Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2017; 23(26): 4669-4674
Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4669
Impact of hepatitis C oral therapy in portal hypertension
Diogo Libânio, Rui Tato Marinho
Diogo Libânio, Department of Gastroenterology, Instituto Português de Oncologia do Porto, 4200-072 Porto, Portugal
Rui Tato Marinho, Department of Gastroenterology and Hepatology, Centro Hospitalar de Lisboa Norte/Hospital Santa Maria, 1649-035 Lisbon, Portugal
Rui Tato Marinho, Faculty of Medicine, University of Lisbon, 1600-276 Lisbon, Portugal
Author contributions: Libânio D and Marinho RT designed and wrote this manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest of any kind regarding this manuscript
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Diogo Libânio, MD, Department of Gastroenterology, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal. diogo.monteiro@ipoporto.min-saude.pt
Telephone: +35-191-0288892
Received: January 22, 2017
Peer-review started: January 24, 2017
First decision: March 16, 2017
Revised: March 28, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: July 14, 2017
Processing time: 170 Days and 10.2 Hours
Abstract

Chronic hepatitis C is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis C treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring

Keywords: Hepatitis C; Portal hypertension; Direct antiviral agents; Cirrhosis; Fibrosis; Interferon

Core tip: Hepatitis C is associated with significant morbidity and mortality, mainly through portal hypertension complications. Hepatitis C treatment is associated with improvement of liver function and fibrosis, better quality of life and reduced mortality. The knowledge of the impact of viral clearance on portal hypertension is also relevant because it greatly influences clinical outcomes and can influence management after treatment. Several studies show that the benefits on portal hypertension are higher if treatment is delivered before clinically significant portal hypertension is developed, encouraging timely and early treatment with the highly efficacious and safe direct antiviral agents.