Brief Article
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World J Gastroenterol. Oct 28, 2013; 19(40): 6849-6856
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6849
Antiviral therapy delays esophageal variceal bleeding in hepatitis B virus-related cirrhosis
Chang-Zheng Li, Liu-Fang Cheng, Qing-Shan Li, Zhi-Qiang Wang, Jun-Hong Yan
Chang-Zheng Li, Qing-Shan Li, Jun-Hong Yan, Department of Gastroenterology and Hepatology, Institute of Hepatobiliary and Gastrointestinal Diseases, Chinese Second Artillery General Hospital, Beijing 100088, China
Liu-Fang Cheng, Zhi-Qiang Wang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li CZ conceived and initiated the research project, conducted clinical and endoscopic treatment and data analysis and wrote the manuscript; Cheng LF, Wang ZQ and Li QS were actively involved in conducting clinical and endoscopic treatment; Yan JH was responsible for database management and data analysis.
Correspondence to: Chang-Zheng Li, MD, Department of Gastroenterology and Hepatology, Institute of Hepatobiliary and Gastrointestinal Diseases, Chinese Second Artillery General Hospital, No. 16, Xinjiekouwai Street, Xicheng District, Beijing 100088, China. licz007@aliyun.com
Telephone: +86-10-66343644 Fax: +86-10-68218056
Received: May 8, 2013
Revised: August 13, 2013
Accepted: September 13, 2013
Published online: October 28, 2013
Processing time: 190 Days and 10.1 Hours
Abstract

AIM: To investigate the effect of antiviral therapy with nucleoside analogs in hepatitis B virus (HBV)-related cirrhosis and esophageal varices.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Keywords: Nucleoside analog; Esophageal variceal bleeding; Hepatitis B virus; Cirrhosis; Resistance; Entecavir; Lamivudine; Adefovir

Core tip: Antiviral therapy with nucleoside analogs improves clinical outcome in hepatitis B virus (HBV)-related decompensated cirrhosis. However, the emergence of resistance results in liver injury. The consequences may be worse in patients with esophageal varices (EV), in which bleeding and death often occur. This study evaluated the efficacy of antiviral treatment over 5 years in patients with HBV-related cirrhosis and EV and found that antiviral therapy decreased the risk of bleeding. However, agents with a high rate of virological breakthrough were ineffective in preventing bleeding. These findings provide evidence-based suggestions for the treatment of this special group of patients.