scholarly journals A study on non endoscopic predictors of esophageal varices and portal hypertension in chronic liver disease

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 228-234
Author(s):  
Karthick M ◽  
Prabakaran P T ◽  
Rajendran K ◽  
Gowrishankar A ◽  
Halleys Kumar E ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Chronic Liver ◽  
First Episode ◽  
Oesophageal Varices ◽  
Screening Endoscopy

Portal hypertension is associated with liver cirrhosis and esophageal varices is a common complication. Cirrhotic liver increases resistance to the passage of blood and thereby increased splanchnic blood flow secondary to vasodilation. Prevalence of portal hypertension varies from 50-60% in patients with liver cirrhosis. The first episode of variceal bleeding causes mortality, which ranges from 40-70%. All cirrhotic patients should be screened for the oesophageal varices according to  Baveno III consensus conference on portal hypertension and recommendation for endoscopy is at 2-3 years intervals in patients without varices and at 1-2 years interval in patients with small varices in order to evaluate the development or variceal progression. But this is questionable as endoscopy is an invasive procedure and also cost-effective. Only 9-36% of patients with cirrhosis were found to have varices on screening endoscopy. Non-invasive assessment of variceal bleeding with good predictivity includes biochemical, clinical and ultrasonographic parameters. Thus unnecessary intervention is avoided and at the same time, the patients at risk of bleeding are also not missed. This study emphasizes the need for an annual ultrasonogram examination as a part of a surveillance program for screening of oesophageal varices in patients of chronic liver disease.

scholarly journals Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease

2020 ◽  
Vol 08 (11) ◽  
pp. E1623-E1632
Author(s):  
Carlos Robles-Medranda ◽  
Roberto Oleas ◽  
Miguel Puga-Tejada ◽  
Manuel Valero ◽  
Raquel Del Valle ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Predictive Value ◽  
Strain Ratio ◽  
Chronic Liver ◽  
Spleen Stiffness ◽  
Eus Elastography ◽  
Sensitivity Specificity

Abstract Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

scholarly journals Correction to: Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xing Hu ◽  
Xiaojie Huang ◽  
Jianhua Hou ◽  
Lei Ding ◽  
Chunling Su ◽  
...  
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Original Version ◽  
Spleen Stiffness

The original version of this article, published on 24 September 2020, unfortunately contained a mistake.

scholarly journals Thickening of Gallbladder Wall in Chronic Liver Disease - A Marker for Esophageal Varices

2013 ◽  
Vol 6 (1) ◽  
pp. 18-20
Author(s):  
Shamsi Ara Begum ◽  
Arif Akbar Saibal ◽  
Kanta Das ◽  
Sharmistha Dey ◽  
Akhtar Uddin Ahmed ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Gallbladder Wall ◽  
Chronic Liver ◽  
Wall Thickening ◽  
Oesophageal Varices ◽  
Group A ◽  
The Mean ◽  
Group B

This study was done to find out the relationship between gallbladder wall thickening and esophageal varices in chronic liver disease (CLD) patients. A total of 61 CLD patients were included and divided into two groups. Group A included 13 CLD patients with no oesophageal varices and Group B composed of 48 CLD patients with esophageal varices. Mean gallbladder wall thickness (GBWT) of Group B was 5.6±0.2mm compared to 2.7±0.1mm of Group A. The mean differences of GBWT were statistically significant between group A and group B (P<0.05). The mean GBWT was significantly (p<0.05) higher in CLD patients with grade III and IV varices (6.1±.8 mm) compared to grade I and II (3.9±0.7 mm). The result suggests that GBWT may be considered as an important marker for the presence of esophageal varices in CLD patients. DOI: http://dx.doi.org/10.3329/imcj.v6i1.14713 Ibrahim Med. Coll. J. 2012; 6(1): 18-20

scholarly journals Non-invasive parameters for the detection of variceal bleed in patients of liver cirrhosis, an experience of a tertiary care hospital in Pakistan

2014 ◽  
Vol 6 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Anam Umar ◽  
Fakhar Ali Qazi ◽  
Rukhsana Abdul Sattar ◽  
Beena Umar
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Chronic Liver ◽  
Care Hospital ◽  
Coagulation Profile ◽  
Variceal Bleed ◽  
Splenic Size

 Objective: Cirrhotic patients commonly undergo screening endoscopy for the existence of esophageal varices. The use of this invasive procedure which is expensive, poorly tolerable and generally not acceptable for the patients is increasing due to increasing number of patients with chronic liver disease and their enriched survival. In this study, our aim is to identify clinical, biochemical, and ultrasonography parameters which might non-invasively predict the presence of esophageal varices and risk of bleeding in patients with liver cirrhosis. Material and Methods: Total 150 Patientsof chronic liver disease admitted in ward-5, JPMC(Sep 2011-Feb 2012) with a complaint of hematemesis or melena were included in the study. Platelet counts of 75,000 to 150,000/μL was defined as grade 1 thrombocytopenia, 50,000 to <75,000/μL as grade II, 25,000 to <50,000/μL as grade III and below 25,000/μL as grade IV. The normal range for the INR is 0.8–1.2. Portal vein size of 1.2 cm or above was taken as dilated. Spleen of >13 cm was considered as enlarged in our study. Results: Out of 72 patients of variceal bleed 69 (46%) were males and 81(54%) were females. Thrombocytopenia was present in 64 (88%) patients with mean platelet count of 85.86/μL (±69.79). Deranged coagulation profile was present in 56 (77%) cases with mean INR of 1.63 (±0.5). Portal vein diameter (PVD) of >1.2 cm was found in 46(63.8%) of patients with mean PVD of 1.22(±0.3023) and splenic size of >13 cm was reported in 54 (75%) cases with mean splenic diameter of 14.5 cm (±2.39). Conclusion: Thrombocytopenia, deranged coagulation profile, large splenic size, and dilated portal vein strongly predict the risk of variceal bleeding. DOI: http://dx.doi.org/10.3126/ajms.v6i1.9624 Asian Journal of Medical Sciences Vol.6(1) 2015 61-66

scholarly journals Child Pugh Score as a Predictor of Large Oesophageal Varices in Chronic Liver Disease Patients

2020 ◽  
Vol 3 (1) ◽  
pp. 37-41
Author(s):  
Awasthi Girish ◽  
Tirtha Man Shrestha
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Tertiary Care ◽  
Disease Patient ◽  
Chronic Liver ◽  
University Teaching ◽  
Oesophageal Varices ◽  
Variceal Hemorrhage ◽  
Abdominal Sonography

Introduction: Variceal hemorrhage is a major complication of chronic liver disease. If patients at low or high risk of having esophageal varices (EV) could be identified by the Child Pugh score in predicting the size of oesophageal varices in patients with chronic liver disease. The main objective of this study was to determine whether Child Pugh Score can be used as a predictor of large oesphageal varices in chronic liver disease patient. Methods: A prospective cross-sectional study was conducted in emergency and medicine ward of Tribhuvan University Teaching Hospital from August 2015 to December 2015 with diagnosed chronic liver disease without history of previous medication for varices and any surgical intervention were studied. Patients underwent physical examination, hematological and biochemical tests and abdominal sonography and upper gastrointestinal endoscopy. Presence and absence of esophageal varices size was noted and correlation with Child Pugh Score and it’s associated variables studied. Results: Alcoholic liver disease was the major cause for chronic liver disease with most common age group involved being 41-50 years and 72% prevalence of esophageal varices. A statistically significant association was found between oesophageal varices grade and Child-Pugh’s classification grades i.e., the higher grade of oesophageal varices is associated with advanced grade of Child’s classification. Conclusions: Child Pugh Score had a predictive value to diagnose esophageal varices in chronic liver disease patients. The predictive accuracy as compared to the gold standard test “UGI endoscopy” showed that these parameters cannot replace endoscopy as the diagnostic test but can be used as a screening tool especially in a country like Nepal where availability of endoscopy facilities and access to tertiary care hospitals is an issue.

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