Antiviral therapy delays esophageal variceal bleeding in hepatitis B virus-related cirrhosis.
ABSTRACT To investigate the effect of antiviral therapy with nucleoside analogs in hepatitis B virus (HBV)-related cirrhosis and esophageal varices.
Eligible patients with HBV-related cirrhosis and esophageal varices who consulted two tertiary hospitals in Beijing, China, the Chinese Second Artillery General Hospital and Chinese PLA General Hospital, were enrolled in the study from January 2005 to December 2009. Of 117 patients, 79 received treatment with different nucleoside analogs and 38 served as controls. Bleeding rate, change in variceal grade and non-bleeding duration were analyzed. Multivariate Cox proportional hazard regression was used to identify factors related to esophageal variceal bleeding.
The bleeding rate was decreased in the antiviral group compared to the control group (29.1% vs 65.8%, P < 0.001). Antiviral therapy was an independent factor related to esophageal bleeding in multivariate analysis (HR = 11.3, P < 0.001). The mean increase in variceal grade per year was lower in the antiviral group (1.0 ± 1.3 vs 1.7 ± 1.2, P = 0.003). Non-bleeding duration in the antiviral group was prolonged in the Kaplan-Meier model. Viral load rebound was observed in 3 cases in the lamivudine group and in 1 case in the adefovir group, all of whom experienced bleeding. Entecavir and adefovir resulted in lower bleeding rates (17.2% and 28.6%, respectively) than the control (P < 0.001 and P = 0.006, respectively), whereas lamivudine (53.3%) did not (P = 0.531).
Antiviral therapy delays the progression of esophageal varices and reduces bleeding risk in HBV-related cirrhosis, however, high-resistance agents tend to be ineffective for long-term treatment.
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ABSTRACT: Aim: Many studies have reported the therapeutic effects of lamivudine on cirrhotic patients with hepatitis B; however, no study has investigated the morphological changes of esophageal varices after lamivudine treatment. Method: The morphological changes of esophageal varices in patients with cirrhosis were retrospectively compared between 12 patients treated with lamivudine and six historical untreated patients. Results: In the treated group, the HBV DNA and hyaluronic acid (HA) levels in the serum were significantly lower than those in the untreated group (P = 0.013 and P = 0.009, respectively) at the end of follow-up, with a significant improvement in the Child-Pugh-Turcotte score (P = 0.022). In the treated group, the disappearance or reduction of esophageal varices was observed in six (50%) of the 12 patients. In three (25%) of the 12 patients, esophageal varices worsened. In the remaining three patients (25%), there were no changes in esophageal varices. In the untreated group, all patients showed the worsening of esophageal varices during the follow-up period, with a significant difference between this group and the treated group (P = 0.009). The serum HA level decreased in the nine treated patients without worsening of esophageal varices. However, in the three patients with worsening, the HA level significantly increased. Conclusion: Lamivudine treatment for patients with cirrhosis improves not only liver function but also esophageal varices.Hepatology Research 08/2007; 37(7):503-9. DOI:10.1111/j.1872-034X.2007.00087.x · 2.22 Impact Factor
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ABSTRACT: Small vessels gradually reappear within the esophageal wall after endoscopic injection sclerotherapy or endoscopic variceal ligation, which causes late recurrent bleeding. Additional ligation or a small amount of sclerotherapy of these thin and serpentine vessels is sometimes difficult to perform, and stenosis of the esophagus sometimes occurs after a small amount of sclerotherapy. In this study we attempted endoscopic photodynamic therapy on newly visible vessels and evaluated its ability to prevent recurrent bleeding. Fourteen patients with newly visible vessels within the esophageal wall were enrolled. All patients had esophageal varices secondary to hepatitis B and had their varices eliminated through endoscopic sclerotherapy before neovascularization. Seven patients received photodynamic therapy, and seven patients served as the control group. In the photodynamic therapy group, intravenous injection of 5 mg/kg of hematoporphyrin monomethyl ether was given and immediately followed by endoscopic irradiation of the newly visible vessels by copper vapor laser for 40 min with a power density of 150 mW/cm(2). Endoscopic examination was performed 3 months later to evaluate the therapeutic effect. The duration of non-bleeding was compared between the two groups. The number of newly visible vessels was found to have decreased after photodynamic therapy when compared with the control group (P < 0.001). Kaplan-Meier analyses demonstrated a longer period of non-bleeding in the photodynamic therapy group. The recurrent bleeding rate in the photodynamic therapy (PDT) group was lower than that in the control group (P = 0.027). One patient in the photodynamic therapy group suffered from facial dermatitis from shining direct light. Endoscopic photodynamic therapy seemed to be effective in the elimination of esophageal newly visible vessels and the prevention of recurrent bleeding.Lasers in Medical Science 02/2008; 24(2):167-71. DOI:10.1007/s10103-008-0542-6 · 2.42 Impact Factor
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ABSTRACT: Entecavir is a potent antiviral agent with high genetic barrier to resistance, hence is currently recommended as first-line antiviral therapy for chronic hepatitis B (CHB). The aim of this study was to investigate the efficacy of entecavir on clinical outcomes and deaths. It was a retrospective-prospective cohort study based on two cohorts of patients. Entecavir cohort included consecutive CHB patients who had received entecavir 0.5 mg daily for at least 12 months. Historical control cohort included untreated patients recruited since1997 who underwent routine clinical care. The primary outcome was the 5-year cumulative probability of hepaticevents, defined as any cirrhotic complications, hepatocellular carcinoma (HCC) and/or liver-related mortality. 1446 entecavir-treated patients (72% male, age 51±12 years, follow-up for 36±13 months) and 424 treatment-naïve patients (65% male, age 41±13 years, follow-up for 114±31 months) were studied. Overall, there was no difference in hepatic events between the entecavir and control cohorts. Among patients with liver cirrhosis (482 entecavir-treated, 69 treatment- naïve), entecavir-treated patients had reduced risks of all clinical outcomes when compared to treatment-naïve cirrhotic patients after adjusted for MELD score: hepatic events (HR=0.51, 95%CI=0.34-0.78, P = 0.002); HCC (HR=0.55, 95%CI=0.31-0.99, P=0.049);liver-related mortality (HR=0.26, 95% CI=0.13-0.55, P<0.001);and all-cause mortality (HR=0.34, 95%CI=0.18-0.62, P<0.001). Entecavir-treated cirrhotic patients who failed to achieve undetectable HBV DNA (105/482, 22%) had comparable risk ofhepatic eventsas the untreated patients. CONCLUSION: Entecavir therapy reduces the risks of hepatic events, HCC, liver-related and all-cause mortality of CHB patients with liver cirrhosis in 5 years, particularly among those who had maintained viral suppression. (HEPATOLOGY 2013.).Hepatology 11/2013; 58(5). DOI:10.1002/hep.26301 · 11.19 Impact Factor