Z Gastroenterol 2020; 58(05): e96
DOI: 10.1055/s-0040-1712302
Hepatologie

Screening for chronic liver diseases in the general population reveals an unexpectedly high prevalence of hepatitis c and advanced NAFLD

S Bachmayer
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
,
G Semmler
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
,
S Wernly
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
,
E Weilnböck
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
,
B Wernly
2   Paracelsus Medical University of Salzburg, Clinic of Internal Medicine II, Department of Cardiology, Salzburg, Austria
,
D Niederseer
3   University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
,
L Stangassinger
4   Biomedical Sciences, Salzburg University of Applied Sciences, Puch/Salzburg, Austria
,
G Oostingh
4   Biomedical Sciences, Salzburg University of Applied Sciences, Puch/Salzburg, Austria
,
K Schwenoha
4   Biomedical Sciences, Salzburg University of Applied Sciences, Puch/Salzburg, Austria
,
U Huber-Schönauer
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
,
E Aigner
5   Paracelsus Medical University, Department of Internal Medicine I, Salzburg, Austria
,
C Datz
1   Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Salzburg, Austria
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Background Hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) are common causes for chronic liver disease. Data on the prevalence in particular are limited. The cost-effectiveness of population-based HCV screening to achieve eradication of HCV is under debate. We provide preliminary data of a population-based combined Hepatitis C and NAFLD screening program in Austria.

Method As part of a colorectal carcinoma colonoscopy screening program (SAKKOPI), we investigated 661 asymptomatic subjects (median age 58.8 years, 56 % males). Diagnosis of NAFLD was established by abdominal ultrasound and transient elastography-based controlled attenuation parameter (CAP) ≥  280 dB/m after exclusion of alcohol mediated, autoimmune, viral and hereditary liver diseases. Assessment of fibrosis using transient elastography (≥  7 kPa for significant fibrosis [≥  F2] and ≥  10 kPa for cirrhosis [F4]) as well as biochemical and metabolic parameters plus a detailed questionnaire of dietary habits and physical activity was performed.

Results In 661 patients, median BMI was 25.9. 200 patients (30 %) had elevated liver enzymes (GGT/ALT) and 246 (37 %) had (pre-) diabetes. 42 % of patients showed increased echogenicity on ultrasound. Mean CAP-value was 265 dB/m (221 - 311), whereas 269 (42 %) patients had CAP-values above 280 dB/m. 63 (10 %) of NAFLD patients had significant fibrosis (≥ F2) and 16 (2.5 %) had liver cirrhosis. 6 patients (0.9 %) had HCV antibodies and 5 of them (0.8 %) had chronic HCV infection confirmed. Notably, two patients with chronic HCV infection had completely normal laboratory, ultrasound and transient elastography findings.

Conclusion We show an unexpectedly high prevalence of chronic HCV infection and advanced NAFLD in a large, well-characterized cohort of asymptomatic patients. Especially the high prevalence of undetected HCV infections (0.8 %) emphasizes the need for HCV screening in a population-based manner. Importantly, 40 % of individuals with unknown HCV infection did not show any evidence for chronic liver disease.



Publication History

Article published online:
26 May 2020

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