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

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.