Endosonography as a predictive tool for first oesophagogastric variceal bleeding

Endosonography [EUS] is a useful tool for evaluating the fine details of the vascular structures at the gastroesophageal junction. The aim of this study is to evaluate the value of extraluminal gastroesophageal vascular collaterals as predictors for first variceal bleeding. Fifty cirrhotic patients with no history of previous upper gastrointestinal [GI] bleeding were recruited into this prospective cohort study. All patients were subjected to upper endoscopy and EUS for assessing the number and size of extramural vascular collaterals and perforating vessels. All patients were followed up for 24 +/- 7.5 months for upper gastrointestinal bleeding. Eighteen out of 50 patients [36%] had at least one attack of upper GI bleeding during the follow up period. All patients had one or more types of extraluminal venous collaterals. The presence of gastric varices [p = 0.02], perigastric collaterals [p = 0.03] and perforators [p = 0.02] were independent risk factors for first variceal bleeding. The presence of 3 or more paraoesophageal collaterals and the presence of perforators were significantly higher in bleeders when compared to non-bleeders [p = 0.034]. Perigastric and paragastric collateral sizes were significantly larger in bleeders than in non-bleeders [p = 0.019 and 0.038, respectively]. Perigastric and paragastric collaterals of size more than or equal to 2 mm and 6.20 mm, respectively were associated with significantly increased risk of first variceal bleeding. EUS may be a promising tool for predicting first variceal bleeding in cirrhotic patients

Some predictors of variceal bleeding in patients with bilharzial hepatic fibrosis

This work was conducted on 35 patients with schistosomal periportal fibrosis and portal hypertension compared with 10 healthy controls to search for some risk factors associated with variceal bleeding such as endoscopic findings, some vasodilator humoral agents in addition to echo-Doppler flowmetry findings. Full clinical examination and routine laboratory investigations were done. Humoral vasodilators included glucagon, enkephalin and prostaglandin E2 [PGE2]. Upper gastrointestinal endoscopy and echo-Doppler duplex study were done to all cases for evaluation of portal venous hemodynamics, superior mesenteric artery dilatation and coronary vein visualization and/or dilatation. Results showed a biochemical profile of hyperglucagonemia is usually associated with a higher portal pressure, larger variceal diameter and a hyperdynamic splanchnic state and if associated with high enkephalin level, there will be a higher chance of bleeding

Urease test in the management and follow-up of campylobacter gastritis

Campylobacter pyloridis colonization of the stomach may be an etiological factor in gastritis and peptic ulceration. Campylobacter pyloridis produces large amounts of urease, and the presence of this enzyme in gastric mucosa usually indicates infection with the organism. In this study CLO test was used to detect Campylobacter pyloridis infection in gastric mucosal biopsies. Out of 32 patients, 30 biopsies were urease test positive, 24 cases after 20 minutes, 26 cases after 3hours and 30 biopsies after 24 hours. The presence of chronic active gastritis was constant in Campylobacter positive biopsies and the use of triple antimicrobial therapy continuously for three weeks proved effective in eradication of the organism, evidenced by rebiopsy in 18 cases came for follow up. A negative test after antibiotic therapy correlates with clearance of the bacteria and healing of active gastritis. The CLO test is an advance for those requiring a fast accurate method of diagnosis of Campylobacter pyloridis infection, and also used to monitor therapy of gastritis with antibacterial agents. The ability of Campylobacter pyloridis to digest urea and produce ammonia in the stomach is a metabolic disorder of particular relevance to patients with renal or hepatic disease which need further investigation