RESUMO
Objetivo: Determinar en una cohorte de enfermos con CEP la frecuencia de VE y los factores asociados para predecir su presencia y riesgo de hemorragia. Material y métodos: Se evaluaron las características demográficas, bioquímicas, endoscópicas y la evolución clínica de 32 enfermos con CEP. En el momento del diagnóstico y con un seguimiento promedio anual a todos se les realizó estudio endoscópico para determinar la presencia de VE. Resultados: Veinticuatro pacientes eran varones (75%) y 8, mujeres (25%). El promedio de edad fue de 40,2 años (intervalo mínimo-máximo, 19-66). En su primera endoscopia ningún paciente tenía historia de hemorragia varicosa y 4 (13%) presentaron VE. En el análisis bivariado, los factores que se asociaron a la presencia de VE fueron: esplenomegalia (4/6 frente a 0/26; p < 0,001), ascitis (2/4 frente a 0/24; p < 0,001), trombocitopenia (96 ± 27 frente a 299 ± 135/103, p < 0,001) e hipoalbuminemia (2,4 ± 0,6 frente a 3,5 ± 0,6 g/dl; p = 0,005). Durante un seguimiento promedio de 7 años (intervalo mínimo-máximo, 2-15) 6 pacientes desarrollaron VE y 7 tuvieron, al menos, un episodio de hemorragia. En el análisis de regresión logística los factores que se asociaron de manera independiente a la presencia de varices fueron trombocitopenia (p = 0,001) y esplenomegalia (p = 0,01). Los factores asociados a hemorragia varicosa fueron el deterioro de la función hepática (p = 0,01) y la esplenomegalia (p = 0,02). Conclusiones: En pacientes con CEP existen marcadores no invasivos de hipertensión portal que pueden ser útiles para predecir la presencia de VE y un mayor riesgo para hemorragia varicosa. Es importante identificar la presencia de esplenomegalia, trombocitopenia y deterioro de la función hepática en estos pacientes, ya que podrían beneficiarse con la vigilancia endoscópica
Background: Primary sclerosing cholangitis (PSC) is characterized by progressive destruction of bile ducts, which may lead to cirrhosis and portal hypertension. The factors associated with the presence of esophageal varices (EV) and the risk of bleeding have not been well defined. Aim: To determine the factors associated with the presence of EV and risk of bleeding in a cohort of patients with PSC. Material and methods: We analyzed the demographic, biochemical and endoscopic characteristics, and follow-up of 32 patients with a diagnosis of PSC. All patients underwent endoscopic evaluation to determine the presence of EV at diagnosis and annually during follow-up. Results: There were 24 men (75%) and 8 women (25%). The mean age was 40.2 years (range, 19-66). At diagnosis, none of the patients had a previous history of variceal bleeding and 4 (13%) had EV on endoscopic examination. In bivariate analysis, the factors associated with the presence of EV were: splenomegaly (4/6 vs 0/26; p < 0.001), ascites (2/4 vs 0/24; p < 0.001), thrombocytopenia (96 ± 27 vs 299 ± 135 x 103, p < 0.001), and hypoalbuminemia (2.4 ± 0.6 vs 3.5 ± 0.6 g/dl; p = 0.005). During a mean follow-up period of 7 years (range, 2-15 years), 6 patients developed EV and 7 patients had at least one episode of variceal bleeding. In logistic regression analysis, the factors independently associated with the presence of EV at diagnosis were thrombocytopenia (p = 0.001) and splenomegaly (p = 0.01). The factors associated with variceal bleeding were worsening of liver function (p = 0.01) and splenomegaly (p = 0.02). Conclusions: There are noninvasive indicators of portal hypertension that could predict the presence of EV and risk of bleeding in patients with PSC. The presence of thrombocytopenia, splenomegaly or worsening of liver function should be detected in these patients, as they could benefit from endoscopic surveillance
Assuntos
Masculino , Feminino , Adulto , Idoso , Pessoa de Meia-Idade , Humanos , Colangite Esclerosante/complicações , Hipertensão Portal/etiologia , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Medição de RiscoRESUMO
Objetivo: Determinar en una cohorte de enfermos con CEP la frecuencia de VE y los factores asociados para predecir su presencia y riesgo de hemorragia. Material y métodos: Se evaluaron las características demográficas, bioquímicas, endoscópicas y la evolución clínica de 32 enfermos con CEP. En el momento del diagnóstico y con un seguimiento promedio anual a todos se les realizó estudio endoscópico para determinar la presencia de VE. Resultados: Veinticuatro pacientes eran varones (75%) y 8, mujeres (25%). El promedio de edad fue de 40,2 años (intervalo mínimo-máximo, 19-66). En su primera endoscopia ningún paciente tenía historia de hemorragia varicosa y 4 (13%) presentaron VE. En el análisis bivariado, los factores que se asociaron a la presencia de VE fueron: esplenomegalia (4/6 frente a 0/26; p < 0,001), ascitis (2/4 frente a 0/24; p < 0,001), trombocitopenia (96 ± 27 frente a 299 ± 135/103, p < 0,001) e hipoalbuminemia (2,4 ± 0,6 frente a 3,5 ± 0,6 g/dl; p = 0,005). Durante un seguimiento promedio de 7 años (intervalo mínimo-máximo, 2-15) 6 pacientes desarrollaron VE y 7 tuvieron, al menos, un episodio de hemorragia. En el análisis de regresión logística los factores que se asociaron de manera independiente a la presencia de varices fueron trombocitopenia (p = 0,001) y esplenomegalia (p = 0,01). Los factores asociados a hemorragia varicosa fueron el deterioro de la función hepática (p = 0,01) y la esplenomegalia (p = 0,02). Conclusiones: En pacientes con CEP existen marcadores no invasivos de hipertensión portal que pueden ser útiles para predecir la presencia de VE y un mayor riesgo para hemorragia varicosa. Es importante identificar la presencia de esplenomegalia, trombocitopenia y deterioro de la función hepática en estos pacientes, ya que podrían beneficiarse con la vigilancia endoscópica
Background: Primary sclerosing cholangitis (PSC) is characterized by progressive destruction of bile ducts, which may lead to cirrhosis and portal hypertension. The factors associated with the presence of esophageal varices (EV) and the risk of bleeding have not been well defined. Aim: To determine the factors associated with the presence of EV and risk of bleeding in a cohort of patients with PSC. Material and methods: We analyzed the demographic, biochemical and endoscopic characteristics, and follow-up of 32 patients with a diagnosis of PSC. All patients underwent endoscopic evaluation to determine the presence of EV at diagnosis and annually during follow-up. Results: There were 24 men (75%) and 8 women (25%). The mean age was 40.2 years (range, 19-66). At diagnosis, none of the patients had a previous history of variceal bleeding and 4 (13%) had EV on endoscopic examination. In bivariate analysis, the factors associated with the presence of EV were: splenomegaly (4/6 vs 0/26; p < 0.001), ascites (2/4 vs 0/24; p < 0.001), thrombocytopenia (96 ± 27 vs 299 ± 135 x 103, p < 0.001), and hypoalbuminemia (2.4 ± 0.6 vs 3.5 ± 0.6 g/dl; p = 0.005). During a mean follow-up period of 7 years (range, 2-15 years), 6 patients developed EV and 7 patients had at least one episode of variceal bleeding. In logistic regression analysis, the factors independently associated with the presence of EV at diagnosis were thrombocytopenia (p = 0.001) and splenomegaly (p = 0.01). The factors associated with variceal bleeding were worsening of liver function (p = 0.01) and splenomegaly (p = 0.02). Conclusions: There are noninvasive indicators of portal hypertension that could predict the presence of EV and risk of bleeding in patients with PSC. The presence of thrombocytopenia, splenomegaly or worsening of liver function should be detected in these patients, as they could benefit from endoscopic surveillance
