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

doi:10.1111/apt.15320

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 (Lead / Corresponding author), 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

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Abstract

Background: Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening.

Aim: To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland.

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: About 34% were 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 language	English
Pages (from-to)	425-434
Number of pages	10
Journal	Alimentary Pharmacology & Therapeutics
Volume	50
Issue number	4
Early online date	3 Jun 2019
DOIs	https://doi.org/10.1111/apt.15320
Publication status	Published - Aug 2019

Keywords

Oesophageal and gastric varices
endoscopy
screening
hepatitis C virus
gastrointestinal haemorrhage

ASJC Scopus subject areas

Gastroenterology
Pharmacology (medical)
Hepatology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/apt.15320

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McDonald, S. A., Barclay, S. T., Hutchinson, S. J., Stanley, A. J., Fraser, A., Dillon, J. F., Innes, H. A., Peters, E., Kennedy, N., Bathgate, A., Bramley, P., Morris, J., Goldberg, D. J., & Hayes, P. C. (2019). 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. Alimentary Pharmacology & Therapeutics, 50(4), 425-434. https://doi.org/10.1111/apt.15320

McDonald, Scott A. ; Barclay, Stephen T. ; Hutchinson, Sharon J. et al. / 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. In: Alimentary Pharmacology & Therapeutics. 2019 ; Vol. 50, No. 4. pp. 425-434.

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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.Aim: To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland.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: About 34% were 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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year = "2019",

month = aug,

doi = "10.1111/apt.15320",

language = "English",

volume = "50",

pages = "425--434",

journal = "Alimentary Pharmacology & Therapeutics",

issn = "0269-2813",

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McDonald, SA, Barclay, ST, Hutchinson, SJ, Stanley, AJ, Fraser, A, Dillon, JF, Innes, HA, Peters, E, Kennedy, N, Bathgate, A, Bramley, P, Morris, J, Goldberg, DJ & Hayes, PC 2019, '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', Alimentary Pharmacology & Therapeutics, vol. 50, no. 4, pp. 425-434. https://doi.org/10.1111/apt.15320

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. (Lead / Corresponding author); Barclay, Stephen T.; Hutchinson, Sharon J. et al.
In: Alimentary Pharmacology & Therapeutics, Vol. 50, No. 4, 08.2019, p. 425-434.

Research output: Contribution to journal › Article › peer-review

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

T2 - 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 - No Funding.

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.Aim: To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland.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: About 34% were 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.Aim: To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland.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: About 34% were 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

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U2 - 10.1111/apt.15320

DO - 10.1111/apt.15320

M3 - Article

C2 - 31157411

SN - 0269-2813

VL - 50

SP - 425

EP - 434

JO - Alimentary Pharmacology & Therapeutics

JF - Alimentary Pharmacology & Therapeutics

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McDonald SA, Barclay ST, Hutchinson SJ, Stanley AJ, Fraser A, Dillon JF et al. 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. Alimentary Pharmacology & Therapeutics. 2019 Aug;50(4):425-434. Epub 2019 Jun 3. doi: 10.1111/apt.15320

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

Keywords

ASJC Scopus subject areas

UN SDGs

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