Impact of Diabetes Mellitus on the Clinical Outcome of Cirrhosis

Abstract

© 2011, INASL 20 population. Mean age of death being 47.25. Total years lived with disability 311. Considering disability weight of alcoholic cirrhosis as 0.33 and average life expectancy of male Keralites as 72 DALY calculated is 20.95. Conclusion: Alcoholic cirrhosis imparts a huge economic burden on family and society with loss of quality of life and early deaths. Conflict of Interest: None Lactose Intolerance in Liver Cirrhosis Patients SV Rana*, S Sharma*, RK Dhiman**, YK Chawla**, K Singh* Departments of *Gastroenterology and **Hepatology, PGIMER, Chandigarh Background: Malnutrition, characterized by protein and energy deficiency, is considered the most prevalent complication of liver disease. Studies of small bowel mucosa in cirrhosis report a diverse spectrum of histological abnormalities. These include increased mucosal edema, decreased villus to crypt ratio, villus atrophy and decreased total absorptive surface. This may result in decreased lactase activity causing lactose intolerance. Aim: Therefore, this study was planned to evaluate lactose intolerance in patients with liver cirrhosis. Materials and Methods: Lactose intolerance was estimated by using non-invasive lactose hydrogen breath test in 59 patients of liver cirrhosis and 63 ageand sex-matched apparently healthy controls. For lactose hydrogen breath test 25 g lactose dissolved in 250 mL water was given orally to the subjects after taking fasting breath H2 concentration. End expiratory breath was collected every 30 minutes up to 4 hours. H2 concentration was measured by using SC Microlyzer (Quintron, USA). Rise ≥ 20 ppm over baseline value in H2 concentration in two consecutive readings was considered as lactose intolerance. Results: In liver cirrhotic patient, 46 were males and 13 females, while in controls 49 males and 14 females. Out of 59 patients, 27 had viral cirrhosis and 32 had alcoholic cirrhosis. Mean ± SD of age in patients was 45.6 ± 16.4 years and in controls 47.8 ± 15.3 years. Out of 59 patients of liver cirrhosis, 41 (69.5%) were lactose intolerant while in controls 28 (44.4%) out of 63 subjects. The difference was statistically significant (p < 0.01). Lactose intolerance was present in 19 (70.4%) out of 27 viral cirrhosis patients while in 22 (68.75%) out of 32 alcoholic cirrhosis patients. Lactose intolerance was significantly higher in both the groups as compared to control group. Conclusion: This study indicates that lactose intolerance was significantly higher in cirrhotic patients. Conflict of Interest: None Impact of Diabetes Mellitus on the Clinical Outcome of Cirrhosis TM Ramachandran, AR Rajneesh, T Varghese Additional Professor, DM Trainee and Presenting Author, Professor, Department of Gastroenterology, Government Medical College, Calicut, Kerala Objectives: To assess the impact of diabetes mellitus on the natural history, complication rate, hospital admission rate and mortality of cirrhotic patients. Methods: Cirrhotic patients admitted at a tertiary care institution during the period of July 2009 to January 2011 with and without diabetes mellitus were analyzed in a prospective comparative study. The clinical characteristics, various complication rates and hospital admission rates in patients who died as well as survived were analyzed. Pregnant women, Stage IV and V chronic kidney disease, hepatoma and other secondary causes of diabetes were excluded from the study. Results: Of the 199 cirrhotic patients, 106 (53.3%) were diabetic and 93 (46.7%) were non-diabetic. Average age was 57.14 (diabetic) and 53.7 (non-diabetic) years. Mean CTP score was 10 in both groups. Average duration of cirrhosis was 19 months in both groups. Diabetics had a higher prevalence of cryptogenic etiology (p value 0.013) and family history of diabetes (p 0.001). Presentation as acute on chronic liver failure was more in non-diabetic group (p 0.035). Mean albumin value was higher in diabetics (2.72 vs. 2.5; p value 0.017). Number of prior hospital admissions (mean 2.93 vs. 2.17) and number of decompensation episodes (mean 2.96 vs. 2.16) were higher in the diabetic group (p value 0.023). Prevalence of gallstones were common in diabetics (26.41%) compared to non-diabetics (5.37%) (p value 0.001). Frequency of urinary tract infection was higher in the diabetic group (37.7%) vs. non-diabetics (5.3%) (p value 0.001). Frequency of spontaneous bacterial peritonitis was 19.8% (diabetic) and 23.63% (non-diabetics) (p value NS). Frequencies of other infections (pneumonia, tuberculosis, cellulitis, abscess) were also higher in diabetics than non-diabetics. Conclusion: Age, cryptogenic etiology, number of decompensation episodes, number of hospital admissions, serum albumin and gallstones were more in the diabetic group. Urinary tract infection was more common among diabetics whereas spontaneous bacterial peritonitis was present in both groups. Conflict of Interest: None 03_JCEH-Abstract.indd 20 3/18/2011 11:13:04 AM