Letter to the Editor| Volume 68, ISSUE 4, P851-853, April 2018

Download started.


Stomach reduction or gastric bypass as risk factor for treatment failure after DAA therapy for hepatitis C?

Published:November 21, 2017DOI:
      Treatment of chronic hepatitis C virus (HCV) with direct acting antivirals (DAA) is effective in more than 95% of patients. The current European Association for the Study of the Liver treatment recommendations address all topics related to the treatment of HCV infection and provide recommendations for optimized DAA therapies based on factors associated with treatment failure such as genotype, pretreatment, cirrhosis or baseline resistance.
      European Association for the Study of the Liver
      EASL recommendations on treatment of hepatitis C 2016.
      Herein, we suggest that bariatric or gastric surgery leading to stomach reduction or gastric bypass may influence response to DAA treatment.


      Linked Article

      • EASL Recommendations on Treatment of Hepatitis C 2016
        Journal of HepatologyVol. 66Issue 1
        • Preview
          Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide [1]. The long-term impact of HCV infection is highly variable, ranging from minimal histological changes to extensive fibrosis and cirrhosis with or without hepatocellular carcinoma (HCC). The number of chronically infected persons worldwide is estimated to be about 180 million [2], but most are unaware of their infection. Clinical care for patients with HCV-related liver disease has advanced considerably during the last two decades, thanks to an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and improvements in therapy and prevention.
        • Full-Text
        • PDF
      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 to Journal of Hepatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • European Association for the Study of the Liver
        EASL recommendations on treatment of hepatitis C 2016.
        J Hepatol. 2017; 66 (PubMed PMID: 27667367): 153-194
        • Honer Zu Siederdissen C.
        • Maasoumy B.
        • Marra F.
        • Deterding K.
        • Port K.
        • Manns M.P.
        • et al.
        Drug-drug interactions with novel all oral interferon-free antiviral agents in a large real-world cohort.
        Clin Infect Dis. 2016; 62 (PubMed PMID: 26611779): 561-567
        • Darwich A.S.
        • Henderson K.
        • Burgin A.
        • Ward N.
        • Whittam J.
        • Ammori B.J.
        • et al.
        Trends in oral drug bioavailability following bariatric surgery: examining the variable extent of impact on exposure of different drug classes.
        Br J Clin Pharmacol. 2012; 74 (PubMed PMID: 22463107. Pubmed Central PMCID: PMC3495142): 774-787
        • Geraldo Mde S.
        • Fonseca F.L.
        • Gouveia M.R.
        • Feder D.
        The use of drugs in patients who have undergone bariatric surgery.
        Int J Gen Med. 2014; 7 (PubMed PMID: 24872717. Pubmed Central PMCID: PMC4026560. Epub 2014/05/30. eng): 219-224
        • Braghetto I.
        • Davanzo C.
        • Korn O.
        • Csendes A.
        • Valladares H.
        • Herrera E.
        • et al.
        Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects.
        Obes Surg. 2009; 19 (PubMed PMID: 19714384): 1515-1521
        • Pellegrini C.A.
        • Deveney C.W.
        • Patti M.G.
        • Lewin M.
        • Way L.W.
        Intestinal transit of food after total gastrectomy and Roux-Y esophagojejunostomy.
        Am J Surg. 1986; 151 (PubMed PMID: 3946743): 117-125
        • German P.
        • Mathias A.
        • Brainard D.
        • Kearney B.P.
        Clinical pharmacokinetics and pharmacodynamics of ledipasvir/sofosbuvir, a fixed-dose combination tablet for the treatment of hepatitis C.
        Clin Pharmacokinet. 2016; 55 (PubMed PMID: 27193156): 1337-1351
        • Chan L.N.
        • Lin Y.S.
        • Tay-Sontheimer J.C.
        • Trawick D.
        • Oelschlager B.K.
        • Flum D.R.
        • et al.
        Proximal Roux-en-Y gastric bypass alters drug absorption pattern but not systemic exposure of CYP3A4 and P-glycoprotein substrates.
        Pharmacotherapy. 2015; 35 (PubMed PMID: 25757445. Pubmed Central PMCID: PMC4696861): 361-369
        • Menon R.M.
        • Polepally A.R.
        • Khatri A.
        • Awni W.M.
        • Dutta S.
        Clinical pharmacokinetics of paritaprevir.
        Clin Pharmacokinet. 2017; (PubMed PMID: 28236252)
        • Azran C.
        • Wolk O.
        • Zur M.
        • Fine-Shamir N.
        • Shaked G.
        • Czeiger D.
        • et al.
        Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations.
        Obes Rev. 2016; 17 (PubMed PMID: 27335140): 1050-1066
        • von Felden J.
        • Scheurich C.
        • Yamamura J.
        • Brainard D.M.
        • Mogalian E.
        • Lohse A.W.
        • et al.
        Successful treatment of chronic hepatitis C with ground ledipasvir/sofosbuvir in a patient with Crohn’s disease and short bowel syndrome.
        J Viral Hepat. 2017; (PubMed PMID: 28783205)