Featured Research

from universities, journals, and other organizations

Antiviral Therapy Impacts Esophageal Varices in HCV-Induced Cirrhosis

Date:
May 25, 2010
Source:
Wiley - Blackwell
Summary:
Italian researchers have discovered that antiviral treatment and sustained virologic response (SVR) prevents esophageal varices in patients with compensated hepatitis C (HCV)-induced cirrhosis, indicating that endoscopic surveillance can be safely delayed or avoided in these patients. Full findings are published in the June issue of Hepatology, a journal of the American Association for the Study of Liver Diseases (AASLD).

Italian researchers have discovered that antiviral treatment and sustained virologic response (SVR) prevents esophageal varices in patients with compensated hepatitis C (HCV)-induced cirrhosis, indicating that endoscopic surveillance can be safely delayed or avoided in these patients. Full findings are published in the June issue of Hepatology, a journal of the American Association for the Study of Liver Diseases (AASLD).

According to the National Digestive Diseases Information Clearinghouse (NDDIC), an estimated 4.1 million Americans have antibody to HCV (anti-HCV), indicating ongoing or previous infection with the virus. Researchers estimate that at least 20% of patients with chronic HCV develop cirrhosis. Progression of cirrhosis leads to portal hypertension, which can result in esophageal varices (EV) and other complications.

EVs are abnormally enlarged veins in the esophagus that occur when portal hypertension obstructs normal blood flow to the liver, causing blood to back up into the esophageal vessels. Esophageal varices can rupture which can be life-threatening. The onset of EV marks a crucial turning point in the outcome of cirrhosis. The research team led by Savino Burno, M.D., set out to determine whether antiviral treatment resulting in SVR could prevent this condition.

The study, spanning from January 1989 to December 1992, evaluated 218 patients less than 70 years of age with compensated Child-Pugh class A cirrhosis who presented at three referral centers in Milan and tested positive for serum anti-HCV. Only subjects who agreed to undergo upper endoscopy at the time of enrolment and who were found to be EV-free were included. All 218 subjects had regular follow up with surveillance ultrasound for hepatocellular carcinoma (HCC) every six months and endoscopy every three years to identify de-novo varices.

The standard antiviral regimens of recombinant alpha IFN monotherapy or combination with both IFN and ribavirin were administered, regardless HCV genotype, for at least six months and for an additional six-month period in patients who achieved a complete biochemical response. Combination therapy with IFN or pegylated IFN and ribavirin was administered in agreement with guidelines. SVR was defined as undetectable serum HCV-RNA (<50 IU/ML) six months after stopping therapy.

The primary endpoints were development of de-novo varies or HCC. Of the 218 patients, 149 (68%) received HCV therapy and 34 (23%) achieved SVR and no EVs. During the follow-up of median 11.4 years, de-novo EVs were detected equally among untreated and treated patients who did not achieve SVR. Sixty-seven patients, 7 of whom achieved SVR, developed HCC.

"Our study provides an accurate estimate of the 10-year cumulative incidence of EV in this population of patients," stated Dr. Bruno. "A major finding of our study, of great importance in clinical practice, is that the achievement of SVR abolishes the development of EV in the long-term. The reliability of our result is guaranteed by the ample length of observation among this group of patients. In routine clinical practice, serial surveillance by EGD can be safely delayed or avoided in SVR patients, sparing a significant amount of useless invasive and costly procedures."

The Milan study is the largest study with the longest follow-up to date that addresses the impact of SVR on the development of esophageal varices. In his editorial also published in Hepatology this month, Dr. Richard Sterling concurs, "If these results are confirmed, it may not be necessary to subject patients with HCV-induced cirrhosis to the expense and risks of repeated endoscopies." He further points out that the current study is the first to demonstrate a pharmacologic treatment to reduce (or in this case, eliminate) the development of varices. However, Dr. Sterling cautions, "Before we get too excited, we must remember that current treatment to achieve SVR in those with cirrhosis is difficult and there are often increased side effects, more cytopenias, and lower response rates than those without cirrhosis. Therefore, given the cost, both in dollars and resources, the increased side effects, and decreased response rates of HCV therapy, it remains to be determined if the "bang is worth the buck" in this select group of patients."


Story Source:

The above story is based on materials provided by Wiley - Blackwell. Note: Materials may be edited for content and length.


Journal Reference:

  1. Savino Bruno, Andrea Crosignani, Corinna Facciotto, Sonia Rossi, Luigi Roffi, Alessandro Redaelli, Roberto de Franchis, Piero Luigi Almasio, Patrick Maisonneuve. Sustained virologic response prevents the development of esophageal varices in compensated, child-pugh class a hepatitis C virus-induced cirrhosis. A 12-year prospective follow-up study. Hepatology, 2010; DOI: 10.1002/hep.23528

Cite This Page:

Wiley - Blackwell. "Antiviral Therapy Impacts Esophageal Varices in HCV-Induced Cirrhosis." ScienceDaily. ScienceDaily, 25 May 2010. <www.sciencedaily.com/releases/2010/05/100525094732.htm>.
Wiley - Blackwell. (2010, May 25). Antiviral Therapy Impacts Esophageal Varices in HCV-Induced Cirrhosis. ScienceDaily. Retrieved October 2, 2014 from www.sciencedaily.com/releases/2010/05/100525094732.htm
Wiley - Blackwell. "Antiviral Therapy Impacts Esophageal Varices in HCV-Induced Cirrhosis." ScienceDaily. www.sciencedaily.com/releases/2010/05/100525094732.htm (accessed October 2, 2014).

Share This



More Health & Medicine News

Thursday, October 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola Might Not Be Out Of Control In U.S., But Coverage Is

Ebola Might Not Be Out Of Control In U.S., But Coverage Is

Newsy (Oct. 2, 2014) Coverage of the lone Ebola patient discovered in Texas has U.S. media in a frenzy — but does the coverage match the reality? Video provided by Newsy
Powered by NewsLook.com
Rhode Island Child With Enterovirus Dies After Infection

Rhode Island Child With Enterovirus Dies After Infection

Reuters - US Online Video (Oct. 2, 2014) A Rhode Island child hospitalized with Enterovirus D68 has died of a bacterial infection, in what state public health officials say was an unusual and dangerous combination. Mana Rabiee reports. Video provided by Reuters
Powered by NewsLook.com
US Hunts Contacts of Ebola Patient, Including Children

US Hunts Contacts of Ebola Patient, Including Children

AFP (Oct. 2, 2014) Health officials in Texas on Wednesday scoured the Dallas area for people, including schoolchildren, who came in contact with a Liberian man who was diagnosed with Ebola in the United States. Duration: 00:55 Video provided by AFP
Powered by NewsLook.com
Study Says Losing Sense Of Smell Can Indicate Death

Study Says Losing Sense Of Smell Can Indicate Death

Newsy (Oct. 2, 2014) Researchers found elderly adults with a poor sense of smell are more likely to die within five years. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins