Diagnosis Of Chronic Liver Disease Research Articles

Prevalence of Celiac Disease in Patients with Primary Biliary Cholangitis.

BackgroundPrimary biliary cholangitis (PBC) frequently coexists with other autoimmune diseases, including celiac disease (CeD). Although the prevalence of CeD is high among cohorts with PBC, few studies have directly compared this prevalence to those among individuals with other liver diseases (OLD).AimTo compare the prevalence of CeD between a cohort with PBC and a cohort with OLD.MethodsRetrospective study from January 2013 to December 2016. All consecutive patients with an anti-transglutaminase (tTG) assay requested by a hepatologist and a diagnosis of chronic liver disease were included. CeD diagnosis was confirmed by duodenal biopsies.ResultsWe included 399 consecutive patients (53.1 years SD 14.0, 54.1% women), notably 51 individuals with PBC and 348 individuals with OLD. PBC group included significantly more women (90.2% versus 48.9% P < 0.0001). The prevalence of CeD was higher in the group with PBC compared to the group with OLD (11.8 versus 2.9%, P < 0.003). In the OLD group, the prevalence of CeD was comparable regardless of the etiologic subgroup (nonalcoholic steatohepatitis 2.7% versus alcoholic liver disease 4.3%, versus viral 1.5% versus other autoimmune liver diseases 3.3%, NS). The presence of gastrointestinal symptoms at the time of the tTG assay was comparable between PBC and OLD groups (31.4 versus 29.6%, NS).ConclusionThere is a higher prevalence of CeD in the PBC group compared to other liver diseases.

Ultrasound shear wave elastography and liver biopsy to determine liver fibrosis in adult patients.

Introduction:Liver biopsy is considered as the gold standard for diagnosis of chronic liver disease, yet liver biopsy is an invasive method that may be associated with complications. Therefore, non-invasive methods are needed to diagnose fibrosis. This study was conducted to compare liver stiffness measured by Shear-wave Elastography (SWE) to fibrosis in liver biopsy.Method and Materials:In this prospective study, 176 adult patients with chronic liver disease of different etiologies were included. All patients were evaluated using SWE and a liver biopsy. The diagnostic accuracy of SWE was evaluated using receiver operating characteristics (ROC) plots based on the degree of fibrosis (METAVIR score). SPSS software version 19 was used for statistical analysis and P < 0.05 considered significant.Results:There was a significant correlation between liver stiffness and fibrosis stage (ρ=0.939; P < 0.0001). The ROC curve AUC were 0.871, 0.895 and 0.937 for fibrosis stages F2, F3 and F4 respectively. The cutoff values were 8.6 kPa for F2, 10.7 kPa for F3, and 13.8 kPa for F4, with sensitivity and specificity of 81.76% and 77.01%, 90.20% and 78.40%, 89.53% and 94.38% respectively.Conclusion:The results of this study showed that liver SWE is an effective non-invasive method for assessing liver fibrosis in patients with chronic liver disease of different etiologies.

PGI36 THE RECENT CHANGE IN EPIDEMIOLOGY OF CHRONIC LIVER DISEASE IN JAPAN: AN ANALYSIS OF CLAIMS DATABASE

Hepatitis B or C infection has been major cause of chronic liver disease (CLD) in Japan. Actions to control infection have been performed such as hepatitis B immunization program to prevent vertical infection. Also, innovative medicines for hepatitis C were recently introduced. However, little is understood about nationwide epidemiological changes in the etiology of CLD. Our objective was to chronologically visualize the landscape of CLD. The hospital-based commercial claim database (N=25 million) was used (April 2008-August 2018). Patients with any diagnosis of CLD (defined by disease name) were included and classified into following nine categories with mutually exclusive criteria; hepatitis B, hepatitis C, hepatitis B and C, viral hepatitis, autoimmune, toxic/drug induced, alcoholic, Non-alcoholic fatty liver disease (NAFLD) and others. Patients distribution, demographics, and comorbidities were calculated by disease category and calendar year. A total of 1,790,449 individuals were extracted and their mean age was 66.4. Female patients account for 45.8%. The percentages of patients of hepatitis B (8.7%, to 21.3%), alcoholic (0.3% to 5.9%) or NAFLD (0.1% and 2.9%) were increased, whereas that of hepatitis C was decreased (45.5% to 33.7%) from 2008 to 2018. The mean age of patients with hepatitis B (57.9 to 63.6), hepatitis C (65.5 to 70.0) hepatitis B and C (62.8 to 66.6) autoimmune (62.6 to 66.4) or alcoholic (59.2 to 64.4) was getting older from 2008 to 2018. 30-50% of patients in every category had GERD, hypertension and hyperlipidemia and the percentage was higher especially in alcoholic and NAFLD. Hepatitis C still accounts for a large percentage of the population but has decreased over time. Other types of CLD have relatively grown overtime, but the change in prevalence is still unknown. Additional research is needed to understand whether the prevalence of them is increasing and if increasing why that happens.

Family Quality of Life Among Families with a Member Diagnosed with CLD – What to Expect?

Abstract Background and objectives. Health-related quality of life (HRQoL) is a very important outcome in patients with chronic liver disease. Thus, the present study attempts to assess the family quality of life of these patients, since it is well known that families have always represented the primary environment of most people. Matherial and methods. A sample of 30 participants with a family member who had CLD were recruited to be interviewed through the Romanian adaptation of the Family Quality of Life Survey – general version 2006 (FQOLS-2006), an evaluation tool developed in Canada with the purpose of studying families’ quality of life among. Primary caregivers completed the FQOL Survey. The data was analysed to describe population characteristics and to explore the relationship between the main domains and dimensions of QoL and the patients and caregivers characteristics. Results. The findings showed highest domain scores for Support from services and Family relationships and lowest for Support from others. Dimension scores were highest for Importance and lowest for Stability. Overall FQOL approximated average (78.5±13.4). Younger patients scored lower rates of FQOL domains. Alcohol-related liver disease led to lower rates of all the domains, except from Support from others and Leisure and Recreation activities. Patients with liver cirrhosis or liver cancer negatively influence their caregiver’s success in career. Also, families of liver cirrhosis patients reported the lowest level of satisfaction among all respondents. Conclusions. The results of this study suggest that there are some significant areas of family life highly influenced by a chronic liver disease diagnosis in one of their members.

Lowering the upper limit of serum alanine aminotransferase levels may reveal significant liver disease in the elderly.

This study sought to determine the prevalence of significant liver disease in those subjects with serum alanine aminotransferase levels in the range between the current and the newly suggested upper limit of normal (termed the delta range). The files of the previous study subjects (who underwent at least one alanine aminotransferase measurement in 2002 and followed to 2012) were reviewed for a diagnosis of chronic liver disease; aspartate aminotransferase/platelet ratio index, FIB-4 and alanine aminotransferase/aspartate aminotransferase ratio were used to evaluate liver fibrosis. The prevalence of significant liver disease, by diagnoses and fibrosis scores was compared between subjects with alanine aminotransferase levels in the delta range (men, 42–45 IU/L; women, 26–34 IU/L) and in the newly suggested normal range (men, 15–42 IU/L; women, 10–26 IU/L). The cohort included 49,634 subjects (41% male, mean age 83±6 years) of whom 2022 were diagnosed with chronic liver disease including 366 with cirrhosis. Compared to subjects with alanine aminotransferase levels in the newly suggested normal range, subjects with alanine aminotransferase levels in the delta range had a significantly higher rate of chronic liver disease (men, 15.3% vs. 4.9%; women, 7.8% vs. 3.3%) and of cirrhosis specifically (men, 4.2% vs. 0.9%; women, 1.5% vs. 0.4%) and also had higher mean fibrosis scores (P <0.001 for all). Lowering the current upper limit of normal of serum alanine aminotransferase may help to identify elderly patients at risk of significant liver disease.

Increased risk of chronic liver disease in patients with major depressive disorder: A population-based study

ObjectiveThis study investigated the prevalence and incidence of chronic liver disease in patients with major depressive disorder (MDD), and aimed to identify associated factors. MethodsData of 766,427 adult subjects aged ≥18 years were randomly selected from the National Health Research Institute database from the year 2005. The study first searched for subjects with at least one primary diagnosis of MDD in 2005, and then for those with a primary or secondary diagnosis of chronic liver disease were also identified. The differences in the prevalence of chronic liver disease and its associated factors between patients with MDD and the general population in 2005 were then analyzed. We also compared the incidence of chronic liver disease in patients with MDD and in the general population from 2006 to 2010. ResultsThe prevalence of chronic liver disease in patients with MDD was 2.27 times as high as that of the general population in 2005 (12.4% vs. 5.8%; odds ratio (OR) = 2.27; 95% confidence interval (CI) = 2.07–2.48). The average annual incidence of chronic liver disease in patients with MDD during 2006–2010 was also higher than that of the general population (2.6% vs. 1.7%; risk ratio (RR) = 1.52; 95% CI = 1.37–1.7). ConclusionsPatients with MDD had a significantly higher prevalence and incidence of chronic liver disease than the general population. Among patients with MDD, an older age, the male sex, diabetes, hyperlipidemia and first-generation antipsychotic use were factors associated with chronic liver disease.

Assessment of bleeding in chronic liver disease and coagulopathy using the IMPROVE bleeding criteria

Background: In this study, the authors utilized the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding definition to explore the safety profile of pharmacologic venous thromboembolism (VTE) prophylaxis in patients with chronic liver disease (CLD) and concurrent coagulopathy (INR ≥1.5).Methods: A retrospective study was conducted on 193 adult patient admissions with a diagnosis of CLD and INR ≥1.5 not due to therapeutic anticoagulation. Patients were stratified based on their receipt of pharmacological thromboprophylaxis or not during hospitalization. The rates of overall bleeding, defined as the composite of major bleeding and clinically relevant non-major bleeding; major bleeding; and clinically relevant non-major bleeding, within 14 days of admission were evaluated. Secondary endpoints included the rates of thrombosis and mortality.Results: The composite of overall bleeding occurred in 17.6% of the admissions. More patients in the group not receiving pharmacological thromboprophylaxis had overall bleeding (18.5% vs 10%), major bleeding (13.3% vs 10%), and clinically relevant non-major bleeding (14.5% vs 5%), with overlapping 95% CI. When stratified per pharmacological thromboprophylaxis status, IMPROVE bleeding risk score (BRS) ≥ 7 was associated with higher rates of overall bleeding, major bleeding, and clinically relevant non-major bleeding as compared to IMPROVE BRS <7, whether patients received or did not receive pharmacological thromboprophylaxis. The overall incidence of in-hospital mortality among our study population was 15.5%. Receiving pharmacological thromboprophylaxis was markedly associated with higher in-hospital mortality (OR = 16.58, 95% CI = 4.47–61.45).Conclusion: This study shows that the IMPROVE BRS calculated on admission may serve as a guide for omission of thromboprophylaxis in advanced CLD.

Monitoring methotrexate-induced liver fibrosis in patients with psoriasis: utility of transient elastography.

Increasingly, existing evidence indicates that methotrexate-associated liver injury is related to comorbid risk factors such as diabetes, alcoholism, and obesity, rather than to methotrexate itself. Despite this fact, significant effort continues to be expended in the monitoring of low-dose methotrexate in patients with psoriasis. The gold standard investigation has been liver biopsy, but this is associated with significant morbidity and mortality. As methotrexate-induced liver injury is uncommon, the risk/benefit ratio of liver biopsy has been questioned. Fortunately, a number of new technologies have been developed for the diagnosis of chronic liver disease, including transient elastography (TE). TE is a type of shear wave ultrasound elastography, which measures the speed of shear waves used to estimate hepatic tissue stiffness. Several meta-analyses show very high pooled sensitivity and specificity for the diagnosis of hepatic cirrhosis (87% and 91%, respectively) in a variety of chronic liver disorders. It has a negative predictive value for cirrhosis of >90% and a positive predictive value of 75%. Recent European guidelines now advocate the use of TE as the first-line test for the assessment of fibrosis in alcohol- or hepatitis-related liver disease, including nonalcoholic fatty liver disease (NAFLD). As the prevalence of obesity and metabolic syndrome, including NAFLD, is significantly elevated in patients with psoriasis, TE may be worth considering as a routine investigation for any patient with psoriasis. Although high-quality studies comparing TE with standard liver biopsy in the monitoring of psoriatics on low-dose methotrexate are lacking, the evidence from multiple small cohort studies and case series demonstrates its effectiveness. A recent Australasian position statement recommends that TE should be considered as a routine investigation for monitoring methotrexate therapy, repeated every 3 years if kPa <7.5 and yearly if kPa >7.5. Liver biopsy should be considered for patients with a kPa >9.5.

Phenotypic spectrum and diagnostic pitfalls of ABCB4 deficiency depending on age of onset.

Genetic variants in the adenosine triphosphate‐binding cassette subfamily B member 4 (ABCB4) gene, which encodes hepatocanalicular phosphatidylcholine floppase, can lead to different phenotypes, such as progressive familial intrahepatic cholestasis (PFIC) type 3, low phospholipid‐associated cholelithiasis, and intrahepatic cholestasis of pregnancy. The aim of this multicenter project was to collect information on onset and progression of this entity in different age groups and to assess the relevance of this disease for the differential diagnosis of chronic liver disease. Clinical and laboratory data of 38 patients (17 males, 21 females, from 29 families) with homozygous or (compound) heterozygous ABCB4 mutations were retrospectively collected. For further analysis, patients were grouped according to the age at clinical diagnosis of ABCB4‐associated liver disease into younger age (<18 years) or adult age (≥18 years). All 26 patients diagnosed in childhood presented with pruritus (median age 1 year). Hepatomegaly and splenomegaly were present in 85% and 96% of these patients, respectively, followed by jaundice (62%) and portal hypertension (69%). Initial symptoms preceded diagnosis by 1 year, and 13 patients received a liver transplant (median age 6.9 years). Of note, 9 patients were misdiagnosed as biliary atresia, Alagille syndrome, or PFIC type 1. In the 12 patients with diagnosis in adulthood, the clinical phenotype was generally less severe, including intrahepatic cholestasis of pregnancy, low phospholipid‐associated cholelithiasis, or (non)cirrhotic PFIC3. Conclusion: ABCB4 deficiency with onset in younger patients caused a more severe PFIC type 3 phenotype with the need for liver transplantation in half the children. Patients with milder phenotypes are often not diagnosed before adulthood. One third of the children with PFIC type 3 were initially misdiagnosed, indicating the need for better diagnostic tools and medical education. (Hepatology Communications 2018;2:504‐514)

Magnetic resonance elastography: Status of clinical applications

Magnetic resonance elastography (MRE) is an imaging technology that has been available as an FDA-cleared upgrade to MRI systems since 2009. Worldwide, MRE technology has been installed on approximately 1000 MRI systems. In October 2017, the AMA approved the creation of a CPT code for MRE. In MRE, propagating shear waves in the range of 30–300 Hz are generated in tissue, and imaged with a phase contrast MRI technique. The wave images are processed with an inversion algorithm to generate cross-sectional images quantitatively depicting the complex shear modulus of tissue. The main application of MRE is currently in noninvasive diagnosis of chronic liver disease. Published studies have established the MRE is the most accurate and technically successful non-invasive modality for diagnosing liver fibrosis. Many other promising applications of MRE are being explored by investigators around the world, including assessment of diseases of the brain, heart, lung, and muscle and tumors of breast, liver, prostate, liver, and other organs. The new applications that closest adoption in clinical practice are (1) assessment of brain disease and (2) advanced diagnosis of liver disease. These new applications require acquisition sequences and processing algorithms that are more advanced than the current product MRE techniques.Magnetic resonance elastography (MRE) is an imaging technology that has been available as an FDA-cleared upgrade to MRI systems since 2009. Worldwide, MRE technology has been installed on approximately 1000 MRI systems. In October 2017, the AMA approved the creation of a CPT code for MRE. In MRE, propagating shear waves in the range of 30–300 Hz are generated in tissue, and imaged with a phase contrast MRI technique. The wave images are processed with an inversion algorithm to generate cross-sectional images quantitatively depicting the complex shear modulus of tissue. The main application of MRE is currently in noninvasive diagnosis of chronic liver disease. Published studies have established the MRE is the most accurate and technically successful non-invasive modality for diagnosing liver fibrosis. Many other promising applications of MRE are being explored by investigators around the world, including assessment of diseases of the brain, heart, lung, and muscle and tumors of breast, liver, prostate, liv...

PREVALENCE OF COMMON INTESTINAL PARASITES IN ADULT PATIENTS WITH CHRONIC LIVER DISEASES ASSOCIATED WITH HELICOBACTER PYLORI INFECTION

The present study investigated the prevalence of common intestinal parasites in association with H. pylori infection among a group of patients with the most common chronic disease prevalent in Egypt. These patients were known to be chronic liver disease with different etiology and followed up in gastroenterology out-patients clinic. They were 77 complaining of various abdominal symptoms either some or all symptoms such as; nausea, vomiting, abdominal pain, heart burn, flatulence, constipation, distension, melena and sometimes diarrhea. The diagnosis of chronic liver disease was confirmed by the history, clinical examination, laboratory investigations, and sonographic images. There were 37 males and 40 females with mean age (48.5+14.2). Types of liver diseases were liver cirrhosis in 28 patients and fatty liver in 49 patients (Non Alcoholic Fatty liver disease; NAFLD). None of the patients was diabetic. Afresh single fecal sample was collected from both patients and controls. Each sample was divided into two parts; one for examination of common intestinal parasites, and the other part for detection of H. pylori antigen by Copro-immunoassay. The results showed no significant difference among intestinal parasites in patients and controls. But, E. histolytic was the commonest parasite (48%) compared to; G. lamblia (4%), A. lumbricoides (5.3%), E. vermicularis (2.7%), S. mansoni (1.3%), 2/3 of patients with E. histolylica were co-infected with H. pylori infection. The prevalence of H. pylori infection was (81.8%) compared to controls (63%), with significant difference.

Prevalence of Common Intestinal Parasites in Adult Patients with Chronic Liver Diseases Associated with Helicobacter Pylori Infection

The present study investigated the prevalence of common intestinal parasites in association with H. pylori infection among a group of patients with the most common chronic disease prevalent in Egypt. These patients were known to be chronic liver disease with different etiology and followed up in gastroenterology out-patients clinic. They were 77 complaining of various abdominal symptoms either some or all symptoms such as; nausea, vomiting, abdominal pain, heart burn, flatulence, constipation, distension, melena and sometimes diarrhea. The diagnosis of chronic liver disease was confirmed by the history, clinical examination, laboratory investigations, and sonographic images. There were 37 males and 40 females with mean age (48.5+14.2). Types of liver diseases were liver cirrhosis in 28 patients and fatty liver in 49 patients (Non Alcoholic Fatty liver disease; NAFLD). None of the patients was diabetic. Afresh single fecal sample was collected from both patients and controls. Each sample was divided into two parts; one for examination of common intestinal parasites, and the other part for detection of H. pylori antigen by Copro-immunoassay. The results showed no significant difference among intestinal parasites in patients and controls. But, E. histolytic was the commonest parasite (48%) compared to; G. lamblia (4%), A. lumbricoides (5.3%), E. vermicularis (2.7%), S. mansoni (1.3%), 2/3 of patients with E. histolylica were co-infected with H. pylori infection. The prevalence of H. pylori infection was (81.8%) compared to controls (63%), with significant difference.

Prevalence of Type 2 Diabetes Mellitus in patients with Chronic Liver Disease

Background and Purpose: The development of type 2 diabetes mellitus (T2DM) is caused by a combination of genetic factors and lifestyle factors like obesity, lack of physical activity and stress. T2DM can develop in chronic liver disease (CLD) though its actual mechanism is not fully understood. In case of hepatitis B virus (HBV) related CLD, HBV infection has been directly related to development of abnormal glucose metabolism by pancreatic islets cell injury. Development of Insulin resistance in case of hepatitis C virus (HCV) is the key pathogenesis of development of type 2 diabetes. We aimed to study the magnitude of the problem of T2DM among the patients with various types of CLD and to find out the association of diabetes mellitus with the demographic and clinical characteristics of the patient admitted in Medicine ward in Dhaka Medical College Hospital.Methods: This was an observational cross sectional study of 60 patients admitted into department of Medicine, Dhaka Medical college hospital between June, 2013 to December, 2013. It included all patients ?18 years of age and admitted with CLD. A diagnosis of CLD was made clinically by any 2 stigmata of liver disease and biochemical, ultrasonographic, endoscopic evidence of esophageal varices ± liver biopsy.Results: Of the total 60 CLD patients, 40 (66.7%) suffered from chronic HBV infection, 11 (18.3%) chronic HCV infection and alcoholic liver disease 5 (8.3%), Autoimmune 1 (1.7%), Wilson disease 1 (1.7%) and unknown cause were 2 (3.3%). Among the study subjects 21.67% had overt Diabetes Mellitus and it was found to be highest among those with chronic hepatitis C (36.4%) and those with chronic hepatitis B (20%) alcohol (20%). Type 2 DM was significantly higher among the CLD patients aged more than 50 years or more.Conclusions: It can be concluded that the occurrence of diabetes and impaired glucose tolerance (IGT) could be a matter of great concern in CLD patients, indicating towards the need for regular monitoring of the glycemic status in these patients, which would have a definite role upon the treatment strategy.J MEDICINE July 2017; 18 (2) : 68-74

Statins and Angiotensin-Converting Enzyme Inhibitors are Associated with Reduced Mortality and Morbidity in Chronic Liver Disease.

Liver fibrosis is a common response to many chronic liver diseases. The aim of our study was to explore whether pharmacotherapy for concurrent diseases affects overall mortality, liver-related mortality and liver-related morbidity in patients with chronic liver disease. We performed a register-based cohort study of all patients with a first-time diagnosis of chronic liver disease between 2005 and 2012 in Sweden (n=70546). Data from the Patient Register, the Prescribed Drug Register and the Death Certificate Register were linked. We studied whether the use of statins, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and antibiotics affected the risk of total mortality, liver-specific mortality and morbidity. We found a reduction in mortality risk for statin users (n=11,245) with hazard ratios from 0.57 (95% CI: 0.32-0.99) for patients with autoimmune hepatitis to 0.84 (95% CI: 0.75-0.95) for patients with alcoholic liver disease. There was a significantly reduced liver-related mortality for patients with alcoholic liver disease who used angiotensin-converting enzyme inhibitors, 0.85 (95% CI: 0.65-0.96). There were increased overall mortality risks for antibiotic users (n=44,572), with hazard ratios up to 1.67 (95% CI, 1.55-1.80) for viral hepatitis. Statin use was associated with decreased risks of liver-specific mortality and morbidity, and reduced total mortality foremost among patients with alcoholic liver disease. Angiotensin -converting enzyme inhibitors was associated with reduced liver-related mortality among patients with alcoholic liver disease.

An efficient electrochemiluminescence amplification strategy via bis-co-reaction accelerator for sensitive detection of laminin to monitor overnutrition associated liver damage

With the world wildly improvement in dietary and nutrition status, it couldn't be ignored that the chronic liver disease (CLD) resulted from the overnutrition. In order to estimate nutrition status for healthy living, an efficient and sensitive electrochemiluminescence (ECL) sandwich immunosensor of laminin (LN), a marker of CLD, was proposed for early diagnosis of CLD. In this work, the anodic ECL behavior of perylene derivative using H2O2 as co-reactant was demonstrated and the possible ECL mechanism was proposed. Furthermore, a significantly amplified ECL response could be obtained via Ag and Fe-Fe2O3 nanoparticles as bis-co-reaction accelerator. As a result, the proposed ECL immunosensor performed good sensitivity and accuracy with a detection limit down to 0.03pg/mL. Moreover, this immunosensor was successfully employed to monitor patient serum, which exhibited an alternative avenue for the early diagnosis of other diseases via proteins, nucleotide sequence, microRNA and cells.

Association of Hyponatremia and Encephalopathy in Patients with Chronic Liver Disease

&lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: To determine the association of hyponatremia in chronic liver disease patients with presentation of hepatic encephalopathy (HE) at Isra university Hospital Hyderabad.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This study was cross sectional and carried out at medicine and gastroenterology department of Isra university Hospital Hyderabad and MMC Mirpurkhas. Study duration was from September 2015 to March 2016. All the cases with age more than 25 years, both genders after diagnosis of chronic liver disease with sign and symptoms of Hepatic Encephalopathy were selected in this study. Blood sample for serum sodium level, was send to diagnostic laboratory of the hospital. Hyponatremia was classified as: 130–135 mEqL (mild), 125–130 mEq/L (moderate) and &amp;lt; 125 mEq/L (severe). Hepatic encephalopathy was categorized according to the West Haven classification (4 grades).&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Total number of cases was 80. Mean age was 48 + 8.5 years. 55 (68.5%) patients were male. Majority of cases, 55 (68.5%) patients were infected with HCV. 40% patients had normal level of sodium, 25% had mild, 20% had moderate while 15% patients had severe hyponatremia. On the grading of encephalopathy, 30 (37.5%) patients had grade 1 encephalopathy while 25/(31.2%) patients had grade 2, 15/(18.8%) had grade 3 while 10 (12.5%) patients hade grade 4. The serum sodium levels significantly decreased with increasing severity of hepatic encephalopathy (P = 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;We concluded that the hyponatremia is significantly linked with Hepatic Encephalopathy (HE) in patients having chronic liver disease (CLD).&lt;/p&gt;

Portal Hypertension: 2 years Experience in Department of Pediatric Gastroenterology and Nutrition, at a Tertiary Care Hospital, Bangladesh

Background: Portal hypertension is a clinical syndrome defined by a pathologic increase of portal venous pressure. The objectives of this study were to evaluate etiological and clinical presentation of portal hypertension admitted in a tertiary care centre of Bangladesh.Materials and Methods: This cross sectional study was done at the Department of Paediatric Gastroenterology &amp; Nutrition, BSMMU on 100 consecutive cases admitted during the period from July 2013 through June 2015. Confirmation of the presence of portal hypertension was done by demonstration of oesophageal varices during upper GI endoscopic examination. The diagnosis of chronic liver disease was based on a combination of clinical, biochemical (abnormal liver function tests) and ultrasonographic (coarse echotexture of liver) features. Extrahepatic portal hypertension was diagnosed on the basis of clinical, normal liver function test and ultrasonographic evidence of portal or splenic vein thrombosis, with or without cavernous transformation. Doppler ultrasound showed increase portal venous pressure.Results: Patient's age group was 2 to 15 years. 69 cases were extra hepatic portal hypertension. Haematemesis and/or melaena were found in 42(60.9%) and splenomegaly was found in 68(98.6%) cases. Of extra hepatic 69 cases 10% had history of umbilical sepsis. Of the 31cases of CLD with portal hypertension, haematemesis and/or melaena was found in 20(64.5%) cases, splenomegaly in 30(96.8%), ascites 8(25.8%).Most (50%) of CLD cases were cryptogenic followed by Wilson’s disease 29%. Of the 100 cases, endoscopy revealed grade 3 esophageal varices in 45% cases. All the patients were treated with propranolol. EVL was done in 70% cases.Conclusion: In this study, most of the cases were extra hepatic portal hypertension. Gastrointestinal bleeding &amp; splenomegaly were found in most of the cases. No risk factor was found in most of extra hepatic cases. Portal vein thrombosis &amp; cryptogenic were the most common cause in extra-hepatic and intra-hepatic cases respectively.J Shaheed Suhrawardy Med Coll, June 2016, Vol.8(1); 26-29

Occult liver disease burden: Analysis from a large general practitioners' database.

Cirrhosis represents the end stage of chronic liver disease, characterized by high mortality and morbidity. The prevalence of liver disease is difficult to assess, given its clinical latency up to the late stage. We aimed to assess the prevalence of unrecognized chronic liver disease and cirrhosis using surrogate indicators from medical records of family physicians. Medical records of 139,104 subjects, collected from 99 family physicians of the Veneto region, were used. Persistently high transaminases were used as indicators of occult chronic liver disease; thrombocytopenia, unrelated to haematological malignancies, was used as indicator of occult cirrhosis. Diagnosis of chronic liver disease and cirrhosis was assessed using ICD9-CM-1997 codes. Alteration of transaminases was found in 32.7% of the subjects, and among them only one-third had an already diagnosed liver disease. Patients with diagnosis of cirrhosis were 0.3%, while thrombocytopenia, indicator of occult cirrhosis, was detected in 1.3% of the remaining population. Patients with overt and occult cirrhosis showed a higher metabolic profile, with significantly higher prevalence of arterial hypertension, obesity and diabetes than the general population. A large proportion of patients with chronic liver disease is still undiagnosed. Surrogate biochemical indicators might be useful for disease recognition.

P335 Prevalence and risk factors for non alcoholic fatty liver disease in inflammatory bowel disease

Background: Non alcoholic fatty liver disease (NAFLD) is responsible for up to 40% of hepatic alterations diagnosed in inflammatory bowel diseases (IBD). We aimed to evaluate the prevalence and risk factors for NAFLD in a large cohort of IBD patients and the stage of liver fibrosis by transient elastography (TE). Methods: This study included consecutive patients affected by Crohn's disease (CD) or ulcerative colitis (UC), referred to our tertiary centre for IBD from December 2015 to July 2016. Patients with previous diagnosis of chronic liver disease with different etiology from NAFLD, daily alcohol consumption higher than 20 g in women and 30 g in men or conditions affecting the execution of TE were excluded. Data regarding IBD characteristics and liver laboratory tests were collected. The markers of metabolic syndrome were analyzed. All subjects underwent an abdominal ultrasonography to estimate presence/degree of steatosis and TE to measure liver stiffness (LS). An age and sex-matched group of controls was recruited. Student's t or Chi-squared tests were used where indicated. For multivariate analysis, multinomial logistic regression was used to determine which factors could have influenced the presence of NAFLD. Results: NAFLD was observed in 106 out of 378 (28%) patients with IBD and in 33 (20.1%) of 162 controls (p=0.04). The prevalence of diabetes and abdominal excessive adiposity was higher for IBD than controls. Patients with NAFLD were more frequently male, young and affected by diabetes, hypertension and insulin resistance. Their mean waist circumference and BMI were higher in NAFLD compared to non-NAFLD patients. Additionally, NAFLD subjects showed higher levels of transaminases and gamma-glutamyltranspeptidase, HDL cholesterol, triglycerides and fasting blood glucose. Finally, their mean LS was higher than in non-NAFLD patients. At multivariate analysis the risk of NAFLD in IBD was directly correlated to insulin resistance (odd ratio OR=14.73 p<0.0001), high waist circumference (OR=4.85 p=0.04), high BMI (OR=1.6 p=0.01), high gamma-glutamyltranspeptidase level (OR=3.9 p=0.04) and high fasting blood glucose (OR=1.3 p=0.04). Detailed aspects of our analysis are reported in the table. Table 1. Comparison between controls and IBD Conclusions: Despite NAFLD is an increasing problem in IBD, it seems to be correlated to the presence of metabolic syndrome rather than to IBD characteristics.

An automatic method improving the reliability of shear wave elastography in the diagnosis of chronic liver disease

Introduction Chronic Liver Disease (CLD) is considered as one of the leading causes of death worldwide today. Shear Wave Elastography (SWE) is a recently introduced technique which offers real-time elasticity imaging as well as stiffness quantification over a 2D region-of-interest (ROI). The major challenge for clinicians nowadays is the accurate and on-time estimation of liver fibrosis progress toward an efficient treatment to avoid unnecessary and costly invasive procedures. Purpose Classify CLD from SWE imaging by means of an optimized ROI selection procedure and a computer aided diagnosis system. Materials and methods The proposed algorithm employs a ROI selection technique (areas with no stiffness variation across-time) to quantify 32 SWE images (16 healthy and 16 with CLD). The selection procedure employs four SWE images from the same area of liver parenchyma having 5 s time distance acquired from each patient. Subsequently, the mean stiffness value of pixels having Stiffness Standard Deviation Results Highest classification accuracy from the SVM-model was 94.3% with sensitivity and specificity values of 93.8% and 94.6%, respectively. Best feature combination for the SVM model comprised the Standard Deviation, Sum-Variance and Contrast features. Conclusion A new automatic SWE reliability algorithm for CLD diagnosis has been developed that could prove to be of value to physicians improving the diagnostic accuracy of CLD. Disclosure No disclosure.