Hypertensive Gastropathy Research Articles

EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study

Portal hypertension (PH) is a serious adverse event of liver cirrhosis. The hepatic venous pressure gradient or portal pressure gradient (PPG) accurately reflects the degree of PH and is the single best prognostic indicator in liver disease. This is usually obtained by interventional radiology (IR), although it isnot routinely performed. Recently, we developed a simple novel technique for EUS-guided PPG measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and IR-PPGM. We present the first human pilot study of EUS-PPGM in patients with liver disease. EUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25-gauge fine-needle aspiration needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted using a transgastric-transduodenal approach. Clinical parameters of PH were evaluated in each patient. Feasibility was defined as successful PPGM in each patient. Safety was based on adverse events captured in a postprocedural interview. Twenty-eight patients underwent EUS-PPGM with 100% technical success and no adverse events. PPG ranged from 1.5 to 19mm Hg and had excellent correlation with clinical parameters of portal hypertension including the presence of varices (P= .0002), PH gastropathy (P= .007), and thrombocytopenia (P= .036). PPG was increased in patients with high clinical evidence of cirrhosis (P= .005). This novel technique of EUS-PPGM using a 25-gauge needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease.

CIRRHOTIC PATIENTS

Objectives: The aim behind this study was to determine the prevalence of portalhypertensive gastropathy in cirrhotic patients undergoing upper gastrointestinal endoscopy at atertiary care hospital in Shaheed Benazeerabad. Study Design: Hospital based cross sectionalstudy. Setting: Medicine Department of People’s Medical University, Shaheed Benazeerabad.Period: Six months from 20th August 2014 to 21st February 2015. Material and Methods: Atotal of 115 patients presenting with variceal bleeding (having history of liver cirrhosis since>2 years) and who further was undergoing diagnostic Endoscopic gastrodudenoscopy wereenrolled in the study. All endoscopies were performed by the endoscopists using a GIFQ 160Gastroscope (Olympus, Tokyo, Japan) in the left lateral position. The presence or absenceof PH gastropathy (outcome variable) was noted at each endoscopy. SPSS version 17.0 wasused to analyze the collected data. Results: The average age of the patients was 39.98±11.02years and mean duration of liver cirrhosis was 4.62±1.5 years. There were 70 (60.87%) maleand 45 (39.13%) were female. Regarding socioeconomic status, most of the cases were inlower and middle class. Frequency of portal hypertensive gastropathy (PHG) in patients of livercirrhosis undergoing upper gastrointestinal endoscopy was observed in 60% (69/115) cases.Conclusion: The frequency of PHG was 60% in the studied group of cirrhotic patients. Thisconcludes that if in the liver cirrhosis patients early identification and appropriate therapeuticmeasures of PHG is taken the morbidity in these patients can be decreased.

Endoscopic Evaluation in Children With End-Stage Liver Disease-Associated Portal Hypertension Awaiting Liver Transplant.

Routine oesophago-gastro-duodenoscopy (OGD) pre-liver transplantation (LT) for evaluation and management of gastrointestinal (GI) pathology, in particular GI varices secondary to portal hypertension, is common practice in adult LT programmes. There is no universal consensus for this practice in children. We report our endoscopic experience in children with end-stage liver disease (ESLD) pre-LT. Retrospective audit of LT database and review of OGD findings of patients who had undergone endoscopy preceding LT. Of 69 patients with ESLD, 50 (72.4%) had pre-LT OGD, 37 of which were done electively, whereas the remaining 13 were event driven. Forty-eight (96%) patients who underwent OGD had abnormalities, in which 38 (76%) patients had varices and 23 (46%) had portal hypertensive gastropathy. Eleven (22%) patients required therapeutic intervention at initial OGD either with endoscopic variceal band ligation or endoscopic sclerotherapy. Compared with the group who underwent elective OGDs, the group who had event-driven OGDs had a significantly higher requirement for endoscopic intervention (P < 0.0001), occurrence of rebleeding (P < 0.029) and requirement for repeat OGDs (P = 0.014). There was no significant difference in terms of patient (P = 0.2746) or graft survival (P = 0.3192) between the 2 groups. The role of pre-LT OGDs in patients with ESLD associated with portal hypertension is possibly limited to control of bleeding during episodes of GI bleed, where the aim would be to stabilize the patient until eventual LT. Multicentre prospective studies are required to provide more evidence on the use of routine endoscopy for pre-LT assessment in children.

Gastrointestinal bleeding from vascular malformations: Is octreotide effective to rescue difficult-to-treat patients?

Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations". The first line therapy of acute/chronic bleeding from digestive vascular malformations is endoscopy, followed by angiographic embolization and surgical resection when this is unsuccessful. In the setting of difficult-to-treat patients, octreotide has been proposed as an alternative therapeutic strategy. Studies reported in the literature show a high efficacy and safety of octreotide, but described only a small number of enrolled patients, heterogeneous therapeutic schedules and short-term follow-up, with the exception of acute bleeding from esophageal varices. As a consequence, the use of octreotide is not approved in this setting and it is currently still prescribed as an off-label drug. Studies in larger populations are needed to confirm the promising results observed in the small case series reports, so as to provide physicians with a treatment option for patients without available alternatives. Octreotide could also determine a strong decrease in the management costs of these clinical conditions, and especially, could dramatically reduce hospital admission costs.

Portal hypertensive gastropathy as a prognostic index in patients with liver cirrhosis.

BackgroundPortal hypertensive gastropathy (PHG) is a frequently overlooked complication of liver cirrhosis (LC). The clinical implications of PHG as a prognostic factor of LC or a predictive factor for the development of hepatocellular carcinoma (HCC) have not been established. The aim of this study was to assess the clinical significance of PHG in patients with LC.MethodsPatients with LC were prospectively enrolled and followed in a single tertiary hospital in the Republic of Korea. Baseline hepatic vein pressure gradient (HVPG) was measured, and esophagogastroduodenoscopy (EGD) was performed. The associations of PHG with HVPG, survival and the development of HCC were evaluated.ResultsA total of 587 patients were enrolled. The mortality rate was 20.3 % (n = 119), and HCC developed in 9.2 % (n = 54) during the follow-up period (32.6 ± 27.8 months). The grade of PHG was well correlated with HVPG (no PGH: median 9.2 [IQR: 7.2–16.7], mild PHG: 14.6 [10.1–19.3], and severe PHG: 17.3 [12.3–21.5], P < 0.001), as well as with Child-Pugh class, MELD score or survival. However, it was not associated with the development of HCC. The grade of PHG (HR 3.29, 95 % CI: 1.12–9.63, severe vs. no PHG) and Child-Pugh class (HR 3.53, 95 % CI: 1.79–6.97, Child C vs A) showed significant associations with mortality.ConclusionPHG was well correlated with portal hypertension and could be used as a prognostic factor for LC but not for the prediction of HCC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0508-2) contains supplementary material, which is available to authorized users.

Study on Gastrointestinal Evaluation of Iron Deficiency Anaemia Patients Attending at BIRDEM Hospital

Background: Anaemia is common among general population in developing Asian countries. Iron deficiency anaemia (IDA) is the commonest type of anaemia. It is usually due to chronic gastrointestinal blood loss. The standard of care for these patients with IDA includes evaluation of the Gastrointestinal (GI) tract for bleeding lesions. Iron deficiency anemia is considered as an alarm sign for the presence of possible GI malignancies, and inadequate evaluation of patients with IDA may delay the diagnosis of GI tumors especially colorectal cancer.Objective: To identify the gastrointestinal lesions endoscopically in patients with iron deficiency anaemia. To determine the usefulness of endoscopic procedures (both upper and lower GI) in diagnosis of underlying cause of iron deficiency.Method: This cross-sectional study was conducted to evaluate Iron deficiency anaemia in patients with or without GI symptoms during the period of July 2010 to December 2010 in the department of Gastroenterology, BIRDEM General Hospital. Sixty eight adult eligible patients with iron deficiency anaemia were taken as per inclusion criteria. All study subjects were underwent endoscopy and colonoscopic procedure after adequate preparation along with examination of their stool. Data were collected through faceto- face interview, observation and document review. Data were recorded and analyzed.Results: Majority of patients were 55 to 64 years age group (33.8%). Mean age ± SD of this study subject was 54.00 ±11.792 with maximum and minimum age 86 and 27 years respectively. More than half of the patients were female (51.5%) and rests were male 33 (48.5%). Among the study subjects, 70.58% patients had GI symptoms, 29.42% had non-GI symptoms. On stool examination, 17.64% patients had ova/cyst of helminthes; 82.36% were normal. Stool OBT revealed 11.8% positive and 88.2% negative. On upper GI endoscopy 32.4% had normal findings, 67.6% had some lesions. Majority of these lesions were ulcers and erosions (30.9%), malignancy (ca stomach) was 4.41%; others (which includes congestive gastropathy, reflux oesophagitis, vascular ectasias and helminthiasis) were 32.4%. On colonoscopy, 30.88% patients had normal colon; 69.12% had lesions. Among the lesions, most common lesion was hemorrhoids (36.76%); ca colon was 5.88% and others (includes ulcers, polyps, vascular ectasias and helminthes) were 26.47%. Patients with normal upper GI endoscopy- 50% had GI symptoms and 50% had non-GI symptoms whereas patients having lesions on upper GI endoscopy 80.4% had GI symptoms and 19.6% had non-GI symptoms. This difference was statistically significant (p&lt;0.05). Patients with normal colonoscopy- 42.9% had GI symptoms and 57.1% had non-GI symptoms. On the other hand, patients having lesions on colonoscopy 70.6% had GI symptoms and 29.4% had non-GI symptoms. This was also statistically significant.Conclusion: Majority of the study population had lesions on endoscopy (both upper GI endoscopy and colonoscopy) including malignant lesions. Study showed that lesions are more common in patients with GI symptoms than those without GI symptoms (non-GI symptoms). Therefore, Routine endoscopic (both upper and lower GI) procedures is valuable in evaluating patients with iron deficiency anaemia- for diagnostic as well as therapeutic purposes. Effective treatment of patients with IDA is predicated on the identification of a specific lesion.J Bangladesh Coll Phys Surg 2015; 33(3): 126-132

The spectrum of gastric pathology in portal hypertension—An endoscopic and pathologic study of 550 cases

One of the main tasks for pathologists when evaluating gastric biopsies from patients with portal hypertensive gastropathy (PHG) is to examine whether there is increased mucosal vasculature as suggested by endoscopy. However, the full spectrum of pathology findings in patients with portal hypertension (pHTN) is largely unknown. We systematically characterized the endoscopic and pathologic features in gastric biopsies from pHTN patients (study group) and compared with those from patients without pHTN (control group). The study group consisted of 550 consecutive surveillance esophagogastroduodenoscopic (EGD) biopsies, whereas the control group included 281 consecutive EGD biopsies for a variety of indications. As expected, the endoscopic prevalence of PHG was 28%, among which two-thirds showed corresponding histopathologic evidence of increased vasculature. However, non-Helicobacter pylori gastritis was the most common finding in pHTN patients on histology (40%). In addition, hyperplastic polyp was also more common in pHTN patients than in controls (6% vs 3%; P=0.0314). In contrast, pathology findings of nonspecific reactive changes (29% vs 51%; P<0.0001), proton pump inhibitor-related changes (16% vs 30%; P<0.0001), and malignancy (1% vs 3%; P=0.0138) were less common in pHTN patients. Our results show a spectrum of gastric endoscopic and pathologic findings in pHTN patients. The predominant gastric pathology in pHTN patients may be associated with pHTN-induced gastric microcirculation impairment.

Non-Invasive Diagnosis of Portal Hypertensive Gastropathy: Quantitative Analysis of Microbubble-Induced Stomach Wall Enhancement

The aim of the study described here was to elucidate the efficacy of contrast-enhanced ultrasound (CEUS) prospectively as a tool in the diagnosis of portal hypertensive gastropathy (PHG). The peak enhancement time at the upper stomach wall (PT) and intensity ratio at the upper stomach/the spleen (IR) between pre- and peak enhancement were evaluated by CEUS with perflubutane microbubble agent in 56 patients, 42 with cirrhosis (16 with PHG) and 14 controls. The IR was higher in patients with PHG (1.21 ± 0.11) than in those without (0.91 ± 0.15, p < 0.05) and the controls (0.78 ± 0.11, p < 0.01), although PT did not differ between these groups. The area under the receiver operating characteristic curve for IR was 0.8199 in the presence of PHG, with the best cutoff value of 0.94, sensitivity 65.9%, specificity 72.6%, positive predictive value 62.2%, negative predictive value 73.1% and accuracy 70.4%. CEUS may have potential as a less invasive tool for diagnosis of PHG in patients with cirrhosis.

Small bowel capsule endoscopy and portal hypertensive enteropathy in cirrhotic patients: results from a tertiary referral centre

Background and rationale. Portal hypertensive enteropathy (PHE) remains difficult to diagnose in patients with cirrhosis and portal hypertension. Limited test choices exist for the inspection of the small bowel in these patients. Small bowel capsule endoscopy (SBCE) is ideal in this situation but rarely performed. We aimed to determine the prevalence of PHE using SBCE in a cirrhotic patient population and correlate its presence with clinical and CT imaging findings.Material and methods. We retrospectively analysed data from cirrhotic patients who underwent SBCE at our unit. Studies were evaluated for the presence of cirrhosis-related findings in the oesophagus, stomach and small-bowel. The relationships between PHE and patients’ clinical characteristics were evaluated.Results. 53 patients with cirrhosis underwent SCBE. We used PillCam®SB on 36 patients and MiroCam® capsule on 17. Thirty patients were referred for iron deficiency anaemia, 15 for obscure gastrointestinal bleeding, and 4 for other indications. Four data sets were not available for review, leaving 49 patients. Mean age was 61.19 ± 14.54 years (M/F = 27/22). Six SBCE examinations were incomplete. Thirty three patients had evidence of portal hypertensive gastropathy (PHG) and 17 had evidence of oesophageal varices. In total, 29 patients had SCBE evidence of PHE (57%). 28/29 (96.5%) patients with PHE had also evidence of PHG. 13/17 (76.4%) patients with oesophageal varices had also evidence of PHE.Conclusions. The prevalence of PHE in our study was 57%. SBCE is a useful tool in evaluating PHE in cirrhotic patients irrespective of aetiology.

Investigation of direct medical expense for surgical patients with splenomegalic advanced schistosomiasis in Hunan Province from 2010 to 2014

To understand the direct medical expense for surgical patients with splenomegalic advanced schistosomiasis and its influencing factors, so as to provide evidences for relevant departments to improve the rescue strategy of advanced schistosomiasis. The data about the expenses of patients with splenomegalic advanced schistosomiasis hospitalized in Xiangyue Hospital affiliated to Hunan Institute of Schistosomiasis Control from January 2010 to August 2014 were collected, the hospitalization expense and hospital stays of the patients were analyzed, and the factors influencing the hospital expenses were analyzed by the univariate and multi-factor analyses. From January 2010 to August 2014, totally 249 cases were hospitalized in the hospital, their average hospital stays and hospital expenses were 28.92 d and 18 896.13 Yuan, and both of them were increased year by year. Among all the kinds of expenses, the constitution ratios of the medicine expenses were the highest, and those in the 5 years were all above 44%. The results of the univariate and multi-factor analyses showed that the hospital stays, the amount of intraoperative bleeding, liver function classification, postoperative complications, age, portal hypertensive gastropathy were the influencing factors of the hospital expenses. Presently, the burden of the direct hospital expenses of the patients with splenomegalic advanced schistosomiasis is still heavy. The government should further improve the proportion of the compensation of medical assistance and perfect the medical aid scheme. Meanwhile, the hospitals should strengthen the management and standardize medical behavior to reduce the hospitalization expenses of the patients.

Endoscopic contrast enhanced ultrasound in the study of portal hypertensive gastropathy

Background: Portal Hypertensive Gastropathy (PHG) is a microvascular gastric mucosal e submucosal alteration associated to mucosal patterns, identified during upper endoscopy, responsible for acute and chronic gastrointestinal bleeding in patients with portal hypertension of any etiology. Objective: To establish patterns of mucosal and submucosal blood flow in patients with portal hypertension for chronic viral hepatitis with and without endoscopic PHG, using Contrast Enhanced Ultrasound (CEUS). Method: 20 Patients with portal hypertension for chronic viral hepatitis, presenting esophageal varices, without previous endoscopic or surgical treatment and free of propranolol for at least 04 weeks, divided into two groups of ten each (with and without endoscopic PHG), were submitted to CEUS and upper endoscopy and endoscopic gastric biopsies. Results: Intense mucosal and submucosal blood flow was identified in all patients in the group with endoscopic PHG and only in one patient in the group without endoscopic PHG, presenting sensibility, sensitivity, positive predictive value and negative predictive value, respectively of 100.0%, 90.0%, 90.9%, 100.0%, with statistical significance (p < 0.001). Conclusion: CEUS identified two different patterns of mucosal and submucosal blood flow in patients with portal hypertension for chronic viral hepatitis with and without PHG, present and intense in patients with PHG (100% of cases) and absent in patients without PHG (90% of cases).

Effect of endoscopic variceal obliteration by band ligation on portal hypertensive gastro-duodenopathy: endoscopic and pathological study.

A few studies have shown that the degree of portal hypertensive gastropathy (PHG) and duodenopathy (PHD) has been worsening after the introduction of therapeutic endoscopic interventions. This study aimed to determine the impact of esophageal variceal eradication by endoscopic variceal ligation (EVL) on PHG and PHD using endoscopic and histopathologic assessment. Fifty patients with esophageal varices for which EVL was indicated were included. EVL was carried out until complete variceal eradication was achieved. The degree of severity of PHG and PHD were recorded before and 4weeks after variceal eradication. Biopsies were taken from various parts of the stomach and duodenum before and 4weeks after variceal eradication. The whole Baveno score (4 vs. 2.5) increased significantly after variceal eradication when compared to those before eradication (p<0.05). After obliteration, only 19 (38%) patients had mild PHG versus 37 (74%) before EVL, while severe PHG was found in 31 (62%) patients versus 11 (22%) before EVL and the difference was highly statistically significant. No significant changes were found regarding endoscopic PHD lesions before and after variceal eradication. Pathological changes as average blood vessel count, angiogenesis, ectasia and blood extravasation in stomach and duodenum significantly increased after EVL. Large esophageal varices (III-IV) and Baveno score (>1) at baseline endoscopy were independent risk factors for development of severe PHG after variceal obliteration (p<0.05). PHG increased significantly, endoscopically and pathologically, after variceal obliteration by EVL. Although PHD did not significantly change as documented by endoscopy, pathological examination documented statistically significant changes in the duodenum after EVL.

Research advances in portal hypertensive gastropathy

Research advances in portal hypertensive gastropathy

Prevalence of Helicobacter pylori infection in patients with portal hypertensive gastropathy owing to liver cirrhosis in Upper Egypt

Background Gastrointestinal bleeding and anemia in patients with liver cirrhosis are common problems caused by various etiologies such as bleeding esophageal and gastric varices, bleeding peptic ulcer whether Helicobacter pylori or non-H. pylori related, portal hypertensive gastropathy (PHG), and other causes. Impairment of the gastric protective barriers and production of inflammatory cytokines such as tumor necrosis factor-α and interleukins, which occur because of colonization of gastric mucosa by H. pylori, may make the stomach more susceptible to the effects of portal hypertension. Aim of work The aim of this study was to investigate the prevalence of H. pylori infection and its association with PHG in patients with liver cirrhosis. Patients and methods Overall, 50 patients with liver cirrhosis and PHG (cases) and 50 patients with cirrhosis without PHG (controls) were enrolled in this study. H. pylori stool antigen rapid bedside test and upper endoscopy were done for patients in both groups to diagnose PHG and H. pylori infection. Results The prevalence of H. pylori infection among patients with PHG was higher than those without PHG (34 vs. 10%, respectively; P=0.031), and prevalence of H. pylori infection was 22% among the whole of the studied groups. There was no correlation between H. pylori infection and severity of PHG (P=0.381), Child score, Model for End-Stage Liver Disease score, or serum albumin level. However, our study showed a significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG (P=0.002). Conclusion There is significant association between H. pylori infection and PHG, but there is no significant correlation between H. pylori infection and the severity of PHG or the severity of liver cirrhosis. Also, there is significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG.

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy.

To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepatic-portosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. PHG is important to recognize in patients with cirrhotic or non-cirrhotic portal hypertension because it can cause acute or chronic GI bleeding that often requires pharmacologic therapy.

Transient Elastography (Fibroscan) Compared to Diagnostic Endoscopy in the Diagnosis of Varices in Patients with Cirrhosis

We evaluated the effectiveness of the Transient elastography using (Fibroscan) for the prediction of varices and portal hypertensive gastropathy in patients with chronic liver disease. We performed a cross-sectional study of patients with compensated chronic liver disease who had never experienced variceal bleeding and underwent both a Fibroscan assessment for liver fibrosis and a diagnostic UGIE no more than 3 months apart. We collected the patients’ demographic data, serum ALT and platelet count values, and Fibroscan and endoscopy results. We included 75 patients in the final analysis; 39 (52%) had males. Hepatitis C was the most common diagnosis (27, 36%). A total of 37 patients (49.3%) had either gastric or esophageal varices (OV), portal hypertensive gastropathy (PHG), or both. The mean stiffness score was 30.1 kPa (SD 1.2 kPa). The Fibroscan score was highly correlated with the presence of varices (r=.85 and P=.002). The mean stiffness score was higher in patients with OVs or PHG than in patients without OVs or PHG, (34.5, SD 18.3 and 25.8, SD 14.9, respectively, P=.027), but no difference was found in the stiffness scores between the patients with small and large varices. The ROC analysis of a stiffness score showed AUC of.67 for the detection of varices. In conclusion: Fibroscan can predict the presence of varices and PHG in patients with cirrhosis, but it cannot distinguish between small and large varices.

Esophageal capsule endoscopy is not the optimal technique to determine the need for primary prophylaxis in patients with cirrhosis.

IntroductionCapsule endoscopy has been suggested as a potential alternative to endoscopy for detection of esophagogastric varices and severe portal hypertensive gastropathy (PHG). The aim of the study was to determine whether PillCam esophageal capsule endoscopy could replace endoscopy for screening purposes.Material and methodsSixty-two patients with cirrhosis with no previous variceal bleeding had PillCam capsule endoscopy and video endoscopy performed on the same day. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of capsule endoscopy were compared to endoscopy for the presence and severity of esophageal and gastric varices, PHG and the need for primary prophylaxis. Patients’ preference was assessed by a questionnaire.ResultsFour (6%) patients were unable to swallow the capsule. Sensitivity, specificity, PPV and NPV of capsule endoscopy for detecting any esophageal varices (92%, 50%, 92%, 50%), large varices (55%, 91%, 75%, 80%), variceal red signs (58%, 87%, 69%, 80%), PHG (95%, 50%, 95%, 50%), and the need for primary prophylaxis (91%, 57%, 78%, 80%) were not optimal, with only moderate agreement (κ) between capsule and upper GI endoscopy. Had only a capsule endoscopy been performed, 12 (21.4%) patients would have received inappropriate treatment. Capsule endoscopy also failed to detect (0/13) gastric varices. The majority of patients ranked capsule endoscopy as more convenient (69%) and their preferred (61%) method.ConclusionsDespite the preference expressed by patients for capsule endoscopy, we believe that upper GI endoscopy should remain the preferred screening method for primary prophylaxis.

A study of clinical profile of patients presenting with abnormalities detected by upper gastrointestinal endoscopy

Background: Alcoholic liver disease (ALD) continues to be a cause of disability and death throughout the world. According to two recent studies from the United States, 50-67% of the adult population drinks alcohol. The objective of the study was to study the upper gastrointestinal endoscopic abnormalities of patients with alcoholic Liver Disease. Methods: We conducted an observational, cross-sectional study to study the upper gastrointestinal endoscopic abnormalities in patients with alcoholic liver disease. A total of 97 patients, who satisfied the inclusion and exclusion criteria have been enrolled into our study. Results: On upper gastrointestinal endoscopy, 94.73% cirrhotic patients were found to have esophageal varices (P<0.001), 23.68% cirrhotic patients were found to have esophagogastroduodenal PHG (P = 0.04) and 15.78 % cirrhotic patients were found to have GAVE. None of the patients with USG findings of fatty liver / acute hepatitis had the above endoscopic abnormalities. Conclusions: Most significant clinical association’s esophageal varices and portal hypertensive gastropathy. Early detection and management of the above conditions may be helpful in lowering the disease burden and its morbidity.

Upper gastrointestinal endoscopy in patients with liver cirrhosis: Spectrum and prevalence of lesions

Aim: This was to describe the different types of lesions that can be found in patients with liver cirrhosis during upper gastrointestinal endoscopy. Patients and Methods: Consecutive patients with liver cirrhosis who gave their consent to participate in the study were recruited. The diagnosis of liver cirrhosis was made by clinical and radiological features and a total of 56 patients were recruited. After taking informed consent, upper gastrointestinal endoscopy was performed on all the patients. Results: The patients consisted of 43 (76.8%) males and 13 (23.2%) females. Mean age was 45.5 ΁ 13.8 years (range: 20-77 years). Analysis showed that 21 (37.5%) patients were less than 40 years of age, 16 (28.6%) were between 40 years and 49 years, and 19 (33.9%) were 50 years and above. Esophageal varices was diagnosed in 54 (96.4%) patients. The esophageal mucosal findings observed were erosions (7.1%), ulcer (1.8%), candidiasis (8.9%) while one (1.8%) patient had both esophageal erosions and candidiasis. Gastric varices were observed in 11 (19.6%) patients and the analysis showed that the most frequent form was isolated gastric varices type 1 (IGV1) was recorded in six (10.7%) patients. Portal hypertensive gastropathy (PHG) was seen in 45 (80.4%) patients. Other gastric mucosal lesions were erosions (12.5%) and ulcers (10.7%). Duodenal varices were not seen in any of the patients. Other lesions seen were duodenitis, duodenal erosions, and duodenal ulcers in one (1.8%) patient, one (1.8%) patient, and four (7.1%) patients, respectively. Conclusion: This study has revealed different pattern of lesions that can be seen in patients with liver cirrhosis apart from varices.

Non-variceal upper gastrointestinal bleeding in cirrhotic patients in Nile Delta.

Acute upper gastrointestinal bleeding (AUGIB) in cirrhotic patients occurs mainly from esophageal and gastric varices; however, quite a large number of cirrhotic patients bleed from other sources as well. The aim of the present work is to determine the prevalence of non-variceal UGIB as well as its different causes among the cirrhotic portal hypertensive patients in Nile Delta. Emergency upper gastrointestinal (UGI) endoscopy for AUGIB was done in 650 patients. Out of these patients, 550 (84.6%) patients who were proved to have cirrhosis were the subject of the present study. From all cirrhotic portal hypertensive patients, 415 (75.5%) bled from variceal sources (esophageal and gastric) while 135 (24.5%) of them bled from non-variceal sources. Among variceal sources of bleeding, esophageal varices were much more common than gastric varices. Peptic ulcer was the most common non-variceal source of bleeding. Non-variceal bleeding in cirrhosis was not frequent, and sources included peptic ulcer, portal hypertensive gastropathy, and erosive disease of the stomach and duodenum.