Platelet Count to Prothrombin Time: A Noninvasive Predictor of Esophageal Varices in Patients With Chronic Liver Disease.

Introduction Esophageal variceal bleeding is a potentially deadly consequence of portal hypertension in patients with cirrhosis. Although upper gastrointestinal endoscopy is still the preferred method for identifying esophageal varices (EV), the present study measured the platelet count to prothrombin time (PLT/PT) ratio for the assessment of portal hypertension and subsequent diagnosis of EVs in patients with chronic liver disease (CLD). Methods This was an observational comparative study conducted in the outpatient department of Patel Hospital, Karachi, Pakistan, using a non-probability consecutive sampling technique. Ethical approval was obtained from the Patel Hospital ethical review committee (PH/IRB/2022/028). An independent sample t-test was used for parametric data, whereas the Mann-Whitney U test was used for non-parametric data. The chi-square test was used to compare the categorical data of patients with and without EV. Receiver operating characteristic (ROC) analysis was performed to evaluate the cutoff values for the PLT/PT ratio, sensitivity, specificity, and area under the curve (AUC). Results The study involved 105 patients with and without EV. Among them, 38 (63.3%) males and 22 (36.7%) females had EV, whereas 30 (66.7%) males and 15 (33.3%) females did not. The platelet (PLT) count was also significantly lower in patients with EV (87.6 ± 59.8) than in those without (176.6 ± 87.7) (p < 0.001). The PLT/PT ratio was significantly lower in patients with EV (median: 5.04, IQR: 3.12-9.21) compared to those without (median: 14.57, IQR: 8.08-20.58) (p < 0.001). The sensitivity and specificity of the PLT/PT ratio for identifying EVs were 97.80% and 83.30%, respectively. Conclusion We found a significantly lower PLT/PT ratio in cases with EV than those without EV. After defining an optimal cutoff, PLT/PT had a high sensitivity in identifying cases with EVs in CLD. Therefore, we conclude that in patients with CLD, the PLT/PT ratio is a noninvasive predictor for the presence of EV.

Oesophageal Varices And Associated Factors In Cirrhotic Patients With Hepatitis C.

BACKGROUND: Infection with hepatitis C virus is reported to have infected almost 71 million people worldwide. This study was done to assess the frequency and associated factors leading to oesophageal varices in patients presenting with hepatitis C related liver cirrhosis. METHODS: A cross-sectional study was conducted at Patel Hospital, Karachi, Pakistan from 9th May to 5th October 2019. Patients of either gender having age >20 years presenting with HCV related liver cirrhosis, and Child Pugh class A, B and C were consecutively enrolled in the study. Data on variables like: age, gender, Childs Pugh Score (A/B/C), smoking status, laboratory characteristics like hemoglobulin (Hb), TLC, platelets, serum albumin level, cholesterol, alkaline phosphate (ALK), alkaline transaminase (ALT), ascites and presence of oesophageal varices was recorded and analysed using SPSS-21.0. RESULTS: Out of 167 patients, mean age was 44.86±14.74 years. Eight-nine (53.3%) of the patients were males. The mean duration of cirrhosis was 5.78±1.10 months. Thrombocytopenia was observed in majority (n=130, 77.8%) of the patients. There were 33 (19.8%) patients with Child Pugh score A while Child-Pugh score B and C was found in 67 (40.1%) each. The frequency of oesophageal varices was 141 (84.4%). A significantly higher proportion of oesophageal varices were found among thrombocytopenic patients (p<0.001), ascites (p-0.024), and having "C" Child-Pugh score (p-0.012). CONCLUSIONS: Oesophageal varices were found in a considerable proportion. Thrombocytopenia, ascites and Child-Pugh class C were found as leading contributing factors to oesophageal varices.

Frequency And Factors Leading To Helicobacter Pylori Infection Among Dyspeptic Patients.

BACKGROUND: Helicobacter pylori is infecting 50 percent or more of the world's population, putting it the most ubiquitous infection on the world. This study is done with the objective to determine the frequency and risk factors of Helicobacter pylori infection among dyspepsia patients at Patel Hospital Karachi. METHODS: This cross-sectional study was conducted at the gastroenterology department at the Patel Hospital in Karachi from 10th Jan to 10th July 2021. All patients with dyspepsia for at least 6 months having age 20-60 years of either gender were included. Three samples from stomach (2 from antrum,1 from corpus) for biopsies were collected from each patient. The specimen was sent to the microbiology department of the hospital and was reported as having histopathological confirmation of Helicobacter pylori infection. RESULTS: Of 111 patients with dyspepsia, mean age of the patients was 44.19±16.41 years. Most of the patients (n=65, 58.6%) were males and 46 (41.4%) were females. The mean duration of dyspepsia was 11.48±5.53 months. Helicobacter pylori was discovered to be present in 93 percent of individuals (83.8 percent). The odds of Helicobacter pylori infection were found to be 7.99 times higher among patients over 40 years old (AOR: 7.99, 95 percent CI: 2.02-31.64, p: 0.003), 3.93 times higher among patients with >9 months of dyspepsia (AOR: 3.93, 95 percent CI: 1.09-14.16, p: 0.036), and 11.85 times higher among smokers as compared to non-smokers (AOR: 11.85, 95 percent CI: 1.42-99.08, p-value 0.023). CONCLUSIONS: The rate of Helicobacter pylori infection in patients with dyspepsia was found to be higher. Furthermore, increasing age, increase duration of dyspepsia and smoking is found to be independent risk factors.

Percutaneous endoscopic gastrostomy; success and outcome of a novel modality for enteral nutrition.

OBJECTIVE: To determine the indications and complications of percutaneous endoscopic gastrostomy tube. METHODS: The retrospective audit study was conducted at the Department of Gastroenterology, Endoscopy Unit, Patel Hospital, Karachi, and comprised data of patients aged 4-95 years who underwent placement of percutaneous endoscopic gastrostomy under conscious sedation and for patients under 18 years of age having obtained anaesthesia fitness, under general anaesthesia, from August, 2008, to July, 2018. Pre-procedure treatment and follow-up was noted on a structured proforma. Data analysed using SPSS 21. RESULTS: Of the 367 patients, 237(64.6%) were males and the overall mean age of the sample was 63±15 years. Of the total, 257(70%) procedures were done in the day-care setting. The most common primary indication for tube placement was neurological dysphagia 259(70.6%). No procedure-related mortality was observed, but 35(9.5%) patients had PEG-site infection, and 3(8.5%) of them required removal of the tube. CONCLUSIONS: Percutaneous endoscopic gastrostomy was found to be an effective and useful feeding alternative, leading to improved nutrition.

Bouveret's syndrome: successful endoscopic treatment of gastric outlet obstruction caused by an impacted gallstone.

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. This is a report of a 62 years old female who presented with complaint of persistent vomiting and upper abdominal pain for the last 5 days. Ultrasound abdomen was suggestive of pneumobilia. CT scan of upper abdomen showed cholecystoduodenal fistula and complete obstruction of third part of duodenum by a large stone, which was reported as Bouveret's syndrome. She underwent emergency gastroscopy. The stone was retrieved by Dormia basket, crushed with lithotripter and extracted endoscopically.Complete intestinal obstruction was relieved endoscopically.

Glue embolism: a rare cause of pulmonary embolism.

N-butyl-2-cyanoacrylate is widely used to sclerose bleeding gastric varices. We report the case of a 65-year-old lady, known case of cirrhosis secondary to hepatitis C infection, who presented to the emergency department with coffee ground vomiting and melena for four days. Gastroscopy showed non-bleeding small esophageal varices, mild portal hypertensive gastropathy and a large gastric fundal varix. Injection sclerotherapy was completed successfully and haemostasis was secured. During the procedure, she was hemodynamically stable with an oxygen saturation of 98%. Immediately after the procedure, she went into cardiopulmonary arrest; cardiopulmonary resuscitation (CPR) was started, but she could not be revived. A provisional diagnosis of pulmonary embolism was made. X-ray chest showed linear hyperdense shadows in both pulmonary arteries and in some of their branches, which were not seen on pre-procedural chest X-ray. The patient died of massive pulmonary embolism as confirmed on X-ray chest.

Frequency of common factors for post endoscopic retrograde cholangiopancreatography pancreatitis.

OBJECTIVE: To determine the frequency of factors leading to post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Gastroenterology, Liaquat National Hospital, Karachi, from November 2007 to October 2008. METHODOLOGY: Fifty (50) patients of diagnosed cases of post-ERCP pancreatitis were included in this study. The collected data included age, gender, previous post-ERCP pancreatitis, recurrent pancreatitis, recurrent abdominal pain, number of attempts of common bile duct (CBD) cannulation, difficult CBD cannulation, precut sphincterotomy, biliary sphincterotomy, pancreatic duct contrast injections, primary diagnosis, device used, therapeutic procedure undertaken and the pancreatic enzymes level. Results were described as frequency percentages. RESULTS: Out of 50 patients, 32 (64%) were females. The average age of the patients was 52.23 ± 13.4 years. Frequency of common factors regarding post-ERCP pancreatitis were age ² 60, (n = 38, 76%) patients, female gender (n = 32, 64%), precut sphincterotomy (n = 34, 68%), pancreatic duct contrast injections (n = 27, 54%), biliary sphincterotomy (n = 25, 50%). Higher number of attempts of CBD cannulation and difficult CBD cannulation were recognized as factors for post ERCP pancreatitis. Other factors like previous history, post-ERCP pancreatitis, recurrent pancreatitis, and recurrent abdominal pain were not found in this study. CONCLUSION: Age, female gender, precut papillotomy, pancreatic duct contrast injections and biliary sphincterotomy were common factors for post-ERCP pancreatitis. Risk stratification will allow endoscopists to better identify patients who are at risk and permit detailed informed consent in high-risk groups or to adapt the measures to prevent the complications and reduce the risk related with the procedure.