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Kookwan Sawadpanich,1 Palinee Promasen,1 Pisaln Mairiang,1 Wattana Sukeepaisarnjareon,1 Apichat Sangchan,1 Tanita Suttichaimongkol,1 Kawin Tangvoraphonkchai,1 Chingching Foocharoen2 1Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand; 2Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, ThailandCorrespondence: Chingching Foocharoen, Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Tel +66-43-363-746 ; +66-43-363-664, Email fching@kku.ac.thBackground: Abnormal liver function tests (LFTs) can indicate cirrhosis or liver cancer leading to mortality among systemic sclerosis (SSc) patients. No recent studies have investigated the clinical predictors of an abnormal LFT in SSc. We aimed to determine the incidence of abnormal LFT (including from hepatitis and cholestasis) and to identify its clinical predictors in SSc patients.Methods: An historical cohort was conducted on 674 adult SSc patients who attended the Scleroderma Clinic, Khon Kaen University, between January 2012 and November 2019 and who underwent routine screening for LFT. A Cox regression was used to analyze the clinical predictors of abnormal LFT.Results: Four hundred and thirty cases, representing 4190 person-years, had abnormal LFTs (viz, from hepatitis, cholestasis, and cholestatic hepatitis) for an incidence rate of 10.2 per 100 person-years. The respective incidence of hepatitis, cholestasis, and cholestatic hepatitis was 20.5, 12.9, and 20.4 per 100 person-years. The respective median first-time detection of hepatitis, cholestasis, and cholestatic hepatitis was 3.0, 5.9, and 2.8 years, and none had signs or symptoms suggestive of liver disease. According to the Cox regression analysis, the predictors of an abnormal LFT in SSc were elderly onset of SSc (hazard ratio (HR) 1.02), alcoholic drinking (HR 1.74), high modified Rodnan Skin Score (mRSS) (HR 1.03), edematous skin (HR 2.94), Raynaud’s phenomenon (HR 1.39), hyperCKaemia (HR 1.88), and methotrexate use (HR 1.55). In contrast, current sildenafil treatment (HR 0.63) and high serum albumin (HR 0.70) were protective factors.Conclusion: Occult hepatitis, cholestasis, and cholestatic hepatitis can be detected in SSc patients using LFT screening, especially in cases of early disease onset. The long-term outcome is uncertain, and more longitudinal research is required.Keywords: systemic sclerosis, scleroderma, scleroderma and related disorders, hepatitis, cholestasis, cholestatic hepatitis, abnormal liver function test, liver, cohort study

Human gnathostomiasis is a harmful foodborne parasitic infection caused by nematodes of the genus Gnathostoma. Here, we report an unusual case of gastric gnathostomiasis seen in a hospital in Thailand along with the clinical characteristics, treatment, and outcome. A 39-year-old man presented with complaints of epigastric pain, dizziness, and history of passing dark, tarry stools for 2 days. The patient had a history of consuming raw freshwater fish. Supplementary differential diagnosis was performed via rapid serological testing, and presence of the causative agent was confirmed based on video gastroscopy, morphology of the removed parasite, and molecular identification. After its surgical removal from the stomach, the parasite was morphologically identified as Gnathostoma species. Molecular identification was performed via DNA extraction from the recovered worm, and amplification and sequencing of the second internal transcribed spacer (ITS2) region and partial cytochrome c oxidase subunit I (cox1) gene. The ITS2 and cox1 sequences were consistent with those of Gnathostoma spinigerum. Clinicians in endemic areas should therefore be aware of the rare clinical manifestations and use of supplementary serological tests to facilitate early diagnosis and treatment of gastric gnathostomiasis.

Helicobacter pylori is an important causative agent of gastrointestinal and hepatobiliary diseases. The aim of this study was to investigate phylogenetic relationships among H. pylori strains from the oral cavities of healthy individuals, gastric biopsies from gastroduodenal (GI) patients and bile samples from hepatobiliary (HB) patients in the northeast of Thailand. The DNA sequences of a portion of the vacuolating cytotoxin A gene (vacA) were investigated. Phylogenetic trees were constructed using the neighbor-joining and maximum-likelihood methods. The vacA sequences of H. pylori fell into four main groups on the trees. Strains from healthy persons fell into two widely separated but well-supported groups, while most H. pylori vacA sequences from HB patients were distributed in another two groups. In contrast, the H. pylori strains from GI patients were scattered across the tree, without a clear geographical pattern. In conclusion, the sequence of vacA may be useful to classify the genetic relationship of H. pylori derived from different sources.

Introduction: H. pylori has been detected in patients with hepatobiliary diseases. It is currently unclear whether the H. pylori detected in hepatobiliary patients are genetically similar to those in gastro-duodenal patients. The aim of this study was to determine H. pylori vac A and cag A genotypes in Thai patients with gastro-duodenal and hepatobiliary diseases. Methodology: H. pylori DNA was extracted from samples from gastric biopsies of gastro-duodenal patients (n=100) and from bile samples of hepatobiliary patients (n=80). The vac A and cag A genotypes were performed via polymerase chain reaction (PCR) followed by DNA sequencing. Results: The vac A m1 was found in Thai hepatobiliary patients (90%) at a higher rate compared with gastro-duodenal patients (50%).The combined vac A s1a+c/m1 were mostly found in Thai gastro-duodenal and hepatobiliary patients. The cag A gene was detected in 94% of patients with gastro-duodenal diseases compared with 28.8% in those with hepatobiliary diseases (p

Background Small intestinal bacterial overgrowth (SIBO) results in nutrient malabsorption and malnutrition, thereby increasing the morbidity and mortality in systemic sclerosis (SSc) patients. Objectives To evaluate the prevalence and associated factors of SIBO in SSc patients. Method A cross-sectional study was conducted between July 2015 and January 2016 in SSc patients over 18, using the glucose H2 /CH4 breath test to evaluate SIBO. Results Eighty-nine SSc patients (30 male and 59 female) underwent the glucose H2 /CH4 breath test. The mean age was 54.4. Twelve participants were positive for the glucose H2 /CH4 breath test, yielding a SIBO prevalence of 13.5% (95% CI 7.2-22.4) among SSc patients. A multivariate analysis revealed that duration of disease >5 years was significantly associated with SIBO (adjusted odds ratio 9.38; 95% CI 1.09-80.47). Conclusion The prevalence of SIBO, using the glucose H2 /CH4 breath test, is not common among Thai SSc patients. However, a positive result was associated with longer duration of disease.

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)

Immune thrombocytopenic purpura (ITP) is the condition caused by increased platelet destruction and or decreased platelet production. Previous studies have demonstrated the association and efficacy of Helicobacter pylori (H. pylori) eradication therapy in patients with chronic ITP. Data in Thai patients, however, are limited. A prospective cross-sectional analytic study was conducted in adult patients with chronic ITP to determine the prevalence and clinical predictive factors of H. pylori infection and evaluate the efficacy of H. pylori eradication therapy. H. pylori-infected patients received eradication therapy (omeprazole 40 mg/day, clarithromycin 1000 mg/day, amoxicillin 2000 mg/day) for 2 weeks. The platelet counts at baseline and monthly for 6 months after the end of treatment were evaluated. Of the 25 patients, 9 patients (36%) had H.pylori infection. H. pylori infection is higher among women than men. There were two clinical factors included 1) relapsed ITP 2) response after the first-line treatment statistically proven to be associated with H. pylori infection with an odds ratio and p value of 7.7, p = 0.035 and ND (not determined due to small sample size), p

The aims of this study were to determine the prevalence of cagA type in Helicobacter pylori isolated from dyspeptic patients in northeastern Thailand and to determine whether the pattern of cagA EPIYA motifs were associated with clinical outcomes. One hundred and forty-seven H. pylori-infected dyspeptic patients were enrolled, of whom 68 had non-ulcer dyspepsia (NUD), 57 peptic ulcer disease (PUD), 18 gastric cancer (GCA), and 4 other gastroduodenal diseases. PCR and DNA sequence analysis were used to determine the cagA genotype and the pattern of EPIYA motifs. cagA-positive H. pylori were identified in 138 (94%) of H. pylori-infected dyspeptic patients of whom 75 (54%) were of the Western-type, 44 (32%) the East Asian type and 19 (14%) of the other types. The Western type is significantly found in PUD patients (p = 0.0175). The majority of cagA EPIYA was EPIYA-ABC (43%) and EPIYA-ABD (28%). There is no significant correlation between the increase in number of EPIYA-C motifs and clinical outcomes. Thus, the most frequent cagA type found among northeastern Thai dyspeptic patients was the Western cagA type, which is significantly associated with PUD indicating a possible predictive parameter for clinical outcome.

The present study is aimed to identify the prevalence of Blastocystis subtypes isolated from patients in a major hospital in northeastern Thailand. A total of 562 stool samples were examined by culture technique, and 56 Blastocystis-positive samples were analyzed further by the combination of restriction fragment length polymorphism (RFLP) followed by polymerase chain reaction with sequence-tagged site primers (PCR-STS). By RFLP profiles, Blastocystis genotypes were categorized into four groups: group A (12, 21.4%), group B (32, 57.1%), group C (10, 17.9%), and group D (2, 3.6%). By PCR-STS, only four subtypes were identified. All 12 (21.4%) isolates in group A were identified as subtype 1. Similarly, all 32 (57.1%) isolates in group B were subtype 3. In group C, 10 (17.9%) samples were all subtype 7, and two samples (3.6%) in group D were both subtype 6. Of 56 Blastocystis-positive patients, 31 (55.4%) were asymptomatic and 22 (39.4%) have gastrointestinal symptoms. No significant association was observed between the Blastocystis subtypes and the clinical features. Among the Blastocystis-positive patients, the most characteristic stool samples were loose (78.6%) and soft (17.9%). In conclusion, the most common Blastocystis spp. in northeastern Thailand was subtype 3 followed by subtype 1. Relatively minor subtypes, subtype 6 and subtype 7 which are considered as avian subtypes, were found for the first time in humans in Thailand.

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.