Factors That Determine the Development and Progression of Gastroesophageal Varices in Patients With Chronic Hepatitis C

Robert J. Fontana, Arun J. Sanyal, Marc G. Ghany, William M. Lee, Andrea E. Reid, Deepa Naishadham, Gregory T. Everson, Jeffrey A. Kahn, Adrian M. Di Bisceglie, G. Szabó, Timothy R. Morgan, James E. Everhart

Research output: Contribution to journalArticle

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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-α2a therapy and β-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-α2a therapy and β-blockers do not reduce the risk of variceal development or progression.

Original languageEnglish
JournalGastroenterology
Volume138
Issue number7
DOIs
Publication statusPublished - Jun 2010

Fingerprint

Varicose Veins
Chronic Hepatitis C
ROC Curve
Endoscopy
Fibrosis
Hemorrhage
Hyaluronic Acid
Therapeutics
Hepatitis C
Aspartate Aminotransferases
Alanine Transaminase
Platelet Count
Hispanic Americans
African Americans
Antiviral Agents
Albumins
Biomarkers
Incidence
Serum

Keywords

  • Cirrhosis
  • Esophagogastroduodenoscopy
  • Hyaluronic Acid
  • Portal Hypertension

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Fontana, R. J., Sanyal, A. J., Ghany, M. G., Lee, W. M., Reid, A. E., Naishadham, D., ... Everhart, J. E. (2010). Factors That Determine the Development and Progression of Gastroesophageal Varices in Patients With Chronic Hepatitis C. Gastroenterology, 138(7). https://doi.org/10.1053/j.gastro.2010.02.058

Factors That Determine the Development and Progression of Gastroesophageal Varices in Patients With Chronic Hepatitis C. / Fontana, Robert J.; Sanyal, Arun J.; Ghany, Marc G.; Lee, William M.; Reid, Andrea E.; Naishadham, Deepa; Everson, Gregory T.; Kahn, Jeffrey A.; Di Bisceglie, Adrian M.; Szabó, G.; Morgan, Timothy R.; Everhart, James E.

In: Gastroenterology, Vol. 138, No. 7, 06.2010.

Research output: Contribution to journalArticle

Fontana, RJ, Sanyal, AJ, Ghany, MG, Lee, WM, Reid, AE, Naishadham, D, Everson, GT, Kahn, JA, Di Bisceglie, AM, Szabó, G, Morgan, TR & Everhart, JE 2010, 'Factors That Determine the Development and Progression of Gastroesophageal Varices in Patients With Chronic Hepatitis C', Gastroenterology, vol. 138, no. 7. https://doi.org/10.1053/j.gastro.2010.02.058
Fontana, Robert J. ; Sanyal, Arun J. ; Ghany, Marc G. ; Lee, William M. ; Reid, Andrea E. ; Naishadham, Deepa ; Everson, Gregory T. ; Kahn, Jeffrey A. ; Di Bisceglie, Adrian M. ; Szabó, G. ; Morgan, Timothy R. ; Everhart, James E. / Factors That Determine the Development and Progression of Gastroesophageal Varices in Patients With Chronic Hepatitis C. In: Gastroenterology. 2010 ; Vol. 138, No. 7.
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AU - Sanyal, Arun J.

AU - Ghany, Marc G.

AU - Lee, William M.

AU - Reid, Andrea E.

AU - Naishadham, Deepa

AU - Everson, Gregory T.

AU - Kahn, Jeffrey A.

AU - Di Bisceglie, Adrian M.

AU - Szabó, G.

AU - Morgan, Timothy R.

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KW - Esophagogastroduodenoscopy

KW - Hyaluronic Acid

KW - Portal Hypertension

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