Effect of portal hypertensive gastropathy on electrogastrographic changes and gastric emptying time

Dyspepsia is a frequent symptom in cirrhotic patients. Congestive gastropathy or portal hypertensive gastropathy [PHG] was detected as a possible cause of sustained dyspepsia in 40% of these patients, and prolonged gastric emptying time [GE] with decrease gastric wall compliance were detected in cirrhoric patients. Electrogastrography [EGG] is a non-invasive method to study gastric myoelectrical activity from the body surface by electrodes. whereas, an ultrasonographic method can be used for the estimation of gastric emptying by measuring what so called half emptying and full emptying times with other parameters. Aim of this work is to study patterns of EGG and ultrasnographic GE. In cirrhotic patients with or without PHG. 45 patients were chosen for this study and were divided into 3 groups ; group 1 is cirrhotic patients with PHG negative upper gastrointestinal [U.G.I.T.] endoscopy and group 2 is cirrhotic patients with PHG positive and group 3 is healthy subjects taken as control. We found significant delay in GE in gp. 2 in relation to group 3 [p < 0.05]. EGG reveiled power ratio lower in gp. 1, 2 [2.01 - 1.93] respectively compared to group. 3 [2.63]. Also there was highly significint increase in "Dominant frequency" at rest [DF] in group.1 campared to group. 2 and 3 [p>0.01] where mean of group 1 was 2944.9, in group 2 was 2477 and in group 3 was 1934 and the power meal at DF was higher in group 1 than 2 , 3 but siatistically insignificant where the mean in group 1 was 5922.5 and in group. 2 was 4804.8 and was 5087.8 in group 3 [p>0.05]. Delayed gastric emptying by U.S, and changes in EGG records of cirrohotic patients especially in presence of portal hypertensive gastropathy may explain dyspepsia frequently occurring with portal hypertensive gastropathy

Portal hypertensive gastropathy; the role of helicobacter pylori infection

This study was conducted on 60 patients, 54 men and 6 women, aged 30 to 65 years [mean 42.1] with chronic liver disease and portal hypertension as evidenced by the presence of esophageal varices. In addition, 20 patients, 15 men and 5 women, aged 25 to 68 years [mean 39.3] having non-ulcer dyspepsia and no evidence of chronic liver disease were admitted as a controls. All patients were subjected to full clinical assessment, liver function tests, abdominal ultrasonographic examination, and upper gastrointestinal endoscopy. All patient's group had endoscopic evidences of portal gastropathy. Multiple antral biopsies were taken from all patients and controls and sujected for hisopathological examination to assess the presence of portal gastropathy, the degree of H.pylori colonization, the presence and the degree of inflammatory gastritis. The results showed high prevalence of H.pylori in both patients and controls. However, the grade of colonization was significantly higher in patient's group. The majority of patients [95%] showed histological manifestations of both portal gastropathy and inflammatory gastritis. On the other hand, 65% of the controls had no gastritis, and all showed no evidence of portal gastropathy. The severity of gastritis and gastric erosions was significantly correlated to the degree of H.pylori colonization. The latter was not correlated to the presence of variceal bleeding nor to occerrence of encephalopathy. It was concluded that, gastric mucosa of patients with portal hypertension is not inhospitable for H.pylori and in contrast H.pylori infection is more likely to be associated with more colonization and gastric mucosal lesions

Prediction of early rebleeding and mortality after sclerotherapy in patients with bleeding esophageal varices

Sclerotherapy is considered the most effective way to stop bleeding from esophageal varices, but acute variceal bleeding is still associated with high risk of rebleeding and mortality. Early prognostic assessment may he important in identifying those patients who will be at more risk. This work was conducted to study the predictors of early rebleeding and mortality after emergency sclerotherapy. The study included 102 patients with acute variceal bleeding who underwent emergency sclerotherapy. They were 82 men and 20 women with their ages ranged from 30-80 years [mean = 51.5]. The patients were followed for one week after sclerotherapy and the rates of rebleeding and mortality were recorded, Several clinical, biochemical, endoscopic, hematological, and therapeutic parameters were evaluated to assess their predictability for early rebleeding and mortality. The results showed that rebleeding occurred in 33 [31.4%] patients and death in 12 [11.8%] patients during the 7 days after the index bleed. Univariate analysis showed that the followings were significant in patients with rebleeding: presence of ascites [P =0.001], use of balloon tamponade [P =0.00007], elevated levels of ALT [P =0.001], AST [P =0.0002], bilirubin [P =0.006], prothrombin time [PT] [P =0.006], serum creatinine [P =0.003], low serum albumin [P =0.046], large varices [P =0.007], presence of fundal varices [P =0.01], and the use of ethanolamine oleate in amount less than 10 mL or more than 20 mL [P =0.03]. In contrast, the presence of red signs showed no significant relation to rebleeding. Patients in Child A were at a significant less risk of rebleeding than patients in Child B or C.A logistic regression analysis of the significant variables showed that elevated ALT, AST, prolonged PT, presence of fundal varices, large varices, and the use of balloon tamponade to be the variables independently associated with rebleeding. Regarding early mortality, the results showed the presence of encephalopathy, rebleeding, and shrunken liver were the independent significant risk factors that predicted early mortality. In conclusion, patients who are at risk for early rebleeding and mortality can be identified and should be looked for early. It seems reasonable to start therapy with vasoactive agents in those patients and to continue therapy for several days after sclerotherapy