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

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

Association between Serum-Ascites Albumin Gradient and Esophageal Varices in Patients of Cirrhotic Ascites

TAJ Journal of Teachers Association ◽

10.3329/taj.v27i2.37639 ◽

2018 ◽

Vol 27 (2) ◽

pp. 36-38

Author(s):

SM Alam ◽

MN Huda ◽

MN Nurul ◽

Towfiq I ◽

MZ Haque ◽

...

Keyword(s):

Portal Hypertension ◽

Esophageal Varices ◽

Gastrointestinal Endoscopy ◽

Positive Association ◽

Descriptive Study ◽

Upper Gastrointestinal Endoscopy ◽

Statistical Association ◽

Cross Sectional ◽

Upper Gastrointestinal ◽

Significant Statistical Association

Background: Serum-Ascitic Albumin Gradient (SAAG) can identify ascites related to portal hypertension. Esophageal varix (EV) is another feature of portal hypertension in cirrhosis. This study was done to find out the relation between SAAG and esophageal varices.Materials and methods: It was a cross- sectional descriptive study of 50 cases of cirrhotic ascites. SAAG was measured and upper gastrointestinal endoscopy was done for esophageal varices.Results: Among 50 cases, mean SAAG value 1.77 (±0.45 SD). Esophageal varices were found in 43(86%) cases. All cases with SAAG value >2.0gm/dl had EV. A significant statistical association was found between level of SAAG and the presence of esophageal varices (p=0.01).Conclusion: In patients of cirrhosis, the level of SAAG has positive association with the esophageal varices. This finding may permit us to use SAAG as a preliminary parameter of esophageal varices (EV) especially where endoscopy facilities are not available.TAJ 2014; 27(2): 36-38

Download Full-text

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

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-04 ◽

2017 ◽

Vol 54 (1) ◽

pp. 21-26 ◽

Cited By ~ 4

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.

Download Full-text

THE RELATIONSHIP OF APRI SCORE (ASPARTATE AMINOTRANS FERASE-TO-PLATELET RATIO INDEX) AND PUGH CHILD SCORE

Jurnal Ilmu Kesehatan ◽

10.30650/jik.v7i2.289 ◽

2020 ◽

Vol 7 (2) ◽

pp. 122-129

Author(s):

Adelia Muhlifa Saputri ◽

Magdaleni Agustina Rahayu ◽

Sinta Murti

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Function ◽

Esophageal Varices ◽

Aspartate Aminotransferase ◽

Secondary Source ◽

Cross Sectional ◽

Prognosis Of Liver Cirrhosis ◽

Apri Score ◽

Relationship Of

Liver cirrhosis is the last stage of chronic liver disease that is in the path of the disease can cause damage of liver function and/or portal hypertension. The prognosis of liver cirrhosis can be assessed by manifestations of liver function disorders with Child Pugh score that include the presence or absence of ascites, encephalopathy, bilirubin serum, albumin serum, and prothrombin time or INR, while portal hypertension also occurs in patient of cirrhosis can lead the formation of esophageal varices. APRI score has platelet count and AST serum as its variable is suspected to be related to the Child Pugh score in assessing prognosis of cirrhosis patients. This study purposed to find the relation between APRI score (Aspartate Aminotransferase-to-Platelet Ratio Index) and Child Pugh score. Purpose of this research is to find the relation between APRI score (Aspartate Aminotransferase-to-Platelet Ratio Index) and Child Pugh score and degree of esophageal varices in patients with cirrhosis. Method used is a retrospective analytic study with cross sectional approach. The data source is secondary source. The sample in this study were patients with liver cirrhosis who were diagnosed by a doctor and had complied the inclusion criteria. The data obtained was analyzed using ANOVA. The result of this study is include 48 cirrhosis patients, male 81,3%, with a mean age 49,98 years. The most common cause of cirrhosis is hepatitis B obtained from reactive HBsAg examination in 33 patients (68,8%). The APRI score was found to have a weak correlation (r = 0.044) and not significant (p = 0.868) with the Child Pugh score. The APRI score do not able to assess the prognosis in advanced cirrhotic patients.

Download Full-text

Study of Upper Gastrointestinal Tract Endoscopic findings in Portal Hypertension

Journal of Nepal Medical Association ◽

10.31729/jnma.2113 ◽

1970 ◽

Vol 52 (190) ◽

Cited By ~ 1

Author(s):

Lochan Karki ◽

Manen Prasad Gorkhaly ◽

Buddha Bahadur Karki

Keyword(s):

Portal Hypertension ◽

Gastrointestinal Tract ◽

Esophageal Varices ◽

Endoscopic Finding ◽

Upper Gastrointestinal Tract ◽

Erosive Gastritis ◽

Hypertensive Patients ◽

Endoscopic Findings ◽

Upper Gi ◽

Upper Gastrointestinal

Introduction: The gut mucosa in portal hypertension is the seat of microcirculatory changes that compromise its integrity and increase its susceptibility to damage. The mucosal changes in portal hypertension may require pharmacological, directed endoscopic or portal decompressive therapy. The objective of the study is to find out various upper gastrointestinal tract endoscopic findings in patients of portal hypertension.Methods: A prospective, cross-sectional, observational study of sixty patients of portal hypertension was conducted from June to October 2009. The esophagus, stomach and upper duodenum was visualized for any changes, especially by taking the tip of the instrument close to the mucosa.Results: Out of total, 60, 47 (78.3%) cases were cirrhotic and 13 (21.7%) cases were non-cirrhotic portal hypertension. The most frequent upper GI endoscopic finding was esophageal varices 56 (98.3%) followed by gastropathy 49 (81.6%), gastric hyperemia 19 (31.6%), duodenal hyperemia and erosive gastritis 16 (26.6% in each) and gastric varices 12 (20%). Esophageal varices were equally prevalent among cirrhotic and non cirrhotic portal hypertensive patients, 46 out of 47 (97.9%) and 13 out of 13 (100%) respectively. Gastropathy was more prevalent in cirrhotic patients with 87.2% vs. 75% in NCPF followed by 40% in EHO. However, duodenal ulcers were seen only in EHO 12.5%. Erosive gastritis was more prevalent in EHO (75%) followed by NCPF (60%), however, it was less frequent in cirrhotic portal hypertension (14.8%).Conclusions: The most common upper GI endoscopic finding in portal hypertensive patients were found to be esophageal varices followed by gastropathy, peptic ulcer disease (gastric and duodenal hyperemia, chronic gastritis, erosive gastritis, gastric ulcer and duodenal ulcer)._______________________________________________________________________________________Keywords: gastrointestinal tract; portal hypertension; varices.

Download Full-text

Clinical and Endoscopic Profile of Upper Gastrointestinal Bleed: A Cross-sectional Study from a Tertiary Care Hospital in Southern India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46047.14617 ◽

2021 ◽

Author(s):

Manju Surendran ◽

K Sunil Kumar

Keyword(s):

Portal Hypertension ◽

Tertiary Care ◽

Cross Sectional Study ◽

Southern India ◽

Oesophageal Varices ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Upper Gastrointestinal

Introduction: Acute Upper Gastrointestinal (UGI) bleed is a common potentially life threatening emergency. The aetiological profile of bleed and prognosis varies according to geographical region and availability of endoscopic facilities. Aim: To determine the clinical and endoscopic profile of UGI bleed, risk factors and prognosis in the patients. Materials and Methods: This was a cross-sectional study conducted over a period of 12 months at a tertiary care centre in Southern India. Patients admitted with history of hematemesis and melena, satisfying the inclusion criteria was taken consecutively. Clinical and endoscopic profile were noted and followed-up for six weeks. Statistical analysis was performed using chi-square test for qualitative variables and independent t-test for quantitative variables. Significance level was fixed as p-value of <0.05. Results: A total of 138 patients were studied in this period. The male to female ratio in the study was 3.5:1. The mean age was 53.5±13.17 years. The most common clinical presentation was hematemesis in 57 patients (41.3%) followed by haematemesis and melena in 46 patients (33.3%). The most common cause on endoscopy was portal hypertension-related oesophageal and gastric varices (51.4%) followed by antral gastritis (15.2%). The cause of UGI bleeding could not be identified in 5.1% in which the endoscopy was normal. Haemogram, platelet count and serum albumin were significantly lower in variceal bleed group, compared to non-variceal group. Eleven patients succumbed to death secondary to UGI bleed. Conclusion: The most common causes of UGI bleed are portal hypertension related gastric and oesophageal varices. The in-hospital mortality in the study was 7.9%.

Download Full-text

Helicobacter pylori Infection in Patients with Portal Hypertensive Gastropathy Owing to Liver Cirrhosis: Prevalence and Relation with Severity of Gastropathy

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_34_17 ◽

2017 ◽

Vol 08 (03) ◽

pp. 123-128

Author(s):

Shekhar Puri ◽

Mukesh Jain ◽

Kumar Shwetanshu Narayan ◽

Sudhakar Pandey ◽

Sandeep Nijhawan

Keyword(s):

Helicobacter Pylori ◽

Liver Cirrhosis ◽

Meld Score ◽

Upper Gastrointestinal Endoscopy ◽

Portal Hypertensive Gastropathy ◽

Cirrhotic Patients ◽

The Difference ◽

H Pylori ◽

Ctp Score ◽

Upper Gastrointestinal

ABSTRACT Background and Aim: Helicobacter pylori is a major human pathogen. Its role in the pathogenesis of portal hypertensive gastropathy (PHG) is debated. The aim of this study was to evaluate the prevalence of this infection in patients with portal hypertension due to liver cirrhosis and its relation with severity of gastropathy. Patients and Methods: Sixty consecutive patients with liver cirrhosis were enrolled in the study. All patients were subjected to an upper gastrointestinal endoscopy (UGIE), and rapid urease testing for H. pylori was performed. The diagnosis and severity of PHG was evaluated on UGIE. ChildαTurcotteαPugh (CTP) and model for endαstage liver disease (MELD) scores were calculated to assess the severity of liver cirrhosis. Results: H. pylori infection was reported in 33 patients with overall prevalence 55%. The presence of H. pylori was observed in 26 (67%) cirrhotic patients with PHG compared to 7 (33%) cirrhotic patients without PHG. The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P = 0.0133, odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.298–12.325). Out of the 26 patients with PHG and H. pylori infection, 17 had severe PHG (65.3%) and 9 had mild PHG (34.6%) whereas 4 patients had severe PHG (30.8%) and 9 had mild PHG (69.2%%) in the group of H. pyloriαnegative patients. The difference was statistically significant (P = 0.04, OR: 4.25, 95% CI: 1.0188–17.729). Of the 39 patients with PHG, 21 (53.85%) had severe PHG and 18 (46.15%) had mild PHG. No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards CTP score (P = 0.76) and MELD score (P = 0.56). Conclusion: Our results showed a significant association between H. pylori infection and the occurrence and also the severity of gastropathy in patients with liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of gastropathy.

Download Full-text

CIRRHOTIC PATIENTS;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.01.423 ◽

2017 ◽

Vol 24 (01) ◽

pp. 132-138

Author(s):

Ammarah Saeed ◽

Tehzeeb Zehra ◽

Ayaz Ahmad ◽

Umbreen Idrees ◽

Sajjad Sabir

Keyword(s):

Portal Hypertension ◽

Esophageal Varices ◽

Gastric Varices ◽

Common Type ◽

Type I ◽

Portal Hypertensive Gastropathy ◽

Vascular Changes ◽

Cross Sectional ◽

Study Results ◽

Child Class

At present time portal hypertension is perceived as one of the complications ofadvanced liver disease. It results in various vascular changes in gastrointestinal tract (GI),including esophageal varices, gastric varices and portal hypertensive gastropathy (PHG). PHGand gastric varices are a common cause of acute as well as chronic bleeding from GI tractwhich resulted in significant mortality among patients. Objectives: To determine the frequencyof gastric vascular changes in various causes of cirrhosis. Study Design: Cross sectional study.Setting: Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad.Period: 1st August 2007 to 31st July 2008. Materials and Methods: Patients of age ≥30 years,with clinical evidence of cirrhosis and without prior treatment of esophagiogastric varices wereincluded in the study. Results: A total of 100 patients were enrolled in the study out of which47 were male and 53 were females with mean age of 53.6 years. The most common type ofcirrhosis was turned out to be Hepatitis C affecting 50% of patients and most of the patientswere in Child class C. Portal hypertensive gastropathy was present in 74% of patients. Amongthem 24.3% have mild changes while severe changes were present in75.7% of patients. Gastricvarices were found in 40% of the patients and the most common type was IGV type I whichwas present in 29(72.5%) of the patients. Correlation of severity of PHG was seen with gradingof esophageal varices, grading of gastric varices and Child class. Conclusion: Frequency ofsevere gastropathy is higher than the mild gastropathy. It is also concluded that gastric vascularchanges are associated with cause of cirrhosis, child class and degree of portal hypertension.

Download Full-text

Peptic Ulcer Diseases in Patients with Liver Cirrhosis and Portal Hypertension: Experience in a Tertiary Level Hospital in Bangladesh

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v16i2.55303 ◽

2021 ◽

Vol 16 (2) ◽

pp. 68-71

Author(s):

Ahmed Lutful Moben ◽

Md Abdullahel Kafee ◽

Md Jahangir Kabir ◽

Arunanagshu Raha ◽

Farjana Majid ◽

...

Keyword(s):

Liver Cirrhosis ◽

Peptic Ulcer ◽

Portal Hypertension ◽

Peptic Ulcer Disease ◽

Oesophageal Varices ◽

Portal Hypertensive Gastropathy ◽

Class Iii ◽

Cross Sectional ◽

Ulcer Disease ◽

Cirrhosis Of Liver

Introduction: Cirrhosis of liver and peptic ulcer disease (PUD) are very common in Bangladesh. PUD may coexist with cirrhosis and portal hypertension. Haematemesis and melaena in cirrhosis of liver are not always from ruptured oesophageal varices; rather it may be due to bleeding peptic ulcer disease. Objective: To find the prevalence of PUD among patients with liver cirrhosis and portal hypertension. Materials and Methods: This cross sectional, descriptive study was conducted on 96 patients of cirrhosis of liver diagnosed with oesophageal varices at endoscopy unit of Kurmitola general hospital, during endoscopic evaluations in 4 months period from september 2017 to december 2017. Results: Total cirrhotic patients enrolled were 96 (M=61, F=35), mean age was 51.8 ± 14.2 yrs (18-86years). Hepatitis B virus (HBV) was the leading cause of cirrhosis in 54.1%, Hepatitis C virus (HCV) 5.2 %, proven non-alcoholic steatohepatitis (NASH) were 11.5% and rest were from unknown aetiology. Their average Child-Turcotte-Pugh (CTP) score were 8.6 (12-5), 37.6% associated with portal hypertensive gastropathy. Grade-III oesophageal varices found in 52 patients, whereas grade-II in 25 patients. Among this 96 patients 39 (40.6%) revealed peptic ulcer disease more in the form of gastric ulcer (n=23) than duodenal ulcer (n=10) and both (n=6). Most of the ulcers belonged to Forrest class III (76.9%). Conclusions: Variceal bleeding and portal hypertensive gastropathy are the common causes of bleeding and anaemia in patients with cirrhosis of liver. Peptic ulcer disease has been found to be one of the potential causes of haematemesis, melaena, and anaemia among these patients in Bangladesh. Large multicenter controlled studies are needed to confirm the reports. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 68-71

Download Full-text

Noninvasive clinical predictors of portal hypertensive gastropathy in patients with liver cirrhosis

Journal of Translational Internal Medicine ◽

10.1515/jtim-2017-0025 ◽

2017 ◽

Vol 5 (3) ◽

pp. 169-173 ◽

Cited By ~ 2

Author(s):

Rajesh Mandhwani ◽

Farina M. Hanif ◽

Muhammad Manzoor Ul Haque ◽

Rajesh Kumar Wadhwa ◽

Nasir Hassan Luck ◽

...

Keyword(s):

Liver Cirrhosis ◽

Platelet Count ◽

Esophageal Varices ◽

Predictive Value ◽

Abdominal Ultrasound ◽

Portal Hypertensive Gastropathy ◽

Clinical Predictors ◽

Liver Lobe ◽

Cross Sectional ◽

Gi Endoscopy

AbstractBackground and ObjectivesPortal hypertensive gastropathy (PHG) is described endoscopically as “mosaic-like appearance” of gastric mucosa with or without the red spots. It can only be diagnosed by upper gastrointestinal (GI) endoscopy. The aim of this study was to determine the diagnostic accuracy of platelet count to spleen diameter ratio (PSR) and right liver lobe diameter to albumin ratio (RLAR) in the detection of PHG using upper GI endoscopy as a gold standard in patients with liver cirrhosis.Material and MethodsThis cross-sectional study was conducted in the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi. All consecutive patients with ages 18–65 years who were screened using esophagogastroduodenoscopy (EGD) to exclude esophageal varices were enrolled. At the same time, findings related to PHG were noted. After informed consent, all the patients had blood tests including platelet count and albumin and abdominal ultrasound determining spleen diameter and right liver lobe diameter.ResultsOut of 111 patients, 59 (53.15%) were males with a mean age of 44 ± 12.61 years. Rate of PHG was observed in 84.68% (94/111) cases confirmed by EGD. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PSR were 87.23%, 5.88%, 83.67%, 7.69%, and 74.7%, respectively, and those of RLAR were 28.72%, 70.59%, 84.38%, 15.19%, and 35.14%, respectively.ConclusionPSR is better predictor of PHG than RLAR but at the expense of relatively lower specificities and NPV likely because of underlying pathophysiology (portal hypertension) which is similar for esophageal varices, PHG, and ascites.

Download Full-text

Correlation of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24879 ◽

2018 ◽

Vol 16 (2) ◽

pp. 50-53

Author(s):

Anil Shrestha ◽

Dipendra Khadka ◽

Richa Shrestha

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

Cross Sectional ◽

Class A ◽

Red Color ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Small Varices

Background: Majority of cirrhotic patients develop varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

Download Full-text