Sustained Virologic Response Prevents the Development of Esophageal Varices in Compensated, Child-Pugh Class A Hepatitis C Virus-Induced Cirrhosis. A 12-Year Prospective Follow-up Study

被引:143
作者
Bruno, Savino [1 ]
Crosignani, Andrea
Facciotto, Corinna [1 ]
Rossi, Sonia [1 ]
Roffi, Luigi [2 ]
Redaelli, Alessandro [3 ]
de Franchis, Roberto [4 ,5 ]
Almasio, Piero Luigi [6 ]
Maisonneuve, Patrick [7 ]
机构
[1] AO Fatebenefratelli & Oftalm, Dept Internal Med, Milan, Italy
[2] AO Sondrio, Sondrio, Italy
[3] AOS Gerardo, Endoscopy Unit, Monza, Italy
[4] Osped Policlin, Gastroenterol & Gastrointestinal Endoscopy Unit, Milan, Italy
[5] Univ Milan, Dept Med Sci, Milan, Italy
[6] Univ Palermo, Gastroenterol & Hepatol Unit, Palermo, Italy
[7] European Inst Oncol, Div Epidemiol & Biostat, Milan, Italy
关键词
VENOUS-PRESSURE GRADIENT; HEPATOCELLULAR-CARCINOMA; NATURAL-HISTORY; ADVANCED FIBROSIS; LIVER; DIAGNOSIS; MORTALITY; SURVIVAL; THERAPY; RISK;
D O I
10.1002/hep.23528
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
The incidence of de novo development of esophageal varices (EV) in patients with compensated liver cirrhosis has been determined by few studies in the short term and never in the long term. The aims of the present study were to determine the incidence and the risk factors associated with the development of EV and to assess whether antiviral treatment and achievement of sustained virologic response (SVR) may prevent de novo EV development in patients with HCV-induced cirrhosis. We studied 218 patients with compensated EV-free, HCV-induced cirrhosis consecutively enrolled between 1989 and 1992 at three referral centers in Milan, Italy. Endoscopic surveillance was performed at 3-year intervals according to international guidelines. SVR was defined as undetectable serum HCV-RNA 24 weeks after treatment discontinuation. During a median follow-up of 11.4 years, 149/218 (68%) patients received antiviral treatment and 34 (22.8%) achieved SVR. None of the SVR patients developed EV compared with 22 (31.8%) of the 69 untreated subjects (P<0.0001) and 45 (39.1%) of the 115 non-SVR patients (P < 0.0001). On multivariate analysis, HCV genotype 1b (hazard ratio [HR] 2.40; 95% confidence interval [CI] 1.17-4.90) and baseline model for end-stage liver disease (MELD) score (HR 1.20; 95% CI 1.07-1.35 for 1 point increase) were independent predictors of EV. Conclusion: In the long term, the achievement of SVR prevents the development of EV in patients with compensated HCV-induced cirrhosis. Therefore, in these patients, endoscopic surveillance can be safely delayed or avoided. Genotype 1b infection and MELD score identify the subset of patients at higher risk of EV development who need tailored endoscopic surveillance. (HEPATOLOGY 2010;51:2069-2076)
引用
收藏
页码:2069 / 2076
页数:8
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