Prevalence and risk factors associated with esophageal varices in subjects with

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Gastrointest Endosc. 2006 Dec;64(6):855-864

The prevalence and risk factors associated with esophageal varices in

subjects with hepatitis C and advanced fibrosis.

Sanyal AJ, Fontana RJ, Di Bisceglie AM, Everhart JE, Doherty MC, Everson GT,

Donovan JA, Malet PF, Mehta S, Sheikh MY, Reid AE, Ghany MG, Gretch DR, The

Halt-C Trial Group.

Current affiliations: Division of Gastroenterology, Virginia Commonwealth

University Health System, Richmond, Virginia (Dr Sanyal); Division of

Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan

(Dr Fontana); Division of Gastroenterology and Hepatology, Saint Louis

University, School of Medicine, St. Louis, Missouri (Dr Di Bisceglie);

Division of Digestive Diseases and Nutrition, National Institute of Diabetes

and Digestive and Kidney Diseases, National Institutes of Health, Department

of Health and Human Services, Bethesda, land (Dr Everhart); New England

Research Institutes, Watertown, Massachusetts (Dr Doherty); Section of

Hepatology, Division of Gastroenterology and Hepatology, University of

Colorado School of Medicine, Denver, Colorado (Dr Everson); Division of

Gastrointestinal and Liver Diseases, Keck School of Medicine, University of

Southern California, Los Angeles, California (Dr Donovan); Division of

Digestive and Liver Diseases, University of Texas Southwestern Medical

Center, Dallas, Texas (Dr Malet); Gastroenterology Division, University of

Massachusetts Medical Center, Worcester, Massachusetts (Dr Mehta); Division

of Gastroenterology, University of California - Irvine, Irvine, California

(Dr Sheikh); Gastrointestinal Unit (Medical Services), Massachusetts General

Hospital and the Department of Medicine, Harvard Medical School, Boston,

Massachusetts (Dr Reid); Liver Diseases Branch, Division of Digestive

Diseases and Nutrition, National Institute of Diabetes and Digestive and

Kidney Diseases, National Institutes of Health, Department of Health and

Human Services, Bethesda, land (Dr Ghany); Departments of Laboratory

Medicine and Medicine, University of Washington, Seattle, Washington (Dr

Gretch), USA.

BACKGROUND: The factors predictive of the presence or the absence of

esophageal varices in hepatitis C virus (HCV) and advanced fibrosis have not

been defined. OBJECTIVES: To define the prevalence of esophageal varices and

the factors that are positively and negatively with such varices in

hepatitis C and advanced fibrosis. DESIGN: A prospective study of esophageal

varices and associated risk factors in subjects with hepatitis C and

advanced fibrosis. SETTING: Prerandomization data from the HALT-C (hepatitis

C long-term antiviral treatment against cirrhosis) clinical trial. PATIENTS

AND INTERVENTION: Subjects with bridging fibrosis or cirrhosis, who were

virologic nonresponders to treatment with pegylated interferon alpha 2a and

ribavirin, underwent endoscopy. RESULTS: Sixteen percent of subjects with

bridging fibrosis (95/598) and 39% of subjects with cirrhosis (164/418) had

varices (P < .0001); 2% of subjects with bridging fibrosis (13/598) and 11%

of those with cirrhosis (48/418) had medium or large varices. Subjects with

bridging fibrosis and varices had a significantly lower platelet count and

higher bilirubin and international normalized ratio (INR) compared with

those without varices, suggesting that the biopsy may have underestimated

the severity of fibrosis. A platelet count >150,000/mm(3) was associated

with a negative predictive value of 99% for esophageal varices. By logistic

regression modeling, African American race and female sex were protective,

whereas a lower platelet count and higher bilirubin and INR predicted

varices (c statistic, 0.758). CONCLUSIONS: The risk of having varices

increases with decreasing platelet counts, increasing bilirubin, and INR.

The probability of having medium or large varices at platelet counts

>150,000/mm(3) is negligible in this population.

PMID: 17140886 [PubMed - as supplied by publisher]

_________________________________________________________________

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[Guest guest]

Gastrointest Endosc. 2006 Dec;64(6):855-864

The prevalence and risk factors associated with esophageal varices in

subjects with hepatitis C and advanced fibrosis.

Sanyal AJ, Fontana RJ, Di Bisceglie AM, Everhart JE, Doherty MC, Everson GT,

Donovan JA, Malet PF, Mehta S, Sheikh MY, Reid AE, Ghany MG, Gretch DR, The

Halt-C Trial Group.

Current affiliations: Division of Gastroenterology, Virginia Commonwealth

University Health System, Richmond, Virginia (Dr Sanyal); Division of

Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan

(Dr Fontana); Division of Gastroenterology and Hepatology, Saint Louis

University, School of Medicine, St. Louis, Missouri (Dr Di Bisceglie);

Division of Digestive Diseases and Nutrition, National Institute of Diabetes

and Digestive and Kidney Diseases, National Institutes of Health, Department

of Health and Human Services, Bethesda, land (Dr Everhart); New England

Research Institutes, Watertown, Massachusetts (Dr Doherty); Section of

Hepatology, Division of Gastroenterology and Hepatology, University of

Colorado School of Medicine, Denver, Colorado (Dr Everson); Division of

Gastrointestinal and Liver Diseases, Keck School of Medicine, University of

Southern California, Los Angeles, California (Dr Donovan); Division of

Digestive and Liver Diseases, University of Texas Southwestern Medical

Center, Dallas, Texas (Dr Malet); Gastroenterology Division, University of

Massachusetts Medical Center, Worcester, Massachusetts (Dr Mehta); Division

of Gastroenterology, University of California - Irvine, Irvine, California

(Dr Sheikh); Gastrointestinal Unit (Medical Services), Massachusetts General

Hospital and the Department of Medicine, Harvard Medical School, Boston,

Massachusetts (Dr Reid); Liver Diseases Branch, Division of Digestive

Diseases and Nutrition, National Institute of Diabetes and Digestive and

Kidney Diseases, National Institutes of Health, Department of Health and

Human Services, Bethesda, land (Dr Ghany); Departments of Laboratory

Medicine and Medicine, University of Washington, Seattle, Washington (Dr

Gretch), USA.

BACKGROUND: The factors predictive of the presence or the absence of

esophageal varices in hepatitis C virus (HCV) and advanced fibrosis have not

been defined. OBJECTIVES: To define the prevalence of esophageal varices and

the factors that are positively and negatively with such varices in

hepatitis C and advanced fibrosis. DESIGN: A prospective study of esophageal

varices and associated risk factors in subjects with hepatitis C and

advanced fibrosis. SETTING: Prerandomization data from the HALT-C (hepatitis

C long-term antiviral treatment against cirrhosis) clinical trial. PATIENTS

AND INTERVENTION: Subjects with bridging fibrosis or cirrhosis, who were

virologic nonresponders to treatment with pegylated interferon alpha 2a and

ribavirin, underwent endoscopy. RESULTS: Sixteen percent of subjects with

bridging fibrosis (95/598) and 39% of subjects with cirrhosis (164/418) had

varices (P < .0001); 2% of subjects with bridging fibrosis (13/598) and 11%

of those with cirrhosis (48/418) had medium or large varices. Subjects with

bridging fibrosis and varices had a significantly lower platelet count and

higher bilirubin and international normalized ratio (INR) compared with

those without varices, suggesting that the biopsy may have underestimated

the severity of fibrosis. A platelet count >150,000/mm(3) was associated

with a negative predictive value of 99% for esophageal varices. By logistic

regression modeling, African American race and female sex were protective,

whereas a lower platelet count and higher bilirubin and INR predicted

varices (c statistic, 0.758). CONCLUSIONS: The risk of having varices

increases with decreasing platelet counts, increasing bilirubin, and INR.

The probability of having medium or large varices at platelet counts

>150,000/mm(3) is negligible in this population.

PMID: 17140886 [PubMed - as supplied by publisher]

_________________________________________________________________

WIN up to $10,000 in cash or prizes – enter the Microsoft Office Live

Sweepstakes http://clk.atdmt.com/MRT/go/aub0050001581mrt/direct/01/