Variceal Bleeding Group Research Articles

Risk factors and construction of a nomogram model for cirrhotic portal vein thrombosis combined with esophagogastric variceal bleeding

Objective: To investigate the risk factors and construct a nomogram model for predicting the occurrence of cirrhotic portal vein thrombosis in patients combined with esophagogastric variceal bleeding (EVB). Methods: Clinical data on 416 cirrhotic PVT cases was collected from the First Hospital of Lanzhou University between January 2016 and January 2022. A total of 385 cases were included after excluding 31 cases for retrospective analysis. They were divided into an esophagogastric variceal bleeding group and a non-esophagogastric variceal bleeding group based on the clinical diagnosis. The esophagogastric variceal group was then further divided into an EVB group and a non-bleeding group. All patients underwent gastroscopy, serology, and imaging examinations. The risk factors of PVT combined with EVB were identified by univariate analysis using SPSS 26. The prediction model of cirrhotic PVT in patients combined with EVB was constructed by R 4.0.4. The prediction efficiency and clinical benefits of the model were evaluated by the C-index, area under the receiver operating characteristic curve, calibration plots, and decision curve. The measurement data were examined by a t-test or Mann-Whitney U test. The counting data were tested using the χ(2) test or the Fisher exact probability method. Results: There were statistically significant differences in the etiology, Child-Pugh grade,erythrocyte count, hematocrit, globulin, and serum lipids between the esophageal and non-esophageal varices groups (P < 0.05). There were statistically significant differences in etiology, erythrocyte count, hemoglobin, hematocrit, neutrophil percentage, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and neutrophil lymphocyte ratio (NLR) between the EVB and non-bleeding groups (P < 0.05). Multivariate logistic regression analysis showed that etiology (OR = 3.287, 95% CI: 1.497 ~ 7.214), hematocrit (OR = 0.897, 95% CI: 0.853 ~ 0.943), and high-density lipoprotein cholesterol (OR = 0.229, 95% CI: 0.071 ~ 0.737) were independent risk factors for cirrhotic PVT patients combined with EVB. The constructed normogram model predicted the probability of bleeding in patients. The nomogram model had shown good consistency and differentiation (AUC = 0.820, 95% CI: 0.707 ~ 0.843), as verified by 10-fold cross-validation (C-index = 0.799) and the Hosmer-Lemeshow goodness of fit test (P = 0.915). The calibration plot and the decision curve suggested that the prediction model had good stability and clinical practicability. Conclusion: The risk factors for EVB occurrence include etiology, erythrocyte, hemoglobin, hematocrit, percentage of neutrophils, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and NLR in patients with cirrhotic liver. The constructed prediction model has good predictive value, and it can provide a reference for medical personnel to screen patients with high bleeding risk for targeted treatment.

Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding.

Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates. To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d). We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance. All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; P < 0.001), and ABC score (AUROC = 0.775; P < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, P = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; P = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; P = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality (P < 0.05) and by 12-fold if added to GBS score (P < 0.003). No score proved to be a good predictor for length of admission. ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.

Predictive Value of Spectral Computed Tomography Parameters in Esophageal Variceal Rupture and Bleeding in Cirrhosis.

To evaluate the value of the spectral CT parameters in predicting the risk of esophageal variceal bleeding in cirrhosis with portal hypertension and to provide a reference for clinical diagnosis and treatment. Seventy-eight patients were divided into an esophageal variceal bleeding group and a non- esophageal variceal bleeding group. A comparison of variables including age, gender, platelet count, Child-Pugh classification, and spectral parameters between the 2 groups was done. Baseline model and spectral model were constructed with conventional parameters and conventional parameters coupled with spectral parameters, respectively. The 2 models were analyzed by the Receiver Operating Characteristic (ROC) curve. The baseline model was established based on 4 conventional parameters and evaluated by ROC curve analysis. The spectral model was constructed based on the variables in the baseline combined with normalized iodine density in the liver parenchyma for the arterial phase, normalized iodine density in the liver parenchyma for the portal phase, normalized iodine density in the splenic parenchyma for the portal phase, diameter of the main portal vein, diameter of the splenic vein, and normalized iodine density of the left gastric vein. Normalized iodine density of the left gastric vein, normalized iodine density in the liver parenchyma for the portal phase, and Child-Pugh classification were the influencing factors of esophageal variceal bleeding in cirrhosis patients. The Area Under Curve (AUC) for the baseline and spectral models were compared (0.664 vs. 0.860) and the difference was found to be statistically significant (P < .001). The use of spectral CT parameters in consort with the conventional parameters can improve the diagnostic effectiveness of esophageal variceal bleeding in cirrhosis cases and screen for high-risk esophageal variceal bleeding patients. It may also provide an objective basis for the clinical prevention and treatment of esophageal variceal bleeding.

Clinical outcomes of transjugular intrahepatic portosystemic shunt with PTFE-covered stents after liver transplantation and technical results in split and whole liver graft recipients.

To assess the outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation using PTFE-covered stents in liver transplant (LT) recipients and to analyze the technical result of TIPS creation in split grafts (SG) compared with whole liver grafts (WG). Single-center, retrospective study, analyzing LT patients who underwent TIPS using PTFE-covered stents. Clinical and technical variables were analyzed. Between 2005 and 2021, TIPS was created using PTFE-covered stents in 48 LT patients at a median of 43 months (range, 0.5-192) after LT. TIPS indications were refractory ascites (RA) in 33 patients (69%), variceal bleeding (VB) in 9 patients (19%), others in 6 (12%). Ten patients (21%) received a SG. Technical success rate was 100% in both groups: in two WG recipients, (5%) a second attempt was required. An unconventional approach (combined transhepatic or transplenic access) was needed in 2 WG (5%) and 2 SG recipients (20%). Two procedure-related death occurred in the WG group. After a median follow-up of 22 months (range, 0,1-144), 16 patients (48%) in the RA group did not require post-TIPS paracentesis, in the VB group rebleeding occurred in 3 patients (33%). Fifteen patients (31%) underwent TIPS revision. Overt hepatic encephalopathy occurred in 14 patients (29%). Patient survival at 6 months, 1 year, and 3 years was 77%, 66%, and 43%, respectively. The feasibility and safety of TIPS creation in SG are comparable to that of WG. TIPS creation using PTFE-covered stents represents a viable option to treat portal hypertensive complications in LT recipients. • TIPS creation using PTFE-covered stents represents a viable option to treat complications of PH in LT recipients. • TIPS creation in LT SG recipients appears to be safe and feasible as in WG. • Results from this study may help to refine the management of LT patients with recurrent portal hypertensive complications encouraging physicians to consider TIPS creation as a treatment option in both SG and WG recipients.

Comparative Study of Clinical Profile and Outcome Among Variceal and Nonvariceal Bleeding in a Tertiary Referral Hospital of Nepal During Covid Pandemic

Introduction: Upper Gastrointestinal Bleeding is a common medical emergency that is broadly classified into variceal and non-variceal bleeding. Preendoscopicemperical treatment is based on clinical findings and laboratory parameters. The article aimed to compare these parameters among variceal and non-variceal bleeding. Materials and Methods: This is a retrospective descriptive study conducted in a tertiary level referral hospital after taking approval from the Institutional review board. The data included was from September 2020 to August 2021. All patients with relevant data who underwent upper GI endoscopy were enrolled. The clinical and laboratory parameters were compared using appropriate statistical tests. Results: A total of 85 patients were studied with 40 (47.06%) in the variceal and 45 (52/94%) in the non-variceal group. Significantly more patients in the variceal bleeding group had a history of alcohol consumption (85% vs 60%) and smoking history (52.50 % vs 31.10%) compared to the non-variceal group. Jaundice, ascites, splenomegaly, low platelet count, and high INR all were predictors of variceal bleeding (p&lt;0.005). In the variceal group, 39 (97.5%) needed endo therapy compared to only 4 (8.9%) in the non-variceal group. Conclusions: Clinical and laboratory parameters differ significantly in the variceal and non-variceal groups which can guide the pre-endoscopic management of the patients.

Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices

Upper gastrointestinal bleeding (UGIB) is common in liver cirrhosis. Although esophageal and gastric varices (EGV) is the main bleeding source, there were still a proportion of patients with peptic ulcer bleeding. Thus, this study aimed to analyze the characteristic of variceal bleeding and peptic ulcer bleeding in liver cirrhosis. Cirrhotic patients with confirmed UGIB by urgent endoscopy from July 2012 to June 2018 were enrolled, and classified into peptic ulcer bleeding group (n = 248) and variceal bleeding group (n = 402). Clinical and endoscopic characteristics, therapeutic efficacy and prognosis were evaluated, and independent risk factors for 42-day morality were determined. The mean age and gender ratio of peptic ulcer bleeding group were higher than those in variceal bleeding group (55.58 ± 11.37 vs. 52.87 ± 11.57, P < 0.01; 4.51:1 vs. 2.87:1, P = 0.023). Variceal bleeding group most commonly presented as red blood emesis and coffee grounds (67.16%), while peptic ulcer group primarily manifested as melena (62.10%). Hepatocellular carcinoma was more prevalent in peptic ulcer group (141 vs. 119, P < 0.01). Albumin level in variceal bleeding group was lower higher (P < 0.01), but serum bilirubin, creatinine and prothrombin time were significantly higher (all P < 0.01). Success rate of endoscopic hemostasis for variceal bleeding and peptic ulcer bleeding was 89.05% and 94.35% (P = 0.021). Univariate and multivariate analysis identified prothrombin time (P = 0.041, OR [95% CI] 0.884 [0.786–0.995]), MELD score (P = 0.000, OR [95% CI] 1.153 [1.073–1.240]), emergency intervention (P = 0.002, OR [95% CI] 8.656 [2.219–33.764]), hepatic encephalopathy before bleeding (P = 0.003, OR [95% CI] 8.119 [2.084–31.637]) and hepatic renal syndrome before bleeding (P = 0.029, OR [95% CI] 3.877 [1.152–13.045]) as the independent predictors for 42-day mortality. Peptic ulcer bleeding should be distinguished from variceal bleeding by clinical and endoscopic characteristics.

Connective Tissue Dysplasia is a Possible Predictor of Esophageal Variceal Bleeding in Liver Cirrhosis

The aim of this work is to assess the connective tissue skeleton of esophageal varices in patients with liver cirrhosis for the study of morphological predictors of variceal bleeding.Material for morphological research were the fragments of the esophageal wall from the lower third of esophagus taken at autopsy (samples of 10 cases in each group). Four groups of samples were: cirrhotic patients who died due to initial variceal bleeding (group 3), due to recurrent variceal bleeding (group 4). The control (comparing group) consists of fragments of the intact wall of the lower third of the esophagus in patients who died from other pathologies (group 1), and dead from liver cirrhosis, who hadn't pronounced esophageal varices, whose death was not associated with bleeding (group 2).Immunohistochemistry was performed on paraffin sections with a thickness of 5–6 μm using an indirect Coons method. The collagens were identified by monoclonal antibodies (MA) to collagen I, III, IV types (Chemicon International Inc., Daco Cytomation, USA). According to the original technique, it was determined the intensity of the fluorescence of preparation treated with MA and expressed in arbitrary units of fluorescence (AUF).In cirrhotic patients with variceal bleeding revealed the predominance of immature collagen type III (instead of dominated collagen type I) in the composition of the connective tissue of the mucous membrane and submucosal layer of the esophagus, increased intensity of collagen type III in the vascular wall and perivascular space, decrease of fluorescence intensity of collagen type IV in the basal membranes of veins (tables 1, 2). Abnormalities of collagen formation in the basal membranes of the esophageal veins, as well as the replacement of the elastic and muscular elements of the venous walls with immature connective tissue can lead to thinning and rupture of the vein wall.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Serum concentration levels of magnesium, copper, and zinc in patients with post-viral liver cirrhosis

Abstract. Liver cirrhosis and chronic liver failure are leading causes of morbidity and mortality, caused by excessive viral hepatitis (B or C), alcohol consumption, or nonalcoholic fatty liver disease. Aim: The aim of this study was to evaluate serum concentrations of magnesium, copper, and zinc in post-viral liver cirrhosis patients. Materials and methods: This study was conducted in the Emergency Department (ED) and included 32 patients with post-viral liver cirrhosis with variceal bleeding, 32 patients with post-viral liver cirrhosis without variceal bleeding, and 35 patients without cirrhosis which served as control group. Serum concentrations of zinc, copper, and magnesium were determined using atomic absorption spectrophotometry. Statistical analyses were performed using Pearson’s correlation test and ANOVA test. Results: The serum levels of magnesium (11.490 ± 2.94 mg/L) and zinc (0.7959 ± 0.39 mg/L) were significantly decreased (p < 0.05) in postviral cirrhotic patients with variceal bleeding and without variceal bleeding compared with control group. Also, the mean serum concentration of copper (1.7519 ± 0.78 mg/L) was significantly increased (p < 0.05) in patients with postviral liver cirrhosis. The mean difference of magnesium (8.722 mg/L) using the Child-Pugh score in postviral liver cirrhotic patients with variceal bleeding was statistically significant (p < 0.05). Conclusion: There are significant differences between total magnesium, zinc, and copper serum concentrations between postviral cirrhotic patients with variceal bleeding compared to cirrhotic patients without variceal bleeding and control group.

Is the Promising AIMS-65 Score Really Useful? An European Center Experience

Introduction: Current guidelines recommend risk assessment as an initial step in the management of patients with upper gastrointestinal bleeding. AIMS65 is a five factor score recently proposed to be used in the UGIB setting. The aim of this study was to compare the accuracy of AIMS65 score in predicting clinically relevant outcomes between variceal and non-variceal bleeding patients. Methods: Retrospective single-center study including 315 UGIB episodes between January 2011 and December 2014. For each patient clinical, demographic, laboratorial and endoscopic data were collected and AIMS65 score (albumin, INR, altered mental status, systolic blood pressure, and age older than 65 years) was calculated. The accuracy of AIMS65 score to predict clinical outcomes (30-day mortality, 30-day rebleeding, blood transfusion, endoscopic therapy, and surgery) was evaluated using area under the ROC curve (AUROC). Results: From the analyzed patients, 195 (61.9%) were men, and the mean age was 68 years. Variceal and non-variceal bleeding was confirmed in 75 (23.8%) and 186 (59.0%) patients, respectively. In 54 patients (17.1%) no bleeding origin was found during upper endoscopy. There were no significant differences in the mean AIMS65 score between the variceal and non-variceal bleeding group (1.81 vs 1.70; p=0.442). When applied to variceal bleeding patients, AIMS65 score could fairly predict 30-day mortality (AUROC=0.723), but not 30-day rebleeding (AUROC=0.529) and need for blood transfusion (AUROC=0.612). As all patients in this group received endoscopic therapy and any of them required a surgical intervention, AIMS65 score could not be assessed for these outcomes. Contrarily, when applied to non-variceal bleeding patients, AIMS65 score was not able to predict any of the studied outcomes, namely 30-day mortality (AUROC=0.604), 30-day rebleeding (AUROC=0.521), endoscopic therapy (AUROC=0.535), and need for blood transfusion (AUROC=0.657) or surgery (AUROC=0.586). Conclusion: Although AIMS65 score may be useful to predict mortality in patients with variceal bleeding, it is not a reliable score to predict other clinically relevant outcomes. Furthermore, this score seems to be useless in non-variceal bleeding cases, which may preclude its routine use for initial assessment of patients in the emergency department.

Assessment of risk of complications in cirrhosis using portal thallium scans

To investigate the usefulness of a novel thallium scan shunt index for assessing portosystemic shunt-related cirrhotic complications. We enrolled 209 chronic hepatitis B-related cirrhosis patients. After rectal thallium instillation, radioactive isotope activity in the heart and liver was measured. The ratio of radiation uptake between the heart and the liver was calculated (the shunt index). This value indicates the degree of portosystemic circulation shunting. Blood tests, serum biochemistry tests, abdominal ultrasonography, gastroscopy and examination of clinical features such as the occurrence of varices, bleeding and hepatic encephalopathy were performed. Multivariate analysis was used to identify independent risk factors for complications. We compared the cumulative incidence rates of complications during the follow-up period. The thallium scan shunt index was significantly higher in the decompensated liver cirrhosis group than in the compensated liver cirrhosis group (0.91 ± 0.39 vs 0.39 ± 0.32, P < 0.001). It was also higher in the varices group, the hepatic encephalopathy group, and the variceal bleeding group than in the control group (P < 0.001). Multivariate analysis showed that the index was an independent risk factor for predicting decompensated liver cirrhosis. When the cut-off value was 0.75, the shunt index had a sensitivity of 82.6%, a specificity of 84%, a positive predictive value of 61.5%, and a negative predictive value of 94.4% in diagnosing decompensated cirrhosis. When the shunt index was greater than 0.75, there was a significant increase in the number of decompensated events. The thallium shunt index is a good predictor of cirrhosis-related complications.

Outcome of Upper Gastro Intestinal Haemorrhage - a Hospital Based Prospective Study

Upper GI bleeding is a common medical emergency with a significant mortality, outcome of which depends upon the cause, appropriate and early intervention in a specialized center. This study was carried out to see the outcome of patient with Upper GI haemorrhage. Fifty cases with episode of upper gastrointestinal haemorrhage, admitted into medicine units of Faridpur Medical College Hospital from January 2011 to December 2011, were studied. Duodenal ulcer was the commonest cause of haematemesis and melaena followed by oesophageal varices, gastric ulcer and erosive gastritis. The peak incidence was among 35 to 45 years of age. Over all male female ratio was 4.55:1 but in case of duodenal ulcer it was 9:1. During hospital stay recurrent bleeding was noted in 10% of patients and during subsequent follow up it was 10% of the total and 50% in case of variceal bleeding group. Over all hospital mortality was 4% . DOI: http://dx.doi.org/10.3329/fmcj.v8i1.16891 Faridpur Med. Coll. J. 2013;8(1): 15-17

Aetiology and Management Outcome of Upper Gastrointestinal Bleeding in Adult Patients Presenting at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria

BACKGROUND AND AIM : Upper gastrointestinal bleeding (UGIB) is one of the commonest gastrointestinal emergencies. Endoscopy done within the first 24 hours of bleeding has been shown to be the most reliable means of establishing the source of upper gastrointestinal haemorrhage. This study was carried out to determine the aetiology and management outcome of patients with UGIB presenting at our facility located in Southwest Nigeria. MATERIALS AND METHOD : 67 patients who presented with UGIB and underwent upper gastrointestinal endoscopy between April 2010 and March 2011 at the Ekiti State University Teaching Hospital (EKSUTH), Ado- Ekiti, Southwest Nigeria were retrospectively studied, relevant data extracted and analysed. RESULTS : The demographic data of the patients showed a mean age of 41.84± 12.81 years, (ages ranged from 17 to 75 years), 40 (59.7%) were males while 27 (40.3%) were females giving a male to female ratio of 1.5:1. Clinical presentations included haematemesis and melena in 26 (38.8%), followed by haematemesis in 22 (32.8%) and melena in 19 (28.4%) of the patients. Antral mucosal erosions were the commonest cause of UGIB (49%), followed by peptic ulcer disease (25.4%), varices (11.9%) and gastric mass (1.5%). No cause for UGIB was found in 8 cases (11.9%). Endoscopy diagnostic accuracy was greater within the first 24 hours of the bleeding onset compared to those who had it done later (p<0.003). Three patients died giving a mortality rate of 4.5%. These deaths were recorded from among the variceal bleeding group giving a mortality rate of 42.9% in this group of patients. CONCLUSION : Antral mucosal erosions were the commonest cause of UGIB in our environment. NSAIDS intake was very high among the populace, especially in mucosal erosion group leading to high morbidity, absent from work and huge financial cost. It is recommended that serious awareness campaigns be mounted to educate the populace of the dangers inherent in indiscriminate use of NSAIDS in our society. As endoscopy diagnostic accuracy was greater within the first 24 hours of the bleeding onset, it is equally recommended that early endoscopy should be performed within 24 h of the onset of bleeding.

Changes in the clinical outcomes of variceal bleeding in cirrhotic patients: a 10-year experience in gangwon province, South Korea.

Background/AimsVariceal rupture is one of the main causes of mortality in cirrhotic patients. However, there are limited data on the long-term outcomes of variceal bleeding.MethodsWe investigated the incidence and mortality of variceal bleeding at three endoscopic centers in Gangwon province during 3 periods (August 1996 to July 1997, August 2001 to July 2002, and August 2006 to July 2007).ResultsA total of 1,704 upper gastrointestinal (GI) bleedings occurred during the study periods. Peptic ulcers were found in 825 patients (48.5%), and variceal ruptures were found in 607 patients (35.6%). The variceal bleeding rate did not decrease in each period (26.0% vs 43.7% vs 33.9%, respectively). In the variceal bleeding group, the 6-week mortality rate steadily and significantly decreased (15.5% vs 10.8% vs 6.4%, respectively, p=0.027). In addition, the mortality rate was significantly higher in the variceal bleeding group than in the non-variceal bleeding group (10.4% vs 2.0%, p<0.001; odds ratio, 5.659; 95% confidence interval, 3.445 to 9.295).ConclusionsVariceal bleeding was still the major cause of upper GI bleedings and did not decrease in prevalence over the 10-year period in Gangwon province, South Korea. However, the mortality rate of variceal bleeding decreased significantly.

Increased Serum Activity of Matrix Metalloproteinase-9 in Patients with Acute Variceal Bleeding

Background/AimsMatrix metalloproteinases (MMP)-2 and -9 can degrade essential components of vascular integrity. The aim of this study was to investigate the association between those MMPs and variceal bleeding (VB).MethodsFifteen controls, 12 patients with acute ulcer bleeding (UB) group, 37 patients with varix (V group), and 35 patients with acute VB group were enrolled. Serum was obtained to measure MMP-2 and -9 activity by zymogram protease assays.ResultsThe activity levels of these compounds were compared with the controls' median value. The median MMP-9 activity was 1.0 in controls, 1.05 in the UB group, 0.43 in the V group, and 0.96 in the VB group. The level of MMP-9 activity was higher in the VB group than in the V group (p<0.001). In the VB group, there was a signifi cant decrease in MMP-9 activity over time after bleeding (p<0.001). The median MMP-2 activity level was 1.0 in controls, 1.01 in the UB group, 1.50 in the V group, and 1.55 in the VB group. The level of MMP-2 activity was similar in the VB and V groups.ConclusionsThe level of MMP-9 activity increased in association with VB. The role of MMP-9 in the pathogenesis of VB should be verified.

Less-invasive MR indices of clinically evident esophageal variceal bleeding in biliary atresia patients

Esophageal variceal hemorrhaging is potentially life threatening for long-term survivors of biliary atresia. We evaluated the feasibility of less-invasive parameters for predicting the presence of clinically significant esophageal variceal bleeding in biliary atresia patients. A total of 30 patients aged 108-5314 days (median = 285 days) with biliary atresia underwent a magnetic resonance examination with fast spin-echo T2-weighted imaging and spin-echo, T1-weighted images with fat saturation after use of a contrast medium on a 1.5-tesla scanner. The splenic length-platelet ratio was divided by the each patient's body height (m) to produce the corrected splenic length-platelet ratios. In addition, the splenic volume index-to-platelet count ratio was divided by the patient's body weight (kg) to produce a corrected ratio. The corrected splenic length-platelet ratio was more significantly increased in 21 patients with esophageal variceal bleeding (Group A) than in nine patients without variceal bleeding [(Group B) 0.98 ± 0.64 vs. 0.44 ± 0.18, p < 0.01]. The splenic volume index-to-platelet count ratio corrected by body weight was significantly larger in Group A (510.7 ± 536.2) than in Group B (148.1 ± 88.9, p < 0.01). Less-invasive indices, including the corrected splenic length platelet ratio and the splenic volume index-to-platelet count ratio, may be valuable predictors of esophageal variceal bleeding in patients with biliary atresia.

Is the Glasgow Blatchford Score useful in the risk assessment of patients presenting with variceal haemorrhage?

IntroductionThe Glasgow Blatchford Score (GBS) is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage (UGIH). It can predict need for intervention or death and identifies low...

Outcomes of Patients with Hepatocellular Carcinoma Presenting with Variceal Bleeding

Variceal bleeding is an important manifestation of hepatocellular carcinoma (HCC). However, little has been documented in the literature regarding the outcomes of HCC patients presenting with variceal bleeding. This study evaluated the clinical characteristics, management, and outcomes of this specific group of patients. A retrospective analysis of a prospectively collected database comprising 2,928 HCC patients managed from January 1989 to December 2002 identified 78 patients who had presented with variceal bleeding. Their clinical outcomes were compared to those patients who did not present with variceal bleeding, and a multivariate analysis was performed to identify prognostic factors for their survival. HCC patients who presented with variceal bleeding had more severe cirrhosis than those who did not, with a significantly higher serum bilirubin level, lower albumin level, lower platelet count, and longer prothrombin time. They had significantly smaller HCCs but more frequent portal vein thrombosis. There was a significant difference in the overall survival between HCC patients who presented with variceal bleeding and those who did not (median 3.5 months vs 7.5 months, p < 0.001). In the variceal bleeding group, by multivariate analysis, treatment with transarterial chemoembolization was the only significant independent prognostic factor for survival (odds ratio 17.16, 95% CI: 2.81-104.91, p= 0.002). HCC patients who presented with variceal bleeding can be expected to have a significantly worse survival outcome than the general HCC patients. However, transarterial chemoembolization may offer some survival benefit to a selected group of HCC patients presenting with variceal bleeding.

Effect of endoscopic sclerotherapy of esophageal varices on vagus nerve integrity

Endoscopic sclerotherapy is an effective method of controlling variceal hemorrhage, but complications frequently occur. Recent studies have shown that sclerotherapy may induce transient alterations in gastrointestinal motility. It has been suggested that these complications result from vagal nerve injury due to sclerotherapy. We have tested this hypothesis by measuring pancreatic polypeptide secretion in response to insulin-induced hypoglycemia (insulin 0.1 U/kg i.v.), a well-known stimulus for vagal nerve function. We studied six patients with cirrhosis and variceal bleeding (group A, mean age 52 years) on two occasions, before and 3 days after the first sclerotherapy. In addition six other patients with cirrhosis (group B, mean age 51 years) 6 months after successful repeated sclerotherapy for esophageal varices and 12 control subjects (mean age 50 years) were investigated. Basal plasma pancreatic polypeptide concentrations were not significantly different between group A patients before sclerotherapy (28 +/- 4 pM) or after sclerotherapy (24 +/- 6 pM), group B patients (40 +/- 9 pM) and controls (29 +/- 4 pM). Although the plasma pancreatic polypeptide peak increment in response to insulin hypoglycemia was reduced in group A patients after sclerotherapy (90 +/- 35 pM) compared to pre-sclerotherapy (120 +/- 18 pM), to group B patients (146 +/- 20 pM) and to controls (143 +/- 7 pM), this difference was not significant. Nor did sclerotherapy significantly reduce the integrated pancreatic polypeptide secretion between or within groups. However, in two group A patients a transient and reversible reduction in pancreatic polypeptide secretion was observed directly after sclerotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)