.2),unsafe injection (OR = 3.3, 95%CI, 1.8-5.9), unused condom (OR = 1.6; 95%CI, 1.1, 2.4). No risk was shown for a history of tattoo, ear piercing, or acupuncture and multiple sexual partners. CONCLUSION: The risk factors for HCV infection in healthy blood donors in Thailand are IDU, past history of blood transfusion and unsafe injection.

Association between HLA class II alleles and autoimmune hepatitis type 1 in Thai patients.

OBJECTIVE: To investigate the association between HLA class II alleles and autoimmune hepatitis (AIH) type I in Thai patients. MATERIAL AND METHOD: The clinical data of 50 autoimmune hepatitis patients type I (AIH) at Siriraj hepatitis clinic were analysed, 37 of whom were tested for HLA class II genotyping using polymerase chain reaction and sequence-specific oligonucleotide technique (PCR-SSO). RESULTS: AIH is an uncommon chronic hepatitis in Thailand with females predominant. The HLA DRB1*0301, and DQA1*0101 were significantly associated with AIH patients when compared to controls; (OR = 3.92 [1.18-13.30], p 0.021, OR = 2.31 [1.13-4.73], p 0.019, respectively). When 18 patients with "definite" AIH were analysed, only HLA DRB1*0301 was still significantly associated with AIH (OR = 5.22, 95%CI = 1.28-20.92, p 0.015). CONCLUSION: HLA genotyping has shown that HLA DRB1*0301 and HLA DQA1*0101 were significantly associated with AIH.

Predictive factors for synchronous common bile duct stone in patients with symptomatic cholelithiasis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic cholelithiasis. About 8-15 per cent of patients with symptomatic gallstones may bear associated common bile duct (CBD) stones, The management of choledocholithiasis in the laparoscopic era remain debatable. Although pre-operative endoscopic cholangiopancreatography (ERCP) is available and highly accurate in the detection of CBD stones, its routine use is controversial because of its inherent disadvantages. OBJECTIVE: The aim of this retrospective study was to generate an effective predictive model for bile duct stones detection by pre-operative ERCP. METHOD: Twelve pre-operative clinical, biochemical and sonographic variables from 206 consecutive patients who underwent pre-operative ERCP with LC for gallstones with/without CBD stones from October 1998 to December 2000 were retrospectively analysed RESULTS: 143 of the 206 patients with gallstones were found to have CBD stones. The mean age was 61 (20-93) yr old, and 55.9 per cent were female. Multivariate analysis showed a high predictive value for the presence of CBD stones in patients aged > or = 55 yr old (Odd radio (OR) 1.03, 95% confidence interval (95% CI) 1.01-1.05), jaundice (OR 2.7, 95% CI 1.7-4.8), elevated alkaline phosphatase (OR 1.002, 95% CI 1.000-1.005), CBD dilatation on ultrasound (OR 3.8, 95% CI 1.8-8) and CBD stone on ultrasound. CONCLUSION: The important clinical presentations and investigating could allow more appropriate use of pre-operative ERCP in patients who have symptomatic gallstones with a suspected CBD stone prior to cholecystectomy.

Novel aspects in the management of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the commonest cancers in Thailand, which usually develops on a background of cirrhosis. We report a multimodal approach to the management of HCC. Though surgical treatment is the only opportunity for curing HCC, it is only feasible in a minority of patients. Various non-surgical treatment modalities have been developed and used extensively, but their efficacy is far from satisfactory and the prospect for the development of more effective treatments is dismal. Multidisciplinary treatment such as the combination of transcatheter oily chemoembolization and percutaneous ethanol injection appears to be the current trend of management for nonresectable HCC, and improvement in survival can be achieved compared to single mode treatment. Portal vein embolization is useful in patient in need of wide hepatectomy to induce pre-operative hypertrophy of future remnant liver, which would have been insufficient for safe resection. Moreover, intra-arterial 131-Iodine-Lipiodol given after curative resection significantly decreased the rate of recurrence and increased disease-free and overall survival in patients with HCC.

Causes and clinical courses of chronic diarrhoea in Siriraj Hospital.

Background : Chronic diarrhoea remains a major gastroenterological problem in Thailand Data regarding investigation, diagnosis and treatment of chronic diarrhoea varies from one country to another. Socio-economic status including sanitation and hygiene may also affect etiology and the clinical course of disease. There data may be misleading for practitioners facing the problem in Thailand. To date, few studies on chronic diarrhoea in Thailand are available. Objectives : To find the causes and clinical courses of chronic diarrhoea. To determine the frequency of various causes. Finally, to see if simple guidelines can be developed to help investigators in Thailand reach a final diagnosis. Methods : Thirty-four in-patients with chronic diarrhoea at Siriraj Hospital were worked up using a systematic scheme for evaluation of chronic diarrhoea by prospective study. Close follow-ups were monitored for an average period of six months. Results : Among the 34 cases, a definite diagnosis was reached in 21 cases (62%) : parasitic infestation seven cases (33%), carcinoma of colon four cases (19%), lymphoma there cases (14%), radiation proctitis two cases (9%), malabsorption and/or maldigestion two cases (9%), tuberculous peritonitis one cases (5%) hyperthyroidism one case (5%) and villous adenoma one case (5%). Conclusion : Our study suggests that a simple investigation using complete blood count, stool examination, and especially concentration methods and sigmoidoscopy in all patients can usually find in up to 38 per cent, while further investigations can detect causes in up to 62 per cent. Of the 13 patients for whom no definite diagnosis was reached, spontaneous remission of chronic diarrhoea was found in four cases (31%).

Eradicating helicobacter pylori and symptoms of non-ulcer dyspepsia: The effect of treatment with a combination of ranitidine and amoxicillin.

Although dyspepsia frequently occurs in general population, its causes are poorly understood. This study is aimed at determining the role of Helicobacter pylori in non-ulcer dyspepsia (NUD) and evaluating the efficacy of dual therapies for H.pylori. Two groups totaling of 39 patients with endoscopically-proven NUD participated in the study. One group, comprising of 23 patients, received 300 mg of ranitidine daily for 4 weeks together with 500 mg of amoxicillin four time a day for two weeks. The second group, comprising of 16 patients, received GacidaTM 1 tablet for 4 weeks together with 500 mg of amoxicillin four time a day for 2 weeks respectively. H.pylori status was determined by histology and CLO testTM before and in the fourth and eighth week after treatment. Thirty-six patients completed the study, 21 in the ranitidine treatment group and 15 in the GacidaTM group H.pylori was successfully eradication in 47.3 percent (9/21) of ranitidine treatment group. Symptom relief at the second and sixth weeks was significantly higher under ranitidine regimen at 90.47 percent (19/21) and 100 percent (21/21) respectively, compared with the gacida regimen at 46.66 percent (7/15) and 53.33 percent (8/15) respectively. The number of patients who were symptom-free at the sixth week of treatment was significantly higher in the ranitidine group at 71.4 percent (15/21), compared with the gacida group at 20 percent (3/15). We concluded that the ranitidine regimen can relief the symptoms of NUD patients with H.pylori infection. However, the role of H.pylori needs further studies.

Efficacy of colloidal bismuth subcitrate vs. cimetidine for treatment of helicobacter pylori positive non-ulcer dyspepsia.

We report an open trial study to determine the role of Helicobacter pylori (HP) in patients with non-ulcer dyspepsia (NUD) and to determine the effect of two drugs (colloidal bismuth subcitrate, CBS and cimetidine) on HP. Our study consisted of 48 patients, 30 received CBS two tablets twice daily and 18 received cimetidine 400 mg twice daily. The result of HP suppression detected by rapid urease test was 66.7% and 86.7% for CBS group after receiving the drug for 4 and 8 weeks respectively, for cimetidine only 11.1% urease test negative during the same period. Follow up urease test 19.2% of patients treated by CBS remained negative but none in the cimetidine group. AII patients felt better during treatment irrespective to status of HP. Our conclusion is that there is no correlation between HP status and NUD symptoms. To evaluate this relationship, further study must be done. To date there is no strong evidence to recommend HP eradication in HP associated NUP patients.

Prevalence of Hepatitis B Virus, Hepatitis C virus and human immune deficiency virus in cirrhotic patients undergoing sclerotherapy for esophageal varices at Siriraj Hospital.

116 sera from cirrhotic patients were tested for HbsAg, Anti-HCV and Anti-HIV to assess the prevalence and determine risk factors of virus acquisition. Forty-two patients (36.21%) were positive for HbsAg, thirty patients (25.86%) were positive for Anti-HCV, five patients positive both HbsAg and Anti-HCV and only one patient (0.86%) was positive for Anti-HCV. There is no statistically different between risk factors (IVDU, prostitute, units of blood transfusion) and positity of viral markers, but alcohol seems to be less in HbsAg positive patients (p < 0.0001). For HIV the prevalrnce is comparable to general populations there is no need for routine Anti-HIV examination in cirrhotic patients with bleeding esophageal varices, but universal precaution is still the rule.