Hepatitis D virus (HDV) infection is highly prevalent in patients with chronic hepatitis B (CHB). AASLD guidelines recommend a risk-based screening approach. Our aim was to ascertain if the risk-based approach leads to appropriate HDV screening, identify targets to improve screening rates, and study HDV clinical burden. CHB patients screened for HDV from 01/2016 to 12/2021 were identified. Level of training and specialty of providers ordering HDV screening tests were determined. HDV seropositive (HDV+) patient charts were reviewed for the presence of individual risk factors per the AASLD guidelines to determine if they met screening criteria. The severity of liver disease at the time of HDV screening was compared between the HDV+ group and a matched (based on age, hepatitis B e antigen status, BMI and sex) HDV seronegative (HDV−) group. During the study period, 1444/11,190 CHB patients were screened for HDV. Most screening tests were ordered by gastroenterology (90.2%) specialists and attending physicians (80.5%). HDV+ rate was 88/1444 (6%), and 72 HDV+ patients had complete information for analysis. 18% of HDV+ patients would be missed by a risk-based screening approach due to unreported or negative risk factors (see Table ). A significantly higher number of HDV+ patients had developed significant fibrosis (p = 0.001) and cirrhosis (p < 0.01) by the time of screening than HDV− (n = 67) patients. In conclusion, targeted interventions are needed towards trainees and primary care clinics to improve screening rates. Current risk-based criteria do not appropriately screen for HDV. It is time for universal screening of HDV in CHB patients.
Discussion: Bezoars are collections of indigestible foreign material accumulated and conglomerated in different locations throughout the gastrointestinal tract, however, they are most commonly found in the stomach . Bezoars are divided into 4 groups according to their combination, including phytobezoars, trichobezoars, pharmacobezoars and lactobezoar. Among the 4 types of bezoars, phytobezoars are the most common. Bezoars from fruits and vegetables tend to accumulate in the stomach, however, seed bezoars, due to their small size, pass the pylorus more easily and tend to form an impaction either in colon and rectum. The diagnosis of seed bezoars is based on careful history and digital rectal examination. However, imaging scans help physicians to diagnose seed bezoar in the small intestine and colon which require further investigations. The most frequently seen CT findings of bezoars include the appearance of a round or ovoid or a long sausage-shaped mass containing mottled gas at the obstructed site. Treatment and evacuation of phytobezoar is based on its location in the gastrointestinal tract. The currently available treatment options for phytobezoar include dissolution of the bezoar by Coca-Cola, papain, cellulase, removal by endoscopic devices, laparotomy, and laparoscopic surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.