Influence of esophageal flap valve on esophageal variceal bleeding

Abstract

Background and Aim: Increased exposure to gastric acid in patients with abnormal gastroesophageal flap valve (GEFV) may lead to increase esophageal variceal bleeding. We aimed to investigate the relationship between GEFV and esophageal variceal bleeding episodes. Methods: It is an interim analysis of a cross-sectional study involving 109 patients with esophageal varices and flap valve of any grade. Patients are divided into two groups on basis of Hill’s grade of flap valve (Hill’s grade 1,2-normal and Hill’s grade 3,4-abnormal). They are assessed with esophagogastroduodenoscopy and incidence of variceal bleeding and size of varices (Two groups: large{>5mm} and small {<5 mm} varices) are compared with Hill’s Grade of flap valve. Results: This study included 109 patients out of which 72 had normal and 37 had abnormal flap valve. Number of bleeding episodes was significantly higher in patients with esophageal varices who had abnormal flap valve compared to whom having normal flap valve (Mean number of bleeding episodes- 2.5 vs 1.1, p<0.001). Predominantly, patients with abnormal flap valve had larger varices while patients with normal flap valve had smaller varices (94.6% vs 73.6%, p<0.001). Conclusions: Abnormal GEFV is independent risk factor for esophageal variceal bleeding.