Advertisement

Geographical pattern of chronic liver diseases in Italy: Results from two pooled national surveys

Published:October 22, 2018DOI:https://doi.org/10.1016/j.ejim.2018.10.015

      Highlights

      • Alcohol-related CLD prevails in North/Central Italy (N/C) (p < .001).
      • HBV-CLD and HCV-CLD prevail in South Italy/Sicily/Sardinia (SI/S/S) (p = .02; p < .001)
      • Differences in aetiology were stable over time.
      • Cirrhosis was diagnosed more frequently in SI/S/S than in N/C (p < .01).
      • The proportion of cirrhosis increased overtime in N/C (p < .01) and SI/S/S (p < .01).

      Abstract

      Background

      The information on the geographical characteristics of chronic liver diseases (CLD) in Italy is out-dated.

      Aim

      To provide up-dated information on the geographical pattern of patients with CLD born in Italy.

      Methods

      Patients with CLD were enrolled in two national surveys performed in 2001 and 2014, which prospectively recruited subjects aged ≥18 years referring to Italian liver units located throughout the country that apply a similar clinical approach and analytical methods.

      Results

      The total number of patients enrolled was 11,676. Alcohol-related CLD was more frequently observed in northern/central areas (25.0% vs. 20.7%, p < .001), while HBV-related (15.4% vs. 13.3%, p = .02) and HCV-related (71.2% vs. 67.1%, p < .001) CLD prevailed in southern areas/main islands (Sicily and Sardinia). These differences were stable over time. Liver cirrhosis without HCC was diagnosed more frequently in southern area/islands than in northern/central areas (23.7% vs. 18.8%, p < .01). Moreover, an increased proportion over time of patients with cirrhosis without HCC was observed both in northern/central areas (17.3% vs. 27.4%, p < .01) and in southern area/islands (22.6% vs. 27.9%, p < .01).

      Conclusions

      These up-dated findings show different geographical patterns of CLD in Italy, reflecting different behavioural habits and socio-economic conditions across the country. They may be useful to apply more adequate preventive measures and to allocate economic resources.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Giusti G.
        • Sagnelli E.
        • Gallo C.
        • Piccinino F.
        • Galanti B.
        • Gaeta G.B.
        The etiology of chronic hepatitis in Italy: a multicenter study.
        Hepatogastroenterology. 1994; 41: 397-400
        • Stroffolini T.
        • Pasquini P.
        • Mele A.
        HBsAg carriers among pregnant women in Italy: results from the screening during a vaccination campaign against hepatitis B.
        Public Health. 1988; 102: 329-333
        • Chiaramonte M.
        • Stroffolini T.
        • Caporaso N.
        • Coppola R.
        • Craxì A.
        • Gaeta G.B.
        • et al.
        Hepatitis-C virus infection in Italy: a multicentric sero-epidemiological study (a report from the HCV study group of the Italian Association for the Study of the Liver).
        Ital J Gastroenterol. 1991; 23: 555-558
        • Sagnelli E.
        • Stroffolini T.
        • Mele A.
        • Almasio P.
        • Coppola N.
        • Ferrigno L.
        • et al.
        The importance of HCV on the burden of chronic liver disease in Italy: a multicenter prevalence study of 9,997 cases.
        J Med Virol. 2005; 75: 522-527
        • Sagnelli E.
        • Stroffolini T.
        • Sagnelli C.
        • Smedile A.
        • Morisco F.
        • Furlan C.
        • et al.
        Epidemiological and clinical scenario of chronic liver diseases in Italy: data from a multicenter nationwide survey.
        Dig Liver Dis. 2016; 48: 1066-1071
        • Alvarez F.
        • Berg P.A.
        • Bianchi F.B.
        • Bianchi L.
        • Burroughs A.K.
        • Cancado E.L.
        • et al.
        International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis.
        J Hepatol. 1999; 31: 929-938
        • Taal B.G.
        • Schalm S.W.
        • ten Kate F.W.
        • Hermans J.
        • Geertzen R.G.
        • Feltkamp B.E.
        Clinical diagnosis of primary biliary cirrhosis: a classification based on major and minor criteria.
        Hepatogastroenterology. 1983; 30: 178-182
        • Adams P.C.
        • Chakrabarti S.
        Genotypic/phenotypic correlations in genetic hemochromatosis: evolution of diagnostic criteria.
        Gastroenterology. 1998; 114: 319-323
        • Ferenci P.
        • Caca K.
        • Loudianos G.
        • Mieli-Vergani G.
        • Tanner S.
        • Sternlieb I.
        • et al.
        Diagnosis and phenotypic classification of Wilson disease.
        Liver Int. 2003; 23: 139-142
        • Becker U.
        • Deis A.
        • Sørensen T.I.
        • Grønbaek M.
        • Borch-Johnsen K.
        • Müller C.F.
        • et al.
        Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study.
        Hepatology. 1996; 23: 1025-1029
        • McCullough A.J.
        • O'Connor J.F.
        Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology.
        Am J Gastroenterol. 1998; 93: 2022-2036
        • Angulo P.
        • Lindor K.D.
        Non-alcoholic fatty liver disease.
        J Gastroenterol Hepatol. 2002; 17: S186-S190
        • Gaiani S.
        • Gramantieri L.
        • Venturoli N.
        • Piscaglia F.
        • Siringo S.
        • D'Errico A.
        • et al.
        What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy.
        J Hepatol. 1997; 27: 979-985
        • Bruix J.
        • Sherman M.
        • Llovet J.M.
        • Beaugrand M.
        • Lencioni R.
        • Burroughs A.K.
        • et al.
        Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver.
        J Hepatol. 2001; 35: 421-430
        • Ishak K.
        • Baptista A.
        • Bianchi L.
        • Callea F.
        • De Groote J.
        • Gudat F.
        • et al.
        Histological grading and staging of chronic hepatitis.
        J Hepatol. 1995; 22: 696-699
        • Bedossa P.
        • Poynard T.
        An algorithm for the grading of activity in chronic hepatitis C. the METAVIR Cooperative Study Group.
        Hepatology. 1996; 24: 289-293
        • Gamal S.
        • Khaled Z.
        Chronic Hepatitis C, Liver Biopsy Takahashi Hirokazu Ishak versus METAVIR: Terminology, Convertibility and Correlation with Laboratory Changes. InTech, 2011 (ISBN: 978-953- 307-644-7. Available from: http://www.intechopen.com/books/liverbiopsy/Ishak versus METAVIR: Terminology, Convertibility and Correlation with Laboratory Changes in Chronic Hepatitis C)
        • Scafato E.
        Sistema Italiano Monitoraggio Alcol (SISMA) online database.
        • Guadagnino V.
        • Stroffolini T.
        • Caroleo B.
        • Menniti Ippolito F.
        • Rapicetta M.
        • Ciccaglione A.R.
        • et al.
        Hepatitis C virus infection in an endemic area of Southern Italy 14 years later: evidence for a vanishing infection.
        Dig Liver Dis. 2013; 45: 403-407
        • Andriulli A.
        • Stroffolini T.
        • Mariano A.
        • Valvano R.
        • Grattagliano I.
        • Ippolito A.M.
        • et al.
        Declining prevalence and increasing awareness of HCV infection in Italy: a population-based survey in five metropolitan areas.
        Eur J Intern Med. 2018; https://doi.org/10.1016/j.ejim.2018.02.015