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Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial.
Am J Gastroenterol. 2006 May; 101(5):983-92.AJ

Abstract

OBJECTIVES

The clinical significance of portal hypertensive gastropathy (PHG) in patients with compensated liver disease is not well established. The aim of this study was to determine the prevalence and correlates of PHG in a large cohort of patients with chronic hepatitis C virus (HCV) infection and bridging fibrosis/compensated cirrhosis entering the randomized phase of the Hepatitis C Antiviral Long-term Treatment against Cirrhosis trial (HALT-C).

METHODS

The presence and severity of PHG in 1,016 HCV patients with no prior history of gastrointestinal bleeding was determined at surveillance endoscopy using the New Italian Endoscopy Club criteria.

RESULTS

Overall, 37% of HALT-C patients had PHG with 34% having mild and 3% with severe changes. The mucosal mosaic pattern was identified in 33%, red marks in 15%, and gastric antral vascular ectasia (GAVE) features in only 3%. Independent correlates of PHG included biochemical markers of liver disease severity (lower serum albumin, higher bilirubin), portal hypertension (lower platelet count), insulin resistance (higher glucose), and non-African American race. Independent correlates of GAVE included a history of smoking, nonsteroidal anti-inflammatory drugs (NSAIDs) use within the past year, and higher serum bilirubin and glucose levels. There was a strong positive association between the presence of PHG and esophageal varices (p < 0.0001).

CONCLUSIONS

PHG is associated with the histological and biochemical severity of liver disease in patients with HCV and advanced fibrosis but is mild in most patients. The clinical relevance of these findings will be further explored during the randomized phase of the HALT-C study.

Authors+Show Affiliations

Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16573786

Citation

Fontana, Robert J., et al. "Portal Hypertensive Gastropathy in Chronic Hepatitis C Patients With Bridging Fibrosis and Compensated Cirrhosis: Results From the HALT-C Trial." The American Journal of Gastroenterology, vol. 101, no. 5, 2006, pp. 983-92.
Fontana RJ, Sanyal AJ, Mehta S, et al. Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial. Am J Gastroenterol. 2006;101(5):983-92.
Fontana, R. J., Sanyal, A. J., Mehta, S., Doherty, M. C., Neuschwander-Tetri, B. A., Everson, G. T., Kahn, J. A., Malet, P. F., Sheikh, M. Y., Chung, R. T., Ghany, M. G., & Gretch, D. R. (2006). Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial. The American Journal of Gastroenterology, 101(5), 983-92.
Fontana RJ, et al. Portal Hypertensive Gastropathy in Chronic Hepatitis C Patients With Bridging Fibrosis and Compensated Cirrhosis: Results From the HALT-C Trial. Am J Gastroenterol. 2006;101(5):983-92. PubMed PMID: 16573786.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial. AU - Fontana,Robert J, AU - Sanyal,Arun J, AU - Mehta,Savant, AU - Doherty,Michael C, AU - Neuschwander-Tetri,Brent A, AU - Everson,Gregory T, AU - Kahn,Jeffrey A, AU - Malet,Peter F, AU - Sheikh,Muhammad Y, AU - Chung,Raymond T, AU - Ghany,Marc G, AU - Gretch,David R, AU - ,, PY - 2006/4/1/pubmed PY - 2006/6/7/medline PY - 2006/4/1/entrez SP - 983 EP - 92 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 101 IS - 5 N2 - OBJECTIVES: The clinical significance of portal hypertensive gastropathy (PHG) in patients with compensated liver disease is not well established. The aim of this study was to determine the prevalence and correlates of PHG in a large cohort of patients with chronic hepatitis C virus (HCV) infection and bridging fibrosis/compensated cirrhosis entering the randomized phase of the Hepatitis C Antiviral Long-term Treatment against Cirrhosis trial (HALT-C). METHODS: The presence and severity of PHG in 1,016 HCV patients with no prior history of gastrointestinal bleeding was determined at surveillance endoscopy using the New Italian Endoscopy Club criteria. RESULTS: Overall, 37% of HALT-C patients had PHG with 34% having mild and 3% with severe changes. The mucosal mosaic pattern was identified in 33%, red marks in 15%, and gastric antral vascular ectasia (GAVE) features in only 3%. Independent correlates of PHG included biochemical markers of liver disease severity (lower serum albumin, higher bilirubin), portal hypertension (lower platelet count), insulin resistance (higher glucose), and non-African American race. Independent correlates of GAVE included a history of smoking, nonsteroidal anti-inflammatory drugs (NSAIDs) use within the past year, and higher serum bilirubin and glucose levels. There was a strong positive association between the presence of PHG and esophageal varices (p < 0.0001). CONCLUSIONS: PHG is associated with the histological and biochemical severity of liver disease in patients with HCV and advanced fibrosis but is mild in most patients. The clinical relevance of these findings will be further explored during the randomized phase of the HALT-C study. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/16573786/Portal_hypertensive_gastropathy_in_chronic_hepatitis_C_patients_with_bridging_fibrosis_and_compensated_cirrhosis:_results_from_the_HALT_C_trial_ DB - PRIME DP - Unbound Medicine ER -