Interrelation between Esophageal Varices, and Systemic and Hepatic Hemodynamics in Male Patients with Compensated Cirrhosis.

Aim. The reproductive hormone levels and systemic physiology of women with hepatic cirrhosis are altered. Existing data have indicated the adverse effects of cirrhosis on both the mother and the fetus. Pregnancy is successful in most of the patients with chronic liver disease. But maternal and fetal complication rates are still high for decompensated hepatic cirrhosis. In this study, we aimed to evaluate the clinical features, etiological factors, medications, morbidity, mortality, and obstetric outcomes of pregnant women with hepatic cirrhosis. Methods. Pregnant women, who were diagnosed with maternal hepatic cirrhosis and followed up in our clinic between 2014 and 2017, were retrospectively evaluated. The pregnant women that had been followed up for hepatic cirrhosis were classified as compensated disease and decompensated disease. Eleven cases were included in this period. Results. The mean age of cases was 33.5±5.5 years. The mean gravida number was 3.2±1.1, and the mean parity number was 1.7±1. Six cases were in the compensated cirrhosis stage, and 5 cases were in the decompensated cirrhosis stage. A pregnancy with decompensated cirrhosis was terminated after the fetal heart sound was negative in the 9th week of pregnancy. Spontaneous abortus occurred in one case (<20 weeks). The mean gestational week of the 9 cases was 33.3±6.2. Two of the 9 cases delivered birth vaginally. Seven cases delivered by cesarean section. The mean first- and fifth-minute APGAR scores were 6.6±1.41 and 8.2±1.56, respectively. The mean birth weight was 2303±981 g. Among 9 cases with live birth, 6 had compensated cirrhosis and 3 had decompensated cirrhosis. In the second trimester, upper gastrointestinal endoscopy was performed to all patients in terms of esophageal varices. Endoscopic band ligation was performed in 3 cases with upper gastrointestinal bleeding. The postpartum mortality did not occur. Discussion. Pregnancy is not recommended for patients with hepatic cirrhosis due to high maternal and fetal morbidity and mortality. The pregnancy course of cases with cirrhosis changes according to the stage of liver injury and severity of disease. Although the delivery method is controversial, delivery by cesarean section is recommended for patients with esophageal varices by the reason of bleeding from varices after pushing during labor. The bleeding risk must be kept in mind as coagulopathy is common in hepatic diseases. The maternal-fetal morbidity and mortality rates have been decreased by the current developments in hepatology, prevention of bleeding from varices with drugs and/or band ligation, improvement in liver transplantation, and increasing experience in this issue.

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Risk factors for the exacerbation of esophageal varices or portosystemic encephalopathy after sustained virological response with IFN therapy for HCV-related compensated cirrhosis

Journal of Gastroenterology ◽

10.1007/s00535-012-0679-8 ◽

2012 ◽

Vol 48 (7) ◽

pp. 847-855 ◽

Cited By ~ 12

Author(s):

Yuko Nagaoki ◽

Hiroshi Aikata ◽

Tomoki Kobayashi ◽

Takayuki Fukuhara ◽

Keiichi Masaki ◽

...

Keyword(s):

Risk Factors ◽

Sustained Virological Response ◽

Esophageal Varices ◽

Virological Response ◽

Portosystemic Encephalopathy ◽

Compensated Cirrhosis ◽

Ifn Therapy

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A55 PREDICTORS OF ENDOSCOPIC HIGH RISK ESOPHAGEAL VARICES IN COMPENSATED CIRRHOSIS: CAN WE AVOID FIBROSCAN?

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwy009.055 ◽

2018 ◽

Vol 1 (suppl_2) ◽

pp. 88-88

Author(s):

G Huard ◽

J Hercun ◽

M Bilodeau ◽

J Bissonnette ◽

J Giard

Keyword(s):

High Risk ◽

Esophageal Varices ◽

Compensated Cirrhosis

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Rapid Development of Bleeding Esophageal Varices after Placement of Continuous Flow Left Ventricular Assist Device

Case Reports in Hepatology ◽

10.1155/2019/8410420 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Kaushal Majmudar ◽

Michael Northcutt ◽

Robert Gordon ◽

Claus J. Fimmel

Keyword(s):

Portal Hypertension ◽

Esophageal Varices ◽

Continuous Flow ◽

Rapid Development ◽

Fatal Outcome ◽

Left Ventricular ◽

Ventricular Assist ◽

Compensated Cirrhosis ◽

Bleeding Esophageal Varices ◽

Cirrhotic Patients

We describe a patient with compensated cirrhosis and portal hypertension who underwent continuous flow LVAD implantation. Shortly after LVAD implantation, the patient developed new onset bleeding esophageal varices and ultimately had a fatal outcome. Our experience suggests that even well-compensated cirrhotic patients with significant portal hypertension are at risk of variceal bleeding after LVAD placement.

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Frecuencia y factores de riesgo asociados a re-sangrado posterior a ligadura de várices esofágicas en pacientes con cirrosis hepática

Revista Médica del Hospital José Carrasco Arteaga ◽

10.14410/2020.12.3.ao.28 ◽

2020 ◽

Vol 12 (3) ◽

pp. 193-198

Author(s):

María Lisseth Sánchez Garzón

Keyword(s):

Blood Transfusion ◽

Esophageal Varices ◽

Prevalence Ratio ◽

Functional Class ◽

P Value ◽

Severe Anemia ◽

Statistical Association ◽

Cross Sectional ◽

Male Patients ◽

Endoscopic Ligation

BACKGROUND: Re-bleeding of esophageal varices after endoscopic ligation is a frequent complication, that significantly increases morbidity and mortality in this patients. This study aims to describe the frequen-cy of rebleeding due to esophageal varices after endoscopic ligation, as well as the frequency of certain factors and their association with rebleeding. METHODS: Cross-sectional, descriptive and correlational, observational study. A total of 179 patients who underwent endoscopic ligation of esophageal varices participated. For the association analysis Chi2 test was applied, prevalence ratio was obtained, with 95% IC. Data was presented with charts, with frequencies and percentages. RESULTS: Alcoholism was the main cause of cirrhosis in patients that underwent ligation of esophageal varices (44.1%). Most of the cases were classified as Child Pugh Sore B functional class, with a frequency of 36.3%. The prevalence of rebleeding was 49.2% (95% CI 41.55%- 56.76%), it was more frequent in patients 65 years old and older (58%), and male patients (64.8%). Death rate due to rebleeding after ligation was 43%. We found significant statistical association of rebleeding with factors such as: TPT >33.3 (PR: 1.91, 95% CI 1.07-3.39, p value =0.00); moderate and severe anemia (PR: 1.43, 95% CI 1.05-1.96, p value =0.02), and blood transfusion (PR: 2.23. 95% CI 1.37-3.65, p value=0.00). CONCLUSION: Rebleeding frequency was 49.2% (early and late rebleeding), it was more common in male patients, and patients aged 65 or more. This study found statistical association between rebleeding and: elevated values of partial thromboplastin time, moderate and severe anemia, and blood transfusion. Mor-tality due to rebleeding was 43%. KEYWORDS: ESOPHAGEAL AND GASTRIC VARICES, LIVER CIRRHOSIS, PORTAL HYPERTENSION

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