Positive white nipple sign on esophageal varices: Not a just bystander; our experience

Abstract Background and study aims The goal of this study was to assess whether a white nipple sign on esophageal varices is of no prognostic significance or mandates more attention. Patients and methods We retrospectively analyzed data from 2601 patients undergoing upper gastrointestinal endoscopy for variceal bleed from January 2008 to January 2020. Intraprocedural events like onset of active spurt while performing endoscopy, active spurt while attempting to band the varix with a nipple, need for rescue glue therapy required to control bleed in cases of failed endoscopic variceal ligation (EVL), slipping of band and rebleed despite successful band application, need for emergency intubation, and pulmonary aspiration-related complications were noted. Results A total of 2601 patients underwent endoscopy for variceal bleeding. Of them, 631 had a positive white nipple sign. Of that subgroup, 137 (21.7 %) patients developed active spurt during endoscopy. In patients with the white nipple sign, 12.3 % required endotracheal intubation and 6.7 % developed aspiration pneumonia, which were significantly higher than in those without the sign. Rescue glue injection in esophageal varices was needed in 5.6 % as compared to 0.6 % in those without white nipple. Conclusions The white nipple sign is not only a predictor of recent bleed, but it carries statistically significant increased risk of intraoperative bleeding, need for endotracheal intubation, esophageal glue injections, and aspiration-related complications. Therefore, it is not just a bystander, but rather, a sign of increased danger and a need to be more vigilant with patient management.

Download Full-text

CandidaEsophagitis in an Immunocompetent Pregnant Woman

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s106474499300033x ◽

1993 ◽

Vol 1 (3) ◽

pp. 149-152 ◽

Cited By ~ 1

Author(s):

Jeffrey S. Greenspoon ◽

Seth Kivnick

Keyword(s):

Human Immunodeficiency Virus ◽

Weight Loss ◽

Candida Albicans ◽

Gastrointestinal Endoscopy ◽

Epigastric Pain ◽

Upper Gastrointestinal Endoscopy ◽

Second Trimester ◽

Increased Risk ◽

Immunodeficiency Virus ◽

Upper Gastrointestinal

Background:Nausea and vomiting are common during the first half of pregnancy and usually require only supportive measures. When symptoms are progressive and weight loss occurs, treatable causes should be sought by means of upper gastrointestinal endoscopy. We report a case of an immunocompetent gravida with invasiveCandida albicansesophagitis.Case:The immunocompetent primigravida developed progressive nausea, vomiting, epigastric pain, and a 4.1 kg weight loss during the second trimester of pregnancy. Treatment with metoclopramide and cimetidine for presumed gastroesophageal reflux was not effective. The patient had normal T-cell CD4 and CD8 subsets and was human immunodeficiency virus (HIV) antibody negative. Upper gastrointestinal endoscopy revealedC. albicansesophagitis which was treated with oral nystatin. The esophagitis had resolved completely when reassessed postpartum. The use of histamine2blockers is associated with an increased risk for fungal esophagitis and may have been a contributing cause in this case.Conclusion:Pregnant patients with persistent nausea, vomiting, and weight loss should be evaluated by endoscopy for fungal esophagitis.

Download Full-text

Outcome of Esophageal Variceal Ligation in Cirrhotic Patients: Experience in a Tertiary Care Hospital in Dhaka

BIRDEM Medical Journal ◽

10.3329/birdem.v9i1.39727 ◽

2019 ◽

Vol 9 (1) ◽

pp. 63-69

Author(s):

Shireen Ahmed ◽

Md Nazmul Hoque ◽

Tareq Mahmud Bhuiyan

Keyword(s):

Adverse Events ◽

Esophageal Varices ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Care Hospital ◽

Esophageal Variceal ◽

Band Ligation ◽

Esophageal Variceal Ligation ◽

Upper Gastrointestinal

Background: Bleeding from esophageal varices in cirrhosis is an emergency condition. Esophageal varices band ligation has shown better results in terms of variceal obliteration as well as having fewer side effects like ulceration, perforation and stricture formation. Methods: This observational study was conducted at the gastroenterology department of BIRDEM general hospital, from September 2014 to March 2015. Subjects were eligible if they had a diagnosis of cirrhosis based on history, physical examination, biochemical parameters and presence of esophageal varices in upper gastrointestinal endoscopy. All patients were tested to determine the cause of liver cirrhosis. All patients under-went upper gastrointestinal endoscopy after consent. Esophageal variceal ligation was done at appropriate situation and patients were followed up later on. SPSS 23 was used for statistical analysis. Results: The sample size was 69. The cumulative mean age was 55.58±14.462 years (range: 20-90), with gender-based mean age of 54.76±15.704 years for males and 57.22±11.739 years for female. Mild portal hypertensive gastropathy (PHG) was found 31 (44.9%) patient and severe PHG 36 (52.2%). Patients were followed up for mean period of 8.52±3.6 months. Variceal obliteration was achieved in 25 (36.2%) patients, while 06 (8.7%) cases developed re-bleeding during the study period and this type of patients were managed by other modalities or combination therapies. Recurrence of varices occurred in 13 (18.8%). 25 (36.2%) patients reduction of varix size occured after esophageal variceal ligation (EVL), 32 (46.4%) required second session and 12 (17.4%) required more than second session (Table-2). Thirty nine (56.5%) patients experienced minor adverse events like GI discomfort (retrosternal pain or dysphagia), while severe adverse events were noticed in 13 (18.8%) patients. Fundal varix was found among 8 (11.6%) patient on follow up endoscopy and GAVE found in 6 (8.69%) patients. All patient developed PHG during follow up endoscopy. Conclusion: Band ligation eradicates esophageal varices with less complications and a lower re-bleeding rate, but at the same time eradication is associated with more frequent development of PHG and fundal varices. Birdem Med J 2019; 9(1): 63-69

Download Full-text

SPECTRUM OF FINDINGS IN PATIENTS PRESENTING FOR UPPER GASTROINTESTINAL ENDOSCOPY AT A TERTIARY CARE HOSPITAL AND THE INFLUENCE OF AGE AND GENDER

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i3.2940 ◽

2021 ◽

Vol 71 (3) ◽

pp. 744-48

Author(s):

Fayyaz Hassan ◽

Khalil Ahmad ◽

Saeed Bin Ayaz ◽

Heyyan Bin Khalil

Keyword(s):

Esophageal Varices ◽

Gastrointestinal Endoscopy ◽

Age Groups ◽

Military Hospital ◽

Upper Gastrointestinal Endoscopy ◽

Care Hospital ◽

Age And Gender ◽

Number Of Patients ◽

And Gender ◽

Upper Gastrointestinal

Objective: To determine the spectrum of findings in patients presenting for upper gastrointestinal (UGI) endoscopy and investigate role of age and gender. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gastroenterology & Internal Medicine, Combined Military Hospital Kharian, from Jul 2017 to Mar 2019. Methodology: The data regarding 638 consecutive patients who underwent upper gastrointestinal endoscopy in the department were collected from the computer-based database and patients were stratified into two groups according to their age: ≤50 and >50 years. Results: The mean age was 50.2 ± 17.4 (range: 7-100) years. There were 431 males and 207 females. The commonest presenting complaint was decompensated chronic liver disease (CLD) 162 (25.4%). The upper gastrointestinal endoscopy was normal in 306 (48%) and abnormal in 332 (52%) patients. The commonest abnormality seen on upper gastrointestinal endoscopy was esophageal varices seen in 167 (26.2%) followed by non-specific gastropathy, and hiatal hernia seen in 28 (4.4%) and 21 (3.3%) patients respectively. No significant differences were observed among males and females for a positive upper gastrointestinal endoscopy. Significantly large number of patients of age >50 years had an abnormal upper gastrointestinal endoscopy (p<0.001). The commonest upper gastrointestinal endoscopic abnormalities were similar in both genders and age-groups. Conclusion: The commonest finding on upper gastrointestinal endoscopy were esophageal varices and non-specific gastropathies. Females and patients ≤50 years had a higher prevalence of a normal upper gastrointestinal endoscopy. The commonly observed upper gastrointestinal endoscopy findings were generally similar among the genders and the age-groups.

Download Full-text

Laboratory Predictors of Esophageal Varices in Children with Chronic Liver Disease

Faridpur Medical College Journal ◽

10.3329/fmcj.v16i1.55728 ◽

2021 ◽

Vol 16 (1) ◽

pp. 3-7

Author(s):

Gias Uddin Ahmed ◽

Md Monir Hossain ◽

Swapan Kumar Halder ◽

Sabnam Sultana ◽

Mohammad Neamat Hossain ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Esophageal Varices ◽

Gastrointestinal Endoscopy ◽

Independent Predictor ◽

Chronic Liver ◽

Upper Gastrointestinal Endoscopy ◽

Independent Variables ◽

Laboratory Variables ◽

Upper Gastrointestinal

Variceal bleeding results as a consequence of portal hypertension and it is a leading cause of morbidity and mortality of children with chronic liver disease (CLD). Upper gastrointestinal endoscopy is the only confirmatory tool for detecting esophageal varices but due to its invasive nature, high cost and lack of available facilities for pediatric endoscopy, alternative laboratory predictors are essential. In this study, we aimed at identifying laboratory predictors that may predict the presence of esophageal varices in children with CLD. This cross-sectional study was done at the department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2008 to June 2010. Fifty consecutive children with CLD, aged 3-15 years of both sexes, who had no history of active/recent variceal bleeding, taking beta blockers or surgery for esophageal varices were included in the study. All patients underwent history and physical examination. Venous blood of the patients was taken for laboratory analysis of serum bilirubin, serum alanine aminotransferase, serum albumin, platelet count and International Normalization Ratio (INR). Later, upper gastrointestinal endoscopy of the patients were done. Based on endoscopic findings children were divided into two groups. Group-I: CLD with esophageal varices included 29 children and Group-II: CLD without esophageal varices included 21 children. A univariate analysis was initially done on laboratory variables followed by a logistic regression analysis to identify the independent variables associated with presence of esophageal varices. Then performance of these independent variables were analyzed using upper gastrointestinal endoscopy as the gold standard test. Out of 50 patients 30 were male. Male-female ratio was 1.5:1. Fifty eight percent (29 out of 50) had esophageal varices. Amongst all the laboratory variables, thrombocytopenia (platelet count <150000/mm3) was an independent predictor of esophageal varices (p=0.018). Thrombocytopenia showed good sensitivity and specificity (82.7% and 80.9% respectively) to be used as a screening test for predicting esophageal varices in children with chronic liver disease. Thrombocytopenia can be used as an independent predictor for esophageal varices in children with chronic liver disease. Faridpur Med. Coll. J. 2021;16(1):3-7

Download Full-text

Upper Gastrointestinal Endoscopy in Lumbini Medical College and Teaching Hospital

Journal of Lumbini Medical College ◽

10.22502/jlmc.v1i1.3 ◽

2013 ◽

Vol 1 (1) ◽

pp. 7

Author(s):

Bishal Khattri Chhetri ◽

M S Paudel ◽

Nabin Pokharel ◽

Shadev Prasad Dhungana ◽

Anuj Paudel ◽

...

Keyword(s):

Duodenal Ulcer ◽

Gastrointestinal Tract ◽

Teaching Hospital ◽

Esophageal Varices ◽

Gastrointestinal Endoscopy ◽

Common Finding ◽

Upper Gastrointestinal Endoscopy ◽

Ulcer Disease ◽

Medical College ◽

Upper Gastrointestinal

Introduction: Upper gastrointestinal (UGI) endoscopy includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum, with real time assessment and interpretation of the findings encountered. An upper endoscopy is indicated in the diagnostic evaluation of signs and symptoms of a wide variety of gastrointestinal disorders. Besides there are some therapeutic implication of the endoscopy. This study was conducted to study the spectrum of diseases found during the upper gastrointestinal endoscopy in patient presenting in Lumbini Medical College and Teaching Hospital (LMCTH). Methods: This was a retrospective observational study carried out in LMCTH. The endoscopic record book of the patients who underwent UGI endoscopy for various reasons from February 2011 to 2013 was analysed. The risk factor of smoking and alcohol was also included and analysed in the study. Results: All together 550 upper GI endoscopy was performed in the two years. There were 290 males (52.72%) and females were 260 (47.38%). The mean age was 45.7 years (SD=17.9). Most of the patient belonged to the age group 41 to 80 years (71%). Among total patients, 209 (38%) of them were found to be macroscopically normal. Of those who had positive endoscopic findings; 165 (48.4%) had gastritis and 36 (10.6%) had duodenal ulcer, esophageal varices was in 30 (8.8%), gastric carcinoma in nine (2.6%) of cases. Cigarette smoking was significantly associated with the presence of peptic ulcer disease (p=0.01) and malignancy of gastrointestinal tract (p=0.03). Alcohol intake was non-significantly related to peptic ulceration (p=0.07) and malignancy of gastrointestinal tract (p=0.09). Conclusion: Upper gastrointestinal endoscopy is a safe and useful procedure for investigating patients with gastrointestinal complains. Gastritis was the most common finding among the patients who had abnormal endoscopy followed by duodenal ulcer and esophageal varices.

Download Full-text

Celiac disease prevalence is not increased in patients with functional dyspepsia

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-07 ◽

2017 ◽

Vol 54 (1) ◽

pp. 37-40 ◽

Cited By ~ 3

Author(s):

Juan LASA ◽

Liliana SPALLONE ◽

Silvina GANDARA ◽

Elsa CHAAR ◽

Saul BERMAN ◽

...

Keyword(s):

Celiac Disease ◽

Gastrointestinal Endoscopy ◽

Disease Diagnosis ◽

Disease Prevalence ◽

Upper Gastrointestinal Endoscopy ◽

Healthy Controls ◽

Increased Risk ◽

Celiac Disease Diagnosis ◽

Upper Gastrointestinal ◽

Duodenal Biopsies

ABSTRACT BACKGROUND Previous evidence trying to assess the risk of celiac disease among dyspeptic patients has been inconclusive, showing in some cases notorious discrepancies. OBJECTIVE To determine the prevalence of celiac disease in patients with dyspepsia compared to healthy controls without dyspepsia. METHODS Adult patients under evaluation for dyspepsia were invited to participate. These patients were offered an upper gastrointestinal endoscopy with duodenal biopsies. On the other hand, asymptomatic adult volunteers who performed a preventive visit to their primary care physician were invited to participate and agreed to undertake an upper gastrointestinal endoscopy with duodenal biopsies as well. Those patients with histologic signs of villous atrophy were furtherly evaluated and serological tests were performed in order to determine celiac disease diagnosis. Celiac disease prevalence was compared between groups. RESULTS Overall, 320 patients with dyspepsia and 320 healthy controls were recruited. There were no significant differences in terms of gender or age between groups. Celiac disease diagnosis was made in 1.25% (4/320) of patients in the dyspepsia group versus 0.62% (2/320) in the control group. CONCLUSION Patients with dyspepsia who underwent routine duodenal biopsies did not show an increased risk for celiac disease when compared to healthy individuals.

Download Full-text

Helicobacter pylori Infection: Clinical, Endoscopic, and Histological Findings in Lebanese Pediatric Patients

International Journal of Pediatrics ◽

10.1155/2020/4648167 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

F. AL Kirdy ◽

M. Rajab ◽

N. El-Rifai

Keyword(s):

Helicobacter Pylori ◽

Gastrointestinal Endoscopy ◽

Pediatric Patients ◽

Epigastric Pain ◽

Demographic Data ◽

Upper Gastrointestinal Endoscopy ◽

Histopathological Findings ◽

Increased Risk ◽

H Pylori ◽

Upper Gastrointestinal

Background. Helicobacter pylori (H. pylori) is a common and universally distributed bacterial infection. However, in children, active gastritis and ulcer are rarely seen. Objectives. The aims of this study were to establish the prevalence of H. pylori infection and to compare the clinical, endoscopic, and histopathological findings between infected and noninfected pediatric patients at Makassed General Hospital. Methods. Patients aged between 1 month and 17 years who underwent upper gastrointestinal endoscopy from January 2011 to January 2017 were included. The diagnosis of H. pylori was confirmed by a CLO test and/or its presence on biopsy specimens. Demographic data, clinical characteristics, endoscopic and histopathological findings, and gastritis score were recorded retrospectively. Results. During the study period, 651 children underwent upper gastrointestinal endoscopy. The main indication was abdominal pain (61%). The prevalence of H. pylori infection was 16.5%. The infection was most commonly seen among children aged between 6 and 10 years (43%). A large number of family members were associated with increased risk of infection (4.8±1.5 versus 5.2±1.8; p<0.05). Epigastric pain was more associated with H. pylori (61.3% versus 14.6% in noninfected patients; p<0.05). Nodular gastritis was commonly seen in infected patients (41.5% vs. 7.9%; p<0.05). Mild and moderate gastritis was seen more in infected versus noninfected patients (mild: 53.8% vs. 14%; moderate: 27.4% vs. 2.4%, respectively). Conclusion. Although epigastric pain was associated with H. pylori, other diagnoses should be considered since the infection are rarely symptomatic in children. Antral nodularity was associated with H. pylori infection; however, its absence does not preclude the diagnosis.

Download Full-text

Upper Gastrointestinal Lesions during Endoscopy Surveillance in Patients with Lynch Syndrome: A Multicentre Cohort Study

Cancers ◽

10.3390/cancers13071657 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1657

Author(s):

Romain Chautard ◽

David Malka ◽

Elia Samaha ◽

David Tougeron ◽

Didier Barbereau ◽

...

Keyword(s):

Helicobacter Pylori ◽

Lynch Syndrome ◽

Gastrointestinal Endoscopy ◽

Precancerous Lesions ◽

Upper Gastrointestinal Endoscopy ◽

Gastrointestinal Lesions ◽

Increased Risk ◽

Duodenal Lesions ◽

Upper Gastrointestinal ◽

Multicentre Cohort

Background: Patients with Lynch syndrome are at increased risk of gastric and duodenal cancer. Upper gastrointestinal endoscopy surveillance is generally proposed, even though little data are available on upper gastrointestinal endoscopy in these patients. The aim of this retrospective study was to evaluate the prevalence and incidence of gastrointestinal lesions following upper gastrointestinal endoscopy examination in Lynch patients. Methods: A large, multicentre cohort of 172 patients with a proven germline mutation in one of the mismatch repair genes and at least one documented upper gastrointestinal endoscopy screening was assessed. Detailed information was collected on upper gastrointestinal endoscopy findings and the outcome of endoscopic follow-up. Results: Seventy neoplastic gastrointestinal lesions were diagnosed in 45 patients (26%) out of the 172 patients included. The median age at diagnosis of upper gastrointestinal lesions was 54 years. The prevalence of cancer at initial upper gastrointestinal endoscopy was 5% and the prevalence of precancerous lesions was 12%. Upper gastrointestinal lesions were more frequent after 40 years of age (p < 0.001). Helicobacter pylori infection was associated with an increased prevalence of gastric, but not duodenal, lesions (p < 0.001). Conclusions: Neoplastic upper gastrointestinal lesions are frequent in patients with Lynch syndrome, especially in those over 40 years of age. The results of our study suggest that Lynch patients should be considered for upper gastrointestinal endoscopic and Helicobacter pylori screening.

Download Full-text

Clinical Profile and Upper Gastrointestinal Endoscopic Findings of Patients Presenting with Liver Cirrhosis with Portal Hypertension

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v3i1.27780 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Shatdal Chaudhary ◽

Niraj Kumar Jaiswal ◽

Aakash Shahi ◽

Pradip Chhetri

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Esophageal Varices ◽

Clinical Profile ◽

Upper Gastrointestinal Endoscopy ◽

Portal Hypertensive Gastropathy ◽

Cross Sectional ◽

Female Ratio ◽

Endoscopic Findings ◽

Upper Gastrointestinal

Introduction: Liver cirrhosis is a common problem faced by physicians worldwide and is also responsible for 11th most common cause of death globally. Data regarding prevalence of esophageal varices and other upper gastrointestinal changes in patients with liver cirrhosis is scare in Nepal. So this study was carried out to find clinical profile and upper gastrointestinal endoscopic findings of patients presenting with liver cirrhosis with portal hypertension. Methods: This was a cross-sectional observational hospital based study conducted in the department of internal medicine and endoscopy unit of the Universal College of Medical Sciences, Bhairahawa, Nepal. The study was done from 21 February 2019 to 20 November 2019 in the patients presented with liver cirrhosis with portal hypertension. Sample size of 80±10 was calculated based on the statistics of previous data. The upper gastrointestinal endoscopy was done in all the patients. The data was collected using the predesigned pro-forma. Results: Total 89 patients with liver cirrhosis were enrolled with mean age of 51.84±12.26 years and male: female ratio of 3.68:1. As per Child Pugh classification (CTP) 45 patients (51%) were in Class C, 33 patients (37%) were in Class B and 11 patients (12%) were in Class A. Esophageal varices were present in 51 (57.3%) patients. According to Westaby classification grade I esophageal varices were seen in 17 (19.1%), grade II esophageal varices were seen in 26 (29.2%), grade III esophageal varices were seen in 8 (8.9%) patients. Portal hypertensive gastropathy (PHG) was seen in 64 (71%) patients. The association between esophageal varices and PHG grade was found statistically significant (P= <0.001). Conclusions: Liver cirrhosis was more commonly seen in middle age males. Esophageal varices and portal hypertensive gastropathy were common endoscopic findings present in patients with liver cirrhosis. There was statistically significant association between esophageal varices and PHG.

Download Full-text