Gautam Ray1. 1. Head of Gastroenterology Unit, Department of Medicine, B R Singh Hospital, Kolkata, West Bengal, India.
Abstract
BACKGROUND: There is scarce Indian data on time trends of hepatitis, an impediment to formulate an effective public health policy on the matter. OBJECTIVE: The aim was to study secular trends and burden of hepatitis in a railway population. MATERIALS AND METHODS: Outdoor, indoor, endoscopy unit and mortality records of patients attending this hospital from January 2003 to December 2011 were searched manually and relevant parameters of hepatitis patients were noted, especially etiology, clinical features, treatment, and mortality. Cochran-Armitage trend test was used to test significance of any trend in these parameters. Binary logistic regression analysis of various factors was carried out to study their effect on the liver related mortality of hepatitis B and C cases and Kaplan-Meyer survival curves were generated for significant factors. Two-sided P < 0.05 was considered to be significant. RESULT: Chronic liver disease (CLD) due to alcohol showed a significant rising trend with early age (mean 48.4 years) and high percentage of decompensated disease (75%) at presentation and high early mortality (63%). No trend was observed for hepatitis B and C, but significant reduction in mortality was observed when definitive therapy was given. Cryptogenic CLD showed a decreasing trend though overall it still remained the most important etiology and survival was better compared with alcohol even with conservative therapy. Only 4% patients had hepatocellular carcinoma. CONCLUSION: A menace of alcohol related liver disease affecting young productive work force in this part of India is foreseen, which might impact the country's economy and mandates immediate containment policy.
BACKGROUND: There is scarce Indian data on time trends of hepatitis, an impediment to formulate an effective public health policy on the matter. OBJECTIVE: The aim was to study secular trends and burden of hepatitis in a railway population. MATERIALS AND METHODS: Outdoor, indoor, endoscopy unit and mortality records of patients attending this hospital from January 2003 to December 2011 were searched manually and relevant parameters of hepatitispatients were noted, especially etiology, clinical features, treatment, and mortality. Cochran-Armitage trend test was used to test significance of any trend in these parameters. Binary logistic regression analysis of various factors was carried out to study their effect on the liver related mortality of hepatitis B and C cases and Kaplan-Meyer survival curves were generated for significant factors. Two-sided P < 0.05 was considered to be significant. RESULT: Chronic liver disease (CLD) due to alcohol showed a significant rising trend with early age (mean 48.4 years) and high percentage of decompensated disease (75%) at presentation and high early mortality (63%). No trend was observed for hepatitis B and C, but significant reduction in mortality was observed when definitive therapy was given. Cryptogenic CLD showed a decreasing trend though overall it still remained the most important etiology and survival was better compared with alcohol even with conservative therapy. Only 4% patients had hepatocellular carcinoma. CONCLUSION: A menace of alcohol related liver disease affecting young productive work force in this part of India is foreseen, which might impact the country's economy and mandates immediate containment policy.
Authors: Shiv K Sarin; Manoj Kumar; Mohammed Eslam; Jacob George; Mamun Al Mahtab; Sheikh M Fazle Akbar; Jidong Jia; Qiuju Tian; Rakesh Aggarwal; David H Muljono; Masao Omata; Yoshihiko Ooka; Kwang-Hyub Han; Hye Won Lee; Wasim Jafri; Amna S Butt; Chern H Chong; Seng G Lim; Raoh-Fang Pwu; Ding-Shinn Chen Journal: Lancet Gastroenterol Hepatol Date: 2019-12-15