A Systematic Review of the Extrahepatic Manifestations of Hepatitis C Infection in East Asia

( Zobair M. Younossi ),( Linda Henry ),( Janus Ong ),( Atsushi Tanaka ),( Yuichiro Eguchi ),( Masashi Mizokami ),( Young-suk Lim ),( Yock Young Dan ),( Ming-lung Yu ),( Maria Stepanova ),( Sooji Lee ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Chronic hepatitis C (CHC) infection causes a systemic infection with hepatic and extrahepatic manifestation (EHMs). Although the prevalence of EHMs in Western countries is well described, the same is not well known in East Asian countries. We performed a systematic review to quantify the prevalence of selected EHMs among CHC patients in East Asia. Methods: PubMed, Medline, and Japan databases searched (1990-Dec 2016) with “hepatitis c virus” “chronic hepatitis C”, “extrahepatic manifestations”, and respective EHM’s. Data were collected and reviewed by two per PRISMA guidelines. EHMs were by ICD-9 codes or clinically: depression:BDI-2 score>19, chronic kidney disease (CKD): eGFR of < 60 mL/ min/1.73 m2 per MDRD, diabetes (DM):fasting blood glucose level > 126 mg/dL. Pooled prevalence determined by random effects models. Results: 75 articles were identified. After applying inclusion and exclusion criteria, 23 articles remained (Japan=6; China=3, Korea= 4, Taiwan=9, Asia=1) with a total of 468,656 subjects (n= 51,160 CHC and n= 417,496 non-HCV controls). HCV patient age ranged from 44-70 (mean age 55), 50% were male (range 0%-67%), and over 80% of diagnosis was established through positive HCV anti-body. CHC subjects had higher risk of lymphoma (n=2) 4.6% vs. 2.3%, OR=1.79 (1.47-2.19), P<0.0001; DM (n=11) 16.7% vs. 9.4%, OR=1.84 (1.52-2.21), P<0.0001; SS (n=2) 9.6% vs. 3.5%, OR=9.80 (1.25-76.56), P=0.0295; LP (n=5) 8.2% vs. 4.2%, OR=2.45 (1.36-4.41), P=0.0027; depression (n=1) 51.6% vs. 27.7%, OR=2.77 (1.25-6.15), P=0.0121; CKD (n=5) 3.8% vs. 1.7%, OR=2.00 (1.09-3.70), P=0.026; RA (n=2) 0.9% vs. 0.3%, OR=2.41 (1.54-3.76), P=0.0001; CVA (n=2) 25.3% vs. 19.3%, hazard ratio 1.38 (1.24-1.53), P<0.05; IHD (n=1) 25.3% vs 11.6%, OR=1.76 (1.04-2.96), P=0. 0.034. Additionally, the prevalence of MC (symptomatic and asymptomatic; n=1) in CHC was 46.9% in CHC vs. 1.9% in general population with a risk ratio of 24.7 (17.2-32.2). Conclusions: Our review found that CHC in East Asia is associated with increased risk for EHMs.

The Korean Society of Gastroenterology & SIDDS 2040 : Slide Session ; S-LI-05 : Liver ; Isolated Portal Vein Thrombosis in a Young Female with Protein C and S Defi ciency: A Case Report

( Antonio Jr Faltado ),( Josephine Anne Lucero ),( Maria Therese Panlili ),( Janus Ong ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Synopsis: Portal vein thrombosis is a relatively rare condition seen in various settings - cirrhosis, malignancy, pancreatitis, infections and hypercoagulable states. The Case: A 19-year-old female sought consult due to multiple episodes of hematemesis over the past nine years. No other symptoms or episodes of thrombosis had occurred during the interim except for the increase in frequency of hematemesis. Physical exam showed splenomegaly with no signs of chronic liver disease. Esophagogastroduodenoscopy revealed esophageal and gastric varices, liver biopsy indicated fatty change, and computed tomography scan showed no cirrhosis but prominent dilated vessels in the portal region with a portal vein that is not clearly delineated. Investigation into pre-hepatic causes of portal hypertension ensued with an unremarkable APAS panel, no gene mutation for Factor V Leiden and Prothrombin G2021A and a low Protein C and S. Defi nitive management for a young patient involved a cadaveric liver transplant. While awaiting a suitable match, a splenectomy and distal splenorenal shunt was performed to reduce portal pressures. She was discharged improved, started on anticoagulation, and has had no episodes of hematemesis since. Close follow-up will be done to monitor the varices and hypercoagulable state. Signifi cance and Conclusion: We are presented with a young female presenting with multiple episodes of bleeding esophageal varices, initially managed supportively as a case of portal hypertension from bleeding esophageal varices. Various diagnostics were done to investigate the cause of the portal hypertension revealing portal vein thrombosis in a noncirrhotic liver and Protein C and S defi ciency.

Prevalence of Vitamin D Deficiency in Chronic Liver Disease at the Outpatient Clinics of the University of the Philippines- Philippine General Hospital

( Aubrey Q. Taguba ),( Mariel Dianne S. Velasco ),( Mara Teresa T. Panlilio ),( Maria Joanne M. Rubio ),( Margaret Elaine J. Villamayor ),( Janus P. Ong ),( Ma. Lourdes O. Daez ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Low vitamin D levels result in higher incidence of liver fibrosis and cirrhosis, poor treatment response, and increased morbidity and mortality in patients with chronic liver disease (CLD). This study assessed whether CLD patients in the Philippines, despite adequate sunlight exposure, have vitamin D deficiency and whether this is associated with poor outcomes. Methods: Consecutive CLD patients at the outpatient clinics of PGH were included. Clinical data such as age, gender, body mass index, etiology of CLD, presence of cirrhosis and ascites, and number of hours of sun exposure daily were recorded. Standard biochemical liver tests within 3 months of enrolment into the study, such as alanine and aspartate aminotransferases, prothrombin time, total bilirubin, and albumin were documented. Child Pugh scores for cirrhotic patients were computed. Serum vitamin D was determined using the ARCHITECT chemiluminescent microparticle assay. STATA SE version12 for Windows was used for statistical analyses. Univariate analysis and simple logistic regression were used to determine independent predictors of vitamin D deficiency. A p-value of<0.05 was considered as statistically significant. Results: A total of 72 patients were included. The prevalence of vitamin D deficiency (<20ng/mL) was 6.9%; insufficiency (20.1 to 29ng.mL) 52.8%; and sufficiency (>30ng/mL) 40.3%. Both univariate analysis and logistic regression showed no statistical difference among vitamin D deficient, insufficient, and sufficient subjects in terms of etiology and factors affecting the severity of CLD. Conclusions: Vitamin D deficiency and insufficiency are prevalent in Filipino CLD subjects. Guidance on adequate sunlight exposure and dietary intake should be part of health maintenance intervention for these patients.

Correlating Abdominal Ultrasound and Upper GI Endoscopic Findings of Schistosomiasis

( Aeden Bernice G. Timbol ),( Angela V. Djajakusuma ),( Vanessa Charlene O. Co ),( Melissa A. Llanto ),( Edhel S. Tripon ),( Ma. Lourdes O. Daez ),( Janus P. Ong ),( Nonette A. Cupino ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: This study aims to correlate the ultrasound and endoscopic findings of portal hypertension in patients with schistosomiasis and to determine which among these findings showed the best predictive values for the presence of endoscopic signs of portal hypertension. This study also aims to determine the correlation of Hepatitis B and/or Hepatitis C co-infection with the endoscopic and sonographic characteristics of patients with schistosomiasis. Methods: This is a prospective, cross-sectional study of 82 adult patients diagnosed with schistosomiasis. Each patient underwent screening upper endoscopies to assess the presence of varices and portal hypertensive gastropathy and holoabdominal ultrasound with doppler studies to assess the extent of hepatosplenic involvement. One-way ANOVA, Chi-square, Fischer’s exact test were performed to determine which ultrasound findings showed the best predictive values for the presence of endoscopic signs of portal hypertension. Results: Of the 82 patients, almost half (47.6%) had esophageal varices (54% small vs 46% large), 8.5% had gastric varices, and 46.3% had portal hypertensive gastropathy (PHG) on screening upper endoscopy. A significant correlation was found between the presence of esophageal varices, gastric varices, and PHG with the following ultrasonographic findings: grade of liver appearance, surface irregularity, spleen length, and size of right lobe. Seventeen percent tested positive for HbsAg while none tested positive for anti-HCV. Among the patients with hepatitis B/schistosomiasis co-infection, grade III (severely coarsened) echopattern, irregular liver surface, and the presence of short gastric vein collateral had a significant correlation with findings of portal hypertension on endoscopy. Conclusions: Among patients with schistosomiasis, the grade of liver appearance, surface irregularity, spleen length, and size of right lobe on abdominal ultrasound strongly predicts the presence of endoscopic signs of portal hypertension.

Clinical Profile, Prognostic Factors, and Survival of Patients with Hepatocellular Carcinoma in Two Philippine Tertiary Centers

( Mara Teresa T. Panlilio ),( Rei Joseph P. Prieto ),( Angela D. Djajakusuma ),( Neil S. Bacaltos ),( Cynthia A. Balagot ),( Jade D. Jamias ),( Ramon L. De Vera ),( Janus P. Ong ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death in the Philippines and in the world. Most burden of disease is seen in developing countries, with highest incidence reported in hyperendemic regions for Hepatitis B infection. This study identified the prognostic factors and overall survival of patients with HCC. Methods: This retrospective study included adult patients diagnosed with HCC at two Philippine tertiary hospitals from 2007 to 2014. Demographics, tumor characteristics, risk factors, and treatment outcomes were retrieved through review of medical records. STATA v12 was used to perform univariate and multivariate logistic regression. Overall survival was also determined. Results: Four hundred twenty-nine patients, with a mean age of 59.6+13.2 years (M:F ratio 3.6:1), were included. Almost half (49%) had advanced HCC on diagnosis. Fifty-two percent had documented HBV infection, and liver cirrhosis was present in 56%. Furthermore, tumors were usually solitary (59%). Only 57% were able to proceed with treatment. Significant predictors of survival were surgical resection (OR 0.12, p-value <0.001), Child Turcotte Pugh (CTP) classification (CTP B: OR 2.26, p-value 0.024; CTP C: OR 5.54, p-value 0.013), liver cirrhosis (OR 2.56, p-value 0.007), and portal vein thrombosis (PVT) (OR 2.68, p-value 0.035). Forty-two percent of the patients died, with a median overall survival of 16 months. Conclusions: CTP classification, liver cirrhosis, PVT, and surgical resection were identified as significant predictors of survival in HCC. Due to innate limitations of retrospective studies, a prospective study will help in determination of association between severity of disease and treatment outcomes.