scholarly journals Endoscopic Band Ligation in Patients with Variceal Bleeding

2018 ◽  
Vol 3 (1) ◽  
pp. 320-324
Author(s):  
Narayan Prasad Belbase ◽  
Aditya Jalan ◽  
Hari Prasad Upadhya ◽  
Rohit Mishra ◽  
Mukesh Karki ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Esophageal Varices ◽  
Alcoholic Cirrhosis ◽  
Oesophageal Varices ◽  
Common Cause ◽  
Band Ligation ◽  
Male Predominance ◽  
History Of ◽  
Cirrhosis Mortality

Introduction: Esophageal varices (EV) affect about 50% of patients with liver cirrhosis. Mortality rate from the initial EV bleeding can rise up to 30% in patients with advanced liver disease and large varices. Several RCTs have shown endoscopic variceal banding to be more effective than sclerotherapy for the long-term prevention of variceal bleeding.Objective: This study was conducted to see the outcome of endoscopic banding in the management of esophageal varices in Nepalese population.Methodology: This was a prospective observational study conducted in the Department of Surgical Gastroenterology, College of Medical Sciences and Teaching Hospital (COMS-TH), Bharatpur, Nepal over a period of 2 years. Patients attending the COMS emergency/surgical OPD with history of UGI bleed with features consistent with portal hypertension during this period were enrolled. The endoscopic variceal band ligation was done based on similar principles applied to Barren and ligation in the treatment of internal haemorrhoids.Results During this period of two years 50 patients were analysed. The mean age of the study subjects was 52.26+/-12.80 years and male predominance was seen (M:F=42:8). Alcoholic chronic liver disease (CLD) (74%) was the most common cause of portal hypertension. Child's B score was seen among 54%, grade III varices were seen in 36% and grade II in 32%. Acute bleeding of varices was present in nine (18%) cases. On an average 3.8 sessions were required to obliterate the varices. Control of acute bleed and variceal eradication was seen in 77.78% cases and in 96% cases respectively. Complications following banding were seen in 20% cases. Mortality was seen in two (4%) cases.Conclusions: Alcoholic cirrhosis was the most common cause of portal hypertension and endoscopic banding of oesophageal varices in Nepalese population had comparable eradications, complications and recurrences with similar other studies conducted in other parts of the world. BJHS 2018;3(1)5 : 320-324

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.

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

Primary Biliary Cirrhosis

2015 ◽  
Author(s):  
Daniel S. Pratt ◽  
Lindsay Y. King
Keyword(s):  
Differential Diagnosis ◽  
Liver Disease ◽  
Primary Biliary Cirrhosis ◽  
Liver Diseases ◽  
American Association ◽  
Cholestatic Liver Disease ◽  
Biliary Cirrhosis ◽  
Common Cause ◽  
History Of

Primary biliary cirrhosis (PBC) is a progressive autoimmune disease of the liver. It is the most common cause of chronic intrahepatic cholestatic liver disease in adults. This review addresses the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of PBC. Figures show the pathogenesis and natural history of PBC and histologic features of the four stages of PBC. Tables list diagnostic criteria for PBC via the American Association for the Study of Liver Diseases, differential diagnosis for PBC, medications used to treat PBC, secondary therapy for PBC, and follow-up of patients with PBC. This review contains 2 highly rendered figures, 5 tables, and 45 references.

Fontan-Associated Liver Disease: Pathophysiology, Staging, and Management

2021 ◽  
Author(s):  
Luis Téllez ◽  
Enrique Rodríguez de Santiago ◽  
Agustín Albillos
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Fontan Procedure ◽  
Elevated Risk ◽  
Histological Changes ◽  
Global Management ◽  
Screening Strategies ◽  
History Of ◽  
Fontan Patients

AbstractFontan-associated liver disease is the term used to encompass the disorders arising from abnormal hemodynamic alterations and systemic venous congestion after the Fontan procedure. The histological changes produced in the liver are similar but not equivalent to those seen in other forms of cardiac liver disease. While the natural history of this form of liver disease is poorly established, many Fontan patients ultimately develop portal hypertension-related complications such as ascites, esophageal varices, malnutrition, and encephalopathy. Fontan survivors also show an elevated risk of hepatocellular carcinoma. Adequate staging of the liver damage is essential to anticipate screening strategies and improve global management.

scholarly journals Rupture of esophageal varices due to portal hypertension

2010 ◽  
Vol 50 (5) ◽  
pp. 316
Author(s):  
Yusri Dianne Jurnalis ◽  
Yorva Sayoeti ◽  
Marlinda Marlinda
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Variceal Hemorrhage ◽  
Common Cause ◽  
Initial Episode ◽  
One Year ◽  
The One ◽  
Upper Gastrointestinal ◽  
Emergent Case

Variceal bleeding is the most common cause of serious upper gastrointestinal (UGI) bleeding in children. Most variceal bleeding is esophageal.1 Hemorrhages from esophageal varices due to portal hypertension are a major cause of morbidity and mortality. There is a 30% mortality rate following an initial episode of variceal hematemesis. Mortality increases to 70% with recurrent variceal hemorrhage. Moreover, the one year survival rate after variceal hemorrhage is often poor (32 to 80%).2-4 We report a case of esophageal varices rupture caused by portal hypertension, an emergent case in the Pediatric Gastrohepatology division.

scholarly journals Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis

1980 ◽  
Vol 79 (6) ◽  
pp. 1139-1144 ◽  
Author(s):  
Didier Lebrec ◽  
Patrice De Fleury ◽  
Bernard Rueff ◽  
Henri Nahum ◽  
Jean-Pierre Benhamou
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Esophageal Varices ◽  
Alcoholic Cirrhosis

scholarly journals Platelet Count/Splenic Diameter Ratio to Predict Oesophageal Varices in Portal Hypertension

2019 ◽  
Vol 2 (2) ◽  
pp. 192-196
Author(s):  
Buddhi Sagar Lamichhane ◽  
Manoj Koirala ◽  
Bishwo Raj Baral
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rural Areas ◽  
Predictive Value ◽  
Tertiary Hospital ◽  
Diameter Ratio ◽  
Oesophageal Varices ◽  
Cirrhosis Of Liver

Background: One of the major causes of morbidity and mortality in Nepal is portal hypertension due to liver cirrhosis. In rural areas where a lot of cases of cirrhosis of liver are prevalent and endoscopic expertise and facilities are not available, predicting the presence of esophageal varices through non-invasive means may reduce a large number of unnecessary endoscopies. This study is to identify the relationship of platelet count /splenic bipolar diameter ratio with the presence of esophageal varices in portal hypertension. Materials and methods: Eighty patients were included in this study between Jestha 2072 to Baisakh 2073 with the diagnosis of portal hypertension admitted in Bir hospital, Kathmandu which is a tertiary hospital of government of Nepal, which were mostly due to liver cirrhosis. The patients fulfilling the inclusion criteria underwent lab investigations, ultra sonogram and UGI endoscopy. The data were assessed for descriptive studies and means were compared using t-test. The cut off value of platelet count to spleen diameter ratio of 1150 was used to predict the presence or absence of oesophageal varices. Statistical analysis was done using SPSS 20 software Results: Platelet count to splenic diameter ratio with a cut off value of 1150 has sensitivity of 89.7%, specificity of 83.3%, positive predictive value of 96.8% and negative predictive value of 58.8% (p= 0.002, CI=95%) with 89.5 % accuracy. Conclusion: Platelet count to splenic bipolar diameter ratio can be a good predictor of presence of esophageal varices in patients with portal hypertension in the resource poor settings.

scholarly journals Evaluation of endoscopic secondary prophylaxis in children and adolescents with esophageal varices

2017 ◽  
Vol 54 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Júlio Rocha PIMENTA ◽  
Alexandre Rodrigues FERREIRA ◽  
Eleonora Druve Tavares FAGUNDES ◽  
Paulo Fernando Souto BITTENCOURT ◽  
Alice Mendes MOURA ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Children And Adolescents ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Secondary Prophylaxis ◽  
Gastric Fundus ◽  
Portal Hypertensive Gastropathy ◽  
Band Ligation ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND Bleeding of esophageal varices is the main cause of morbidity and mortality in children and adults with portal hypertension and there are few studies involving secondary prophylaxis in children and adolescents. OBJECTIVE To evaluate the efficacy of endoscopic secondary prophylaxis in prevention of upper gastrointestinal bleeding in children and adolescents with esophageal varices. METHODS This is a prospective analysis of 85 patients less than 18 years of age with or without cirrhosis, with portal hypertension. Participants underwent endoscopic secondary prophylaxis with sclerotherapy or band ligation. Eradication of varices, incidence of rebleeding, number of endoscopic sessions required for eradication, incidence of developing gastric fundus varices and portal hypertensive gastropathy were evaluated. RESULTS Band ligation was performed in 34 (40%) patients and sclerotherapy in 51 (60%) patients. Esophageal varices were eradicated in 81.2%, after a median of four endoscopic sessions. Varices relapsed in 38 (55.1%) patients. Thirty-six (42.3%) patients experienced rebleeding, and it was more prevalent in the group that received sclerotherapy. Gastric varices and portal hypertensive gastropathy developed in 38.7% and 57.9% of patients, respectively. Patients undergoing band ligation showed lower rebleeding rates (26.5% vs 52.9%) and fewer sessions required for eradication of esophageal varices (3.5 vs 5). CONCLUSION Secondary prophylaxis was effective in eradicating esophageal varices and controlling new upper gastrointestinal bleeding episodes due to the rupture of esophageal varices. Band ligation seems that resulted in lower rebleeding rates and fewer sessions required to eradicate varices than did sclerotherapy.

scholarly journals Is There an Association between Variceal Bleed and Helicobacter pylori Infection in Cirrhotic Patients with Portal Hypertension?

2021 ◽  
Author(s):  
Sathyanarayan Varuna ◽  
Sathasivam Sureshkumar ◽  
Balakrishnan Gurushankari ◽  
Elangovan Archana ◽  
Subair Mohsina ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Esophageal Varices ◽  
Lower Risk ◽  
Acid Output ◽  
Gastric Acid Output ◽  
Pepsinogen I ◽  
H Pylori ◽  
Related Liver Disease

Objectives: The objective of this study was to find the association of H. pylori in patients with variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension. Methods: This was a prospective cohort of patients with bleeding esophageal varices. The primary outcome was correlation between prevalence of H. pylori and the incidence of bleeding/ rebleeding from varices and with encephalopathy. The secondary outcome were correlation between the site of bleeding with H. pylori infection and the association of pepsinogen I & II and the ratio of pepsinogen I/II with bleeding. Results: A total of 190 patients were assessed for eligibility, out of which 159 patients were included in this study. 124 out of 159 patients (77.9%) had alcohol-related liver disease. 8 out of 159 patients had HBV-related liver disease. 7 patients with varices had neither bled at presentation nor did bleed in the follow-up period. A total of 78 out of 159 (49.05%) patients were H.pylori-infected. Patients with esophageal varices [Adjusted Risk (AR)=0.7] and H.pylori infection (AR=0.7) had a lower risk of variceal rebleeding. Among the patients negative for H.pylori, pepsinogen I was higher in patients with rebleeding (30.7 vs 14.4; p<0.001). Among H.pylori positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 vs 1.3; p=0.023). Conclusion: H.pylori infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of H.pylori infection, rebleeding was associated with more gastric acid output demonstrated by the level of pepsinogen. Keywords: Pepsinogen; hepatic encephalopathy; gastric acid output, Helicobacter pylori

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