Gastrointestinal Endoscopy
Volume 64, Issue 6 , Pages 855-864, December 2006

The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis

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, Maryland (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, Maryland (Dr Ghany); Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, Washington (Dr Gretch), USA

Received 7 December 2005; accepted 13 March 2006.

Richmond, Virginia; Ann Arbor, Michigan; St. Louis, Missouri; Bethesda, Maryland; Watertown, Massachusetts; Denver, Colorado; Los Angeles, California; Dallas, Texas; Worcester, Massachusetts; Irvine, California; Boston, Massachusetts; Seattle, Washington, 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/mm3 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/mm3 is negligible in this population.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 See CME section; p. 967.This is publication number 10 from the HALT-C Trial Group. This is original work and is not being considered for publication elsewhere.Presented in part at the annual meeting of the American Association for Study of Liver Diseases, October 24-28, 2003, Boston, Massachusetts.

PII: S0016-5107(06)00617-1

doi:10.1016/j.gie.2006.03.007

Gastrointestinal Endoscopy
Volume 64, Issue 6 , Pages 855-864, December 2006

Article Tools

* Image Usage & Resolution