Liver Flukes and Bile Duct Cancer

Table of Contents

1. What the Presentation Said
2. The Asian Liver Flukes and Where They Live
3. Raw Fish Dishes and How Infection Happens
4. Why These Flukes Are Classed as a Cause of Cancer
5. How a Fluke Can Lead to Bile Duct Cancer
6. Granulin: A Growth Factor Made by the Fluke
7. Praziquantel, Clearing the Infection and Reinfection
8. Ultrasound Screening in Northeast Thailand
9. Health Education and Community Control
10. How the Claim Compares With the Research
11. What Is Not Known
12. Connections
13. Key Research Papers
14. Featured Videos

What the Presentation Said

The presentation, a 2026 webinar given by the medical director of an integrative cancer clinic, did not name liver flukes. It made a general case that parasites help cause cancer, and liver flukes are the best-studied test of that case. The points relevant to this page were:

• that parasites are part of the tumour microenvironment — the mix of cells, blood vessels and signals that surrounds a tumour;
• that cancer is an inflammatory disease, and that infection with parasites starts a chain of chronic inflammation, oxidative stress (damage from reactive oxygen molecules), suppression of the immune system and epigenetic change (changes in which genes are switched on, without a change in the DNA code), leading to DNA damage and the activation of cancer genes — a process the speaker called parasite-driven oncogenesis;
• that parasites release secretions that distort the signals between cells and help create the conditions in which a tumour forms;
• that parasites settle above all in the gut and the liver, and from there can travel to other organs;
• that parasites carry bacteria, viruses and heavy metals with them;
• that sushi, pork and undercooked meat are sources of parasites, and that people who eat sushi or undercooked meat, travel, or live in warm climates were described as candidates for a parasite cleanse once or twice a year.

The speaker did not cite a specific study for the inflammation-to-cancer chain. The sections below report what the research on the two Asian liver flukes shows on each of these points.

The Asian Liver Flukes and Where They Live

A fluke is a flat, leaf-shaped parasitic worm (a trematode). Three closely related flukes live in the bile ducts of people: Clonorchis sinensis in eastern Asia, Opisthorchis viverrini in southeast Asia and Opisthorchis felineus in eastern Europe and Siberia (Qian and colleagues, 2024). The bile ducts are the small tubes that carry bile from the liver to the gut; the adult worms attach to their lining and can live there for many years.

The life cycle

• Eggs pass out in the faeces of an infected person or animal (cats and dogs are reservoirs) and reach fresh water.
• Freshwater snails swallow the eggs, and the larvae multiply inside the snail.
• Free-swimming larvae (cercariae) leave the snail and burrow into the skin and muscle of freshwater fish, where they form cysts called metacercariae.
• A person who eats the raw or undercooked fish swallows the cysts. The young flukes leave the cyst in the small intestine and move up into the bile ducts, drawn by bile (Na and colleagues, 2020).

How many people are infected

• An estimated 15 to 20 million people carry Clonorchis sinensis, mainly in China, Korea and Vietnam (Na and colleagues, 2020).
• Up to 6 million people in Thailand were estimated to carry Opisthorchis viverrini; the fluke is also common in Laos, Cambodia and Vietnam (Chamadol and colleagues, 2017).
• The reviews describe the life-threatening disease as developing over several decades of chronic infection, which helps explain why these infections attract less attention than other neglected diseases (Qian and colleagues, 2024).

Most infections cause few or no symptoms for years. Heavy or long-lasting infection is linked to inflammation of the bile ducts, gallstones, cholangitis (infection of the bile ducts), periductal fibrosis (scarring around the ducts) and, in a minority of people, cholangiocarcinoma (Na and colleagues, 2020; Qian and colleagues, 2024).

Raw Fish Dishes and How Infection Happens

All three flukes reach people through freshwater fish, most often small fish of the carp family. The reviews name dishes of raw fish fillet, raw-fish "sashimi" and fish congee in the Clonorchis areas of eastern Asia (Na and colleagues, 2020). The presentation spoke of sushi in general; the published research on these flukes concerns raw or undercooked freshwater fish, and the parasites of sea fish are covered on the page about food sources of parasites.

Koi pla in northeast Thailand

In northeast Thailand the key dish is koi pla, a salad of chopped raw fish. Studies there report how deeply the habit is rooted:

• In the regional screening cohort described below, 89.1% of the people screened said they had eaten uncooked fish, and 42.2% of those tested for the fluke were infected (Khuntikeo and colleagues, 2015).
• In a cohort of 5,375 people screened over three years, those who believed that adding lime juice or red ants to koi pla, or eating it with white whisky, would kill the parasites were 41% more likely to be infected (adjusted risk ratio 1.41, 95% confidence interval 1.03 to 1.94). People who believed early-stage cholangiocarcinoma could be cured were 57% more likely to be infected (Sornpom and colleagues, 2023). The authors describe these beliefs as misconceptions that raise infection risk.
• Studies of people treated for the infection found that many kept eating raw fish dishes afterwards, which leads to repeated infection (Thinkhamrop and colleagues, 2019).

Infection comes from cysts that are still alive in fish dishes that have not been safely prepared (Saengsawang and colleagues, 2016). The reviews describe the control of these flukes as a mix of treatment, education about eating habits and improved sanitation (Qian and colleagues, 2024).

Why These Flukes Are Classed as a Cause of Cancer

The International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization, classifies infection with Opisthorchis viverrini and infection with Clonorchis sinensis in Group 1, “carcinogenic to humans”. The 2009 International Agency for Research on Cancer review of biological agents confirmed both (Bouvard and colleagues, 2009). Before that review, Clonorchis was rated a probable cause and Opisthorchis viverrini a definite one (Watanapa and Watanapa, 2002). The evidence for Opisthorchis felineus was judged insufficient at that time, although later reviews suggest it may also be carcinogenic (Saltykova and colleagues, 2018).

What the classification rests on

• Where the cancer occurs. Cholangiocarcinoma is rare in most of the world, but northeast Thailand has the highest recorded rate: 135.4 cases per 100,000 men and 43.0 per 100,000 women a year in Khon Kaen Province. Most patients are found at a late stage, and five-year survival is below 10% (Khuntikeo and colleagues, 2015). The disease was reported to kill 20,000 or more people a year in northeast Thailand (Chamadol and colleagues, 2017; Saijuntha and colleagues, 2024).
• Studies in people. In Korea, people with clonorchiasis had about 4.7 times the odds of cholangiocarcinoma, and about 10% of the country's cholangiocarcinomas are believed to be caused by the fluke alone (Kim and Hong, 2025).
• Animal experiments. In hamsters, every animal given both Clonorchis sinensis and a nitrosamine chemical (N-nitrosodimethylamine) developed cholangiocarcinoma, while animals given either one alone did not (Kim and Hong, 2025). The authors read this as the fluke and nitrogen compounds acting together to push bile duct cells toward cancer.

Globally, infections with viruses, bacteria and parasites were estimated to contribute 17.8% of the cancer burden, and only a small share of that comes from worm infections; liver flukes and the bladder fluke Schistosoma haematobium are the three worms in Group 1 (Vennervald and Polman, 2009).

The link is not that infection equals cancer. The reviews describe cholangiocarcinoma as an infrequent outcome that develops in some infected people after decades of infection (Na and colleagues, 2020; Saijuntha and colleagues, 2024). Cholangiocarcinoma also occurs in people without fluke infection (Watanapa and Watanapa, 2002).

How a Fluke Can Lead to Bile Duct Cancer

The research describes several processes working together over many years. Much of the detail comes from hamsters (the standard laboratory model for these flukes) and from cells in culture, with supporting findings in human tumour tissue.

Repeated wounding and healing

The adult worms graze on the lining of the bile duct with their suckers. Each feeding site is a wound that heals and is wounded again, for years. The worms also release growth factors, digestive enzymes and extracellular vesicles (tiny packets of proteins and genetic material). Together with the chronic inflammation, these drive biliary hyperplasia (overgrowth of the duct lining), fibrosis and, eventually, malignant change (Smout and colleagues, 2024). One of the authors of that review holds a patent on a wound-healing peptide derived from the fluke, as the paper declares.

Inflammation and DNA damage

Inflamed tissue releases reactive oxygen and nitrogen molecules. In tumour and precancerous tissue from people with Opisthorchis-related cholangiocarcinoma, researchers found two markers of this kind of DNA damage, 8-oxodG and 8-nitroguanine (Murata, 2018). An older review lists chronic irritation, nitric oxide formation, the formation of nitrosamines inside the body, and activation of drug-metabolising enzymes as possible mechanisms (Watanapa and Watanapa, 2002).

A different genetic pattern

Sequencing of fluke-related cholangiocarcinomas found frequent mutations in TP53 (44%), KRAS (16.7%) and SMAD4 (16.7%), plus genes involved in packaging DNA and in cell signalling. The pattern differs from cholangiocarcinoma without a fluke, and the tumours also showed altered DNA methylation (an epigenetic mark) and inflammation-related gene activity (Jusakul and colleagues, 2015).

Effects on the immune setting of the tumour

In 251 patients with intrahepatic cholangiocarcinoma (cancer of the bile ducts inside the liver) in China, Clonorchis infection was associated with shorter overall survival and poorer response to immunotherapy. In the laboratory, tumour cells exposed to the fluke's secretions made more of a fat-building enzyme, and this was linked to immune cells that suppress the attack on the tumour. A drug blocking that enzyme reversed the suppression in mice (Xu and colleagues, 2024). This is the research version of the presentation's point that parasites shape the tumour microenvironment — shown here for one fluke and one cancer.

Bacteria travelling with the fluke

A community of bacteria, including Helicobacter species, lives with the flukes in the bile ducts. In Thailand, Helicobacter infection was more common in people with heavier fluke infections. In hamsters, the fluke changes the bacteria of the gut, and in people Opisthorchis felineus infection changes the bacteria found in bile (Saltykova and colleagues, 2018). A later review reports that more Helicobacter in fluke-infected patients was associated with bile duct inflammation, fibrosis and cell proliferation, while noting that the role of bacteria in this cancer is still unclear (Ketpueak and colleagues, 2020).

Granulin: A Growth Factor Made by the Fluke

One fluke secretion has been studied in detail: a granulin-like growth factor called Ov-GRN-1, released by Opisthorchis viverrini. Granulins are a family of proteins that make cells divide; humans make their own versions.

• In cell culture, short laboratory-made pieces of the fluke's granulin made a human bile duct cell line multiply (Bansal and colleagues, 2017), and the full protein at concentrations of 10 and 40 nanomolar stimulated human blood-vessel cells to form new vessel-like tubes (angiogenesis) (Haugen and colleagues, 2018). Tumours need new blood vessels to grow, and the authors describe angiogenesis as another hallmark of cancer shown by this fluke.
• In hamsters, researchers used the gene-editing tool CRISPR to knock out the granulin gene in the fluke. The edited flukes still settled in the bile ducts and grew into adults, but the hamsters had less overgrowth of the duct lining and less fibrosis (Arunsan and colleagues, 2019). This is direct evidence, in animals, that a single fluke secretion contributes to the damage that comes before cancer.

The same protein is also being studied the other way round: because it speeds wound repair in mice, short laboratory-made versions are being developed as possible wound-healing medicines (Bansal and colleagues, 2017; Haugen and colleagues, 2018). The overlap between wound healing and cancer growth is the central idea in this line of research.

So the presentation's point that parasite secretions distort cell signals has a documented, specific example in this fluke. The evidence is from cells and hamsters; the granulin has not been tested as a cause of cancer in people.

Praziquantel, Clearing the Infection and Reinfection

Praziquantel is the prescription medicine used against these flukes and the mainstay of control programmes (Qian and colleagues, 2024). The research shows that it clears the worms well, but that clearing them does not end the story.

How well it works

• In 108 people who came to France from Laos, Vietnam and Cambodia with Opisthorchis infection and could not be reinfected there, praziquantel at 25 mg per kg of body weight, three times in a single day, left every patient followed up free of eggs at 90 days. Side effects were mild and short-lived: tiredness, headache, drowsiness, nausea, stomach pain and aches (Ambroise-Thomas and colleagues, 1984).
• A urine test for fluke antigen became negative within four weeks of treatment in a Thai study (Worasith and colleagues, 2020).

Reinfection where raw fish is still eaten

• Of 457 treated villagers in northeast Thailand, 10.9% were infected again within 12 months; the only factor linked to reinfection was having used praziquantel before (Saengsawang and colleagues, 2016). The authors noted the risk of a cycle of infection, treatment and reinfection.
• Within 48 weeks of successful treatment, 16.8% were reinfected by stool test and 27.7% by urine antigen test (Worasith and colleagues, 2020).
• In the large Thai screening cohort, people who had taken praziquantel more than three times had higher odds of current infection than people who had never taken it (adjusted odds ratio 1.86, 95% confidence interval (CI) 1.18 to 2.93), a pattern the authors explain by continued raw-fish eating (Thinkhamrop and colleagues, 2019).
• Five years after treatment, 10.8% of 418 people examined were infected again (Saengsawang and Buakate, 2024).

Scarring that persists after the worms are gone

In Khon Kaen, 785 infected people with advanced periductal fibrosis on ultrasound were invited to yearly ultrasound for five years after praziquantel. More than a third (37.5%) still had or relapsed into advanced fibrosis, and five suspected cholangiocarcinomas were seen during follow-up (Mairiang and colleagues, 2021). The authors concluded that the cancer process may continue long after the fluke is cleared. In other words, treatment removes the worm, but damage already done can remain.

No trial was found that tested herbal or over-the-counter “parasite cleanses” against liver flukes, and no trial tested whether periodic treatment of people who are not exposed lowers their cancer risk. Decisions about cancer treatment and antiparasitic medicines belong with a clinician.

Ultrasound Screening in Northeast Thailand

Because cholangiocarcinoma is usually found too late for surgery, Thailand began large-scale screening of people at high risk.

• The Cholangiocarcinoma Screening and Care Program (CASCAP) is a prospective cohort that offers at least yearly abdominal ultrasound to people from high-risk areas, with a separate registry of patients. When it was described, 85,927 people had enrolled in screening and 2,661 patients with cholangiocarcinoma in the patient cohort (Khuntikeo and colleagues, 2015).
• To read the huge number of scans, the programme set up teleconsultation: ultrasound images are sent to a server and reviewed by expert radiologists, who refer suspected cases for computed tomography (CT) or magnetic resonance imaging (MRI). By 2017, 250,000 people had been screened and 2,000 cases of cholangiocarcinoma diagnosed, with plans to extend the system to Laos, Cambodia and Vietnam (Chamadol and colleagues, 2017).
• In the screened population, 38.7% had some abnormality of the liver or bile ducts on ultrasound (a liver mass, widened bile ducts or periductal fibrosis), most often in men over 60 and in districts along the Chi, Mun and Songkram rivers (Thinkhamrop and colleagues, 2020).

The programme's stated aim is earlier diagnosis that allows curative surgery. The papers cited here describe the design and early findings; they do not yet report whether screening has lowered deaths from cholangiocarcinoma. Long-term survival after surgery for fluke-related cholangiocarcinoma was reported to be similar to that for cholangiocarcinoma without a fluke (Watanapa and Watanapa, 2002).

Researchers are also searching for blood, bile and tissue markers that could detect the cancer earlier, but a 2026 review reports that most candidates are still at the laboratory stage, tested in small groups, without large prospective validation (Huang and colleagues, 2026).

Health Education and Community Control

Thailand's control efforts since 1984 have centred on health education (Khuntikeo and colleagues, 2015). The research on how well this works is mixed but encouraging.

• Education programmes. A 2025 systematic review and meta-analysis of 13 experimental and before-and-after studies in Thailand found that health education based on self-efficacy (a person's belief that they can change a habit) improved knowledge, self-efficacy and reported behaviour. The studies varied widely (high heterogeneity), and they measured knowledge and behaviour scores, not infection or cancer rates (Busabong and colleagues, 2025).
• The Lawa model. At Lawa Lake in Khon Kaen Province, a programme combining treatment, health education designed with the community, changes to the local ecosystem and the involvement of village health volunteers was reported by its own researchers to cut fluke infection from about 60% to under 5% over 15 years. Infection in the local snails and fish became undetectable (Sripa and colleagues, 2025). This is a programme report without a comparison area, so it shows what happened in that district rather than proving which part of the programme caused the fall.
• School children. A 2024 review considers a health education package aimed at school children more useful as a long-term solution, with praziquantel serving short-term control (Saijuntha and colleagues, 2024).

The World Health Organization includes the foodborne trematodes, among them these flukes, in its neglected tropical disease targets for 2030 (Kim and Hong, 2025). Research tools include fish vaccines and new drugs such as tribendimidine, a medicine registered in China for other worms that shows activity against both liver flukes (Qian and colleagues, 2024).

How the Claim Compares With the Research

What the research supports

• Parasites can cause cancer. For Opisthorchis viverrini and Clonorchis sinensis this is established: both are International Agency for Research on Cancer Group 1 carcinogens for cholangiocarcinoma (Bouvard and colleagues, 2009).
• Chronic inflammation, oxidative damage and epigenetic change. Published studies report each of these in fluke-related cholangiocarcinoma: DNA-damage markers in human tissue, a distinct mutation and methylation pattern, and inflammation as the central driver (Murata, 2018; Jusakul and colleagues, 2015).
• Parasite secretions alter cell signals. The fluke's granulin makes cells grow and blood vessels form in culture, and knocking out its gene reduces bile duct damage in hamsters (Haugen and colleagues, 2018; Arunsan and colleagues, 2019).
• Parasites in the tumour microenvironment and immune suppression. In human intrahepatic cholangiocarcinoma, Clonorchis infection was associated with a more immune-suppressed tumour and poorer survival (Xu and colleagues, 2024).
• Parasites carry bacteria. Bacteria, including Helicobacter, live with the flukes in the bile ducts (Saltykova and colleagues, 2018).
• The liver as a site of parasites. These flukes live in the bile ducts of the liver.
• Raw or undercooked fish as a source. Supported, specifically for raw or undercooked freshwater fish.

What it supports only in part

• The general chain from “parasites” to “cancer”. The evidence is strong for a handful of specific parasites in specific organs, not for parasites in general. Only three worms are in International Agency for Research on Cancer Group 1 (Vennervald and Polman, 2009). Most people with liver flukes never develop cancer, and the cancer takes decades.
• Sushi. The liver-fluke research concerns freshwater fish dishes such as koi pla, raw fillets and congee, not sushi as usually eaten in Western countries.

What it does not support or has not tested

• Twice-yearly cleanses. No study was found that tested a routine parasite cleanse in people without exposure, or tested herbal cleanses against liver flukes. The tested treatment is praziquantel, and in endemic areas the studies show high reinfection when raw fish is still eaten, along with bile duct scarring that can persist after the worms are cleared (Mairiang and colleagues, 2021).
• Treating the parasite reverses the cancer risk. No study found shows that clearing the fluke prevents cancer once damage is established; the five-year follow-up suggests the process can continue (Mairiang and colleagues, 2021).
• Heavy metals carried by the flukes. No research on heavy metals in human liver flukes was found for this page.

What Is Not Known

• Why only some infected people get cancer. Infection intensity, duration, nitrosamines in the diet, alcohol, bacteria and inherited genes are all studied, but no test predicts who will develop cholangiocarcinoma.
• Whether screening saves lives. The Thai screening programme reports large numbers screened and cancers found; a measured fall in deaths has not been reported in the papers cited here.
• Early markers. Blood and bile markers for early cancer remain at the laboratory stage (Huang and colleagues, 2026).
• The human role of granulin and other secretions. The knockout evidence is from hamsters; the importance of each secretion in people is not known.
• The role of bacteria. Whether Helicobacter and other bile bacteria cause cancer alongside the fluke, or simply live there, is unsettled (Ketpueak and colleagues, 2020).
• Opisthorchis felineus. How much the eastern European and Siberian fluke raises cancer risk is less well measured than for the Asian species.
• The true size of the problem. Reviews list mapping the current spread, understanding transmission and estimating the disease burden as pressing research needs (Qian and colleagues, 2024).

Connections

• Cancer and Parasites
• Parasites Classified as Cancer-Causing Agents
• How Parasites Can Drive Cancer: The Mechanisms
• Schistosoma and Bladder Cancer
• Food Sources of Parasites: Sushi, Pork and Undercooked Meat
• Clonorchis sinensis (Chinese Liver Fluke)
• Cholangiocarcinoma
• Fasciola (Liver Fluke)
• Liver Cancer
• Gallbladder Cancer
• Acute Cholangitis
• Praziquantel Treatment
• Helicobacter Pylori
• Liver Function Tests
• Parasites

Key Research Papers

1. Qian M-B, Keiser J, Utzinger J, et al. Clonorchiasis and opisthorchiasis: epidemiology, transmission, clinical features, morbidity, diagnosis, treatment, and control. Clinical microbiology reviews. 2024;37(1):e0000923. PubMed PMID: 38169283
2. Bouvard V, Baan R, Straif K, et al. A review of human carcinogens—Part B: biological agents. The Lancet Oncology. 2009;10(4):321-2. PubMed PMID: 19350698
3. Vennervald BJ, Polman K. Helminths and malignancy. Parasite immunology. 2009;31(11):686-96. PubMed PMID: 19825108
4. Watanapa P, Watanapa WB. Liver fluke-associated cholangiocarcinoma. The British journal of surgery. 2002;89(8):962-70. PubMed PMID: 12153620
5. Smout MJ, Laha T, Chaiyadet S, et al. Mechanistic insights into liver-fluke-induced bile-duct cancer. Trends in parasitology. 2024;40(12):1183-1196. PubMed PMID: 39521672
6. Kim EM, Hong ST. Clonorchis sinensis and Cholangiocarcinoma. Journal of Korean medical science. 2025;40(16):e145. PubMed PMID: 40296827
7. Na BK, Pak JH, Hong SJ. Clonorchis sinensis and clonorchiasis. Acta tropica. 2020;203:105309. PubMed PMID: 31862466
8. Murata M. Inflammation and cancer. Environmental health and preventive medicine. 2018;23(1):50. PubMed PMID: 30340457
9. Jusakul A, Kongpetch S, Teh BT. Genetics of Opisthorchis viverrini-related cholangiocarcinoma. Current opinion in gastroenterology. 2015;31(3):258-63. PubMed PMID: 25693006
10. Xu L, Zhang Y, Lin Z, et al. FASN-mediated fatty acid biosynthesis remodels immune environment in Clonorchis sinensis infection-related intrahepatic cholangiocarcinoma. Journal of hepatology. 2024;81(2):265-277. PubMed PMID: 38508240
11. Saltykova IV, Petrov VA, Brindley PJ. Opisthorchiasis and the Microbiome. Advances in parasitology. 2018;102:1-23. PubMed PMID: 30442306
12. Ketpueak T, Thiennimitr P, Apaijai N, et al. Association of Chronic Opisthorchis Infestation and Microbiota Alteration on Tumorigenesis in Cholangiocarcinoma. Clinical and translational gastroenterology. 2020;12(1):e00292. PubMed PMID: 33464733
13. Haugen B, Karinshak SE, Mann VH, et al. Granulin Secreted by the Food-Borne Liver Fluke Opisthorchis viverrini Promotes Angiogenesis in Human Endothelial Cells. Frontiers in medicine. 2018;5:30. PubMed PMID: 29503819
14. Arunsan P, Ittiprasert W, Smout MJ, et al. Programmed knockout mutation of liver fluke granulin attenuates virulence of infection-induced hepatobiliary morbidity. eLife. 2019;8:e41463. PubMed PMID: 30644359
15. Saijuntha W, Sithithaworn P, Wangboon C, et al. Liver Flukes: Clonorchis and Opisthorchis. Advances in experimental medicine and biology. 2024;1454:239-284. PubMed PMID: 39008268
16. Bansal PS, Smout MJ, Wilson D, et al. Development of a Potent Wound Healing Agent Based on the Liver Fluke Granulin Structural Fold. Journal of medicinal chemistry. 2017;60(10):4258-4266. PubMed PMID: 28425707
17. Ambroise-Thomas P, Goullier A, Peyron F. Therapeutic results in opisthorchiasis with praziquantel in a reinfection-free environment in France. Arzneimittel-Forschung. 1984;34(9B):1177-9. PubMed PMID: 6542388
18. Saengsawang P, Promthet S, Bradshaw P. Reinfection by Opisthorchis Viverrini after Treatment with Praziquantel. Asian Pacific journal of cancer prevention. 2016;17(2):857-62. PubMed PMID: 26925692
19. Worasith C, Wangboon C, Kopolrat KY, et al. Application of urine antigen assay to evaluate outcomes of praziquantel treatment and reinfection in opisthorchiasis in northeast Thailand. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2020;114(10):751-761. PubMed PMID: 32735672
20. Thinkhamrop K, Khuntikeo N, Sithithaworn P, et al. Repeated praziquantel treatment and Opisthorchis viverrini infection: a population-based cross-sectional study in northeast Thailand. Infectious diseases of poverty. 2019;8(1):18. PubMed PMID: 30890188
21. Saengsawang P, Buakate P. Re- Infection Rate of Opisthorchis Viverrini Five Years After Treatment with Praziquantel in High-Risk Area: A Community-Based Study. Asian Pacific journal of cancer prevention. 2024;25(8):2679-2684. PubMed PMID: 39205565
22. Mairiang E, Laha T, Kaewkes S, et al. Hepatobiliary morbidities detected by ultrasonography in Opisthorchis viverrini-infected patients before and after praziquantel treatment: a five-year follow up study. Acta tropica. 2021;217:105853. PubMed PMID: 33548204
23. Khuntikeo N, Chamadol N, Yongvanit P, et al. Cohort profile: cholangiocarcinoma screening and care program (CASCAP). BMC cancer. 2015;15:459. PubMed PMID: 26054405
24. Chamadol N, Laopaiboon V, Srinakarin J, et al. Teleconsultation ultrasonography: a new weapon to combat cholangiocarcinoma. ESMO open. 2017;2(3):e000231. PubMed PMID: 29209530
25. Thinkhamrop K, Suwannatrai AT, Chamadol N, et al. Spatial analysis of hepatobiliary abnormalities in a population at high-risk of cholangiocarcinoma in Thailand. Scientific reports. 2020;10(1):16855. PubMed PMID: 33033306
26. Huang C, Wu Y, Wu A, et al. Clonorchis sinensis and cholangiocarcinoma: molecular mechanisms and biomarker advances. Parasite. 2026;33:16. PubMed PMID: 41919759
27. Busabong W, Woradet S, Songserm N. Impact of self-efficacy-based health education programs on behavior modification for Opisthorchis viverrini and cholangiocarcinoma prevention in Thailand: A systematic review and meta-analysis. Parasites, hosts and diseases. 2025;63(1):1-11. PubMed PMID: 40045676
28. Sripa B, Tangkawattana S, Sangnikul M. Integrated opisthorchiasis control through the EcoHealth/one health approach: 15 years of success and experiences with the Lawa model. One Health. 2025;20:101006. PubMed PMID: 40123921
29. Sornpom J, Suwannatrai AT, Suwannatrai K, et al. Influence of misconceptions and inappropriate eating behaviors on Opisthorchis viverrini infection among at-risk populations undergoing cholangiocarcinoma screening in Northeastern Thailand. Parasitology research. 2023;122(12):3131-3138. PubMed PMID: 37855971

PubMed Topic Searches

1. Opisthorchis viverrini and cholangiocarcinoma
2. Clonorchis sinensis and cholangiocarcinoma
3. Liver fluke granulin
4. Praziquantel and reinfection in opisthorchiasis
5. Cholangiocarcinoma ultrasound screening in Thailand

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