GastrOesophageal Varices After Sustained Virological Response
GastrOesophageal Varices After Sustained Virological Response
Chronic hepatitis C remains a public health issue because up to 70 million people are
 chronically infected by hepatitis C virus (HCV) worldwide. Presence of advanced
 fibrosis/cirrhosis might be associated with liver-related complications, such as
 hepatocellular carcinoma and oesophageal varices bleeding. Oesophageal varices (OV) might be
 present in up to 40% of patients with liver cirrhosis have and the mortality rates from
 bleeding might be up to 20% per episode. Early diagnosis of advanced fibrosis/cirrhosis
 associated with hepatitis C treatment are key features for preventive and therapeutic
 measures to reduce liver-related mortality in HCV-infected patients.

 Liver elastography is a high accurate non-invasive test for diagnosis of advanced
 fibrosis/cirrhosis. Few different methods of liver elastography are currently available:
 transient elastography by Fibroscan and ultrasound elastography by point-shear wave (p-SWE)
 and 2D-shear wave (2D-SWE). Gastrointestinal endoscopy (GIE) has been considered the gold
 standard for screening or surveillance of esophageal varices. More recently, international
 guidelines have been recommending the use of non-invasive methods to indicate or avoid OV
 screening: Baveno VI guidelines proposed that compensated cirrhotic patients with a liver
 stiffness measurement (LSM) by transient elastography <20kPa and a platelet count >150,000/μL
 can avoid screening endoscopy. The use of direct-acting agents (DAAs) has revolutionized the
 treatment of chronic hepatitis C with high effectiveness shown using all-oral interferon-free
 regimens. HCV cure, sustained virological response (SVR), has been associated with lower
 rates of liver-related complications, increase in quality of life and decrease in
 waiting-list registrations for liver transplantation in patients with chronic hepatitis C.
 Preliminary studies have been reporting significant regression liver stiffness after SVR.
 However, it is unclear whether SVR might decrease portal hypertension leading to OV
 regression and a reduced risk of variceal bleeding. In addition, the use of non-invasive
 methods to avoid OV screening must be validated in HCV patients after SVR. The aims of this
 cross-sectional study with prospective inclusion of patients will be: (i) to evaluate the
 impact of SVR in portal hypertension in HCV patients with advanced fibrosis/liver cirrhosis
 treated by interferon-free regimens and (ii) to validate non-invasive methods to avoid OV
 screening by GIE
Inclusion Criteria:

 -  Age ≥ 18 years

 -  Presence of advanced fibrosis or cirrhosis (stage F≥3 METAVIR) based on liver
 stiffness by transient elastography (≥ 9,5 kPa) or liver biopsy

 -  Gastrointestinal endoscopy at least 24 months before start of direct-acting agents for
 HCV treatment

 -  Liver stiffness measurement at least 18 months after SVR

 Exclusion Criteria:

 -  Autoimmune hepatitis, hepatosplenic schistosomiasis or cholestasis diseases

 -  Liver transplantation

 -  Presence of high volume ascites or hepatocellular carcinoma

 -  Participation in programs of esophageal band ligation for eradication of esophageal
 varices

 -  Presence of signs of acute decompensated liver disease