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Gastrointest Endosc. 2006 Dec;64(6):855-64.

The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis.

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  • 1Division of Gastroenterology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.

Abstract

BACKGROUND:

The factors predictive of the presence or the absence of esophageal varices in hepatitis C virus (HCV) and advanced fibrosis have not been defined.

OBJECTIVES:

To define the prevalence of esophageal varices and the factors that are positively and negatively with such varices in hepatitis C and advanced fibrosis.

DESIGN:

A prospective study of esophageal varices and associated risk factors in subjects with hepatitis C and advanced fibrosis.

SETTING:

Prerandomization data from the HALT-C (hepatitis C long-term antiviral treatment against cirrhosis) clinical trial.

PATIENTS AND INTERVENTION:

Subjects with bridging fibrosis or cirrhosis, who were virologic nonresponders to treatment with pegylated interferon alpha 2a and ribavirin, underwent endoscopy.

RESULTS:

Sixteen percent of subjects with bridging fibrosis (95/598) and 39% of subjects with cirrhosis (164/418) had varices (P < .0001); 2% of subjects with bridging fibrosis (13/598) and 11% of those with cirrhosis (48/418) had medium or large varices. Subjects with bridging fibrosis and varices had a significantly lower platelet count and higher bilirubin and international normalized ratio (INR) compared with those without varices, suggesting that the biopsy may have underestimated the severity of fibrosis. A platelet count >150,000/mm(3) was associated with a negative predictive value of 99% for esophageal varices. By logistic regression modeling, African American race and female sex were protective, whereas a lower platelet count and higher bilirubin and INR predicted varices (c statistic, 0.758).

CONCLUSIONS:

The risk of having varices increases with decreasing platelet counts, increasing bilirubin, and INR. The probability of having medium or large varices at platelet counts >150,000/mm(3) is negligible in this population.

PMID:
17140886
[PubMed - indexed for MEDLINE]

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