prognostic value of congestion index in patients with portal hypertension due to schistosomal hepatic fibrosis with and without chronic hepatitis C: a clinico-pathological and hemodynamic study

We intended to assess the value of congestion index of portal vein [Cl PV] [derived from the ratio between the cross-sectional area of the portal vein and the mean velocity of portal flow] in assessing the severity of portal hypertension and its correlation with North Italian Endoscopic Club [NIEC] index and risk of bleeding in patients with schistosomal hepatic fibrosis with and without chronic hepatitis C. We studied 64 patients with portal hypertension who were categorized into three groups based on histological diagnosis: group I [19 with pure schistosomal hepatic fibrosis], group II [22 patients with combined schistosomal hepatic fibrosis and chronic hepatitis C] and group III [23 patients with combined schistosomal hepatic fibrosis and chronic hepatitis C with cirrhosis]. All patients were of the Child class A.They were subjected to; clinical examination, stool and serological examinations for schistosoma infection, serum transaminases and alkaline phosphatase, serum albumin, prothrombin activity and virological markers. Upper endoscopy, abdominal Ultrasonography with duplex as well as liver biopsies were performed to all patients. The results showed that the mean value of Cl PV was found to be higher in groups II [0.155 +/- 0.05] and III [0.179 +/- 0.04] than in group I [0.134 +/- 0.04], which reached a significant level only between groups III and I [P<0.05]. The mean values of NIEC index and NIEC risk of bleeding were found to be significantly higher in group III [28.5 +/- 4, 18.3 +/- 6.3] respectively than in groups I [23.6 +/- 5, 10.6 +/- 7.8] and II [23.5+4, 11+6.5] [P<0.05] with no significant difference between groups I and II. The Cl PV was found to have a significant positive correlation with the degree of fibrosis as assessed by both the sonographic and the histopathologic examinations. It was also significantly correlated with NIEC risk of bleeding. We concluded that the congestion index of portal vein is a valuable non invasive parameter in assessing the severity of portal hypertension and in predicting bleeding in schistosomal patients with and without chronic hepatitis C

Helicobacter pylori mitigates upper gastrointestinal haemorrhage: trick or truth?

Upper gastrointestinal haemorrhage [UGIH] constitutes a serious health problem arising mainly from bleeding oesophageal varices [OV] or peptic ulcer disease [PUD] in Egypt.Conflicting results concerning antagonism or synergism between Helicobacter pylori [H.pylori] and UGIH deserves paramount interest .In the present case-control study 300 patients [150 bleeders and 150 non bleeders crossly-matched for age, sex, residence and endoscopic findings] were examined clinically, endoscopically and investigated for H. pylori infection in an essay to identify the relationship of H. pylori to UGIH. OV [37.3%] followed by duodenal ulcers [DU] [26%], gastric erosions [GE] [24.7%] and gastroesophageal reflux [GOR][12%] were the causes of UGIH which yielded positive connection to each of nonsteroidal antiinflammatory drugs [NSAIDs] [33/150=22%], chronic liver disease [CLD] [86/150=57%], and HCV [39/150 =26%] [P<0.05]. Strikingly H. pylori showed only an eminent inverse association with UGIH due to PUD [Z = 2.09] and NSAIDs consumption [P<0.05]. After controlling for confounders-logistic regression analysis presented H. pylori, NSAIDs and HCV as powerful effective independent factors with significant negative impact of H. pylori on UGIH [OR = 0.4, Cl = 0.4-0.86] and a positive one of NSAIDs [OR = 2.1, Cl = 1.2-3.4] and HCV [OR = 1.6, Cl = 1.1-4.0]. In conclusion our study confirmed the principal role of OV followed by PUD in causation of UGIH in addition to the increased risk of UGIH associated with NSAIDs, HCV and CLD. On the contrary H. pylori behaved as if a protective weapon against UGIH arising only from PUD [DU and GE]. No relation was found between H. pylori and UGIH from OV. In the meanwhile ulcer-like dyspepsia [ULD] and dysmotility like dyspepsia [DLD] might be a striking clinical presentation of H.pylori infection