Abstract
Background and study aim: Endoscopic screening of all patients with liver cirrhosis add major burden to endoscopic units. Non-invasive detection of Oesophageal varices (OV) help to reduce the necessity of endoscopic screening.The aim of this work is to assess the diagnostic utility of blood ammonia level (BAL) as noninvasive predictor for presence of OV and evaluate its correlation with variceal size in cirrhotic patients. Patients and Methods: This prospective cross sectional study was conducted upon 100 cirrhotic patients who attended Hepatology, Gastroenterology and Infectious diseases department, Benha University Hospital. Fasting blood ammonia was measured and upper gastrointestinal endoscopy was done for all patients. Patients were divided according to presence of OV into two groups: Group I : included 30 patients with liver cirrhosis without OV. Group II: included 70 patients with liver cirrhosis with OV who were subdivided into four subgroups: Group IIa:included 11 patients with grade I O.V. Group IIb: included 21 patients with grade II O.V. Group IIc: included 15 patients with grade III O.V. Group IId: included 23 patients with grade IV O.V. Results: The study showed that there was a highly significant increase in the mean values of BAL in cirrhotic patients with varices in comparison to those without varices. Also the study showed highly significant increase in the mean values of BAL in patients with large OV (grade III,IV) in comparison to patients with small and medium sized varices (grade I,II). By multivariate analysis, the presence of O.V. was independently associated with increased blood ammonia levels. Conclusion: Blood ammonia level could be a non invasive predictor for the presence of OV and could be clinically useful, as it correlated with the size of OV.
Highlights
Liver cirrhosis is a leading cause of death worldwide
Portal hypertension is a progressive, inevitable sequelae of liver cirrhosis that leads to formation of portosystemic collateral veins, among them, oesophageal varices (OV) have the greatest clinical influence because their rupture results in variceal bleeding that can be fatal
Variables found to be associated with the dependent variable at univariate logistic regression at a probability threshold of less than 0.10 were entered into multivariate logistic regression models to avoid the effect of co linearity. This prospective study was conducted upon 100 adult cirrhotic patients who were classified into two groups; group 1 included 30 cirrhotic patients without esophageal varices and group 2 included 70 cirrhotic patients with esophageal varices
Summary
Liver cirrhosis is a leading cause of death worldwide It is the end result of a long-lasting process, usually clinically silent and unnoticed by the patient and the physician for years [1]. The clinical course of patients with advanced cirrhosis is often complicated by a number of important sequelae that can occur regardless of the underlying cause of the liver disease. These include portal hypertension and its consequences of gastroesophageal variceal hemorrhage [2]. Portal hypertension is a progressive, inevitable sequelae of liver cirrhosis that leads to formation of portosystemic collateral veins, among them, oesophageal varices (OV) have the greatest clinical influence because their rupture results in variceal bleeding that can be fatal. Non-invasive detection of Oesophageal varices (OV) help to reduce the necessity of endoscopic screening.The aim of this work is to assess the diagnostic utility of blood ammonia level (BAL) as noninvasive predictor for presence of OV and evaluate its correlation with variceal size in cirrhotic patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
