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December 1, 2004

Vitamin K Deficiency and Hepatocellular Carcinoma—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(21):2580-2581. doi:10.1001/jama.292.21.2581-a

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.

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