Varices In Chronic Liver Disease Research Articles

Validation of Shear Wave Elastography as a Non-Invasive Procedure To Detect & Grade Esophageal Varices In Chronic Liver Disease.

Validation of Shear Wave Elastography as a Non-Invasive Procedure To Detect & Grade Esophageal Varices In Chronic Liver Disease.

Correlation of Liver Elastography as a Predictor of Esophageal Varices and Its Comparison With Ultrasound Abdomen and Liver Function Tests in Patients With Chronic Liver Disease.

Variceal haemorrhage is a life-threatening complication that occurs in up to 40% of patients with chronic liver disease including cirrhosis. It is associated with a mortality rate of 20%with each episode of variceal bleeding. Esophagogastroduodenoscopy is the gold standard for the detection of esophageal varices but is an invasive procedure and not verycost-effective. Our study was designed to correlate the presence of esophageal varices on endoscopywith the liver stiffness measurement using liver elastography inpatients with chronic liver disease. We also comparedvarious non-invasive predictors like laboratory parameters and ultrasound features andcorrelated them with the presence of varices inpatients with chronic liver disease. This prospective observational study was conducted ina tertiary-care hospital in South Indiafrom November 2017 to April 2019.All patients withchronic liver disease were subjected to endoscopy, and the presence ofesophageal varicesand their grading was noted. The predictive efficacy of ultrasound elastographyusing Toshiba Aplio 500 ultrasound two-dimensional shear wave elastography (2D-SWE) in predicting esophageal varices was calculated and compared with the efficacy of predictingesophageal varices by other non-invasive parameters like laboratory investigations, abdominal ultrasound, and liver scores like Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, fibrosis 4 (FIB-4) score,aspartate aminotransferase-to-platelet ratio index (APRI) score, andaspartate aminotransferase/alanine aminotransferase ratio (AAR). The study includeda total of 168 patients out ofwhich 57% (96 patients) had no varices. About 52 patients(72.2%) had F1/Grade I varices,9(12.5%) had F2/Grade II varices, and 11 (15.3%) had F3/Grade III varices. The greatest predictive value for esophageal variceswas liver stiffness with a diagnostic accuracy of 81.7%.Ultrasound features likecoarse echotexture of the liver (66.7%), splenomegaly (67%), dilated portal vein (78.6%), and presence of moderate ascites (66.7%) had asignificantstatistical association with the presence of esophageal varices. Laboratory parameters like thrombocytopeniaof less than 1.5 lakhs/cu.mm (52.8%), albumin <3 g/dL (60.4%), and reversal of albumin/globulin ratio(52.4%) weresignificant predictors of esophageal varices. The odds ratio for significant scores in predicting oesophageal varices using binary logistic regression was significant in patients whose liver elastography grade wasmore than F4, CTP score was B, MELD score was >11, and FIB-4 scoreswas >3.25 and between 1.46 and 3.25. Liver elastography is a non-invasiveprocedure that can be a useful tool in predicting esophageal varices in chronic liver disease. Other non-invasive predictorslike ultrasound abdomen and laboratory parameters canalso be considered a replacement for repeatedinvasive endoscopy, thusfacilitating early intervention and avoiding unfavourable outcomes in patients withchronic liver disease.

Umbilical Bleed as a Rare Presentation of Ectopic Varices in Chronic Liver Disease

Umbilical Bleed as a Rare Presentation of Ectopic Varices in Chronic Liver Disease

A Study of Thrombocytopenia in Chronic Liver Disease and Its Correlation with Development of Esophageal Varices

Background: The aim and objective of this study was to evaluate relationship of platelet count and esophageal varices in chronic liver disease (CLD) admitted in the medicine unit and gastroenterology department of Dhaka Medical College Hospital. Methods: In this cross-sectional study, a total number of 100 randomly selected, clinically diagnosed patients of chronic liver disease were studied from June 2010 to November 2010 (6 months). All patients were assessed as per Child-Pugh class and had full blood count, HBsAg, Anti-HCV antibodies by ELISA, abdominal ultrasound and Endoscopy of upper gastrointestinal tract. Patients were divided into Group A (Platelet count &lt;1,50,000) and Group B (platelet count&gt;1,50,000). Result: 73 male (73%) and 27 female patients (27%) with age range of 16 to 75 years were evaluated. 24% patient were in between 45-55 years age group. 63% patient fall in child Pugh class A group, 32% fall in child Pugh class B &amp;5% fall in child Pugh class C. Esophageal varices were present in 32 patients (32%) and absent in 68 patients (68%). Group A had 31 patients (31% of the total) with 26 patients (83.87%) having esophageal varices. Group B had 69 patients (69% of the total) with 6 patients (8.70%) having esophageal varices. Sensitivity of thrombocytopenia as a marker of esophageal varices was 81.25% and specificity 92.64%, positive predictive value 83.87% and negative predictive value 91.3% and Odds ratio was 54.6. P value is &lt;0.001. Conclusion: In this study, It was attempted to find out the relationship between thrombocytopenia and esophageal varices in CLD. In Group A that is platelet count &lt;1,50,000, the incidence of EV was more than Group B (platelet count &gt;1,50,000). Hence, thrombocytopenia is a good surrogate marker for the presence of esophageal varices in CLD. Bangladesh J Medicine 2022; 33: 247-251

Spleen Stiffness Measurement as Non-Invasive Surrogate for Esophageal Varices in Chronic Liver Disease

Background: In patients with chronic liver diseases, liver and spleen stiffness measurement by elastography is the most recent available noninvasive tool. However, the accuracy for prediction of esophageal varices has been inconsistent across various studies. So, this study was done to evaluate the diagnostic performance of spleen stiffness measurement for detecting esophageal varices.&#x0D; Materials and Methods: This descriptive cross-sectional study was done from 19 March to 30 June 2019. Participants who met inclusion and exclusion criteria were consecutively enrolled for the study and underwent upper gastrointestinal endoscopic examination along with measurement of liver and spleen stiffness by fibroscan.&#x0D; Results: A total of 78 patients were enrolled. Mean age (±SD) was 49.79 (±10.92) years. Of 78 patients, 58 (74.4 %) had esophageal varices. Among patients with varices, Small esophageal varices were present in 44.8 % (26) and large esophageal varices were present in 55.2 % (32).Liver stiffness higher than 21.7 kPa was found to detect patients with large esophageal varices and the area under the receiver operating curve being 0.79 (95% confidence interval: 0.69 – 0.89); p&lt;0.001. It had sensitivity of 100.0% and specificity of 63% in predicting the presence of large esophageal varices. While, spleen stiffness having a cutoff value of 40 kPa with the area under the receiver operating curve being 0.98 (95% confidence interval: 0.96 – 1.00); p&lt;0.001, had sensitivity of 100.0 % and specificity of 87.0 % in predicting the presence of large esophageal varices.&#x0D; Conclusion: Spleen stiffness measurements by Transient Elastography predict large esophageal varices better than liver stiffness measurements.

An Audit of more than a Thousand uppergastrointestinal Endoscopy in a Tertiary Care Teaching Hospital in South India

Background: Esophagogastroduodeno (EGD) scopy is a benchmark in the modern era of medicine. It is a sensitive tool used to evaluate the upper gastrointestinal (GI) symptoms. Application of EGDscopy is not merely restricted to diagnosis but as well used for therapeutic purpose. Aim of the Study: To find out the common indications for EGDscopy and its findings in a large tertiary care hospital attached to Bangalore medical college and research institute (BMCRI), Bengaluru. Materials and Methods: A retrospective study was conducted on 1030 patients either admitted or seen on outpatient basis at the Bowring and Lady Curzon hospital attached to BMCRI, Bengaluru with the upper GI symptoms like dyspepsia, dysphagia, epigastric pain abdomen, hematemesis etc from September 2016 to August 2018 and the data was analyzed using appropriate statistical methods. Results: Out of 1030 patients who underwent EGDscopy 62% were male and 61% were 31-59year old. The major indications for EGDscopy were epigastric abdominal pain (18%), dyspepsia (18%), chronic liver disease (15%), dysphagia (11%) and hematemesis (8%). The common pathological findings in the above mentioned indications were gastritis and esophagitis in patient with both epigastric abdominal pain and dyspepsia, portal hypertensive gastropathy and esophageal varices in chronic liver disease, esophageal growth in dysphagia and esophageal varices (EV) in cases of hematemesis. Conclusions: The following insights/observations were made during the course of our study-dysphagia is not just oropharyngeal or esophageal in origin but H. pylori gastritis can cause similar complaints, eradication of which relieves the symptoms in our observation. Chronic abdominal pain associated with postprandial urgency which is deemed as Inflammatory Bowel Disease-Diarrhea (IBS-D) may actually be H. pylori gastritis with exaggerated gastro-colic reflex which gets relieved with anti- H. pylori treatment; further studies are needed to prove this claim. Mosaic like pattern with focal areas of hyperemia in the gastric body mucosa is not just typical of portal hypertensive gastropathy but also can be seen with H. pylori gastritis. Corrosive acid ingestion as a mode of suicidal attempt is common in this part of India which can lead to morbidity and even mortality in severe cases, legislative measures need to be put in place to check the sale and use of corrosive acid. Diffuse white spots in duodenum were mostly due to chronic nonspecific duodenitis rather than intestinal lymphangiectasia in our study.

Usefulness of Splenic Stiffness Measurement for Predicting Esophageal Varices in Chronic Liver Disease

Usefulness of Splenic Stiffness Measurement for Predicting Esophageal Varices in Chronic Liver Disease

The Correlation between Serum Ascites Albumin Gradient and Oesophageal Varices in Chronic Liver Disease

Background: Oesophageal varices are abnormally enlarged veins in the tube that connect the throat and esophagus. Such condition occurs most often in people with serious liver diseases. On the other hand, chronic liver disease denotes the disease of the liver which lasts over a period of months or more. The serum ascites albumin gradient (SAAG) is a formula that is used to assist in determining the etiology of ascites. We don’t have any research-based information regarding the correlation between serum ascites albumin gradient and Oesophageal varices in chronic liver disease. Aim of the study: The aim of this study was to assess the correlation between serum ascites albumin gradient and Oesophageal varices in chronic liver disease. Methods: This prospective observational study was conducted in the Department of Hepatology, BSMMU, Dhaka, Bangladesh during the period from January 2005 to December 2005. In total 50 patients with cirrhosis with ascites with high SAAG values (&gt;1.1 gm/dl) were included as the study people. The age of the patients was 15 to 70 years. Both males and females were included in the study. All data were entered into a personal computer, thoroughly checked for any possible error, and then processed and analyzed by the SPSS program. The significance of the test was tested by the chi-square test. P-value of &lt;0.05 was taken as statistically significant. Correlation analysis was done by the Pearson correlation test. Results: In this study, in the SAAG group 1.10-1.49 gm/dl, there were 15 patients, 8 patients (53.28%) of them had small varices, 4 patients (26.64%) had medium-sized varices and 2 patients (13.32%) had large-sized varices. In the SAAG group 1,50-1.99 gm/dl, there were 9 patients, 1 patient (11.11%) of them had small sized varices, 6 patients (66.66%) had medium sized varices and 2 patients (22.22%) had large-sized varices. In SAAG group &gt;2 gm/dl, there were 26 patients. Nine (9) patients (34.2%) of them had small-sized varices, ..........

PLATELET COUNT AND SPLEEN DIAMETER RATIO FOR NON INVASIVE DIAGNOSIS OF ESOPHAGEAL VARICES

BACKGROUND: Portal Hypertension and its consequences mainly, Esophageal Varies (EVs) is one of the most important causes of morbidity and mortality in patients with cirrhosis of liver. Upper GI endoscopy is the investigation of choice for diagnosis of EVs and periodic endoscopies have been recommended for monitoring of varices. There is a need for non-invasive parameters to detect the presence of EVs. Identication of noninvasive predictors of EVs will help us to carry out EGD in selected groups of patients. Unnecessary endoscopies can be avoided and at the same time, patients who require endoscopy can be referred to a higher center, where facilities for endoscopy are available. Among the non-invasive modalities, the platelet count and bipolar spleen diameter ratio has shown promising results in terms of its accuracy in predicting the presence of Esophageal Varices in many studies MATERIALS AND METHODS: Patients with chronic liver disease diagnosed using clinical, Laboratory and ultrasound parameters were assessed using esophagogastroduodenoscopy for the presence or absence of esophageal varices. USG abdomen was done to assess for bipolar splenic diameter and the presence or absence of EV's was correlated with the platelet count/ splenic diameter ratio, CHILD SCORE, MELD score, Platelet count alone and splenic diameter alone. Platelet count/SD ratio of 909 based on previous studies was correlated with the presence or absence of varices. Statistical analysis was done using IBM SPSS software version 20.0 and variables showing statistically signicant correlations with presence of arices were used for plotting ROC curves to assess the cut of points which could be used for non invasive prediction of varices. RESULTS: The PC/SD ratio cut off (909), based on previous studies for non invasive diagnosis of Esophageal Varices gave sensitivity and specicity of 97.9% and 91.7% respectively, in our study, which was statistically signicant (P value &lt;0.001). The positive predicitive value and negative predictive value of the PC/SD ratio (909) was 96.5% and 94.8% respectively and the accuracy of the test was 96%. ROC curve for Platelet count and Splenic diameter ratio area under the curve is 97.8% with P value &lt; 0.001 and cutoff value 895.02 with sensitivity 96.6% and specicity 96.5%. The Positive predictive value and negative predictive value of PC/SD ratio of 895 was found to be 98.6% and 91.8% respectively and the accuracy of the test 96.5%. ROC curve for Child score in our study, area under the curve 71% with a signicant P value &lt; 0.001, and cut-off value obtained for Child score was 8.50 with sensitivity 64.8% and specicity 63.8 %. ROC curve for MELD score revealed area under the curve was 74.3% with P value as &lt; 0.001, and the cut-off value was 15.5 with sensitivity 67.6 % and specicity 67.2%. ROC curve for Platelet count in our study, the area under the curve was 94.5% with P value as &lt; 0.001, and the cut-off value was 108500 with sensitivity and specicity of 89.7% and 89.4% respectively. The ROC curve for Spleen diameter in our study revealed that the area under the curve was 86.8%% with P value as &lt; 0.001, and the cutoff value was 121 with sensitivity and specicity of 78.9% and 81.0% respectively. CONCLUSION: Among the variables studied for non-invasive diagnosis of Esophageal varices, the Platelet count / Spleen diameter ratio had the best sensitivity and specicity for diagnosing EVs. In view of low sensitivities and specicities for the cut off values obtained for Child score, MELD score, platelet count and spleen diameter, these indices may not be useful as PC/SD ratio in the non-invasive prediction of EV's. The Platelet count / Splenic diameter ratio may be proposed as a safe parameter for diagnosing Esophageal Varices in Chronic Liver disease noninvasively, where resources are limited and endoscopy facilities are not available, to select the patients with probable Esophageal Varices who can be referred to higher centres

Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis

ObjectivesTo systematically review studies on the diagnostic accuracy of spleen stiffness measurement (SSM) for the detection of clinical significant portal hypertension (CSPH), severe portal hypertension (SPH), esophageal varices (EV), and high-risk esophageal varices (HREV) in patients with chronic liver diseases (CLD).MethodsThrough a systematic search, we identified 32 studies reporting the accuracy of SSM for the diagnosis of portal hypertension (PH) and/or EV in adults with CLD. A bivariate random-effects model was performed to estimate pooled sensitivity, specificity, likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratios (DOR). The clinical utility of SSM was evaluated by Fagan plot.ResultsA total of 32 studies assessing 3952 patients were included in this meta-analysis. The pooled sensitivities of SSM were 0.85 (95% confidence interval (CI), 0.69–0.93) for CSPH; 0.84 (95% CI, 0.75–0.90) for SPH; 0.90 (95% CI, 0.83–0.94) for any EV; and 0.87 (95% CI, 0.77–0.93) for HREV. The pooled specificities of SSM were 0.86 (95% CI, 0.74–0.93) for CSPH; 0.84 (95% CI, 0.72–0.91) for SPH; 0.73 (95% CI, 0.66–0.79) for EV; and 0.66 (95% CI, 0.53–0.77) for HREV. Summary PPV and NPV of SSM for detecting HREV were 0.54 (95% CI, 0.47–0.62) and 0.88 (95% CI, 0.81–0.95), respectively.ConclusionsOur meta-analysis suggests that SSM could be used as a helpful surveillance tool in management of CLD patients and was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy.Key Points• SSM could be used to rule out the presence of HREV in patients with CLD thereby avoiding unnecessary endoscopy.• SSM has significant diagnostic value for CSPH and SPH with high sensitivity and specificity in patients with CLD.• SSM could be used as a helpful surveillance tool for clinicians managing CLD patients.

Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography

Role of noninvasive tools for prediction of clinically evident portal hypertension in children.

Noninvasive tools (NITs) for predicting varices in children with portal hypertension (PHTN) are infrequently used. Eighty-five consecutive, treatment-naïve children with PHTN and 97 controls were enrolled study from July 2017 to November 2018. Each case was evaluated by esophagogastroduodenoscopy (EGD) and various NITs: platelet spleen size Z (PSZ), clinical prediction rule (CPR), King's variceal prediction rule (KVaPS), Splenic stiffness (SSM) and liver stiffness measurement (LSM) by point shear wave elastrography (pSWE). Had PHTN due to extra hepatic portal vein obstruction (EHPVO) and 70% due to cirrhosis [chronic liver disease (CLD)]. Sixty-five percent of PHTN cases had varices. Children with varices had lower platelet counts, lower albumin and larger spleens. SSM and LSM were significantly higher in cases as compared with controls. SSM was significantly higher in cases with varices than those without. SSM and LSM, at cutoffs of 3.8 and 3.2 kPa, respectively, discriminated PHTN cases from controls with an area under the curve (AUROC) of 0.67 (0.59-0.74). Both SSM and LSM predicted varices in CLD, but in EHPVO, only SSM predicted varices. SSM of 5.2 and 12.8 kPa, in CLD and EHPVO subgroups, respectively, had AUROC of 0.73 and 0.94 for variceal prediction. Blood-based NITs performed better in the CLD subgroup: aspartate aminotransferase platelet ratio index, CPR and KVPS predicted severity of PHTN with AUROC of 0.81, 0.92 and 0.93, respectively. Blood-based NITs outperform elastography for prediction of PHTN/varices in children with CLD. SSM by pSWE is a better predictor of varices than LSM, especially in the EHPVO subgroup.

Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices.

ObjectiveTo determine the diagnostic accuracy of multidetector computed tomography (MDCT) in the detection of esophageal varices by taking endoscopy as the reference standard.Materials and methodsThis was a cross-sectional prospective study conducted at the Department of Radiology, Aga Khan University Hospital, (AKUH) Karachi, for the duration of 12 months from August 1, 2014 to July 31, 2015. One hundred ninety-six patients with a suspicion of chronic liver disease/cirrhosis undergoing 64 slice MDCT were enrolled in our study and underwent computed tomography (CT) scanning in the Department of Radiology at AKUH. Biphasic CT was performed with images obtained during the hepatic arterial phase (30-second delay) and the portal venous phase (65-second delay) after the intravenous (IV) injection of 120 mL of nonionic contrast material at a rate of 3.5 mL/s. The presence of esophageal varices was evaluated on MDCT with endoscopy as gold standard. The sensitivity, specificity, negative predictive value and positive predictive value, and accuracy of MDCT were assessed against the gold standard.ResultsOur results yielded an MDCT sensitivity of 98.96%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 66.67%, and diagnostic accuracy of 98.97% for esophageal varices in chronic liver disease (CLD) patients.ConclusionThe rate of detection of esophageal varices in patients with chronic liver disease on MDCT in our country is comparable to the international data and we advocate that MDCT should be used as a screening tool in patients with chronic liver disease to exclude esophageal varices.

Doppler Sonography for Surrogate Markers of Gastro-Oesophageal Varices in Chronic Liver Disease

Doppler Sonography for Surrogate Markers of Gastro-Oesophageal Varices in Chronic Liver Disease

Correlation of portal vein diameter with the presence of oesophageal varices in chronic liver disease: a prospective study

Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(&gt;13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p&lt;0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.

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English

Spleen Stiffness Is Superior to Liver Stiffness for Predicting Esophageal Varices in Chronic Liver Disease: A Meta-Analysis.

Background and AimsLiver stiffness (LS) and spleen stiffness (SS) are two most widely accessible non-invasive parameters for predicting esophageal varices (EV), but the reported accuracy of the two predictors have been inconsistent across studies. This meta-analysis aims to evaluate the diagnostic performance of LS and SS measurement for detecting EV in patients with chronic liver disease (CLD), and compare their accuracy.MethodsPubmed/Medline, Embase, Cochrane Library and Ovid were searched for all studies assessing SS and LS simultaneously in EV diagnosis. A total of 16 studies including 1892 patients were included in this meta-analysis, and the pooled statistical parameters were calculated using the bivariate mixed effects models.ResultsIn detection of any EV, for LS measurement, the summary sensitivity was 0.83 (95% confidence interval [CI]: 0.78–0.87), and the specificity was 0.66 (95% CI: 0.60–0.72). While for SS measurement, the pooled sensitivity and specificity was 0.88 (95% CI: 0.83–0.92) and 0.78 (95% CI: 0.73–0.83). The summary receiver operating characteristic (SROC) curve values of LS and SS were 0.81 (95% CI: 0.77–0.84) and 0.88 (95% CI: 0.85–0.91) respectively, and the results had statistical significance (P<0.01). The diagnostic odds ratio (DOR) of SS (25.73) was significantly higher than that of LS (9.54), with the relative DOR value was 2.48 (95%CI: 1.10–5.60), P<0.05.ConclusionsUnder current techniques, SS is significantly superior to LS for identifying the presence of EV in patients with CLD. SS measurement may help to select patients for endoscopic screening.

Liver stiffness-spleen size-to-platelet ratio risk score detects esophageal varices in chronic liver disease.

BackgroundNoninvasive markers are needed to identify esophageal varices (EV) in patients with chronic liver disease (CLD). Recently, liver stiffness (LS)-spleen size-to-platelet ratio risk score (LSPS) has been shown to predict EV in patients with chronic hepatitis C. The aim of this study was to validate the clinical value of LSPS for EV detection and identification of high risk EV in Japanese patients with CLD.MethodsA total of 230 patients with CLD who had undergone endoscopy, LS measurement, and ultrasonography between 2013 and 2015 were enrolled. The relationships between clinical data and LSPS were compared with those for other noninvasive markers (aspartate aminotransferase-to-platelet ratio, FIB-4 index, and platelet-to-spleen ratio), along with platelet count, spleen size, and LS. Diagnostic and prognostic abilities were assessed by the area under the receiver operating characteristic curve (AUC) and multivariate logistic regression.ResultsLSPS correlated significantly with EV grade (P < 0.001) and was superior to the other noninvasive indices for determination of EV and high risk EV. Furthermore, LSPS was independently associated with the presence of EV (P < 0.001) and elevated EV risk (P = 0.013) by multivariate logistic regression analysis. The optimal cutoff values of LSPS for EV and high risk EV were 1.1 and 2.2, respectively, at which AUC, negative predictive value, and accuracy were 0.821 [95 % confidence interval (CI) 0.743–0.899], 91.9, and 84.3 % and 0.859 (95 % CI 0.736–0.981), 95.5, and 76.9 %, respectively.ConclusionsLSPS represents a useful, noninvasive, accurate method to detect EV and a high EV risk in Japanese patients with CLD.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2708-1) contains supplementary material, which is available to authorized users.

Acoustic Radiation Force Impulse (ARFI) Imaging: A Non Invasive Tool for Prediction of Esophageal Varices in Chronic Liver Disease

Acoustic Radiation Force Impulse (ARFI) Imaging: A Non Invasive Tool for Prediction of Esophageal Varices in Chronic Liver Disease

Thickening of Gallbladder Wall in Chronic Liver Disease - A Marker for Esophageal Varices

This study was done to find out the relationship between gallbladder wall thickening and esophageal varices in chronic liver disease (CLD) patients. A total of 61 CLD patients were included and divided into two groups. Group A included 13 CLD patients with no oesophageal varices and Group B composed of 48 CLD patients with esophageal varices. Mean gallbladder wall thickness (GBWT) of Group B was 5.6±0.2mm compared to 2.7±0.1mm of Group A. The mean differences of GBWT were statistically significant between group A and group B (P&lt;0.05). The mean GBWT was significantly (p&lt;0.05) higher in CLD patients with grade III and IV varices (6.1±.8 mm) compared to grade I and II (3.9±0.7 mm). The result suggests that GBWT may be considered as an important marker for the presence of esophageal varices in CLD patients. DOI: http://dx.doi.org/10.3329/imcj.v6i1.14713 Ibrahim Med. Coll. J. 2012; 6(1): 18-20