scholarly journals Diagnosis and management of extrahepatic oesophageal variceal bleed in children in a low resourced setting

2020 ◽  
Vol 54 (4) ◽  
pp. 274-278
Author(s):  
Taiba J. Afaa ◽  
Kokou H. Amegan-Aho ◽  
Elikem Richardson ◽  
Bamenla Goka
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Upper Gastrointestinal Bleeding ◽  
Liver Function Tests ◽  
Tertiary Hospital ◽  
Secondary Prophylaxis ◽  
Resource Constraint ◽  
Oesophageal Varices ◽  
Upper Gastrointestinal

Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension (PH) in children. Portal vein thrombosis (PVT) is the most common cause accounting for up to 75% of cases in developing countries. Upper gastrointestinal bleeding is the most dreaded and commonest presentation of portal hypertension. Successful treatment of paediatric PH, though challenging is performed in resource constraint countries. Cases: Five children presented over three years to a tertiary hospital in Ghana, with massive upper gastrointestinal bleeding. They had anaemia, thrombocytopaenia and four had splenomegaly. Liver function tests, INR, haemoglobin electrophoresis as well as HIV serology, hepatitis B and C screening were all normal. Abdominal doppler ultrasound scan confirmed portal vein thromboses. They were resuscitated and managed with octreotide, propranolol, antibiotics and sclerotherapy or oesophageal variceal banding in the acute setting and long term secondary prophylaxis with propranolol. Subsequently, an algorithm was developed to assist with the management of bleeding from oesophageal varices and the diagnosis of EHPVO. Conclusion: Portal hypertension due to EHPVO is an important cause of upper gastrointestinal (GI) bleeding in children. This can be successfully managed even in a resource constraint setting once the appropriate measures are taken.

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.

Emergency Endoscopy in Patients with Portal Hypertension Having Upper Gastrointestinal Bleeding

1997 ◽  
Vol 27 (1) ◽  
pp. 31-34
Author(s):  
S P Misra ◽  
M Dwivedi
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Gastric Varices ◽  
Oesophageal Varices ◽  
Endoscopic Sclerotherapy ◽  
Emergency Endoscopy ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal ◽  
Definite Role

During the last 4 years, 147 patients suffering from portal hypertension with acute upper gastrointestinal bleeding were subjected to emergency endoscopy soon after they were resuscitated. Seventeen (11.5%) patients were referred to us with a clinical diagnosis other than portal hypertension. The causes of bleeding as seen during endoscopy were: oesophageal varices ( n = 130; 88%), gastric varices ( n =11), gastric ulcer ( n = 2) portal hypertensive gastropathy ( n = 2) and erosive gastritis and duodenal ulcer in one patient each. All patient bleeding from oesophageal varices except one underwent emergency endoscopic sclerotherapy. One hundred and twenty-one (94%) stopped bleeding immediately. Rebleeding was seen in 11% and was effectively controlled by a second session of sclerotherapy in all but one patient. Twenty (14%) patients died. It is concluded that emergency endoscopy has a definite role in the management of patients with portal hypertension complicated by gastrointestinal bleeding.

scholarly journals Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

2012 ◽  
Vol 49 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Priscila Menezes Ferri ◽  
Alexandre Rodrigues Ferreira ◽  
Eleonora Druve Tavares Fagundes ◽  
Shinfay Maximilian Liu ◽  
Mariza Leitão Valadares Roquete ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Children And Adolescents ◽  
Portal Vein Thrombosis ◽  
Upper Gastrointestinal Bleeding ◽  
First Episode ◽  
High Morbidity ◽  
Vein Thrombosis ◽  
Upper Gastrointestinal

CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an appropriate diagnostic and treatment approach is desirable in an attempt to reduce morbidity and mortality.

scholarly journals Current Trends in Etiological Profile of Acute Upper Gastrointestinal Bleeding in Northern India: A Retrospective Analysis of 5-Year Endoscopic Data

2021 ◽  
Vol 12 (01) ◽  
pp. 031-035
Author(s):  
Vishal Bodh ◽  
Brij Sharma ◽  
Rajesh Kumar ◽  
Rajesh Sharma
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
The Other ◽  
Western India ◽  
Anastomotic Site ◽  
Care Hospital ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Etiological Spectrum ◽  
Upper Gastrointestinal

Abstract Introduction The etiological spectrum of acute upper gastrointestinal bleeding (AUGIB) varies from region to region. This study was performed to find out the latest etiological spectrum of the AUGIB in a tertiary care hospital in North India and to compare it with etiological spectra from a previous study from the same center and from the other regions of India. Methods Clinical notes and endoscopic data of all consecutive patients who had presented with AUGIB in Indira Gandhi Medical College Shimla, Himachal Pradesh, from May 2015 to December 2019, were analyzed retrospectively with the objective of finding out the various endoscopic etiologies that lead to AUGIB. The findings were compared with the previous study from the same center and with the data from the other regions of the country. Results A total of 1,513 patients were enrolled and majority were males (74.6%) with male:female ratio of 2.9:1. Majority were 41 to 60 years (46.46%) of age. Melena was the presenting complaint in 93.98% and hematemesis in 46.06%. Peptic ulcer disease (PUD; 46.19%) was the commonest cause of AUGIB followed by portal hypertension (26.23%). Other less common causes were erosive mucosal disease, erosive esophagitis, neoplasm, Mallory–Weiss tear, gastric angiodysplasia, anastomotic site ulcers, and Dieulafoy’s lesion. Conclusion PUD was still the commonest cause of AUGIB followed by portal hypertension. This is in agreement with the previous report from the same center and in contrast to the reports from other studies from Northern and Western India that create the impression that portal hypertension related bleeding is the most common cause of AUGIB in India.

scholarly journals Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

2021 ◽  
Vol 8 (2) ◽  
pp. 105-111
Author(s):  
Sunil Adhikari ◽  
Suraj Rijal ◽  
Darlene Rose House
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Clinical Presentation ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Clinical Profile ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

scholarly journals Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0177401 ◽  
Author(s):  
Matthias Buechter ◽  
Alisan Kahraman ◽  
Paul Manka ◽  
Guido Gerken ◽  
Alexander Dechêne ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal
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