Spectrum of hepatic disorders encountered in the Hepatology Clinics of RIPAS Hospital

ABSTRACT

Introduction: In the Southeast Asian region where chronic hepatitis B virus (HBV) infection remains prevalent, HBV related disorders comprise a significant proportion of cases managed by the Hepatology clinics. Additionally, non-alcoholic fatty liver disease (NAFLD) is becoming an increasingly common condition referred to Hepatology clinics for management. We prospectively assessed the spectrum of hepatic disorders managed by the Hepatology clinics in RIPAS hospital, the only tertiary referral centre in Brunei Darussalam. Materials and Methods: All patients seen for hepatic disorders (new referral or follow-up) during a 32 working days period were included in this study. Patients attending for non-hepatic disorders were excluded. Results: During this period, hepatic disorders accounted for 32.2% of the cases managed. The mean age of patients with hepatic disorders was 43.3 ± 12.2 years old with more male patients (65.7%). New referrals accounted for 10%. Overall, 49.6% were positive for HBV, 12% for chronic hepatitis C virus (HCV) infection and 42.1% had evidence of NAFLD. There were overlaps of disorders in 15.5% (12.5% HBV/NAFLD, 2.1% HCV/NAFLD and 1.2% HBV/HCV). Nineteen cases (5.75) had cirrhosis, most commonly associated with HBV and HCV. A quarter were cryptogenic. Patients with NAFLD were significantly heavier than those with HBV, HCV/HBV and the ‘Others’ group. There was also a significant trend for elevated serum alanine aminotransferase among those with NAFLD. Conclusion: Chronic HBV infection is still the most common hepatic disorder encountered in our Hepatology clinics. However, NAFLD is becoming an increasingly more common condition.