Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis†

Abstract

P ortal hypertension (PH), defined by a hepatic venous pressure gradient (HVPG) greater than 6 mmHg, 1 is a common complication of cirrhosis. The presence and the development of esophageal varices (EV) is a clinical manifestation of PH, 2,3 with a prevalence that can range from 40% to 80% in patients with cirrhosis. This prevalence increases progressively in relation to the severity of liver damage. 4,5 The presence of EV is also a clear indicator of a certain stage of cirrhosis. 6 The development of EV in patients with cirrhosis occurs when the HVPG is greater than 10 mmHg, 3,7 with an incidence of approximately 5% per year and a yearly rate of progression to larger varices of 5% to 15%. 4,5,8 The clinical relevance of EV is linked to the risk of bleeding that occurs when HVPG is greater than 12 mmHg, 7-9 with a mortality rate that exceeds 20% within 6 weeks from the bleeding episode, despite aggressive treatment. 10 The Baveno IV 2005 Consensus Workshop 11 and the American Association for the Study of Liver Diseases 2007 single-topic symposium on portal hypertension 12 recommended that endoscopic screening for esophageal and gastric varices should always be performed when a diagnosis of cirrhosis is made. Upper endoscopy should be repeated at 2-year to 3-year intervals in patients without varices, and at 1-year to 2-year intervals in those with small varices, to evaluate their development or progression. 11,12 These guidelines might not be ideal for clinical

A Noninvasive Panel for Diagnosis of Esophageal Varices in Patients with Compensated Cirrhosis

“…The difference between our study and that of Camma` et al, 2009 is that none of our patients were diabetics and whey the IR was higher in their study than ours may agree with the view of Dogru et al, 2009 in their comment on the study of Camma` where we noticed that most of the study participants were overweight and some of them were even obese. Obesity is a strong risk factor for DM and also for IGT (impaired glucose tolerance).…”

“…Also, Emam et al, 2009 reported a diagnostic sensitivity of (98%) with specificity of (64%), positive predictive value of (83%), negative predictive value of (94%) and accuracy of (86%) for the predictor platelet count/spleen diameter ratio. In this study, we did evaluate the predictor introduced by Camma` et al, 2009 which is the association of IR, regardless of diabetes, with the presence of O.V. None of our 124 patients was found to be diabetic.…”

“…Although the underlying mechanisms linking hyperinsulinemia/ IR to fibrosis are far from clear, IR has been systematically associated with advanced fibrosis and fibrosis progression in several reports. So, the quantitative measurement of IR might be a potential predictor of portal hypertension in early cirrhosis, alone or in combination with other clinical features (Camma` et al, 2009). …”

Insulin resistance in patients with cirrhosis and portal hypertension

“…Thus it has been suggested that IR has a negative impact on the response rates to interferon-based therapy in chronic hepatitis C virus infection (19) and that IR could be a predictor of the presence of PH in patients with nonalcoholic fatty liver disease (16). Furthermore, a recent published clinical study has suggested that IR is able to independently predict the presence of gastroesophageal varices in cirrhosis (11). The authors attributed this effect to a possible pathophysiological link between IR and PH.…”

Insulin resistance and platelet count/spleen diameter ratio: Two simple, easy-to-get tests for predicting esophageal varices in cirrhosis #

“…We read with great interest the article by Cammà et al 1 reporting the potential usefulness of insulin resistance (IR) combined with platelet count/spleen diameter ratio as simple, noninvasive, and easy-to-get tests for predicting esophageal varices (EVs) in patients with Child A cirrhosis caused by hepatitis C virus (HCV). We would like to draw attention to similar studies on IR combined with platelet count/spleen diameter ratio in predicting EVs in cirrhosis, not just in Child A HCV cirrhosis.…”