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Vitamin K Deficiency and Hepatocellular Carcinoma—Reply
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In Reply: We agree with Drs Piquet, Hourmand-Ollivier, and Dao regarding the relationship between changes in intestinal flora following oral treatment with poorly absorbable broad-spectrum antibiotics for the treatment of hepatic encephalopathy and reduction in intestinal vitamin K absorption. All of the participants in our study were in Child-Pugh class A; none had had hepatic encephalopathy, and therefore none had received antibiotics or synthetic disaccharides for this indication. No patients had been receiving long-term antibiotic therapy for chronic respiratory tract infection or urinary tract infection. Therefore, this mechanism for vitamin K deficiency is unlikely to have played a role in our participants. Nevertheless, in patients with more advanced hepatic cirrhosis than in our study, the opportunity of receiving long-term antibiotic therapy is greater and may cause vitamin K deficiency.
At the time of patient enrollment into our study, prothrombin time expressed as international normalized ratio did not differ significantly between . . . [Full Text of this Article]
Daiki Habu, MD, PhD
daiki@med.osaka-cu.ac.jp
Department of Hepatology
Susumu Shiomi, MD, PhD
Department of Nuclear Medicine
Takashi Tanaka, MD, PhD
Department of Public Health
Shuhei Nishiguchi, MD, PhD
Department of Hepatology
Graduate School of Medicine
Osaka City University
Osaka, Japan
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