Congestion index of the portal vein and other predictors of variceal bleeding in portal hypertensive patients

ABSTRACT

Rupture of esophageal varices is the most common cause of massive, life threatening hemorrhage from the esophagogastric segment and portal pressure is necessary for rupture of varices but not all patients with elevated portal pressure bleed and local factors play a role. This study was designed to clarify the possible contribution of clinical risk factors and en-doscopic findings with portal hemodynamic changes in initiation of variceal bleeding. The study comprised 50 patients with liver cirrhosis and portal hypertension, 30 of them had a history of previous variceal bleeding and the other 20 patients didn't bleed before. After through history taking and clinical examination, liver function tests and complete blood picture were done, abdominal ultrasonography and Doppler study for the portal vein were performed and the congestion index of the portal vein [CI] was calculated and then upper gastrointestinal endoscopy was done. Results showed that mild to moderate splenomegaly, presence of ascites, increase in Child-Pugh score, thrombocytopenia and low prothrombin activity were associated with more variceal bleeding. Also results showed that CI of the portal vein was highly significantly increased in bleeders when compared to non-bleeders. The endoscopic prognostic index [PI] which depends on the size of esophageal varices, presence of gastric varices and congestive gastropathy was highly significantly increased in bleeders than in non-bleeders. Correlation studies showed that CI was positively correlating with Child-Pugh score and PI and it was negatively correlating with platelets count. From the above we can conclude that, for portal hypertensive patients, Echo Doppler of the portal vein which is a cheap and non-invasive technique should be done to select those with high CI to be submitted to endo-scopic screening for large and risky varices who would benefit from the available pharmacological and endoscopic prophylactic therapies