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Is Cirrhosis Reversible?

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    NATAP - www.natap.org ... Is Cirrhosis Reversible? Abstract 1015. AASLD, Nov 2001. REVERSIBILITY OF CIRRHOSIS At AASLD, there were 2 additional reports showing
    Message 1 of 1 , Jan 2, 2002
      NATAP - www.natap.org

      Is Cirrhosis Reversible?

      Abstract 1015. AASLD, Nov 2001. REVERSIBILITY OF

      At AASLD, there were 2 additional reports showing
      treatment can improve fibrosis.

      1. investigators report finding improved fibrosis
      progression following HCV therapy in patients with
      advanced liver disease (stage 3/4). For nonresponders,
      fibrosis progression reversed, and for nonresponders
      progression slowed.


      2. Poynard & French research group report 49% with
      cirrhosis showed some degree of reversal of cirrhosis
      from F4 stage to either F3, F2 or F1; achieving a
      sustained response was a significant factor.
      Non-responders can slow fibrosis.


      3. Jenny Heathcote reported from study of cirrhotics
      receiving Pegasys that patients with cirrhosis could
      improve their histology (a histologic response in this
      study was defined as a decrease of at least 2 points
      on the 22-point Histological Activity Index). 30%
      using Pegasys montherapy achieved a sustained response
      vs 8% using standard interferon.



      Jeanne Serpaggi, Francoise Carnot, Bertrand Nalpas,
      Ana�s Vallet Pichard, J�rome Guechot, Jean Luc
      Lagneau, Christian Brechot, Stanislas Pol, Necker
      Hosp, Paris France

      Aim: To revisit the concept of the irreversibility of
      cirrhosis by analyzing a large series of non
      immunocompromised patients with cirrhosis of various
      etiologies. Methods: Retrospective analysis of the 113
      cirrhotic patients who had biopsy proven cirrhosis,
      then specific therapy and follow-up biopsies.
      Resolution of cirrhosis was defined as a decrease of
      the fibrosis score 32 by Metavir score after blinded
      analysis by the same pathologist. The biochemical
      (platelets, prothrombin time, hyaluronate and
      PIIINP)and morphological US markers of cirrhosis were
      also analyzed. Results: Respective etiologies of
      cirrhosis were the following : HCV (68%), HBV (15%),
      alcohol (8%), auto-immune (9%). Forteen (all
      Child-Pugh A stage) of the 115 cirrhotic patients
      (12%) had biopsy-proven disappearance of cirrhosis
      with a median time between the two biopsies of 4.3 �
      2.1 years. Eight had virus HCV-related cirrhosis
      including 1 with heavy drinking, 3 HBV including 1
      with heavy drinking, and 3 auto-immune cirrhosis. In
      these 14, by the Metavir score, activity decreased
      from 2.4 � 0.65 to 0.85 � 0.9 (p=0.004) and fibrosis
      from 4 to 1.7 � 0.61 (p=0.001). Normalisation of the
      prothrombine time (n=1), of the platelet count (n=2),
      of serum albumin level (n=2), of ultrasound
      abnormalities (n=6) were observed in the 11 patients
      who had initial features of portal hypertension or
      hepatic insufficiency. Following therapy, serum
      markers (hyaluronate, PIIINP) of fibrosis decreased in
      all patients but more significantly in those pts with
      cirrhosis reversibility (- 95 vs. - 17 mg/l and - 0.58
      vs. - 0.17 U/l, respectively). Among the 11 regressive
      patients with viral cirrhosis, 7 were sustained
      responders and 2 relapsers to anti-viral therapy and
      they accounted for 23 % of the responders. All
      patients with autoimmune cirrhosis responded to
      immunosuppressive therapy (steroid and azathioprine)
      and accounted for 30 % of the responders.

      Conclusions: With repeated liver biopsies,
      clinico-biochemical, radiological and endoscopy tests,
      we provide strong evidence for potential reversibility
      of cirrhosis. Thus, long lasting decrease or
      suppression of the necrotico-inflammatory activity of
      liver disease allowed complete regression of extensive
      fibrosis or cirrhosis.

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