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Long-term outcomes of chronic hepatitis C patients with sustained virological response at 6 months after the end of treatment

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World Journal of Gastroenterology 2006年第34期12卷 5532-5535页

作者： disaya chavalitdhamrong Tawesak Tanwandee Division of Gastroenterology Department of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand

AIM: To assess the clinical, biochemical, and virological outcome during long-term follow-up of chronic hepatitis C patients with sustained virological response following effective antiviral ***: This study was a retrospective cohort study including 171 sustained responders defi ned as HCV RNA PCR negative at 6 mo after the end of effective antiviral treatment (SVR-6). Clinical signs and symptoms, bio- chemical hepatic parameters, ultrasonography and HCV RNA PCR were ***: Mean follow-up period was 35.38 ± 22.2 mo after the end of treatment. Twenty-seven (15.8%) responders had evidence of cirrhosis before treatment. Forty-eight (28.1%), 107 (62.6%) and 6 (3.5%) patients were genotype 1, 3, and 6 respectively, while 10 patients (5.8%) were unclassifi ed. There were no virological and biochemical relapses during the period of follow-up. None of the patients showed evidence of hepatic decom- pensation. However, there were 3 patients (1.8%) de- veloping hepatocellular carcinoma at 14, 18, 29 mo after treatment discontinuation, two of whom had evidence of cirrhosis prior to ***: The study shows that during a follow- up interval for about 3 years in 171 chronic hepatitis C patients with sustained viral response after effective antiviral treatment there were no evident signs of either biochemical or clinical relapse of liver disease in all but three patients who developed hepatocellular carcinoma.

关键词： Chronic hepatitis C Sustained virological response Long-term outcome

Bacterial infections other than spontaneous bacterial peritonitis in cirrhosis

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World Journal of Hepatology 2012年第5期4卷 158-168页

作者： Chalermrat Bunchorntavakul disaya chavalitdhamrong Division of Gastroenterology and Hepatology Rajavithi HospitalCollege of MedicineRangsit UniversityBangkok 12000Thailand Division of Gastroenterology Hepatology and NutritionDepartment of Internal MedicineUniversity of FloridaGainesvilleFL 32608United States

Cirrhotic patients are immunocompromised with a high risk of *** cytokines and hemodynamic circulation derangement further facilitate the development of serious consequences of *** than spontaneous bacterial peritonitis,bacteremia and bacterial infections of other organ systems are frequently ***-negative enteric bacteria are the most common causative *** bacterial infections,such as enterococci,Vibrio spp.,Aeromonas spp.,Clostridium spp.,Listeria monocytogenes,Plesiomonas shigelloides and Mycobacterium tuberculosis are more prevalent and more ***,intravenous third generation cephalosporins are recommended as empirical antibiotic *** incidences of gram-positive and drug-resistant organisms have been reported,particularly in hospitalacquired infections and in patients receiving quinolones *** review focuses upon epidemiology,microbiology,clinical features and treatment of infections in cirrhosis other than spontaneous bacterial peritonitis,including pathogen-specific and liver diseasespecific issues.

关键词： Bacterial infection Cirrhosis

Unexpected anomaly of the common bile duct and pancreatic duct

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World Journal of Clinical Cases 2014年第2期2卷 36-38页

作者： disaya chavalitdhamrong Peter V Draganov Division of Gastroenterology Hepatology and Nutrition University of Florida

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete nonunion of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure.

关键词： Double major papillae Double orifices Cannulation Bile duct Endoscopic retrograde cholangiopancreatography

Management of patients with hepatitis C infection and renal disease

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World Journal of Hepatology 2015年第2期7卷 213-225页

作者： Chalermrat Bunchorntavakul Monthira Maneerattanaporn disaya chavalitdhamrong Division of Gastroenterology and Hepatology Department of Internal Medicine Rajavithi Hospital College of Medicine Rangsit University Division of Gastroenterology and Hepatology Department of Internal Medicine Siriraj Hospital Faculty of Medicine Mahidol University Division of Gastroenterology Hepatology and Nutrition Department of Internal Medicine University of Florida Gainesville

Hepatitis C virus(HCV) infection in patients with end-stage renal disease(ESRD) is associated with more rapid liver disease progression and reduced renal graft and patients' survival following kidney transplantation. Evaluations and management of HCV in patients with renal disease are challenging. The pharmacokinetics of interferons(IFN), ribavirin(RBV) and some direct acting antiviral(DAA), such as sofosbuvir, are altered in patients with ESRD. With dose adjustment and careful monitoring, treatment of HCV in patients with ESRD can be associated with sustained virological response(SVR) rates nearly comparable to that of patients with normal renal function. DAA-based regimens, especially the IFNfree and RBV-free regimens, are theoretically preferred for patients with ESRD and KT in order to increase SVR rates and to reduce treatment side effects. However, based on the data for pharmacokinetics, dosing safety and efficacy of DAA for patients with severe renal impairment are lacking. This review will be focused on the evaluations, available pharmacologic data, and management of HCV in patients with severe renal impairment, patients who underwent KT, and those who suffered from HCV-related renal disease, according to the available treatment options, including DAA.

关键词： Hepatitis C Renal disease Chronic kidneydisease Dialysis Interferon Direct acting antivirals Cryoglobulinemia

Bacterial infections in cirrhosis: A critical review and practical guidance

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World Journal of Hepatology 2016年第6期8卷 307-321页

作者： Chalermrat Bunchorntavakul Naichaya Chamroonkul disaya chavalitdhamrong Division of Gastroenterology and Hepatology Department of Internal Medicine Rajavithi Hospital College of Medicine Rangsit University Division of Gastroenterology and Hepa-tology Department of Internal Medicine Faculty of Medicine Prince of Songkla University Division of Gastroenterology Department of Internal Medicine Harbor--UCLA Medical

Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.

关键词： Bacteria Infection Sepsis Bacteremia Liver cirrhosis Vaccination Spontaneous peritonitis Immune dysfunction

Hepatitis C genotype 6:A concise review and response-guided therapy proposal

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World Journal of Hepatology 2013年第9期5卷 496-504页

作者： Chalermrat Bunchorntavakul disaya chavalitdhamrong Tawesak Tanwandee disaya chavalitdhamrong Division of GastroenterologyHepatology and NutritionDepartment of Internal MedicineRajavithi Hospital College of MedicineRangsit UniversityBangkok 10100Thailand Division of Gastroenterology Hepatology and NutritionDepartment of Internal MedicineUniversity of FloridaGainesvilleFL 32610United States Division of Gastroenterology and Hepatology Department of Internal MedicineSiriraj HospitalFaculty of MedicineMahidol UniversityBangkok 10700Thailand

Hepatitis C genotype 6 is endemic in Southeast Asia[prevalence varies between 10%-60% among all hepatitis C virus(HCV) infection], as well as also sporadically reported outside the area among *** diagnosis of HCV genotype can be inaccurate with earlier methods of genotyping due to identical 5'-UTR between genotype 6 and 1b, hence the newer genotyping methods with core sequencing are *** factors and clinical course of HCV genotype 6 do not differ considerably from other genotypes. Treatment outcome of HCV genotype 6 with a combination of pegylated interferon and ribavirin is superior to genotype 1, and nearly comparable to genotype 3, with expected sustained virological response(SVR) rates of 60%-90%. Emerging data suggests that a shorter course 24-wk treatment is equally effective as a standard 48-wk treatment, particularly for those patients who attained undetectable HCV RNA at week 4(RVR).In addition, baseline and on-treatment predictors of response used for other HCV genotypes appear effective with genotype 6. Although some pan-genotypic directacting antivirals have completed phase Ⅱ/Ⅲ studies(sofosbuvir and simeprevir) with clinical benefit demonstrated in small number of patients with genotype6, broad availability of these agents in Southeast Asia may not be expected in the near future. While awaiting the newer therapy, response-guided therapy seems appropriate for patients with HCV genotype 6. Patients with RVR(representing>70% of patients) are suitable for 24-wk treatment with expected SVR rates>80%. Patients without RVR and/or those with poor response predictors may benefit from 48 wk of therapy,and a detectable HCV RNA at week 12(with no early virological response) serves as a stopping rule. This treatment scheme is likely to have a major economic impact on HCV therapy, particularly in Southeast Asia,wherein treatment can be truncated securely in the majority of patients with HCV genotype 6.

关键词： Hepatitis C Genotype 6 Epidemiology Southeast Asia Treatment Pegylated interferon Ribavirin Response-guided therapy

Air embolism complicating gastrointestinal endoscopy: A systematic review

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World Journal of Gastrointestinal Endoscopy 2013年第8期5卷 359-365页

作者： Suman Donepudi disaya chavalitdhamrong Liping Pu Peter V Draganov Division of Gastroenterology Hepatologyand Nutrition Department of Medicine University of Florida Department of Medicine and Nursing Suzhou Health College

Gastrointestinal endoscopy has become an important modality for the diagnosis and treatment of various gastrointestinal disorders. One of its major advantages is that it is minimally invasive and has an excellent safety record. Nevertheless, some complications do occur, and endoscopists are well aware and prepared to deal with the commonly recognized ones including bleeding, perforation, infection, and adverse effects from the sedative medications. Air embolism is a very rare endoscopic complication but possesses the poten-tial to be severe and fatal. It can present with cardio-pulmonary instability and neurologic symptoms. The diagnosis may be difficult because of its clinical presen-tation, which can overlap with sedation-related cardio-pulmonary problems or neurologic symptoms possibly attributed to an ischemic or hemorrhagic central nervous system event. Increased awareness is essential for prompt recognition of the air embolism, which can allow potentially life-saving therapy to be ***, we wanted to review the risk factors, the clinical presentation, and the therapy of an air embolism from the perspective of the practicing endoscopist.

关键词： Air embolism Endoscopy Endoscopic retrograde cholangiopancreatography Complications Therapy