Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Marco Enea
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Mauro Viganò
Hepatology Unit, Ospedale San Giuseppe, University of Milan, Milan, Italy
Filippo Schepis
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Victor de Ledinghen
Centre d’Investigation de la Fibrose Hépatique, INSERM U1053, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
Annalisa Berzigotti
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Vincent Wai-Sun Wong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
Anna Ludovica Fracanzani
Department of Pathophysiology and Transplantation, Ca’ Granda IRCCS Foundation, Policlinico Hospital, University of Milan, Milan, Italy
Giada Sebastiani
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
Carmen Lara-Romero
UCM Digestive Diseases, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), CIBEREHD, University of Seville, Ciberehd, Seville, Spain
Elisabetta Bugianesi
Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy
Gianluca Svegliati-Baroni
Liver Injury and Transplant Unit, Università Politecnica delle Marche, Ancona, Italy
Fabio Marra
Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy; Research Center DENOTHE, University of Florence, Florence, Italy
Alessio Aghemo
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
Luca Valenti
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Precision Medicine and Biological Resource Center, Department of Transfusion Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico IRCCS, Milan, Italy
Vincenza Calvaruso
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Antonio Colecchia
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Gabriele Di Maria
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Claudia La Mantia
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Huapeng Lin
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
Yuly P. Mendoza
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Nicola Pugliese
Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
Federico Ravaioli
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Manuel Romero-Gomez
UCM Digestive Diseases, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (HUVR/CSIC/US), CIBEREHD, University of Seville, Ciberehd, Seville, Spain
Dario Saltini
Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
Antonio Craxì
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Vito Di Marco
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Calogero Cammà
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy
Salvatore Petta
Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Palermo, Italy; Corresponding author. Address: Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy. Tel.: +39-091-655-2170; fax: +39-091-655-2156.
Background & Aims: We aimed to evaluate the impact of oesophageal varices (OV) and their evolution on the risk of complications of compensated advanced chronic liver disease (cACLD) caused by non-alcoholic fatty liver disease (NAFLD). We also assessed the accuracy of non-invasive scores for predicting the development of complications and for identifying patients at low risk of high-risk OV. Methods: We performed a retrospective assessment of 629 patients with NAFLD-related cACLD who had baseline and follow-up oesophagogastroduodenoscopy and clinical follow-up to record decompensation, portal vein thrombosis (PVT), and hepatocellular carcinoma. Results: Small and large OV were observed at baseline in 30 and 15.9% of patients, respectively. The 4-year incidence of OV from absence at baseline, and that of progression from small to large OV were 16.3 and 22.4%, respectively. Diabetes and a ≥5% increase in BMI were associated with OV progression. Multivariate Cox regression revealed that small (hazard ratio [HR] 2.24, 95% CI 1.47–3.41) and large (HR 3.86, 95% CI 2.34–6.39) OV were independently associated with decompensation. When considering OV status and trajectories, small (HR 2.65, 95% CI 1.39–5.05) and large (HR 4.90, 95% CI 2.49–9.63) OV at baseline and/or follow-up were independently associated with decompensation compared with the absence of OV at baseline and/or follow-up. The presence of either small (HR 2.8, 95% CI 1.16–6.74) or large (HR 5.29, 95% CI 1.96–14.2) OV was also independently associated with incident PVT. Conclusion: In NAFLD-related cACLD, the presence, severity, and evolution of OV stratify the risk of developing decompensation and PVT. Impact and implications: Portal hypertension is the main driver of liver decompensation in chronic liver diseases, and its non-invasive markers can help risk prediction. The presence, severity, and progression of oesophageal varices stratify the risk of complications of non-alcoholic fatty liver disease. Easily obtainable laboratory values and liver stiffness measurement can identify patients at low risk for whom endoscopy may be withheld, and can also stratify the risk of liver-related complications.
