Liver cirrhosis-epidemiological and Clinical Aspects
Liver cirrhosis is the end-stage of many different chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis such as esophageal varices and malignancies in the Nordic countries after the discovery of hepatitis C (HCV). Most hepatocellular c...
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ftunivgoeteborg:oai:gupea.ub.gu.se:2077/10132 2023-10-29T02:37:19+01:00 Liver cirrhosis-epidemiological and Clinical Aspects Gunnarsdóttir, Steingerður Anna 2008-05-19T05:49:13Z application/pdf http://hdl.handle.net/2077/10132 eng eng I. Gunnarsdottir SA, Olsson R, Ólafsson S, Cariglia N, Westin J, Thjódleifsson B, Björnsson ES. Liver cirrhosis in Iceland and Sweden: incidence, etiology and outcomes. In manuscript II. Gunnarsdottir SA, Olsson R, Björnsson ES. Characteristics, prognosis and outcome of patients with oesophageal varices in a university hospital in Sweden 1994-1999. Scand J Gastroenterol 2005;40:1462-1468 ::pmid::16293558 III. Gunnarsdottir SA, Kalaitzakis E, Björnsson ES. Development of different malignancies in patients with liver cirrhosis. In manuscript IV. Gunnarsdottir SA, Sadik R, Shev S, Simrén M, Sjövall H, Stotzer P-O, Abrahamsson H, Olsson R, Björnsson ES. Small intestinal motility disturbances and bacterial overgrowth in patients with liver cirrhosis and portal hypertension. Am J Gastroenterol 2003;98:1362-1370 ::pmid::12818282 978-91-628-7460-5 http://hdl.handle.net/2077/10132 Liver cirrhosis etiology alcoholic liver disease mortality portal hypertension esophageal varices variceal bleeding hepatitis C hepatocellular cancer malignancies small intestinal motility small intestinal bacterial overgrowth text Doctoral thesis Doctor of Philosophy (Medicine) 2008 ftunivgoeteborg 2023-10-04T21:15:00Z Liver cirrhosis is the end-stage of many different chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis such as esophageal varices and malignancies in the Nordic countries after the discovery of hepatitis C (HCV). Most hepatocellular carcinomas (HCC) develop in patients with liver cirrhosis but data on the occurrence of other malignancies than HCCs in these patients are scarce. Gastrointestinal (GI) symptoms such as nausea, vomiting, abdominal pain, and diarrhea are common in patients with advanced liver disease but the importance of portal hypertension for these symptoms is unexplored. The aims of the present study were to evaluate the incidence, outcome and complications of liver cirrhosis in a Swedish population and in Iceland and the effects of portal hypertension on small bowel motility and small intestinal bacterial overgrowth (SIBO) in patients with liver cirrhosis. The annual incidence of liver cirrhosis in Gothenburg was 15.3 ±2.4/100.000 compared to 3.3 ±1.2/100.000 in Iceland, p<0.0001. In Gothenburg 50% of the patients had alcoholic cirrhosis compared to 29% in Iceland (p<0.0001). Only 9% of patients died in their first variceal bleeding, that is within one week of their first bleeding episode. Of the patients diagnosed with esophageal varices after a bleeding episode, 55% had a bleeding episode during follow-up compared to only 13% of the patients diagnosed without a bleeding episode. Variables predicting mortality in a multivariate analysis were: Child-Pugh class, bleeding before diagnosis, age and bilirubin levels. Causes of death were in 26% of cases liver failure, 19% variceal bleeding and the rest other causes. Patients with liver cirrhosis had 267 times increased risk of hepatocellular cancer. Among patients with HCV cirrhosis, 19% developed HCC and 20% of those with HCV and alcoholic liver disease (ALD). We observed 13 times increased risk of cholangiocarcinoma and also increased risk for esophageal, pancreatic, pulmonary ... Doctoral or Postdoctoral Thesis Iceland University of Gothenburg: GUPEA (Gothenburg University Publications Electronic Archive) |
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Open Polar |
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University of Gothenburg: GUPEA (Gothenburg University Publications Electronic Archive) |
op_collection_id |
ftunivgoeteborg |
language |
English |
topic |
Liver cirrhosis etiology alcoholic liver disease mortality portal hypertension esophageal varices variceal bleeding hepatitis C hepatocellular cancer malignancies small intestinal motility small intestinal bacterial overgrowth |
spellingShingle |
Liver cirrhosis etiology alcoholic liver disease mortality portal hypertension esophageal varices variceal bleeding hepatitis C hepatocellular cancer malignancies small intestinal motility small intestinal bacterial overgrowth Gunnarsdóttir, Steingerður Anna Liver cirrhosis-epidemiological and Clinical Aspects |
topic_facet |
Liver cirrhosis etiology alcoholic liver disease mortality portal hypertension esophageal varices variceal bleeding hepatitis C hepatocellular cancer malignancies small intestinal motility small intestinal bacterial overgrowth |
description |
Liver cirrhosis is the end-stage of many different chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis such as esophageal varices and malignancies in the Nordic countries after the discovery of hepatitis C (HCV). Most hepatocellular carcinomas (HCC) develop in patients with liver cirrhosis but data on the occurrence of other malignancies than HCCs in these patients are scarce. Gastrointestinal (GI) symptoms such as nausea, vomiting, abdominal pain, and diarrhea are common in patients with advanced liver disease but the importance of portal hypertension for these symptoms is unexplored. The aims of the present study were to evaluate the incidence, outcome and complications of liver cirrhosis in a Swedish population and in Iceland and the effects of portal hypertension on small bowel motility and small intestinal bacterial overgrowth (SIBO) in patients with liver cirrhosis. The annual incidence of liver cirrhosis in Gothenburg was 15.3 ±2.4/100.000 compared to 3.3 ±1.2/100.000 in Iceland, p<0.0001. In Gothenburg 50% of the patients had alcoholic cirrhosis compared to 29% in Iceland (p<0.0001). Only 9% of patients died in their first variceal bleeding, that is within one week of their first bleeding episode. Of the patients diagnosed with esophageal varices after a bleeding episode, 55% had a bleeding episode during follow-up compared to only 13% of the patients diagnosed without a bleeding episode. Variables predicting mortality in a multivariate analysis were: Child-Pugh class, bleeding before diagnosis, age and bilirubin levels. Causes of death were in 26% of cases liver failure, 19% variceal bleeding and the rest other causes. Patients with liver cirrhosis had 267 times increased risk of hepatocellular cancer. Among patients with HCV cirrhosis, 19% developed HCC and 20% of those with HCV and alcoholic liver disease (ALD). We observed 13 times increased risk of cholangiocarcinoma and also increased risk for esophageal, pancreatic, pulmonary ... |
format |
Doctoral or Postdoctoral Thesis |
author |
Gunnarsdóttir, Steingerður Anna |
author_facet |
Gunnarsdóttir, Steingerður Anna |
author_sort |
Gunnarsdóttir, Steingerður Anna |
title |
Liver cirrhosis-epidemiological and Clinical Aspects |
title_short |
Liver cirrhosis-epidemiological and Clinical Aspects |
title_full |
Liver cirrhosis-epidemiological and Clinical Aspects |
title_fullStr |
Liver cirrhosis-epidemiological and Clinical Aspects |
title_full_unstemmed |
Liver cirrhosis-epidemiological and Clinical Aspects |
title_sort |
liver cirrhosis-epidemiological and clinical aspects |
publishDate |
2008 |
url |
http://hdl.handle.net/2077/10132 |
genre |
Iceland |
genre_facet |
Iceland |
op_relation |
I. Gunnarsdottir SA, Olsson R, Ólafsson S, Cariglia N, Westin J, Thjódleifsson B, Björnsson ES. Liver cirrhosis in Iceland and Sweden: incidence, etiology and outcomes. In manuscript II. Gunnarsdottir SA, Olsson R, Björnsson ES. Characteristics, prognosis and outcome of patients with oesophageal varices in a university hospital in Sweden 1994-1999. Scand J Gastroenterol 2005;40:1462-1468 ::pmid::16293558 III. Gunnarsdottir SA, Kalaitzakis E, Björnsson ES. Development of different malignancies in patients with liver cirrhosis. In manuscript IV. Gunnarsdottir SA, Sadik R, Shev S, Simrén M, Sjövall H, Stotzer P-O, Abrahamsson H, Olsson R, Björnsson ES. Small intestinal motility disturbances and bacterial overgrowth in patients with liver cirrhosis and portal hypertension. Am J Gastroenterol 2003;98:1362-1370 ::pmid::12818282 978-91-628-7460-5 http://hdl.handle.net/2077/10132 |
_version_ |
1781061925241618432 |