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Factors that determine the development and progression of gastroesophageal varices in patients with chronic hepatitis C.

Abstract：

BACKGROUND & AIMS:We aimed to identify the incidence and predictors of de novo gastroesophageal variceal formation and progression in a large cohort of patients with chronic hepatitis C and advanced fibrosis. METHODS:All participants in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial were offered an endoscopy before treatment and again after 4 years. Patients with varices at baseline also had an endoscopy at 2 years. Baseline laboratory and clinical parameters were analyzed as predictors of de novo variceal formation and variceal progression. RESULTS:De novo varices developed in 157 of the 598 (26.2%) patients. Most of the new varices were small (76.4%) and only 1% of patients developed variceal hemorrhage. The likelihood of developing varices was associated with subject race (Hispanic > Caucasian > African American; P = .0005), lower baseline levels of albumin (P = .051), and higher levels of hyaluronic acid (P < .001) with an area under the receiver operating characteristic curve = .70. Among 210 patients with existing gastroesophageal varices, 74 (35.2%) had variceal progression or bleeding during follow-up. Patients with higher baseline ratios of serum aspartate/alanine aminotransferase (P = .028) and lower platelet counts (P = .0002) were at greatest risk of variceal progression (area under the receiver operating characteristic = .72). Prolonged, low-dose peginterferon-alpha2a therapy and beta-blockers did not influence the risk of developing new or enlarging varices. CONCLUSION:Development of varices in patients with chronic hepatitis C is associated with patient race/ethnicity and laboratory markers of disease severity. Prolonged low-dose peginterferon-alpha2a therapy and beta-blockers do not reduce the risk of variceal development or progression.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Fontana RJ,Sanyal AJ,Ghany MG,Lee WM,Reid AE,Naishadham D,Everson GT,Kahn JA,Di Bisceglie AM,Szabo G,Morgan TR,Everhart JE,HALT-C Trial Group.

doi

10.1053/j.gastro.2010.02.058

subject

Has Abstract

pub_date

2010-06-01 00:00:00

pages

2321-31, 2331.e1-2

issue

7

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(10)00334-3

journal_volume

138

pub_type

杂志文章,随机对照试验

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