Browsing by Author "de Alwis, J.P.N."

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Comparison of outcomes of patients with alcoholic cirrhosis and non-alcoholic steatohepatitis (NASH) related cirrhosis
(Sri Lanka Medical Association, 2010) Senanayake, S.M.; Hewawasam, S.P.; Kumarasena, R.S.; Kasturiratne, A.; de Alwis, J.P.N.; Nandasiri, A.S.D.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
OBJECTIVES: Most cases of cirrhosis in Sri Lanka are alcohol induced or cryptogenic. There is mounting evidence that a high proportion of cryptogenic cirrhosis is NASFI related. Although longterm outcome of NASH-cirrhosis is similar to Hepatitis C-cirrhosis, there has been no comparison with outcome of alcoholic cirrhosis. This study was done to compare long term outcomes of probable NASH-cirrhosis and alcoholic cirrhosis. METHODS: Patients with alcoholic cirrhosis and probable NASH-cirrhosis (cryptogenic cirrhosis with type-2 diabetes mellitus or obesity) whose clinical and follow-up details were available were identified from our cirrhosis database. Patients or their families were contacted to obtain the survival status and the date of death. The cause of death was obtained from death certificates and patient records. Outcomes of the two groups were compared using Kaplan-Meier survival curves. Results: Details of 185 patients (alcoholic cirrhosis 106, probable NASH-cirrhosis 79) were available for analysis. Mean survival times of alcoholic cirrhosis and NASH cirrhosis were 309.3 and 95.9 months respectively. There were 26 deaths (21 liver related) in the alcoholic cirrhosis group and 21 deaths (18 liver related) in the probable NASH cirrhosis group. Kaplan-Meier survival curves showed no significant difference in survival between the two groups (logrank test statistic 1.62, p = 0.2). Multivariate analysis using Cox proportional hazards model showed that the predictors of survival were Child-Pugh grade p<0.001) and age at diagnosis (p=0.005). CONCLUSION: The outcome of probable NASH-cirrhosis seems to be similar to that of alcoholic cirrhosis and deaths were mainly liver related.
Low-dose melatonin for sleep disturbances in early-stage cirrhosis: A randomized, placebo-controlled, cross-over trial
(John Wiley & Sons Australia Ltd, 2020) de Silva, A.P.; Niriella, M.A.; Ediriweera, D.S.; de Alwis, J.P.N.; Liyanage, I.K.; Ettickan, U.; Liyanapathirana, K.V.; Undugodage, C.; de Silva, H.A.; de Silva, H.J.
BACKGROUND AND AIM: Melatonin is used to treat sleep disturbances (SDs). The aim of this study was to investigate the safety and efficacy of low-dose melatonin for SDs in early-stage cirrhosis. METHODS: In a single-center, randomized, double-blind, placebo-controlled, cross-over clinical trial, patients with early-stage (Child-Turcotte-Pugh [CTP] class A or B) cirrhosis with SDs, without hepatic encephalopathy, were randomized to placebo or 3 mg of melatonin for 2 weeks. After 2 weeks, the patients were given a washout period of 1 week and crossed over to melatonin or placebo for a further 2 weeks. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to measure sleep quality and daytime sleepiness, respectively. Analysis of results was based on intention to treat, and linear mixed-effect models were used to evaluate the effect of melatonin. Analysis was conducted using R-programming language 3.5.1. RESULTS: Seventy-one patients were recruited (mean age: 61.9 ± 8.7 years, males: 46 [64.8%], and CTP Class A = 52 [73.2%] and Class B = 19 [26.8%]). Sixty patients completed the study (mean age: 61.7 ± 8.8 years, males: 40 [66.6%], and CTP Class A = 45 [75.0%] and Class-B = 15 [25.0%]). Two patients dropped out due to adverse events. Nine patients were lost to follow up. Patients given melatonin had a significantly lower PSQI and ESS compared to both pretreatment (P < 0.001) and postplacebo scores (P < 0.001). Incidence of adverse events was similar (two each of abdominal pain, one each of headache, one each of dizziness) in both groups. CONCLUSION: Melatonin seems safe and effective for use in patients with SDs in early-stage cirrhosis in the short term. However, larger and longer-term studies to assess efficacy and safety are required before its clinical use can be recommended. KEYWORDS: cirrhosis; clinical trial; melatonin; sleep disturbances; treatment.
Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study
(Biomed Central, 2012) Senanayake, S.M.; Niriella, M.A.; Weerasinghe, S.K.; Kasturiratne, A.; de Alwis, J.P.N.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
BACKGROUND: There is no recent data addressing the long term survival of cirrhosis patients without transplantation, but with the availability of optimal pharmacological and endoscopic therapies. We compared the long term transplant free survival of alcoholic (AC) and cryptogenic (CC) cirrhosis patients in a setting where liver transplantation was, until very recently, not available. AC and CC patient details were extracted from our database, maintained since 1995. For those who had not attended clinics within the past 4 weeks, the patient or families were contacted to obtain survival status. If deceased, cause of death was ascertained from death certificates and patient records. Survival was compared using Kaplan-Meier curves. RESULTS: Complete details were available in 549/651 (84.3%) patients (AC 306, CC 243). Mean follow up duration (SD) (months) was 29.9 (32.6). 82/96 deaths (85.4%) among AC and 80/94 deaths (85.1%) among CC were liver related. Multivariate analysis showed age at diagnosis and Child's class predicted overall survival among all groups. The median survival in Child's class B and C were 53.5 and 25.3 months respectively. Survival was similar among AC and CC. Among AC survival was improved by abstinence [HR = 0.63 (95% CI: 0.40-1.00)] and was worse with diabetes [HR=1.59 (95% CI: 1.02- 2.48)] irrespective of alcohol status. CONCLUSIONS: The overall survival of AC was similar to CC. Death in both groups were predominantly liver related, and was predicated by age at diagnosis and Child class. Among AC, presence of diabetes and non-abstinence from alcohol were independent predictors for poor survival.