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Con D, Tu S, Clayton-Chubb D, Lubel JS, Nicoll AJ, Sawhney R, Bloom S. Effect of Concurrent Metabolic Dysfunction-Associated Steatotic Liver Disease on Serial Non-invasive Fibrosis Markers in Chronic Hepatitis B. Dig Dis Sci 2024; 69:1496-1506. [PMID: 38376788 DOI: 10.1007/s10620-024-08354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND & AIMS Concurrent hepatic steatosis has diverse effects on chronic hepatitis B (CHB), however the combined effects of metabolic dysfunction-associated steatotic liver disease (MASLD) and CHB on liver fibrosis progression remains unclear. The primary aim of this study was to utilize serial fibrosis measurements to compare the dynamic change in fibrosis in CHB patients with/without concurrent MASLD. The secondary aim was to investigate factors associated with steatosis development and regression in CHB patients. METHODS This was a retrospective cohort study of all non-cirrhotic CHB patients identified from 1/1/2011 to 31/12/2016. Hepatic steatosis was diagnosed by ultrasound. Fibrosis markers included liver stiffness (LSM) by transient elastography, APRI and FIB-4. General linear mixed effects modelling was used to fit polynomial and linear estimates. RESULTS Of 810 CHB patients (n = 2,373 LSM measurements; median age 44.4y; 48% male; 24% HBeAg positive), 14% had concurrent MASLD. LSM was higher at baseline but decreased in MASLD patients over time, while LSM remained stable in non-MASLD patients, such that all patients had similar LSM beyond 4-5 years. MASLD patients had lower APRI compared to non-MASLD patients, which was predominately due to a higher platelet count and higher ALT over time. There was substantial discordance between LSM, APRI and FIB-4. Baseline BMI was the only factor that predicted steatosis development and regression. CONCLUSIONS We found no evidence of an association between concurrent MASLD and fibrosis progression amongst CHB patients without baseline advanced liver disease. APRI and FIB-4 may have reduced accuracy in MASLD patients.
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Affiliation(s)
- Danny Con
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 3128, Melbourne, VIC, Australia.
| | - Steven Tu
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 3128, Melbourne, VIC, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 3128, Melbourne, VIC, Australia
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 3128, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 3128, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, 8 Arnold Street, Box Hill, 3128, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
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Clayton-Chubb D, Kemp WW, Majeed A, Woods RL, Ryan J, Murray AM, Chong TTJ, Lubel JS, Tran C, Hodge AD, Schneider HG, McNeil JJ, Roberts SK. Late-Life Metabolic Dysfunction-Associated Steatotic Liver Disease and its Association With Physical Disability and Dementia. J Gerontol A Biol Sci Med Sci 2024; 79:glae011. [PMID: 38227760 PMCID: PMC10923210 DOI: 10.1093/gerona/glae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing rapidly, including among older adults. The number of older adults is also rising with concomitantly increasing rates of age-related physical and cognitive dysfunction. However, data on whether MASLD affects physical and cognitive function in older adults is limited. As such, we aimed to identify whether prevalent MASLD influences the risk of incident physical disability or dementia in initially healthy older adults. METHODS A post-hoc analysis of participants from the ASPREE-XT cohort study, which recruited community-dwelling older adults without a history of cardiovascular disease, dementia, or independence-limiting functional impairment. The Fatty Liver Index (to identify MASLD) was calculated in those with complete data. Cox proportional-hazards models were used to investigate the outcomes of dementia and persistent physical disability in participants with MASLD vs those without. RESULTS Of the 9 097 individuals included (mean age 75.1 ± 4.2 years; 45.0% men), 341 (3.7%) developed persistent physical disability and 370 (4.1%) developed dementia over a median follow-up of 6.4 years (IQR 5.3-7.5 years). When adjusting for known contributors including age, gender, education, comorbidity, and functional measures, MASLD was associated with an increased risk of persistent physical disability (HR 1.41 [95% CI: 1.07-1.87]) and reduced risk of incident dementia (HR 0.63 [95% CI: 0.48-0.83]). CONCLUSIONS Prevalent MASLD is associated with reduced rates of incident dementia but increased risk of persistent physical disability in initially relatively healthy older adults. Understanding the mechanisms underlying these divergent results to allow appropriate risk stratification and counseling is important.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William W Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research and Department of Medicine, Geriatrics Division, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Trevor T J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alexander D Hodge
- Department of Medicine, Eastern Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Victoria, Australia
| | - Hans G Schneider
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Clinical Biochemistry Unit, Alfred Pathology Service, Alfred Health, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Lange PW, Turbić A, Soh CH, Clayton-Chubb D, Lim WK, Conyers R, Watson R, Maier AB. Melatonin does not reduce delirium severity in hospitalized older adults: Results of a randomized placebo-controlled trial. J Am Geriatr Soc 2024. [PMID: 38438279 DOI: 10.1111/jgs.18825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Delirium is common in older inpatients, causing distress, cognitive decline, and death. Current therapies are unsatisfactory, limited by lack of efficacy and adverse effects. There is an urgent need for effective delirium treatment. Sleep wake cycle is disturbed in delirium; endogenous Melatonin is perturbed, and exogenous Melatonin is a safe and effective medication for sleep disorders. This study aims to determine the effect of oral Melatonin 5 mg immediate release (IR) nightly for five nights on the severity of delirium in older (≥65 years) medical inpatients. METHODS This was a double-blinded, randomized controlled trial in general internal medicine units of a tertiary teaching hospital. Older inpatients with Confusion Assessment Method positive, hyperactive or mixed delirium within 48 h of admission or onset of in-hospital delirium were included. The primary outcome was change in delirium severity measured with the Memorial Delirium Assessment Scale (MDAS). A previous pilot trial showed 120 participants randomized 1:1 to Melatonin or Placebo would provide 90% power to demonstrate a 3-point reduction in the MDAS. RESULTS One hundred and twenty participants were randomized, 61 to Melatonin 5 mg and 59 to Placebo. The medication was well tolerated. The mean MDAS improvement was 4.9 (SD 7.6) in the Melatonin group and 5.4 (SD 7.2) in the Placebo group, p-value 0.42, a non-significant difference. A post-hoc analysis showed length of stay (LOS) was shorter in the intervention group (median 9 days [Interquartile Range (IQR) 4, 12] vs. Placebo group 10 [IQR 6, 16] p-value = 0.033, Wilcoxon Rank Sum test). CONCLUSIONS This trial does not support the hypothesis that Melatonin reduces the severity of delirium. This may be due to no effect of Melatonin, a smaller effect than anticipated, an effect not captured on a multidimensional delirium assessment scale, or a type II statistical error. Melatonin may improve LOS; this hypothesis should be studied.
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Affiliation(s)
- Peter W Lange
- Department of Aged Care and Medicine, The Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
- Department of Geriatrics and General Medicine, Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Alisa Turbić
- Bone and Fractures Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Cheng Hwee Soh
- Department of Aged Care and Medicine, The Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Prahran, Victoria, Australia
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Victoria, Australia
| | - Wen Kwang Lim
- Department of Aged Care and Medicine, The Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Rachel Conyers
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Heart Disease, Stem Cell Biology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rosie Watson
- Department of Aged Care and Medicine, The Royal Melbourne Hospital, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
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Clayton-Chubb D, Kemp WW, Majeed A, Lubel JS, Woods RL, Tran C, Ryan J, Hodge A, Schneider HG, McNeil JJ, Roberts SK. Metabolic dysfunction-associated steatotic liver disease in older adults is associated with frailty and social disadvantage. Liver Int 2024; 44:39-51. [PMID: 37698034 DOI: 10.1111/liv.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND & AIMS The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing rapidly, as is the number of older adults globally. However, relatively few studies have been performed evaluating the prevalence and risk factors for MASLD in older adults. As such, we aimed to identify the prevalence of MASLD in older adults, as well as sociodemographic, clinical, functional and biochemical associations. METHODS The study population included older adults without a history of cardiovascular disease, dementia or independence-limiting functional impairment who had participated in the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial. MASLD was defined using the Fatty Liver Index (FLI). Associations were identified using Poisson regression with robust variance for FLI ≥ 60 vs FLI < 30. RESULTS 9097 Australian participants aged ≥70 years had complete biochemical and anthropometric data to identify MASLD. The study population had a mean age of 75.1 ± 4.3 years and was 45.0% male. Almost one-third (33.0%) had prevalent MASLD, and the prevalence decreased with increasing age (adjusted RR [aRR] 0.96, 95% CI: 0.96-0.97). MASLD was also negatively associated with social advantage (aRR 0.94, 95% CI: 0.90-0.99) and exercise tolerance and was positively associated with diabetes mellitus (aRR: 1.22, 95% CI: 1.16-1.29), hypertension (aRR: 1.31, 95% CI: 1.22-1.41), male sex (aRR: 1.66, 95% CI: 1.57-1.74), pre-frailty (aRR: 1.99, 95% CI: 1.82-2.12) and frailty (aRR: 2.36, 95% CI: 2.16-2.56). MASLD and nonalcoholic fatty liver disease (NAFLD) results were 100% concordant. CONCLUSION This study in a large cohort of relatively healthy community-dwelling older adults shows that MASLD is common, decreases with age and is associated with poorer metabolic health, social disadvantage and frailty.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
| | - William W Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology, Northern Health, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alexander Hodge
- Department of Gastroenterology, Eastern Health, Melbourne, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, Australia
- Department of Medicine, Eastern Clinical School, Monash University, Melbourne, Australia
| | - Hans G Schneider
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Pathology, Alfred Health, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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Commins I, Clayton-Chubb D, Melton S, Majeed A, Kemp W, Roberts SK. Initial outcomes of a dedicated multidisciplinary non-alcoholic fatty liver disease clinic: a retrospective cohort study. Intern Med J 2023; 53:2065-2072. [PMID: 36880362 DOI: 10.1111/imj.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a major healthcare burden. Real-world outcomes in dedicated tertiary care settings in Australia remain unknown. AIM To evaluate the initial outcomes of patients referred to a dedicated multidisciplinary tertiary care NAFLD clinic. METHODS Retrospective review of all adult patients with NAFLD who attended a dedicated tertiary care NAFLD clinic between January 2018 and February 2020 and who had two clinic visits and FibroScans at least 12 months apart. Demographic and health-related clinical and laboratory data were extracted from electronic medical records. Key outcome measures were serum liver chemistries, liver stiffness measurement (LSM) and weight control at 12 months. RESULTS A total of 137 patients with NAFLD were included. Median (interquartile range (IQR)) follow-up time was 392 days (343-497 days). One hundred and eleven patients (81%) achieved weight control (i.e. weight loss or stability). Markers of liver disease activity were significantly improved, including median (IQR) serum alanine aminotransferase (48 (33-76) vs 41 (26-60) U/L, P = 0.009) and aspartate aminotransferase (35 (26-54) vs 32 (25-53) U/L, P = 0.020). Median (IQR) LSM across the whole cohort was significantly improved (8.4 (5.3-11.8) vs 7.0 (4.9-10.1) kPa, P = 0.001). No significant reduction was observed in mean body weight or the frequency of metabolic risk factors. CONCLUSIONS This study highlights a new model of care for patients with NAFLD and demonstrates promising initial outcomes in relation to significant reductions in markers of liver disease severity. Although most patients achieved weight control, further refinements are needed to achieve significant weight reduction including more frequent and structured dietetic and/or pharmacotherapeutic interventions.
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Affiliation(s)
- Isabella Commins
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Sarah Melton
- Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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Clayton-Chubb D, Roberts SK. Diabetes and non-alcoholic fatty liver disease: a bittersweet symphony. Med J Aust 2023; 219:353-354. [PMID: 37700569 DOI: 10.5694/mja2.52106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Affiliation(s)
| | - Stuart K Roberts
- The Alfred, Melbourne, VIC
- Central Clinical School, Monash University, Melbourne, VIC
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Vaz K, Clayton-Chubb D, Majeed A, Lubel J, Simmons D, Kemp W, Roberts SK. Current understanding and future perspectives on the impact of changing NAFLD to MAFLD on global epidemiology and clinical outcomes. Hepatol Int 2023; 17:1082-1097. [PMID: 37556065 PMCID: PMC10522780 DOI: 10.1007/s12072-023-10568-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION For the first time in nearly half a century, fatty liver disease has undergone a change in name and definition, from the exclusive term, non-alcoholic fatty liver disease (NAFLD), to the inclusion-based, metabolic-associated fatty liver disease (MAFLD). This has led investigators across the globe to evaluate the impact the nomenclature change has had on the epidemiology and natural history of the disease. METHODS This systematic review provides a comprehensive overview on how the shift in name and diagnostic criteria has influenced point prevalence in different geographic regions, as well as morbidity and mortality risk, whilst highlighting gaps in the literature that need to be addressed. CONCLUSIONS MAFLD prevalence is higher than NAFLD prevalence, carries a higher risk of overall mortality, with greater granularity in risk-stratification amongst MAFLD subtypes.
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Affiliation(s)
- Karl Vaz
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- Central Clinical School, Monash University, Melbourne, Australia.
| | - Daniel Clayton-Chubb
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - David Simmons
- Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, Ground Floor Alfred Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Cosentino C, Clayton-Chubb D, McLean C, Roberts SK, Kemp W. Isolated IgG4-associated autoimmune hepatitis or the first manifestation of IgG4-related disease? Hepatobiliary Pancreat Dis Int 2023; 22:415-417. [PMID: 36273965 DOI: 10.1016/j.hbpd.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Carmela Cosentino
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne 3004, VIC, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne 3004, VIC, Australia; Central Clinical School, Monash University, Melbourne 3004, VIC, Australia.
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne 3004, VIC, Australia
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne 3004, VIC, Australia; Central Clinical School, Monash University, Melbourne 3004, VIC, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne 3004, VIC, Australia; Central Clinical School, Monash University, Melbourne 3004, VIC, Australia
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9
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Cosentino C, Clayton-Chubb D, Lubel JS. Management of hepatitis D in general practice. Aust J Gen Pract 2023; 52:536-539. [PMID: 37532443 DOI: 10.31128/ajgp-08-22-6516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Hepatitis D virus (HDV) requires the presence of hepatitis B virus for replication and infection, and is associated with accelerated progression to cirrhosis and an increased risk of hepatocellular carcinoma. Approximately 4% of Australians living with hepatitis B are infected with HDV, although it is likely that HDV remains underdiagnosed. OBJECTIVE This paper highlights the importance of screening for HDV in patients living with chronic hepatitis B (CHB) and provides an overview of diagnosis and treatment approaches for general practitioners (GPs), with the hope of reducing preventable liver-related morbidity and mortality in people living with CHB and HDV coinfection. DISCUSSION The diversity of risk factors and geographical origins of patients in the multicultural Australian populace highlights the need for routine testing for HDV in patients diagnosed with CHB. GPs have a pivotal role in the diagnosis of HDV and should, if possible, promptly refer patients to non-GP specialist physicians to consider HDV therapy.
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Affiliation(s)
- Carmela Cosentino
- BBiomedSc, MD, Junior Doctor, Basic Physician Trainee at Alfred Health, Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Vic
| | - Daniel Clayton-Chubb
- BSc, MD, Consultant Gastroenterologist and Hepatologist, Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Vic
| | - John S Lubel
- BDS, FDSRCS, MBBS, MRCP, FRACP, PhD, Consultant Gastroenterologist and Hepatologist, Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Vic; Adjunct Associate Professor, Central Clinical School, Monash University, Melbourne, Vic
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Clayton-Chubb D, Kemp W, Majeed A, Lubel JS, Hodge A, Roberts SK. Reply to Abenavoli et al. Comment on "Clayton-Chubb et al. Understanding NAFLD: From Case Identification to Interventions, Outcomes, and Future Perspectives. Nutrients 2023, 15, 687". Nutrients 2023; 15:2908. [PMID: 37447237 DOI: 10.3390/nu15132908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Thank you for your interesting comment [...].
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - John S Lubel
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Alex Hodge
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, VIC 3004, Australia
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
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Forcey DS, Clayton-Chubb D, Gurry G, Bhatt S, Wilson S, Teh P, Morrissey O, Roberts S, Basu G. Tacrolimus-associated gastrointestinal ulcers in a kidney transplant recipient. Intern Med J 2023; 53:1087-1088. [PMID: 37349275 DOI: 10.1111/imj.16114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/05/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Dana S Forcey
- Department of Renal Medicine, Alfred Health, Victoria, Melbourne, Australia
- Department of Nephrology, Western Health, Melbourne, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Greta Gurry
- Department of Renal Medicine, Alfred Health, Victoria, Melbourne, Australia
| | - Shivani Bhatt
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Scott Wilson
- Department of Renal Medicine, Alfred Health, Victoria, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peggy Teh
- Department of Renal Medicine, Alfred Health, Victoria, Melbourne, Australia
| | - Orla Morrissey
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Stuart Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gopal Basu
- Department of Renal Medicine, Alfred Health, Victoria, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
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12
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Clayton-Chubb D, Buckle A, Tandiari T, Hosking P, Nicoll AJ. Prevalence of gastric intestinal metaplasia in a single-centre multicultural Australian cohort. Intern Med J 2023; 53:296-297. [PMID: 36822609 DOI: 10.1111/imj.16010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/08/2022] [Indexed: 02/25/2023]
Affiliation(s)
- Daniel Clayton-Chubb
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew Buckle
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
| | - Tissa Tandiari
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
| | - Patrick Hosking
- Department of Anatomical Pathology, Eastern Health, Melbourne, Victoria, Australia
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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13
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Efe C, Kulkarni AV, Terziroli Beretta-Piccoli B, Magro B, Stättermayer A, Cengiz M, Clayton-Chubb D, Lammert C, Bernsmeier C, Gül Ö, la Tijera FHD, Anders M, Lytvyak E, Akın M, Purnak T, Liberal R, Peralta M, Ebik B, Duman S, Demir N, Balaban Y, Urzua Á, Contreras F, Venturelli MG, Bilgiç Y, Medina A, Girala M, Günşar F, Londoño MC, Androutsakos T, Kisch A, Yurci A, Güzelbulut F, Çağın YF, Avcı E, Akyıldız M, Dindar-Demiray EK, Harputluoğlu M, Kumar R, Satapathy SK, Mendizabal M, Silva M, Fagiuoli S, Roberts SK, Soylu NK, Idilman R, Yoshida EM, Montano-Loza AJ, Dalekos GN, Ridruejo E, Schiano TD, Wahlin S. Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome. Hepatology 2022; 76:1576-1586. [PMID: 35567545 PMCID: PMC9348326 DOI: 10.1002/hep.32572] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. APPROACH AND RESULTS We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. CONCLUSIONS SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.
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Affiliation(s)
- Cumali Efe
- Department of GastroenterologyHarran University HospitalŞanlıurfaTurkey
| | - Anand V Kulkarni
- Department of Hepatology and Liver TransplantationAsian Institute of Gastroenterology HospitalsHyderabadIndia
| | | | - Bianca Magro
- Gastroenterology Hepatology and TransplantationASST Papa Giovanni XXIII-BergamoBergamoItaly
| | - Albert Stättermayer
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Mustafa Cengiz
- Department of GastroenterologyGülhane Training and Research HospitalAnkaraTurkey
| | | | - Craig Lammert
- Department of Medicine IndianaUniversity School of MedicineIndianapolisIndianaUSA
| | - Christine Bernsmeier
- Department of BiomedicineUniversity of BaselBaselSwitzerland.,University Centre for Gastrointestinal and Liver DiseasesBaselSwitzerland
| | - Özlem Gül
- Department of GastroenterologyKırıkkale UniversityKırıkkaleTurkey
| | | | - Margarita Anders
- Hepatology and Liver Transplant UnitHospital AlemánCiudad Autónoma de Buenos AiresArgentina
| | - Ellina Lytvyak
- Division of Gastroenterology and Liver UnitUniversity of AlbertaEdmontonAlbertaCanada
| | - Mete Akın
- Department of GastroenterologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Tugrul Purnak
- Division of GastroenterologyHepatology and NutritionMcGovern Medical SchoolHoustonTexasUSA
| | - Rodrigo Liberal
- Gastroenterology and Hepatology DepartmentCentro Hospitalar e Universitário de São JoãoPortoPortugal.,World Gastroenterology Organization (WGO) Porto Training CenterPortoPortugal
| | - Mirta Peralta
- Hepatology SectionHospital Francisco J MuñizCiudad Autónoma de Buenos AiresArgentina.,Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina
| | - Berat Ebik
- Department of GastroenterologyGazi Yaşargil Education and Research HospitalDiyarbakirTurkey
| | - Serkan Duman
- Department of GastroenterologyAnkara University Medical FacultyAnkaraTurkey
| | - Nurhan Demir
- Department of GastroenterologyHaseki Training and Research HospitalIstanbulTurkey
| | - Yasemin Balaban
- Department of GastroenterologyFaculty of MedicineHacettepe UniversityAnkaraTurkey
| | - Álvaro Urzua
- Gastroenterology and Hepatology UnitHospital Clínico Universidad de ChileSantiago de ChileChile
| | | | | | - Yılmaz Bilgiç
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Adriana Medina
- Gastroenterology and Hepatology UnitHospital de Clínicas, Universidad Nacional de AsunciónSan LorenzoParaguay
| | - Marcos Girala
- Gastroenterology and Hepatology UnitHospital de Clínicas, Universidad Nacional de AsunciónSan LorenzoParaguay
| | - Fulya Günşar
- Department of GastroenterologyEge University School of MedicineİzmirTurkey
| | | | - Theodoros Androutsakos
- Department of PathophysiologyNational and Kapodistrian University of AthensMedical SchoolAthensGreece
| | - Ayelen Kisch
- Hepatology SectionHospital Bonorino UdaondoCiudad Autónoma de Buenos AiresArgentina
| | - Alper Yurci
- Department of GastroenterologyErciyes University School of MedicineKayseriTurkey
| | - Fatih Güzelbulut
- Department of GastroenterologyHaydarpaşa Numune Education and Research HospitalİstanbulTurkey
| | - Yasir Furkan Çağın
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Enver Avcı
- Department of GastroenterologyKTO Karatay University Medical School Affiliated Konya Medicana HospitalKonyaTurkey
| | - Murat Akyıldız
- Department of GastroenterologyKoc University School of MedicineIstanbulTurkey
| | | | - Murat Harputluoğlu
- Department of GastroenterologyInönü University School of MedicineMalatyaTurkey
| | - Rahul Kumar
- Department of Gastroenterology and HepatologyChangi General HospitalMedicine Academic Clinical ProgrammeSing Health Duke-NUS Academic Medical CentreSingapore
| | - Sanjaya K Satapathy
- Department of Internal MedicineDonald and Barbara Zucker School of MedicineNorthwell HealthManhassetNew YorkUSA
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and TransplantationASST Papa Giovanni XXIII-BergamoBergamoItaly
| | - Stuart K Roberts
- Department of GastroenterologyAlfred HealthMelbourneVictoriaAustralia.,Central Clinical SchoolDepartment of MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Neşe Karadağ Soylu
- Department of PathologyInönü University Faculty of MedicineMalatyaTurkey
| | - Ramazan Idilman
- Department of GastroenterologyAnkara University Medical FacultyAnkaraTurkey
| | - Eric M Yoshida
- Division of GastroenterologyUniversity of British Columbia and Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver UnitUniversity of AlbertaEdmontonAlbertaCanada
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal MedicineNational Expertise Center of Greece in Autoimmune Liver DiseasesGeneral University Hospital of LarissaLarissaGreece.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)General University Hospital of LarissaLarissaGreece
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN)PilarArgentina.,Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina.,Hepatology SectionDepartment of MedicineCentro de Educación Médica e Investigaciones Clínicas, CEMICCiudad Autónoma de Buenos AiresArgentina
| | - Thomas D Schiano
- Division of Liver Diseasesthe Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI DiseasesKarolinska Institutet and Karolinska University HospitalStockholmSweden
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14
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Kemp W, Clayton-Chubb D, Majeed A, Glenister KM, Magliano DJ, Lubel J, Bourke L, Simmons D, Roberts SK. Impact of renaming NAFLD to MAFLD in an Australian regional cohort: Results from a prospective population-based study. J Gastroenterol Hepatol 2022; 37:395-403. [PMID: 34693553 DOI: 10.1111/jgh.15723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Clinical and public health implications of the recent redefining of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD with NAFLD in a well-defined cohort. METHODS A cross-sectional study was conducted in regional Victoria with participants from randomly selected households. Demographic and health-related clinical and laboratory data were obtained. Fatty liver was defined as a fatty liver index ≥ 60 with MAFLD defined according to recent international expert consensus. RESULTS A total of 722 participants were included. Mean age was 59.3 ± 16 years, and 55.3% were women with a median body mass index of 27.8 kg/m2 . Most (75.2%) participants were overweight or obese. MAFLD was present in 341 participants giving an unadjusted prevalence of 47.2% compared with a NAFLD prevalence of 38.7%. Fifty-nine (17.5%) participants met the criteria of MAFLD but not NAFLD. The increased prevalence of MAFLD in this cohort was primarily driven by dual etiology of fatty liver. All participants classified as NAFLD met the new definition of MAFLD. Compared with NAFLD subjects, participants with MAFLD had higher ALT (26.0 [14.0] U/L vs 30.0 [23] U/L, P = 0.024), but there were no differences in non-invasive markers for steatosis or fibrosis. CONCLUSION Metabolic-associated fatty liver disease is a highly prevalent condition within this large community cohort. Application of the MAFLD definition increased prevalence of fatty liver disease by including people with dual etiologies of liver disease.
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Affiliation(s)
- William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kristen M Glenister
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - John Lubel
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Simmons
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia.,Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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15
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Clayton-Chubb D, Schneider D, Freeman E, Kemp W, Roberts SK. Autoimmune hepatitis developing after the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine. J Hepatol 2021; 75:1249-1250. [PMID: 34171435 PMCID: PMC8219312 DOI: 10.1016/j.jhep.2021.06.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022]
Affiliation(s)
| | - Daniel Schneider
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Elliot Freeman
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Department of Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Newnham ED, Clayton-Chubb D, Nagarethinam M, Hosking P, Gibson PR. Randomised clinical trial: adjunctive induction therapy with oral effervescent budesonide in newly diagnosed coeliac disease. Aliment Pharmacol Ther 2021; 54:419-428. [PMID: 34181750 DOI: 10.1111/apt.16446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/15/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The healing of the mucosal lesion in patients with coeliac disease is slow. AIM To determine whether concurrent budesonide and gluten-free diet hasten small bowel healing and symptomatic improvement in patients with newly diagnosed coeliac disease. METHODS In a pilot, randomised, double-blind trial, effects on Marsh grading and quantitative duodenal morphometry of 10 weeks' effervescent budesonide (initially 9 mg/day) or placebo were assessed after 8 and 52 weeks. Multiple clinical measures and adverse events were assessed. RESULTS Nineteen patients were randomised to budesonide and 18 to placebo. No differences (all P > 0.32) were observed for the week-8 mucosal response (Marsh 0 or 1) (budesonide: 37% vs placebo: 28%), week-8 remission (Marsh 0) (32% vs 17%), week-52 response (63% vs 44%) and week-52 remission (42% vs 33%). Likewise, the improvement from baseline in villous-height : crypt-depth ratio was not different for the treatment groups. There were no statistically significant differences in clinical measures or adverse events between the treatment groups. No corticosteroid adverse effects were observed. In a post hoc analysis of all patients, Marsh 3C was present at the diagnostic biopsy in 1/9 achieving mucosal remission at 8 weeks versus 18/23 not (P < 0.001) and mean villous-height : crypt-depth ratio was 1.06 (SD: 0.73) versus 0.46 (0.38) (P = 0.005). CONCLUSIONS In this pilot trial, induction therapy with budesonide had no significant effect on mucosal healing in patients with coeliac disease concurrently initiated on a gluten-free diet. Mucosal remission at 8 weeks occurred in approximately one in four patients and was associated with less severe histological lesions at diagnosis.
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Affiliation(s)
- Evan D Newnham
- Departments of Gastroenterology and Hepatology, Eastern Health, Melbourne, Vic., Australia
| | - Daniel Clayton-Chubb
- Departments of Gastroenterology and Hepatology, Eastern Health, Melbourne, Vic., Australia
| | - Meena Nagarethinam
- Departments of Gastroenterology and Hepatology, Eastern Health, Melbourne, Vic., Australia
| | | | - Peter R Gibson
- Departments of Gastroenterology and Hepatology, Eastern Health, Melbourne, Vic., Australia.,Department of Gastroenterology, Alfred Health, Melbourne, Vic., Australia
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17
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Con D, Clayton-Chubb D, Lubel J, Sawhney R, Bloom S. Dynamics of liver stiffness in chronic hepatitis B patients with concurrent metabolic-associated fatty liver disease. J Hepatol 2021; 75:236-238. [PMID: 33617924 DOI: 10.1016/j.jhep.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Danny Con
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.
| | | | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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18
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Clayton-Chubb D, Con D, Rangamuwa K, Taylor D, Thien F, Wadhwa V. Thunderstorm asthma: revealing a hidden at-risk population. Intern Med J 2019; 49:74-78. [PMID: 29573176 DOI: 10.1111/imj.13800] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Epidemic thunderstorm asthma (ETSA) refers to large-scale acute bronchospasm events associated with thunderstorm. The most serious episode ever recorded occurred in Melbourne, Australia, in November 2016, where more than 3500 patients were treated in hospitals and 10 died. Previous work has been focused primarily on patient presentations to emergency departments. The prevalence of individuals with milder, non-emergent symptoms and who may be at risk of more serious episodes in the future has not previously been explored. AIM To characterise the nature and extent of respiratory symptoms in healthcare workers during the Melbourne ETSA event. METHODS A survey was conducted among staff and volunteers across Eastern Health, distributed on the intranet homepage, by email and by word of mouth. Anonymous survey questions were constructed to assess prior and current diagnoses of relevance, symptoms, and demography. RESULTS There were 515 participants (80% female, n = 411) of approximately 9000 potential respondents (~6% response rate) who completed the survey; 132 (25.6%) had symptoms suggestive of asthma during the Melbourne ETSA event, the majority of whom did not seek professional medical help. Notably, of those with ETSA-like symptoms, only 58 (43.9%) had a history of asthma, while 97 (73.5%) had a history of allergic rhinitis. Specifically, a history of allergic rhinitis (OR 2.77, P < 0.001), a history of asthma (OR 1.67, P = 0.037) and being of self-identified Asian ethnicity (OR 3.24, P < 0.001) were all strong predictors of ETSA-like symptoms. Being predominantly indoors was not protective. CONCLUSIONS Our study provides evidence of the presence of a large cohort of sufferers during the Melbourne ETSA event of 2016 that did not come to the attention of medical services, implying a potentially hidden and significant susceptible population. Further research should help clarify the true prevalence of vulnerability in the general population, with important public health implications.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Kanishka Rangamuwa
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Melbourne, Victoria, Australia
| | - Francis Thien
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Vikas Wadhwa
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
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19
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Clayton-Chubb D, Rangamuwa K, Taylor D, Thien F, Abramson M, Wadhwa V. Thunderstorm Asthma in Australia – characteristics of a silent cohort. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.pa3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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