Euroasian journal of hepato-gastroenterology

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2018 | January-June | Volume 8 | Issue 1

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Mamun Al-Mahtab

The Journal in the Horizon of Asia and Europe

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/jp-ejohg-8-1-iv  |  Open Access |  How to cite  | 





Osman N Dilek, Oguzhan Ozsay, Serkan Karaisli, Emine Ö Gür, Ahmet Er, Selda G Haciyanli, Haldun Kar, Fatma H Dilek

Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Diagnosis, Multiple primary tumors, Pancreas, Treatment, Whipple procedure

   DOI: 10.5005/jp-journals-10018-1249  |  Open Access |  How to cite  | 


Introduction: The term multiple primary tumor (MPT) is used to describe cases where two or more primary tumors show no histopathological similarities in between. Multiple primary tumor cases have begun to increase in recent years as a result of the increase in life expectancy because of the increase in life standards and progress in diagnostic methods. In this study, MPT cases with periampullary tumors that underwent Whipple procedure were discussed in the light of literature data. Materials and methods: The patient files of 223 cases with periampullary tumors that underwent Whipple procedure in our hospital during the last 6 years were examined retrospectively. More than one primary tumor was detected in 21 patients. Results: Periampullary carcinomas were detected as a second primary tumor in 18 patients. First primary tumor was periampullary carcinoma in 3 patients that underwent Whipple procedure. After the Whipple procedure, 5 patients died due to early complications in the first 30 days and 6 patients died due to metastases and additional problems that developed during follow-up. Discussion: The incidence of MPT has been reported as 0.7 to 14.5% in the literature. Most of them are multiple primary case presentations. In patient management, it is recommended that each tumor should be evaluated independently of its own characteristics, and treatment and follow-up should be planned accordingly. Conclusion: The MPT cases are increasing. The possibility of MPT as well as metastasis should be kept in mind during the evaluation of tumor foci seen during diagnosis and follow-up of patients. The characteristics of each tumor, survival, and prognosis should be evaluated separately and the most appropriate treatment should be offered to the patient. It is recommended that synchronic primary tumors which are considered to be surgically resectable without metastasis should be removed in the same session.



Marjorie Correa, Pritilata Rout, Renuka Malipatel, Mallikarjun Patil, Harshad Devarbhavi

Primary Gastric Lymphoma: Clinicopathological Profile

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Diffuse large B-cell lymphoma, Dyspepsia, Non-Hodgkin's lymphoma, Primary gastric lymphoma

   DOI: 10.5005/jp-journals-10018-1250  |  Open Access |  How to cite  | 


Introduction: Gastrointestinal tract (GIT) is the most common site of involvement of extranodal non- Hodgkin's lymphoma (NHL). There is regional variation in anatomical distribution of extranodal NHL, stomach being the most common site followed by small intestine. Primary gastric lymphoma (PGL) predominantly involves the antrum and corpus of the stomach. It arises from mucosa-associated lymphoid tissue (MALT) and is of B-cell lineage and often associated with Helicobacter pylori infection. Primary gastric lymphoma often presents with nonspecific symptoms. The present study was undertaken to ascertain the clinicopathological characteristics of PGL at a tertiary care center in South India. Materials and methods: It is a retrospective study from 2006 to 2016. Patient's data were obtained from institutional medical records. The histopathology slides were reviewed. The relevant immunohistochemistry (IHC) markers done were leukocyte common antigen (LCA), CD3, CD20, CD79a, CD10, Bcl-2, Bcl-6, CD5, Cyclin D1, CD138, and Ki-67. Correlating with the immunoprofile, further subtyping was done. Results: A total of 405 patients of NHL were seen during the study period, out of which 43 patients were PGL. There were 32 males and 11 females, with M:F of 2.9:1. The mean age at diagnosis was 58 years. Abdominal pain and new-onset dyspepsia were the commonly observed presenting symptoms. The common site of involvement was antrum (20). Diffuse large B-cell lymphoma (DLBCL) was the most common histological subtype. Helicobacter pylori infection was seen in 18 (41%) patients. Majority of the patients were in stages II and III. Conclusion: In our study, the initial presentation of PGL was with nonspecific symptoms like abdominal pain and new-onset dyspepsia. High degree of suspicion of such symptoms and biopsy of all suspicious lesions is essential for early detection. Diffuse large B-cell lymphoma was the most common histological subtype seen in our study.



Tadashi Ohara, Tatsuo Suzutani

Intake of Bifidobacterium longum and Fructooligosaccharides prevents Colorectal Carcinogenesis

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:7] [Pages No:11 - 17]

Keywords: Colorectal carcinoma, Gastroenterology, Intestinal microbiome, Prebiotics, Probiotics, Short-chain fatty acids

   DOI: 10.5005/jp-journals-10018-1251  |  Open Access |  How to cite  | 


Introduction: We aimed to investigate the effects of intake of yogurt containing Bifidobacterium longum (BB536-y) and fructo-oligosaccharides (FOS) in preventing colorectal carcinogenesis in healthy subjects, and the preventive effects of short-chain fatty acids (SCFA), whose production was enhanced by the intake of BB536-y and FOS, in human colon cancer cell lines. Materials and methods: The subjects were 27 healthy persons who were divided into a group taking yogurt containing BB536 (BB536-y group; n = 14) and a group taking yogurt containing BB536 and FOS (BB536-y with FOS group; n = 13) once a day for 5 weeks. The feces were sampled before and after the intake to analyze the amount of SCFA in the feces and the profile of intestinal flora, such as putrefactive bacteria and Bacteroides fragilis enterotoxin (ETBF). Subsequently, human colon cancer cell lines (DLD-1 cells, WirDr cells) were cultured in the presence of SCFA (butyric acid, isobutyric acid, acetic acid) in order to evaluate the cell growth-inhibitory activity of SCFA (WST-8 assay) by calculating the IC50 value from the dose–response curve. Results: Intake of BB536-y increased the total amount of SCFA in the feces and significantly suppressed the detection rate of ETBF and growth of putrefactive bacteria. Intake of BB536-y with FOS was associated with a higher Bifidobacterium detection rate than that of BB536-y alone. The contents of butyric acid, isobutyric acid, and acetic acid, namely, of SCFA, were also decreased. Analysis of the results of culture of DLD-1 cells and WirDr cells in the presence of butyric acid, isobutyric acid, and acetic acid revealed that each of the substances showed significant cell growth-inhibitory activity, with the activity being the highest for butyric acid, followed by that for isobutyric acid and acetic acid. Conclusion: These findings suggest that intake of both BB536-y and BB536-y with FOS prevents colorectal carcinogenesis.



Mohammad A Rahim, Enayet Hossain, Ferdaus Ahammed, Satyajit K Saha, Syed A Foez, Abu S Abdullah

Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:18 - 22]

Keywords: Chronic liver disease, Esophageal varices, Prognosis, Screening

   DOI: 10.5005/jp-journals-10018-1252  |  Open Access |  How to cite  | 


Introduction: Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV. Materials and methods: In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated. Results: Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of ≥905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%. Conclusion: The platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case–control study would be required to validate this.



Mustafa Yakut, Muhammed F Karakaya, Harun Erdal

Diagnostic and Prognostic Role of Serum Interleukin-6 in Malignant Transformation of Liver Cirrhosis

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:8] [Pages No:23 - 30]

Keywords: Cirrhosis, Diagnosis, Hepatocellular carcinoma, Interleukin-6, Prognostic role

   DOI: 10.5005/jp-journals-10018-1253  |  Open Access |  How to cite  | 


Aim: Alpha-fetoprotein (AFP) is still the most commonly used and the single most recommended marker in the diagnosis of hepatocellular carcinoma (HCC). Interleukin (IL)-6 is a circular cytokine and its role on carcinogenesis in various hematological and solid tumors is clearly documented. A combination of serum IL-6 and AFP may provide beneficial information regarding early diagnosis of HCC. In this study, the effect of plasma IL-6 level in the diagnosis of HCC was investigated. Materials and methods: A total of 130 patients with liver cirrhosis, together with 30 control cases were enrolled in the trial. A diagnosis of HCC was present in 75 patients (57.6%) in the liver cirrhosis group. Blood samples were obtained from the enrolled study and control cases. Alpha-fetoprotein was quantified by chemiluminescent method. Plasma IL-6 levels of samples obtained at –80°C were quantified by human IL-6 BMS213/2 BMS213/2TEN kit. Results: The HCC patients were older than the patients in the cirrhosis group (p = 0.016). On comparison of the HCC patients with the control group, AFP (p < 0.001) and IL-6 (p < 0.001) were significantly higher among the HCC patients. Comparison of HCC patients with liver cirrhosis cases with no diagnosis of HCC revealed significantly high AFP (p < 0.001) and IL-6 levels (p < 0.001) in HCC group. Cutoff value for IL-6 was calculated as 5.73 (pg/mL). No difference was detected in AFP (p = 0.600) and IL-6 (0.344) in all three subgroups. A total of 17 patients died during a mean follow-up period of 32.9 months. No correlation was found between mean AFP values and IL-6 values and survival rates. Conclusion: Plasma IL-6 level was found to be significant in the diagnosis of HCC. Alpha-fetoprotein and IL-6 provided no advantage in terms of early diagnosis of HCC and no correlation was observed between these markers and survival.



Muhsin Kaya, Recai Akdogan, Feyzullah Uçmak, Mehmet O Ayyildiz, Abdullah Karakus, Muhammet A Kaplan

The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:7] [Pages No:31 - 37]

Keywords: Acute hepatitis, Complications, Leukemia

   DOI: 10.5005/jp-journals-10018-1254  |  Open Access |  How to cite  | 


Introduction: Liver involvement is common in hematological malignancies, but the incidence and pattern of liver injury vary among the different types. The aims of our study were to determine the incidence and clinical course of acute hepatitis and the important factors for its development in patients with leukemia after chemotherapy. Materials and methods: All patients with the diagnosis of leukemia who were treated at the Department of Hematology between January 2008 and January 2013 were included in the study. A detailed medical history, clinical and laboratory findings, treatment modalities, complications, and clinical course were recorded retrospectively. Results: A total of 124 patients (64 females) with the diagnosis of leukemia were included in the study. The mean age was 45.2 years (16–89 years) and mean follow-up time was 29.7 months (0.25–192 months). A total of 43 (34.6%) patients had acute hepatitis after chemotherapy. Pattern of liver injury was hepatocellular in 31 patients, cholestasis in 2, and mix in 10 patients. Age (p = 0.001), hepatitis B surface antigen (HBsAg, p = 0.007), acute leukemia (p < 0.001), positive blood culture (p = 0.004), the amount of transfused red blood cell (p = 0.001), and amount of transfused platelets (p = 0.002) were significantly different under univariate analysis between the acute hepatitis group and the nonacute hepatitis group. Under multivariate analysis, only acute lymphoblastic leukemia (ALL) was identified as independent predictive factor for development of acute hepatitis after starting chemotherapy. Conclusion: Acute and self-limited hepatitis develops in the substantial proportion of patients with leukemia. The most important factor for development of acute hepatitis is the type of leukemia.



Jorge Aguiar, José A Silva,, Gerardo García,, Gerardo Guillén,, Julio C Aguilar

Cross-validation Studies of a Novel Low-cost Hepatitis B Virus Quantitative Polymerase Chain Reaction System

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Crossing point, Cycles threshold, Hepatitis B virus, Laboratory research, Plasmid, Primer, Quantitative polymerase chain reaction

   DOI: 10.5005/jp-journals-10018-1255  |  Open Access |  How to cite  | 


Aim: This research focused on the results of the cross-validation program related with the performance of a Cuban novel low-cost real-time quantitative polymerase chain reaction (qPCR) assay for hepatitis B virus (HBV) quantification developed by the Therapeutic Vaccine against Hepatitis B Department, Vaccines Division, Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba. Materials and methods: Dilution series with the plasmid standard at concentrations of 900,000 to 0.09 copies/reaction (c/r) were made for each PCR instrument. The mean cycles threshold (Ct) values and PCR efficiency were compared among the cyclers. Hepatitis B virus-positive serum samples were used for the calculation of reproducibility of the HBV assay. Biotecon Diagnostics (BCD) also ordered the oligo sequences from a second supplier and compared the PCR performance to those provided from the CIGB. Results: All PCR cyclers were able to detect concentrations up to 0.09 c/r. However, below the concentration of 9 c/r, the variation of results increased within and between the cyclers. The PCR efficiency showed satisfying results. The overall coefficient of variation (CV) cycler values were 1.29 and 0.91% for M6 and M19 respectively. No significance was observed between the different primer suppliers. Conclusion: The HBV assay was performed with a good concordance between the five real-time instruments from different suppliers. The HBV assay was also performed with a high reproducibility for samples with a high and a low viral load. The HBV assay is robust against different primer suppliers.



Sheikh Mohammad Fazle Akbar, Sakirul I Khan, Mamun Al-Mahtab,

Nature of Host Immunity during Hepatitis B Virus Infection and designing Immune Therapy

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:42 - 46]

Keywords: Chronic hepatitis B, Immune therapy, Pathogenic immunity, Protective immunity, Therapeutic immunity

   DOI: 10.5005/jp-journals-10018-1256  |  Open Access |  How to cite  | 


Hepatitis B virus (HBV) infections represent one of the major public health problems in global context. More than 2 billion people in the world have been infected with this virus at some point of time in their life and millions are chronically infected, indicating that chronic HBV-infected subjects remain as a living source of HBV transmission. The public health impact of this is tremendous. Considerable numbers of chronic HBV-infected individuals would eventually develop progressive liver diseases and their complications like hepatic failure, liver cirrhosis (LC), and hepatocellular carcinoma (HCC). Epidemiological studies have suggested that about 0.6 to 1.2 million people die annually from HBVrelated liver diseases. These figures about death due to HBV and sufferings from HBV-related diseases indicate a notion of medical emergencies about HBV. In addition to these, the impact of HBV on health care delivery system moves beyond these numbers of HBV-related patients and HB-related deaths. This is because significant insights have already been developed about epidemiology, virology, and pathogenesis of HBV. Also, an effective and widely used preventive vaccine is available against HBV. In addition to these, antiviral drugs against HBV have been developed from early 1980s and several such drugs are now available commercially in the open market around the worldwide. Unfortunately, the ongoing therapeutic regimens could not stand the test of time and new insights about HBV pathogenesis are required for the development of new, novel, and evidence-based therapies for chronic HBV infections.


Mini review

Preetam Nath, Shivaram P Singh

Nonalcoholic Fatty Liver Disease: Time to Take the Bull by the Horns

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:47 - 51]

Keywords: Awareness, Lifestyle change, Nonalcoholic fatty liver disease, Prevention

   DOI: 10.5005/jp-journals-10018-1257  |  Open Access |  How to cite  | 


Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world affecting almost one-fourth of the population. It may progress to nonalcoholic steatohepatitis (NASH), cirrhosis, end-stage liver disease, and liver cancer in the long run. Besides, it may make the natural history in other chronic liver diseases worse too. Furthermore, patients of NAFLD more often suffer from metabolic syndrome, ischemic heart disease, and extrahepatic malignancies than others, leading to a lower overall survival than the general population. Obesity and sedentary lifestyle are among the most important risk factors for NAFLD apart from increasing age, male sex, and certain genetic factors. Due to the rising incidence, possible adverse consequences, and the futile available treatment options, prevention is the key to tackle this health menace. Spreading awareness, adopting a healthy lifestyle with appropriate dietary modifications, regular physical activity are the cornerstones for challenging this unfolding monster.


Mini review

Mohammad Noor-E-Alam

Management of Hepatocellular Carcinoma: Bangladesh Perspective

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:2] [Pages No:52 - 53]

Keywords: Bangladesh, Innovative cancer therapy, Liver cancer, Management

   DOI: 10.5005/jp-journals-10018-1258  |  Open Access |  How to cite  | 


Bangladesh is one of the countries facing huge burden of hepatocellular carcinoma (HCC). Hepatocellular carcinoma is the third commonest cancer in the country and it is just behind to cancer of the lung and cancer of the stomach. Hepatitis B virus (HBV) is responsible for 66% of HCC in Bangladesh. Presumptive prevalence of HBV and hepatitis C virus (HCV) may be as high as 5.4 and 0.84%, respectively, in Bangladesh, and liver diseases occupied 8 to 12% of admission in medicine wards of Public Medical College. In this mini review, I would like to highlight the impact of HBV and HCV in the development of HCC and the management of HCC from a Bangladesh perspective.


Mini review

Rosmawati Mohamed, Ruksana Raihan, Amirah Azzeri, Fatiha H Shabaruddin

Hepatocellular Carcinoma in Malaysia and Its Changing Trend

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:3] [Pages No:54 - 56]

Keywords: Cryptogenic, Hepatocellular carcinoma, Malaysia, Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis

   DOI: 10.5005/jp-journals-10018-1259  |  Open Access |  How to cite  | 


Hepatocellular carcinoma (HCC) is one of the leading causes of death globally. In Malaysia liver cancer is the eighth most common cause of cancer for both gender and fifth most common cause of cancer for males. Liver cancer is a cause of premature death in Malaysia: The trend from 1990 to 2010 was observed upward. Since 1990, the annual years of life lost (YLLs) from liver cancer have increased by 31.5%. Older persons are at higher risk and there is male predominance observed. Curative surgical resection, liver transplantation, and supportive symptomatic care, including percutaneous ethanol injection and radiofrequency ablation (RFA), and noncurative transarterial chemoembolization (TACE) are among available treatment facilities. Yet the survival rate is very poor as majority of patients present at very advanced stage. Hepatitis B virus (HBV) remained the leading cause of HCC in Malaysia. Several studies showed cryptogenic causes, which are mainly nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) among the predominant causes of HCC in Malaysia than hepatitis C virus (HCV), alcohol, or any other reason. This mainly correlates with the increasing incidence of diabetes and obesity in Malaysia.


Mini review

Oidov Baatarkhuu, Tsagaantsooj Gerelchimeg, Dashchirev Munkh-Orshikh, Badamnachin Batsukh, Ganbold Sarangua, Jazag Amarsanaa

Epidemiology, Genotype Distribution, Prognosis, Control, and Management of Viral Hepatitis B, C, D, and Hepatocellular Carcinoma in Mongolia

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:6] [Pages No:57 - 62]

Keywords: Genotype, Hepatitis B virus, Hepatitis C virus, Hepatitis D virus, Hepatocellular carcinoma, Mongolia, National program

   DOI: 10.5005/jp-journals-10018-1260  |  Open Access |  How to cite  | 


Mongolia is located between Russia and China. The total population of Mongolia as of December 2017 is estimated to be 3.2 million people. According to our previous study results, the prevalence of HBV was 11.8%, and anti-HDV was detected in 4.8% among the HBsAg-positive subjects. Interestingly, most HCV infection is caused by genotype 1b. Among all HBV DNA-positive samples, 98.5% were classified into genotype D, and regarding HDV genotypes, all HDV RNA-positive samples, 100%, were classified into genotype I. The second study is the baseline survey of a Nationwide Cancer Cohort Study. Prevalence of HBsAg was 10.6%. Additionally, HCV infection was observed in 9.9%, and 0.8% were coinfected with HBV and HCV among the general population aged from 10 to 64 years. The third study investigated the population-based prevalence of hepatitis B and C virus in apparently healthy population of Ulaanbaatar city, Mongolia. The anti-HCV prevalence was 9.0%. In addition, the prevalence of HBV was 8.0%. The fourth study is on the prevalence of HCV and coinfections among nurses in a tertiary hospital in Mongolia. The prevalence of HCV was 18.9%. Additionally, HBV infection was observed in 23.1%, and 1.2% were coinfected with HCV and HBV. Mongolia has the highest HCC incidence in the world (78.1/100,000, 3.5× higher than China). As a result, the Mongolia government has launched The National Viral Hepatitis Program, which is a comprehensive program that involves all aspects from prevention to care and disease control to meet a reduction goal for morbidity and mortality due to HBV, HCV, and HDV. Consequently, access to antiviral therapies is now improving in Mongolia.


Mini review

Liver Cancer in Nepal

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:3] [Pages No:63 - 65]

Keywords: Advanced stage, Hepatocellular carcinoma, Nepal, Treatment modalities

   DOI: 10.5005/jp-journals-10018-1261  |  Open Access |  How to cite  | 


Hepatocellular carcinoma (HCC) is highly incidental in South Asian countries. Nepal, however, has low incidence for HCC owing to low prevalence for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Nepal lacked national cancer registry until 2003. Though there has been some effort in having one, the current registry incorporates twelve centers and may not properly represent the total cancer burden in the country. Serology for HBV and HCV is seen to be positive in nearly 25 to 30% and 5 to 10% of HCCs respectively. Clinical characteristics of HCCs in Nepal have been discussed in this mini-review and it features poor performance status and advanced stage at presentation, making only a small fraction of these subjects eligible for curative treatment options. Most of the standard treatment modalities are available in Nepal and appear to be reasonably affordable as compared with other developed nations.


Mini review

Mark Muthiah, Chern H Chong, Seng G Lim

Liver Disease in Singapore

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:3] [Pages No:66 - 68]

Keywords: Alcoholic liver disease, Burden of disease, Chronic hepatitis B, Chronic hepatitis C, Cirrhosis, Hepatocellular carcinoma, Liver cancer, Nonalcoholic fatty liver disease

   DOI: 10.5005/jp-journals-10018-1262  |  Open Access |  How to cite  | 


Liver disease is a significant health issue in Singapore. In the Singapore Burden of Disease Survey, liver cancer and liver cirrhosis contributed 3.2 and 0.9% of years of life lost (YLL) out of 182,753 YLL respectively. Liver cancer was ranked 8th and liver cirrhosis was ranked 20th in YLL. Liver cancer is the 5th most common cancer in males, and has an age-adjusted rate of 17.6 per 100,000 population. The underlying etiology of liver cirrhosis is chronic hepatitis B (CHB) in 63.3%, alcohol in 11.2%, cryptogenic in 9%, and chronic hepatitis C (CHC) in 6.9%. The overall seroprevalence rate of CHB is 3.6%, while CHC is approximately 0.1%. The trend in prevalence of liver cancer is gradually reducing as is CHB. However, less is known about alcoholic liver disease and fatty liver disease and there is some evidence that the latter is increasing. Singapore has a multilayered health care system designed to provide basic health care needs to the population. There are various schemes available that provide subsidized and assisted health care for treatment of hepatitis B and C as well as liver transplantation. Health policy with regard to a national action plan has not yet been developed and there is room for health care specialists, government and nongovernment agencies to work together to tackle liver disease in Singapore.


Mini review

Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:4] [Pages No:69 - 72]

Keywords: Nonalcoholic fatty liver disease, Prevalence, Sri Lanka

   DOI: 10.5005/jp-journals-10018-1263  |  Open Access |  How to cite  | 


Nonalcoholic fatty liver disease (NAFLD) is becoming one of the most important causes for chronic liver disease and also hepatocellular carcinoma (HCC) in Sri Lanka. This tendency is also recognized worldwide. More than half of the middle-aged and elderly adults in urban Sri Lanka have ultrasonic evidence of NAFLD. The NAFLD is also identified in population from rural areas of Sri Lanka and also in children. Nonalcoholic steatohepatitis (NASH) cirrhosis is the most common cause of referral for liver transplantation in Sri Lankans. The NASH is also the most common cause for rejecting potential donors for liver transplantation in Sri Lanka. Patients who underwent liver transplantation for cryptogenic cirrhosis developed evidence of NASH following liver transplantation. Recent evidence suggests that there is a genetic component to NAFLD. PNPLA3, a single gene polymorphism linked to the short arm of chromosome 22, is associated with the severity of NAFLD. The presence of this genetic polymorphism appears to carry higher risk of patients with NAFLD developing NASH with fibrosis cirrhosis and hepatocellular carcinoma. In a large population-based study from Sri Lanka, there was a tendency to develop NAFLD associated with this genetic polymorphism. In a population-based study, NAFLD was identified as an independent risk factor for development of diabetes. This association is recognized worldwide now. Most patients with HHC in Sri Lanka developed it on a back ground of cryptogenic cirrhosis. At the same time, the prevalence of the markers for hepatitis B and C was rare in Sri Lankan patients with HCC.


Mini review

Hasan Ozkan

Epidemiology of Chronic Hepatitis B in Turkey

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:2] [Pages No:73 - 74]

Keywords: Hepatitis B virus, Management, National support, Prevalence

   DOI: 10.5005/jp-journals-10018-1264  |  Open Access |  How to cite  | 


Hepatitis B virus (HBV) infection is a global public health problem and it is also a major health concern of Turkey. The estimated number of HBV carriers in Turkey is about 3.3 million, with an overall HBV prevalence of 4.57%. Thus, both prevention and therapy of HBV-infected patients are urgent medical need of Turkey. A total of 1,533 among 37,637 patients who were examined at the Department of Gastroenterology, Ankara University School of Medicine were found to be hepatitis B surface antigen (HBsAg) positive (4%). Viral hepatitis treatment is fully reimbursed in Turkey through the national insurance system, which covers all residents across Turkey.


Mini review

Angkham Ounavong

Reviewing of Research Finding of Hepatitis B Virus Infection in Lao People's Democratic Republic

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:2] [Pages No:75 - 76]

Keywords: Occult infection donors, Serological study in different cohort, Seroprevalence of HBsAg among donors, Seroprevalence of HBsAg among pregnant women in Lao People's Democratic Republic

   DOI: 10.5005/jp-journals-10018-1265  |  Open Access |  How to cite  | 


The seroprevalence of hepatitis B virus (HBV) surface antigen (HBsAg)-positive blood donors was 8.7%. The prevalence among males (9.7%) was higher than among females (6.2%). The prevalence of antihepatitis C virus (HCV)-positive blood donors was 1.1%, with no significant differences between males (1.1%) and females (1.0%). Annual positive rates for HBsAg and anti-HCV donors during the years 2003 to 2005 did not differ significantly. In Lao People's Democratic Republic (PDR), HBV is highly endemic. However, blood donations are only screened for HBsAg, leaving a risk of transmission by HBsAg-negative occult infected donors. Here, we characterized first-time blood donors to assess prevalence of HBV infections and occult infected donors. Despite hepatitis B vaccination at birth and at 6, 10, and 14 weeks of age, HBV infection continues to be endemic in Lao PDR. We carried a cross-sectional serological study in infants, preschool children, school pupils, and pregnant women to determine their burden of disease, risk of infection, and vaccination status. The prevalence of HBsAg carriage in pregnant women is a relevant marker for the risk of mother-to-child HBV transmission. This study aimed to assess the changes in prevalence of HBV infection among pregnant women attending Mahosot Prenatal Clinic (Vientiane).


Mini review

Jong-Hon Kang, Takeshi Matsui

Changing Etiology in Liver Cirrhosis in Sapporo, Japan

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:4] [Pages No:77 - 80]

Keywords: Etiology, Japan, Liver cirrhosis

   DOI: 10.5005/jp-journals-10018-1266  |  Open Access |  How to cite  | 


In Japan, preventive measures and antiviral therapy against acute or chronic viral infection had achieved remarkable progress in the 1980s or later. On the contrary, metabolic syndrome complicated with fatty liver has emerged as a public health concern to date. In the current study, we attempted to clarify etiological changes in liver cirrhosis treated in a single tertiary institute in Sapporo, Japan, from 1998 to 2016. Medical records of 1,166 patients (787 males, with mean of 64.9 ± 11.7 years), diagnosed as having liver cirrhosis for 19 years, were retrospectively reviewed to analyze etiology and clinical features. During the past 10 years, annual numbers of cirrhotic patients with chronic infection of hepatitis B virus (HBV) or hepatitis C virus (HCV) decreased from 50 or more to 20 or less, and alcoholic liver disease or cryptogenic liver injury emerged as major cause of liver cirrhosis. Among 100 cirrhotic patients of unknown cause, nonalcoholic fatty liver disease (NAFLD) occupied almost 50% in 19 observational years. In order to control the rising trend in NAFLD related with metabolic syndrome, preventive measures including education in society would be required in Japan.


Mini review

Pelden Wangchuk

Burden of Alcoholic Liver Disease: Bhutan Scenario

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:2] [Pages No:81 - 82]

Keywords: Alcohol, Bhutan, Disease burden, Liver diseases

   DOI: 10.5005/jp-journals-10018-1267  |  Open Access |  How to cite  | 


Alcoholic liver disease (ALD) is one of the major public health problems in Bhutan. The incidence of alcohol liver diseases (per 10,000 populations) in the year 2016 was 46. The burden of mortality associated with it is alarming, going by the size of the population of the country. It is one of the all-time top five killer diseases in the country. In 2016, the mortality attributable to alcohol liver disease was 184 corresponding to 97% of deaths due to reported liver diseases. The ALD is responsible for 15% of all deaths on an average in the last 3 years.


Mini review

Patharapan Lersritwimanmaen, Supot Nimanong

Hepatocellular Carcinoma Surveillance: Benefit of Serum Alfa-fetoprotein in Real-world Practice

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:83 - 87]

Keywords: Alfa-fetoprotein, Hepatocellular carcinoma, Surveillance

   DOI: 10.5005/jp-journals-10018-1268  |  Open Access |  How to cite  | 


Introduction: Better treatment outcome of early-stage hepatocellular carcinoma (HCC) warrants employment of screening programs, in which ultrasonography (US) and serum alfa-fetoprotein (AFP) have been recommended. Considering cost-effectiveness, serum AFP has recently been withdrawn from several guidelines for HCC surveillance. However, there were limited studies on benefits of AFP for HCC surveillance in Thailand. Materials and methods: This is a retrospective study of a proportion of HCC cases in which a diagnostic study was triggered by high serum AFP levels, but US failed to detect the lesion. Patients who received diagnostic imaging for HCC at Siriraj Hospital between January 1, 2012 and December 31, 2014 were included. All the patients must fulfill criteria for HCC surveillance according to American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of HCC 2010 or European Association for the Study of the Liver–European Organisation for Research and Treatment of Cancer (EASL–EORTC) Clinical Practice Guidelines: Management of HCC 2012. Previous diagnosis of any liver malignancy was excluded. Demographic data, underlying liver diseases, screening of AFP and US results, and definite diagnosis of HCC were recorded. Results: Of the 452 cases who fulfilled inclusion and exclusion criteria, chronic hepatitis B, C, and alcoholic cirrhosis were accountable for 53.8, 25.9, and 7.3% respectively. Totally, 150 cases were diagnosed with HCC. Additional HCC detection rate by high serum AFP but failed US of 15.3% was demonstrated. Subgroup analysis revealed significant benefit of AFP in cirrhotic patients with chronic hepatitis B and C (p-value 0.004 and 0.002). No significant benefit was observed in cirrhosis of other causes and in noncirrhotic chronic hepatitis B. Conclusion: We reported a 15.3% additional benefit of serum AFP for HCC surveillance in conjunction with US of liver. Chronic hepatitis B and C with cirrhosis significantly derived the benefit from serum AFP screening.


Mini review

David H Muljono, Teguh Wijayadi, Rizalinda Sjahril

Hepatitis B Virus Infection among Health Care Workers in Indonesia

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:5] [Pages No:88 - 92]

Keywords: Health care workers, Hepatitis B, Hepatitis B virus, Occupational hazard, Occupational risk

   DOI: 10.5005/jp-journals-10018-1269  |  Open Access |  How to cite  | 


Hepatitis B virus (HBV) infection is a global health problem with an estimated 257 million chronically infected people. Indonesia is a moderately hepatitis B-endemic country with 7.1% prevalence of hepatitis surface antigen (HBsAg). This infection is considered as an important occupational hazard among health care workers (HCWs), who may become further transmitters of this infection. The extent of hepatitis B among HCWs and specific control strategy are not available in Indonesia. A study was done on 644 HCWs, who were categorized into administration, nonintervention, and intervention groups. The prevalence of HBsAg, antibody to HBV core antigen (anti-HBc), and antibody to HBsAg (anti-HBs) was 4.7, 18.5, and 36.7% respectively, while 57.3% were negative for all seromarkers, indicating susceptibility to this infection. Increasing trend with age was observed in the exposure to infection (anti-HBc) (p <0.001) and the marker of resolved infection (HBsAg-, anti-HBc+, anti-HBs+) (p = 0.004), suggesting accumulated exposure to HBV infection by increasing age. Rising trend of exposure rate was also observed across the administration, nonintervention, and intervention groups (p < 0.001). By length of service period, significant escalation of exposure (p = 0.010) and resolved infection (p < 0.001) were also observed, suggesting increasing occupational risk to HBV infection. There is an urgent need to safeguard the HCWs with hepatitis B vaccination and provide continuing education at various health care setups. The establishment of a national policy and a roadmap for effective and efficient intervention is required for the prevention, diagnosis, postexposure management, and treatment of HBV infection in this special population.



Remzi A Akdogan, Halil Rakici, Serkan Güngör, Recep Bedir, Elif Akdogan

F-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:4] [Pages No:93 - 96]

Keywords: Computed tomography, Isolated gastric tuberculosis, Positron emission tomography

   DOI: 10.5005/jp-journals-10018-1270  |  Open Access |  How to cite  | 


Introduction: Tuberculosis (TB) infection is still a challenging health issue, especially in developing countries. Diagnosing extrapulmonary infections, especially isolated organ involvement, is difficult in most cases even with the radiological, endoscopic, and histopathological examinations done for accurate diagnosis. Here we describe a case of isolated gastric TB with specific F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings mimicking gastric cancer/ lymphoma. Case report: A 20-year-old male patient was admitted to our hospital with abdominal pain in the epigastric region, weight loss, and fever especially at nights for 2 months. Physical examination was normal. Hemoglobin was 9.6 gm/dL; the patient had iron deficiency anemia. Upper gastrointestinal (GI) endoscopy was suggestive of gastric ulcer mimicking malignancy. F-18 FDG PET/CT revealed multiple hypermetabolic malignant lymphadenopathies in the abdomen and diffuse gastric wall thickening as linitis plastica and multiple hypermetabolic peritoneal implants in the omentum. Exploratory laparotomy was done for tissue diagnosis and exploration of the peritoneum for TB infection, lymphoma, and Crohn's disease to make differential diagnosis. Histopathology revealed granulomatous lymphadenitis with granulomas including giant cells, suspecting TB. Patient was put on antituberculosis treatment (ATT). After treatment, the complaints resolved, and he gained weight. Fusion PET/CT exhibited a complete response to ATT with no residual disease. Conclusion: According to our knowledge, this is the first report about F-18 FDG PET/CT findings in the diagnosis of isolated gastric TB. F-18 FDG PET/CT may provide help in the diagnosis and follow-up of isolated gastric TB in challenging cases.



Aman Kamra

Trichobezoar: Ravenous for Hair

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:2] [Pages No:97 - 98]

Keywords: Bezoar, Rapunzel syndrome, Trichobezoars, Trichophagia

   DOI: 10.5005/jp-journals-10018-1271  |  Open Access |  How to cite  | 


Trichophagia is the habit of chewing hair. On an average, only 1% patients with trichophagia develop trichobezoar. They are usually symptomless until they reach a large size. It is common in young females usually with an underlying psychiatric disorder. The gold standard for diagnosis is upper gastrointestinal endoscopy (UGIE). Here we present a case of trichobezoar in an 11-year-old girl who presented in the emergency with complaint of pain abdomen and symptoms of obstruction.



Alper Parlakgumus, Ali Ezer

Postobstructive Cyst Formation in Pancreatic Duct affecting Surgical Approach

[Year:2018] [Month:January-June] [Volume:8] [Number:1] [Pages:2] [Pages No:99 - 100]

Keywords: Cyst, Pancreatic duct, Postobstruction, Surgical approach

   DOI: 10.5005/jp-journals-10018-1272  |  Open Access |  How to cite  | 


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