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Etiological factors of chronic hepatitis in Italy: a 2014 national survey

Stroffolini, Tommasoa; Sagnelli, Evangelistab; Almasio, Piero L.c; Andriulli, Angelod; Smedile, Antoninae; Pirisi, Mariof; Sagnelli, Caterinab; Russello, Mauriziog; Coppola, Nicolab; de Luca, Massimoh; Pisaturo, Mariantoniettai; Rosina, Florianoj; Gaeta, Giovanni B.kon behalf of EPACRON study group

European Journal of Gastroenterology & Hepatology: September 2017 - Volume 29 - Issue 9 - p 994–997
doi: 10.1097/MEG.0000000000000907
Original Articles: Hepatitis

Background The last Italian prevalence survey on chronic hepatitis (CH) conducted in 2001 showed that the hepatitis C virus (HCV) was the main agent associated with CH.

Aim The aim of this study was to evaluate epidemiological changes in CH occurring after 13 years.

Patients and methods Enrollment of 1392 CH consecutive patients referred to 16 Italian liver units in 2014 scattered all over the country (four in the North, four in the Center, four in the South, and four in the Islands) was performed.

Results The mean age of the patients was 58.3 years, with a sex ratio (male/female) of 1.5. HCV infection (also with other etiologies) continues to be the most prevalent etiology (58.1%). However, this prevalence was lower (P<0.01) than the corresponding figure (76.5%) for 2001. The proportion of hepatitis B virus-related cases almost doubled over time from 12.2% in 2001 to 22.5% in 2014 (P<0.01), most probably biased because of the distribution of entecavir and tenofovir free of charge at outpatient hospital clinics after 2001. Patients reporting risky alcohol intake (also with other etiologies) accounted for 12.4% of cases, a figure lower than that reported in 2001: 19.2% (P<0.01). The proportion of nonalcoholic fatty liver disease cases nearly doubled over time (3.6% in 2001 and 6.2% in 2014; P<0.05), reflecting the greater attention over time devoted to this syndrome.

Conclusion The decreasing role of HCV infection as an etiologic factor of CH in Italy is good news considering the high cost of the directly acting antiviral agents for HCV eradication. Metabolic factors warrant greater attention in the near future.

aDepartment of Tropical and Infectious Diseases, Policlinico Umberto Primo, Rome

bDepartment of Mental Health and Public Medicine

cBiomedical Department of Internal Medicine Specialities (Di.Bi.M.I.S.), University of Palermo, Palermo

dGastroenterology Unit, Fondazione “Casa Sollievo della Sofferenza” IRCCS Hospital, San Giovanni Rotondo, Foggia

eDepartment of Gastroenterology, Molinette Hospital

fDepartment of Translational Medicine, Università del Piemonte Orientale, Novara

gOperative Unit of Hepatology and Gastroenterology, Garibaldi Hospital, Catania

hLiver Unit, Department of Gastroenterology, Cardarelli Hospital, Naples

iDivision of Infectious Diseases, Department of Internal Medicina, AORN Sant'Anna e San Sebastiano di Caserta, Caserta

jHepatogastroenterology Division, Ospedale Gradenigo, 10153 Turin

kInfectious Diseases, Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Italy

Correspondence to Evangelista Sagnelli, MD, Department of Mental and Public Health, Section of Infectious Diseases, Second University of Naples, Largo Madonna delle Grazie n. 1, Naples 80127, Italy Tel: +39 081 566 6503/+39 081 566 6508; fax: +39 081 566 6508; e-mails:;

Received January 17, 2017

Accepted April 26, 2017

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