Liver Fibrosis Clinical Trial
Official title:
Gastrointestinal, Hepatic and Biliary Sequelae of Frequent Ketamine Use: a Prospective Observational Study
30% of ketamine users complain of abdominal discomfort. Long-term ketamine use is associated with hepatotoxicity and pathologic changes to the biliary tract. Yet the prevalence of gastrointestinal and hepatobiliary pathologies in ketamine users has not been well-described. The investigators plan to recruit a large number of ketamine users based on referrals from different Psychiatry clusters in Hong Kong and to investigate the underlying cause of abdominal discomfort, describe the prevalence of different gastrointestinal and hepatobiliary pathologies and describe their long-term outcome.
The recreational use of psychotropic drugs has been increasing over the past 2 decades in
Hong Kong. Ketamine hydrochloride is currently one of the most popular recreational drugs in
Hong Kong, and its recreational use is also increasing in the United Kingdom and Europe.
Inhalation of ketamine could result in hallucinations, out-of-the-body experiences and
psychological dissociation, making it popular among young adults. One of the well-known side
effects of ketamine is bladder dysfunction, which is seen in one-quarter of chronic ketamine
users .
Ketamine has also been known to be associated with gastrointestinal symptoms. Colicky
epigastric / abdominal discomfort in ketamine users, known as "K-cramps", has been reported
in 33.3% of frequent ketamine users, and is the second-most common symptom of presentation
(21%) among ketamine users in the emergency department . Nonetheless, the underlying etiology
resulting in this abdominal discomfort remains poorly defined. A possible etiology is
intestinal motility disorders, since ketamine interferes with gastric motility. Another
possible cause could be ketamine-related cholangiopathy, which has been described in both
Asia and Western countries. Another possible cause could be ketamine-related liver
dysfunction, which is seen in 16% of ketamine users. Chronic ketamine hepatotoxicity is
associated with mitochondrial liver injury , and could result in bridging liver fibrosis.
We plan to recruit subjects from ketamine users seeking medical attention at substance abuse
clinics in different psychiatric clusters in Hong Kong. A screening log will be kept on the
total number of ketamine users attending different substance abuse clinics and the number of
potential subjects referred to our center.
Baseline sociodemographic information will be obtained. A standardized method will be used to
assess and quantify the degree of ketamine use, as well as the recreational use of other
psychotropic drugs (e.g. ecstasy, methamphetamine, marijuana etc.) and alcohol intake.
Subjects will then be assessed for the presence or absence of dyspepsia, biliary-type
abdominal pain, gastroparesis or other abdominal symptoms following standard criteria.
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