scholarly journals Laboratory Predictors of Esophageal Varices in Children with Chronic Liver Disease

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

scholarly journals By-pass Marker for detecting Esophageal Varices in Patients with Chronic Liver Disease

2018 ◽  
Vol 28 (2) ◽  
pp. 15-21
Author(s):  
Sandipan Ghose ◽  
Md Azizul Hoque ◽  
MK Rahman ◽  
MMR Khan ◽  
Mohd Harun Or Rashid ◽  
...  
Keyword(s):  
Liver Disease ◽  
Gall Bladder ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Gastrointestinal Endoscopy ◽  
Bladder Wall ◽  
Chronic Liver ◽  
Wall Thickening ◽  
Gall Bladder Wall ◽  
Grade 11

This study was designed to make a relation between gall bladder wall thickening (GBWT) measured by ultrasonography and esophageal varices (EV) measured byupper gastrointestinal endoscopy in chronic liver disease patients. Itwas cross- sectional descriptive study. 50 cases ofChronic Liver Disease were recruited. GBWT was measured by ultrasonography and upper gastrointestinal endoscopy was done for assessment of the presence and grade of EV in all cases. Among 50 cases, 34 (68%) were male and 16(32%) were female. Mean age (±SD) of the study population was 46.7 (±13.28) years of age. Esophageal varices were found in 42(84%) cases and 8(16%) cases had no varix. Among 42 cases of esophageal varices 9 cases had grade-I, 17 cases had grade-II and 16 cases had Grade-III esophageal varices. Gall bladder wall thickness up to 3mm was considered as normal. In this study GBWT value between (1-3) mm8 cases had no EV GBWT value between (3.1-5.9) mm ,10 cases had EV(9 cases had grade 1 and 1 case had grade 11 EV); GBWT value between (6-8.9) mm, 16 cases had grade 11 EV and GBWT value between (9-12) mm 16 cases had grade 111 EV. A significant statistical correlation was found between the level of GBWT and EV (P<0.001) and also between mean GBWT and EV (P<0.001). This study shows that the presence of EV is directly related to the level of GBWT and there is also association with the grade of EV and level of GBWT. This finding will permit the use of GBWT as a preliminary indirect parameter that will predict the presence EV. It can help clinicians in determining the urgency of care, especially where endoscopy facilities are not available.TAJ 2015; 28(2): 15-21

scholarly journals A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-38
Author(s):  
A Zoughlami ◽  
J Serero ◽  
G Sebastiani ◽  
M Deschenes ◽  
P Wong ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Chronic Liver ◽  
Non Invasive ◽  
Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM &gt;9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM &lt;20 kPa and platelets &gt;150,000) and expanded Baveno VI criteria (LSM &lt;25 kPa and platelets &gt;110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was &gt;10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

scholarly journals Liver stiffness-spleen size-to-platelet ratio risk score detects esophageal varices in chronic liver disease

SpringerPlus ◽  
2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Soichiro Shibata ◽  
Satoru Joshita ◽  
Takeji Umemura ◽  
Tomoo Yamazaki ◽  
Naoyuki Fujimori ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Risk Score ◽  
Esophageal Varices ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Spleen Size

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

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

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