1. INCIDENCE OF CIRRHOSIS IN CHILDREN WITH CHRONIC HEPATITIS. THE VALUE OF LAPAROSCOPY

Abstract

Incidence of cirrhosis (CIR) in children with chronic hepatitis (CH) varies greatly according to previous reports. CIR complicating CH is most often macronodular, this being a cause of sampling error in the interpretation of needle biopsy. We report here on 92 children with CH who were investigated, at admission, for the presence of CIR by the combined use of laparoscopy and needle liver biopsy between 1975 and 1985. - 46 children had hepatitis B virus-related CH. CIR was present in 15 (33 %). Laparoscopy showed nodules in 14; liver histology showed definite signs of CIR in 8, severe signs of aggressivity (A) in 5, moderate A in 5 and no signs of A in 5. Signs of active viral replication were present in 5 of 11 children studied. 6 patients had CIR less than 12 months after the first sign of liver disease. - 46 children had autoimmune hepatitis. CIR was present in 41 (89 %). Laparoscopy showed nodules in all. Histology showed definite signs of CIR in 16, probable or possible CIR in 7 others, severe A in 19, moderate A in 16 and no A in 6. CIR was present in 10 of 10 children studied 2 to 5 months after the first sign of liver disease. - These results indicate that in children with CH (1) combined use of laparoscopy and biopsy is twice as much reliable than biopsy alone for the diagnosis of CIR (2) true incidence of CIR is high (3) CIR occurs early irrespective of etiology.