Journal Mobile Options
Table of Contents
Vol. 25, No. 2, 2007
Issue release date: April 2007
Dig Dis 2007;25:138–143
(DOI:10.1159/000099478)

Liver Diseases in the Elderly: An Update

Floreani A.
Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy
email Corresponding Author

Abstract

Although there are no liver diseases specific to advanced age, the clinical course and management of liver diseases in the elderly may differ in several aspects from those of younger adults. During the last decade an explosion of new knowledge in liver disease has provoked increasing enthusiasm among hepatologists. On the other hand, the development of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches has made it increasingly difficult to validate and assimilate information to be applied in clinical practice. Some liver diseases in the elderly need to be revisited, particularly non-alcoholic fatty liver disease, chronic hepatitis C, alcoholic liver disease, and hepatocellular carcinoma. Moreover, some therapeutic approaches, especially antiviral therapy and liver transplantation, should be discussed also in selected groups of elderly patients.


 goto top of outline Key Words

  • Liver diseases in elderly
  • Non-alcoholic fatty liver disease
  • Hepatitis C virus infection
  • Alcoholic liver disease
  • Hepatocellular carcinoma
  • Liver transplantation

 goto top of outline Abstract

Although there are no liver diseases specific to advanced age, the clinical course and management of liver diseases in the elderly may differ in several aspects from those of younger adults. During the last decade an explosion of new knowledge in liver disease has provoked increasing enthusiasm among hepatologists. On the other hand, the development of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches has made it increasingly difficult to validate and assimilate information to be applied in clinical practice. Some liver diseases in the elderly need to be revisited, particularly non-alcoholic fatty liver disease, chronic hepatitis C, alcoholic liver disease, and hepatocellular carcinoma. Moreover, some therapeutic approaches, especially antiviral therapy and liver transplantation, should be discussed also in selected groups of elderly patients.

Copyright © 2007 S. Karger AG, Basel


 goto top of outline References
  1. Hoshida Y, Ikeda K, Kobayashi M, Suzuki Y, Tsubota A, Saitoh S, Arase Y, Kobayashi M, Murashima N, Chayama K, Kumada H: Chronic liver disease in the extremely elderly of 80 years or more: clinical characteristics, prognosis and patient survival analysis. J Hepatol 1999;31:860–866.
  2. Bellentani S, Saccoccio G, Masutti F, Crocè LS, Brandi G, Sasso F, Cristianini G, et al: Prevalence and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med 2000;132:112–117.
  3. Angulo P: Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221–1231.
  4. Neuschwander-Tetri BA, Caldwell SH: Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 2003;37:1202–1219.
  5. Angulo P, Keach JC, Batts KP, Lindor KD: Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999;30:1356–1362.
  6. Hui JM, Kench JG, Chitturi S, Sud A, Farrell GC, Byth K, Hall P, Khan M, George J: Long-term outcomes of cirrhosis in non alcoholic steatohepatitis compared with hepatitis C. Hepatology 2003;38:420–427.
  7. Poynard T, Yen MF, Ratziu V, Lai CL: Viral hepatitis C. Lancet 2003;362:2095–2100.
  8. Pagliaro L, D’Amico G, Puleo A: Meta-analysis as a source of evidence in gastroenterology: a critical approach. Ital J Gastroenterol Hepatol 1999;31:723–742.
  9. Chiaramonte M, Stroffolini T, Vian A, Stazi MA, Floreani A, Lorenzoni U, Lobello S, Farinati F, Naccarato R: Rate of incidence of hepatocellular carcinoma in patients with compensated viral cirrhosis. Cancer 1999;85:2132–2137.
  10. Marcus E-L, Tur-Kaspa R: Chronic hepatitis C virus infection in older adults. Clin Infect Dis 41:1606–1612, 2005.
  11. Puoti C, Castellacci R, Montagnose F, Zaltron S, Stornaiuolo G, Bergami N, Bellis L, Precone D, Corvisieri P, Puoti M, Minola E, Gaeta GB: Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC). J Hepatol 2002;37:117–123.
  12. Hoofnagle JH: Management of hepatitis C: current and future perspectives. J Hepatol 1999;31(suppl 1):264–268.
  13. NIH Consensus Statement on Management of Hepatitis C: 2002. HIH Consens State Sci Statements 2002;19:1–46.
  14. Bresci G, Del Corso L, Romanelli AM, et al: The use of recombinant interferon-alfa-2b in elderly patients with anti-HCV-positive chronic active hepatitis. J Am Geriatr Soc 1993;41:857–862.
  15. Van Thiel DH, Fridlander L, Caraceni P, et al: Treatment of hepatitis C virus in elderly persons with interferon-α. J Gerontol 1995;50:M330–M333.
  16. Horiike N, Masumoto T, Nakanishi K, et al: Interferon therapy for patients more than 60 years of age with chronic hepatitis C. J Gastroenterol Hepatol 1995;10:246–249.
  17. Marcus E-L, Tur-Kaspa R: Viral hepatitis in older adults. J Am Geriatr Soc 1997;45:755–763.
  18. Gao B, Hong F, Radeva S: Host factors and failure of interferon-α treatment of hepatitis C virus. Hepatology 2004;39:880–890.
  19. Floreani A, Minola E, Carderi I, Ferrara F, Rosa Rizzotto E, Baldo V: Are elderly patients poor candidates for pegylated interferon plus ribavirin in the treatment of chronic hepatitis C? J Am Geriatr Dis 2006;54:549–550.
  20. Bacosi M, Russo F, D’Innocenzo S, Santolamazza M, Migliorasi L, Ursitti A, De Angelis A, Patrizi F, Ricci GL: Amantadine and interferon in the combined treatment of hepatitis C virus in elderly patients. Hepatol Res 2002;22:231–239.
  21. Torre F, Campo N, Giusto R, Ansaldi F, Icardi GC, Picciotto A: Antiviral activity of amantadine in elderly patients with chronic hepatitis C. Gerontology 2001;47:330–333.
  22. Mirand AL, Welte JW: Alcohol consumption among the elderly in a general population from Erie County, New York. Am J Public Health 1996;86:978–984.
  23. Adams WL, Cox NS: Epidemiology of problem drinking among elderly people. Int J Addict 1995;30:1693–1716.
  24. Smith JW: Medical manifestations of alcoholism in the elderly. Int J Addict 1995;30:1749–1798.
  25. Monto A, Patel K, Bostrom A, Pianko S, Pockros P, McHutchison JG, Wright TL: Risks of a range of alcohol intake on hepatitis-C-related fibrosis. Hepatology 2004;39:826–834.
  26. Fabris P, Floreani A, Carlotto A, Giordani MT, Baldo V, Stecca C, Marchiorio L, Tramarin A, Bertin T, Negro F, deLalla F: Alcohol is an important co-factor for both steatosis and fibrosis in Northern Italian patients with chronic hepatitis C. J Hepatol 41:644–651, 2004.
  27. Rigler SK: Alcoholism in the elderly. Am Fam Physicians 2000;61:1710–1716.
  28. Ikeda K, Saitoh S, Suzuki Y, Kobayashi M, Tsubota A, Koida I, Arase Y, Fukuda M, Chayama K, Murashima N, Kumada H: Disease progression and hepatocellular carcinogenesis in patients with chronic viral hepatitis: a prospective observation of 2,215 patients. J Hepatol 1998;28:930–938.
  29. Benvegnù L, Gios M, Alberti A: Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut 2004;53:744–749.
  30. Regimbeau JM, Colombat M, Mognol P, Durand F, Abdalla E, Degott C, Degos F, Farges O, Belghiti J: Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver Transpl 2004;2(suppl 1):S69–S73.

    External Resources

  31. Lui WY, Chau GY, Wu CW, King KL: Surgical resection of hepatocellular carcinoma in elderly cirrhotic patients. Hepatogastroenterology 1999;46:640–645.
  32. Randall HR, Cao S, deVera ME: Transplantation in elderly patient. Arch Surg 2003;138:1089–1092.
  33. Zetterman RK, Belle SH, Hoofnagle JH, Lawlor S, Wei Y, Everhart J, Wiesner RH, Lake JR: Age and liver transplantation: a report on the liver Transplantation Database. Transplantation 1998;66:500–506.
  34. Baccarani U, Adani GL, Toniutto P, Sainz M, Lorenzin D, Viale PL, Ramacciato G, Risaliti A, Bresadola F: Liver transplantation from old donors into HCV and non-HCV recipients. Transpl Proc 2004;36:527–528.
  35. Fernandez-Merino FJ, Nuno-Garza J, Lopez-Hervas P, Lopez-Buenadicha A, Quijano-Collazo Y, Vicente-Lopez E: Donor age a risk factor for patient survival in the liver transplant. Transpl Proc 2003;35:1795–1797.

 goto top of outline Author Contacts

Prof. Annarosa Floreani
Division of Gastroenterology
Via Giustiniani, 2, IT–35128 Padova (Italy)
Tel. +39 049 821 2894, Fax +39 049 876 0820
E-Mail annarosa.floreani@unipd.it


 goto top of outline Article Information

Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 2, Number of References : 35


 goto top of outline Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 25, No. 2, Year 2007 (Cover Date: April 2007)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/DDI


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Although there are no liver diseases specific to advanced age, the clinical course and management of liver diseases in the elderly may differ in several aspects from those of younger adults. During the last decade an explosion of new knowledge in liver disease has provoked increasing enthusiasm among hepatologists. On the other hand, the development of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches has made it increasingly difficult to validate and assimilate information to be applied in clinical practice. Some liver diseases in the elderly need to be revisited, particularly non-alcoholic fatty liver disease, chronic hepatitis C, alcoholic liver disease, and hepatocellular carcinoma. Moreover, some therapeutic approaches, especially antiviral therapy and liver transplantation, should be discussed also in selected groups of elderly patients.



 goto top of outline Author Contacts

Prof. Annarosa Floreani
Division of Gastroenterology
Via Giustiniani, 2, IT–35128 Padova (Italy)
Tel. +39 049 821 2894, Fax +39 049 876 0820
E-Mail annarosa.floreani@unipd.it


 goto top of outline Article Information

Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 2, Number of References : 35


 goto top of outline Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 25, No. 2, Year 2007 (Cover Date: April 2007)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/DDI


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Hoshida Y, Ikeda K, Kobayashi M, Suzuki Y, Tsubota A, Saitoh S, Arase Y, Kobayashi M, Murashima N, Chayama K, Kumada H: Chronic liver disease in the extremely elderly of 80 years or more: clinical characteristics, prognosis and patient survival analysis. J Hepatol 1999;31:860–866.
  2. Bellentani S, Saccoccio G, Masutti F, Crocè LS, Brandi G, Sasso F, Cristianini G, et al: Prevalence and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med 2000;132:112–117.
  3. Angulo P: Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221–1231.
  4. Neuschwander-Tetri BA, Caldwell SH: Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology 2003;37:1202–1219.
  5. Angulo P, Keach JC, Batts KP, Lindor KD: Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999;30:1356–1362.
  6. Hui JM, Kench JG, Chitturi S, Sud A, Farrell GC, Byth K, Hall P, Khan M, George J: Long-term outcomes of cirrhosis in non alcoholic steatohepatitis compared with hepatitis C. Hepatology 2003;38:420–427.
  7. Poynard T, Yen MF, Ratziu V, Lai CL: Viral hepatitis C. Lancet 2003;362:2095–2100.
  8. Pagliaro L, D’Amico G, Puleo A: Meta-analysis as a source of evidence in gastroenterology: a critical approach. Ital J Gastroenterol Hepatol 1999;31:723–742.
  9. Chiaramonte M, Stroffolini T, Vian A, Stazi MA, Floreani A, Lorenzoni U, Lobello S, Farinati F, Naccarato R: Rate of incidence of hepatocellular carcinoma in patients with compensated viral cirrhosis. Cancer 1999;85:2132–2137.
  10. Marcus E-L, Tur-Kaspa R: Chronic hepatitis C virus infection in older adults. Clin Infect Dis 41:1606–1612, 2005.
  11. Puoti C, Castellacci R, Montagnose F, Zaltron S, Stornaiuolo G, Bergami N, Bellis L, Precone D, Corvisieri P, Puoti M, Minola E, Gaeta GB: Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC). J Hepatol 2002;37:117–123.
  12. Hoofnagle JH: Management of hepatitis C: current and future perspectives. J Hepatol 1999;31(suppl 1):264–268.
  13. NIH Consensus Statement on Management of Hepatitis C: 2002. HIH Consens State Sci Statements 2002;19:1–46.
  14. Bresci G, Del Corso L, Romanelli AM, et al: The use of recombinant interferon-alfa-2b in elderly patients with anti-HCV-positive chronic active hepatitis. J Am Geriatr Soc 1993;41:857–862.
  15. Van Thiel DH, Fridlander L, Caraceni P, et al: Treatment of hepatitis C virus in elderly persons with interferon-α. J Gerontol 1995;50:M330–M333.
  16. Horiike N, Masumoto T, Nakanishi K, et al: Interferon therapy for patients more than 60 years of age with chronic hepatitis C. J Gastroenterol Hepatol 1995;10:246–249.
  17. Marcus E-L, Tur-Kaspa R: Viral hepatitis in older adults. J Am Geriatr Soc 1997;45:755–763.
  18. Gao B, Hong F, Radeva S: Host factors and failure of interferon-α treatment of hepatitis C virus. Hepatology 2004;39:880–890.
  19. Floreani A, Minola E, Carderi I, Ferrara F, Rosa Rizzotto E, Baldo V: Are elderly patients poor candidates for pegylated interferon plus ribavirin in the treatment of chronic hepatitis C? J Am Geriatr Dis 2006;54:549–550.
  20. Bacosi M, Russo F, D’Innocenzo S, Santolamazza M, Migliorasi L, Ursitti A, De Angelis A, Patrizi F, Ricci GL: Amantadine and interferon in the combined treatment of hepatitis C virus in elderly patients. Hepatol Res 2002;22:231–239.
  21. Torre F, Campo N, Giusto R, Ansaldi F, Icardi GC, Picciotto A: Antiviral activity of amantadine in elderly patients with chronic hepatitis C. Gerontology 2001;47:330–333.
  22. Mirand AL, Welte JW: Alcohol consumption among the elderly in a general population from Erie County, New York. Am J Public Health 1996;86:978–984.
  23. Adams WL, Cox NS: Epidemiology of problem drinking among elderly people. Int J Addict 1995;30:1693–1716.
  24. Smith JW: Medical manifestations of alcoholism in the elderly. Int J Addict 1995;30:1749–1798.
  25. Monto A, Patel K, Bostrom A, Pianko S, Pockros P, McHutchison JG, Wright TL: Risks of a range of alcohol intake on hepatitis-C-related fibrosis. Hepatology 2004;39:826–834.
  26. Fabris P, Floreani A, Carlotto A, Giordani MT, Baldo V, Stecca C, Marchiorio L, Tramarin A, Bertin T, Negro F, deLalla F: Alcohol is an important co-factor for both steatosis and fibrosis in Northern Italian patients with chronic hepatitis C. J Hepatol 41:644–651, 2004.
  27. Rigler SK: Alcoholism in the elderly. Am Fam Physicians 2000;61:1710–1716.
  28. Ikeda K, Saitoh S, Suzuki Y, Kobayashi M, Tsubota A, Koida I, Arase Y, Fukuda M, Chayama K, Murashima N, Kumada H: Disease progression and hepatocellular carcinogenesis in patients with chronic viral hepatitis: a prospective observation of 2,215 patients. J Hepatol 1998;28:930–938.
  29. Benvegnù L, Gios M, Alberti A: Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut 2004;53:744–749.
  30. Regimbeau JM, Colombat M, Mognol P, Durand F, Abdalla E, Degott C, Degos F, Farges O, Belghiti J: Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver Transpl 2004;2(suppl 1):S69–S73.

    External Resources

  31. Lui WY, Chau GY, Wu CW, King KL: Surgical resection of hepatocellular carcinoma in elderly cirrhotic patients. Hepatogastroenterology 1999;46:640–645.
  32. Randall HR, Cao S, deVera ME: Transplantation in elderly patient. Arch Surg 2003;138:1089–1092.
  33. Zetterman RK, Belle SH, Hoofnagle JH, Lawlor S, Wei Y, Everhart J, Wiesner RH, Lake JR: Age and liver transplantation: a report on the liver Transplantation Database. Transplantation 1998;66:500–506.
  34. Baccarani U, Adani GL, Toniutto P, Sainz M, Lorenzin D, Viale PL, Ramacciato G, Risaliti A, Bresadola F: Liver transplantation from old donors into HCV and non-HCV recipients. Transpl Proc 2004;36:527–528.
  35. Fernandez-Merino FJ, Nuno-Garza J, Lopez-Hervas P, Lopez-Buenadicha A, Quijano-Collazo Y, Vicente-Lopez E: Donor age a risk factor for patient survival in the liver transplant. Transpl Proc 2003;35:1795–1797.