Liver Disease In India Research Articles

Ayurvedic management of Alcoholic Liver Disease : A Case Report

Alcoholic liver disease (ALD) is one of the most prevalent types of liver disease worldwide. According to a 2023 study, the prevalence rate of alcoholic liver disease in India is 4.8%. This case report deals with a 51-year-old male patient initially came to OPD with complaints of yellowish discoloration of eyes, skin, and urine, loss of appetite, anorexia, distention of the abdomen, bilateral pedal edema, easy fatiguability, weakness and weight loss. Liver function test shows-high bilirubin and high transaminase, USG of the abdomen shows-Moderate Hepatomegaly with signs of Hepatitis. It was diagnosed as Kostha-Shakhashrita/Bahupitta Kamala based on the etiopathology and investigations. The patient was treated with Ayurvedic interventions viz, NABB Swarasa, Arogyavardini Vati, Phalatrikadhi Kashaya with Katuki Churna, Patolakaturohinyadhi Kashaya, Laghusoothshekara Rasa and Tab Nirocil were prescribed. After 68 days of treatment protocol, there was marked relief in the symptoms and a reduction in bilirubin and transaminase levels. The above-mentioned oral medications have shown significant results in the present study.

Alteration of liver function tests in various liver diseases

Background: The burden of liver diseases in India has witnessed a significant rise, spurred by factors such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, and a spectrum of metabolic and genetic disorders. Liver function tests (LFTs) serve as invaluable tools in the hands of clinicians, offering insights into the dynamic interplay between hepatic health and various disease processes. This study aims to provide a detailed exploration of the alterations in LFTs associated with various liver diseases prevalent in India. Aim and Objectives: (i) To Identify the various types of Liver diseases; (ii) To evaluate the various liver function tests in various liver diseases. Materials and Methods: The study involved the collection of samples from 100 liver disease patients who seek medical care at C. U. Shah Medical College and Hospital. Informed consent was obtained from all participants and the study protocol was approved by the institutional ethics committee. Results: Our study shows that the prevalence of cirrhosis of liver was 25% among study participants. Majority of liver disease were prevalent in male whereas, mostly affected age group was 51–60 years. Bilirubin was altered in cirrhosis of liver (88%), obstructive jaundice (100%), alcoholic liver disease (80%), viral hepatitis (75%), and in other liver disease (85%). Conclusion: Altered LFT is a useful tool to reach the Etiology of Liver disease. Alterations in liver enzymes as well as HbsAg reactivity are specific tests for cirrhosis of liver and viral hepatitis.

Evaluation of risk factors for non-alcoholic fatty liver disease in India: A systematic review and meta-analysis.

NAFLD is emerging as an important cause of liver disease in India. It is estimated that 16-32% of general population in India (nearly 120 million) has NAFLD. This study aimed to identify the risk factors of NAFLD and to identify the association of lifestyle (dietary and physical activity), genetic, and environmental factors with NAFLD in India. A systematic literature search was conducted using an international electronic database: PubMed (MEDLINE) and Google Scholar from the date of inception 31st March 2021 to 28th September 2021. We included studies examining patients with NAFLD: Adults above 18 years of age. Studies with or without a control population were both eligible. The studies with a diagnosis of NAFLD based solely on abnormal liver tests were excluded. We tried to get unpublished data but they were not of the quality of inclusion. Meta-analysis was performed using the software STATA 14.2 (StataCorp, College Station, TX, USA). For each of the studies, the standard error was calculated using the reported number of outcomes and the sample size. A forest plot was used to graphically represent the study-specific and pooled prevalence estimates for overall and subgroup analysis. In a systematic review and meta-analysis of 8 studies including data from over 1800 individuals, we found that among components of lipid profile, LDL and HDL had a negative effects on NAFLD while triglycerides had a positive effect on NAFLD. Type 2 Diabetes Mellitus, Hypertension, and Obesity were the potential risk factors for NAFLD but the evidence generated was only from single studies.

Stepwise evaluation for the risk of metabolic unhealthiness and significant non-alcoholic fatty liver disease in India

Non-communicable diseases including metabolic health disorders are becoming area of concern for low/middle income countries with poor health-care resources. Present study was planned to assess the prevalence of metabolically unhealthy (MU) subjects in the community and proportion of the MU subjects having the risk of significant Non-alcoholic Fatty Liver Disease (NAFLD) using a step-wise evaluation strategy in a resource-poor setting. Study was performed in 19 community development blocks of Birbhum district, West Bengal, India. Every fifth member in the electoral list was included for the first step evaluation (n = 79,957/1,019,365, 7.8%) to detect any metabolic risk. Subjects with any metabolic risk in the first step (n = 9819/41,095, 24%) were taken for second step evaluation with Fasting blood glucose (FBG) and ALT. Subjects with elevated FBG and/or ALT in the second step (n = 1403/5283, 27%) were taken into third step evaluation. At least one risk factor was found in 51.4% (n = 41,095/79,957). 63% (n = 885/1403) of the subjects with metabolic abnormality (third step) had MU state making its overall prevalence of 1.1% (n = 885/79,957). 53% of MU subjects (n = 470/885) had ‘persistently elevated ALT’ suggesting the risk of having significant NAFLD. Step-wise evaluation strategy could detect the subjects at risk, actually having MU state and proportion of MU subjects at risk of having ‘persistently elevated ALT’ (surrogate of significant NAFLD) in the community with minimum utilization of scarce resources. This study was funded by Bristol Myers Squibb Foundation, USA, under the program ‘Together on Diabetes Asia’ (Project Number: 1205 – LFWB).

ASPARTATE PLATELET RATIO INDEX AS A PREDICTOR OF SEVERITY OF FIBROSIS IN CHRONIC HEPATITS C

Introduction: Hepatitis C is an important emerging cause for chronic liver disease in India, with high risk for chronicity and hepatocellular carcinoma. Chronic hepatitis C (CHC) is the most common cause for chronic liver disease and cirrhosis, and liver transplantation. Liver biopsy is the gold standard for evaluation of fibrosis - however it remains fraught with drawbacks and limitations. The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability is a promising non-invasive alternative to liver biopsy for detecting hepatic fibrosis in CHC. Objectives: (1) The objectives of the study were to determine the association between APRI and severity of fibrosis in Hepatitis C (2) and to describe the clinical profile of patients with Hepatitis C. Methods: A cross-sectional descriptive study in 60 patients diagnosed with hepatitis C for more than 6 months admitted to the General Medicine and Medical Gastroenterology Departments of Govt Medical College, Kottayam. Data were collected with a structured pro forma and analyzed using SPSS. Results: 35 of 60 patients belonged to METAVIR F3 (severe fibrosis) and F4 (cirrhosis). An APRI of 0.5 was associated with a finding of F3 or F4 with a sensitivity of 97.14% and a specificity of 88%. 31 of the 60 patients belonged to F4. An APRI of 1.5 or more was a predictor for cirrhosis with a sensitivity of 93.1% and specificity of 96.77%. The positive predictive value of cirrhosis APRI threshold >1.5 is 96.4%.

Hepatitis B, Hepatitis A, and Pneumococcal Immunization Status in Patients with Cirrhosis of the Liver

Background and Aims: Immunization against hepatitis A, hepatitis B, and pneumococcus has been recommended in patients with cirrhosis of the liver. This questionnaire survey was undertaken to determine the rates of vaccination against these organisms in a cohort of patients with liver disease in India. Methods: We included all patients who were willing for the study and had been seen by a gastroenterologist/hepatologist at least once. Patients offering incomplete information were excluded from the study. Serological tests for confirmation of immunological response were not done. Details of counseling and vaccination status for hepatitis B, hepatitis A, and pneumococcal infection were noted. Results: A total of 305 patients (272 males, 89%) formed the study cohort. The median age was 60 years (range 27–76 years) and the median duration of liver disease was 12 months (1–120 months). The median model of end stage liver disease (MELD) was 14 (range 7–35). Only 37 (12.1%) patients reported that they had been counseled for vaccination against these infections. The rates of vaccination were very low (<10%). Conclusion: Very dismal vaccination rates were noted in Indian patients with liver cirrhosis.

Epidemiology and treatment practices of chronic cholestatic liver disease in India: a physician survey-based study

Background: Chronic cholestatic liver disease (CCLD) constitutes an intricate array of liver diseases in India. A physician-based survey was conducted to understand the prevalence, current treatment approaches, and gaps in the management of CCLD in India. Methods: A total of 215 physicians participated to complete a questionnaire comprising 35 questions related to the prevalence and current treatment of CCLD and assess gaps in its management. Results: Most physicians (53.5%) reported liver disorders with cholestasis to be prevalent in 10-20% of patients, while 34.9% reported their prevalence in 21-30% of patients. Alcoholic liver disease with cholestasis (CCLD [ALD]) was reported in 10-20% of patients and 21-30% of patients by 33.5% and 37.2% of physicians, respectively. Drug-induced liver disease with cholestasis (CCLD [DILI]) was reported to be present in 5-10% of patients by 34.9% of physicians. Ursodeoxycholic acid (UDCA) was found to be used by 60% physicians in >50% of patients with CCLD (ALD), commonly for a period of 4-12 weeks (48.4% physicians), while it was used for 12-24 weeks by 38.1% physicians in CCLD (DILI); for both conditions, the preferred dose was 10-15 mg/kg body weight. UDCA was reported to have good tolerability and efficacy by most physicians for both conditions. Conclusions: In light of scarce data on CCLD prevalence and management approaches in India, the present survey findings provide useful insights on its prevalence in India and support the use of UDCA therapy for the management of its symptoms.

Association of HLA DRB1 allele profile with paediatric autoimmune liver disease in India

Background and Aim: Association of human leucocyte antigen (HLA) DRB1 alleles with treatment response in pediatric autoimmune liver disease (pAILD) has been observed in previous studies. The aim of this study was whether HLA DRB1 alleles are associated with treatment response in Indian children with AILD.

Association of HLA B1 allele profile with pediatric autoimmune liver disease in India

Background and Aim: Association of human leucocyte antigen (HLA) B1 alleles with treatment response in pediatric autoimmune liver disease (pAILD) has been observed in previous studies. The aim of this study was whether HLA B1 alleles are associated with treatment response in Indian children with pAILD.

Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis

Background: Non-alcoholic fatty liver disease (NAFLD) contributes to a large proportion of liver disease burden in the world. Several groups have studied the prevalence of NAFLD in the Indian population.

Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis

Non-alcoholic fatty liver disease (NAFLD) contributes to a large proportion of liver disease burden in the world. Several groups have studied the prevalence of NAFLD in the Indian population. A systematic review of the published literature and meta-analysis was carried out to estimate the prevalence of NAFLD in the Indian population. English language literature published until April 2021 was searched from electronic databases. Original data published in any form which had reported NAFLD prevalence in the Indian population were included. The subgroup analysis of prevalence was done based on the age (adults or children) and risk category, i.e., average-risk group (community population, participants of control arm, unselected participants, hypothyroidic individuals, athletes, aviation crew, and army personnel)and high-risk group (obesity or overweight, diabetes mellitus, coronary artery disease, etc.). The prevalence estimates were pooled using the random-effects model. Heterogeneity was assessed with I2. Sixty-two datasets (children 8 and adults 54) from 50 studies were included. The pooled prevalence of NAFLD was estimated from 2903 children and 23,581 adult participants. Among adults, the estimated pooled prevalence was 38.6% (95% CI 32-45.5). The NAFLD prevalence in average-risk and high-risk subgroups was estimated to be 28.1% (95% CI 20.8-36) and 52.8% (95% CI 46.5-59.1), respectively. The estimated NAFLD prevalence was higher in hospital-based data (40.8% [95% CI 32.6-49.3%]) than community-based data (28.2% [95% CI 16.9-41%]). Among children, the estimated pooled prevalence was 35.4% (95% CI 18.2-54.7). The prevalence among non-obese and obese children was 12.4 (95% CI 4.4-23.5) and 63.4 (95% CI 59.4-67.3), respectively. Available data suggest that approximately one in three adults or children have NAFLD in India.

Saroglitazar and Hepano treatment offers protection against high fat high fructose diet induced obesity, insulin resistance and steatosis by modulating various class of hepatic and circulating lipids

Higher global prevalence of non-alcoholic fatty liver disease (NAFLD) is associated with obesity, steatosis, and insulin resistance (IR), and often progresses to steatohepatitis (NASH). Even after more than twenty years of research, there is still no FDA approved therapy for the treatment of fatty liver disease/NASH though, Saroglitazar - a dual PPAR α/γ agonist has been recently approved as a therapeutic option for the fatty liver disease in India. Hepatoprotective Ayurvedic formulations are widely used and are considered safe. In the present study, C57BL/6 male mice on HFHF diet for four weeks were treated with vehicle, Saroglitazar (3 mg/kg/po), and Hepano - a formulation of five herbs (200 mg/kg/po), at the human equivalent therapeutic doses for additional eight weeks. These animals were evaluated after 12 weeks for obesity, body mass index (BMI), systemic insulin resistance, hyperglycaemia, dyslipidaemia, and hepatic lipid accumulation. Differential liquid chromatography-mass spectrometry (LC-MS/MS) based lipidomics analysis demonstrated significant changes in the different class of lipids [phospholipids, sphingolipids, diglycerides and triglycerides (TG)] in HFHF fed group. The protective effects of both Saroglitazar and Hepano were evident against IR, obesity and in the modulation of different class of lipids in the circulation and hepatic tissue. Saroglitazar reduced TG as well as modulated phospholipids levels, while Hepano modulated only phospholipids, ceramides, oxidised lipids, and had no effect on hepatic or circulating TG levels in HFHF fed mice. In addition, in vitro studies using HepG2, THP1 and LX2 cells demonstrated safety of both the test substances where Hepano possess better anti-inflammatory as well as anti-fibrotic potential. Overall, Saroglitazar seems to be more efficacious than Hepano in the regimen used against HFHF induced IR, obesity, and dyslipidaemia.

Pediatric Liver Disease in India.

Pediatric Liver Disease in India.

Pattern of Alcohol Consumption in Patients of Alcoholic Liver Disease in India

Background: Alcohol-related chronic liver disease (ALD) and its complications are major causes of morbidity and mortality. Predisposing factors for ALD include the amount, type, duration of alcohol consumption, patient’s genetic predisposition, race, sex, and other comorbid conditions. Â

The association between nonalcoholic fatty liver disease and cardiovascular disease: A window of opportunity

Cardiovascular diseases (CVDs) are the leading cause of mortality in India. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in India. People with NAFLD generally share common metabolic risk factors with CVD; yet, NAFLD is independently associated with CVD. As NAFLD is easily diagnosed due to the availability of ultrasound, the awareness regarding association of NAFLD to CVD may prevent both cardiovascular and liver-related morbidity/mortality. We discuss association of NAFLD and CVD and preventive potential in the Indian population.

Nonalcoholic fatty liver disease: New epidemic

The global obesity epidemic has dramatically increased the prevalence of nonalcoholic fatty liver disease (NAFLD), such that it is the most common cause of chronic liver disease in Western nations. NAFLD is an important cause of liver disease in India also. The prevalence of NAFLD in India is around 9%-32% of general population with higher prevalence in those with overweight or obesity and those with diabetes or prediabetes. NAFLD is an important cause of unexplained rise in hepatic transaminases, cirrhosis, and hepatocellular carcinoma. The spectrum of abnormalities which the term NAFLD encompasses is isolated fatty liver, nonalcoholic steatohepatitis (NASH), and cirrhosis. The pathogenesis of NAFLD/NASH is complex and includes the development of insulin resistance, accumulation of excess lipids in the liver, mitochondrial dysfunction, and cell damage, and development of necroinflammation. Diagnosis is usually incidental during the evaluation for unrelated abdominal symptoms, elevated transaminases without any other explanation. Imaging modalities such as ultrasound are useful to diagnose the presence of excessive fat deposition in the liver but are not useful in differentiating simple steatosis from NASH. Liver biopsy may be useful in making this distinction, especially in those with risk factors for significant liver disease. Treatment modalities include weight reduction and exercise, metformin, Vitamin E, pentoxifylline, and saroglitazar and are effective in normalizing transaminases or in improving hepatic steatosis and inflammation in Indian patients with NAFLD. Randomized controlled treatment trials involving large number of patients with histological end point are required to assess the efficacy of different modalities.

Study of Non Alcoholic Fatty Liver in Patients of Andhra Pradesh Population

95 non-alcoholic fatty liver patients aged between 30 and 70 year were studied. The type of NAFLD were Grade-1(Mild steatosis) 21 (22%) Grade-2(moderate steatosis) were 42 (44.2%) Grade-3(sever steatosis) were 32(33.6%) the history of NAFLD patients was BMI in 42(44.2%) patients had 22.8 to 23.2 and in 53(55.7%) patients had 23.3 to 24.3 pre-diabetic patients were 30(31.5%) and diabetic were 65 (68.4%) Normatensive were 20 (21%) and hypertensive were 75 (73.6%) patients with IHD were 20 (21%) and MI patients were 6(6.31%) the parameters of bio-chemical study was total cholesterol value 225± 10.2 triglyceride 250±15.3 HDL 43.2 ± 2.5 LDL 130±15.6 AST 53.7±3.5 ALT 69.2±6. ALP 109± 12.6 S. Albumin value as 3.52± 0.10, total bilirubin 0.95 ± 11 FBS 129 ± 3.2(mg/dl) HbA1C 9.11±3.2 (mg/dl), Systolic BP was 140 ± 5.40, Diastolic Bp 85±5.12.This study of NAFLD is quite useful to review the clinical manifestation because NAFLD is the most prevalent cause of liver disease in India and abroad. The development of non -alcoholic steato hepatitis (NASH) and fibrosis identifies an at risk group with increased risk of cardiovascular and liver related death, hence management of NAFLD remains a clinical challenge.

ASSESSMENT OF CLINICAL PROFILE AND TREATMENT CHART REVIEW FOR ALCOHOLIC LIVER DISEASE (ALD) PATIENTS: A PROSPECTIVE AND OBSERVATIONAL STUDY

Background/Aim: Alcohol remains one of most common cause of liver disease in India, hence the present study was undertaken to assess the clinical profile and treatment chart review of alcoholic liver disease (ALD) patients.
 Materials and Methods: Hospital based prospective and observational study was carried out for a period of nine months in a tertiary care hospital of south India. All the patients of either gender diagnosed with ALD were enrolled in the study and patient consent was taken, the data related to the patients of ALD were documented in a structured patient data collection form and analyzed carefully.
 Results: ALD was mainly affected in male with age group of 41-50 years.Out of 130 patients 43.8% patients were suffered from Fatty Liver disease while 23.1% were suffered from Alcoholic Hepatitis and 33.1% were suffered from Cirrhosis of Liver. The secondary developments to ALD were portal hypertension (13.8%) followed by Ascities (10.8%) and Hepatitis (10%). The major risk factors involved in ALD was alcohol per se (52.3%) and, alcohol and smoking exaggerate the disease condition. The Periodic (61.5%) and regular basis (38.5%) of alcoholism for chronic period of time may land up with ALD. Polypharmacy is essential for the treatment of ALD as it inoved multiple secondary development to ALD. The patients were intervened and counselled on their individual basis for ALD consequences, and motivated for cessation of alcohol and smoking.
 Conclusion: The study enlightens that the early diagnosis and its beneficial outcomes that can exponentially curtail the mortality rate of ALD. Similarly the optimal drug therapy regimen and patient counseling may improve the patient’s quality of life.
 Keywords: Alcoholic Liver Disease; Optimal Drug Therapy; Patient Counselling; Improved Quality of Life

Burden of gastrointestinal and liver diseases in India, 1990-2016.

There is no comprehensive report on the burden of gastrointestinal (GI) and liver diseases in India. In this study, we estimated the age-standardized prevalence, mortality, and disability adjusted life years (DALY) rates of GI and liver diseases in India from 1990 to 2016 using data from the Global Burden of Disease (GBD) Study, which systematically reviews literature and reports for international disease burden trends. Despite a decrease in the overall burden from GI infectious disorders since 1990, they still accounted for the majority of DALYs in 2016. Among noncommunicable disorders (NCDs), there were increases in the prevalence and mortality rates for pancreatitis, liver cancer, paralytic ileus and intestinal obstruction, gallbladder and biliary tract cancer, vascular intestinal disorders, colorectal cancer, and inflammatory bowel disease. Prevalence and mortality rates decreased for peptic ulcer disease, hernias, appendicitis, and stomach and esophageal cancer. For gastritis and duodenitis, cirrhosis and other chronic liver diseases, and gallbladder and biliary tract diseases, there was an increase in prevalence but a decrease in mortality while the opposite was true for pancreatic cancer (decreased prevalence, increased mortality). Indian gastroenterologists and hepatologists must continue to attend to the large majority of patients with infectious diseases while also managing the increasing number of GI and liver diseases, noncommunicable nonmalignant and malignant.

Correlation of APRI Index with Metavir Index in Children with Neonatal Cholestasis Without Biliary Atresia

Introduction and aim. Neonatal cholestasis constitutes for 19 to 33% of all chronic liver disease in India. Cholestasis leads to fibrosis of liver and ultimately cirrhosis. There are various methods of diagnosis of fibrosis of liver like fibroscan, aspartate transaminase to platelet ratio index (APRI) index, FIB-4, fibro index, forns index, heap score, magnetic elastography. Here we are comparing APRI index with METAVIR index in patients with neonatal cholestasis without biliary atresia and determining whether APRI index can be used as a tool to determine fibrosis in these patients.Material and methods. Patients with neonatal cholestasis without biliary atresia were included in the study. This retrospective analysis was done between 2009 and 2015. All patients underwent a liver biopsy and METAVIR index was calculated. APRI at the time of liver biopsy was determined.Results. Forty-eight patients were included in this study with mean age of 3.5 ± 2.8 months with a male: female ratio of 35:13. Metavir Index F0 was seen in was 32 (66.67%) patients, F1 in 6(12.5%), F2 in 4(8.33%), F3 in 0 and F4 in 6(12.5%) patients respectively. Mean APRI for F0-F3 was 1.38 and for F4 was 3.74 respectively. With an APRI of 1.38, the sensitivity and specificity to detect fibrosis/cirrhosis was 100% and 21.43% respectively.Conclusion. APRI is not an effective tool to measure fibrosis or cirrhosis in patients with non-BA neonatal cholestasis in Indian children.