Upper Gastrointestinal Pathology in Non-Cirrhotic Hepatitis C Patients

Abstract

Purpose: Background: Treatment of Hepatitis C (HCV) frequently results in anemia. This not infrequently necessitates reduction or discontinuation of treatment. Other upper GI tract etiologies may contribute to worsening of this anemia. Thus, it is important to look for sources of potential blood loss in patients undergoing treatment of HCV. Aim: To examine the upper gastrointestinal tract pathology in non-cirrhotic HCV patients. Methods: Non-cirrhotic patients who were diagnosed with HCV and had EGD in West Virginia University Hospitals from 2000 to 2007 were identified from electronic record system along with age and sex matched controls. Control group one (C1) was composed of patients without any liver diseases and control group two (C2) was composed of non-cirrhotic liver disease patients without HCV. Baseline hemoglobin (Hgb), hematocrit, pathology, H. pylori status and EGD findings were analyzed. A two-tail P-value of 0.05 or less was considered for statistical significance. Results: A total of 58 non-cirrhotic HCV cases, that also had an EGD, were identified. Of these cases, 40 (69%) were male and 18 (31%) were female. The average age was 49 years. The most common indications for EGD in the HCV group were gastroesophageal reflux disease (40%), anemia (31%) and abdominal pain (22%). There was no statistical difference between the HCV group and 2 sets of controls for indications for an EGD. At base line, HCV group had significantly lower Hgb than C1 or C2 (12.14 vs. 13.4 vs. 13.5 gm/dl respectively, P-value < 0.001). Every patient in the HCV group had pathology on EGD, compared to 88% of C1 and 79% of C2 patients (P-values < 0.05 and < 0.001 respectively). The study group had significantly higher number of upper gastrointestinal pathology on EGD than C1 or C2 (122 vs. 69 vs. 82 respectively, P-value < 0.001). Eighty percent of the HCV cases had more than one finding on EGD as compared to 60% of C1 and 54% of C2 (P-values < 0.05). The distributions of EGD findings between cases vs. C1 and C2 were as follows: gastritis 48 vs. 31 vs. 27, P-value < 0.001; esophagitis 42 vs. 26 vs. 22, P-value < 0.001; duodenitis 27 vs. 14 vs. 11, P-value < 0.001. No statistical difference was observed on H. pylori status between the study and two control groups. Conclusion: Non-cirrhotic HCV patients have significantly more upper gastrointestinal pathology than other non-cirrhotic liver disease patients or patients without any liver disease. This may contribute to worsening of anemia from HCV treatment. Thus, there might be a potential benefit to treating non-cirrhotic HCV patients with proton pump inhibitors before treatment for HCV.