Esophageal Varices In Patients Research Articles

Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices in Patients With Chronic Liver Disease

Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices in Patients With Chronic Liver Disease

Tissue inhibitor of matrix metalloprotinase-1 and collagen type IV in HCV-associated cirrhosis and grading of esophageal varices

BackgroundEsophageal varices are abnormally dilated submucosal veins of the esophagus which develop as a result of portal hypertension due to cirrhosis. Collagen type IV is upregulated with a 14-fold increase in cirrhosis. Tissue inhibitor of metalloproteinases-1 (TIMP-1) is also upregulated during hepatic fibrogenesis and considered to promote fibrosis in the injured liver. The objective of this research was to study the serum levels of tissue inhibitor of matrix metalloprotinase-1 and serum collagen type IV in patients with post hepatitis C cirrhosis and their relation to the different grades of esophageal varices.Patients and methodsThis study was carried out on one hundred and twenty individuals classified into three groups: Group I included thirty patients with liver cirrhosis without esophageal varices. Group II included sixty patients with liver cirrhosis with esophageal varices. Group III included thirty healthy volunteers as controls.ResultsA significant positive correlation was found between collagen type IV and the presence of esophageal varices in esophageal varices group (p = 0001*). Also, a significant positive correlation was found between TIMP-1 and the presence of esophageal varices in esophageal varices group (p = 0.033*). After conducting multivariate logistic regression analysis, collagen type IV and INR were found to be independent risk factors for esophageal varices in patients with cirrhosis.ConclusionThe serum collagen type IV and TIMP-1 levels are useful markers for predicting of presence of esophageal varices.

Studying the effects of stress, mental health and psychological well‐being on wound healing rates after oesophageal varices ligation in liver cirrhosis patients

AbstractIt is of utmost importance to comprehend the impact that psychological factors have on physical rehabilitation, specifically in regards to wound healing following ligation of oesophageal varices in patients with liver cirrhosis. The present study investigated the correlation between wound recovery rates and psychological well‐being, stress and mental health. From January 2022 to September 2023, 148 patients from were evaluated as part of this cross‐sectional observational study. The psychological well‐being of participants was evaluated utilizing the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS) and Psychological General Well‐Being Index (PGWBI). The rates of wound recovery were assessed following ligation. The mean duration for wound recovery was 28.37 ± 9.65 days. The mean wounds healing time of patients who obtained higher PSS scores (18.55) was marginally longer. On the contrary, there was a moderate reduction in healing time associated with higher HADS scores (mean 14.10). On average (68.88), PGWBI scores indicated a negligible effect on wound healing. The variance in healing durations between Child‐Pugh classifications A, B and C (mean values of 28.65, 26.90 and 29.57 days respectively) suggested that the severity of liver disease has an impact. As a result of ligation of oesophageal varices, the study demonstrated that psychological factors and wound recovery in patients with liver cirrhosis are intricately intertwined. There seems to be the substantial and intricate relationship between stress, mental health and wound recovery. The results of this study supported the notion that psychological evaluation and support should be incorporated into the management of patients with liver cirrhosis.

Utility of P²MS Index in Predicting Esophageal Varices in Patients with Hepatitis C Associated Chronic Liver Disease in Pakistani Population

Background: Screening for esophageal varices (EVs) in patients with chronic liver disease is critical for identifying those needing primary prophylaxis against variceal bleeding. The gold standard for EV screening is endoscopy, an invasive and costly procedure often avoided by patients. This necessitates the need for non-invasive predictive tools for the presence of EVs and high-risk varices (HRVs). The P²MS index, a relatively new model, has shown promise in this regard. Objective: This study aimed to evaluate the effectiveness of the P²MS index, alongside APRI and FIB-4 scores, in predicting the presence of EVs and HRVs in patients with hepatitis C-related chronic liver disease. Methods: Conducted at the Sindh Institute of Urology and Transplantation's Hepato-Gastroenterology department, this cross-sectional study involved 375 participants aged 18-50 years, recently diagnosed with liver cirrhosis due to hepatitis C. Excluding those with varied medical backgrounds, the study used non-probability consecutive sampling. Diagnostic procedures included esophagogastroduodenoscopy (EGD) and complete blood count. P²MS index, APRI, and FIB-4 scores were calculated for each participant. Data analysis was performed using SPSS version 25.0, focusing on the Area Under the Receiver Operating Curve (AUROC) to assess diagnostic accuracy. Results: In our population, the P²MS index at a cutoff of <10.7 showed a specificity of 93.22% and sensitivity of 87.88% for predicting the presence of EVs, with a PPV and diagnostic accuracy exceeding 90%. For HRVs, a cutoff of <5.4 demonstrated an excellent NPV, alongside good sensitivity, specificity, and diagnostic accuracy. Compared to APRI and FIB-4, the P²MS index had the highest AUROC for predicting the presence of EVs (0.92, 95% CI 0.89-0.95, p<0.001). For HRVs, it was comparable to APRI (AUROC=0.88, 95% CI 0.85-0.92, p<0.01) and superior to FIB-4. Conclusion: The P²MS index is an effective non-invasive tool for screening EVs in patients with hepatitis C-related chronic liver disease, demonstrating high accuracy for predicting the presence of EVs. However, its efficacy in predicting HRVs is comparable to other non-invasive indices and warrants further validation.

Abdominal Ultrasonography and Splenoportal Doppler Study for Predicting Oesophageal Varices in Patients Admitted with Chronic Liver Disease at a Tertiary Medical Hospital in Kolkata, India: A Cross-sectional Study

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey’s Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease.

Exploring new noninvasive parameters to predict oesophageal varices in patients with NAFLD-associated compensated liver cirrhosis

Exploring new noninvasive parameters to predict oesophageal varices in patients with NAFLD-associated compensated liver cirrhosis

Screening of Esophageal Varices in Patients With Fontan Palliation

Screening of Esophageal Varices in Patients With Fontan Palliation

Prediction of Severe Esophageal Varices in Patients With Cirrhosis Based on Levitt's CO Breath Test: A Proof of Concept Study.

This study investigated the feasibility of using erythrocyte (RBC) lifespan determined by Levitt's CO breath test (LCOBT) to predict esophageal varices needing treatment (VNT) in patients with cirrhosis. Esophageal varix bleeding is a common fatal complication of cirrhosis and portal hypertension. The gold standard for identifying VNT is esophagogastroduodenoscopy (EGD), an invasive procedure with low patient compliance. VNT screening based on Baveno VI criteria has mediocre specificity. RBC lifespan was determined by LCOBT in 53 cirrhotic patients (13 without varices, 11 mild/moderate varices, and 29 severe varices). Correlation of varix severity with RBC lifespan and other variables was analyzed. Rates of shortened RBC lifespan and thrombocytopenia (Baveno VI criteria) were compared. RBC lifespan correlated inversely with severity of varices (r=-0.793, P<0.001). Mean RBC lifespans were 129±31, 96±21, and 59±21 days for Nonvarix, Mild/Moderate, and Severe groups. Shortened RBC lifespan (<75d) was observed in 79.3% (23/29) of patients with severe varices, a frequency similar or identical to thrombocytopenia rates [original Baveno VI criteria, 86.2% (25/29), P=0.487; expanded criteria, 79.3% (23/29), P>0.999]. Among 24 patients without severe varices, shortened RBC lifespan was observed in 1 patient whereas thrombocytopenia was detected in 13 and 8 patients based on the original (P<0.001) and expanded criteria (P=0.010), respectively. RBC lifespan correlates inversely with varix severity in patients with cirrhosis. LCOBT may enable specific screening for VNT.

Serum Kallistatin Level as a Predictor of Esophageal Varices in Patients of Liver Cirrhosis

Abstract Background Esophageal varices are porto-systemic collaterals resulting from portal hypertension, and considered the most lethal complication of liver cirrhosis so early diagnosis of varices can improve prognosis of liver cirrhosis. Kallistatin a tissue kallikrein-binding protein and a serine proteinase inhibitor (serpin) is mainly formed and secreted in liver and its serum level diminished in liver cirrhosis. It has anti-angiogenic, anti-oxidant, anti-inflammatory and anti-tumor effects. Kallistatin level is believed by many literature to be related to the severity of liver disease. Aim of the Work The aim of this study was to assess the relation between serum kallistatin level and presence of OVs. This study also aimed to evaluate serum kallistatin level as a non-invasive predictor of OVs. Patients and Methods This study was conducted in the Gastro-enterology unit, Internal medicine department, Ain Shams University hospitals &amp;Theodor Bilharz Institute. This is a case control study including 60 cirrhotic patients and 20 healthy. Results There was no significant differences between the studied groups regarding demographic data. There was no significant differences between the studied groups as regards Hb, WBCs, ALT, AST, creatinine and, urea but there was highly significant differences between cirrhotic groups and healthy group in the means of platelet count, serum albumin, serum sodium, total and direct bilirubin but no significant difference between groups I and II. Regarding to prothrombin time, there was highly significant differences between the 3 groups as it was higher in group I more than II more than III. There was also no significant difference between the cirrhotic groups regarding to Child Pugh score, MELD score and portal hypertensive gastropathy (PHG). There were significant differences between the 3 studied groups regarding to the means of splenic diameter and portal vein diameter. Kallistatin level showed significant decrease in both patients with OVs and patients without OVs vs. healthy individuals and there was highly significant difference between patients with OVs and patients without OVs. The level of Kallistatin concentration is not correlated with size of varices or risky signs suggesting that Kallistatin level can predict presence of O.V but it can’t reflect the size and severity of varices. There was no significant correlation between serum level of Kallistatin and age, gender and smoking. There was positive correlation to hemoglobin, platelet count, albumin level and negative correlation with PT, INR and urea. There was positive correlation to portal hypertensive gastropathy (PHG) and negative correlation with MELD score and portal vein diameter. Conclusion Serum level of Kallistatin level may express the degree of liver dysfunction. It is correlated with presence of O.V but not correlate to size or risky signs of OVs suggesting that Kallistatin level can’t reflect the presence of O.V. It can predict the presence of severe PHG.

Predicting the Severity of Esophageal Varices in Patients with Hepatic Cirrhosis Using Non-Invasive Markers.

The presence and extent of severity of esophageal varices (EV) in patients with liver cirrhosis (LC) are predicted using noninvasive clinical, biochemical, and imaging parameters. The aim of this study was to investigate the accuracy of noninvasive predictors of EV, such as the platelet count-to-spleen diameter ratio (PSR), platelet count-to-spleen volume ratio (PSVR), spleen size (SZ), and a combination of these markers in determining the severity of EV in patients with cirrhosis. We recruited 82 inpatients with LC from the Department of Gastroenterology at the First Affiliated Hospital of Guangxi Medical University between January 2018 and December 2019 for this diagnostic investigation. All patients underwent endoscopy, ultrasound, computed tomography, and routine laboratory investigations. For the study, we evaluated and compared the diagnostic accuracy of PSR, PSVR, SZ, and their combinations. There were significant differences in the area under the receiver operating characteristic (ROC) curve (AUC) in the prediction of severe and moderate/severe EV for all the variables. PSR+PSVR had the highest AUC at 0.735 (95% CI: 0.626-0.826) and 0.765 (95% CI: 0.659-0.852) for predicting severe and moderate/severe EV, respectively. There were statistically significant differences in the AUCs (95% CI) for PSR, PSVR, and PSR+PSVR in predicting the existence of EV. As per the overall model quality chart, the combination of PSR+PSVR was the best indicator for detecting the presence of EV (AUC, 0.696; 95% CI: 0.584-0.792). In our study, we found that these noninvasive parameters could predict the extent of severity of EV in patients with LC. We anticipate the use of a combination of PSR + PSVR to emerge as the superior indicator as studies progress.

Association Between Platelet Count and Grading of Esophageal Varices in Patients with Liver Cirrhosis

Background: Upper GI endoscopy is the gold standard technique for diagnosing esophageal varices and to assess the risk of bleeding but is invasive in nature, costly, time consuming and burden for the department. Besides this platelet count is also an important tool to predict the esophageal varices in cirrhotic patient and it is a highly accurate test. it has been noted that platelet count in cirrhotic patients with esophageal varices, is less than 100,000/cmm but very few of the data is available so the aim of the current study was to find out the association between mean platelet count and grading of esophageal varices in patients with liver cirrhosis. Methods: A descriptive cross-sectional study was conducted at the medicine department of Jinnah Postgraduate Medical Center (JPMC), Karachi. For testing platelet count the blood sample was sent to the pathology laboratory of the hospital. Gastroenterologist performed the upper gastrointestinal endoscopy to grade the esophageal varices. Data was analyzed by using the Statistical Package for Social Science (SPSS) version-20. ANOVA with Post-Hoc Tuckey test was applied to find out the correlation between the variables. p-value less than 0.05 was considered as significant. Results: The mean age of the study participants was 34.9±8.6 years. Majority of the study participants were male (61.1%) as compared to their counterparts. The mean platelet count among the study participants was 113,200±29000 /u L majority of cirrhotic patients included in the study were having grade III of esophageal varices (39.5%). It has been noted that mean platelet count decreased with increasing grade of esophageal varices and the association was significant. Cirrhotic patients having Grade I esophageal varices were having near normal mean platelet count but those who were in Grade V of esophageal varices, having markedly decreased platelet count as compared to Grade I, II, III and IV. Conclusion: It can be concluded that the mean platelet count is significantly inverse association with the grading of esophageal varices, as low as the platelet count, worst the esophageal varices in patients with liver cirrhosis. So testing mean platelet count can be used for screening purpose of esophageal varices as it is a cost effective test. Keywords: Cirrhosis, Esophageal varices, Mean Platelet count,

WED-260 - RESIST criteria accurately rule-out high-risk esophageal varices in patients with primary biliary cholangitis and compensated advanced chronic liver disease

WED-260 - RESIST criteria accurately rule-out high-risk esophageal varices in patients with primary biliary cholangitis and compensated advanced chronic liver disease

Prediction of esophageal varices in patients with hepatitis B-associated liver cirrhosis by non-invasive markers

AimsTo assess the non-invasive markers for diagnosing and grading esophageal varices(EV) in hepatitis B-associated liver cirrhosis by non-invasive method. MethodsA total of 209 treatment-naive patients with hepatitis B-associated liver cirrhosis were included in this study. These patients were divided into no EV, large grade EV and any grade EV groups according to electronic gastroscope (EGD) results. Blood tests, physical examination, and abdominal ultrasound scan (USS) were measured. The non-invasive indexes for predicting esophageal varices were screened, and non conditional logistic regression model was established. Performance was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). ResultsIn the 209 patients, 155 (74.2%) EV and 106(50.7%) large EV were found. There were significant differences in spleen-length (SL), portal vein diameter (PVD), platelet blood cell (PLT) and white blood cell (WBC) between patients with any grade or large and without EV by univariate analysis. The logistic regression model was Y=-2.083-0.011∗PLT+0.101∗PVD+0.013∗SL with any grade EV, the prediction formula is Y= ​0.427-0.013∗PLT -0.861∗WBC+0.008∗SL with large EV. ConclusionsSpleen-length, portal vein diameter, platelet and white blood cell can predict esophageal varices and large esophageal varices in hepatitis B-associated liver cirrhosis.

Prediction of Esophageal Varices by Non-Invasive Markers in Patients of Hepatic Cirrhosis due To Chronic Hepatitis C

Background: Esophageal varices develop as a consequence of portal hypertension in patients with chronic liver disease. Predicting the varices by non-invasive methods at the time of registration is likely to predict the need for prophylactic β blockers or endoscopic variceal ligation in patients with cirrhosis and portal hypertension. Objective: To evaluate the accuracy of combined non-invasive parameters in predicting the presence of esophageal varices in patients with hepatic cirrhosis due to chronic hepatitis C, using the positive predictive value (PPV) as a measure of performance. Methods: In this cross-sectional study conducted in the Department of Medicine, Unit-I, Sir Ganga Ram Hospital, Lahore, 125 patients fulfilling the inclusion criteria were included. Platelet count, Prothrombin Time/International Normalized Ratio (PT/INR) and portal vein diameter was assessed. Upper gastrointestinal endoscopy was done in all patients to check the presence or absence of esophageal varices. Results: Mean age of the patients was 52.52±8.39 years with 64% males. Mean PT was 10.09±3.13, mean INR was 1.75±0.22, mean platelet count was 83.56±13.47 while mean portal vein diameter was 13.79±0.84. In 61 patients (48.8%) esophageal varices were present on endoscopy and in 85 patients (68%) esophageal varices were predicted by combined non-invasive parameters. Positive predictive value of combined non-invasive parameters was 71.7%. Practical implications: Noninvasive predictors can be used as a screening tool to decide need for preventive drug therapy in esophageal varices and thus help reduce the workload and financial burden of routine endoscopies in all cirrhosis patients. Conclusion: The results suggest that combined non-invasive parameters may be a useful tool in the prediction of esophageal varices in patients with hepatic cirrhosis Keywords: Esophageal varices, Non-invasive predictors, Portal hypertension

Correlation between serum ascites albumin gradient and esophageal varices in patients with chronic liver disease

Correlation between serum ascites albumin gradient and esophageal varices in patients with chronic liver disease

Evaluation of Spleen Stiffness-Spleen Size-to-Platelet Ratio Score (SSPS) as Non-Invasive Predictor of Oesophageal Varices in Patients with Cirrhosis of Liver

Evaluation of Spleen Stiffness-Spleen Size-to-Platelet Ratio Score (SSPS) as Non-Invasive Predictor of Oesophageal Varices in Patients with Cirrhosis of Liver

Evaluation of Spleen Stiffness-Spleen Size-to-Platelet Ratio Score (SSPS) as Non-Invasive Predictor of Oesophageal Varices in Patients with Cirrhosis of Liver

Evaluation of Spleen Stiffness-Spleen Size-to-Platelet Ratio Score (SSPS) as Non-Invasive Predictor of Oesophageal Varices in Patients with Cirrhosis of Liver

Platelet Count/Spleen Diameter Ratio as a Non-invasive Parameter in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis

Background: Esophagogastroduodenoscopy (EGD) is the gold standard for detecting oesophageal varices (OVs) in cirrhotic patients. However, due to the possible limitations of EGD, there has been much interest in the use of non-invasive techniques for this purpose. This study aimed to evaluate the use of platelet count/ spleen diameter ratio (PC/SD) in the prediction of the presence and grading of OVs in cirrhotic patients.&#x0D; Methods: One hundred cirrhotic patients were included in this cross-sectional study and subjected to EGD after informed consent. Either absence or the grade of OVs if existent was correlated with values of the PC/SD ratio. Univariate and multivariate analyses of data and areas under the receiver operating characteristic curve (AUC) were used.&#x0D; Results: The PC/SD ratio was a good indicator in predicting the development of OVs (AUC of 0.897) with cut-off values of (987.28). Also, it correlated well with grades of oesophageal varices, a significant stepwise progressive decrease in PC/SD ratio was recorded through the grades of oesophageal varices as follows: Mean ± SD (882.59±390.43) (603.33±266.99) (503.76±190.80) (439.69±22.51) for grades I, II, III and IV respectively (p &lt;0.002),(AUC=0.688, 0.764, 0.795, 0.849) with a cut-off value of (784.37, 640.27, 597.50, 462.00) in grades I, II, III and IV respectively.&#x0D; Conclusion: The PC/SD ratio could be considered a non-invasive method of choice for screening OVs, sparing EGD for patients in need of intervention.

Diagnostic accuracy of triphasic CT scan abdomen in the diagnosis of distal esophageal varices taking endoscopic findings as gold standard.

Objective: To determine the diagnostic accuracy of multidetector computed tomography in detection of esophageal varices in patients with hrpatic cirrhosis. Study Design: Cross Sectional study. Setting: Department of Diagnostic Radiology, Kot Khawaja Saeed Teaching Hospital, Lahore. Period: January, 2021 to July, 2021. Material &amp; Methods: Two hundred seventy five patients diagnosed with liver cirrhosis were included in our study. Multidetector CT of the abdomen was performed using multislice CT and the findings were recorded. The cases underwent endoscopy within the subsequent 8 weeks. The results of MDCT were compared with endoscopy findings, which were taken as gold standard. Results: We found 190 true-positives, 80 true-negatives, 03 false-negatives, and 02 false-positive results. MDCT demonstrated a sensitivity of 98.4%, a specificity of 97.6%, PPV of 99.0%, NPV of 96.4%, and an accuracy of 98.1%. Extra-esophageal findings on MDCT included other porto-systemic collaterals and hepatocellular carcinoma. Conclusion: MDCT is an effective modality for diagnosis of esophageal varices and can be used as a screening test for varices. CT also permits evaluation of extra-luminal pathology that impacts management.

Study Cardiac Dysfunction as an Early Predictor of Esophageal Varices in Patients with Liver Cirrhosis ‎

Study Cardiac Dysfunction as an Early Predictor of Esophageal Varices in Patients with Liver Cirrhosis ‎