Endoscopy for varices diagnosis

[LurkAndLearn]

Hello.  I saw the dr today for the first time to discuss treatment.  He said I was eligible but wanted to perform an ultrasound and endoscopy first.  I am wondering if this pre-treatment is common among hcv patients as he justified it by saying the spleen seemed like it was a bit enlarged when he palpitated.  I wonder if it was just a reason to generate some $$.  Because writing the script for Solv/Oly will not be making him any $$.  Times have changed for he hep dr..

I am not really a candidate for cirrhosis and he did not feel a biopsy was necessary.  I am concerned because a endoscopy will cause me to pay out of pocket to meet my deductible and I have read that a CT or MRI can achieve the same result to determine if any varices exist in the esophagus.  I realize it may be due diligence on his part if he has to treat the varices but it just seems unnecessary to treat the hcv at this point..  Thoughts?

Oh, and he said he wanted to treat with Interferon/Riba and Solvadi.  I balked at the IF and he said the success rates dropped to 70% w/o it.  Is that accurate?

[HectorSF]

These tests are only for people that are suspected of or known to have cirrhosis of the liver.  An enlarged spleen and varices are common indications of cirrhosis.

These tests will confirm cirrhosis and help to determine the extent of your cirrhosis. You will also need further testing and follow up to fully assess your cirrhosis.

People that have chronic hepatitis C infection and cirrhosis have a different prognosis than those with lesser liver disease. People with hep C and cirrhosis are harder to treat and require specific hepatitis C treatment(s) for  the best and safest out comes and require additional monitoring of their liver condition while treating.

You should be referred to a liver transplant center, have a full evaluation of your cirrhosis evaluated and have your hepatitis treated by them as soon as possible to prevent further, irreversible damage to your liver. They are the only doctors with the knowledge and experience to provide proper care and treatment for both your hepatitis C and your cirrhosis.

Unfortunately curing hepatitis C does not cure cirrhosis and in the best of cases you will need years of follow up care for your advanced liver disease. Hopefully your cirrhosis can still be be reversed over time. People with cirrhosis are at risk of liver decompensation and failure or liver cancer and need constant monitoring for many years after curing their hepatitis C. Should either of these events occur, liver transplantation will be the only treatment option.

You need to have your hepatitis C treated as soon as possible to prevent further liver damage and have the best prognosis. Get a referral from your doctor to a liver transplant center as soon as possible.

Good luck.
Hector

[Dee1956]

oops, replied to wrong post, so sorry

[Dee1956]

Hi I found some information re Sovaldi, I hope it helps you

From Sovaldi prescribing information
http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/sovaldi/sovaldi_pi.pdf

[flyinlynn]

Hi

What kind of Dr are you seeing a Hepatologist?

I had my first upper endoscopy when I was diagnosed by liver biopsy with early cirrhosis in 2008 because of the possibilitity of portal hypertension that results from cirrhosis. At that time they found I had grade 1 varicies.
I have been getting abdominal ultra sounds for years prior to the cirrhosis every year to monitor my liver spleen etc. I also had a biopsy every 5 years. I have never had a CT or an MRI so I cannot comment about that.

What is your genotype and have you treated before? So many options based on Genotype if you have cirrhosis and if you have treated before.

per the hcv guidelines site:

"Recommended regimen for treatment-naive patients with HCV genotype 1 who are eligible to receive IFN.
Daily sofosbuvir (400 mg) and weight-based RBV (1000 mg [<75 kg] to 1200 mg [≥75 kg]) plus weekly PEG for 12 weeks is recommended for IFN-eligible persons with HCV genotype 1 infection, regardless of subtype."

Results with Sovaldi, RBV, & PEG:
The SVR12 for patients with genotype 1 infection was 89%. SVR12 did not differ substantially by baseline characteristic
but was lower in patients with cirrhosis (80%) than in those without cirrhosis (92%).

Results with Sovaldi and RBV without interferon:
not much data for GT 1 that I could find but for GT 2 92-94% and for GT 3 68-21% (without cirrhosis- with cirrhosis)

here is the link to the full report:

http://www.hcvguidelines.org/sites/default/files/full_report.pdf

the prescribing info for Sovaldi:

http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/sovaldi/sovaldi_pi.pdf

Good luck
Lynn