Publications by authors named "Omar Alshuwaykh"

6 Publications

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Trends in the Prevalence of Hepatitis C Virus Infection based on the Insurance Status in the United States from 2013 to 2018.

Liver Int 2021 Nov 24. Epub 2021 Nov 24.

Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States.

Background & Aims: With the recent improvement in the treatment of hepatitis C virus (HCV) infection, a better understanding of the infection burden is needed. We aimed to (1) estimate the trends in the national prevalence of HCV infection based on the type of health insurance coverage and (2) identify at-risk populations for HCV infection in the United States (US) general population.

Methods: Population-based analyses using the National Health and Nutrition Examination Survey (2013-2018) were performed with a focus on HCV infection. We analyzed the prevalence of HCV infection based on the health insurance status before the direct-acting antiviral (DAA) era (2013-2014) and during the DAA era (2015-2018).

Results: The age-adjusted prevalence of active HCV infection (HCV RNA [+]) was 0.92% (95% confidence interval [CI], 0.71%-1.19%) in the US non-institutionalized civilian population. While the prevalence of active HCV infection has remained stable, the prevalence of resolved HCV infection has increased after the introduction of DAA. In terms of health insurance coverage, the prevalence of active HCV infection decreased, and the prevalence of resolved HCV infection increased among individuals who had health insurance, especially private health insurance. The independent risk factors of active HCV infection were 40-69 years group, male, less than high school education, unmarried, below poverty status, being born in the US, history of blood transfusion, and not having private health insurance.

Conclusion: The burden of active HCV infection has decreased among individuals who had health insurance, especially private health insurance, during the DAA era.
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http://dx.doi.org/10.1111/liv.15113DOI Listing
November 2021

Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation.

Hepatol Commun 2021 03 27;5(3):516-525. Epub 2020 Dec 27.

Division of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USA.

Liver transplantation (LT) is definitive treatment for end-stage liver disease. This study evaluated factors predicting successful evaluation in patients transferred for urgent inpatient LT evaluation. Eighty-two patients with cirrhosis were transferred for urgent LT evaluation from January 2016 to December 2018. Alcohol-associated liver disease was the common etiology of liver disease (42/82). Of these 82 patients, 35 (43%) were declined for LT, 27 (33%) were wait-listed for LT, 5 (6%) improved, and 15 (18%) died. Psychosocial factors were the most common reasons for being declined for LT (49%). Predictors for listing and receiving LT on multivariate analysis included Hispanic race (odds ratio [OR], 1.89;  = 0.003), Asian race (OR, 1.52 = 0.02), non-Hispanic ethnicity (OR, 1.49 = 0.04), hyponatremia (OR, 1.38;  = 0.04), serum albumin (OR, 1.13 = 0.01), and Model for End-Stage Liver Disease (MELD)-Na (OR, 1.02 = 0.003). Public insurance (i.e., Medicaid) was a predictor of not being listed for LT on multivariate analysis (OR, 0.77 = 0.02). Excluding patients declined for psychosocial reasons, predictors of being declined for LT on multivariate analysis included Chronic Liver Failure Consortium (CLIF-C) score >51.5 (OR, 1.26 = 0.03), acute-on-chronic liver failure (ACLF) grade 3 (OR, 1.41 = 0.01), hepatorenal syndrome (HRS) (OR, 1.38 = 0.01), and respiratory failure (OR, 1.51 = 0.01). Predictors of 3-month mortality included CLIF-C score >51.5 (hazard ratio [HR], 2.52;  = 0.04) and intensive care unit (HR, 8.25 < 0.001). MELD-Na, albumin, hyponatremia, ACLF grade 3, HRS, respiratory failure, public insurance, Hispanic race, Asian race, and non-Hispanic ethnicity predicted liver transplant outcome. Lack of psychosocial support was a major reason for being declined for LT. The CLIF-C score predicted being declined for LT and mortality.
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http://dx.doi.org/10.1002/hep4.1644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917272PMC
March 2021

Current and future strategies for the treatment of chronic hepatitis C.

Clin Mol Hepatol 2021 Apr 3;27(2):246-256. Epub 2020 Dec 3.

Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Chronic hepatitis C infection is a major cause of liver disease and hepatocellular carcinoma worldwide. While hepatitis C has been treated for decades with some success, the introduction of direct acting antiviral agents has revolutionized the treatment of hepatitis C with finite, highly effective, well-tolerated therapy and there are few populations that cannot be successfully treated now or are complicated to manage. The World Health Organization has released elimination targets in an effort to eliminate viral hepatitis and reduce dramatically the morbidity and mortality caused by both viral hepatitis. While hepatitis C is straightforward to treat, it remains problematic to eliminate on a global scale. Diagnosis of hepatitis C remains the major gap in the cascade of care and numerous screening strategies will be required to reduce this gap. While historically, treatment of hepatitis C has been centralized, decentralized approaches will be required to diagnose, evaluate, and link to care the large population of individuals worldwide with hepatitis C across low-, middle-, and high-income countries. With the introduction of multiple pangenotypic treatment options and reduced cost for these therapies, assessment and treatment for those with hepatitis C has been simplified and made more accessible worldwide. There are multiple populations for whom care models are being developed and refined, including those when inject drugs, those who are incarcerated, those who present with sexually transmitted disease including the men who have sex with men population, amongst many others. While a vaccine for hepatitis C remains elusive these efforts continue. Multiple successful elimination efforts have been reported.
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http://dx.doi.org/10.3350/cmh.2020.0230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046635PMC
April 2021

Trends in mortality in hepatitis C infection and alcoholic liver disease based on drug overdose in the United States.

J Viral Hepat 2021 02 18;28(2):436-439. Epub 2020 Nov 18.

Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.

We examined trends in mortality from hepatitis C virus (HCV) infection and alcoholic liver disease (ALD) in the setting of drug overdose. Using US Census and national mortality records (2009-2018), we identified deaths with HCV infection, ALD and drug overdose. HCV-related mortality without drug overdose increased up to 2014, followed by a marked decrease. Mortality from HCV and drug overdose increased significantly. Whereas ALD-related mortality without drug overdose continued to rise, no significant trend from ALD with drug overdose was noted. HCV-related mortalities reduced after the introduction of DAA agents, while drug overdose-related mortality in HCV was constantly increased.
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http://dx.doi.org/10.1111/jvh.13435DOI Listing
February 2021

Early Impact of COVID-19 on Solid Organ Transplantation in the United States.

Transplantation 2020 11;104(11):2221-2224

Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA.

Background: The regional impact of coronavirus disease 2019 on solid organ transplantation in the United States has not been fully evaluated.

Methods: A retrospective analysis of month-to-month trends on waitlist additions, waitlist deaths, and transplant surgeries between all United Network for Organ Sharing (UNOS) regions was performed. A linear regression model trained on historical data was used to estimate anticipated transplantation volume.

Results: All UNOS regions reported a decrease in total waitlist additions and transplant surgeries. The largest decreases in total transplants were identified in regions 1, 2, 6, and 9, with regions 2, 7, 8, and 9 noting the largest decrease in waitlist additions. Six of the 11 regions noted increases in waitlist deaths, with UNOS regions 9, 1, and 2, all located within the Northeast, noting the highest percent increase in waitlist deaths at 170%, 89%, and 54%, respectively. The largest reductions in solid organ transplantation and waitlist deaths were seen in kidney and lung transplantation. Current transplantation volume is significantly lower than the low range of the 95% confidence interval derived from the linear regression model (2182 versus 3110; P < 0.05).

Conclusions: Significant decreases in total waitlist additions and transplant surgeries with increases in waitlist deaths were noted in the majority of US transplant domains. The impact was especially prevalent in areas with high burden of coronavirus disease 2019 infection. National and regional strategies aimed at minimizing disruptions in transplantation are needed.
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http://dx.doi.org/10.1097/TP.0000000000003391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406203PMC
November 2020

A Case of Heyde Syndrome with Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement.

Am J Case Rep 2018 Aug 7;19:924-926. Epub 2018 Aug 7.

Department of Gastroenterology, North Bay Medical Center, Fairfield, CA, USA.

BACKGROUND Heyde syndrome is the association between gastrointestinal (GI) bleeding from arteriovenous malformation (AVM) and aortic stenosis. The aim of this study was to review Heyde syndrome and to discuss the management of this condition. CASE REPORT A 56-year-old female with a history of severe aortic stenosis and recurrent GI bleeding secondary to small bowel AVM, presented for hospital admission with melena and maroon blood in her stool. The patient underwent esophagogastroduodenoscopy with push enteroscopy, full colonoscopy, and mesenteric angiogram with failure to identify any active bleeding sources. Her hemoglobin continued to drop, requiring daily transfusion of packed red blood cells (PRBCs). Von Willebrand factor (VWF) antigen was low at 37%, and VWF large multimers were low and consistent with acquired VWF disease. The patient was then transferred to a tertiary care center and underwent transcatheter aortic valve replacement. Two weeks after discharge, she presented again with an episode of melena, with hemoglobin of 7.6 gm/dL and hematocrit of 25.1%. She was transfused 4 units of PRBCs and monitored for 48 hours, and then discharged without further episodes of GI bleeding. At the 2-month follow-up, she had stable hemoglobin at 15.1 gm/dL without further episodes of GI bleeding. At the 6-month follow-up she showed stable hemoglobin at 14.3 gm/dL without further episodes of GI bleeding. CONCLUSIONS Physicians need to consider Heyde syndrome in patients with aortic stenosis and GI bleeding secondary to angiodysplasia. Physicians should also be attentive in patients with Heyde syndrome presenting with GI bleeding after undergoing aortic valve replacement, as GI bleeding might take time to resolve completely in these patients.
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http://dx.doi.org/10.12659/AJCR.911298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091341PMC
August 2018
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