Kullavanijaya P, Tangkijvanich P, Poovorawan Y
Department of Medicine, Faculty of Medicine, Chulalongkorn University and Hospital, Bangkok, Thailand.
Southeast Asian J Trop Med Public Health. 1999 Mar;30(1):96-105.
The objective of this overview is to assess the present situation with regards to gastrointestinal and hepatobiliary diseases prevailing in Thailand. In that context, special emphasis has been put on those forms of viral hepatitis prevalent in the region, namely, hepatitis A the frequency of which has undergone a change from hyper- to hypoendemic with a resulting decline in naturally acquired immunity; hepatitis B with its tendency to cause chronic liver disease mainly due to asymptomatic infections during early childhood and the impact of mass vaccination programs on its endemicity; hepatitis C which can also lead to chronicity; hepatitis D solely found as a coinfection with hepatitis B; hepatitis E acute cases of which can sporadically be found; hepatitis G encountered in healthy subjects at a prevalence similar to that seen in patients with chronic liver disease and rather more prevalent among people at risk for contracting blood borne agents; finally the novel hepatitis TT virus with a distribution comparable to that of hepatitis G virus and a similarly unclear role as to the etiology of serious liver disease. Particularly in connection with hepatitis B we have examined the situation regarding hepatocellular carcinoma which represents one of the most common malignancies among the Thai population. Cholangiocarcinoma caused by the liver fluke Opisthorchis viverrini is the most common form of liver cancer in the northeastern part of Thailand where an estimated 70% of the population are infested with the parasite. Peptic ulcer caused by Helicobacter pylori constitutes another common gastrointestinal affliction with the overall prevalence of antibodies to the agent amounting to 63 to 74% in patients exhibiting gastroduodenal symptoms. The final part of the paper deals with HIV-related gastrointestinal and liver disease and with amebic and pyogenic liver abscesses.
本综述的目的是评估泰国流行的胃肠道和肝胆疾病的现状。在此背景下，特别强调了该地区流行的几种病毒性肝炎，即甲型肝炎，其发病率已从高度流行转变为低度流行，导致自然获得性免疫力下降；乙型肝炎，主要由于儿童早期无症状感染而倾向于导致慢性肝病，以及大规模疫苗接种计划对其流行程度的影响；丙型肝炎也可导致慢性化；丁型肝炎仅作为乙型肝炎的合并感染被发现；戊型肝炎偶有急性病例；庚型肝炎在健康人群中的患病率与慢性肝病患者相似，在有感染血源性病原体风险的人群中更为普遍；最后是新型的TT型肝炎病毒，其分布与庚型肝炎病毒相似，在严重肝病病因方面的作用同样尚不明确。特别是关于乙型肝炎，我们研究了肝细胞癌的情况，肝细胞癌是泰国人群中最常见的恶性肿瘤之一。由肝吸虫华支睾吸虫引起的胆管癌是泰国东北部最常见的肝癌形式，估计该地区70%的人口感染了这种寄生虫。由幽门螺杆菌引起的消化性溃疡是另一种常见的胃肠道疾病，在出现胃十二指肠症状的患者中，该病原体抗体的总体患病率为63%至74%。本文的最后一部分论述了与艾滋病相关的胃肠道和肝脏疾病以及阿米巴性和化脓性肝脓肿。
