Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial.
OBJECTIVE
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.
Fontana
Robert J
RJ
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Sanyal
Arun J
AJ
Mehta
Savant
S
Doherty
Michael C
MC
Neuschwander-Tetri
Brent A
BA
Everson
Gregory T
GT
Kahn
Jeffrey A
JA
Malet
Peter F
PF
Sheikh
Muhammad Y
MY
Chung
Raymond T
RT
Ghany
Marc G
MG
Gretch
David R
DR
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000150:complications*; D008107:Liver Diseases / Q000097:blood; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D015995:Prevalence; D044469:Racial Groups; D012709:Serum Albumin / Q000032:analysis; D012907:Smoking / Q000009:adverse effects; D013272:Stomach Diseases / Q000453:epidemiology* / Q000473:pathology*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D012709:Serum Albumin; D001663:Bilirubin