Interferon-induced thyroid dysfunction in chronic hepatitis C
Background: Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5–14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction. Methods: A retrospective analysis was performed on all patients tr...
Gespeichert in:
| Veröffentlicht in: | Journal of gastroenterology and hepatology 2009-06, Vol.24 (6), p.1017-1023 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1023 |
|---|---|
| container_issue | 6 |
| container_start_page | 1017 |
| container_title | Journal of gastroenterology and hepatology |
| container_volume | 24 |
| creator | Jamil, Khaleel M Leedman, Peter J Kontorinis, Nickolas Tarquinio, Lorenzo Nazareth, Saroja McInerney, Marion Connelly, Crystal Flexman, James Burke, Valerie Metcalf, Cecily Cheng, Wendy |
| description | Background: Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5–14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction.
Methods: A retrospective analysis was performed on all patients treated with interferon alpha (IFN) or pegylated interferon alpha (PEG‐IFN) ± ribavirin (RBV), who developed abnormal thyroid function tests (TFTs). These cases were compared with treatment‐matched controls to identify factors predictive of thyroid dysfunction. Statistical methods consisted of: χ2 test, Fischer's exact test, Welch's t‐test, and multivariate analysis.
Results: From a total of 511 patients, 45 cases with TD were identified (8.8%). Pegylated interferon alpha was associated with higher rates of TD than IFN (14.1% vs 6.0%, P = 0.0029). Female sex (OR 5.6, 95% CI 1.1–7) and Asian ethnicity (OR 2.7, 95% CI 1.4–22) were independent predictors of developing TD. Cytology was obtained in 13 patients: benign follicular pattern (8); thyroiditis (3); and normal (2). Thyroid peroxidase (TPO) antibodies (P = 0.004) and earlier onset of dysfunction (P = 0.03) were associated with need for treatment. Sixteen patients had persistent TD by the end of the follow‐up period, predicted by female sex, non‐Asian ethnicity, prior history of TD and TPO antibodies.
Conclusions: Pegylated interferon alpha, female sex and Asian ethnicity are independent risk factors for TD. Thyroid peroxidase antibodies and earlier TD within the course of IFN are associated with the requirement for treatment. Thyroid function tests should be monitored during and after IFN‐based therapy. The most common cytological finding is a benign follicular pattern. |
| doi_str_mv | 10.1111/j.1440-1746.2008.05690.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_733573033</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>733573033</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5330-e225a62989cc663e1d09f4ee85e794a49ffb5f8e189f4970df2c339db8eb4373</originalsourceid><addsrcrecordid>eNqNkEGPEyEYQInRuHX1L5i5qKcZPwYY4LAH02i72mhiNnoklPlIqe1MhZnY_nsZ29SbkQsE3gPyCCkoVDSPt9uKcg4llbypagBVgWg0VMdHZHY9eExmoKgoNaP6hjxLaQsAHKR4Sm6oBsFroWfk7r4bMHqMfVeGrh0dtsWwOcU-tEV7Sn7s3BD6rghd4TYZCq7Y4MEOYQipmD8nT7zdJXxxmW_Jw4f3D_NlufqyuJ-_W5VOMAYl1rWwTa2Vdq5pGNIWtOeISqDU3HLt_Vp4hVTlbS2h9bVjTLdrhWvOJLslb87XHmL_c8Q0mH1IDnc722E_JiMZE5IBY5l8_U8yx2qU4DSD6gy62KcU0ZtDDHsbT4aCmRqbrZlSminlpCnzp7E5ZvXl5Y1xvcf2r3iJmoFXF8AmZ3c-2s6FdOVqKqjQss7c3Zn7FXZ4-u8PmI-L5bTKfnn2QxrwePVt_GEayaQw3z8vzJJ_BaFW38wn9htJ16W1</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20068541</pqid></control><display><type>article</type><title>Interferon-induced thyroid dysfunction in chronic hepatitis C</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Jamil, Khaleel M ; Leedman, Peter J ; Kontorinis, Nickolas ; Tarquinio, Lorenzo ; Nazareth, Saroja ; McInerney, Marion ; Connelly, Crystal ; Flexman, James ; Burke, Valerie ; Metcalf, Cecily ; Cheng, Wendy</creator><creatorcontrib>Jamil, Khaleel M ; Leedman, Peter J ; Kontorinis, Nickolas ; Tarquinio, Lorenzo ; Nazareth, Saroja ; McInerney, Marion ; Connelly, Crystal ; Flexman, James ; Burke, Valerie ; Metcalf, Cecily ; Cheng, Wendy</creatorcontrib><description>Background: Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5–14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction.
Methods: A retrospective analysis was performed on all patients treated with interferon alpha (IFN) or pegylated interferon alpha (PEG‐IFN) ± ribavirin (RBV), who developed abnormal thyroid function tests (TFTs). These cases were compared with treatment‐matched controls to identify factors predictive of thyroid dysfunction. Statistical methods consisted of: χ2 test, Fischer's exact test, Welch's t‐test, and multivariate analysis.
Results: From a total of 511 patients, 45 cases with TD were identified (8.8%). Pegylated interferon alpha was associated with higher rates of TD than IFN (14.1% vs 6.0%, P = 0.0029). Female sex (OR 5.6, 95% CI 1.1–7) and Asian ethnicity (OR 2.7, 95% CI 1.4–22) were independent predictors of developing TD. Cytology was obtained in 13 patients: benign follicular pattern (8); thyroiditis (3); and normal (2). Thyroid peroxidase (TPO) antibodies (P = 0.004) and earlier onset of dysfunction (P = 0.03) were associated with need for treatment. Sixteen patients had persistent TD by the end of the follow‐up period, predicted by female sex, non‐Asian ethnicity, prior history of TD and TPO antibodies.
Conclusions: Pegylated interferon alpha, female sex and Asian ethnicity are independent risk factors for TD. Thyroid peroxidase antibodies and earlier TD within the course of IFN are associated with the requirement for treatment. Thyroid function tests should be monitored during and after IFN‐based therapy. The most common cytological finding is a benign follicular pattern.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/j.1440-1746.2008.05690.x</identifier><identifier>PMID: 19054259</identifier><language>eng</language><publisher>Melbourne, Australia: Blackwell Publishing Asia</publisher><subject>Adult ; autoimmune thyroid disease ; Biological and medical sciences ; Case-Control Studies ; Chi-Square Distribution ; Drug Therapy, Combination ; Endocrinopathies ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatitis C, Chronic - drug therapy ; hepatitis-C ; Human viral diseases ; Humans ; Infectious diseases ; interferon ; Interferon-alpha - adverse effects ; Interferon-alpha - therapeutic use ; Male ; Medical sciences ; Middle Aged ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Recombinant Proteins ; Retrospective Studies ; Ribavirin - adverse effects ; Ribavirin - therapeutic use ; Risk Factors ; Sex Factors ; Thyroid Diseases - chemically induced ; Thyroid Function Tests ; Thyroid. Thyroid axis (diseases) ; TPO antibodies ; Viral diseases ; Viral hepatitis ; Western Australia</subject><ispartof>Journal of gastroenterology and hepatology, 2009-06, Vol.24 (6), p.1017-1023</ispartof><rights>2008 The Authors. Journal compilation © 2008 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5330-e225a62989cc663e1d09f4ee85e794a49ffb5f8e189f4970df2c339db8eb4373</citedby><cites>FETCH-LOGICAL-c5330-e225a62989cc663e1d09f4ee85e794a49ffb5f8e189f4970df2c339db8eb4373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1440-1746.2008.05690.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1440-1746.2008.05690.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21515972$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19054259$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jamil, Khaleel M</creatorcontrib><creatorcontrib>Leedman, Peter J</creatorcontrib><creatorcontrib>Kontorinis, Nickolas</creatorcontrib><creatorcontrib>Tarquinio, Lorenzo</creatorcontrib><creatorcontrib>Nazareth, Saroja</creatorcontrib><creatorcontrib>McInerney, Marion</creatorcontrib><creatorcontrib>Connelly, Crystal</creatorcontrib><creatorcontrib>Flexman, James</creatorcontrib><creatorcontrib>Burke, Valerie</creatorcontrib><creatorcontrib>Metcalf, Cecily</creatorcontrib><creatorcontrib>Cheng, Wendy</creatorcontrib><title>Interferon-induced thyroid dysfunction in chronic hepatitis C</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background: Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5–14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction.
Methods: A retrospective analysis was performed on all patients treated with interferon alpha (IFN) or pegylated interferon alpha (PEG‐IFN) ± ribavirin (RBV), who developed abnormal thyroid function tests (TFTs). These cases were compared with treatment‐matched controls to identify factors predictive of thyroid dysfunction. Statistical methods consisted of: χ2 test, Fischer's exact test, Welch's t‐test, and multivariate analysis.
Results: From a total of 511 patients, 45 cases with TD were identified (8.8%). Pegylated interferon alpha was associated with higher rates of TD than IFN (14.1% vs 6.0%, P = 0.0029). Female sex (OR 5.6, 95% CI 1.1–7) and Asian ethnicity (OR 2.7, 95% CI 1.4–22) were independent predictors of developing TD. Cytology was obtained in 13 patients: benign follicular pattern (8); thyroiditis (3); and normal (2). Thyroid peroxidase (TPO) antibodies (P = 0.004) and earlier onset of dysfunction (P = 0.03) were associated with need for treatment. Sixteen patients had persistent TD by the end of the follow‐up period, predicted by female sex, non‐Asian ethnicity, prior history of TD and TPO antibodies.
Conclusions: Pegylated interferon alpha, female sex and Asian ethnicity are independent risk factors for TD. Thyroid peroxidase antibodies and earlier TD within the course of IFN are associated with the requirement for treatment. Thyroid function tests should be monitored during and after IFN‐based therapy. The most common cytological finding is a benign follicular pattern.</description><subject>Adult</subject><subject>autoimmune thyroid disease</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Chi-Square Distribution</subject><subject>Drug Therapy, Combination</subject><subject>Endocrinopathies</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>hepatitis-C</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>interferon</subject><subject>Interferon-alpha - adverse effects</subject><subject>Interferon-alpha - therapeutic use</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Recombinant Proteins</subject><subject>Retrospective Studies</subject><subject>Ribavirin - adverse effects</subject><subject>Ribavirin - therapeutic use</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Thyroid Diseases - chemically induced</subject><subject>Thyroid Function Tests</subject><subject>Thyroid. Thyroid axis (diseases)</subject><subject>TPO antibodies</subject><subject>Viral diseases</subject><subject>Viral hepatitis</subject><subject>Western Australia</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkEGPEyEYQInRuHX1L5i5qKcZPwYY4LAH02i72mhiNnoklPlIqe1MhZnY_nsZ29SbkQsE3gPyCCkoVDSPt9uKcg4llbypagBVgWg0VMdHZHY9eExmoKgoNaP6hjxLaQsAHKR4Sm6oBsFroWfk7r4bMHqMfVeGrh0dtsWwOcU-tEV7Sn7s3BD6rghd4TYZCq7Y4MEOYQipmD8nT7zdJXxxmW_Jw4f3D_NlufqyuJ-_W5VOMAYl1rWwTa2Vdq5pGNIWtOeISqDU3HLt_Vp4hVTlbS2h9bVjTLdrhWvOJLslb87XHmL_c8Q0mH1IDnc722E_JiMZE5IBY5l8_U8yx2qU4DSD6gy62KcU0ZtDDHsbT4aCmRqbrZlSminlpCnzp7E5ZvXl5Y1xvcf2r3iJmoFXF8AmZ3c-2s6FdOVqKqjQss7c3Zn7FXZ4-u8PmI-L5bTKfnn2QxrwePVt_GEayaQw3z8vzJJ_BaFW38wn9htJ16W1</recordid><startdate>200906</startdate><enddate>200906</enddate><creator>Jamil, Khaleel M</creator><creator>Leedman, Peter J</creator><creator>Kontorinis, Nickolas</creator><creator>Tarquinio, Lorenzo</creator><creator>Nazareth, Saroja</creator><creator>McInerney, Marion</creator><creator>Connelly, Crystal</creator><creator>Flexman, James</creator><creator>Burke, Valerie</creator><creator>Metcalf, Cecily</creator><creator>Cheng, Wendy</creator><general>Blackwell Publishing Asia</general><general>Wiley-Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200906</creationdate><title>Interferon-induced thyroid dysfunction in chronic hepatitis C</title><author>Jamil, Khaleel M ; Leedman, Peter J ; Kontorinis, Nickolas ; Tarquinio, Lorenzo ; Nazareth, Saroja ; McInerney, Marion ; Connelly, Crystal ; Flexman, James ; Burke, Valerie ; Metcalf, Cecily ; Cheng, Wendy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5330-e225a62989cc663e1d09f4ee85e794a49ffb5f8e189f4970df2c339db8eb4373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>autoimmune thyroid disease</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Chi-Square Distribution</topic><topic>Drug Therapy, Combination</topic><topic>Endocrinopathies</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatitis C, Chronic - drug therapy</topic><topic>hepatitis-C</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>interferon</topic><topic>Interferon-alpha - adverse effects</topic><topic>Interferon-alpha - therapeutic use</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Recombinant Proteins</topic><topic>Retrospective Studies</topic><topic>Ribavirin - adverse effects</topic><topic>Ribavirin - therapeutic use</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Thyroid Diseases - chemically induced</topic><topic>Thyroid Function Tests</topic><topic>Thyroid. Thyroid axis (diseases)</topic><topic>TPO antibodies</topic><topic>Viral diseases</topic><topic>Viral hepatitis</topic><topic>Western Australia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jamil, Khaleel M</creatorcontrib><creatorcontrib>Leedman, Peter J</creatorcontrib><creatorcontrib>Kontorinis, Nickolas</creatorcontrib><creatorcontrib>Tarquinio, Lorenzo</creatorcontrib><creatorcontrib>Nazareth, Saroja</creatorcontrib><creatorcontrib>McInerney, Marion</creatorcontrib><creatorcontrib>Connelly, Crystal</creatorcontrib><creatorcontrib>Flexman, James</creatorcontrib><creatorcontrib>Burke, Valerie</creatorcontrib><creatorcontrib>Metcalf, Cecily</creatorcontrib><creatorcontrib>Cheng, Wendy</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jamil, Khaleel M</au><au>Leedman, Peter J</au><au>Kontorinis, Nickolas</au><au>Tarquinio, Lorenzo</au><au>Nazareth, Saroja</au><au>McInerney, Marion</au><au>Connelly, Crystal</au><au>Flexman, James</au><au>Burke, Valerie</au><au>Metcalf, Cecily</au><au>Cheng, Wendy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interferon-induced thyroid dysfunction in chronic hepatitis C</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2009-06</date><risdate>2009</risdate><volume>24</volume><issue>6</issue><spage>1017</spage><epage>1023</epage><pages>1017-1023</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background: Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5–14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction.
Methods: A retrospective analysis was performed on all patients treated with interferon alpha (IFN) or pegylated interferon alpha (PEG‐IFN) ± ribavirin (RBV), who developed abnormal thyroid function tests (TFTs). These cases were compared with treatment‐matched controls to identify factors predictive of thyroid dysfunction. Statistical methods consisted of: χ2 test, Fischer's exact test, Welch's t‐test, and multivariate analysis.
Results: From a total of 511 patients, 45 cases with TD were identified (8.8%). Pegylated interferon alpha was associated with higher rates of TD than IFN (14.1% vs 6.0%, P = 0.0029). Female sex (OR 5.6, 95% CI 1.1–7) and Asian ethnicity (OR 2.7, 95% CI 1.4–22) were independent predictors of developing TD. Cytology was obtained in 13 patients: benign follicular pattern (8); thyroiditis (3); and normal (2). Thyroid peroxidase (TPO) antibodies (P = 0.004) and earlier onset of dysfunction (P = 0.03) were associated with need for treatment. Sixteen patients had persistent TD by the end of the follow‐up period, predicted by female sex, non‐Asian ethnicity, prior history of TD and TPO antibodies.
Conclusions: Pegylated interferon alpha, female sex and Asian ethnicity are independent risk factors for TD. Thyroid peroxidase antibodies and earlier TD within the course of IFN are associated with the requirement for treatment. Thyroid function tests should be monitored during and after IFN‐based therapy. The most common cytological finding is a benign follicular pattern.</abstract><cop>Melbourne, Australia</cop><pub>Blackwell Publishing Asia</pub><pmid>19054259</pmid><doi>10.1111/j.1440-1746.2008.05690.x</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0815-9319 |
| ispartof | Journal of gastroenterology and hepatology, 2009-06, Vol.24 (6), p.1017-1023 |
| issn | 0815-9319 1440-1746 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_733573033 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult autoimmune thyroid disease Biological and medical sciences Case-Control Studies Chi-Square Distribution Drug Therapy, Combination Endocrinopathies Female Gastroenterology. Liver. Pancreas. Abdomen Hepatitis C, Chronic - drug therapy hepatitis-C Human viral diseases Humans Infectious diseases interferon Interferon-alpha - adverse effects Interferon-alpha - therapeutic use Male Medical sciences Middle Aged Non tumoral diseases. Target tissue resistance. Benign neoplasms Recombinant Proteins Retrospective Studies Ribavirin - adverse effects Ribavirin - therapeutic use Risk Factors Sex Factors Thyroid Diseases - chemically induced Thyroid Function Tests Thyroid. Thyroid axis (diseases) TPO antibodies Viral diseases Viral hepatitis Western Australia |
| title | Interferon-induced thyroid dysfunction in chronic hepatitis C |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T07%3A00%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Interferon-induced%20thyroid%20dysfunction%20in%20chronic%20hepatitis%20C&rft.jtitle=Journal%20of%20gastroenterology%20and%20hepatology&rft.au=Jamil,%20Khaleel%20M&rft.date=2009-06&rft.volume=24&rft.issue=6&rft.spage=1017&rft.epage=1023&rft.pages=1017-1023&rft.issn=0815-9319&rft.eissn=1440-1746&rft_id=info:doi/10.1111/j.1440-1746.2008.05690.x&rft_dat=%3Cproquest_cross%3E733573033%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=20068541&rft_id=info:pmid/19054259&rfr_iscdi=true |