DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170652

Non-invasive markers for prediction of varices in patients with portal hypertension

Vijant Singh Chandail, Suman Kumar Kotwal, Shanky Koul, Rajesh Gupta, Annil Mahajan

Abstract


Background: The incidence of esophageal varices in patients with cirrhosis ranges from 35 to 80%. Thus, screening all cirrhotic patients with upper gastrointestinal (UGI) endoscopy to detect the presence of varices implies a number of unnecessary endoscopies, which increase the workload of endoscopy units and UGI endoscopy has its own limitations. The present study was conducted to investigate series of non-invasive biochemical and radiological markers for prediction of esophageal varices in patients with portal hypertension.

Methods: Patients of either sex, aged 18-80 years with diagnosis of chronic liver disease, cirrhosis, extrahepatic portal vein obstruction or any other cause of portal hypertension were studied. Patients were subjected to UGI endoscopy within 2 weeks of investigation of laboratory parameters. All patients were subjected to detailed clinical history and physical examination and biochemical and radiological investigations. Endoscopy was done with an olympus gastroscope using 20% xylocaine spray.

Results: Out of 51 patients in the study, esophageal varices were seen in 34 (66.67%) patients and absent in 17 (33.33%) patients. On multiple logistic regression analysis, the variables independently linked to the presence of esophageal varices were; spleen diameter [odds ratio (OR): 1.137, 95% confidence interval: 1.033-1.255; p=0.009] and Portal vein size [odds ratio (OR): 41.531, 95% confidence interval: 1.858-928.304; p=0.019].

Conclusions: Non-invasive prediction for varices by biochemical and radiological methods are reliable methods for screening of cirrhotics patients because of increasing patient overload, when a major chunk of these patients do not show any evidence of varice.

 


Keywords


Cirrhosis, Noninvasive, Portal hypertension, Varices

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References


Garcia-Tsao G, Escorsell A, Zakko M. Predicting the presence of significant portal hypertension and varices in compensated cirrhotic patients. Hepatology. 1997;26:927-30.

Merli M, Nicolini G, Angeloni S, Rinaldi V, De Santis A, Merkel C et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266-72.

D’Amico G, Pagliaro L, Bosch J, Patch D. Pharmacological treatment of portal hypertension: an evidence-based approach. Sem Liver Dis. 1999;19:475-505.

de Franchis R. Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43:167-76.

Pascal JP, Cales P, Desmorat H. Natural history of oesophageal varices. In: Bosch J, Rode’s J (editors), Recent Advances in the Pathophysiology and Treatment of Portal Hypertension. Serono Symposia Review No. 22; Rome, Italy 1989;127-42.

Sarin SK, Sundaram KR, Ahuja RK. Predictors of variceal bleeding: an analysis of clinical, endoscopic, and haemodynamic variables, with special reference to intravariceal pressure. Gut 1989;30:1757-64.

de Mattos AZ, de Mattos AA, Daros LF, Musskopf MI. Aspartate aminotransferase-to-platelet ratio index (APRI) for the non-invasive prediction of esophageal varices. Ann Hepatol. 2013;12:910-4.

Tafarel JR, Tolentino LH, Correa LM, Bonilha DR, Piauilino P, Martins FP et al. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol 2011;23:754-58

Giannini E, Botta F, Borro P, Risso D, Romangnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52:1200-05.

Tarzamni MK, Somi MH, Farhang S, Jalilvand M. Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients. World J Gastroenterol. 2008;14(12):1898-902.

Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM et al. Predictors of large oesophageal varices in cirrhosis. Am J Gastroenterol 1999;94:3103-05.

Sudha Rani KVL, Sudarsi B, Siddeswari R, Manohar S. Correlation of portal vein size with esophageal varices severity in patients with cirrhosis of liver with portal hypertension. IJSRP 2015;1(5).

Chawla S, Katz A, Attar BM, Gupta A, Sandhu DS, Agarwal R. Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review. Eur J Gastroenterol Hepatol. 2012;24:431-6.