Surveillance of patients with chronic hepatitis C not on antiviral therapy: a practical approach.

Surveillance of patients with HCV-related chronic liver disease (CHC) not on antiviral therapy is mandatory, because of the risk of worsening of the disease and progression to cirrhosis and its lethal complications. Unfortunately, data from the literature are scarce, and sometimes there are differences among experts and discrepancies between recommendations. Furthermore, the wide range of diagnostic tests and the continuous development of new diagnostic tools not rarely results in expensive, redundant and not justified surveillance programs. The identification of the optimal frequency of follow-ups constitutes another source of difficulties for the physicians. The purpose of this article is to provide practicing physicians with published criteria for performing a cost-effective and adequate surveillance program for patients with CHC not on antiviral treatment. On the basis of randomized controlled trials (RCTs), metanalysis, and international guide-lines and Consensus Conference statements we have attempted to outline a cost-effective surveillance program for HCV carriers with normal aminotransferases (ALT), for responders to previous interferon (IFN) treatment and for patients with CHC non-eligible for antiviral therapy. This surveillance strategy relies upon the judicious use of un-expensive and widely available tests.

Hepatic venous pressure gradient does not correlate with the presence and the severity of portal hypertensive gastropathy in patients with liver cirrhosis.

BACKGROUND AND AIMS: To evaluate whether the hepatic venous pressure gradient (HVPG) differs between cirrhotic patients with severe portal hypertensive gastropathy (PHG) and those with mild or absent PHG. METHODS: 59 cirrhotic patients with portal hypertension underwent hepatic vein catheterisation. 44 patients (76%) had PHG (16 mild and 28 severe). SETTING: tertiary care setting (Liver Unit, Internal Medicine). RESULTS: HVPG values did not differ between the patients without PHG (21.6 +/- 10.1 mmHg) and those with PHG (18.6 +/- 9.1 mmHg), nor between those with mild (19.3 +/- 4.3 mmHg) or severe PHG (17.7 +/- 4.6 mmHg; p = 0.26). The overall prevalence of PHG and the proportion of patients with severe PHG did not differ regarding the Child Pugh classification. The etiology of the cirrhosis did not influence the HVPG. No correlations were found between HVPG values and Child Pugh score, age, platelet count, prothrombin time, bilirubin levels and ALT values. The HVPG did not differ between patients with small, medium or large esophageal varices, nor between subjects with or without gastric varices. CONCLUSIONS: Our data show that PHG does not correlate with the degree of portal pressure, and that the prevalence and the severity of this condition are not influenced by the severity of underlying liver disease or by the size of varices.