Changes in the prevalence of hepatitis C virus genotype among Italian injection drug users-relation to period of injection started.

BACKGROUND: Chronic hepatitis C is a worldwide health problem. Intravenous drug users are the main risk group. OBJECTIVES: To determine the prevalence of HCV genotypes in Italian injecting drug users and the distribution of genotypes in relation to the period when the infection was acquired. STUDY DESIGN: Two hundred sera from patients with chronic hepatitis C and a history of intravenous drug use were assayed for HCV-RNA and genotyped by a commercial line probe assay. RESULTS: Genotypes 1 (45.5%) and 3 (35%) were the most common genotypes, followed by genotypes 4 (15%) and 2 (3%). One genotype 5 (0.5%) was found. Two mixed infections (1%) were detected. Subtype could be determined in 160 cases (80%): subtype 3a was the most prevalent (41.3%), followed by subtypes 1a (23.1%) and 1b (20.6%). A significant change in the distribution of prevalent genotypes occurred since 1965 (p=0.020). Genotype 3 infections declined from 48/116 (41.4%) in 1965-1985 to 22/84 (26.2%) in 1986-2006. The prevalence of genotype 4 was significantly higher in patients infected after 1985 compared to patients infected before this year (11/116 [9.5%] vs. 19/84 [22.6%], respectively; p=0.018). CONCLUSIONS: Since 1965 the common HCV genotype 3 has become less common in Italy. Genotype 4, an imported genotype, has become more common.

Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance.

BACKGROUND: This study aimed to determine the detection rate and clinical relevance of portosystemic collaterals. METHODS: We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endoscopy. RESULTS: Of the cirrhotics, 130 had portosystemic collaterals (39.9% total, left gastric vein 11%, paraumbilical vein 7.4%, splenorenal shunts 13.8%, and combined shunts 7.7%). Cirrhotics without portosystemic collaterals or with a paraumbilical vein had a significantly narrower portal vein diameter than cirrhotics with a left gastric vein (P < 0.001). Cirrhotics with a paraumbilical vein had a significantly smaller splenic area than cirrhotics with a left gastric vein (P < 0.001), splenorenal shunts (P < 0.001), combined shunts (P < 0.001), or without portosystemic collaterals (P < 0.05). A significant association between portosystemic collaterals and Child's classes or presence and type of esophageal varices was found (P < 0.0001 and P = 0.0004, respectively). The highest prevalence of Child's class C and large (F-3) esophageal varices was found in cirrhotics with a left gastric vein (41.7% and 36.1%, respectively), whereas esophageal varices were absent in 47.4% of cirrhotics without portosystemic collaterals and in 58.3% of cirrhotics with a paraumbilical vein. CONCLUSIONS: The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course.

Postmeal portal flow variations in HCV-related chronic hepatitis and liver cirrhosis with and without hyperdynamic syndrome.

BACKGROUND: Doppler ultrasonography (US) of portal blood flow and portal flow volume (PFV) are useful to define changes in portal hemodynamics of patients with chronic liver diseases. The meal test with postmeal PFV measurements is generally accepted as a reproducible noninvasive test to evaluate the severity of portal hypertension. The aim of this study was to evaluate whether monitoring PFV changes after ingestion of a standard meal would be useful to characterize patients with chronic hepatitis or liver cirrhosis in the presence or absence of hyperdynamic syndrome (HS) characterized by elevated PFV, splenomegaly, systemic hypotension and/or increased cardiac output. PATIENTS AND METHODS: Thirty-seven patients (22 men and 15 women, median age 53 years) with hepatitis C virus infection and 20 healthy age- and sex-matched volunteers (Controls) were enrolled in the study. There were 19 (51.4%) patients with chronic hepatitis (Group A) and 18 (48.6%) with ultrasonographic evidence of liver cirrhosis (Child-Pugh class B), 9 of whom had an HS (Group B) while the remainder (Group C) did not. Each patient underwent liver color Doppler US and the test was repeated 30, 60 and 90 minutes after administration of a standard meal (300 kcal fluid meal containing 12 g of proteins, 11.6 g of lipids and 36.8 g of carbohydrates). RESULTS: The baseline PFV did not differ (p=NS) between Controls and both Groups A and C, while the PFV of Group B patients was significantly (p<0.01) higher. After 30 minutes, the PFV increased (p<0.01) both in Controls and Group A patients, while the differences were not significant in cirrhotic patients (Groups B and C). Our study confirmed that the postmeal PFV increases in both healthy individuals and in patients with chronic hepatitis, while in cirrhotic patients no significant changes occur. In conclusion, monitoring the portal blood flow in cirrhotic patients before and after administration of a standard meal might be a suitable test to evaluate potential disturbances of the flow itself. Moreover, the test could be useful to determine optimal pharmacological or surgical interventions aimed at restoring a better flow to the liver by reducing or favouring the occurrence of spontaneous mesenteric-systemic venous shunts.

Portal diameter in the diagnosis of esophageal varices in 266 cirrhotic patients: which role?

The aim was to evaluate the predictability of portal diameter (PD) in the diagnosis of esophageal varices (EV) and of large size EV (F3EV) in a large series of patients with cirrhosis. Two-hundred sixty-six persons with cirrhosis (M:F = 153:113; mean age 65.4 +/- 10 y) were studied by abdominal sonography and upper endoscopy. Portal hypertensive gastropathy (PHG) was found in 16.1% and EV was found in 60.9% of patients. Only Child's class (B vs. A: OR 3.4, p < 0.0001; C vs. A: OR 10.3, p < 0.0001; C vs. B: OR 3.1, p = 0.01) and age (OR 1.04, p = 0.03) were independent predictors of EV, whereas PD was not (p = 0.4). Child's class and age were also the only independent predictors of F3EV. Mean PD showed a slight and not significant increase in PHG patients compared with patients with negative endoscopy, a reduction in F1EV patients and then a progressive increase in F2EV and F3EV patients. Patients with PD <12 mm showed a significantly higher prevalence of F1-F2EV (p < 0.05) and a near-significant lower prevalence of endoscopies negative for EV (p = 0.06) than patients with 12 < or = PD < or = 13 mm. PD was not able to predict EV or F3EV in a large series of patients with cirrhosis. The oscillatory trend of PD, proceeding from patients with negative endoscopy to F3EV patients, seems to indicate that EV may unload portal pressure in the initial phases of portal hypertension.