Abstract
Background: Oesophageal varices (OV) have the greatest clinical impact. Upper endoscopy is the gold standard for OV diagnosis, despite its own limitations. Non-invasive detection of OV promises to decrease the necessity of endoscopic screening. Objectives: To assess blood ammonia level, spleen longitudinal (SLD), portal vein (PVD), splenic vein (SVD) diameters, platelets count and platelets/SLD ratio to evaluate their predictive accuracy as non-invasive indicators for the presence of OV and their correlation with variceal size. Patients and methods: This was a prospective study. Sixty cirrhotic patients were screened using upper endoscopy (for the presence and size of OV) and abdominal ultrasonography (for measurement of PVD, SVD, SLD). Fasting blood ammonia level, platelets / SLD ratio were measured. Results: Blood ammonia, PVD, SVD and SLD were significantly higher in patients with OV than those without (P < 0.001 for all). Using area under receiver operating characteristic curve (AUC), these parameters were good predictors for the presence of OV where, PVD had the highest AUC (I.00) followed by blood ammonia (AUC 0.99). Blood ammonia level correlated with variceal size (rho = 0.442, P = 0.002). Conclusion: Blood ammonia, PVD, SVD and SLD were good non-invasive predictors for OV presence with the superiority of PVD and ammonia. Blood ammonia level could be clinically useful, as it correlated with the size of OV so, pinpoint those patients requiring closer follow-up and endoscopic screening.
Highlights
Oesophageal varices (OV), formed as a result of portal hypertension, have a great clinical impact due their severe complications [1]
Blood ammonia, portal vein diameter (PVD), SVD and spleen longitudinal (SLD) were significantly higher in patients with OV than those without (P < 0.001 for all)
Blood ammonia level correlated with variceal size
Summary
Oesophageal varices (OV), formed as a result of portal hypertension, have a great clinical impact due their severe complications [1]. While they are found in approximately 50% in cirrhosis, they are developed at a rate of 8% per year in patients without varices. The progression from small to large varices occurs in 10 to 20% of cases yearly and their presence correlates with the severity of liver disease [2]. The American association for the study of liver disease single topic symposium stated that cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed [5]. Non-invasive detection of OV promises to decrease the necessity of endoscopic screening
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