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The prevalence of cancer in primary biliary cirrhosis
204
Poster Sessions
Conclusion: Although intima-media thickness did not change in chronic liver disease, pulsatility index and resistive index in the carotid artery were increased with the severity of liver disease and significantly correlated with blood ammonia. Carotid artery ultrasound in chronic liver disease can predict cerebral blood flow.
[-72-~ SURVlVAL OF PATIENTS WITH PRIMARY BILIARY CIRRHOSIS IN A DISTRICT GENERAL HOSPITAL C.E. Richardson, J.G.C. Kingham. Department of Gastroenterology,
Singleton Hospital, Swansea, UK Aim: Survival figures for patients with primary biliary cirrhosis (PBC) come largely from tertiary referral centres. The study aim was to determine the survival of an unselected cohort of PBC patients diagnosed consecutively over 20 years, in 2 district general hospitals, serving a population of 250,000. Study population: 119 (15 male) patients with PBC, age at diagnosis 61.1 5:1.1 (mean 5: SEM) years, under review for 8.4 5:2.2 years (range 1 to 22 years). Methods: Survival after diagnosis to either death or liver transplantation was determined and compared, using the Chi squared test, to that of an age and sex matched control population calculated from interim life tables. Results: In male and female PBC patients a significant reduction (P < 0.05) in survival was seen 15 and 8 years after diagnosis respectively (Table). Table: Percentage survival of PBC patients and controls
~-]
THE PREVALENCE OF CANCER IN PRIMARY BILIARY CIRRHOSIS
C.E. Richardson, J.G.C. Kingham. Department of Gastroenterology,
Singleton Hospital, Swansea, UK Aim: To determine the prevalence of cancer in an unselected cohort of patients with primary biliary cirrhosis (PBC) in 2 district general hospitals serving a population of 250,000. Typical clinical, biochemical features, liver biopsy and anti-mitochondrial antibody serology established the diagnosis of PBC Study population: 119 (15 male) PBC patients, age at diagnosis 61.1 -4- 1.1 (mean -4- SEM) years reviewed for 8.4 -4- 2.2 years. Methods: The prevalence of cancer was determined by history, examination and investigation. In those cancers with more than one case identified, relative risk was calculated by comparison to normal, age and sex matched, data from the Welsh Cancer Intelligence Unit. Results: Twenty-one cancers were identified in 19 patients; 7 died from their cancer. The cancers were; cervix 5, breast 4, colon 3, and 1 each of pancreatic, gastric, hepatic primary, hepatic secondary, ovarian, thyroid, bone, melanoma and Bowen's disease of the skin. Five cancers were diagnosed before diagnosis of PBC: cervix 3 (19, 6, 2 years), breast 1 (2 years), thyroid 1 (15 years). In the remainder cancer was diagnosed 5.7 + 1.0 years after PBC. The relative risks for cancer development were, cervix 22.1 (95 percent confidence interval 9.2 to 53.7), colon 2.5 (0.8 to 7.8) and breast 1.6 (0.6 to 4.2). Conclusion: Patients with PBC appear at increased risk of colonic, breast and, in particular, cervical cancer compared to the normal population.
Years of follow up Female patients Female controls Male patients Male controls 5 8 10 12 14
15 20
93 80.1+ 75++ 58.9+++ 34.4+++ 29.7+++ 10.3+++
95.5 91 87.8 84 79.3 76.6 61.6
91 90 88 75 60 33+++
92.8 86.4 81.2 75.1 68.4 64.8
+P = 0.02, ++P = 0.01, +++ P< 0.001 Conclusion: PBC was associated with a significant reduction in life expectancy compared to a control population. Aim: Survival figures for patients with primary biliary cirrhosis (PBC) come largely from tertiary referral centres. The study aim was to determine the survival of an unselected cohort of PBC patients diagnosed consecutively over 20 years, in 2 district general hospitals, serving a population of 250,000. Study population: 119 (15 male) patients with PBC, age at diagnosis 61.1 5:1.1 (mean 5: SEM) years, under review for 8.4 5:2.2 years (range 1 to 22 years). Methods: Survival after diagnosis to either death or liver transplantation was determined and compared, using the Chi squared test, to that of an age and sex matched control population calculated from interim life tables. Results: In male and female PBC patients a significant reduction (P < 0.05) in survival was seen 15 and 8 years after diagnosis respectively (Table). Table: Percentage survival of PBC patients and controls Years of follow up patients controls 5 8 10 12 14 15 20
PBC
PBC
Female
Female
Male
Male
93 80.1+ 75++ 58.9+-~ 34.4+++ 29.7+++ 10.3++~
95.5 91 87.8 84 79.3 76.6 61.6
91 90 88 75 60 33+++
92.8 86.4 81.2 75.1 68.4 64.8
+P = 0.02, ++P = 0.01, -~-H.p< 0.001 Conclusion: PBC was associated with a significant reduction in life expectancy compared to a control population.
~7~'] UPPER GASTROINTESTINAL HAEMORRHAGE IN CIRRHOTIC PATIENTS (A FRENCH SURVEY) EPIDEMIOLOGY AND CLINICAL PRACTICES: A POPULATION STUDY IN 4 FRENCH AREAS Stephane Lecleire l , Pierre Czernichow 2, Frederic Di Fiore l , Sophie Herve ~, Michel Amouretti 3, J. Louis Dupas 4, H. Gouerou 5 , Raymond Colin I . 1ADEN EA 1296, 76031 Rouen University Hospital;
2Epidemiology Unit, 76000 Rouen University Hospital; 3Hepatogastroenterology Unit, 33000 Bordeaux University Unit; 4Hepatogastroenterology Unit, 80000 Amiens University Unit; 5Hepatogastroenterology Unit, 29000 Brest University Unit, France Aims: The aim of this study was to evaluate clinical and epidemiological characteristics of upper gastrointestinal haemorrhage (UGH) in cirrhotic patients. Patients a n d Methods: We included between 1 January and 30 June 1996 all the UGH in cirrhotic patients. We registered epidemiological characteristics, endoscopic assessment, liver functions and clinical course. Mortality was determined, and factors associated with death were tested by the chisquare test. Results- 468 patients were included in the study (328 (70%) men, 140 (30%) women, mean age 59 years (-t-12)). 370 (79%) were alcoholic. In 309 (66%) it was the first bleeding event. The main diagnosis were oesophageal or gastric varices (59%), peptic ulcers (16%), or portal hypertension gastritis (7%). 98 (21%) were treated by beta-blockers, 16 (3.4%) by non-steroidal anti-inflammatory drug, 23 (4.9%) by aspirin, 19 (4.1%) by a corticosteroid, 21 (4.5%) by anticoagulants drug. An endoscopic treatment was performed in 220 (47%) patients (sclerotherapy: 67%, ligations: 23%, adrenaline haemostatic injection: 10%). Length of stay was more than one week in 59%. Hospital mortality was 23%, it was very high in the 48 first hours (56% of the deaths). Mortality was nigher in in-patients, in patients with digestive malignancy comorbidity, or in patients with low Quick time. Conclusion: According to our study annual french incidence of UGH in cirrhotic patients would be 28600 with 17900 variceal bleeding and 6500 annual deaths.
Poster Sessions
Conclusion: Although intima-media thickness did not change in chronic liver disease, pulsatility index and resistive index in the carotid artery were increased with the severity of liver disease and significantly correlated with blood ammonia. Carotid artery ultrasound in chronic liver disease can predict cerebral blood flow.
[-72-~ SURVlVAL OF PATIENTS WITH PRIMARY BILIARY CIRRHOSIS IN A DISTRICT GENERAL HOSPITAL C.E. Richardson, J.G.C. Kingham. Department of Gastroenterology,
Singleton Hospital, Swansea, UK Aim: Survival figures for patients with primary biliary cirrhosis (PBC) come largely from tertiary referral centres. The study aim was to determine the survival of an unselected cohort of PBC patients diagnosed consecutively over 20 years, in 2 district general hospitals, serving a population of 250,000. Study population: 119 (15 male) patients with PBC, age at diagnosis 61.1 5:1.1 (mean 5: SEM) years, under review for 8.4 5:2.2 years (range 1 to 22 years). Methods: Survival after diagnosis to either death or liver transplantation was determined and compared, using the Chi squared test, to that of an age and sex matched control population calculated from interim life tables. Results: In male and female PBC patients a significant reduction (P < 0.05) in survival was seen 15 and 8 years after diagnosis respectively (Table). Table: Percentage survival of PBC patients and controls
~-]
THE PREVALENCE OF CANCER IN PRIMARY BILIARY CIRRHOSIS
C.E. Richardson, J.G.C. Kingham. Department of Gastroenterology,
Singleton Hospital, Swansea, UK Aim: To determine the prevalence of cancer in an unselected cohort of patients with primary biliary cirrhosis (PBC) in 2 district general hospitals serving a population of 250,000. Typical clinical, biochemical features, liver biopsy and anti-mitochondrial antibody serology established the diagnosis of PBC Study population: 119 (15 male) PBC patients, age at diagnosis 61.1 -4- 1.1 (mean -4- SEM) years reviewed for 8.4 -4- 2.2 years. Methods: The prevalence of cancer was determined by history, examination and investigation. In those cancers with more than one case identified, relative risk was calculated by comparison to normal, age and sex matched, data from the Welsh Cancer Intelligence Unit. Results: Twenty-one cancers were identified in 19 patients; 7 died from their cancer. The cancers were; cervix 5, breast 4, colon 3, and 1 each of pancreatic, gastric, hepatic primary, hepatic secondary, ovarian, thyroid, bone, melanoma and Bowen's disease of the skin. Five cancers were diagnosed before diagnosis of PBC: cervix 3 (19, 6, 2 years), breast 1 (2 years), thyroid 1 (15 years). In the remainder cancer was diagnosed 5.7 + 1.0 years after PBC. The relative risks for cancer development were, cervix 22.1 (95 percent confidence interval 9.2 to 53.7), colon 2.5 (0.8 to 7.8) and breast 1.6 (0.6 to 4.2). Conclusion: Patients with PBC appear at increased risk of colonic, breast and, in particular, cervical cancer compared to the normal population.
Years of follow up Female patients Female controls Male patients Male controls 5 8 10 12 14
15 20
93 80.1+ 75++ 58.9+++ 34.4+++ 29.7+++ 10.3+++
95.5 91 87.8 84 79.3 76.6 61.6
91 90 88 75 60 33+++
92.8 86.4 81.2 75.1 68.4 64.8
+P = 0.02, ++P = 0.01, +++ P< 0.001 Conclusion: PBC was associated with a significant reduction in life expectancy compared to a control population. Aim: Survival figures for patients with primary biliary cirrhosis (PBC) come largely from tertiary referral centres. The study aim was to determine the survival of an unselected cohort of PBC patients diagnosed consecutively over 20 years, in 2 district general hospitals, serving a population of 250,000. Study population: 119 (15 male) patients with PBC, age at diagnosis 61.1 5:1.1 (mean 5: SEM) years, under review for 8.4 5:2.2 years (range 1 to 22 years). Methods: Survival after diagnosis to either death or liver transplantation was determined and compared, using the Chi squared test, to that of an age and sex matched control population calculated from interim life tables. Results: In male and female PBC patients a significant reduction (P < 0.05) in survival was seen 15 and 8 years after diagnosis respectively (Table). Table: Percentage survival of PBC patients and controls Years of follow up patients controls 5 8 10 12 14 15 20
PBC
PBC
Female
Female
Male
Male
93 80.1+ 75++ 58.9+-~ 34.4+++ 29.7+++ 10.3++~
95.5 91 87.8 84 79.3 76.6 61.6
91 90 88 75 60 33+++
92.8 86.4 81.2 75.1 68.4 64.8
+P = 0.02, ++P = 0.01, -~-H.p< 0.001 Conclusion: PBC was associated with a significant reduction in life expectancy compared to a control population.
~7~'] UPPER GASTROINTESTINAL HAEMORRHAGE IN CIRRHOTIC PATIENTS (A FRENCH SURVEY) EPIDEMIOLOGY AND CLINICAL PRACTICES: A POPULATION STUDY IN 4 FRENCH AREAS Stephane Lecleire l , Pierre Czernichow 2, Frederic Di Fiore l , Sophie Herve ~, Michel Amouretti 3, J. Louis Dupas 4, H. Gouerou 5 , Raymond Colin I . 1ADEN EA 1296, 76031 Rouen University Hospital;
2Epidemiology Unit, 76000 Rouen University Hospital; 3Hepatogastroenterology Unit, 33000 Bordeaux University Unit; 4Hepatogastroenterology Unit, 80000 Amiens University Unit; 5Hepatogastroenterology Unit, 29000 Brest University Unit, France Aims: The aim of this study was to evaluate clinical and epidemiological characteristics of upper gastrointestinal haemorrhage (UGH) in cirrhotic patients. Patients a n d Methods: We included between 1 January and 30 June 1996 all the UGH in cirrhotic patients. We registered epidemiological characteristics, endoscopic assessment, liver functions and clinical course. Mortality was determined, and factors associated with death were tested by the chisquare test. Results- 468 patients were included in the study (328 (70%) men, 140 (30%) women, mean age 59 years (-t-12)). 370 (79%) were alcoholic. In 309 (66%) it was the first bleeding event. The main diagnosis were oesophageal or gastric varices (59%), peptic ulcers (16%), or portal hypertension gastritis (7%). 98 (21%) were treated by beta-blockers, 16 (3.4%) by non-steroidal anti-inflammatory drug, 23 (4.9%) by aspirin, 19 (4.1%) by a corticosteroid, 21 (4.5%) by anticoagulants drug. An endoscopic treatment was performed in 220 (47%) patients (sclerotherapy: 67%, ligations: 23%, adrenaline haemostatic injection: 10%). Length of stay was more than one week in 59%. Hospital mortality was 23%, it was very high in the 48 first hours (56% of the deaths). Mortality was nigher in in-patients, in patients with digestive malignancy comorbidity, or in patients with low Quick time. Conclusion: According to our study annual french incidence of UGH in cirrhotic patients would be 28600 with 17900 variceal bleeding and 6500 annual deaths.