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2.
Clinics ; 76: e2921, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278928

ABSTRACT

OBJECTIVES: Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a life-threatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/or mortality associated with AVB. METHODS: This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively). RESULTS: In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively). CONCLUSION: Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.


Subject(s)
Humans , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/etiology , End Stage Liver Disease , Prognosis , Severity of Illness Index , Retrospective Studies , ROC Curve , Hospital Mortality , Risk Assessment , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy
3.
Gac. méd. Méx ; 156(6): 502-508, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249959

ABSTRACT

Resumen Introducción: Con la escala de Glasgow-Blatchford (EG-B) se califica mediante datos clínicos, el riesgo de resangrado después de hemorragia del tubo digestivo alto (HTDA); y con las escalas de Forrest y Dagradi, mediante endoscopia. Objetivo: Evaluar la capacidad de la EG-B para identificar riesgo de resangrado a 30 días después de una HTDA; el estándar de oro de comparación fue la endoscopia. Método: Se analizaron 129 expedientes de pacientes con HTDA y endoscopia. Se cuantificaron las escalas de Glasgow-Blatchford, Forrest y Dagradi; se calculó sensibilidad, especificidad y área bajo la curva ROC (ABC-ROC) del riesgo de resangrado reportado por EG-B. Resultados: La EG-B identificó a 53 pacientes con riesgo bajo de resangrado (41.09 %) y 76 con riesgo alto (58.91 %). Con la endoscopia se identificó a 107 pacientes con hemorragia no variceal (82.94 %), 98 con riesgo bajo (89.9 %) y 11 con riesgo alto (10.09 %); además, 22 pacientes con hemorragia variceal (17.05 %), 12 con riesgo bajo (54.54 %) y 10 con riesgo alto (45.45 %). La EG-B mostró sensibilidad de 0.857, especificidad de 0.462 y ABC-ROC de 0.660. Conclusiones: La EG-B es sencilla, objetiva y útil para identificar riesgo de resangrado después de HTDA; se sugiere como herramienta de triaje en urgencias.


Abstract Introduction: The Glasgow-Blatchford scale (GBS) classifies the risk of re-bleeding after upper gastrointestinal bleeding (UGIB) using clinical data, whereas the Forrest and Dagradi scales do it by endoscopy. Objective: To assess GBS’s ability to identify re-bleeding risk within 30 days of an UGIB, using endoscopy as the gold standard for comparison. Method: 129 medical records of patients with UGIB and endoscopy were analyzed. The Glasgow-Blatchford, Forrest and Dagradi scales were quantified; sensitivity, specificity and area under the ROC curve (AUC-ROC) of GBS-reported re-bleeding risk were calculated. Results: GBS identified 53 patients with low re-bleeding risk (41.09 %) and 76 with high risk (58.91 %). Endoscopy identified 107 patients with non-variceal bleeding (82.94 %): 98 with low risk (89.9 %) and 11 with high risk (10.09 %); in addition, it identified 22 patients with variceal hemorrhage (17.05 %): 12 with low risk (54.54 %) and 10 with high risk (45.45 %). GBS showed a sensitivity of 0.857, specificity of 0.462 and an AUC-ROC of 0.660. Conclusions: GBS is simple, objective and useful to identify the risk of re-bleeding after UGIB; it is suggested as a triage tool in the emergency department.


Subject(s)
Humans , Male , Female , Middle Aged , Esophageal and Gastric Varices/diagnosis , Triage/methods , Endoscopy, Gastrointestinal/standards , Gastrointestinal Hemorrhage/diagnosis , Recurrence , Sensitivity and Specificity , Risk Assessment/methods , Area Under Curve
4.
Rev. argent. cir ; 112(1): 55-57, mar. 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1125782

ABSTRACT

Si bien no se encuentra entre las principales causas de disfagia u odinofagia, la lesión de la mucosa del esófago a causa de la medicación administrada como píldoras debe ser tenida en cuenta, en particular en algún grupo etario con patologías crónicas. Presentamos el caso de una mujer con dolor retroesternal de confuso diagnóstico y buena evolución con tratamiento conservador. El mecanismo preciso por el cual se producen las lesiones no está bien claro. La videoendoscopia digestiva alta es la herramienta clave para observar las lesiones producidas y realizar diagnóstico diferencial; además puede resolver algunas complicaciones. En la mayoría de los casos, el tratamiento es médico. Esta situación debe tenerse presente para realizar un correcto interrogatorio y examen endoscópico.


Dysphagia and odynophagia should be considered as symptoms of pill-induced esophageal injury, particularly in age groups with chronic diseases. We report a case of a female patient with retrosternal chest pain of unclear diagnosis and favorable outcome with conservative treatment. The precise mechanism of esophageal injury remains uncertain. Upper gastrointestinal videoendoscopy is the essential tool to examine the lesions, make differential diagnosis and treat some complications. Medical treatment is useful in most cases. This condition should be kept in mind for proper interrogation and endoscopic examination.


Subject(s)
Humans , Female , Aged, 80 and over , Esophageal and Gastric Varices/diagnosis , Esophagitis/diagnosis , Valsartan/adverse effects , Esophageal and Gastric Varices/pathology , Esophageal and Gastric Varices/drug therapy , Endoscopy, Digestive System/methods , Drug-Related Side Effects and Adverse Reactions/diagnosis , Hypertension/complications
5.
Arq. gastroenterol ; 54(3): 222-224, July-Sept. 2017. tab
Article in English | LILACS | ID: biblio-888205

ABSTRACT

ABSTRACT BACKGROUND - Variceal bleeding has a high mortality among cirrhotics, and screening with endoscopy is indicated at the diagnosis of cirrhosis. Screening with endoscopy implies discomfort, risks and considerable costs. OBJECTIVE - To evaluate platelet count squared/spleen diameter-aspartate aminotransferase ratio (PS/SA), as a non-invasive predictor of esophageal varices in cirrhotics. METHODS - This cross-sectional study evaluated cirrhotics for PS/SA and presence of esophageal varices. Outpatient records of cirrhotic patients were reviewed for the abovementioned data. Sensitivity, specificity, negative and positive predictive values of PS/SA were calculated. After the univariate analysis, variables with P<0.10 were submitted to a logistic regression. RESULTS - The study included 164 cirrhotics, 59.70% male, with a mean age of 56.7 years. Hepatitis C was the most frequent cause of cirrhosis, being present in 90 patients. Patients were classified as Child-Pugh A in 52.44% and as Child-Pugh B or C in 47.56%. Esophageal varices were present in 72.56% of the patients at endoscopy. PS/SA, with a cutoff of 3x108, had a sensitivity of 95.80% (confidence interval of 95% - 95%CI=0.92-0.99), a specificity of 22.70% (95%CI=0.10-0.35), a positive predictive value of 77.20% (95%CI=0.70-0.84) and a negative predictive value of 66.70% (95%CI=0.42-0.91). In the logistic regression, only platelet count and Child-Pugh score were associated to esophageal varices (P<0.05). CONCLUSION - PS/SA has an excellent sensitivity to predict esophageal varices, allowing almost one fourth of patients without esophageal varices to spare endoscopy. Nevertheless, PS/SA is not independently associated to esophageal varices.


RESUMO CONTEXTO - A hemorragia varicosa tem elevada mortalidade entre cirróticos, e o rastreamento endoscópico de varizes está indicado no momento do diagnóstico da cirrose. O rastreamento endoscópico implica desconforto, riscos e custos consideráveis. OBJETIVO - Avaliar a razão da contagem de plaquetas ao quadrado/diâmetro do baço-aspartato aminotransferase (PQ/BA) como preditor não-invasivo de varizes esofágicas em cirróticos. MÉTODOS - Este estudo transversal avaliou cirróticos quanto ao PQ/BA e à presença de varizes esofágicas. Prontuários ambulatoriais de cirróticos foram revisados quanto a tais dados. Sensibilidade, especificidade e valores preditivos negativo e positivo do PQ/BA foram calculados. Após a análise univariada, variáveis com P<0,10 foram submetidas à regressão logística. RESULTADOS - O estudo incluiu 164 cirróticos, 59,70% masculinos, com média de idade de 56,7 anos. Hepatite C foi a mais frequente causa de cirrose, estando presente em 90 pacientes. Os pacientes foram classificados como Child-Pugh A em 52,44% e em Child-Pugh B ou C em 47,56%. As varizes esofágicas estiveram presentes à endoscopia em 72,56% dos pacientes. PQ/BA, com um ponto de corte de 3x108, teve sensibilidade de 95,80% (intervalo de confiança de 95% - IC95%=0,92-0,99), especificidade de 22,70% (IC95%=0,10-0,35), valor preditivo positivo de 77,20% (IC95%=0,70-0,84) e valor preditivo negativo de 66,70% (IC95%=0,42-0,91). Na regressão logística, apenas a contagem de plaquetas e o escore de Child-Pugh associaram-se às varizes esofágicas (P<0,05). CONCLUSÃO - PQ/BA apresentou excelente sensibilidade para predizer varizes esofágicas, permitido que cerca de um quarto dos pacientes sem varizes esofágicas evitasse a endoscopia. Entretanto, PQ/BA não se associou de maneira independente às varizes esofágicas.


Subject(s)
Humans , Male , Female , Aspartate Aminotransferases/blood , Esophageal and Gastric Varices/diagnosis , Liver Cirrhosis/complications , Organ Size , Platelet Count , Spleen/enzymology , Spleen/pathology , Biomarkers/blood , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/blood , Cross-Sectional Studies , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity , Gastrointestinal Hemorrhage/blood , Middle Aged
6.
Health sci. dis ; 16(3): 1-5, 2015.
Article in French | AIM, AIM | ID: biblio-1262735

ABSTRACT

OBJECTIFS. Identifier des parametres cliniques et para cliniques pour l'approche non endoscopique du diagnostic des varices osophagiennes chez les patients atteints de cirrhose; en contexte sub-saharien. MATeRIELS ET MeTHODES. Les dossiers de patients cirrhotiques camerounais examines au Centre Hospitalier et Universitaire de Yaounde entre mars 2013 et novembre 2014 ont ete revus. Les donnees cliniques; biologiques; echographiques et ont ete analysees et comparees a la severite des varices osophagiennes retrouvees par endoscopie. La methode de classification et regression par carte a permis de construire un arbre de prediction des varices osophagiennes. ReSULTATS. Nous avons inclus 98 patients cirrhotiques d'age compris entre 14 et 80 ans. Les hepatites virales B et C ont ete retrouvees chez 78 patients (79;59%). 53 patients (54;08%) etaient classes Child-Pugh C. La prevalence des varices osophagiennes etait de 92% (90/98) avec 63;27% de grade III. Les variables independamment associes a la severite des varices osophagiennes etaient les taux de prothrombine; d'hemoglobine; d'albumine; de leucocytes; de creatinine serique et la taille de la rate. Ces facteurs ont ete utilises pour construire un arbre de prediction de survenue des VO. CONCLUSION. A l'aide d'un arbre decisionnel integrant la taille de la rate et cinq facteurs biologiques; il est possible de predire la severite des varices osophagiennes post-cirrhotiques en contexte sub-saharien


Subject(s)
Esophageal and Gastric Varices/diagnosis , Liver Cirrhosis
7.
Article in English | WPRIM | ID: wpr-176458

ABSTRACT

BACKGROUND/AIMS: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea. METHODS: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0+/-11.0 years, mean+/-SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated. RESULTS: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001). CONCLUSIONS: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Asian Continental Ancestry Group , Endoscopy , Esophageal and Gastric Varices/diagnosis , Female , Gastrointestinal Hemorrhage , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Prognosis , Republic of Korea , Retrospective Studies , Sclerotherapy , Severity of Illness Index , Treatment Outcome , Young Adult
10.
Article in English | WPRIM | ID: wpr-23433

ABSTRACT

Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.


Subject(s)
Enbucrilate/therapeutic use , Endoscopy, Gastrointestinal/methods , Esophageal and Gastric Varices/diagnosis , Gastrointestinal Hemorrhage/diagnosis , Hemostasis, Endoscopic/methods , Humans , Sclerotherapy/methods
11.
Rev. chil. pediatr ; 82(5): 381-387, oct. 2011. ilus, tab
Article in Spanish | LILACS | ID: lil-612166

ABSTRACT

Children with chronic liver disease or portal vein thrombosis frequently develop portal hypertension. The main complication of the portal hypertension are the development of esophageal varices who are at risk of variceal bleeding, which is associated with significant morbidity and mortality. Guidelines for adults with portal hypertension recommend performing esophagogastroduodenoscopy to identify those with varices that may benefit from prophylactic therapy, however there are no consensus in the pediatric age. This revision includes the incidence, diagnostic and the evidence for primary prophylactic treatment of the esophageal varices in children.


Pacientes pediátricos con daño hepático crónico o con trombosis de la vena porta frecuentemente desarrollan hipertensión portal. La principal complicación de la hipertensión portal es el desarrollo de várices esofágicas que conlleva riesgo de hemorragia variceal, la cual se asocia a significativa morbimortalidad. Las guías clínicas para adultos recomiendan realizar, en pacientes cirróticos, una endoscopia como screening para el diagnóstico de várices esofágicas y su tratamiento profiláctico, sin embargo, en pacientes pediátricos no existe consenso. En esta revisión se actualiza la incidencia, diagnóstico y evidencia del tratamiento profiláctico primario de várices esofágicas en pediatría.


Subject(s)
Humans , Child , Antibiotic Prophylaxis , Gastrointestinal Hemorrhage/prevention & control , Esophageal and Gastric Varices/surgery , Esophageal and Gastric Varices/drug therapy , Adrenergic beta-Antagonists/therapeutic use , Chronic Disease , Endoscopy , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/complications , Hepatic Insufficiency/complications , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/etiology
12.
Clinics ; 66(1): 119-124, 2011. ilus, tab
Article in English | LILACS | ID: lil-578607

ABSTRACT

OBJECTIVES: Recent guidelines recommend that all cirrhotic patients should undergo endoscopic screening for esophageal varices. That identifying cirrhotic patients with esophageal varices by noninvasive predictors would allow for the restriction of the performance of endoscopy to patients with a high risk of having varices. This study aimed to develop a decision model based on classification and regression tree analysis for the prediction of large esophageal varices in cirrhotic patients. METHODS: 309 cirrhotic patients (training sample, 187 patients; test sample 122 patients) were included. Within the training sample, the classification and regression tree analysis was used to identify predictors and prediction model of large esophageal varices. The prediction model was then further evaluated in the test sample and different Child-Pugh classes. RESULTS: The prevalence of large esophageal varices in cirrhotic patients was 50.8 percent. A tree model that was consisted of spleen width, portal vein diameter and prothrombin time was developed by classification and regression tree analysis achieved a diagnostic accuracy of 84 percent for prediction of large esophageal varices. When reconstructed into two groups, the rate of varices was 83.2 percent for high-risk group and 15.2 percent for low-risk group. Accuracy of the tree model was maintained in the test sample and different Child-Pugh classes. CONCLUSIONS: A decision tree model that consists of spleen width, portal vein diameter and prothrombin time may be useful for prediction of large esophageal varices in cirrhotic patients.


Subject(s)
Female , Humans , Male , Middle Aged , Decision Trees , Esophageal and Gastric Varices/diagnosis , Liver Cirrhosis/complications , Endoscopy, Gastrointestinal/methods , Organ Size , Platelet Count , Predictive Value of Tests , Prognosis , Portal Vein/pathology , Prothrombin Time/methods , Regression Analysis , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Spleen/pathology , Splenomegaly/complications
13.
JPC-Journal of Pediatric Club [The]. 2011; 11 (1): 21-36
in English | IMEMR | ID: emr-154452

ABSTRACT

Gastroesophageal variceal bleebing is a serious complication of portal hypertension. Endoscopic variceal Sclerotherapy [EVS] has been considered the mainstay of therapy for bleeding esophageal varices but it is associated with substantial local and systemic complications. However, recent data have shown that ehdoscopic variceal ligation [EVL] is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done in children. The aim of this work was to compare the effectiveness and safety of endoscopic variceal ligation [EVL] and endoscopic variceal Sclerotherapy [EVS] in children with portal hypertension who had proved recent bleeding from esophageal varices. This study was conducted on 30 children [17 males and 13 females] with portal hypertension who had proved recent bleeding from esophageal varices. Their ages ranged from 5 to 18 years. They were selected from those admitted to the Hepatology Unit of Pediatric Department, Tanta University Hospitals. In this study all patients were subjected to the following: full clinical history, thorough physical examination, routine abdominal ultrasonography as well as laboratory investigations. The latter included complete blood count, liver function tests, blood urea, serum creatinine and hepatitis markers. Upper gastrointestinal endoscopy was performed after resuscitation of bleeding patients for diagnosis and treatment of bleeding esophageal varices. Fifteen patients were treated with Sclerotherapy [Group I], and the other 15 patients were treated with band ligation [Group II]. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications, the number of sessions needed to eradicate varices, rebleeding and recurrences of varices. Endoscopic Sclerotherapy and ligation were equally effective for the control of active variceal bleeding and no significant differences were found between the Sclerotherapy and ligation groups in arresting active index bleeding and achieving variceal eradication. The rate of variceal eradication in the EVS group was not significantly different from the EVL group [86.7% vs. 93.3%, respectively, P = 0.55], but band ligation eradicated varices more quickly than did Sclerotherapy [59.2 +/- 17 vs. 91.3 +/- 32.6 days, respectively, P = 0.0001] and in fewer endoscopic sessions [4.7 +/- 1.1 vs. 7.3 +/- 2.6, respectively, P= 0.0001]. The overall rate of rebleeding before variceal eradication wassignificantly higher in patients undergoing EVS than those undergoing EVL [39.9% vs. 6.6%, P = 0.034] as was the rate of major complications [46.2% vs. 6.6%, P =0.035] After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy [21.4%% vs. 15.4%, P =0.927]. EVL is superior to EVS for acute and long-term management of bleeding esophageal varices because of its relative ease, faster obliteration, and lower complication and rebleeding rates. It appears that band ligation may replace sclerotherapy as the first choice for control of acute variceal bleeding and for eventual esophageal variceal eradication. Further long-term studies are needed to understand the evolution of variceal recurrence and portal hypertensive gastropathy in patients undergoing EVL


Subject(s)
Humans , Male , Female , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/therapy , Ligation/methods , Sclerotherapy/methods , Comparative Study , Child , Follow-Up Studies
14.
Arab Journal of Gastroenterology. 2011; 12 (2): 62-67
in English | IMEMR | ID: emr-123875

ABSTRACT

Non-invasive predictors of medium/large oesophageal varices [LOVs] could reduce the number of screening endoscopies. As portal hypertension is a consequence of liver fibrosis, serum fibrosis markers were evaluated together with other variables as possible non-invasive predictors of medium OV/LOV. A total of 154 cirrhotic patients with splenomegaly and 30 healthy control subjects were recruited in a prospective study in two gastroenterology centres in Upper Egypt. Clinical parameters assessed included Child-Pugh class, liver size and ascites. Laboratory parameters included complete blood count, liver function tests, and aspartate aminotransferase [AST]/platelet ratio. Transforming growth factor-p! [TGF-beta [1]], alpha2 macro globulin [A[2]M] and hyaluronic acid [HA] were assayed. Ultraso-nographic examination was done for assessment of liver span, portal vein diameter and detection of minimal ascites. Oesophageal varices were diagnosed and graded by oesophagogastroduodenoscopy. Fifty-four patients [35%] had no or small varices and 100 [65%] patients had medium OV/LOV by endoscopy. On multivariate analysis, the independent predictors of medium OV/LOV were the presence of ascites [beta = 0.258, p = 0.047] and serum HA [beta = 0.449, p = 0.009]. The receiver operating characteristic curve for HA showed the area under the curve to be 0.916. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of HA at a cut-off value of 207 micro g T[1] were 94%, 77.8%, 88.7%, 87.5% and 88.3%, respectively. The presence of ascites and serum HA level higher than 207 micro g T[1] can predict the presence of medium OV/LOV in cirrhotic patients. This would help physicians to identify patients who would most likely benefit from screening endoscopy and thus, reduce costs and discomfort from unnecessary endoscopic procedures


Subject(s)
Humans , Female , Male , Liver Cirrhosis/complications , Esophageal and Gastric Varices/diagnosis , Biomarkers , Liver Function Tests , Gastrointestinal Hemorrhage
15.
Arq. gastroenterol ; 47(3): 275-278, jul.-set. 2010. tab
Article in English | LILACS | ID: lil-567309

ABSTRACT

CONTEXT: Upper gastrointestinal bleeding associated to esophageal varices is the most dramatic complication of cirrhosis. It is recommended screening every cirrhotic for esophageal varices with endoscopy. OBJECTIVES: To evaluate the capacity of the platelet count/spleen diameter ratio in non-invasively predicting esophageal varices in a population of cirrhotics originated in an independent center from the one in which it was developed. METHODS: The study included patients from the ambulatory care clinic of cirrhosis of a Brazilian hospital and studied platelet count, spleen diameter and presence of esophageal varices, as well as Child and MELD scores. It used a cutoff value of 909 for the platelet count/spleen diameter ratio, as previously published. A sample of 139 patients was needed to grant results a 95 percent confidence level. RESULTS: The study included 164 cirrhotics, 56.7 percent male, with a mean age of 56.6 ± 11.6 years. In the univariate analysis, platelet count, spleen diameter, presence of ascites, Child and MELD scores and the platelet count/spleen diameter ratio were related to esophageal varices (P<0.05). The platelet count/spleen diameter ratio had sensitivity of 77.5 percent (95 percent CI = 0.700-0.850), specificity of 45.5 percent (95 percent CI = 0.307-0.602), positive predictive value of 79.5 percent (95 percent CI = 0.722-0.868), negative predictive value of 42.6 percent (95 percent CI = 0.284-0.567) and accuracy of 68.9 percent (95 percent CI = 0.618-0.760). In the multivariate analysis, platelet count was the only variable which related to esophageal varices (P<0.05). CONCLUSION: Platelet count/ spleen diameter ratio is not adequate to predict esophageal varices in cirrhotics.


CONTEXTO: Hemorragia digestiva por varizes esofágicas é a complicação mais dramática da cirrose. É recomendada triagem de varizes esofágicas em todo o cirrótico. OBJETIVO: Avaliar o índice de contagem de plaquetas/diâmetro do baço como predição de varizes esofágicas em uma população distinta daquela em que ele foi desenvolvido. MÉTODOS: O estudo incluiu pacientes do ambulatório de cirrose de um hospital brasileiro quanto ao número de plaquetas, diâmetro ecográfico do baço, presença de varizes esofágicas, Child e MELD. O ponto de corte do índice foi de 909. Amostra de 139 pacientes foi estimada para conferir nível de confiança de 95 por cento. RESULTADOS: Incluíram-se 164 cirróticos, 56,7 por cento homens e com média de idade de 56,6 anos. Na análise univariada, número de plaquetas, diâmetro do baço, ascite, Child, MELD e o índice de contagem de plaquetas/diâmetro do baço relacionaram-se às varizes esofágicas (P<0,05). Na multivariada, só a contagem de plaquetas associou-se a elas (P<0,05). O índice de contagem de plaquetas/diâmetro do baço apresentou sensibilidade de 77,5 por cento (IC 95 por cento = 0,700-0,850), especificidade de 45,5 por cento (IC 95 por cento = 0,307-0,602), valor preditivo positivo de 79,5 por cento (IC 95 por cento = 0,722-0,868), valor preditivo negativo de 42,6 por cento (IC95 por cento = 0,284-0,567) e precisão de 68,9 por cento (IC 95 por cento = 0,618-0,760). CONCLUSÃO: O índice de contagem de plaquetas/diâmetro do baço não é adequado para a triagem de varizes esofágicas em cirróticos.


Subject(s)
Female , Humans , Male , Middle Aged , Esophageal and Gastric Varices/diagnosis , Liver Cirrhosis/complications , Spleen/pathology , Brazil , Esophageal and Gastric Varices/blood , Esophageal and Gastric Varices/etiology , Liver Cirrhosis/blood , Organ Size , Platelet Count , Predictive Value of Tests
16.
GEN ; 64(2): 104-107, jun. 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-664478

ABSTRACT

La cápsula endoscópica (CE) para intestino delgado inició una revolución tecnológica que se extendió a esófago buscando alternativas para la endoscopia digestiva superior (EDS), “gold standard” en estudio de várices esofágicas (VE) pero invasivas y desagradables sin sedación. Antes de EDS con sedación moderada, 9 pacientes cirróticos de consulta de Hepatología, 6 para seguimiento VE (66.6%) y 3 para despistaje (33.4%) ingirieron PillCam™ESO (Given Imaging). Endoscopista entrenado en CE (ciego a hallazgos EDS pero no a historia del paciente) leyó dos veces los resultados. Se evaluó en imágenes CE y EDS: Presencia-tamaño de várices esofágicas, Riesgo de sangrado, Presencia-grado de Gastropatía Portal Hipertensiva (GPH), várices gástricas. Se aplicaron dos cuestionarios de satisfacción: pre y post procedimiento. CE demostró 88,8% de sensibilidad para determinar tamaño y riesgo de sangrado y 66.6% para GPH. Un hallazgo visto solo por CE, incluyó una várice gástrica. 88% de los pacientes manifestó mayor ansiedad-incomodidad con EDS, prefiriendo CE para futuros procedimientos. A pesar de la eficacia, comodidad y utilidad de CE para seleccionar pacientes para EDS, no creemos que pueda sustituir totalmente a EDS por imposibilidad de tratamiento y costo. Los resultados son prometedores, ampliando la muestra tendremos conclusiones más sólidas...


Endoscopic Capsule (EC) for small bowl is a gastrointestinal breakthrough which extended to esophagus searching for alternatives to esophagogastroduodenoscopy (EGD); “gold standard” for esophageal varices (EV) study (but invasive and uncomfortable without sedation). We report our preliminary EC results in Maracaibo. Before EGD with moderated sedation, 9 cirrhotic patients, 6 (55%) for surveillance and 3 for variceal screening, underwent EC PillCam™ESO (Given Imaging). Endoscopist with EC training (blinded to EGD founds but not to patient’s history) read twice the results. EC and EGD images were evaluated for EV size, bleeding risk, portal hypertensive gastropathy (PHG) grade, gastric varices and other founds. Two satisfaction questionnaires were applied (pre and post procedure). EC showed 88.8% sensibility in determining EV size and bleeding risk and 66.6% sensitivity for PHG. A gastric varice was seen only by EC. 88% of the patients were more anxious and uncomfortable with EGD preferring EC for future procedures. Though EC is efficient, comfortable and useful in deciding which patients would benefi t from EGD we don’t think it will totally replace EGD, due to its cost and impossibility for treatment. Results are promising although bigger samples are necessary for solid conclusions...


Subject(s)
Humans , Male , Female , Capsule Endoscopy/methods , Endoscopy, Digestive System/methods , Stomach Diseases/diagnosis , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices , Gastroenterology
17.
Arq. gastroenterol ; 47(2): 202-216, abr.-jun. 2010.
Article in English | LILACS | ID: lil-554688

ABSTRACT

In the last decades, several improvements in the management of variceal bleeding have resulted in a significant decrease in morbidity and mortality of patients with cirrhosis and bleeding varices. Progress in the multidisciplinary approach to these patients has led to a better management of this disease by critical care physicians, hepatologists, gastroenterologists, endoscopists, radiologists and surgeons. In this respect, the Brazilian Society of Hepatology has, recently, sponsored a consensus meeting in order to draw evidence-based recommendations on the management of these difficult-to-treat subjects. An organizing committee comprised of four people was elected by the Governing Board and was responsible to invite 27 researchers from distinct regions of the country to make a systematic review of the subject and to present topics related to variceal bleeding, including prevention, diagnosis, management and treatment, according to evidence-based medicine. After the meeting, all participants met together for discussion of the topics and the elaboration of the aforementioned recommendations. The organizing committee was responsible for writing the final document. The meeting was held at Salvador, May 6th, 2009 and the present manuscript is the summary of the systematic review that was presented during the meeting, organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.


Vários avanços científicos obtidos nas últimas duas décadas foram incorporados no manejo da hemorragia digestiva alta varicosa, levando a uma redução significante da sua morbimortalidade, atribuída à abordagem multidisciplinar do sangramento varicoso por paramédicos, emergencistas, intensivistas, gastroenterologistas, hepatologistas, endoscopistas, radiologistas intervencionistas e cirurgiões. Recentemente, a Sociedade Brasileira de Hepatologia patrocinou uma reunião de consenso, visando o estabelecimento de recomendações nacionais, sobre o manejo da hemorragia digestiva alta varicosa, incluindo sua prevenção, diagnóstico e tratamento, de acordo com a melhor evidência científica disponível. A diretoria da Sociedade Brasileira de Hepatologia elegeu quatro membros para a comissão organizadora que, por sua vez, convidou 27 pesquisadores de diferentes regiões do país, para realizar uma revisão sistemática sobre tópicos relacionados ao manejo hemorragia digestiva alta varicosa. A reunião de consenso ocorreu em Salvador, BA, em 6 de março de 2009. Após o encontro, todos os participantes se reuniram para elaboração das recomendações, cuja redação ficou sob a responsabilidade da comissão organizadora. O presente artigo descreve as recomendações da Sociedade Brasileira de Hepatologia sobre o manejo do sangramento associado à hipertensão portal, divididas em módulos e precedidas por resumo das apresentações realizadas na reunião de consenso.


Subject(s)
Humans , Esophageal and Gastric Varices , Evidence-Based Medicine , Gastrointestinal Hemorrhage , Acute Disease , Brazil , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Societies, Medical
18.
Arch. méd. Camaguey ; 14(3)mayo-jun. 2010.
Article in Spanish | LILACS | ID: lil-577923

ABSTRACT

Fundamento: la hipertensión portal es la complicación más común de la cirrosis que explica una importante morbilidad y mortalidad, principalmente debido a hemorragia por várices esofágicas, la ascitis y sus infecciones bacterianas sobreañadidas, la encefalopatía hepato-amoniacal, y el síndrome hepatorrenal. Los avances en el diagnóstico y su manejo son examinados a continuación en vistas a las perspectivas actuales. Desarrollo: la medición del gradiente de presión de la vena hepática, aporta una importante información pronóstico en estos pacientes. La prueba no invasiva con elastografía, cápsula endoscópica, y tomografía computarizada para el diagnóstico de várices esofágicas son prometedoras pero se necesita más información. Los datos clínicos en pacientes con sangramiento por várices esofágicas proveen una información importante para la terapia inicial y el pronóstico. Las nuevas terapias para pacientes con hiponatremia dilucional con antagonistas de la vasopresina son prometedoras y pueden mejorar el manejo de esta afección. Conclusiones: el terlipressin es la mejor terapia médica actualmente disponible para el manejo del síndrome hepatorrenal como se confirmó recientemente. Los pacientes con la enfermedad hepática avanzada se benefician de la administración por largos períodos del norfloxacin para prevenir el desarrollo del síndrome hepatorrenal y mejorar la supervivencia. Los avances en el diagnóstico y manejo de pacientes con cirrosis e hipertensión portal mejoraran la morbilidad y mortalidad de sus complicaciones.


Background: portal hypertension is the most common complication of cirrhosis that explains an important morbidity and mortality, mainly due to hemorrhage for esophageal varices, ascites and its superadded bacterial infections, the hepato-ammoniacal encephalopathy, and the hepatorenal syndrome. Advances in diagnosis and their management are examined next in view of current perspectives. Development: the pressure gradient mensuration of the hepatic vein, contributes an important prognostic information in these patients. The non invasive test with elastography, endoscopic capsule, and computed tomography for esophageal varices diagnosis are promising but more information is needed. Clinical data in patients with bleeding for esophageal varices provide important information for initial therapy and prognosis. New therapies for patients with dilutional hyponatremia with vasopressin antagonists are promising and may improve this affection management. Conclusions: the terlipressin is currently the best available medical therapy for the hepatorenal syndrome management as has been confirmed recently. Patients with advanced liver disease are benefiting with norfloxacin administration for long periods to prevent hepatorenal syndrome development and to improve survival. Advances in diagnosis and patients’ management with cirrhosis and portal hypertension improved morbidity and mortality of their complications.


Subject(s)
Humans , Gastrointestinal Hemorrhage , Hypertension, Portal/complications , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/therapy
19.
JCPSP-Journal of the College of Physicians and Surgeons Pakistan. 2010; 20 (11): 714-718
in English | IMEMR | ID: emr-117624

ABSTRACT

To determine the frequency and specific characteristic features of portal hypertensive gastropathy [PHG] in cirrhosis due to viral etiology. Cross-sectional descriptive study. The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastro-duodenoscopy [EGD] for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh [CTP] score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test. Out of 360 patients who underwent screening EGD, 226 [62.8%] were males. Two hundred and eighty one [78%] had hepatitis C while 79 [22%] suffered from hepatitis B related cirrhosis. Three hundred patients [83.3%] had PHG while 71 [24%] had severe PHG. Higher proportion of esophageal varices [89.7%] was present among those who had PHG [p < 0.001]. On univariate analysis lower platelet counts [117 +/- 55 vs. 167 +/- 90; p < 0.001], increased spleen size [14.1 +/- 2.9 cm vs. 12 +/- 2.4cm; p < 0.001] were found in PHG patients as compared to those without it. Similarly, lower platelet/spleen ratio was noted in patients with severe PHG [916 +/- 400 vs. 1477 +/- 899; p < 0.001]. Furthermore, on multivariate analysis CTP score > 8 MELD score > 12 and platelets/spleen ratio < 900 were significantly associated factors with severe PHG. Frequency of PHG was 83% while severe PHG was seen in 24% cases of viral hepatic cirrhosis. MELD score > 12, CTP score >/= 8 and platelets/spleen ratio

Subject(s)
Humans , Male , Hepatitis, Viral, Human/complications , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/epidemiology , Cross-Sectional Studies , Severity of Illness Index , ROC Curve , Logistic Models , End Stage Liver Disease
20.
Article in Korean | WPRIM | ID: wpr-84434

ABSTRACT

Portal hypertensive gastropathy (PHG) is a term used to define the endoscopic findings of gastric mucosa with a characteristic mosaic-like pattern with or without red spots, and a common finding in patients with portal hypertension. These endoscopic findings correspond to dilated mucosal capillaries without inflammation. The pathogenesis of PHG in not well known, but portal hypertension and some humoral factors seem to be crucial factors for its development. Pharmacological (e.g. propranolol), or interventional radiological (such as transjugular intrahepatic portosystemic shunt) procedures may be useful in preventing re-bleeding from PHG. The classic features of gastric antral vascular ectasia (GAVE) syndrome include red, often haemorrhagic lesions predominantly located in the gastric antrum which can result in significant blood loss. Although the pathogenesis of GAVE is not clearly defined, it seems to be a separate disease entity from PHG, because GAVE generally does not respond to a reduction of portal pressures. Endoscopic ablation (such as argon plasma coagulation) is the first-line treatment of choice. This review will focus on the incidence, clinical importance, etiology, pathophysiology, and treatment of PHG and GAVE syndrome in the setting of portal hypertension.


Subject(s)
Esophageal and Gastric Varices/diagnosis , Gastric Antral Vascular Ectasia/diagnosis , Gastric Mucosa/metabolism , Humans , Hypertension, Portal/complications , Portasystemic Shunt, Transjugular Intrahepatic , Vasodilator Agents/therapeutic use
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