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Flow Chart- Demographics and Distribution of CBD size * Inclusion criteria: liver ultrasound performed, absence of biliary tree pathology/gallstones Bile.

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Presentation on theme: "Flow Chart- Demographics and Distribution of CBD size * Inclusion criteria: liver ultrasound performed, absence of biliary tree pathology/gallstones Bile."— Presentation transcript:

1 Flow Chart- Demographics and Distribution of CBD size * Inclusion criteria: liver ultrasound performed, absence of biliary tree pathology/gallstones Bile Duct Dilatation With Opiate Replacement Therapy In Patients With Hepatitis C And A History Of Intravenous Drug Use R. Sood *, R. Hassan, D. Tesh, R. Rameshshanker, S. Moreea; Gastroenterology, Bradford Teaching Hospitals, United Kingdom INTRODUCTION Opiate replacement therapies such as methadone and buprenorphine are commonly used in patients with opioid dependence. Studies have suggested an association between non- obstructive common bile duct (CBD) dilatation and prolonged use of opiate replacement therapy, most likely secondary to sphincter of Oddi contraction. (1) AIM To assess the association between CBD diameter and opioid replacement therapies in patients with chronic viral hepatitis. REFERENCE (1)Bile Duct Dilatation in Patients With Chronic Viral Hepatitis on Maintenance Methadone Therapy. Trinh Meyer, MD, Denis Kapkov, MD, Michael J. Lipp, MD et al. Gastroenterology & Hepatology Volume 5, Issue 9 September 2009 RESULTS In our centre, we have 679 patients with Hepatitis C infection. Of these, 320 patients have a known previous history of Intravenous Drug Use (IVDU), as per flow chart. 91 of the 320 patients met the criteria for the study. Those that did not meet the criteria included those with gallstones, other biliary tree pathology and patients with no previous ultrasound report. The control and study groups were 83% and 74% male respectively. The mean ages were 40.3 and 33.1 for the control and study groups respectively. The demographics for our total hepatitis C cohort is shown in the flow chart opposite. Table 1 demonstrates CBD sizes in control and study groups; table 2 demonstrates serum liver function tests in the two groups Our results show no significant difference in CBD dilatation sizes between the control and study groups. METHODS Patients were categorised into those on methadone or buprenorphine (study group) and those with no known history of opiate replacement therapy use (control group). The following data was extracted; demographics, CBD size on ultrasound, presence of gallstones and other biliary pathology, mean alanine aminotransferase (ALT), alkaline phosphatase (ALP ) and bilirubin. CBD diameter /mm Mean ALP /iU/L ( ) Mean Bilirubin /µmol/L (5-21) Mean ALT /iU/L (<40) Control group, n=58 Normal borderline Dilated- Study group, n=33 Normal borderline Dilated Common bile duct diameter /mm < 4 Normal 5-7 borderline > 8 dilatation Control group N=58 (%) 57 (98.3)1 (1.7)0 (0) Study group N=33 (%) 29 (87.88)2 (6.06) P value CONCLUSIONS Our study does not suggest any association between common bile duct dilatation and opiate replacement therapy. Table1- Distribution of CBD size in the control and study groups Table 2- Mean Liver Function Tests in the control and study groups 679 patients with hepatitis C 56% South Asian, 42% Caucasian, 2% other. Mean age 45.3, age range 19-92, 64% male 359 non-IVDU history. 56% Caucasian, 41% South Asian, 3% other,. Mean age 44.9, 54.2%male 320 IVDU history. 94% Caucasian, 4% South Asian, 2% other. Mean age 37.7, 75% male 120 failed to attend clinic, mean age 36.9, 74% male 106 not receiving opioid Replacement, mean age 42.3, 79% male 58 meeting criteria* (control group), mean age 40.3, 83% male 57 (98%) normal CBD 1 (2%) borderline CBD) 0 dilated CBD 94 receiving opioid Replacement, mean age 36.6, 77% male 33 meeting criteria* (study group), mean age 33.1, 74% male 29 (88%) normal CBD 2 (6%) borderline CBD) 2 (6%) dilated CBD


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