[Show abstract][Hide abstract] ABSTRACT: Background & Aims
Both corticosteroid and pentoxifylline reduce short-term mortality in severe alcoholic hepatitis. However, few studies have directly compared the efficacy of pentoxifylline and corticosteroid in patients with this condition.
In this multicentre, open-labelled, randomised non-inferiority trial, we assigned 121 patients with severe alcoholic hepatitis (Maddrey’s discriminant function ⩾32) to receive either pentoxifylline (400 mg, 3 times daily, in 62 subjects) or prednisolone (40 mg daily, in 59 subjects). The primary end point was non-inferiority in survival at the 1 month time point for the pentoxifylline treatment compared with prednisolone.
The 1-month survival rate of patients receiving pentoxifylline was 75.8% (15 deaths) compared with 88.1% (7 deaths) in those, taking prednisolone, for a treatment difference of 12.3% (95% confidence interval, −4.2% to 28.7%; p = 0.08). The 95% confidence interval for the observed difference exceeded the predefined margin of non-inferiority (Δ15%) and included zero. The 6-month survival rate was not significantly different between the pentoxifylline and prednisolone groups (64.5% vs. 72.9%; p = 0.23). At 7 days, the response to therapy assessed by the Lille model was significantly lower in the prednisolone group (n = 58) than in the pentoxifylline group (n = 59): 0.35 vs. 0.50 (p = 0.012). Hepatitis complications, including hepatorenal syndrome and side effects, such as infection and gastrointestinal bleeding, were similar in the two groups.
The findings demonstrate that the efficacy of the pentoxifylline is not statistically equivalent to the efficacy of prednisolone, supporting the use of prednisolone as a preferred treatment option in patients with severe alcoholic hepatitis.
[Show abstract][Hide abstract] ABSTRACT: Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical characteristics of patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 and A hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
Between January 2001 and September 2011, 129 patients with BCLC stage 0 and stage A HCC who underwent TACE were retrospectively enrolled. Patient characteristics, routine computed tomography and TACE findings, survival time and 1-, 5-, and 10-year survival rates, risk factors for mortality, and survival rates according to the number of risk factors were assessed.
The mean size of HCC tumors was 2.4 ± 1.1 cm, and the mean number of TACE procedures performed was 2.5 ± 2.1. The mean overall survival time and 1-, 5-, and 10-year survival rates were 80.6 ± 4.9 mo and 91%, 63% and 49%, respectively. In the Cox regression analysis, a Child-Pugh score > 5 (P = 0.005, OR = 3.86), presence of arterio-venous shunt (P = 0.032, OR = 4.41), amount of lipiodol used (> 7 mL; P = 0.013, OR = 3.51), and female gender (P = 0.008, OR = 3.47) were risk factors for mortality. The 1-, 5-, and 10-year survival rates according to the number of risk factors present were 96%, 87% and 87% (no risk factors), 89%, 65%, and 35% (1 risk factor), 96%, 48% and unavailable (2 risk factors), and 63%, 17%, and 0% (3 risk factors), respectively (P < 0.001).
TACE may be used as curative-intent therapy in patients with BCLC stage 0 and stage A HCC. The Child-Pugh score, arterio-venous shunt, amount of lipiodol used, and gender were related to mortality after TACE.
World Journal of Gastroenterology 01/2014; 20(3):745-54. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is unclear whether sarcopenia contributes to the prediction of metabolic dysregulations in addition to that predicted by waist circumference.
Subjects consisted of 6832 adult participants in the 2009 Korea National Health and Nutrition Examination Survey, grouped into categories of waist circumference (normal vs. high). Sarcopenia was assessed by appendicular skeletal muscle mass divided by weight.
In the normal waist circumference category, the risk of metabolic syndrome was nearly 3.5-fold higher in sarcopenic men (OR, 3.39; 95% CI, 1.67-6.90) than in those without sarcopenia. For the high waist circumference category, the risk of metabolic syndrome was 2.5-fold higher in sarcopenic women (OR, 2.37; 95% CI, 1.66-3.40) than in those without sarcopenia. The corresponding risk was also higher in sarcopenic men (OR, 1.81; 95% CI, 1.11-2.94) than in those without sarcopenia. With the exception in men with high waist circumference category, adjustments for other potential confounders did not substantially affect the results. Appendicular skeletal muscle mass divided by weight as a continuous variable was also associated with metabolic syndrome in men (OR, 0.39; 95% CI, 0.35-0.44) and women (OR, 0.53; 95% CI, 0.48-0.60).
Sarcopenia is associated with metabolic syndrome in men with normal waist circumference and women with high waist circumference. Our results emphasize that sarcopenia may contribute additionally to the risk of metabolic abnormalities beyond what is predicted by the abdominal obesity category.
[Show abstract][Hide abstract] ABSTRACT: Low muscle mass has been associated with arterial stiffness. The aim of the study was to determine whether sarcopenic obesity is associated with hypertension. Subjects consisted of 6832 adults who participated in the 2009 Korea National Health and Nutrition Examination Survey. Participants were classified as normal, sarcopenic, obese, or sarcopenic-obese based on the following measures: waist circumference and appendicular skeletal muscle mass divided by weight (ASM/Wt). The sarcopenic-obese group had systolic and diastolic blood pressure levels that were ≈12 mm Hg and 5 mm Hg higher, respectively, than those in the normal group. Compared with the normal group, the odds ratio (OR) of having hypertension for the sarcopenic, obese, and sarcopenic-obese groups were 2.48 (95% confidence interval [CI], 1.89-6.16), 3.15 (95% CI, 2.76-3.59), and 6.42 (95% CI, 4.85-8.48) times higher, respectively. When waist circumference and ASM/Wt were used as continuous variables in the same regression model, ASM/Wt was a significant predictor of hypertension (OR, 0.94; 95% CI, 0.89-0.98). Sarcopenic obesity is associated with hypertension, while low muscle mass is also correlated with hypertension, independent of abdominal obesity. Abdominal obesity and sarcopenia may potentiate each other to induce hypertension.
Journal of the American Society of Hypertension (JASH) 07/2013;
[Show abstract][Hide abstract] ABSTRACT: AIM: Early identification of the metabolic syndrome (MS) and abnormal lipid levels with subsequent life-style intervention is vital to halt disease progression and safeguard the future health of children and adolescents. METHODS: Data from a representative sample of 1554 adolescents (821 boys and 733 girls) aged 10-19 from the 2007-2008 Korea National Health and Nutrition Examination Survey was analysed. The MS was defined using the paediatric criteria of the International Diabetes Federation. Abnormal lipid levels were classified according to the guidelines of the American Academy of Pediatrics. RESULTS: Approximately 13.7% of adolescents have a body mass index (BMI) between the 85th and 94th percentiles, and 8.4% have a BMI of ≥95th percentile. The prevalence of the MS was 2.3% among all the participants, 2.7% among boys and 2.1% among girls. The prevalence of the MS was 2.8% among overweight adolescents and 23.7% among obese adolescents. A low high-density lipoprotein cholesterol level was the most common component for the MS. Nearly 20% of adolescents (21% of boys and 19% of girls) had at least one lipid abnormality. Approximately 32% of overweight adolescents and 50% of obese adolescents were candidates for therapeutic life-style counselling based on lipid levels. CONCLUSIONS: The present study provides the most updated prevalence estimates of the MS in the Korean adolescent population and highlights the strong association of the MS with BMI. The prevalence of abnormal lipid levels in overweight and obese adolescents is high, illustrating the large burden of cardiovascular disease in the future Korean population.
Journal of Paediatrics and Child Health 06/2013; · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Hepatic venous pressure gradient (HVPG) of 6-10 mmHg has been accepted as a hemodynamic parameter of stage 1 compensated liver cirrhosis (LC). The diagnostic accuracy of HVPG in the prediction of stage 1 compensated LC has been investigated in patients with chronic hepatitis B (CHB). METHODS: A total of 219 patients with CHB who underwent HVPG and liver biopsy were enrolled. The diagnostic accuracy of two methods was compared. Risk factors associated with the diagnosis of stage 1 compensated LC on the basis of the findings of HVPG, biopsy, and both HVPG and biopsy were evaluated. RESULTS: The HVPG score was correlated positively with the stage of biopsy (r=0.439). The sensitivity/specificity of HVPG for predicting stage 1 compensated LC were 78/81% in 6 mmHg, respectively. A total of 57 (26%), 28 (13%), and 20 (9%) patients were diagnosed with stage 1 compensated LC on the basis of the findings of HVPG, biopsy, and both HVPG and biopsy (P>0.05), respectively. Platelet/age (-0.77-0.01×platelet+0.03×age), albumin/platelet (5.05-1.19×albumin-0.01×platelet), and platelet (0.24-0.01×platelet) were found to be risk factors (logit model) for the diagnosis of stage 1 compensated LC on the basis of the findings of HVPG, biopsy, and both HVPG and biopsy. CONCLUSION: HVPG showed a positive correlation with biopsy, and platelet was found to be a common risk factor for the diagnosis of stage 1 compensated LC in patients with CHB.
European journal of gastroenterology & hepatology 04/2013; · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea.
The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated.
The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001).
The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.
Clinical and molecular hepatology. 03/2013; 19(1):36-44.
[Show abstract][Hide abstract] ABSTRACT: GOALS AND BACKGROUND:: Premedication with pronase, dimethylpolysiloxane, and sodium bicarbonate improves visibility during upper gastrointestinal (UGI) endoscopy. However, the optimal time for this combination to take effect is unknown. We investigated the optimal time of pre-UGI endoscopy medication. STUDY:: A randomized, investigator-blind, controlled trial. The 300 patients who were to receive premedication were randomized into 3 groups according to the following medication time before UGI endoscopy: 10 minutes (group A, n=98), 10 to 30 minutes (group B, n=97), and 30 minutes premedication (group C, n=99). Visibility scores (range, 1 to 4, with lower scores indicating better gastric mucosal visibility) were assessed for the antrum, lower body, upper body, and fundus and compared, including the sum of the scores, between the 3 groups. RESULTS:: Group B had significantly lower visibility scores for the lower body, upper body, and fundus than group C (P=0.001, 0.009, and 0.002, respectively). Group A obtained significantly lower scores for the antrum and lower body than group C (P=0.007 and 0.005, respectively). The total visibility scores of groups A and B were significantly lower compared with those of group C (P=0.001, 0.003, respectively). CONCLUSIONS:: Administration of pronase, dimethylpolysiloxane, and sodium bicarbonate within 30 minutes before UGI endoscopy significantly improved endoscopic visualization. However, the optimal time to achieve the best visibility was between 10 to 30 minutes before UGI endoscopy.
Journal of clinical gastroenterology 02/2013; · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: The incremental usefulness of adding hepatic venous pressure gradient (HVPG) for predicting the risk of death has not, to our knowledge, been evaluated among patients with decompensated cirrhosis. We investigated whether the incorporation of the HVPG in an established model improved the prediction of death in a cohort of decompensated cirrhosis patients. Methodology: We used data from 106 consecutive patients with decompensated cirrhosis who underwent a hemodynamic study between January 2006 and December 2007, to investigate whether the HVPG improved the risk discrimination of a patient beyond an assessment that was based on the Model for End-stage Liver Disease (MELD) or MELD-Na. We used occurrence vs. non-occurrence of events within 12 months as the outcome for analysis. Results: For prediction of 12 months survival, the area under the receiver-operating characteristic curve (AUROC) for the MELD-Na was significantly greater than that of the MELD (79.4% vs. 70.5%, p=0.05). The MELD performed similar to the HVPG (70.5% vs. 71.2%, p=0.471). Adding the HVPG measurement to the MELD or the MELD-Na did not result in significant increase of the AUROC, with only a small improvement of about 5% in both cases. Conclusions: The MELD-Na is the most predictive for 12-month survival in patients with decompensated cirrhosis. The addition of the HVPG to the MELD or the MELD-Na score does not appear to improve the prognostic accuracy of the MELD or the MELD-Na score significantly.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: For the geriatric population, upper reference limits (URLs) for alanine aminotransferase (ALT) levels have not been established. The aim of the study was to determine the URLs for ALT and to describe the factors associated with elevated ALT level in an elderly population. DESIGN AND METHODS: We set the URLs for ALT for participants aged 65years and over (n=3646) based on the 2007-2009 Korea National Health and Nutrition Examination Survey at the 97.5th percentile of that population who were determined to be at low risk for liver disease (n=896; low risk was defined as testing negative for the HBs antigen, low alcohol intake, and the absence of metabolic syndrome, medical comorbidity, or medication use). RESULTS: The URLs for ALT were 39IU/L for men and 30IU/L for women. The weighted prevalence for the elevated ALT level was 8.0% (95% confidence interval [CI], 7.1% to 8.9%) in the sample, 5.8% (95% CI, 4.7% to 7.1%) in men and 9.5% (95% CI, 8.3% to 10.8%) in women. CONCLUSIONS: The URLs for ALT are established for the first time in the elderly, and our results may be useful for monitoring trends in the burden of liver disease, in addition to guiding the evaluation of ALT abnormalities in clinical practice.
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT The Alcohol Use Disorders Identification Test (AUDIT) has been found to provide an accurate measure for risk of hazardous and harmful alcohol use, as well as possible dependence. Data from 2 representative samples of 7693 adults in the Korea National Health and Nutrition Examination Survey (KNHANES) 2005 and 6276 participants in 2009 were analyzed. The overall age-adjusted prevalence of alcohol use disorder (AUD) in 2009 (38.8%) was higher than that in 2005 (32.7%), with a difference of 6.1% (95% confidence interval [CI], 2.9%-9.3%; P = .0002). Men were about 7 times as likely as women to meet the criteria for AUD (odds ratio [OR] = 7.16; 95% CI, 6.27-8.17). Current smoking was the most important correlate associated with AUD in both genders (women: OR = 6.03; 95% CI, 4.40-8.27; men: OR = 2.83; 95% CI, 2.29-3.48). Among women, unmarried (OR = 1.76; 95% CI, 1.35-2.31), less than high school education (OR = 2.71, 95% CI, 1.86-3.96), and lowest income (OR = 1.45, 95% CI, 1.06-1.97) were associated with AUD. These findings provide the most updated prevalence estimates of AUD in the Korean population and they highlight its strong association with smoking, gender differences, and lower socioeconomic status in the Korean population.
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: Currently, a split-dose of polyethylene glycol (PEG) is the mainstay of bowel preparation due to its tolerability, bowel-cleansing action, and safety. However, bowel preparation with PEG is suboptimal because residual fluid reduces the polyp detection rate and requires a more thorough colon inspection. The aim of our study was to demonstrate the efficacy of a sufficient dose of prokinetics on bowel cleansing together with split-dose PEG. Methods: A prospective endoscopist-blinded study was conducted. Patients were randomly allocated to two groups: prokinetic with split-dose PEG or split-dose PEG alone. A prokinetic [100 mg itopride (Itomed®)], was administered twice simultaneously with each split-dose of PEG. Bowel-cleansing efficacy was measured by endoscopists using the Ottawa scale and the segmental fluidity scale score. Each participant completed a bowel preparation survey. Mean scores from the Ottawa scale, segmental fluid scale, and rate of poor preparation were compared between both groups. Results: Patients in the prokinetics with split-dose PEG group showed significantly lower total Ottawa and segmental fluid scores compared with patients in the split-dose of PEG alone group. Conclusion: A sufficient dose of prokinetics with a split-dose of PEG showed efficacy in bowel cleansing for morning colonoscopy, largely due to the reduction in colonic fluid.
[Show abstract][Hide abstract] ABSTRACT: GOALS AND BACKGROUND:: Colonoscopy with consecutive esophagogastroduodenoscopy (CCEGD) can be more convenient than performing each procedure individually. There has been no randomized controlled trial comparing carbon dioxide (CO2) versus air insufflations during CCEGD in sedated patients. CO2 insufflation instead of air during CCEGD may reduce abdominal pain and be more comfortable. We investigated the efficacy and safety of CO2 insufflation during CCEGD in moderately sedated outpatients. STUDY:: This was a randomized, double-blind, controlled trial. A total of 96 outpatients were randomly assigned to the groups of CO2 or air insufflation. Postprocedure pain was assessed using a 0 to 10 visual analogue scale, and the proportion of pain-free patients was compared between the groups. Waist circumferences and end-tidal CO2 (ETCO2) were measured. RESULTS:: Among 96 patients, cecal intubation failed in 2 patients, who were excluded from the analysis. Forty-eight patients in the CO2 and 46 patients in the air group completed the study. There was significant difference between the 2 groups regarding the proportion of pain-free patients 30 minutes after the procedures [air group, 35/46 (76.1%) vs. CO2 group, 44/48 (91.6%)] (P=0.03). However, there was no significant difference in the proportion at 6 and 24 hours after the procedures. The mean increase in waist circumference was greater with air than with CO2 (1.54 vs. 0.18 cm, P<0.001). The ETCO2 measured immediately after the procedures was slightly higher in the CO2 group than in the air group (38.6 vs. 37.2 mm Hg, P=0.02), but the values were within the normal range. No significant adverse events occurred. CONCLUSIONS:: CO2 insufflation during CCEGD reduced postprocedural pain and distension compared with air. It was comfortable and safe to use in moderately sedated outpatients.
Journal of clinical gastroenterology 07/2012; · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: GOALS:: We evaluated the efficacy of initial and follow-up hepatic venous pressure gradient (HVPG), models of end-stage liver disease (MELD), and MELD-Na for predicting the survival of patients with decompensated liver cirrhosis (LC). BACKGROUND:: MELD with/without Na score and HVPG have been important predictors of mortality in patients with LC. STUDY:: Between January 2006 and 2011, a total of 57 patients with decompensated LC, all of whom underwent >2 HVPG measurements for the confirmation of propranolol dosing, were enrolled. MELD and MELD-Na scores were calculated on the day of HVPG measurement. The prognostic accuracy of the initial and follow-up HVPG, MELD, and MELD-Na were analyzed, and independent factors for mortality were evaluated. RESULTS:: Ten patients (17.5%) died from LC. Initial HVPG (0.883), initial MELD-Na (0.877), follow-up HVPG (0.829), and follow-up MELD-Na (0.802) showed good area under the receiver operating characteristic curve scores in predicting 1-year mortality. In predicting 2-year mortality, only follow-up HVPG (0.821, cut-off value 18 mm Hg) showed good score. Overall area under the receiver operating characteristic curves (initial and follow-up) were 0.843 and 0.864 in HVPG, 0.721 and 0.674 in MELD, and 0.762 and 0.715 in MELD-Na, respectively. In the Cox regression analysis, only follow-up HVPG (P=0.02; odds ratio, 1.11) was associated with mortality. CONCLUSIONS:: The efficacy of HVPG for predicting mortality is excellent compared with that of MELD or MELD-Na. Therefore, aside from the confirmation of adequate propranolol dosing, HVPG may be needed for predicting the survival of patients with decompensated LC.
Journal of clinical gastroenterology 07/2012; 46(10):880-886. · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES:: For the pediatric population, upper reference limits (URLs) for aminotransferase levels have not been established. The prevalence of high aminotransferase levels provides important information regarding the burden of liver disease in the current childhood obesity endemic. STUDY DESIGN:: We set the URL of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for participants aged 10-19 years (n = 2,746) from the 2007-2009 Korea National Health and Nutrition Examination Survey at the 97.5 percentile of that population who were determined to be at low risk for liver disease (n = 1,717; low risk was defined as testing negative for HBs antigens, the absence of alcohol use disorder, having normal body mass index, and having normal lipid or carbohydrate metabolism). RESULTS:: The URLs for ALT were 33 IU/L for boys and 25 IU/L for girls, and the corresponding limits for AST were 33 IU/L for boys and 28 IU/L for girls. The weighted prevalence of elevated ALT levels was 6.5% in the sample, 8.2% in boys and 4.5% in girls. The prevalence of elevated AST levels was 3.9% and had no gender differences. We also found that elevated ALT levels are associated with male gender, older age, obesity, and presence of abnormal lipid levels. Having elevated AST levels is associated with obesity, younger age, and exhibiting laboratory indicators of abnormal lipid metabolism. CONCLUSIONS:: Aminotransferase URLs are being established for the first time, and our results may be useful in determining a baseline level for monitoring the secular trends of liver disease in future studies of adolescent populations.
Journal of pediatric gastroenterology and nutrition 06/2012; · 2.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To address a growing concern about drug-induced liver injury (DILI), a nationwide study was performed to investigate the significance of DILI in Korea.
From May 2005 to May 2007, cases of DILI (alanine transferase >3 × upper normal limit or total bilirubin >2 × upper normal limit) from 17 referral university hospitals were prospectively enrolled. Adjudication by the seven review boards was considered for the confirmation of causality and the Roussel Uclaf Causality Assessment Method (RUCAM) scale was used.
A total of 371 cases were diagnosed with DILI. The extrapolated incidence of hospitalization at university hospital in Korea was 12/100,000 persons/year. The causes included "herbal medications" (102, 27.5%), "prescription or non-prescription medications" (101, 27.3%), "health foods or dietary supplements" (51, 13.7%), "medicinal herbs or plants" (35, 9.4%), "folk remedies" (32, 8.6%), "combined" (30, 8.2%), "herbal preparations" (12, 3.2%), and others (8, 2.2%). Nine cases were linked to acetaminophen. The frequencies of hepatocellular, mixed, and cholestatic types were 76.3, 14.8, and 8.9%, respectively. A total of 234 cases met the criteria for Hy's law. Five patients died or underwent transplantation. Twenty-five cases (21 herbs and 4 medications) did not meet the time-to-onset criteria of the RUCAM.
DILI appears to be a highly relevant health problem in Korea. "Herbal medications" are the principal cause of DILI. A more objective and reproducible causality assessment tool is strongly desired as the RUCAM scale frequently undercounts the cases caused by herbs owing to a lack of previous information and incompatible time criteria.
The American Journal of Gastroenterology 06/2012; 107(9):1380-7. · 9.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Trends in hepatitis B virus (HBV) infection are important in evaluating the effectiveness of the recommended routine vaccination of infants and adolescents.
The prevalence of HBV infection was determined in a representative sample of the Korea National Health and Nutrition Examination Survey for 1998 (n=9771) and 2009 (n=8304). Participants aged ≥10 years were tested for the hepatitis B surface antigen (HBsAg).
The overall age-adjusted HBsAg seroprevalence was 4.6% (95% confidence interval (CI) 4.2-5.0%) in 1998 and 3.2% (95% CI 2.9-3.6%) in 2009, which represents a relative decrease of 30.4% between the two survey populations (p<0.05). The prevalence of HBsAg decreased among persons 10-19 years of age (from 2.2% to 0.3%), 20-29 years of age (from 5.4% to 2.5%), 30-39 years of age (from 6.1% to 4.3%), 40-49 years of age (from 5.1% to 4.7%), and 50-59 years of age (from 5.3% to 3.7%). HBsAg seroprevalence did not decrease among persons ≥60 years of age (2.7% vs. 2.9%).
These data show a decline in HBsAg seroprevalence, primarily due to the dramatic decrease in adolescents and younger adults.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 06/2012; 16(9):e669-72. · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:: Despite suggestions to lower the upper reference limits (URL) for aminotransferase activities to increase the detection of liver disease, there is no generally accepted URL in the general Korean population. METHODS:: We set the URL for alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities at the 97.5th percentile in a population at low risk for liver disease (n=3316; negative HBs antigen, low alcohol intake, normal waist circumference, normal lipid or carbohydrate metabolism, and absence of medication use) derived from the 2007 to 2009 Korean National Health and Nutrition Examination Survey (KNHANES; n=16,608). RESULTS:: The URLs for ALT activity were 53 IU/L for men and 30 IU/L for women, and the corresponding limits for AST activity were 37 IU/L for men and 29 IU/L for women. The age-adjusted prevalence of the elevated ALT activity was 8.6% [95% confidence interval (CI), 8.2%-9.1%] in the 2007 to 2009 KNHANES and 6.9% (95% CI, 6.3%-7.5%) in the 2001 KNHANES, a relative increase of 24.6% (P<0.05). This increase was concentrated among those aged 20 to 29, with a relative increase of 66.7%, and those aged 30 to 39, with a relative increase of 54.4%. There was no significant change in the prevalence of elevated AST activity. CONCLUSIONS:: The URL for ALT activity among the general Korean population is clearly higher than recently proposed thresholds. The trajectory of the increasing prevalence of elevated ALT activity heralds an increased burden of chronic liver disease in the future Korean population.
Journal of clinical gastroenterology 06/2012; · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Hepatocellular carcinoma (HCC) screening has been recommended for hepatitis B virus (HBV)-infected individuals in an effort to detect HCC at a sufficiently early stage to provide potentially curative treatments. The study reported here is the first to address the rate of HCC screening use in an HBV endemic area. METHODS: Data were collected from 11,147 adults aged ≥40 years who participated in the 2007-2009 Korea National Health and Nutrition Examination Survey and had a valid HBV surface antigen test. Current HCC screening was defined as either receiving an ultrasonography or an α-fetoprotein measurement in the past year. Prevalence estimates were weighted. RESULTS: The response rate was 78.4 %, and 436 cases of HBV infection were identified. The overall seroprevalence of the HBV surface antigen was 4.1 % [95 % confidence interval (CI) 3.9-4.4 %]. Of the 436 HBV-infected subjects, only 23.2 % (95 % CI 19.5 -27.4 %) were aware that they had been infected, and approximately 27 % (27.1 %; 95 %CI 23.2-to 31.5 %) were up to date with their HCC screening tests; more than half (52.9 %, 95 % CI 48.2-57.5) had never been screened. In a multivariate analysis that included various sociodemographic variables, only self-reported awareness of HBV infection was significantly associated with current HCC screening tests (odds ratio 2.82; 95 % CI 1.64-4.84). CONCLUSIONS: Adoption of HCC screening as a standard practice among HBV-infected Korean adults aged ≥40 years is suboptimal. Evidence-based programs in communities and education for both healthcare providers and HBV-infected persons are needed to improve the implementation of HCC screening in clinical practice.
Digestive Diseases and Sciences 06/2012; · 2.26 Impact Factor