scholarly journals Primary prevention of bleeding esophageal varices in patients with liver cirrhosis

2020 ◽  
pp. 56-61
Author(s):  
N. N. Smagina
Keyword(s):  
Liver Cirrhosis ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Beta Blockers ◽  
Control Group ◽  
Endoscopic Screening ◽  
Basic Group ◽  
Drug Of Choice ◽  
Bleeding Esophageal Varices ◽  
Observation Period

Objective: to evaluate the effectiveness of the application of beta-blockers for primary prevention of bleeding esophageal varices in patients with liver cirrhosis. Material and methods. A retrospective study included 46 patients with liver cirrhosis of various etiology having II-III stage esophageal varices. All the patients were divided into two equal groups. The basic group was made up of 23 (50 %) patients who were prescribed beta-blockers at recommended dosages continuously over the observation period from 2009 till 2018 for the purpose of primary prevention of bleeding esophageal varices. The control group included 23 (50 %) patients with liver cirrhosis in whom the primary prevention of the bleedings was not performed. Results. The assessment of the effectiveness of beta-blockers was performed with two indicators: the frequency of bleeding esophageal varices and their mortality. The application of beta-blockers made it possible to reduce the bleeding frequency from 34.8 % to 13 % (р = 0.10) and the mortality from 21.7 % to 0 % (р = 0.02). Conclusion. In order to detect early stages of esophageal varices, endoscopic screening should be performed for all patients with liver cirrhosis. The presence of II-III stage esophageal varices requires primary prevention of the bleedings. The drug-of-choice are non-selective beta-blockers. Timely and adequately prevention reduces the risk of the bleedings and their mortality.

scholarly journals The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Daniel W. Gunda ◽  
Semvua B. Kilonzo ◽  
Zakhia Mamballah ◽  
Paulina M. Manyiri ◽  
David C. Majinge ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Clinical Laboratory ◽  
Cross Sectional Study ◽  
Endoscopic Examination ◽  
Clinical Predictors ◽  
Endoscopic Screening ◽  
Cross Sectional ◽  
Northwestern Tanzania ◽  
Cirrhotic Patients

Abstract Background Bleeding esophageal varices is a deadly complication of liver cirrhosis. Guidelines recommend an early diagnosis of esophageal varices before incident bleeding by screening all patients diagnosed with liver cirrhosis. Though it has been reported elsewhere that the presence of esophageal varices varies widely among cirrhotic patients this has not been assessed in Tanzania since endoscopy is not readily available for routine use in our setting. This study was designed to determine the prevalence of esophageal varices and assess the utility of clinical parameters in predicting the presence of varices among cirrhotic patients in northwestern Tanzania. Methods A cross-sectional analysis of adult patients with liver cirrhosis was done at Bugando Medical Centre. Demographic, clinical, laboratory and endoscopic data were collected and analyzed using STATA 13. The presence of esophageal varices was detected using endoscopic examination and associated factors were assessed by logistic regression. The predictive value of clinical predictors was also assessed by calculating sensitivity and specificity. Results A total of 223 patients were enrolled, where 88 (39.5%; 95%CI: 33.0–45.9) had esophageal varices. The varices were independently associated with increased age (OR: 1.02; 95%CI: 1.0–1.04; p = 0.030); increased splenic diameter (OR:1.3; 95%CI:1.2–1.5; p <  0.001), increased portal vein diameter (OR:1.2; 95%CI: 1.07–1.4; p = 0.003), having ascites (OR: 3.0; 95%CI: 1.01–8.7; p = 0.046), and advanced liver disease (OR: 2.9; 95%CI: 1.3–6.7; p = 0.008). PSDR least performed in predicting varices, (AUC: 0.382; 95%CI: 0.304–0.459; cutoff: < 640; Sensitivity: 58.0%; 95%CI: 46.9–68.4; specificity: 57.0%; 95%CI: 48.2–65.5). SPD had better prediction; (AUC: 0.713; 95%CI: 0.646–0.781; cut off: > 15.2 cm; sensitivity: 65.9%; (95% CI: 55–75.7 and specificity:65.2%; 95%CI: 56.5–73.2), followed by PVD, (AUC: 0.6392; 95%CI: 0.566–0.712;cutoff: > 1.45 cm; sensitivity: 62.5%; 95CI: 51.5–72.6; specificity: 61.5%; 95%CI: 52.7–69.7). Conclusion Esophageal varices were prevalent among cirrhotic patients, most of which were at risk of bleeding. The non-invasive prediction of varices was not strong enough to replace endoscopic diagnosis. However, the predictors in this study can potentially assist in the selection of patients at high risk of having varices and prioritize them for endoscopic screening and appropriate management.

Principles of primary prophylaxis of bleeding from oesophagealvaricies in patients with liver cirrhosis

2016 ◽  
Vol 94 (7) ◽  
pp. 503-509
Author(s):  
Dmitry V. Garbuzenko
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Primary Prevention ◽  
Esophageal Varices ◽  
Retrieval System ◽  
Primary Prophylaxis ◽  
Inclusion Criteria ◽  
Cochrane Reviews ◽  
Pubmed Database ◽  
Endoscopic Ligation

The principles of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis are discussed with reference to the stage ofportal hypertension. The information was collectedfrom the PubMed database, Google Scholar retrieval system, Cochrane reviews, and lists of references from relevant publications for 1980-2015 using the key words «bleeding from esophageal varices», «prophylaxis», «portal hypertension». Inclusion criteria were confined to primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis. The analysis showed that the drugs of choice for primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis are non-selective beta-adrenoblockers, but their application is indicated only in case of clinicallyl significant portal hypertension in patients with large and mediumsize esophageal varices. When the use of these drugs is contraindicated, endoscopic ligation of esophageal varices can be recommended.

scholarly journals Role of portal color Doppler ultrasonography as noninvasive predictive tool for esophageal varices in cirrhotic patients

2022 ◽  
Vol 53 (1) ◽  
Author(s):  
Mohamed Alaa ELdin Nouh ◽  
Mohamed Kamel Abd-Elmageed ◽  
Amany Abas Mohamed Amer ◽  
Moamena Said ELhamouly
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Esophageal Varices ◽  
Resistance Index ◽  
Cirrhotic Liver ◽  
Control Group ◽  
Predictive Tool ◽  
Endoscopic Screening ◽  
Cirrhotic Patients

Abstract Background Esophageal varices (EV) is the most common apprehensive complication of portal hypertension in patients with cirrhotic liver. Guidelines recommend Upper gastro-intestinal endoscopic screening for EV in patients with newly diagnosed chronic cirrhosis (Imperiale et al. in Hepatology 45(4):870–878, 2007). Yet, it is invasive, time consuming and costly. To avoid unnecessary endoscopy, some studies have suggested Doppler ultrasound examination as simple, and noninvasive tool in prediction and assessment of severity of EV (Agha et al. in Dig Dis Sci 54(3):654–660, 2009). Our study was to assess the role of different Doppler indices of portal vein, hepatic and splenic arteries as a noninvasive tool for prediction of esophageal varices in cirrhotic patients. Results This prospective case control study was conducted on 100 cirrhotic liver patients and 100 of healthy volunteers as control group. Patients were subjected to clinical examination, upper gastrointestinal tract endoscopy, abdominal ultrasonography with duplex Doppler evaluation of different portal Doppler hemodynamic indices were done for each patient. The results revealed that portal vein diameter, hepatic artery pulsatility index, portal hypertensive index, portal vein flow velocity, portal congestion index have high sensitivity for prediction of EV. However, Splenic artery resistance index, hepatic artery resistance index HARI, liver vascular index and platelet count/spleen diameter have less sensitivity for prediction of EV. Conclusion Measuring the portal hemodynamic indices can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening especially when endoscopic facilities are limited.

scholarly journals Action of the Triglycyl Hormonogen of Vasopressin (Glypressin) in Patients With Liver Cirrhosis and Bleeding Esophageal Varices

1977 ◽  
Vol 72 (4) ◽  
pp. 605-609 ◽  
Author(s):  
Jiří Vosmík ◽  
Karel Jedlička ◽  
Jan L. Mulder ◽  
Joseph H. Cort
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Bleeding Esophageal Varices

scholarly journals Correlation between Platelet Count vs Spleen Bipolar Diameter Ratio and Esophageal Varices in Liver Cirrhosis

2018 ◽  
Vol 8 (2) ◽  
pp. 159-166
Author(s):  
Md Mahfuzzaman ◽  
Md Nazmul Hoque ◽  
Shireen Ahmed ◽  
Tareq Mahmud Bhuiyan
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Complete Blood Count ◽  
Diameter Ratio ◽  
Noninvasive Methods ◽  
Endoscopic Screening ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Cirrhosis Of Liver

Background: Esophageal variceal bleeding is a potentially fatal complication in patients with liver cirrhosis and portal hypertension. In cirrhotic patients, endoscopic screening for esophageal varices (EV)is currently recommended at the time of diagnosis. The present study intends to find out correlation between platelet countspleen bipolar diameter ratio and esophageal varices in liver cirrhosis and prospectively validate its use for the noninvasive diagnosis of EV.Methods: This observational study was done at theDepartment of Gastrointestinal Hepatobiliary and Pancreatic Disorder, BIRDEM General Hospital, Dhaka, during the period of November, 2013 to October, 2014. A total 64 patients with cirrhosis of liver were included. Complete blood count, liver function tests, ultrasonographyof whole abdomenand endoscopy of upper gastro-intestinal tract (GIT)were done in all patients. Statistical analysis was done with SPSS version 16.Results: Among 64 study population EV were detected in 54 patients (84.4%). The platelet count/ spleen bipolar diameter ratio was significantly higher without EV compared with those with EV(1570 ± 493) and (688 ± 227), respectively; (p<0.001).Patients with EV had lower platelet counts (86799.84 ±27389.99/mm3, p<0.001), higher bipolar spleen diameters (127.94±15.14 mm, p<0.001) and lower platelet count/ spleen bipolar diameter ratios (688.79 ±227.13, p<0.001). In this analysis, by applying (ROC)curve the platelet count-spleen bipolar diameter ratio at a cut-of 908.5 maintained high sensitivity (100 %), Robust negative predictive value NPV (100%),specificity (55.6%) and PPV (85.4%), with an overall diagnostic accuracy of 87.50% for the prediction of EV.With advancing Child-Pugh (C-P) class the percentage of patients with varices increased, 33.3% in C-P class A, 85.7% in C-P class B and 91.6% in C-P class C. The presence of EVcorrelated significantly with the severity of liver cirrhosis (p = 0.03) as measured by Child-Pugh score.Conclusion: The identification of non-endoscopic, noninvasive methods that can accurately predict esophageal varicesin cirrhosis of liver has been addressed in several recent studies. This study was yet another attempt to achieve this goal. Predicting the presence of EV by noninvasive means would restrict the performance of endoscopy and reducing the number of unpleasant screening endoscopiesBirdem Med J 2018; 8(2): 159-166

Sclerotherapy of esophageal varices in hemophilia patients with liver cirrhosis – a prospective, controlled clinical study

2018 ◽  
Vol 90 (1) ◽  
pp. 29-34
Author(s):  
Andrzej B. Szczepanik ◽  
Konrad Pielaciński ◽  
Anna M. Oses-Szczepanik ◽  
Sławomir Huszcza ◽  
Andrzej Misiak ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Hemophilia A ◽  
Secondary Prophylaxis ◽  
Severe Form ◽  
Control Group ◽  
Endoscopic Sclerotherapy ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding

Introduction: Bleeding from esophageal varices is a serious clinical condition in hemophilia patients due to congenital deficiency or lack of clotting factors VIII (in hemophilia A) and IX (in hemophilia B), decreased clotting factor II, VII, IX, X synthesis in the course of chronic liver disease and hipersplenic thrombocytopenia. The aim of this study was to assess the efficacy and safety of endoscopic sclerotherapy in acute esophageal variceal bleeding and in secondary prophylaxis of hemorrhage. The aim was also to investigate the optimal activity of deficiency factors VIII or IX and duration of replacement therapy required to ensure proper hemostasis after sclerotherapy procedures. Material and methods: 22 hemophilia patients (A-19, B-4) with coexistent liver cirrhosis and active esophageal variceal bleeding treated with endoscopic sclerotherapy were subjected to prospective analysis. The patients who survived were qualified to repeated sclerotherapy procedures every 3 weeks within secondary prophylaxis of bleeding (investigated group). A 3-day substitution therapy enhanced the infusion of the deficient or lacking factor in doses allowing to reach 80-100% of normal value activity of factor VIII on the 1st day and 60-80% in the next two days. The desired activity of factor IX was 60- 80% and 40-60% respectively. The control group consisted of 20 non-hemophiliac patients with liver cirrhosis comparable in terms of age, sex, stage of advancement of liver cirrhosis, who underwent the same medical proceedings as the investigated group. Results: Active esophageal bleeding was stopped in 21 of 22 (95%) hemophilia patients. Complications were observed in 3 patients; 2 patients died. The rate of hemostasis, complications and deaths in the control group were comparable and no statistical differences were found. In hemophilia patients subjected to secondary prophylaxis of hemorrhage, in 18 of 20 (80%), complete eradication of esophageal varices was achieved after 4 to 7 sclerotherapy procedures in 1 patient (average 5.4). Recurrent bleeding was observed in 15% of patients, complication in 20%; 1 patient died. Time lapse from bleeding to eradication was 12-21 weeks (average 15.2). In the control group the rate of variceal eradication, complication and deaths was comparable and no statistical differences were found. The usage of factor VIII concentrates was as follows: in hemophilia A, in a severe form - 80.9 U/kg b.w./day, in hemophilia A in a severe form with an inhibitor <5 BU – 95.2 U/kg b.w./day, in mild form – 64.2 U/kg b.w./day and in severe hemophilia B – 91.6 U/kg b.w./day. Conclusions: Sclerotherapy is an effective method in the management of esophageal variceal bleeding in hemophilia patients. It is also effective for total eradication of varices when applied as a secondary prophylaxis of hemorrhage. In our opinion, a 3-day replacement therapy at the applied doses is sufficient to ensure hemostasis and avoid bleeding complications.

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