BackgroundPortal vein thrombosis (PVT) is a rare condition associated with serious morbidity and mortality. The objective of this study was to determine the frequency, clinical presentations, and risk factors of PVT from the set of data firstly collected among the Southeast Asian population.MethodsA retrospective study was undertaken to identify patients diagnosed with thrombosis of the portal system and other abdominal veins. The hospital medical records were retrieved based on the selected ICD-10 codes. Clinical presentations were collected and risk factors determined.ResultsFrom 2000-2009, 467 hospital charts with designated ICD-10 codes of I81, I82.2, I82.3, I82.8, I82.9, or K55.0 were identified. PVT (I81) was the most common thrombosis (194 cases, 41.54%). The majority of PVT patients were males (65%), older than 40 years (75%), and presented with abdominal distension/ascites (69%), splenomegaly (54.6%), and abdominal pain (50.5%). Overall, the predominant risk factor was hepatocellular carcinoma (HCC) (52.5%), followed by liver cirrhosis without cancer (9.3%), abdominal infection/inflammation (9.3%), cholangiocarcinoma (8.2%), and abdominal intervention (7.7%). In young patients, abdominal interventions including umbilical catheterization (23.1%) and hepatectomy (7.7%) were the most frequent risks whereas in older cases, primary hepatobiliary cancer and cirrhosis (78%) were the major risks. Liver metastases from other organs were infrequently found. Chronic hepatitis B virus (HBV) infection was the main etiology associated with cirrhosis/HCC leading to PVT in this cohort. A third of the older PVT patients (age >40) had HBV and very few carried hepatitis C virus (HCV) whereas none of the young PVT patients (age <20) had HBV or HCV. A variety of abdominal infections/inflammations were also found including liver abscess, splenic abscess, cholangitis, cholecystitis, pancreatitis, omphalitis, and abdominal tuberculosis. Single cases of systemic lymphangiomatosis and Klippel-Trénaunay vascular malformation syndrome were also identified. Other thrombophilic conditions such as myeloproliferative neoplasms, paroxysmal nocturnal hemoglobinuria, protein S deficiency, and anti-phospholipid syndrome were rarely encountered.ConclusionHBV is the major risk of PVT in the Southeast Asian population. Several risk factors identified in this population have rarely been described and some are remarkably different from those reported in the West. Host and environmental factors may play a causal role in the initiation and development of PVT in various ethnicities and geographic locations.

Background Diarrhea in enteral tube‐fed patients is not uncommon and can lead to unfavorable outcomes. Fiber in enteral nutrition (EN) formula might play a role in postfeeding diarrhea. Theoretically, soluble fiber is beneficial for both prevention and treatment of postfeeding diarrhea, but different types of soluble fiber may not provide the same effect. This study aims to determine whether supplementation with psyllium in standard EN reduces the incidence of diarrhea in tube‐fed patients. Methods We conducted a prospective, randomized, double‐blind, controlled study in general medical wards patients who were expected to receive EN for ≥5 days. Exclusion criteria were hemodynamic instability, known significant gastrointestinal problems, and recent pancreatitis. Eligible patients were randomized to receive either Mucilin SF (15.2 g/L)‐added Blendera (psyllium‐added formula: Psyllium group [PG]) or Blendera (fiber‐free formula: Control group [CG]). All patients were given EN for 10 days or until discharge/oral intake/death. Bowel movements (BMs) were monitored using King's Stool Chart. Results Eighty‐three patients were enrolled, 42 in the PG and 41 in the CG. Baseline characteristics were similar. The proportion of patients with ≥1 day of diarrhea (King's stool score ≥15) was comparable (42.9% vs 31.7%; P = 0.41, in PG and CG, respectively). There were no significant differences in the frequency of daily BMs and the median diarrhea score between PG and CG (3 vs 2, P = 0.06 and 3.8 vs 2.4, P = 0.42, respectively). Conclusion Supplementation with psyllium showed no beneficial effect on reducing incidence of diarrhea in general medical patients receiving EN. This study was registered on Thai Clinical Trials Registry (http://www.clinicaltrials.in.th: TCTR identification number TCTR20170821004).

Background and Aim Clostridium difficile‐associated diarrhea (CDAD) and enteral nutrition (EN)‐associated diarrhea are the most common recognized etiologies of nosocomial diarrhea. However, in clinical practice, the data regarding how each etiology contributes to the diarrheal episodes are limited. We identify the causes and factors associated with post‐feeding diarrhea. Methods Using the data of patients enrolled in “Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube‐Fed Patients: A Prospective, Randomized, and Controlled Trial”, the randomized controlled trial showed no difference in diarrheal incidences between fiber‐added and fiber‐free formulas. Hence, we analyzed the data of all enrolled patients. The causes of diarrhea were classified according to pre‐specified definitions. The factors associated with diarrhea were analyzed using logistic regression. Results Diarrhea was found in 37.3% (n = 31/83). The most common cause was medication associated (61.3%). CDAD and EN‐associated diarrhea were found in only 9.7% and 6.5%, respectively. Patients with baseline albumin <3 g/dL and underlying cerebrovascular disease were more likely to develop diarrhea (adjusted odds ratio 5.70, 95% confidence interval 1.79–20.51, and adjusted odds ratio 10.83, 95% confidence interval 2.96–48.57, respectively). Compared with those without diarrhea, the length of hospital stay in CDAD patients was significantly longer (+23.1 days, P = 0.02), a trend of longer hospital stay in patients with diarrhea from other causes was observed (+3.2 days, P = 0.096). Conclusions Our study found that the most common cause of post‐feeding diarrhea is medication associated. Review and cessation of possible drugs should be undertaken before EN modification. CDAD accounts for <10% of diarrhea causes, but it impacts the clinical outcome and should be identified and treated properly.