title: Factors that determine the development and progression of gastroesophageal varices in patients with chronic hepatitis C.
abstract: OBJECTIVE
  We aimed to identify the incidence and predictors of de novo gastroesophageal variceal formation and progression in a large cohort of patients with chronic hepatitis C and advanced fibrosis.
  
  
  METHODS
  All participants in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial were offered an endoscopy before treatment and again after 4 years. Patients with varices at baseline also had an endoscopy at 2 years. Baseline laboratory and clinical parameters were analyzed as predictors of de novo variceal formation and variceal progression.
  
  
  RESULTS
  De novo varices developed in 157 of the 598 (26.2%) patients. Most of the new varices were small (76.4%) and only 1% of patients developed variceal hemorrhage. The likelihood of developing varices was associated with subject race (Hispanic > Caucasian > African American; P = .0005), lower baseline levels of albumin (P = .051), and higher levels of hyaluronic acid (P < .001) with an area under the receiver operating characteristic curve = .70. Among 210 patients with existing gastroesophageal varices, 74 (35.2%) had variceal progression or bleeding during follow-up. Patients with higher baseline ratios of serum aspartate/alanine aminotransferase (P = .028) and lower platelet counts (P = .0002) were at greatest risk of variceal progression (area under the receiver operating characteristic = .72). Prolonged, low-dose peginterferon-alpha2a therapy and beta-blockers did not influence the risk of developing new or enlarging varices.
  
  
  CONCLUSIONS
  Development of varices in patients with chronic hepatitis C is associated with patient race/ethnicity and laboratory markers of disease severity. Prolonged low-dose peginterferon-alpha2a therapy and beta-blockers do not reduce the risk of variceal development or progression.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-0362, USA. rfontana@med.umich.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Marc G
authors.initials: MG
authors.lastname: Ghany
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Reid
authors.forename: Deepa
authors.initials: D
authors.lastname: Naishadham
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Everson
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kahn
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Di Bisceglie
authors.forename: Gyongyi
authors.initials: G
authors.lastname: Szabo
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Morgan
authors.forename: James E
authors.initials: JE
authors.lastname: Everhart
mesh_terms: D000328:Adult; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C417083:peginterferon alfa-2b