Development and progression of portal hypertensive gastropathy in patients with chronic hepatitis C

Robert J. Fontana, Arun J. Sanyal, Marc G. Ghany, Herbert L. Bonkovsky, Timothy R. Morgan, Heather J. Litman, Andrea E. Reid, William M. Lee, Deepa Naishadham

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Abstract

Objectives: The objective of this study was to determine the incidence and risk factors associated with new-onset and worsening portal hypertensive gastropathy (PHG) in patients with chronic hepatitis C (CHC). Methods: A total of 831 CHC patients with bridging fibrosis or cirrhosis at the time of entry were prospectively monitored for clinical and histological liver disease progression while receiving either low-dose peginterferon α2a or no antiviral therapy in the HALT-C (Hepatitis C Antiviral Long-term Treatment against Cirrhosis) trial. Upper endoscopy with grading of PHG was performed at baseline and at year 4 of the study. The presence and severity of PHG were determined using the NIEC (New Italian Endoscopy Conference) criteria, and worsening PHG was defined as a score increase of 1 point. Results: During a median follow-up of 3.85 years, 50% of 514 subjects without PHG developed new-onset PHG, whereas 26% of 317 patients with baseline PHG had worsening PHG. Independent predictors of new-onset PHG included higher alkaline phosphatase and being diabetic, whereas predictors of worsening PHG were Caucasian race, lower albumin, as well as higher serum aspartate transaminase/alanine transaminase ratio and homeostatic model assessment levels. New-onset and worsening PHG were significantly associated with clinical and histological progression. They were also associated with new-onset and worsening gastroesophageal varices. Conclusions: New-onset and worsening PHG develop at a rate of 12.9% per year and 6.7% per year, respectively, in non-responder CHC patients with advanced fibrosis. If confirmed in other studies, endoscopic surveillance for PHG may need to be tailored to individual patient risk factors.

Original languageEnglish (US)
Pages (from-to)884-893
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume106
Issue number5
DOIs
StatePublished - May 1 2011

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ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Fontana, R. J., Sanyal, A. J., Ghany, M. G., Bonkovsky, H. L., Morgan, T. R., Litman, H. J., Reid, A. E., Lee, W. M., & Naishadham, D. (2011). Development and progression of portal hypertensive gastropathy in patients with chronic hepatitis C. American Journal of Gastroenterology, 106(5), 884-893. https://doi.org/10.1038/ajg.2010.456