Cross‐sectional study of Opisthorchis viverrini infection and cholangiocarcinoma in communities within a high‐risk area in northeast thailand

Abstract

We describe an innovative strategy to quantify risk of cancer associated with varying levels of exposure to chronic parasitic infection through the identification of asymptomatic cases of cholangiocarcinoma within a population-based survey of Opisthorchis viverrini infection. Stool samples from 12,311 adults over age 24 years from 85 villages in northeast Thailand were examined for intensity of liver fluke infection. People from varying egg count categories were selected for ultrasound examination to identify hepatobiliary disease. Fifteen preclinical cases of cholangiocarcinoma were diagnosed from a total of 1,807 people based on ultrasonographic evidence with confirmation by endoscopy where possible. The prevalence odds of the diagnosis of cholangiocarcinoma increased gradually within the light and moderate intensity groups. In contrast, sharply elevated prevalence odds [age-, sex- and locality-adjusted prevalence odds ratio (POR) 14.1, p < 0.05] were observed within the most heavily liver fluke-infected group compared with the uninfected group. Males were more frequently affected than females (crude POR 4.5), but after controlling for intensity of infection, age and locality, the magnitude and significance of this measurement was reduced. Our data clearly demonstrate a significant relationship between intensity of liver fluke infection and cholangiocarcinoma and a strikingly high prevalence of the disease among heavily infected males.

Cholangiocarcinoma: Modern advances in understanding a deadly old disease

“…The parasite persists and progressively accumulates in the biliary system for years leading to a chronic inflammatory response and increased risk of cholangiocarcinoma. In one endemic area the adjusted prevalence odds ration for cholangiocarcinoma was 14.1% (13). A likely distinct type of cholangiocarcinoma arises in the setting of fibropolycystic malformations of the biliary tree; indeed there is a 1% per year cumulative increase in cancer risk in patients with choledochal cysts.…”

Cytotoxicity, Toxicity, and Anticancer Activity of Zingiber Officinale Roscoe Against Cholangiocarcinoma

“…It is an uncommon adenocarcinoma which arises from the epithelial cells of the bile ducts anywhere along the intrahepatic and extrahepatic biliary tree excluding the papilla of Vater and the gall bladder (Mosconia et al, 2009). Opisthorchis viverrini (OV) infection is a high risk factor of CCA (Haswell-Elkins et al, 1994). The highest incidence rate in the world is observed in the northeast region of Thailand, where the prevalence of infection with OV is also highest (Haswell-Elkins et al, 1994;Sriamporn et al, 2004).…”

“…Opisthorchis viverrini (OV) infection is a high risk factor of CCA (Haswell-Elkins et al, 1994). The highest incidence rate in the world is observed in the northeast region of Thailand, where the prevalence of infection with OV is also highest (Haswell-Elkins et al, 1994;Sriamporn et al, 2004). The challenges posed by this often lethal biliary tract cancer are daunting, with conventional treatment options being limited and the only hope for longterm survival being that of complete surgical resection of the tumor.…”

Diversity of human intestinal helminthiasis in Lao PDR

“…[8][9][10] Moreover, O. viverrini is an established risk factor for cholangiocarcinoma; indeed, the highest incidence of cholangiocarcinoma in the world has been found in northeast Thailand, with >60% being attributed to O. viverrini. 9,11,12 In addition to O. viverrini, other food-borne trematodes with intestinal tropism occur in Lao PDR, the most prominent of which is Haplorchis spp. 13,14 Stool analysis of Lao patients treated for 'opisthorchiasis' in Czechoslovakia, as well as a recent survey conducted in the central and southern parts of Lao PDR, revealed that a significant number of patients suffered from opisthorchiasis and haplorchiasis concurrently.…”