Screening in liver disease

World Journal of Gastroenterology

Volumn 12, Issue 33, 2006, Pages 5272-5280

  Del Poggio, Paolo ^a   Mazzoleni, Marzio ^b  

^a TREVIGLIO HOSPITAL   (Italy)

^b Italian Society of Family Physicians (SIMG)   (Italy)

Author keywords

Genetic hemochromatosis; Hepatitis B; Hepatitis C; Risk factors; Screening

Indexed keywords

ALPHA 1 ANTITRYPSIN; ANTIVIRUS AGENT; COPPER; FERROPORTIN 1; HEPATITIS B VACCINE; WILSON DISEASE PROTEIN;

ALPHA 1 ANTITRYPSIN DEFICIENCY; BLOOD TRANSFUSION; CHELATION THERAPY; DIABETES MELLITUS; DRUG DEPENDENCE; EDITORIAL; EDUCATION PROGRAM; ETHNIC GROUP; EUROPE; FEASIBILITY STUDY; GENE DELETION; GENE MUTATION; GENERAL PRACTITIONER; HEALTH CARE PERSONNEL; HEALTH CARE PLANNING; HEALTH PROMOTION; HEMOCHROMATOSIS; HEPATITIS B; HEPATITIS C; HIGH RISK PATIENT; HUMAN; IMMIGRANT; JUVENILE RHEUMATOID ARTHRITIS; LIVER CIRRHOSIS; LIVER DISEASE; MASS SCREENING; MUTATIONAL ANALYSIS; PHENOTYPE; POPULATION RESEARCH; PRACTICE GUIDELINE; PREVALENCE; PRISON; RISK ASSESSMENT; SCREENING TEST; SEXUAL BEHAVIOR; SEXUAL DYSFUNCTION; SKILL; SKIN PIGMENTATION; WILSON DISEASE;

EID: 33749409772     PISSN: 10079327     EISSN: None     Source Type: Journal    
DOI: 10.3748/wjg.v12.i33.5272     Document Type: Editorial

References (103)

1. Morrison AS. Screening in chronic disease. Monographs in Epidemiology and Biostatistics, 1992
2. Smeeth L. Time for evidence-based screening? J R Soc Med 1998; 91: 347-348
3. Langenberg M, Hellemons BS, van Ree JW, Vermeer F, Lodder J, Schouten MJ, Knottnerus JA. Atrial fibrillation in elderly patients: prevalence and comorbidity in general practice. BMJ 1996; 313: 1534
4. Somerville S, Somerville J, Croft P, Lewis M. Atrial fibrillation: a comparison of methods to identify cases in general practice. Br J Gen Pract 2000; 50: 727-729
5. Grimes DA, Schulz KF. Uses and abuses of screening tests. Lancet 2002; 359: 881-884
6. Prorok PC. Epidemiologic approach for cancer screening. Problems in design and analysis of trials. Am J Pediatr Hematol Oncol 1992; 14: 117-128
7. Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000; 31: 777-782
8. Grant WC, Jhaveri RR, McHutchison JG, Schulman KA, Kauf TL. Trends in health care resource use for hepatitis C virus infection in the United States. Hepatology 2005; 42: 1406-1413
9. World Health Organization. Hepatitis B: WHO fact sheet 204, 2000 http://www.who.int/mediacentre/factsheets/fs204/en/
10. Lee WM. Hepatitis B virus infection. N Engl J Med 1997; 337: 1733-1745
11. Adams LA, Angulo P. Recent concepts in non-alcoholic fatty liver disease. Diabet Med 2005; 22: 1129-1133
12. Adams PC, Arthur MJ, Boyer TD, DeLeve LD, Di Bisceglie AM, Hall M, Levin TR, Provenzale D, Seeff L. Screening in liver disease: report of an AASLD clinical workshop. Hepatology 2004; 39: 1204-1212
13. Beutler E, Felitti VJ, Koziol JA, Ho NJ, Gelbart T. Penetrance of 845G→ A(C282Y) HFE hereditary haemochromatosis mutation in the USA. Lancet 2002; 359: 211-218
14. Wong T, Lee SS. Hepatitis C: a review for primary care physicians. CMAJ 2006; 174: 649-659
15. Marcellin P, Lau GK, Bonino F, Farci P, Hadziyannis S, Jin R, Lu ZM, Piraatvisuth T, Germanidis G, Yurdaydin C, Diago M, Gurel S, Lai MY, Button P, Pluck N. Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B. N Engl J Med 2004; 351: 1206-1217
16. Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER, Tobias H, Wright TL. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States. Clin Gastroenterol Hepatol 2004; 2: 87-106
17. Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004; 39: 1147-1171
18. Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, Goodman ZD, Koury K, Ling M, Albrecht JK. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001; 358: 958-965
19. Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL Jr, Haussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002; 347: 975-982
20. Chou R, Clark EC, Helfand M. Screening for hepatitis C virus infection: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004; 140: 465-479
21. Alter MJ, Seeff LB, Bacon BR, Thomas DL, Rigsby MO, Di Bisceghe AM. Testing for hepatitis C virus infection should be routine for persons at increased risk for infection. Ann Intern Med 2004; 141: 715-717
22. Chander G, Sulkowski MS, Jenckes MW, Torbenson MS, Herlong HF, Bass EB, Gebo KA. Treatment of chronic hepatitis C: a systematic review. Hepatology 2002; 36: S135-144
23. Lau DT, Kleiner DE, Ghany MG, Park Y, Schmid P, Hoofnagle JH. 10-Year follow-up after interferon-alpha therapy for chronic hepatitis C. Hepatology 1998; 28: 1121-1127
24. Bruno S, Stroffolini T, Bollani S, Benvegnù L, Gaeta G, Persico M, Mazzella G, Ascione A, Mangia A, Santantonio T, Andreone P, Almasio P. Long term outcome of patients with HCV related Child A cirrhosis treated with Interferon alpha: the impact of sustained virologic response on hepatocellular carcinoma occurrence and mortality. Hepatology 2005; 42: S229A
25. National Institutes of Health Consensus Development Conference Statement: management of hepatitis C. Hepatology 2002; 36: S3-20
26. Booth JC, O'Grady J, Neuberger J. Clinical guidelines on the management of hepatitis C. Gut 2001; 49 Suppl 1: 11-21
27. Treatment of hepatitis C. 2002 Feb 27-28; Paris, France. Ann Med Interne (Paris) 2002; 153: 467-477
28. Expert Consensus Istituto Superiore Sanità Screening of Hepatitis C virus in Italian adults, 2005 May 5-6; Rome. Available from: http://www.pnlg.org
29. Sherman M, Bain V, Villeneuve JP, Myers RP, Cooper C, Martin S, Lowe C. The management of chronic viral hepatitis: a Canadian consensus conference 2004. Can J Gastroenterol 2004; 18: 715-728
30. Dienstag JL, McHutchison JG. American Gastroenterological Association medical position statement on the management of hepatitis C. Gastroenterology 2006; 130: 225-230
31. Alberti A, Noventa F, Benvegnu L, Boccato S, Gatta A. Prevalence of liver disease in a population of asymptomatic persons with hepatitis C virus infection. Ann Intern Med 2002; 137: 961-964
32. Stroffolini T, Mariano A, Iantosca G. Reported risk factors are useless in detecting HCV-positive subjects in the general population. Dig Liver Dis 2004; 36: 547-550
33. Health Canada and The College of Family Physicians of Canada. Physicians' Desk Reference-Primary care management of hepatitis C. Pamphlet. Ottawa, 2002
34. Alter MJ, Kruszon-Moran D, Nainan OV, McQuillan GM, Gao F, Moyer LA, Kaslow RA, Margolis HS. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999; 341: 556-562
35. Nyamathi AM, Dixon EL, Robbins W, Smith C, Wiley D, Leake B, Longshore D, Gelberg L. Risk factors for hepatitis C virus infection among homeless adults. J Gen Intern Med 2002; 17: 134-143
36. Josset V, Torre JP, Tavolacci MP, Van Rossem-Magnani V, Anselme K, Merle V, Godart J, Libert A, Ladner J, Czernichow P. Efficiency of hepatitis C virus screening strategies in general practice. Gastroenterol Clin Biol 2004; 28: 351-357
37. UK Department of Health. Hepatitis C infected health care workers: implementing getting ahead of the curve, action on blood borne viruses. Dept. of Health 2003. Available from: http://www.doh.gov.uk/assetRoot/04/ 05/95/44/04059544.pdf
38. Mariano A, Mele A, Tosti ME, Parlato A, Gallo G, Ragni P, Zotti C, Lopalco P, Pompa. MG, Graziani G, Stroffolini T. Role of beauty treatment in the spread of parenterally transmitted hepatitis viruses in Italy. J Med Virol 2004; 74: 216-220
39. Scaraggi FA, Lomuscio S, Perricci A, De Mitrio V, Napoli N, Schiraldi O. Intrafamilial and sexual transmission of hepatitis C virus. Lancet 1993; 342: 1300-1302
40. Akahane Y, Kojima M, Sugai Y, Sakamoto M, Miyazaki Y, Tanaka T, Tsuda F, Mishiro S, Okamoto H, Miyakawa Y, Mayumi M. Hepatitis C virus infection in spouses of patients with type C chronic liver disease. Ann Intern Med 1994; 120: 748-752
41. Kao JH, Chen PJ, Lei MY, Wang TH, Chen DS. Sexual transmission of HCV. Lancet 1993; 342: 626
42. Vandelli C, Renzo F, Romano L, Tisminetzky S, De Palma M, Stroffolini T, Ventura E, Zanetti A. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol 2004; 99: 855-859
43. Alter MJ, Coleman PJ, Alexander WJ, Kramer E, Miller JK, Mandel E, Hadler SC, Margolis HS. Importance of heterosexual activity in the transmission of hepatitis B and non-A, non-B hepatitis. JAMA 1989; 262: 1201-1205
44. Salleras L, Bruguera M, Vidal J, Plans P, Dominguez A, Salleras M, Navas E, Gali N. Importance of sexual transmission of hepatitis C virus in seropositive pregnant women: a case-control study. J Med Virol 1997; 52: 164-167
45. Feldman JG, Minkoff H, Landesman S, Dehovitz J. Heterosexual transmission of hepatitis C, hepatitis B, and HIV-1 in a sample of inner city women. Sex Transm Dis 2000; 27: 338-342
46. Thomas DL, Zenilman JM, Alter HJ, Shih JW, Galai N, Carella AV, Quinn TC. Sexual transmission of hepatitis C virus among patients attending sexually transmitted diseases clinics in Baltimore - an analysis of 309 sex partnerships. J Infect Dis 1995; 171: 768-775
47. Strickland GT, Elhefni H, Salman T, Waked I, Abdel-Hamid M, Mikhail NN, Esmat G, Fix A. Role of hepatitis C infection in chronic liver disease in Egypt. Am J Trop Med Hyg 2002; 67: 436-442
48. Frank C, Mohamed MK, Strickland GT, Lavanchy D, Arthur RR, Magder LS, El Khoby T, Abdel-Wahab Y, Aly Ohn ES, Anwar W, Sallam I. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet 2000; 355: 887-891
49. Ahmad K. Pakistan:a cirrhotic state? Lancet 2004; 364: 1843-1844
50. Monnet E, Mercet P, Woronoff-Lemsi MC, Bresson-Hadni S, Pruniaux J, Cottray P, Bouiller C, Allemand H, Miguet JP. Organized hepatitis C screening. Results and cost of a one-year campaign in a pilot area. Gastroenterol Clin Biol 2000; 24: 541-546
51. Shehab TM, Sonnad SS, Jeffries M, Gunaratnum N, Lok AS. Current practice patterns of primary care physicians in the management of patients with hepatitis C. Hepatology 1999; 30: 794-800
52. Peksen Y, Canbaz S, Leblebicioglu H, Sunbul M, Esen S, Sunter AT. Primary care physicians' approach to diagnosis and treatment of hepatitis B and hepatitis C patients. BMC Gastroenterol 2004; 4: 3
53. Clark EC, Yawn BP, Galliher JM, Temte JL, Hickner J. Hepatitis C identification and management by family physicians. Fam Med 2005; 37: 644-649
54. Bonny C, Rayssiguier R, Ughetto S, Aublet-Cuvelier B, Baranger J, Blanchet G, Delteil J, Hautefeuille P, Lapalus F, Montanier P, Bommelaer G, Abergel A. Medical practices and expectations of general practitioners in relation to hepatitis C virus infection in the Auvergne region. Gastroenterol Clin Biol 2003; 27: 1021-1025
55. Coppola AG, Karakousis PC, Metz DC, Go MF, Mhokashi M, Howden CW, Raufman JP, Sharma VK. Hepatitis C knowledge among primary care residents: is our teaching adequate for the times? Am J Gastroenterol 2004; 99: 1720-1725
56. Rotily M, Loubiere S, Prudhomme J, Portal I, Tran A, Hofliger P, Valla D, Moatti JP. Factors related to screening of hepatitis C virus in general medicine. Gastroenterol Clin Biol 2002; 26: 261-269
57. D'Souza RF, Glynn MJ, Alstead E, Osonayo C, Foster GR. Knowledge of chronic hepatitis C among East London primary care physicians following the Department of Health's educational campaign. QJM 2004; 97: 331-336
58. Ouzan D, Hofliger P, Cavailler P, Mamino C, Tran A. Screening and hepatitis C management survey in general medicine in the Alpes-Maritimes and east Var area. Gastroenterol Clin Biol 2003; 27: 90-93
59. Sood A, Midha V, Awasthi G. Hepatitis C - knowledge & practices among the family physicians. Trop Gastroenterol 2002; 23: 198-201
60. Nicklin DE, Schultz C, Brensinger CM, Wilson JP. Current care of hepatitis C-positive patients by primary care physicians in an integrated delivery system. J Am Board Fam Pract 1999; 12: 427-435
61. Shehab TM, Orrego M, Chunduri R, Lok AS. Identification and management of hepatitis C patients in primary care clinics. Am J Gastroenterol 2003; 98: 639-644
62. Roudot-Thoraval F, Monnet E, Mercet P, Bastie A, Dhumeaux D, Miguet JP. Strategies of hepatitis C screening in general practice. Results of a two-center randomized trial. Gastroenterol Clin Biol 2000; 24: 1037-1041
63. Babany G, Bourliere M, Chevalier H, Chousterman M, Couzigou P, Desmorat H, Dhumeaux D, Doffoel M, Gournay J, Loiseau D, Mercet P, Moussalli J, Trepo C, Tucat G, Doan Tran D, Saint-Marc-Girardin MF. Do general practitioners want to manage chronic hepatitis C and take part in hepatitis C health networks? A national survey. Gastroenterol Clin Biol 1999; 23: 1289-1295
64. Del Poggio P, Jazzetti M, Mazzoleni M, Suardi G, Jamoletti C, Puhalo V Management disease by primary of patients with liver disease by primary care physicians: do we need specific guidelines for family practice? Dig Liver Dis 2004; 36: A36-37
65. Zdanuk S, Gimpel J, Uhanova J, Kaita KD, Minuk GY. The impact of medical informatics on the confidence of rural physicians caring for patients with chronic hepatitis C viral infections. Fam Pract 2001; 18: 602-604
66. Wright TL. Introduction to chronic hepatitis B infection. Am J Gastroenterol 2006; 101 Supply 1: S1-6
67. Beutels P. Economic evaluations of hepatitis B immunization: a global review of recent studies (1994-2000). Health Econ 2001; 10: 751-774
68. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004; 11: 97-107
69. Hou J, Liu Z, Gu F. Epidemiology and Prevention of Hepatitis B Virus Infection. Int J Med Sci 2005; 2: 50-57
70. Pollack H, Wan K, Ramos R, Rey M, Sherman A, Tobias H, Tsang T, Tso A, Wang CB, Son S, Poon E, Bialek S, Bell B. Screening for chronic Hepatitis B among Asian/Pacific islander populations - New York City, 2005 available from: http://cdc.gov/mmwr/preview/mmerhtml/mm5518a2.htm
71. World Health Organization Hepatitis B. World Health Organization Fact Sheet 204 (revised October 2000). WHO Web site. 2000. http://who.int/ int-fs/en/fact204html
72. Iwarson S. Report from Working Group 3 (the Czech Republic, Denmark, Finland, Norway, The Netherlands, Slovakia, Sweden and the UK). Vaccine 1998; 16 Suppl: S63-64
73. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, Moyer LA, Bell BP, Alter MJ. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 2005; 54: 1-31
74. Pietrangelo A. Hereditary hemochromatosis - a new look at an old disease. N Engl J Med 2004; 350: 2383-2397
75. Adams PC, Reboussin DM, Barton JC, McLaren CE, Eckfeldt JH, McLaren GD, Dawkins FW, Acton RT, Harris EL, Gordeuk VR, Leiendecker-Foster C, Speechley M, Snively BM, Holup JL, Thomson E, Sholinsky P. Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med 2005; 352: 1769-1778
76. Asberg A, Thorstensen K, Hveem K, Bjerve KS. Hereditary hemochromatosis: the clinical significance of the S65C mutation. Genet Test 2002; 6: 59-62
77. Carella M, D'Ambrosio L, Totaro A, Grifa A, Valentino MA, Piperno A, Girelli D, Roetto A, Franco B, Gasparini P, Camaschella C. Mutation analysis of the HLA-H gene in Italian hemochromatosis patients. Am J Hum Genet 1997; 60: 828-832
78. Camaschella C, Fargion S, Sampietro M, Roetto A, Bosio S, Garozzo G, Arosio C, Piperno A. Inherited HFE-unrelated hemochromatosis in Italian families. Hepatology 1999; 29: 1563-1564
79. Pietrangelo A, Montosi G, Totaro A, Garuti C, Conte D, Cassanelli S, Fraquelli M, Sardini C, Vasta F, Gasparini P. Hereditary hemochromatosis in adults without pathogenic mutations in the hemochromatosis gene. N Engl J Med 1999; 341: 725-732
80. Niederau C, Fischer R, Purschel A, Stremmel W, Haussinger D, Strohmeyer G. Long-term survival in patients with hereditary hemochromatosis. Gastroenterology 1996; 110: 1107-1119
81. Milman N, Pedersen P, a Steig T, Byg KE, Graudal N, Fenger K. Clinically overt hereditary hemochromatosis in Denmark 1948-1985: epidemiology, factors of significance for long-term survival, and causes of death in 179 patients. Ann Hematol 2001; 80: 737-744
82. Asberg A, Hveem K, Thorstensen K, Ellekjter E, Kannelonning K, Fjosne U, Halvorsen TB, Smethurst HB, Sagen E, Bjerve KS. Screening for hemochromatosis: high prevalence and low morbidity in an unselected population of 65,238 persons. Scand J Gastroenterol 2001; 36: 1108-1115
83. Burt MJ, George PM, Upton JD, Collett JA, Frampton CM, Chapman TM, Walmsley TA, Chapman BA. The significance of haemochromatosis gene mutations in the general population: implications for screening. Gut 1998; 43: 830-836
84. Powell LW, Dixon JL, Ramm GA, Purdie DM, Lincoln DJ, Anderson GJ, Subramaniam VN, Hewett DG, Searle JW, Fletcher LM, Crawford DH, Rodgers H, Allen KJ, Cavanaugh JA, Bassett ML. Screening for hemochromatosis in asymptomatic subjects with or without a family history. Arch Intern Med 2006; 166: 294-301
85. Phatak PD, Ryan DH, Cappuccio J, Oakes D, Braggins C, Provenzano K, Eberly S, Sham RL. Prevalence and penetrance of HFE mutations in 4865 unselected primary care patients. Blood Cells Mol Dis 2002; 29: 41-47
86. Pietrangelo A. Non-HFE hemochromatosis. Hepatology 2004; 39: 21-29
87. Adams P, Brissot P, Powell LW. EASL International Consensus Conference on Haemochromatosis. J Hepatol 2000; 33: 485-504
88. Tavill AS. Diagnosis and management of hemochromatosis. Hepatology 2001; 33: 1321-1328
89. Qaseem A, Aronson M, Fitterman N, Snow V, Weiss KB, Owens DK. Screening for hereditary hemochromatosis: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005; 143: 517-521
90. Schmitt B, Golub RM, Green R. Screening primary care patients for hereditary hemochromatosis with transferrin saturation and serum ferritin level: systematic review for the American College of Physicians. Ann Intern Med 2005; 143: 522-536
91. Thorstensen K, Asberg A. Transferrin saturation should not be corrected for body mass index in screening studies for haemochromatosis. J Hepatol 2006; 44: 1003-1004
92. Shaheen NJ, Lawrence LB, Bacon BR, Barton JC, Barton NH, Galanko J, Martin CF, Burnett CK, Sandler RS. Insurance, employment, and psychosocial consequences of a diagnosis of hereditary hemochromatosis in subjects without end organ damage. Am J Gastroenterol 2003; 98: 1175-1180
93. Patch C, Roderick P, Rosenberg W. Comparison of genotypic and phenotypic strategies for population screening in hemochromatosis: assessment of anxiety, depression, and perception of health. Genet Med 2005; 7: 550-556
94. Rudnick DA, Perlmutter DH. Alpha-1-antitrypsin deficiency: a new paradigm for hepatocellular carcinoma in genetic liver disease. Hepatology 2005; 42: 514-521
95. Sveger T. Liver disease in alpha1-antitrypsin deficiency detected by screening of 200,000 infants. N Engl J Med 1976; 294: 1316-1321
96. Sveger T. The natural history of liver disease in alpha 1-antitrypsin deficient children. Acta Paediatr Scand 1988; 77: 847-851
97. Vogel W, Graziadei I, Zeller H, Wiurz E, Schloegl A, Ulmer H. Prognosis of alpha-1 Antitrypsin deficiency. Hepatology 2005; 42 suppl 1: 456A
98. Abusriwil H, Stockley RA. Alpha-1-antitrypsin replacement therapy: current status. Curr Opin Pulm Med 2006; 12: 125-131
99. Roberts EA, Schilsky ML. A practice guideline on Wilson disease. Hepatology 2003; 37: 1475-1492
100. Bull PC, Thomas GR, Rommens JM, Forbes JR, Cox DW. The Wilson disease gene is a putative copper transporting P-type ATPase similar to the Menkes gene. Nat Genet 1993; 5: 327-337
101. Petrukhin K, Fischer SG, Pirastu M, Tanzi RE, Chernov I, Devoto M, Brzustowicz LM, Cayanis E, Vitale E, Russo JJ. Mapping, cloning and genetic characterization of the region containing the Wilson disease gene. Nat Genet 1993; 5: 338-343
102. Ferenci P, Merle U, Fohloffer A, Eustatiev R, Yurdaydin C, Bruha R, Caca K, Wihleim C, Demir K, Houwen R, Szalay F, Stemmel W. Phenotype-genotype correlations between Wilson's disease, results of a multinational study in 1008 patients. Hepatol 2005; 42 suppl 1: 258A
103. Frydman M. Genetic aspects of Wilson's disease. J Gastroenterol Hepatol 1990; 5: 483-490