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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Etiology of chronic liver diseases in the Northwest of Italy, 1998 through 2014
Giorgio Maria Saracco, Andrea Evangelista, Sharmila Fagoonee, Giovannino Ciccone, Elisabetta Bugianesi, Gian Paolo Caviglia, Maria Lorena Abate, Mario Rizzetto, Rinaldo Pellicano, Antonina Smedile
Giorgio Maria Saracco, Department of Oncology, University of Turin, 10123 Turin, Italy
Andrea Evangelista, Giovannino Ciccone, Unit of Cancer Epidemiology (CPO Piemonte), University of Turin, 10123 Turin, Italy
Sharmila Fagoonee, Institute for Biostructures and Bioimages-CNR c/o Molecular Biotechnology Center, University of Turin, 10126 Turin, Italy
Elisabetta Bugianesi, Gian Paolo Caviglia, Maria Lorena Abate, Mario Rizzetto, Antonina Smedile, Department of Medical Sciences, University of Turin, 10123 Turin, Italy
Elisabetta Bugianesi, Mario Rizzetto, Giorgio Maria Saracco, Rinaldo Pellicano, Antonina Smedile, Unit of Gastroenterology, Molinette Hospital, 10123 Turin, Italy
Author contributions: Saracco GM, Fagoonee S, Rizzetto M and Pellicano R revised the paper critically for important and intellectual contents; Evangelista A and Ciccone G performed statistical analysis; Bugianesi E, Caviglia GP, Abate ML and Pellicano R collected the data; Pellicano R and Smedile A wrote the paper; Pellicano R and Smedile A contributed equally to the paper; Smedile A designed the research.
Supported by Regione Piemonte grants, No. R01 DK090317 and No. R01 DA031095 (in part); Bando Ricerca Scientifica Applicata Anno 2003.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Molinette Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data, it was performed several years after the consultation (retrospective) and the design was observational (clinical setting) without therapeutic involvement.
Conflict-of-interest statement: None to declare.
Data sharing statement: No additional data are available.
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: Rinaldo Pellicano, MD, Unit of Gastroenterology, Outpatient Clinic, Molinette Hospital, corso Bramante 88, 10123 Turin, Italy. rinaldo_pellican@hotmail.com
Telephone: +39-633-6333918 Fax: +39-633-6336224
Received: June 22, 2016
Peer-review started: June 22, 2016
First decision: July 29, 2016
Revised: August 8, 2016
Accepted: August 30, 2016
Article in press: August 30, 2016
Published online: September 28, 2016
AIM
To assess the etiology of chronic liver diseases (CLD) from 1998 to 2014 at the outpatient clinic of Gastroenterology of the main hospital in Northwest of Italy among those dedicated to hepatology.
METHODS
A random sample of charts of patients referred to for increased liver enzymes between January 1998 and December 2006, and between January 2012 and December 2014 were reviewed. Etiology search included testing for hepatitis B virus (HBV), hepatitis C virus (HCV), autoimmune hepatitis, primary biliary cirrhosis, Wilson’s disease and hereditary hemocromatosis. A risky alcohol consumption was also considered. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in patients with histological and/or ultrasound evidence of steatosis/steatohepatitis, and without other causes of CLD.
RESULTS
The number of patients included was 1163. Of them, 528 (45%) had positivity for HCV and 85 (7%) for HBV. Among the virus-free patients, 417 (36%) had metabolic disorders whereas the remaining had history of alcohol abuse, less prevalent causes of CLD or concomitant conditions. In comparison to 1998-2000 (41%), a reduction of HCV alone-related cases was detected during the periods 2001-2003 (35%, OR = 0.75, 95%CI: 0.53-1.06), 2004-2006 (33%, OR = 0.70, 95%CI: 0.50-0.97) and 2012-2014 (31%, OR = 0.64, 95%CI: 0.46-0.91). On the contrary, in comparison to 1998-2000 (31%), metabolic-alone disorders increased in the period 2004-2006 (39%, OR = 1.37, 95%CI: 0.99-1.91) and 2012-2014 (41%, OR = 1.53, 95%CI: 1.09-2.16). The other etiologies remained stable. The increase of incidence of metabolic-alone etiology during the period 2004-2006 and 2012-2014 tended to be higher in older patients (≥ 50 years) compared to younger (P = 0.058).
CONCLUSION
In the Northwest of Italy, during this study period, the prevalence of HCV infection decreased notably whereas that of NAFLD increased.
Core tip: The epidemiological knowledge of variations of etiology of chronic liver diseases (CLD) is crucial for health policy of resource allocation and for planning strategies of prevention and treatment. Our study, carried out in a large population from 1998 to 2014 period, shows that, in Northwest Italy, viral CLD decreased and CLD due to metabolic disorders remarkably increased. These results suggest the need to perform a strategy of rigorous education and counseling, in particular in overweight and obese subjects.
