Background: Small intestinal bacterial overgrowth (SIBO) results in nutrient malabsorption and malnutrition, thereby increasing the morbidity and mortality in systemic sclerosis (SSc) patients. Objectives: To evaluate the prevalence and associated factors of SIBO in SSc patients. Method: A cross-sectional study was conducted between July 2015 and January 2016 in SSc patients over 18, using the glucose H 2 /CH 4 breath test to evaluate SIBO. Results: Eighty-nine SSc patients (30 male and 59 female) underwent the glucose H 2 / CH 4 breath test. The mean age was 54.4. Twelve participants were positive for the glucose H 2 /CH 4 breath test, yielding a SIBO prevalence of 13.5% (95% CI 7.2-22.4) among SSc patients. A multivariate analysis revealed that duration of disease >5 years was significantly associated with SIBO (adjusted odds ratio 9.38; 95% CI 1.09-80.47). Conclusion: The prevalence of SIBO, using the glucose H 2 /CH 4 breath test, is not common among Thai SSc patients. However, a positive result was associated with longer duration of disease. K E Y W O R D S hydrogen breath test, scleroderma, small intestinal bacterial overgrowth, systemic sclerosis | CON CLUS IONThe prevalence of SIBO as detected by the glucose H 2 /CH 4 breath test was not common among Thai SSc patients. When present, SIBO was associated with a longer duration of disease. ACK N OWLED G EM ENTSThe authors thank the patients for their participation, the Faculty of Medicine and the Scleroderma Research Group, Khon Kaen University for their support, The Gastroenterological Association of Thailand for its support, and Mr. Bryan Roderick Hamman for assistance with the English-language presentation under the aegis of the Publication

Background and aim: Autoimmune hepatitis (AIH) is a rare chronic form of hepatitis, the prognosis for which has not been definitively established. The current study aimed to define the prognostic factors for remission and compare the median time to remission, complications, and relapse rate between type 1 AIH patients treated with prednisolone monotherapy and those treated using prednisolone in combination with azathioprine. Materials and methods: The data of 86 patients diagnosed with type 1 AIH between January 1998 and January 2018 were retrospectively reviewed. Clinical, serological, and histological parameters were obtained. Coxproportional hazard and logistic regression analyses were applied to the data. Results: The prognostic factors related to complete remission were absence of liver cirrhosis, hypertension, and azathioprine exposure. The median time to complete remission of the prednisolone group (92 days; 95%CI; 65-264 days) was significantly shorter (P ¼ 0.01) than that of the combination group (336 days; 95%CI; 161-562 days); however, the prednisolone group had higher rates of treatment complications-including skin and soft tissue infections (P ¼ 0.010) and cushingoid appearance (P ¼ 0.011)-than the combination group. The prednisolone group also had a higher relapse rate (odds ratio 6.13, 95% CI 1.72-21.80, P ¼ 0.005). Conclusions: The absence of liver cirrhosis and hypertension at the time of diagnosis and no azathioprine exposure during the treatment period were favorable prognostic factors for complete remission. The prednisolone group had a significantly shorter median time to complete remission but higher rates of treatment complications and a higher relapse rate than the combination group.

Author contribution: Sakkarin Chirapongsathorn contributed to the review of data for eligibility, evaluation of quality and data extraction; writing the manuscript, data analysis, authorship. Tongluk Teerasarntipan contributed to the review of data for eligibility and data extraction, evaluation of quality. Krit Tipchaichatta contributed to the review of data for eligibility and data extraction, drafting the manuscript. Tanita Suttichaimongkol, Naichaya Chamroonkul, Chalermrat Bunchorntavakul, Sith Siramolpiwat, Siwaporn Chainuvati, Abhasnee Sobhonslidsuk, and Apinya Leerapun contributed to the data extraction. Teerha Piratvisuth, Wattana Sukeepaisarnjaroen, and Tawesak Tanwandee contributed to the supervising and study concept.

Liver disease remains a major critical challenge in Thailand due to viral hepatitis. Clinical management requires close monitoring of liver fibrosis severity. Non-invasive testing is an attractive method for probing of disease progression. Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel serum marker for fibrosis staging. The current study evaluates the marker among healthy donors and hepatitis C (HCV) patients. 100 HCV subjects were evaluated by liver biopsy. These patients had varying fibrosis severity based on METAVIR scores. Healthy donors were confirmed based on normal liver functions tests. Comparisons of M2BPGi levels among different study groups were performed and the effectiveness was evaluated using receiver operating characteristics (ROC) curves. Using liver biopsy as the reference standard, median M2BPGi levels in HCV cases were 0.74, 1.38 and 2.88 COI for F0-1, F2 and > F3 cases respectively. In healthy donors, the baseline values ranged 0.1–0.24 COI and statistically lower than liver disease cases profiled using M2BPGi. ROC analysis demonstrated superior results for M2BPGi levels among diseased populations and healthy controls. AUROC was determined at 0.983. Comparing with other non-invasive tests, M2BPGi showed a positive linear trend that indicated a strong match to existing methodologies. M2BPGi addresses a critical need in the management of liver disease by providing straightforward means to probe fibrosis severity. In this study, we found significant differences between hepatitis C and healthy subjects and established the background level in healthy donors.

Background & objectives Cirrhosis patients with worsening of the liver function are defined as acute decompensation (AD) and those who develop extrahepatic organ failure are defined as acute-on-chronic liver failure (ACLF). Both AD and ACLF have an extremely poor prognosis. However, information regarding prognostic predictors is still lacking in Asian populations. We aimed to identify prognostic factors for 30-day and 90-day mortality in cirrhosis patients who develop AD with or without ACLF. Methods We included 9 tertiary hospitals from Thailand in a retrospective observational study enrolling hospitalized cirrhosis patients with AD. ACLF was diagnosed according to the EASL-CLIF criteria, which defined as AD patients who have kidney failure or a combination of at least two non-kidney organ failure. Outcomes were clinical parameters and prognostic scores associated with mortality evaluated at 30 days and 90 days. Results Between 2015 and 2020, 602 patients (301 for each group) were included. The 30-day and 90-day mortality rates of ACLF vs. AD were 57.48% vs. 25.50% (p<0.001) and 67.44% vs. 32.78% (p<0.001), respectively. For ACLF patients, logistic regression analysis adjusted for demographic data, and clinical information showed that increasing creatinine was a predictor for 30-day mortality (p = 0.038), while the CLIF-C OF score predicted both 30-day (p = 0.018) and 90-day (p = 0.037) mortalities, achieving the best discriminatory power with AUROCs of 0.705 and 0.709, respectively. For AD patients, none of the parameters was found to be significantly associated with 30-day mortality, while bacterial infection, CLIF-AD score and Child-Turcotte-Pugh score were independent parameters associated with 90-day mortality, with p values of 0.041, 0.024 and 0.024. However, their predictive performance became nonsignificant after adjustment by multivariate regression analysis. Conclusions Regarding Thai patients, the CLIF-C OF score was the best predictor for 30-day and 90-day mortalities in ACLF patients, while appropriate prognostic factors for AD patients remained inconclusive.