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Background: Accurate population-based data are required concerning the rate, economic impact, and long-term outcome from acute on chronic liver failures (ACLF) in hospitalized cirrhosis patients.Objective: We aimed to discover time trends for the epidemiology, economic burden, and mortality of ACLF in Thailand.Methods: We conducted a nationwide, population-based, cohort study which involved all hospitalized cirrhosis patients in Thailand during the period between 2009 and 2013, with data from the National Health Security Office. ACLF was defined by two or more extrahepatic organ failures in cirrhosis patients. Primary outcomes were trends in hospitalizations, hospital costs, together with inpatient mortality. Results The number of ACLF hospitalizations in Thailand doubled between 3,185 in 2009 and 7,666 in 2013. The average cost of each ACLF hospitalization was 3.5-fold higher than for cirrhosis (฿ 61,928 versus ฿ 16,995). The hospital is paid using a diagnosis-related group (DRG) payment system that is only 15% of the average treatment costs (฿ 9,371 from ฿ 61,928). The in-hospital fatality rate was 51% for ACLF while the additional fatality rate was 85% up to 1 year. The ACLF organ failure trends indicated sepsis with septic shock and renal failure as the majority proportion. Age, the number and types of organ failure and male sex were predictors of ACLF death. Conclusions and Relevance Cirrhosis and ACLF both represent substantial and increasing health and economic burdens for Thailand. These data can assist national health care policy stakeholders to target high-risk cirrhosis patients for care.

ObjectiveWe aimed to study the prevalence of achlorhydria (AC) in a large Asian population.DesignMedical records of patients who underwent oesophagogastroduodenoscopy (OGD) with Congo red staining method at the Vichaiyut Hospital from January 2010 to December 2019 were retrospectively reviewed.ResultsA total of 3597 patients was recruited; 223 were excluded due to concurrent use of proton pump inhibitors. Eighteen from 3374 patients (0.53%) had AC. Seven patients were presented with permanent AC (5F, 2M) (median age=69 years; range 58–92). Among 11 patients with temporary AC (5M, 6F: mean age 73.4 years; SD 13.2 years), all had gastrointestinal Helicobacter pylori bacterial infection and were over 45 years old. After successful treatment for H. pylori, AC was absent among patients with temporary AC. If counting only patients over 45 years of age, the prevalence of AC was 0.68% (18/2614). No adverse events arising from Congo red occurred.ConclusionAC is relatively rare. Permanent and temporary AC were found only when they were over 55 and 45 years old, respectively. Staining Congo red on gastric mucosa can be safely and routinely incorporated into the OGD procedure for early detection of AC. We recommended a low-cost screening test such as serum vitamin B levels for screening only in patients aged 50 and over.

In Thailand, the burden of liver abscess, a life-threatening infectious disease, has not been thoroughly evaluated. We developed a predictive scoring system to estimate survival of patients with liver abscess using information from the 2008-2013 Nationwide Hospital Admission Data to evaluate the burden of liver abscess in Thailand. All patients with primary diagnosis of pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were included. Epidemiological data, baseline characteristics, hospital course, and survival were analyzed. Overall, 11,296 admissions comprising 8,423 patients from 844 hospitals across Thailand were eligible for analysis. The mean age was 52 ± 17 years and 66.1% of patients were male. ALA was significantly prevalent in southern and western border regions of Thailand, and PLA occurred nationwide. The highest incidence of liver abscess occurred in the rainy season (June-November, P < 0.01). The median length of hospital stay was 8 days (interquartile range = 4-13 days), and mean direct cost of hospitalization was 846 ± 1,574 USD. The overall inhospital mortality rate was 2.8%. Incidence of ALA decreased over the 5-year study period, whereas PLA incidence increased (P < 0.01). Using multivariable Cox regression methods with stepwise variable selection, we developed a final model with five highly significant baseline parameters associated with increased 60-day mortality: older age, PLA, underlying chronic kidney disease, cirrhosis, and human immunodeficiency virus infection. Range of estimated probability of 60-day survival was 95-16% at cumulative risk score 0-13. This simplified score is practical, and may help clinicians prioritize patients requiring more intensive care.

Background Acute liver failure (ALF) is uncommon but progresses rapidly with high mortality. We investigated the incidence, etiologies, outcomes, and predictive factors for 30-day mortality in patients with ALF. Methods We conducted a population-based study of ALF patients hospitalized between 2009 and 2013 from the Thai Nationwide Hospital Admission database, which comprises 76% of all admissions from 858 hospitals across 77 provinces in Thailand. ALF was diagnosed using ICD-10 codes K72.0 and K71.11. Patients with liver cirrhosis were excluded. Results There were 20,589 patients diagnosed with ALF during the study period with 12,277 (59.6%) males and mean age of 46.6 ± 20.7 years. The incidence of ALF was 62.9 per million population per year. The most frequent causes of ALF were indeterminate (69.4%), non-acetaminophen drug-induced (26.1%), and viral hepatitis (2.5%). Acetaminophen was the presumptive cause in 1.7% of patients. There were 5502 patients (26.7%) who died within 30 days after admission. One patient (0.005%) underwent liver transplantation. The average hospital stay was 8.7 ± 13.9 days, and the total cost of management was 1075.2 ± 2718.9 USD per admission. The most prevalent complications were acute renal failure (ARF)(24.2%), septicemia (18.2%), and pneumonia (12.3%). The most influential predictive factors for 30-day mortality were ARF (HR = 3.64, 95% CI: 3.43–3.87, p

Background and rationale. Cirrhosis is responsible for significant health-care costs and morbidity. This study aims to evaluate the burden of illness associated with cirrhosis, its impact on the universal coverage public health care system in Thailand. Material and methods. We used data from the 2010 Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand. Their baseline characteristics, hospital costs, and outcomes were analyzed according to national health insurance categories including medical welfare scheme (MWFS), social security scheme (SSS) and civil servant medical benefit scheme (CSMBS). Results. 92,301 admissions were eligible for analysis. The mean age was 55 ± 12.8 years, and 63.3% of patients were above 50 years old. The majority of patients (79%) belonged to the MWFS group. The MWFS group incurred the lowest medical expense and had the shortest hospital stay compared to the SSS and CSMBS groups. Overall in-hospital mortality was 10.7%. Cirrhosis complications include bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma. These complications significantly increased mortality rates compared to patients without complications (26 vs. 8.9%, p < 0.001). In-hospital mortality of patients with cirrhosis complications did not differ among the three national health insurance groups. Respiratory failure and septicemia were associated with the highest risk of death (HR 5.4; 95% CI: 4.8-5.9 and HR 5.2; 95% CI: 4.9-5.6 respectively; P < 0.001). Conclusions. Illness associated with cirrhosis is a significant public health problem in Thailand. Outcomes of cirrhosis complications did not differ between universal public health care coverage systems in Thailand.

Aim To identify the potential risk factors of cholangiocarcinoma, we determined the characteristics of cholangiocarcinoma patients among 5 different regions of Thailand. Methods All patients diagnosed with cholangiocarcinoma between 2008 and 2013 were identified using the Nationwide Hospital Admission Data registry (n = 39421). Baseline characteristics, comorbidities and survival were abstracted. Results The annual incidence during the study period was stable in all regions. Most patients lived in the Northeast (62.8%), followed by the North (16.9%), Central (12.3%), Bangkok (5.4%), and South (n = 2.6%) regions (p < 0.0001). Significantly more cholangiocarcinoma patients had diabetes, cirrhosis, and chronic viral hepatitis B/C infection than noncholangiocarcinoma participants (diabetes: 11.42% vs 5.28%; cirrhosis: 4.81% vs 0.92%; hepatitis B: 0.74% vs 0.12%; and hepatitis C: 0.50% vs 0.10%, p < 0.0001 for all, respectively). The overall 1-year mortality rate was 81.7%, with a stable trend over time. Conclusions Diabetes and chronic liver diseases may be associated with cholangiocarcinoma in the Thai population.

The Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand, showed an average of 1,051,146 patients/year or 1,365,557 admissions/year with diagnosis of gastrointestinal diseases (GI) during 2009–2013. Table S2 Hospitalization patients with diagnosis of ICC based on ICD-221 (N = 72,479 admissions) during the 5-year period. Table S3. Comparison ICC patients who had length of hospital stay (LOS) ≤7 days and those with LOS >7 days. Table S4. The average cost of hospitalization and the in-hospital mortality rate classified by disease; during 2009–2013 from the Nationwide Hospital Admission Data of Thailand. (DOCX 20 kb)

Background Toxic liver diseases are mainly caused by drug-induced liver injury (DILI). We assessed incidences and outcomes of DILI including associated factors for mortality. Methods We performed a population-based study of hospitalized patients with DILI. Information was retrieved from the Nationwide Hospital Admission Data using ICD-10 code of toxic liver diseases (K71) and additional codes (T36–T65). The associated factors were analyzed with log-rank test, univariate and multiple cox regression analysis. Results During 2009–2013, a total of 159,061 (average 21,165 per year) admissions were related to liver diseases. 6,516 admissions (1,303 per year) were due to toxic liver diseases. The most common type of toxic liver disease was acute hepatitis (33.5 %). In-hospital and 90-day mortality rates were 3.4 % and 17.2 %. DILI with cirrhosis yielded the highest in-hospital and 90-day mortality rates (15.8 % and 47.4 %). Acetaminophen, cirrhosis and age ≥ 60 years were seen in 0.5 %, 8.3 % and 50.1 % of patients who died versus 5 %, 2.3 % and 32.4 % of survivors. Factors associated with mortality were cirrhosis (HR 2.72, 95 % CI: 2.33–3.19), age ≥60 years (HR 2.16, 95 % CI: 1.96–2.38), human immunodeficiency viral infection (HR 2.11, 95 % CI: 1.88–2.36), chronic kidney disease (HR 1.59, 95 % CI: 1.33–1.90), chronic obstructive pulmonary disease and bronchiectasis (HR 1.55, 95 % CI: 1.17–2.04), malnutrition (HR 1.43, 95 % CI: 1.10–1.86) and male (HR 1.31, 95 % CI: 1.21–1.43). Acetaminophen DILI yielded lower risks of mortality (HR 0.24, 95 % CI: 0.13–0.42). The most common causes of DILI were acetaminophen (35.0 %) and anti-tuberculous drugs (34.7 %). Conclusions DILI is an uncommon indication for hospitalization carrying lower risks of death except in patients with non-acetaminophen, cirrhosis, elderly or concomitant diseases.

Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis. Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013. The rate of dying in the hospital increased steadily by 12% from 9.6% in 2009 to 10.8% in 2013 (P

Modern manometric and scintigraphic techniques were employed in an effort to determine the relationships between esophageal contractions and esophageal transit and clearance. The effects of direct cholinergic stimulation with bethanechol and blockade with atropine were evaluated in a total of 20 normal subjects and 13 patients with symptomatic gastroesophageal reflux. Bethanechol increased the amplitudes of deglutition-induced and distention-induced esophageal contractions, but diminished their propagation velocities. Both esophageal transit and clearance were decreased in patients with reflux, but both were improved after bethanechol. Atropine sulfate decreased the amplitudes of contraction, accelerated their propagation velocities, and delayed esophageal transit and clearance. Both transit and clearance were diminished significantly when reflux patients were compared with normal subjects. The amplitudes of esophageal contraction were significantly lower in patients with reflux than in normal subjects. Neither bethanechol nor atropine affected the incidence of deglutition-induced esophageal contractions. These studies suggest that the efficiency of esophageal emptying may be determined by the amplitudes of esophageal contractions.

Colonoscopy and barium enema are complementary studies in the diagnosis of the cause of lower intestinal bleeding. The air usually insufflated during colonoscopy often makes it impossible to perform a good barium enema on the same day. As a possible solution to this problem, we studied the quality of barium enemas performed immediately following carbon dioxide-insufflated colonoscopy. All 15 patients who underwent unsuccessful total colonoscopies using carbon dioxide insufflation were able to have barium enemas performed the same day in contrast to only one out of 15 patients who had air-insufflated colonoscopy. In a survey of all hospitals in Illinois with 150 beds or more, we found only 15 of 146 hospitals used carbon dioxide for colonoscopy insufflation. We recommend the routine use of carbon dioxide for colonoscopic insufflation not only for greater safety and comfort for the patient, but also for the convenience and cost savings.

The effects of an intoxicating dose of alcohol (79 g of 100 proof alcohol) on pyloric sphincter function were studied in 12 normal subjects using an infused manometric system. Alcohol had no effect on resting pyloric sphincter pressure. Intraduodenal administration of olive oil and hypertonic amino acids increased pyloric sphincter pressure significantly to 10.8 +/- 1.4 and 10.2 +/- 2.0 mm Hg, respectively. These responses were not affected by the administration of alcohol. In contrast, alcohol decreased the pyloric pressure response to duodenal acidification from 12.0 +/- 2.1 to 8.0 +/- 1.3 mm Hg (P less than 0.05). These results suggest that an intoxicating dose of alcohol may interfere with the normal function of the pyloric sphincter.

Constipation is a common problem and is frequently taken for granted by both the lay and medical populations. Although sometimes easily resolved it can prove to be a lifelong, debilitating problem, both medically and sociologically. Most frustrating is the category of idiopathic chronic constipation, a problem without identifiable etiology and diagnosed by exclusion. This paper takes an in-depth view of chronic and more specifically, idiopathic chronic constipation, discussing etiology, diagnosis and treatment. Two case histories are presented illustrating opposite ends of the spectrum in terms of severity. The objective of this paper is to enhance the reader's knowledge about a "common" problem and to increase the future appreciation for patients experiencing this alteration in bowel functioning.

Background We aimed to examine the burden of intrahepatic cholangiocarcinoma (ICC) in Thailand and identify the prognostic factors for all-causes of death. Methods We conducted a population-based study of ICC patients admitted during 2009–2013 using the Nationwide Hospital Admission Database, the National Health Security Office (NHSO). There was an average of 1,051,146 patients/year with diagnosis of gastrointestinal diseases (GI). All patients with a diagnosis of ICC (ICD10- C221) were included from a total of 72,479 admissions from 858 hospitals. The surgical resection procedures such as the radical pancreaticoduodenectomy, subtotal and partial hepatectomy were analyzed. Data for all patients were censored 1 year post-study or death, whichever came first. Results A total of 34,325 patients with ICC during a 5-year study period (on average, 6865 patients/year, with the incidence rate of 14.6 per 100,000 population, per year. The ICC patients had a mean age of 63.8+/−11.6 years and 63% were males. The mean length of hospital stay was 6.4+/−7.3 days with a mean+/−SD cost of hospitalization of $595+/−$1160 USD per admission. There were 659 patients (1.9%) underwent surgical resection. The overall survival of ICC patients with surgery was significantly better than those patients without surgery. Hazard ratio of death for patients without surgery was 2.5 (95% CI of 2.3–2.7). Approximately 14% of the ICC patients died during hospitalization. The median overall survival of all patients after the first admission was 53 +/−0.6 days. From the multivariate analysis, factors related to all-causes of death were: patients’ age >60 years (OR = 1.2, 95% CI; 1.1–1.3), length of hospital stay of >7 days (OR = 1.1, 95% CI; 1.02–1.2), male (OR = 1.3, 95% CI; 1.2–1.4), living in the northern part of Thailand (OR = 1.5, 95% CI; 1.3–1.8) and presence of complications during admission (OR = 1.3, 95% CI; 1.1–1.5). Conclusion The disease burden of patients with ICC in Thailand is significant with the incidence rate of 14.6 per 100,000 population, per year during 2009–2013 and showed high mortality rate of 14%. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0565-6) contains supplementary material, which is available to authorized users.