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Background: Hypoxic hepatitis (HH) is an acute severe liver injury usually associated with several types of hemodynamic instability. The mortality rate is about 50% to 70%. Objective: To evaluate the prevalence of HH and to study the clinical course and outcomes of these patients. Materials and Methods: The present study was a retrospective study conducted at Siriraj Hospital. Data were retrieved from the hospital admissions between 2008 and 2018. HH was defined by serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels of more than or equal to 20 times the upper limit of normal in the absence of other causes. Baseline patients' condition, laboratory, and clinical course were collected. Results: Of the 4,000 admissions, 29 (0.73%) met the criteria for HH. Mean age was 68.2 years old and the median serum AST and ALT levels at the time of diagnosis were 2,065 and 815 IU/L, respectively. Underlying diseases in these patients included hypertension (69%), diabetes mellitus (48.3%), and chronic kidney disease (37.9%). Comorbidities included acute kidney injury (93.1%), sepsis (79.3%), hypotension (75.9%), requirement of vasopressors (65.5%), and acute respiratory failure (55.2%). The mortality rate at day 28 was 72.4%, none were liver related. The only significant risk factor for mortality was lower bicarbonate levels at the time of diagnosis (p=0.012). Conclusion: HH is uncommon, at 0.73%, and most patients had episodes of hypotension and multi-organ failure. Monitoring of liver function test is advised in this group of patients. The twenty-eight-day mortality rate was 72.4% but none from liver failure. The most common cause of mortality was related to comorbidity of the patients and the only predictor of high mortality was the lower bicarbonate level. [ABSTRACT FROM AUTHOR]

Objective: Acute gastrointestinal [GI] bleeding is common in anticoagulant users. Optimal management regarding the role of endoscopy is lacking. This study aimed to elucidate the prevalence of significant endoscopic lesions and predictors of significant lesions and management change with endoscopy. Materials and Methods: A retrospective cohort study of anticoagulated patients with GI bleeding who underwent endoscopy between January 2005 and December 2014 were reviewed and analyzed. Results: There were 94 patients. Male and female were equal in number with a mean age of 71.6±10.8 years. Most (81.8%) received warfarin. Upper GI bleeding was the most common site (60.9%) followed by lower GI bleeding (28.2%), mid GI bleeding (5.5%) and undetermined (2.7%). Significant GI lesions were found in 62.7%. Peptic ulcer and colonic diverticulosis were the 2 most common causes (41.8% and 28.2%, respectively). Bleeding from coagulopathy occurred in 26.4%. Significant GI lesions led to the change of management in 53.6%, mostly with endoscopic therapy. Hematochezia (odds ratio [OR] 4.90, 95% confidence interval [CI] 1.22 to 19.50, p = 0.024) and INR <4 (OR 4.07, 95% CI 1.17 to 14.27, p = 0.028) were associated with significant GI lesions, while concomitant antiplatelets was negatively associated with significant lesions (OR 0.32, 95% CI 0.12 to 0.88, p = 0.027). Hematochezia at presentation (OR 3.64, 95% CI 1.27 to 10.53, p = 0.016) and no use of antiplatelets (OR 0.28, 95% CI 0.09 to 0.89, p = 0.031) were associated with the change of management. Conclusion: Significant GI lesions were present in two-third of anticoagulated patients who had acute GI bleeding and led to the change of management in one-third. Hematochezia, INR <4 and no concomitant antiplatelets predicted significant GI lesions. Hematochezia and no concomitant antiplatelets predicted the change of management, mostly with endoscopic therapy. [ABSTRACT FROM AUTHOR]

Objective: Direct-acting antivirals [DAAs] arecurrently widely used for treatment of patients with chronic hepatitis C [CHC]. Few patients are able to access these regimens, especiallyin developing countries. Pegylated interferon [peg-IFN] and ribavirin [RBV] treatment is, therefore, still important. Since 2012, the Thai government has declared peg-IFN and RBV treatment is the standard of care for Thai patients with CHC. The aims of this study were to evaluate the effectiveness of peg-IFN and RBV treatment in CHC, genotype 3 patients in a real-world setting and to determine factors indicating favorable response. Materials and Methods: This was a retrospective chart review. The data were collected from 30 hospitals in Bangkok and 14 hospitals in Northeastern Thailand during 2012 to 2014. The inclusion criteria were age 18 to 65 years, baseline hepatitis C virus [HCV] viral load [VL] ≥5,000 IU/mL, naive to treatment, and at least moderate fibrosis before treatment. Patients with HIV or hepatitis B virus [HBV] co-infection or decompensated cirrhosis were excluded. All patients were treated with peg-IFN and RBV for 24 weeks. Results: A total of 523 patients were enrolled. The mean age was 48.7±8.6 years, and 51.6% of patients had age above 50 years. Fifty-two percent were male, and the mean body mass index [BMI] was 24.5±3.7 kg/m2. Fifty-eight percent of patients had cirrhosis at baseline. Mean HCV VL was 5.8±0.8 log10 IU/mL, and 62.1% had HCV VL above 5.6 log10 IU/mL. The mean alanine aminotransferase [ALT] level at baseline was 106.8±66.5 U/L, and the mean platelet count was 158,000±65,900/mm3. The overall prevalence of sustained virological response [SVR] was 74.6%. The prevalences of SVR in patients with cirrhosis and without cirrhosis were 66.8% and 84%, respectively (p<0.001). Factors determining good response were noncirrhosis, HCV VL <5.6 log10 IU/mL at baseline, age <50 years, no reduced dose of peg-IFN during treatment, and platelet count >150,000/mm3. Multivariate analysis, however, demonstrated that factors indicating favorable response were age <50 years, no cirrhosis, and HCV <5.6 log10 IU/mL at baseline. Conclusion: The effectiveness of peg-IFN and RBV for treatment of patients with CHC, genotype 3 was good. Patients with old age, cirrhosis, and high HCV VL at baselinetended to have treatment failure. DAAsmay be considered as the first treatment for patients with these factors. [ABSTRACT FROM AUTHOR]

Objective: Lactulose is widely used for treating patients with hepatic encephalopathy [HE] despite of no strong evidence of its effectiveness. L-ornithine-L-aspartate [LOLA] can lower serum ammonia level and improve mental state in patients with mild HE. We evaluated the add-on benefit of oral LOLA in patients with grade II-III HE those treated with optimal dose of lactulose. Materials and Methods: In a randomized, double-blinded, placebo-controlled trial, cirrhotic patients with grade II and III HE according to West-Haven criteria those treated with lactulose were stratified randomized by serum creatinine level to receive LOLA (3 grams thrice daily) or placebo for 7 days. The primary outcome was the improvement of mental status, and secondary outcomes were the improvement of the number connection test [NCT], plasma ammonia level, asterixis, electroencephalogram [EEG], portal systemic encephalopathy index [PSEI] and safety. Results: Thirty-five patients with overt HE (grade II 25 patients and grade III 10 patients) were assigned to LOLA group (n = 18) or placebo group (n = 17). The LOLA group tended to have improvement of mental status by 90% compared to 84.6% of placebo group at day 7 (p = 1.0) by per-protocol analysis. Both groups also had similar improvement in mental status at day 4, asterixis, EEG and PSEI. Dose of lactulose and daily bowel movement were comparable in both groups. Treatment of infection which was the main precipitating factor, strongly correlated with better mental state in day 7 (p = 0.025). No serious adverse effect of LOLA was found. Conclusion: There was no add-on benefit of oral LOLA for cirrhotic patients with overt HE who were treated with an optimal dose of lactulose. The more effective treatment of HE was to correct the precipitating factors especially infection. [ABSTRACT FROM AUTHOR]