Ping-Hsien Chen

Inverse association between hepatitis B virus infection and fatty liver disease: a large-scale study in populations seeking for check-up.

Background Although many studies have attempted to clarify the association between hepatitis B virus (HBV) infection and fatty liver disease, no prior studies have emphasized the relationship of HBV and fatty liver regarding different demographics of age and body mass index (BMI). Aim To investigate the correlation of HBV and fatty liver in the different demographics of age and BMI. Methods We enrolled consecutive subjects who had received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009 and ultrasonography was used to diagnose fatty liver according to the practice guidelines of the American Gastroenterological Association. Results Among the 33,439 subjects enrolled in this study, fatty liver was diagnosed in 43.9% of the population and 38.9% of patients with chronic HBV infection. Multivariate analysis showed that BMI, age, waist circumference, systolic blood pressure, fasting glucose, cholesterol, alanine aminotransferase (ALT) levels, and platelet counts were positively associated, while hepatitis B surface antigen (HBsAg) positivity was inversely associated with fatty liver, especially for subjects with BMI>22.4 kg/m2 and age>50 years. On the contrary, HBV infection was positively correlated with the presence of elevated serum ALT levels in subjects with fatty liver disease regardless of their age and BMI. Conclusions Metabolic factors are important determinants for the prevalence of fatty liver. Patients with HBV infection were inversely associated with fatty liver disease than the general population, especially in older and obese patients. Furthermore, metabolic factors and HBV infection were associated with elevated serum ALT levels in fatty liver disease.

Combined platelet count with sCD163 and genetic variants optimizes esophageal varices prediction in cirrhotic patients

Endoscopic screening for esophageal varices (EVs) is expensive and invasive. Besides traditional noninvasive markers, we explore additional candidate markers including portal hypertension serum marker‐soluble CD136 (sCD163) and genetic variants of splanchnic vasodilatation and revascularization pathways for prediction of EVs in cirrhotic patients.

Management of acute gastric varices bleeding

&NA; Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs) occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV) bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon‐occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

Duodenal variceal bleeding caused by chronic pancreatitis

A 73-year-old man with no history of hepatitis Bvirus, hepatitis C virus, alcoholism, or cirrhosis wasadmitted because of tarry stool passage for 1 day. Hehad been diagnosed 7 years earlier as having gallstones,which induced acute necrotizing pancreatitis compli-cated with pseudocyst formation. On this admission, hispulse rate was 100 beats per minute and blood pressurewas 152/79 mm Hg. Physical examination revealed paleconjunctiva and tachycardia. Laboratory test resultswere as follows: hemoglobin 9.9 g/dL, platelet count104,000/mm

Clinical Outcomes and Complications of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms in the Elderly

AbstractThe number of elderly people with superficial gastric neoplasms is increasing, but the clinical outcome of endoscopic submucosal dissection (ESD) for treating elderly people with superficial gastric neoplasms remains unclear. We aimed to compare the efficacy and safety of ESD for patients with early gastric cancer (EGC) and precancerous lesions in elderly (≥75 years of age) and nonelderly (<75 years of age) patients.From October 2005 to December 2014, 83 consecutive patients with EGC and precancerous lesions (86 lesions) who were treated using ESD in our hospital were retrospectively reviewed. There were 44 lesions in 42 elderly patients who were at least 75-years old. The following parameters were compared between the 2 groups: preexisting comorbidities, performance status (PS), lesion inclusion criteria, lesion characteristics, treatment outcomes, surgery time, duration of hospitalization, complications, and intraoperative hemodynamic changes.Elderly patients had significantly higher preexisting comorbidity rates (90.9% vs 59.5%, P = 0.001), expanded lesion criteria rates (43.2% vs 19.0%, P = 0.016), and lower best PS rates (38.6% vs 81.0%, P < 0.001) than nonelderly patients. Lesion characteristics were similar in the 2 groups. The elderly had higher intraoperative hypotension rates (47.7% vs 21.4%, P = 0.011) and oxygen desaturation rates (9.1% vs 0.0%, P = 0.045) than nonelderly patients. In addition, the elderly also had a longer surgery time (107.0 ± 51.4 vs 91.5 ± 66.2 minutes, P = 0.049) and duration of hospitalization (7.5 ± 3.8 vs 5.9 ± 2.0 days, P = 0.016) than nonelderly patients. There were no differences in the prevalence rates of en-bloc resection, complete resection, bleeding, perforation, pneumonia, or intraabdominal free air between the 2 groups.Although elderly patients who underwent ESD for superficial gastric neoplasms had an increasing risk of intraoperative hypotension and oxygen desaturation, all patients were treated appropriately without postoperative sequelae. ESD is a safe and feasible intervention for elderly patients who have more comorbidity, a worse PS and more expanded lesions.

The impact of esophagogastric varices on the prognosis of patients with hepatocellular carcinoma

Whether or not esophagogastric varices (EGV) could determine the outcomes of patients with hepatocellular carcinoma (HCC) is still unclear. A total of 990 treatment-naive HCC patients who received an esophagogastroduodenoscopy at the time of HCC diagnosis were retrospectively enrolled. The factors in terms of prognosis were analyzed by Cox proportional hazards model and propensity score matching analysis. Among the enrolled patients, 480 (48.5%) patients had EGV. Patients with EGV had a significantly lower cumulative 5-year survival rate than those without EGV (24.9% versus 46.4%, p < 0.001). It was confirmed by a multivariate analysis and propensity score matching analysis. Stratified by tumor stage, the patients with EGV had lower survival rates than the patients without EGVs in all Barcelona Clinic Liver Cancer stages except stage D. Moreover, the patients with EGV had lower survival rates than those without EGV, both by curative or non-curative treatment modalities. In conclusion, EGV was an independent risk factor predicting poor prognosis for the patients with HCC by multivariate analysis, propensity score matching analysis, and subgroup analysis.

Acute kidney injury predicts mortality in cirrhotic patients with gastric variceal bleeding

The International Club of Ascites (ICA) recently proposed a new definition of acute kidney injury (AKI) in cirrhotic patients. The study evaluated the ICA‐AKI criteria and their association with the prognosis of cirrhotic patients with gastric variceal bleeding (GVB).

Risk factors of the peptic ulcer bleeding in aging uremia patients under regular hemodialysis.

Background: Previous studies have shown that uremia patients under hemodialysis (HD) have a significantly higher occurrence of peptic ulcer bleeding (PUB) than healthy controls and that elderly patients remain at high risk of peptic ulcer disease (PUD) and PUB. Here we aimed to identify the risk factors for PUB in aging (≥65‐years‐old) uremic patients under regular HD. Methods: Using data from the National Health Insurance Research Database of Taiwan, we compared 18,252 aging regular HD patients and 17,883 age‐, gender‐, and medication‐matched patients without kidney disease (control group). The log‐rank test was performed to analyze the differences in accumulated hazard of PUB between the two groups. Cox proportional hazard regressions were performed to evaluate independent risk factors for PUB between the two groups and identify risk factors of PUB in aging HD patients. Results: In a 7‐year follow‐up, aging HD patients had significantly higher incidences of PUB than the matched controls (p < 0.001 by the log‐rank test). By Cox proportional hazard regression analysis, HD (hazard ratio [HR] = 4.61; 95% confidence intervals [CI] 4.03–5.27) was independently associated with increased risk of PUB. Age, diabetes mellitus (DM), history of uncomplicated PUD, cirrhosis, and use of non‐steroidal anti‐inflammatory drugs (NSAIDs) and corticosteroids were risk factors for PUB in aging HD patients. Conclusion: Aging HD patients are associated with higher risk of PUB. The use of NSAIDs and corticosteroids and co‐morbidities including DM, history of uncomplicated PUD, and cirrhosis were identified as risk factors for PUB in these patients.

Proton Pump Inhibitors and Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B or C

Researchers have hypothesized that the long‐term use of proton pump inhibitors (PPIs) can increase the risk of developing cancer. However, the association between PPI use and hepatocellular carcinoma (HCC) risk is unclear. Using data from the Taiwan National Health Insurance Research Database for the period between 2003 and 2013, we identified 35,356 patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. One‐to‐one propensity score matching by gender, age, cohort entry year, comorbidity, and medication resulted in the inclusion of 7,492 pairs of patients (PPI users and non‐PPI users) for analyses. We performed multivariate and stratified analysis using the Kaplan‐Meier method and Cox proportional hazards models in order to estimate the association between PPI use and the risk of developing HCC. In the HBV cohort, 237 patients developed HCC during a median follow‐up of 53 months. However, PPI use was not associated with an increased risk of developing HCC (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 0.90‐1.73; P = 0.18). In the HCV cohort, 211 patients developed HCC; but again, PPI use was not associated with an increase in the risk of developing HCC (aHR, 1.19; 95% CI, 0.88‐1.61; P = 0.25). We observed no relationship between a dose‐dependent effect of PPI use and HCC risk. Subgroup analysis also confirmed that PPI use was not correlated to an increased HCC risk. Conclusion: Based on a retrospective population‐based cohort study throughout Taiwan, where the prescription of PPI is tightly regulated, PPI use is not associated with the risk of developing HCC among patients with chronic HBV or HCV infections.

Low air temperature increases the risk of oesophageal variceal bleeding: a population and hospital‐based case‐crossover study in Taiwan

Studies concerning seasonal variations and the impact of air temperature on oesophageal variceal bleeding have yielded conflicting results. We aimed to explore the impact of air temperature on the occurrence of variceal bleeding.