Aetiology of cirrhosis in a tertiary referral centre in Sri Lanka

Abstract

INTRODUCTION: Alcoholic liver disease is believed to be the commonest cause of cirrhosis in Sri Lanka. However, with the rising prevalence of obesity and diabetes, non-alcoholic steatohepatitis (NASH) is increasingly being diagnosed. The prevalence of both Hepatitis B (<2%) and C (<1 %) is low in our population. OBJECTIVE: To study the aetiology of cirrhosis in a tertiary referral centre in Sri Lanka. DESIGN, SETTING AND METHODS: We analysed the database of outpatients with cirrhosis maintained since 2001, reviewing records with regard to aetiology. Diagnosis of cirrhosis was established on clinical, biochemical and radiological evidence, and confirmed histologically when required. A detailed alcohol and drug history was obtained. Hepatitis B and C serology, iron and copper studies, and an autoimmune screen were also performed. RESULTS: Records of 204 patients were analysed [male: female =160:44, mean age 51.2y (SD 12.2)]. The aetiology of cirrhosis was: alcohol in 116 (57.1%, male: female= 110:6); cryptogenic in 63 (31%, male:female 38:25), chronic Hepatitis B in 7 (male: female = 4:3), Wilson disease in 6 (male: female= 4:2), confirmed NASH in 6 (male: female= 2:4), autoimmune hepatitis in 4 (ai! females), chronic Hepatitis C in 1 (male) and haemochromatosis in 1 (male). Prevalence of diabetes was 44% among patients with cryptogenic cirrhosis and 24% among others. CONCLUSIONS: Alcohol remains the commonest cause of cirrhosis. Cryptogenic cirrhosis was the second commonest cause, and the leading cattse among females. The high prevalence of diabetes in cryptogenic cirrhosis suggests an aetiology of burned out NASH. Chronic viral hepatitis remains an uncommon cause for cirrhosis.