Portal Hypertension Lesions Research Articles

Unlikely Death From Esophageal Variceal Hemorrhage in a Post-Orthotopic Liver Transplant Patient.

Gastrointestinal bleeding is one of the complications seen after a liver transplant with a poor prognosis and low survival. The most common cause of gastrointestinal bleeding after a liver transplant is ulcers followed by hemorrhagic enteritis and portal hypertensive lesions. We present a case of a middle-aged male, with improving liver function labs and imaging, who passed away from large-volume hematemesis approximately 2 months after a liver transplant. On autopsy, the cause of death was concluded to be from acute upper gastrointestinal hemorrhage due to esophageal variceal bleeding.

Management of Endoscopic Portal Hypertension Lesions in Cirrhotic Patients in a Country with Limited Resources: About 603 Cases in the City of Douala in Cameroon

Management of Endoscopic Portal Hypertension Lesions in Cirrhotic Patients in a Country with Limited Resources: About 603 Cases in the City of Douala in Cameroon

Endoscopic profile and clinical outcome of patients presenting with upper gastrointestinal bleeding

Background: Acute upper gastrointestinal bleeding is a common medical emergency with significant mortality. The aim of the present study is to study endoscopic profile and clinical outcome of patients presenting with upper gastrointestinal bleeding in this region. Methods: This prospective observational study carried out on 100 patients admitted with upper gastrointestinal bleeding. All patients included in study underwent upper gastrointestinal endoscopy after initial evaluation and stabilization. Status of study group patients was noted at discharge. Patients were telephonically contacted at day 15 and were asked about rebleed, readmission for gastrointestinal bleed or death of the patient.Results: The mean age of patients was 48.98 ±14.50 years with male to female ratio of 2.57:1. The most common lesions causing UGI bleed were related to portal hypertension (esophageal and gastric varices) and were seen in 67% of patients. Non portal hypertensive lesions causing UGI bleed (peptic and other lesions) were seen in 46% patients. Twenty six percent patients had combination of lesions while endoscopy was normal in 3% patients. Rebleeding within 15 days was seen in 11 patients out of whom 3 died during same admission. Out of other 8 patients with rebleed, readmission was seen in 6 patients while 2 patients had minor bleed. We found no correlation of mortality and rebleed with factors like age, history of liver disease, diabetes, NSAIDs use, peptic ulcer disease and presence of cirrhosis. However the correlation between rebleed and death was found to be statistically significant.Conclusions: Portal hypertension is the most common cause of upper gastrointestinal bleeding in this region. There is strong correlation between rebleeding and death. However there is no correlation between age, history of liver disease, diabetes, NSAIDs use, peptic ulcer disease and presence of cirrhosis with rebleed or mortality.

Upper Digestive Lesions Not Linked to Portal Hypertension during Cirrhosis: About 82 Cases in the Hepato-Gastroenterology Department of Aristide Le Dantec Hospital

Introduction: The aim of this study was to determine the frequency of digestive lesions unrelated to portal hypertension during cirrhosis and to look for a possible correlation between these lesions and the severity of chronic liver disease. Material and method: Over a period of 15 months (April 1, 2014 to June 30, 2015), all the records of cirrhotic patients who followed up on an outpatient or inpatient basis in the hepato-gastroenterology department of the Aristide Le Dantec Hospital were collected. The data collected were as follows: age, sex, Child-Pugh severity score, etiology of cirrhosis, indication for endoscopy and endoscopic lesions observed. Results: Data were analyzed from 82 patient records with a mean age of 43 years (range 16 and 79 years) and a sex ratio of 1.4 (54 males). Cirrhosis was classified as Child-Pugh B in 47% of cases and Child-Pugh C in 35% of cases. The etiology was viral B in 75 patients (91.5%), B-D co-infection in 2 cases, and alcoholic in 1 case. The indication for oeso-gastroduodenal endoscopy was a systematic search for signs of portal hypertension in 66 cases (80.4%), upper gastrointestinal haemorrhage in 11 cases (13.4%) and epigastralgia in 6.2% of cases. Endoscopic lesions unrelated to portal hypertension were observed in 61 patients (74.4%). Peptic ulcer was present in 26 patients (31.7%), and congestive gastrobulbitis was observed in 38 patients (46.3%) and erosive gastrobulbitis in 32 patients (39%). Of the 43 upper GI endoscopies with biopsies, Helicobacter pylori was found at histology in 17 cases (39.5%). Eighteen patients (21.9%) had esophageal candidiasis. In multivariate analysis, there was no association between no portal hypertension lesions and the severity of cirrhosis. Conclusion:Upper gastro intestinal lesions unrelated to hypertension were present in 3/4 of cirrhotic patients. Peptic ulcer disease and congestive and erosive gastrobulbitis were the most frequently observed lesions. There was no significant association between non-PTH-related lesions and the severity of cirrhosis.

Su1469 - Doppler Endoscopic Probe Guided Hemostasis Improves Outcomes of Severe Ugi Hemorrhage from Varices and Other Portal Hypertension Lesions

Su1469 - Doppler Endoscopic Probe Guided Hemostasis Improves Outcomes of Severe Ugi Hemorrhage from Varices and Other Portal Hypertension Lesions

Acute on chronic gastrointestinal bleeding: a unique clinical entity

Gastrointestinal bleeding is defined in temporal–spatial terms—as acute or chronic, and/or by its location in the gastrointestinal tract. Here, we define a distinct type of bleeding, which we have coined...

Portal Gastropathy and Duodenopathy in Children With Extrahepatic and Intrahepatic Portal Hypertension: Endoscopic Diagnosis and Histologic Scoring

The aim of the study was to determine the frequency of portal gastropathy (PG) and duodenopathy (PD) in children, to document the correlation of various clinical and laboratory parameters associated with portal hypertensive gastroduodenal lesions, to compare the endoscopic portal hypertensive lesions with different histologic findings, and to evaluate the use of a possible histologic scoring system. All children undergoing endoscopic investigation for portal hypertension (PH) between January 2006 and November 2007 were analysed retrospectively. Clinical and demographical data and endoscopic and histologic findings were recorded. Histologic findings suggestive of PG and PD (capillary dilation, increased numbers of capillaries, histologic bleeding, and edema) were scored. Of 51 consecutive children (29 boys, mean age 10.1 ± 3.6 years [range 2.5-15.8 years]), 28 were cirrhotic. PG was diagnosed in 58.8% endoscopically. Children with cirrhotic PH had the highest rate of PG (64.3%), whereas those with extrahepatic or intrahepatic noncirrhotic PH were alike (50% and 54.5%, respectively). Baveno PG scores were higher in children with cirrhosis with higher Child-Pugh scores. Capillary dilation was the only histologic finding showing significant association with the endoscopic diagnosis. Only 9% had PD on endoscopy. None of the histologic findings correlated with endoscopic diagnosis of PD. PG and PD are seen in children with extrahepatic and intrahepatic PH at rates similar to those reported in adult studies. Baveno PG scores increased in parallel with Child-Pugh class in children with cirrhosis. Capillary dilation was the only histologic finding showing significant association with the endoscopic diagnosis of PG in this study.

High MELD Score and Type of Immunosuppression Are Predictors of Gastrointestinal Bleeding after Liver Transplantation

Purpose: Gastrointestinal bleeding (GIB) after liver transplantation is associated with significant morbidity and mortality. There is a paucity of information about the effects of various immunosuppression therapies on GI bleeding as well as the predictive value of the MELD score in GIB. The aim of our study was to define the incidence, causes of GIB after liver transplantation, and to identify the clinical and demographic variables that are associated with GIB in post liver transplant patients. Methods: The records of the 522 consecutive primary liver transplants performed at Albert Einstein Medical Center since January of 1995 to December of 2005 were reviewed retrospectively. A preliminary analysis examined the association among these variables and the complication of GIB after liver transplant patients. A logistic regression was used to determine the predictors of GIB after liver transplant patients. Results: The incidence of GIB after liver transplant was 8.9%. The most common causes of bleeding after liver transplant were peptic ulcers 34.5%, followed by viral enteritis (CMV) (12.7%), portal hypertensive lesions (10.9%), anastomotic bleeds(4.5%), and other miscellaneous events. A MELD score ≥ 32 prior to transplant statistically increases the risk (OR: 6.4; CI: 6.35–6.56: P < 0.001), and immunotherapy with Tacrolimus decreases the risk of post transplant bleeding (OR 0.28; CI: 0.26–0.38: P= 0.001). No other variables were associated with GIB post transplant. The presence of GIB after liver transplant is associated with a higher mortality Conclusion: Patients with MELD scores >32 are candidates for prophylaxis against post transplant GIB. Immunosupression with Tacrolimus should be considered in these patients especially those with high MELD.Table: Logistic Regression Analysis

Gastrointestinal bleeding after liver transplantation.

To investigate the causes of gastrointestinal bleeding (GIB) and its impact on patient and graft survival after orthotopic liver transplantation (OLTx), the first 1000 consecutive OLTx using tacrolimus were studied. Our patient population consisted of 834 adults. The bleeding episodes of patients with GIB (n=74) were analyzed, and patients without GIB (n=760) were used as controls. The mean age, gender, and United Network for Organ Sharing status were similar in both groups. Endoscopy was done in 73 patients with GIB and yielded a diagnosis in 60 patients (82.2%): 39 with a single, and 21 with multiple GIB episodes. In the remaining 13 patients (17.8%), the bleeding source was not identified. Of 92 GIB episodes with endoscopic diagnoses, ulcers (n=25) were the most common cause of bleeding, followed by enteritis (n=24), portal hypertensive lesions (n=15), Roux-en-Y bleeds, and other miscellaneous events (n=28). The majority (73%) of the GIB episodes occurred during the first postoperative trimester. The patient and graft survival rates were statistically lower in the GIB group compared with the control group. The adjusted relative risk of mortality and graft failure was increased by bleeding. In summary, the cumulative incidence of GIB was 8.9%. Endoscopy identified the source of GIB in most cases. Ulcers were the most common cause of GIB after OLTx. The onset of GIB after OLTx was an indicator of decreased patient and graft survival.