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May 16, 2021
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May 16, 2021
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Abstract

Esophageal varices (EVs) are a serious consequence of portal hypertension in patients with liver diseases. Several studies have evaluated possible noninvasive markers of EVs to reduce the number of unnecessary endoscopies in patients with cirrhosis but without varices. This prospective study was conducted to evaluate noninvasive predictors of large varices (LV). The study analyzed 100 patients with liver diseases from February 2014 and July 2015. Relevant clinical parameters assessed included Child-Pugh class, ascites etc. Laboratory parameters like hemoglobin level, platelet count, prothrombin time, serum bilirubin, albumin and ultrasonographic characteristics like splenic size, portal vein diameter were assessed. Univariate and multivariate analysis was done on the data for predictors of large EVs. The incidence of large varices were seen in 44. 46%. On multivariate analysis, independent predictors of the presence of LV were palpable spleen, low platelet count, spleen diameter >154 mm, portal vein >13 mm, splenic vein >11.5 mm. Platelet count /spleen diameter <815 had a sensitivity. The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices.

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Esophageal varices non-invasive predictors platelet spleen ratio portal hypertension

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How to Cite
G.Chandra Shekar, B.Balaji, V. Chandra Shekar, P.Sammaiah, R.Kathyayani, & Kishan.B. (2021). Study of non-invasive predictors of oesophageal varices in chronic liver disease. International Journal of Research in Pharmacology & Pharmacotherapeutics, 5(1), 53-65. https://doi.org/10.61096/ijrpp.v5.iss1.2016.53-65
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References

  1. [1]. "NHS Choices". Cirrhosis. Retrieved 6 October 2015.
  2. [2]. De franchis r, primignani m. natural history of portal hypertension in patients with cirrhosis. clin liver dis 2001; 5:645-63.
  3. [3]. Garcia-Tsao G, Groszmann Rj, fisher Rl, et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. A Hepatology 1985; 5 (3): 419-424.
  4. [4]. Viallet A, Marleau D, Huet M, et al. Hemodynamic evaluation of patients with intrahepatic portal hypertension. Relationship between bleeding varices and the portohepatic gradient. Gastroenterology 1975; 69 (6): 1267-1300.
  5. [5]. Chang YW: Indication of treatment for esophageal varices: who and when? Digestive Endoscopy2006, 18 (1): 10-15.
  6. [6]. Endoscopic screening for Esophageal Varices in Cirrohisis: Is it Ever Cost Effecivbe?; Brennan M. R.Spiegel, Laura Targownick, Gareth S. Dulai, Hetal A. Karsan, and I an M. Gralnek; Hepatology, Vol. 37, No.2, 2003;366-377.
  7. [7]. Cirera I, Feu F, Luca A, et al. Effects of bolus injections and continuous infusions of somatostatin and placebo in patients with cirrhosis: a double-blind hemodynamic investigation. Hepatology 1995; 22 (1): 106-11.
  8. [8]. Wolfgang kratzer et al, factors affecting liver size,A sonographic survey of 2080 subjects, American institute of ultrasound in medicine,J Ultrasound Med 22, 1155-1161,2003.
  9. [9]. Lopamudra Mandal et al,Correlation of portal vein diameter and spleen size with gastro oesophageal varices in cirrhosis of liver,JIACM,2011,12(4):266-70.
  10. [10]. La fortune M, Marleau D, Breton G, et al: Portal venous system measurements in portal hypertension. Radiology 1984:151:27-30.
  11. [11]. La fortune M, Constantin A, Breton G et al: The rcanalized umbilical vein in portal hypertension: A myth, AJR 1985; 144:549-553.
  12. [12]. Bolondi L, Gatta A, Groszmann RJ, et al. Baveno II consensus statements: imaging techniques and hemodynamic measurements in portal hypertension. In: d Franchis R, ed. Portal hypertension II: proceedings of the second Baveno P. 478 inernational consensus workshop on definitions, methodology and therapeuticstrategies. Blackwell science. Oxford, 1996:67.
  13. [13]. Jijo V Cherian ,Non invasive predictors of oesophagael varices, The Saudi Journal of Gastroenterology, 2011:17(1),64-8
  14. [14]. Spina GP, Arcidiacono R, Bosch J, et al. Gastric Endoscopic features in portal hypertension: final report of a consensus conference, Milan, Italy, September 19,1992. J Hepatol 1994;21(3):461-467.
  15. [15]. Sarwar S, Khan AA, Alam A et al. Non-endoscopic prediction of presence of oesophageal varices in cirrhosis. J Coll Physicians Surg Pak 2005; 15 (9): 528-31.
  16. [16]. G. Spinzi, N. Terreni, G. Mandelli, and S. Paggi, “Comment on a prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices,” Hepatology, vol. 48, no. 3, p. 1017, 2008.
  17. [17]. Groszmann R, Bosch J and Grace N: Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroentrology, 1999,99:1401-1407
  18. [18]. Boyer T,: Natural history of portal hypertension. In: LaBreque D, ed. Vol. 1. Clinics in liver diseases-Portal hypertension. PhiladilphiaL: WB Saunder; 1997, 31-44.
  19. [19]. Zaman A,Becker T and Lapidus J: Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med, 2001, 161:2564-2570.
  20. [20]. Grace N,Groszmann R and Garcia-Tsao G:Portal hypertension and variceal bleeding: An AASLD single topic symposium.Hepatology; 1998,28:868-80.
  21. [21]. Sarin S, Lamba G and Kumar M: Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med;
  22. [22]. De Franchis R, Dell'Era A. Diagnosis and therapy of esophageal vascular disorders. Curr Opin Gastroenterol. 2007; 23:422-7.
  23. [23]. Fook-Hong NG, Siu-Yin W, Ching-Hong L, Kwong -Ming L, Chi-Wing L, Chi-Sing C. Prediction of esophageal varices in patients with liver cirrhosis. J Gastroenterol Hepatol 1999; 14:785–790.
  24. [24]. Principles of General Medicine, Harrison, 19TH edition.
  25. [25]. Chalasani N, Imperiale TF, Ismail A. Predictors of large varices in patients with cirrhosis. Am J Gastroenterol. 1999; 94:3285–91. [PubMed]
  26. [26]. Schepis F, Camma C, Niceforo D. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001; 33:333–8.
  27. [27]. Prihatini J, Lesmana LA, Manan C, Gani RA. Detection of oesophageal varices in liver cirrhosis using non-invasive parameters. Acta Med Indones 2005; 37 (3): 1.
  28. [28]. Schepis F,Camma` C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology 2001;33:333–338
  29. [29]. Sarwar S, Khan AA, Alam A et al. Non-endoscopic prediction of presence of oesophageal varices in cirrhosis. J Coll Physicians Surg Pak 2005; 15 (9): 528-31.
  30. [30]. Sharma SK, Aggarwal R. Prediction of large oesophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters. Journal of Gastroenterology and Hepatology 22 (11): 1909-15, November 2.
  31. [31]. Giannini E, Botta F, Borro P, 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; 52:1200–5.
  32. [32]. Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000; 14(Suppl D):60D–6D.