Esophagogastric varices as a prognostic factor for the determination of clinical stage in patients with primary biliary cirrhosis.
BACKGROUND
Primary biliary cirrhosis (PBC) is usually classified as either asymptomatic PBC (a-PBC) or symptomatic PBC (s-PBC). Although the proportion of a-PBC versus s-PBC patients has been consistently increasing, it is not clear whether the present criteria for the staging of PBC are optimal or not. We investigated the clinical stage of PBC patients from the standpoint of esophagogastric varices (EGV).


METHODS
One hundred and nine PBC patients were enrolled in this retrospective study. We investigated the clinical features of PBC based on laboratory data, histological stage, symptoms, and existence of EGV. In addition, the clinical course and prognosis in patients who were periodically followed up were also studied.


RESULTS
(1) EGV was detected in a-PBC patients, and there was no difference in the grade of EGV between a-PBC and s-PBC patients. (2) a-PBC patients with EGV had more liver damage than those without EGV, and a-PBC patients with EGV had a poorer prognosis than those without EGV. (3) Three of 11 patients who progressed from a-PBC to s-PBC within 3 years had EGV. (4) One of 3 a-PBC patients with EGV had progressed to s-PBC at 3-year follow-up.


CONCLUSIONS
These results indicate that EGV is one of the most important factors for evaluating PBC. Therefore, we would like to propose that a-PBC patients with EGV should either be included in the presently defined s-PBC class, or that new prognostic classes of PBC be created that include EGV as a prognostic factor.
Takeshita
Eiji
E
Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu-cho Ehime 791-0295, Japan.
Kumagi
Teru
T
Matsui
Hidetaka
H
Abe
Masanori
M
Furukawa
Shinya
S
Ikeda
Yoshiou
Y
Matsuura
Bunzo
B
Michitaka
Kojiro
K
Horiike
Norio
N
Onji
Morikazu
M
D000328:Adult; D000368:Aged; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000145:classification* / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models