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Some peculiarities of hepatobiliary diseases in Vietnam
1Department of Gastroenterology, Central Hospital Tran Hung Dao, Hanoi, Vietnam.
Insights
Hepatobiliary diseases like hepatitis, cirrhosis, and liver cancer are common in Vietnam, primarily caused by Hepatitis B (HBV) and C (HCV) infections, alcohol, and chemicals. Early diagnosis and prevention strategies show promising results.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Diseases
Background:
- Hepatobiliary diseases are prevalent in Vietnam, with chronic hepatitis, cirrhosis, and primary liver cancer being most frequent.
- Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are the leading causes of chronic hepatitis and cirrhosis.
- Other contributing factors include alcohol, chemicals, malaria, and parasitic infections like ascaridiasis.
Purpose of the Study:
- To provide a comprehensive overview of the epidemiology and etiology of major hepatobiliary diseases in Vietnam.
- To highlight the challenges and current approaches in diagnosis and treatment of these conditions.
- To discuss recent advancements in prevention and management strategies.
Main Methods:
- Review of existing literature and clinical data on hepatobiliary diseases in Vietnam.
- Analysis of etiological factors, including viral infections, parasitic infestations, and environmental exposures.
- Examination of diagnostic techniques and therapeutic interventions for liver abscesses, biliary lithiasis, and primary liver cancer.
Main Results:
- Hepatitis B and C are the primary drivers of chronic liver disease and hepatocellular carcinoma.
- Ascaris-related cholangitis is a significant cause of choledocholithiasis and intrahepatic lithiasis.
- Acalculous cholecystitis occurs more frequently than in Western populations.
- Hepatocellular carcinoma accounts for over 90% of primary liver cancers, with HBV and HCV as major risk factors.
Conclusions:
- Effective management of hepatobiliary diseases in Vietnam requires addressing viral hepatitis, parasitic infections, and lifestyle factors.
- Early detection through screening programs utilizing sonography and AFP levels is crucial for improving outcomes.
- Novel therapeutic approaches, including Gacavit and percutaneous ethanol injection, show potential in managing cirrhotic complications and liver tumors.
Abstract:
The most frequent hepatobiliary diseases in Vietnam are chronic hepatitis and cirrhosis, liver abscess, hepatobiliary ascaridiasis, angiocholitis, biliary lithiasis and primary liver cancer. The principal causes of chronic hepatitis and cirrhosis are HBV and HCV infections. Alcohol and chemicals (drugs, agricultural, industrial, war herbicides) also play an important role. Malaria causes hepatitis and fibrosis lesions, however no cirrhotic lesions were observed. There are two categories of liver abscess, amoebic and cholangitic, often caused by ascaridiasis. Treatment of amoebic abscesses is, at first, non-surgical for small abscesses, often combined with ultrasound guided abscess puncture. Cholangitis abscesses are more serious and often require surgical intervention. Among the gallstones, only 15% are of the gall-bladder, the majority are choledocho- and intrahepatic-lithiasis, composed largely of calcium bilirubinate and are frequently caused by Ascaris-related cholangitis and the nucleation of Ascaris eggs. Forty-seven per cent of acute cholecystitis are acalculous, showing a higher frequency than in Western countries. Primary liver cancer is one of the most frequent malignancies in Vietnam. More than 90% of liver cancers are hepatocellular carcinomas. The principal causes are HBV infection, followed by HCV infection, aflatoxin, alcohol and chemicals. Recent efforts aiming at earlier diagnosis, by selective screening in high-risk groups, have used clinical surveillance, abdominal sonography and AFP level determination. Promising results were obtained in prevention trials by reducing the high AFP level of cirrhotic patients using a vegetal drug, Gacavit, and by treatment with percutaneous ethanol injection therapy, as an alternative therapeutic measure for liver tumour resection.