Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005–2016: a national database linkage study

Scott A. McDonald, Stephen T. Barclay, Sharon J. Hutchinson, Adrian J. Stanley, Andrew Fraser, John F. Dillon, Hamish A. Innes, Erica Peters, Nicholas Kennedy, Andrew Bathgate, Peter Bramley, Judith Morris, David J. Goldberg, Peter C. Hayes

Research output: Contribution to journalArticle

Abstract

Background. Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening.Aims. Among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland, to identify factors associated with (i) screening and (ii) a first hospital admission for variceal bleeding.Methods. The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005–2016 (n=2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression.Results. 34% was screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005–2010 at 42%, declining to 37% in 2011–2013 and 26% in 2014–2016. Odds of screening were decreased for age-groups <40 (OR=0.61, 95% CI:0.48–0.77) and 60+ years (OR=0.67, 95% CI:0.48–0.94), history of antiviral therapy (OR=0.70, 95% CI:0.55–0.89), and cirrhosis diagnosis in 2014–2015, compared with 2008–2010 (OR=0.67, 95% CI:0.52–0.86). Compared with 2008–2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR=0.56, 95% CI:0.32-0.97).Conclusions. Overall screening uptake following cirrhosis diagnosis was low, and the decline into the IFN-free therapy era is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.
Original languageEnglish
Pages (from-to)425-434
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume50
Issue number4
Early online date3 Jun 2019
DOIs
Publication statusPublished - Aug 2019

Fingerprint

Varicose Veins
Chronic Hepatitis C
Fibrosis
Databases
Hemorrhage
Infection
Hepacivirus
Death Certificates
Scotland
Hepatitis C
Antiviral Agents
Hospitalization
Age Groups
Logistic Models
Odds Ratio
Morbidity
Mortality
Therapeutics

Keywords

  • oesophageal and gastric varices
  • endoscopy
  • screening
  • hepatitis C virus
  • gastrointestinal haemorrhage

Cite this

@article{c6328720423f452fa8a9d5a920d4fae5,
title = "Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005–2016: a national database linkage study",
abstract = "Background. Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening.Aims. Among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland, to identify factors associated with (i) screening and (ii) a first hospital admission for variceal bleeding.Methods. The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005–2016 (n=2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression.Results. 34{\%} was screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005–2010 at 42{\%}, declining to 37{\%} in 2011–2013 and 26{\%} in 2014–2016. Odds of screening were decreased for age-groups <40 (OR=0.61, 95{\%} CI:0.48–0.77) and 60+ years (OR=0.67, 95{\%} CI:0.48–0.94), history of antiviral therapy (OR=0.70, 95{\%} CI:0.55–0.89), and cirrhosis diagnosis in 2014–2015, compared with 2008–2010 (OR=0.67, 95{\%} CI:0.52–0.86). Compared with 2008–2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR=0.56, 95{\%} CI:0.32-0.97).Conclusions. Overall screening uptake following cirrhosis diagnosis was low, and the decline into the IFN-free therapy era is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.",
keywords = "oesophageal and gastric varices, endoscopy, screening, hepatitis C virus, gastrointestinal haemorrhage",
author = "McDonald, {Scott A.} and Barclay, {Stephen T.} and Hutchinson, {Sharon J.} and Stanley, {Adrian J.} and Andrew Fraser and Dillon, {John F.} and Innes, {Hamish A.} and Erica Peters and Nicholas Kennedy and Andrew Bathgate and Peter Bramley and Judith Morris and Goldberg, {David J.} and Hayes, {Peter C.}",
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doi = "10.1111/apt.15320",
language = "English",
volume = "50",
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Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005–2016: a national database linkage study. / McDonald, Scott A.; Barclay, Stephen T.; Hutchinson, Sharon J.; Stanley, Adrian J.; Fraser, Andrew; Dillon, John F.; Innes, Hamish A.; Peters, Erica; Kennedy, Nicholas; Bathgate, Andrew; Bramley, Peter ; Morris, Judith; Goldberg, David J.; Hayes, Peter C. .

In: Alimentary Pharmacology and Therapeutics, Vol. 50, No. 4, 08.2019, p. 425-434.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005–2016: a national database linkage study

AU - McDonald, Scott A.

AU - Barclay, Stephen T.

AU - Hutchinson, Sharon J.

AU - Stanley, Adrian J.

AU - Fraser, Andrew

AU - Dillon, John F.

AU - Innes, Hamish A.

AU - Peters, Erica

AU - Kennedy, Nicholas

AU - Bathgate, Andrew

AU - Bramley, Peter

AU - Morris, Judith

AU - Goldberg, David J.

AU - Hayes, Peter C.

N1 - Acceptance in SAN AAM: 12m embargo

PY - 2019/8

Y1 - 2019/8

N2 - Background. Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening.Aims. Among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland, to identify factors associated with (i) screening and (ii) a first hospital admission for variceal bleeding.Methods. The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005–2016 (n=2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression.Results. 34% was screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005–2010 at 42%, declining to 37% in 2011–2013 and 26% in 2014–2016. Odds of screening were decreased for age-groups <40 (OR=0.61, 95% CI:0.48–0.77) and 60+ years (OR=0.67, 95% CI:0.48–0.94), history of antiviral therapy (OR=0.70, 95% CI:0.55–0.89), and cirrhosis diagnosis in 2014–2015, compared with 2008–2010 (OR=0.67, 95% CI:0.52–0.86). Compared with 2008–2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR=0.56, 95% CI:0.32-0.97).Conclusions. Overall screening uptake following cirrhosis diagnosis was low, and the decline into the IFN-free therapy era is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.

AB - Background. Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening.Aims. Among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland, to identify factors associated with (i) screening and (ii) a first hospital admission for variceal bleeding.Methods. The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005–2016 (n=2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression.Results. 34% was screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005–2010 at 42%, declining to 37% in 2011–2013 and 26% in 2014–2016. Odds of screening were decreased for age-groups <40 (OR=0.61, 95% CI:0.48–0.77) and 60+ years (OR=0.67, 95% CI:0.48–0.94), history of antiviral therapy (OR=0.70, 95% CI:0.55–0.89), and cirrhosis diagnosis in 2014–2015, compared with 2008–2010 (OR=0.67, 95% CI:0.52–0.86). Compared with 2008–2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR=0.56, 95% CI:0.32-0.97).Conclusions. Overall screening uptake following cirrhosis diagnosis was low, and the decline into the IFN-free therapy era is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.

KW - oesophageal and gastric varices

KW - endoscopy

KW - screening

KW - hepatitis C virus

KW - gastrointestinal haemorrhage

U2 - 10.1111/apt.15320

DO - 10.1111/apt.15320

M3 - Article

VL - 50

SP - 425

EP - 434

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 4

ER -