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Journal of Gastroenterology

, Volume 48, Issue 7, pp 847–855 | Cite as

Risk factors for the exacerbation of esophageal varices or portosystemic encephalopathy after sustained virological response with IFN therapy for HCV-related compensated cirrhosis

  • Yuko Nagaoki
  • Hiroshi AikataEmail author
  • Tomoki Kobayashi
  • Takayuki Fukuhara
  • Keiichi Masaki
  • Mio Tanaka
  • Noriaki Naeshiro
  • Takashi Nakahara
  • Yohji Honda
  • Daisuke Miyaki
  • Tomokazu Kawaoka
  • Shintaro Takaki
  • Masataka Tsuge
  • Akira Hiramatsu
  • Michio Imamura
  • Hideyuki Hyogo
  • Yoshiiku Kawakami
  • Shoichi Takahashi
  • Hidenori Ochi
  • Kazuaki Chayama
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

We aimed to identify risk factors contributing to the exacerbation of esophageal varices (EV) or portosystemic encephalopathy after hepatitis C virus (HCV) eradication with interferon (IFN) therapy in patients with compensated cirrhosis. Also, the prognosis after HCV eradication was analyzed.

Methods

Fifty-two patients with sustained virological response to IFN treatment for HCV-related compensated cirrhosis were enrolled in this retrospective cohort study.

Results

At the achievement of HCV eradication, in 31 of the 52 patients (60 %), feeding vessels for EVs (left gastric vein, posterior gastric vein, short gastric vein) were shown, and in 18 patients (35 %) there were extrahepatic portosystemic shunts (paraesophageal vein, paraumbilical vein, and splenorenal shunt). Although the HCV eradication was successful, significant improvements were not observed in portosystemic collateral vessels 1 year after HCV eradication, and EVs were exacerbated in 19 (36 %) patients. The cumulative 1- and 3-year rates of EV exacerbation were 13 % and 49 %, respectively. By multivariate analysis, the existence of feeding vessels for EVs at HCV eradication was an independent predictive factor for the exacerbation of EVs (P = 0.009). Seven patients who had an extrahepatic portosystemic shunt at HCV eradication developed portosystemic encephalopathy during follow up. The 1-, 3-, and 5-year incidences of portosystemic encephalopathy were 6, 21, and 34 %, respectively. The cumulative 5-year survival rate of the cohort was 81 %. Two patients died of hepatocellular carcinoma (HCC).

Conclusions

Our findings suggest that the existence of radical portosystemic collateral vessels at successful HCV eradication increases the risk of the exacerbation of EVs and the incidence of portosystemic encephalopathy in patients with HCV-related cirrhosis.

Keywords

HCV-related cirrhosis Interferon therapy Sustained virological response Esophageal varices Portosystemic encephalopathy Portosystemic collateral vessels 

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer 2012

Authors and Affiliations

  • Yuko Nagaoki
    • 1
  • Hiroshi Aikata
    • 1
    Email author
  • Tomoki Kobayashi
    • 1
  • Takayuki Fukuhara
    • 1
  • Keiichi Masaki
    • 1
  • Mio Tanaka
    • 1
  • Noriaki Naeshiro
    • 1
  • Takashi Nakahara
    • 1
  • Yohji Honda
    • 1
  • Daisuke Miyaki
    • 1
  • Tomokazu Kawaoka
    • 1
  • Shintaro Takaki
    • 1
  • Masataka Tsuge
    • 1
  • Akira Hiramatsu
    • 1
  • Michio Imamura
    • 1
  • Hideyuki Hyogo
    • 1
  • Yoshiiku Kawakami
    • 1
  • Shoichi Takahashi
    • 1
  • Hidenori Ochi
    • 1
  • Kazuaki Chayama
    • 1
  1. 1.Programs for Applied Biomedicine, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical ScienceHiroshima UniversityHiroshimaJapan

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