Influence of Distal Gastrectomy on Chronic Hepatitis C

Abstract

Purpose: It has been reported that iron overload is frequently observed in chronic hepatitis C patients, and iron excess is involved in liver inflammation and carcinogenesis. On the other hand, distal gastrectomy patients tend to have a low iron load. This is believed to be due to the fact that Fe3+ cannot be converted to Fe2+ in the absence of gastric acid. To date, no studies have addressed the relationship between distal gastrectomy and chronic hepatitis C. The purpose of this study was to investigate the influence of distal gastrectomy on chronic hepatitis C. Methods: Twenty-eight consecutive chronic hepatitis C patients aged 80 years or older who had visited our hospital regularly between April 2007 and 2010 were enrolled in this study. They consisted of 15 men and 13 women, with a median age of 83 years (range, 80-93 years). None of them were positive for HBs antigen. All of them showed a natural course of chronic hepatitis C, with no history of antiviral interferon therapy. Seven patients had a history of distal gastrectomy: 6 for gastroduodenal ulcer and 1 for early gastric cancer. The patients were classified into gastrectomy and non-gastrectomy groups, and were evaluated regarding: 1) the presence or absence of anti-HBc antibody as an indicator of a history of HBV infection, 2) the ferritin level as an indicator of the iron load, 3) the albumin level as an indicator of the ability of the liver to synthesize proteins, and 4) the incidence of hepatocellular carcinoma. Results: 1. The anti-HBc antibody-positive rate was the same, at 42.3%, in both groups. 2. The mean ferritin level in the gastrectomy group was 63.3 ng/ml, being lower than that (80.1 ng/ml) in the non-gastrectomy group. 3. The mean albumin level in the gastrectomy group was 3.96 g/dl, being higher than that (3.70 g/dl) in the non-gastrectomy group. 4. The incidence of hepatocellular carcinoma in the gastrectomy group was 14.3% (1/7), being lower than that (42.3%, or 9/21) in the non-gastrectomy group. 5. The number of patients was so small that these results failed to reach significant. Conclusion: The iron load was lower, and the ability of the liver to synthesize proteins was higher, in post-gastrectomy patients with chronic hepatitis C than in their non-gastrectomized counterparts, which may explain the lower incidence of hepatocellular carcinoma in the post-gastrectomy patients. Further studies involving more patients are needed.