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Clinical spectrum of chronic liver disease in north Indian children
T R Dangwal1, V Aggarwal, V Malhotra
1Department of Paediatrics, Maulana Azad Medical College, New Delhi.
Insights
This study investigated chronic liver disease (CLD) in Indian children, finding infantile cholangiopathy and cryptogenic cirrhosis common. Chronic hepatitis B and C infections appear infrequent in this pediatric population.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Viral Serology
Background:
- Chronic liver disease (CLD) diagnosis and understanding have advanced with serodiagnosis.
- Limited research exists on CLD in Indian children.
- This study addresses the need for data on pediatric CLD in India.
Purpose of the Study:
- To define the clinical spectrum of CLD in children.
- To investigate the histopathology of pediatric CLD.
- To determine the seroepidemiology of hepatotropic viruses in children with CLD.
Main Methods:
- Studied 40 children diagnosed with CLD.
- Utilized routine labs, liver function tests, ultrasound, liver biopsy, and upper GI endoscopy.
- Assessed serological markers for Hepatitis B and C.
Main Results:
- Common symptoms included jaundice (70%), fever (67%), and abdominal distention (60%).
- Hepatomegaly and icterus were observed in 80% of patients.
- Hepatitis B surface antigen (HbsAg) was positive in 12.5% and anti-HCV in 7.5% of children.
- Infantile cholangiopathy (20%) was the most frequent histopathological diagnosis.
Conclusions:
- The incidence of chronic hepatitis B and C appears low in Indian children.
- Further extensive research is needed to confirm these findings and track disease progression.
- Infantile cholangiopathy is a significant cause of CLD in this pediatric cohort.
Abstract:
Recent advances in serodiagnosis of hepatotropic viruses have revolutionized the approach to diagnosis and understanding of chronic liver disease (CLD). There are few studies on CLD in children from India. The present study was planned to define the clinical spectrum of CLD in children, its histopathology and seroepidemiology. Forty children with clinical features satisfying the criteria for diagnosing chronic liver disease were studied. All underwent routine laboratory investigations, liver function tests and ultrasound scan of the abdomen. Liver biopsy, upper GI endoscopy and other special investigations were done wherever indicated. The most common presenting features were jaundice (70%), fever (67%), and abdominal distention (60%). On examination hepatomegaly and icterus (80% each) and splenomegaly (67%) were the commonest findings. Serum transaminases were raised in 62.5% of children while prothrombin time was prolonged in 75% patients. Oesophageal and/or gastric varices were seen in 13 out of 29 patients subjected to upper GI endoscopy. Hepatitis B surface antigen (HbsAg) was positive in 5 children (12.5%) while 3 (7.5%) tested positive for anti HCV antibody. The commonest histopathological diagnosis was infantile cholangiopathy (20%) followed by cryptogenic cirrhosis and idiopathic chronic active hepatitis (17.5% each). The study suggests that the incidence of chronic hepatitis B and C is rather low in childhood. However larger and longer studies are required to delineate the exact incidence of these conditions in childhood and their progression in adolescence and early adulthood.