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Causes of cholestasis in Thailand. A study of 276 consecutive patients
Insights
This study investigated cholestasis causes in 276 patients, finding extrahepatic cholestasis more common. Malignancy, particularly cholangiocarcinoma linked to opisthorchiasis, was a significant factor, especially in Thailand.
Area of Science:
- Hepatology and Gastroenterology
- Biliary System Pathophysiology
- Tropical Medicine
Background:
- Cholestasis presents diverse etiologies globally.
- Regional variations in biliary diseases, like stone composition and prevalence, are notable.
- Infectious and congenital factors significantly impact biliary health, particularly in tropical regions.
Purpose of the Study:
- To analyze the causes of cholestasis in a patient cohort.
- To investigate the prevalence of intrahepatic versus extrahepatic cholestasis.
- To explore the role of malignancy, parasitic infections, and congenital anomalies in cholestasis, with a focus on Thailand.
Main Methods:
- Retrospective analysis of 276 patients with 296 biliary lesions.
- Categorization of cholestasis into intrahepatic and extrahepatic types.
- Examination of etiological factors including malignancy, parasitic infections (Opisthorchiasis), gallstones, and congenital anomalies.
Main Results:
- Extrahepatic cholestasis occurred in 58.4% of patients; intrahepatic in 41.6%.
- Malignant disease accounted for 34.8% of cases, with cholangiocarcinoma being prevalent.
- Opisthorchiasis viverrini was strongly associated with intrahepatic cholangiocarcinoma, biliary calculi, and other biliary issues in Thailand.
- Infectious diseases and congenital anomalies like choledochal cysts were also significant causes.
Conclusions:
- Cholestasis etiology varies significantly by region, with Thailand showing a high burden of Opisthorchiasis-related biliary diseases.
- Malignancy, especially cholangiocarcinoma, is a major cause of cholestasis, potentially influenced by parasitic infections and carcinogens.
- Understanding regional differences in biliary calculi and congenital anomalies is crucial for effective diagnosis and management.
Abstract:
The causes of cholestasis in 276 patients with a total of 296 lesions were studied. Extrahepatic cholestasis was found in 58.4 percent of the patients, and 41.6 percent had intrahepatic cholestasis. Malignant disease was found in 34.8 percent of the patients (extrahepatic cholestasis in 20 and intrahepatic cholestasis in 70). Cholangiocarcinoma, especially the hilar intrahepatic type, seems to be the most prevalent in the medical literature. It is possible that the combination of opisthorchiasis and carcinogenic agents, such as nitrosamines, induce a precancerous stage at the hilar area. Some unknown factors, may be the immune system in immune surveillance that act as a catalyst leading to malignant transformation. Acute calculous cholecystitis, choledocholithiasis, and intrahepatic stones are more common in Thailand than in the western countries, and their causes have been discussed herein. The composition of stones is also different; pigment stones are found more often in Thailand. These differences between the western and oriental types of biliary calculi are significant in regard to diagnostic approach and management, and morbidity and mortality. In Thailand, Opisthorchiasis viverrini has significant influence in the development of several cholestatic diseases, such as hilar intrahepatic cholangiocarcinoma, biliary calculi, opisthorchiatic intrahepatic cysts, and aggregated dead opisthorchiatic worms blocking the biliary system. In tropical countries, infectious diseases such as virus B hepatitis; severe systemic infectious diseases such as salmonellosis; and amebiasis and tuberculosis were also important causes of intrahepatic cholestasis. In the category of congenital anomalies, the prevalence of choledochal cysts was higher than in the United States. The prevalence of other forms of congenital anomalies of the biliary system is unknown, but may be similar to the prevalence of choledochal cysts.