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

March 10, 2010

Hepatology. 2010 Jan 27. [Epub ahead of print]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.Bruno S, Crosignani A, Facciotto C, Rossi S, Roffi L, Redaelli A, de

Franchis R, Almasio PL, Maisonneuve P.Department of Internal Medicine, A.O.

Fatebenefratelli e Oftalmico, Milan, Italy.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

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.PMID:

20196120 [PubMed - as supplied by publisher]

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