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

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

Reliability of Plasma Von Willebrand Factor Antigen in Prediction of Oesophageal Varices in Pediatric and Adolescent Patients with Portal Hypertension

Background Ruptured oesophageal varices (OVs) is a major cause of mortality in Portal hypertension (PHT) patients, It has been a great issue of interest and research to screen and early detect OVs via oesophageal varices non-invasive methods. Objective The aim of this study was to assess the reliability of measuring plasma von willibrand factor antigen (VWF-Ag) for prediction of the occurrence of oesophageal varices in patients with portal hypertension. Subjects & Methods This was a prospective cross-sectional study, done on 47 children with portal hypertension. The children were recruited from Pediatrics Hepatology clinic, Ain Shams University. Patient’s data was collected including age, sex, etiology and duration of PHT, along with medical treatment. Also an upper GIT endoscope, abdominal doppler ultrasound, and laboratory tests including measuring of plasma VWF-Ag were done to each patient. Then the children were divided based on their endoscopic findings into two groups; variceal group which included 37 patients, and a nonvariceal group which included 10 patients Results: The results of our study revealed an elevated plasma VWF-Ag in patients with oesophageal varices, whilst normal levels of plasma VWF-Ag in the non-variceal patients. In addition, there was a direct positive correlation between increased plasma VWF-Ag and the degree of oesophageal varices. Conclusion Since the plasma VWF-Ag level correlates with the presence and degree of OVs, it can be used as a noninvasive indicator of the presence and degree of OVs, However, further studies using larger sample might be needed to support this.

Gastroenterology

Disorders of the mouth and pharynx?, Dyspepsia, dysphagia and reflux, Upper GI bleeding, Oesophageal varices, Acute abdominal pain, Acute diarrhea, Persistent diarrhea, Compendium of diarrhea-causing pathogens, Travelers’ diarrhea, Food poisoning, Intestinal flukes, Schistosomiasis (bilharzia), Soil-transmitted helminths (STH), Toxocariasis, Perianal complaints, Acute pancreatitis, Biliary disease, Liver flukes, Liver disease, Viral hepatitis, Alcohol and drug-induced hepatitis, Chronic liver disease and cirrhosis, Portal hypertension, Liver failure, Amoebic liver disease, Liver cancer, Hydatid disease

Oesophageal Transection for Bleeding Varices: Case Report and Literature Review

Surgical oesophageal transection for uncontrolled variceal bleeding is a last resort measure that is rarely needed due to modern endoscopic advancements. Since it is infrequently required, most of the younger General Surgeons have not been exposed to this procedure. However, it remains a valuable consideration when endoscopic measures and balloon tamponade fail to control bleeding oesophageal varices and should remain in the armamentarium of the General Surgeon. Here we present a case of such a patient who underwent oesophageal transection as a life-saving procedure with satisfactory outcome, together with a brief literature review on this topic.

Diagnostic Accuracy of Multi-Detector Computed Tomography Esophagography in Grading of Esophageal Varices in Cirrhotic Patients

Objective: To assess the diagnostic accuracy of computed tomography esophagography in grading esophageal varices using upper gastrointestinal endoscopy as a gold standard. Study Design: Cross-sectional (validation) study Place and Duration of Study: Radiology department, Holy Family Hospital, Rawalpindi from 14th July 2016 to 13th January 2017. Methodology: One hundred and forty five clinically diagnosed patients of liver cirrhosis, age between 35-80 years were enrolled in this study. All patients underwent multi-detector computed tomography and endoscopy examination for the identification as well as grading of oesophageal varices. Results: High risk varices were identified in 106 (73.1%) of patients on multi-detector computed tomography and were identified in 108 (74.5%) of patients on endoscopy. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of multi-detector computed tomography forthe identification of high risk esophageal varices were found to be 94.4%, 89.2%, 84.6%, 96.2% and 93.1% respectively. Conclusion: Multi-detector computed tomography esophagography detected high risk esophageal varices with excellent accuracy. This could be a practical and non-invasive choice of imaging for the identification& grading of esophageal varices. Key words: Esophageal varices, Multi-detector computed tomography (MDCT), Endoscopy

Study of the correlation of oesophageal varices with portal vein diameter and ratio of platelet count to splenic diameter and their comparative evaluation in liver cirrhosis

Background: The aim of the study was to determine the correlation of oesophageal varices (OV) with portal vein diameter and the platelet count to splenic diameter ratio and their comparative evaluation in patients of liver cirrhosis.Methods:The present study consisted of 50 patients diagnosed with liver cirrhosis. Necessary investigations were performed in all the patients including Upper gastrointestinal (GI) endoscopy. Platelet count/spleen diameter ratio, spleen diameter and portal vein diameter were calculated for all patients and the presence and grading of OV was then comparatively evaluated. The results were systematically recorded and statistically analysed.Results: The mean age of patients was 49.82±10.23 years. 78% of patients presented with OV. The portal vein diameter, platelet count, spleen diameter and platelet count/spleen diameter ratio were significantly increased in patients with OV than those without OV (p<0.0001). Highly significant positive correlation between portal vein diameter, spleen diameter and grading of OV was seen. Platelet count/spleen diameter ratio and platelet count was significantly decreased as the grade of OV increased in the patients. There was statistically, a highly significant negative correlation between them.Conclusions: The non-invasive parameters used to detect presence of OV in liver cirrhosis were portal vein diameter and platelet count/spleen diameter ratio. Though, both seemed to be effective in predicting OV, platelet count/spleen diameter ratio proved to be slightly more significant when compared to the other.

ENDOSCOPIC FINDINGS IN PATIENTS PRESENTING WITH DYSPHAGIA

INTRODUCTION: Dysphagia is a condition in which disruption of swallowing process interferes with patient ability to eat due various causes. Endoscopy is the mainstay of diagnostic workup of these patients and subsequent treatment. AIM: The objective of the study was to determine the frequency of various types of endoscopic ndings in patients with dysphagia. METHODS: Cross-section descriptive study carried out in DDHD, KMC, Chennai, a tertiary care hospital from November 2018 to May 2019. Duration of symptoms was noted and all patients underwent upper gastrointestinal endoscopy to nd out the cause of dysphagia. Tissue biopsies were obtained and further histopathological examination was performed to correlate the ndings with symptoms of dysphagia. RESULTS: A total of 197 patients presenting with dysphagia were studied, 93 (47%) were males and 104 (53%) were females. The mean age was 55 ± 8 years. Oesophageal malignancy was the most common nding noted in 54(27%) patients. It was followed by post cricoid web in 24 (12%), benign stricture oesophagus 21(10%), cricopharngeal malignancy in 14(7%), anastomatic stricture 14(7%), normal UGI in 12(6%), post RT stricture in 11(5%), peptic stricture in 8(4%), hypopharynx malignancy in 8(4%), OGJ growth in 8(4%), corrosive stricture in 7(4%), patients and reux esophagitis in 5 (2.9%) patients, oesophageal candidiasis in 5(2.9%), achalasia in 4(2%) ,pyriform fossa malignancy in 3(1.5%),oesophageal web in 3(1.5%), one patient each in Schatzki's ring, pill esophagitis, oesophageal varices, oesophageal diverticula(0.5 %). CONCLUSION: Malignancies and malignancy related conditions are more common cause of dysphagia in our set of population. Patient presenting with dysphagia, endoscopy is initial and better choice of investigation unless contraindicated