title: The course of esophageal varices in patients with hepatitis C cirrhosis responding to interferon/ribavirin therapy.
abstract: BACKGROUND
  Gastrointestinal haemorrhage from ruptured esophageal varices (EV) is a significant cause of morbidity and mortality in patients with HCV-related cirrhosis. The risk of developing EV and bleeding is influenced by hepatitis severity, which can be attenuated by successful interferon (IFN) therapy. Our aim was to prospectively assess whether a successful IFN therapy modifies development and/or progression of EV in patients with HCV-related compensated cirrhosis.
  
  
  METHODS
  Child-Pugh A patients with either no or small (F1) EV underwent surveillance with repeated endoscopy during and after completion of IFN-based therapy.
  
  
  RESULTS
  A total of 127 patients (59 years, 79 males, 65 HCV-1/4 and 17 F1 EV) received weight-based ribavirin (RBV) combined with either IFN-α2b 3 MU three times per week (n=36), weekly pegylated (PEG)-IFN-α2b 1.5 μg/kg (n=68) or weekly PEG-IFN-α2a 180 μg (n=23). Patients were followed-up for 18-108 months after treatment completion with a median endoscopic follow-up of 68 months for the 62 patients with a sustained virological response (SVR) and 57 months for the 65 non-SVR patients (P=0.3). De novo EV developed in 10 (9.1%) patients including 2/57 SVR and 8/53 non-SVR (3.5% versus 15.1%; P=0.047), whereas EV progressed in size in 3 patients, including 1/5 SVR and 2/12 non-SVR (P=0.87). Two non-SVR patients bled from EV and one died.
  
  
  CONCLUSIONS
  A successful IFN therapy prevents or delays the de novo onset of EV in patients with compensated cirrhosis due to HCV, but does not abrogate the need for continued endoscopic surveillance.
authors.affiliation: AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: D'Ambrosio
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Rumi
authors.forename: Massimo
authors.initials: M
authors.lastname: Primignani
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dell'Era
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Donato
authors.forename: Stella
authors.initials: S
authors.lastname: De Nicola
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Prati
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D007372:Interferons; C100416:peginterferon alfa-2a