Diabetes and Gallstones in Chronic Viral Liver Disease
The prevalence of intrahepatic cholestasis in viral chronic liver disease isstill undefined; it was estimated to be higher than 30% in a population from Italy and from the London area (Bartolini et al. Drug Invest. 1992; 4 suppl., 83-9). Cholestasis can negatively affect the evolution of cirrhosis and the responsiveness to interferon (IFN) treatment in viral chronic hepatitis. In this retrospective multicentre survey we evaluated 1557 consecutive virus hepatitis patients (1993-1994) from South Italy, of whom 770 with chronic hepatitis (mean age 47 yrs; range 14-81) and 787 with cirrhosis (mean age 56; range 18-86 yrs). An increase of both the cholestatic enzymes, (alcaline phosphatase [ALP] and gamma-glutamyl-transferase [GGT] was detected in 230 patients (14.7%), 50% of whom with hyperbilirubinemia. The liver disease originated from C-hepatitis virus in 80.4% of patients and from B hepatitis virus in 17.4% The serum increase of cholestatic enzymes was similar in degree and frequency in C and B virus cases (11% vs 12.6%; p = n.s.). The cholestatic enzymes were increased in 7.4% of patients with chronic hepatitis (23% of them with hyperbilirubinemia) and in 22% of cirrhotics (64% with hyperbilirubinemia) (p less than 0.01). The prevalence of asymptomatic gallstones and diabetes was evaluated in relation to the increase in cholestatic enzymes. In chronic hepatitis, diabetes was present in 20.4% of subjects with versus 6.8% of subjects without serum increase of ALP and GGT (p less than 0.005). In the cirrhotic group the frequency of diabetes was similar in both subgroups of patients (26.6% vs 33.8%; p = n.s.). Gallstones were detected in 11.9% and in 6.5% of patients with and without enzyme increase respectively (p = n.s.). In the cirrhotic group gallstones were significantly more frequent in the cholestatic group (28.8 versus 19.8% non cholestatic; p less than 0.05). In conclusion diabetes, gallstones and serum increases of ALP and GGT were significantly more frequent in cirrhosis than in chronic hepatitis. In chronic hepatitis diabetes was more frequent in patients with cholestasis, while gallstones were observed more frequently in cholestatic cirrhosis. The physiopathologic relationships of diabetes and gallstones with cholestasis and their effects on antiviral therapy require further evaluation in viral chronic liver disease.
Authors: G. Budillon. L. Cimino, A. D'Arienzo, M.R. Franco, B. D'Ascoli, N. Caporaso*, A. AscioneØ. C. Del Vecchio Blanco*. Cattedre di Gastroenterologia Universita "Federico II" Napoli, *II Ateneo Napoli, ØUnita Fegato Ospedale A. Cardarelli Napoli - Italy
Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting