Fibrosis progression occurs in a subgroup of heavy drinkers with typical histological features
Article first published online: 22 FEB 2007
Alimentary Pharmacology & Therapeutics
Volume 25, Issue 9, pages 1047–1054, May 2007
How to Cite
MATHURIN, P., BEUZIN, F., LOUVET, A., CARRIÉ-GANNE, N., BALIAN, A., TRINCHET, J. C., DALSOGLIO, D., PREVOT, S. and NAVEAU, S. (2007), Fibrosis progression occurs in a subgroup of heavy drinkers with typical histological features. Alimentary Pharmacology & Therapeutics, 25: 1047–1054. doi: 10.1111/j.1365-2036.2007.03302.x
- Issue published online: 22 FEB 2007
- Article first published online: 22 FEB 2007
- Publication data Submitted 10 November 2006 First decision 2 December 2006 Resubmitted 6 February 2007 Accepted 18 February 2007
Background Studies using consecutive liver biopsies constitute an attractive approach to gaining insight into the pathogenesis of alcoholic liver disease.
Aim To analyse histological factors at baseline, which are predictive of fibrosis progression and recurrence of alcoholic hepatitis.
Results A total of 193 drinkers underwent consecutive biopsies at an interval of 4 years. At baseline, 20 had normal livers, 135 steatosis, five fibrosis and 33 alcoholic hepatitis. The fibrosis score increased from 1.07 ± 0.07 to 1.7 ± 0.94 (P < 0.001). In multivariate analysis, only steatosis (P = 0.04), alcoholic hepatitis (P = 0.0004) and stage of fibrosis (P < 0.0001) were independent predictive factors of the fibrosis score at the second biopsy. Cirrhosis developed more frequently in patients with steatosis (11%) and alcoholic hepatitis (39%) than in others (0%, P < 0.0001). Alcoholic hepatitis recurred more frequently in patients with alcoholic hepatitis at baseline: 58% vs. 15%, P < 0.0001. In multivariate analysis, alcoholic hepatitis at the first biopsy was the only predictive factor of its recurrence (P < 0.0001).
Conclusions In a large cohort of drinkers with consecutive biopsies, steatosis, fibrosis stage and alcoholic hepatitis at baseline were independent predictive factors of fibrosis progression. In terms of mechanisms, we propose a novel concept of multiple hits of alcoholic hepatitis occurring in the same patient.